Community pharmacy

Question 1

NHS Community Pharmacist Consultation Service

Answer 1

• ## Under the NHS CPCS, NHS 111 can refer patients to a community pharmacy for a minor illness or urgent supply of a prescription medication

Question 2

General GP referral

Answer 2

Long duration of symptoms
Recurring or worsening problems
Severe pain
Failed medication (one or more appropriate medicines used already, without improvement)
Suspected adverse drug reactions (to prescription or OTC medicine)
Danger symptoms

• Long term conditions e.g. regular pain relief for chronic arthritis.
• Treatment of more complex forms of minor illnesses.
• For those patients that have red flag symptoms that suggest the condition is not minor.
• Treatment for complex patients e.g. immunosuppressed patients.
• OTC products to treat an adverse effect or symptom of a more complex
  illness.
• Circumstances where the product licence doesn’t allow the product to be sold over the counter to certain groups of patients.
• Minor condition suitable for self-care that has not responded sufficiently to treatment with an OTC product.

Question 3

Identify SEPSIS and Meningitis

Answer 3

Symptoms: TempInfectionMentaldeclineExtremelyill, fever, chills, rapid SOB, high heart rate, pain, rash, confusion, and disorientation

NB:

Question 4

Identify SEPSIS and Meningitis

Answer 4

Symptoms of meningitis and sepsis include:
a high temperature
cold hands and feet
vomiting
confusion
breathing quickly
muscle and joint pain
pale, mottled or blotchy skin
spots or a rash
headache
a stiff neck
a dislike of bright lights
being very sleepy or difficult to wake
fits (seizures)

Sepsis symptoms: TempInfectionMentaldeclineExtremelyill, fever, chills, rapid SOB, high heart rate, pain, rash, confusion, and disorientation

meningitis: stiff neck, photophobia, rash,
Fever, headache, vomiting, muscle pain and fever with cold extremities.

NB: Classical signs of meningitis are often absent in infants with bacterial meningitis

Question 5

OTC medication to avoid with warfarin

Answer 5

Daktarin oral gel.

Question 6

referral

Answer 6

immunocompromised pt with fungal infection (ringworm, dandruff, nail infection, thrush)

First vaginal thrush, >2x in 6m, OTC not working, <16/>60y

Question 7

OTC medication to avoid with HF

Answer 7

NSAIDS (hold fluid and cause swelling. Harm your kidneys)
Pseudoephedrine or phenylephrine.
Alka-Seltzer® – this has too much sodium (salt).

Question 8

conditions

Answer 8

DM: sugary syrup, decongestant

enlarged prostate, narrow angle glaucoma: antihistamine, decongestant

heart disease: antaacids, decongestant, NSAIDS

HBP: Decongestants, NSAIDs, Cold medicines, Some antacids (high in sodium)

Question 9

Paracetamol

Answer 9

Avoid taking other medication with paracetamol
CI: severe liver damage
may increase AG effect of warfarin

Question 10

Interaction Considerations for Common OTC Drug Classes

Answer 10

antihistamines: CNS depressants. elderly (already have in)

acid suppressants
medication affected by reduced stomach acidity: azole antifungals, non-nucleoside reverse transcriptase inhibitors, bisphosphonates, and the cephalosporins cefuroxime and cefditoren

PPI (low OTC dose):
NB: om/esomeprazole = weak CYP2C19 inhibitors: clopidogrel

Antacids: levothyroxine, tetracyclines, fluoroquinolones, decreasing absorption.
NB: can avoid interactions with quick onset & short DOA by separating administration by hours.

Antidiarrheals
Loperamide (= substrate of CYP3A4, CYP2C8, P-gp): at high doses, these inhibitors

Levonorgestrel:
(decrease [L]) Enzyme-inducing meds, barbiturates, carbamazepine, oxcarbazepine, phenytoin, topiramate, efavirenz, rifampin, SJW

Question 11

Sore Throat red flags

Answer 11

• A sore throat that is severe or lasts longer than a week
• Pain swallowing, breathing or opening the mouth
• Joint pain, earache or swelling of the neck
• Fever higher than 38oC (100oF) with or without shaking chills and night sweats
• Frequently recurring sore throats
• Hoarseness lasting more than two weeks
• Sign of strep throat: sudden pain, painful swallowing, swollen tonsils, swollen/tender lymph nodes

Question 12

sore throat management

Answer 12

• self limiting, warm water and salt
• OTC anti-inflammatory and analgesic agents, lozenges, sprays, drops and mouthwash
  e.g. Benzocaine, Benzydamine
  One lozenge dissolved in mouth; repeat every 2h
  Apply one spray; spit after one minute; may repeat up to four times
  Allow 1m to stay in local area. use <2d.

Question 13

GI

Answer 13

Red flag: haematemesis (vomit) or stool (haematochezia), dark or black faeces (melena), persistent vomiting, progressive unintentional weight loss (up to 5% of the body normal weight over six to 12 months without an identifiable cause), chest pain, or severe difficulty in swallowing (dysphagia