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Pre Reg 2021 Darush > Community Pharmacy (OTC) > Flashcards

Community Pharmacy (OTC) Flashcards

1
Q

What organism causes RING WORM?

A

Tinea Corporis

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2
Q

A patient presents with the following at your pharmacy. They ask for some Brolene eye drops. What do you do?

A

This is a subcojunctival haemorrhage

Ask them if it is painful- any pain then refer

Ask them if they are on WARFARIN- if yes seek medical attention ASAP

Have you had any injury to the eye recently?

If no to the above- reassure the patient that it is self limiting, usually better within 2 weeks and no OTC products are recommended

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3
Q

What kind of medication is Guaiphenesin?

A

Cough EXPECTORANT

These claim to make the coughing easier while enhancing production of mucus and phlegm.

Other example: Acetylcysteine, ammonium chloride

Not effective in children

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4
Q

What kind of medicine is Dextromethorphan?

A

Cough suppressant (antitussive)

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5
Q

What antihistamine do we usually give to children?

A

Chlorphenamine maleate

Suitable for 1 year and over

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6
Q

What age are steroid nasal sprays e.g. beconase, flixonase, not suitable in?

A

Under 18’s

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7
Q

What drugs can be given on instalment prescriptions (FP10MDA) Other than Methadone?

A

Schedule 2 Controlled Drugs;

Buprenorphine;

Buprenorphine/naloxone (Suboxone); and

Diazepam

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8
Q

How is payment for Instalment precriptions worked out?

A

Payment is based on each occasion the pharmacist provides an instalment to the patient; i.e. each time the patient collects their drug from the pharmacy

Pharmacy needs to fill out back of prescription each time the patient picks up an instalment

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9
Q

What formulations have more potential for abuse by addicts?

A

Sugar free

Syrup base less liable to abuse

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10
Q

Is it pharmacologically rational for a cough/cold remedy to contain dextromethorphan and guanefenesin? What about dextromethorphan and ammonium chloride?

A

No:
Dextromethorphan is a cough suppressant so person coughing less

Guanefenesin and ammonium chloride both cough expectorants which means they make it easier to cough things up: work against eachother

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11
Q

What is the medication causing drowsniess usually included in cough/ cough rememdies to help people sleep?

A

Diphenhydramine

A sedating antihistamine, found in things like Night nurse.

Also found in sleep aids such as sominex

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12
Q

What is cinnarazine and what is it used in?

A

characterized as an antihistamine and a calcium channel blocker

Used for travel sickness and vertigo and tinnitus (problems with inner ear)

Very sedating

Found in Stugeron- 2 tablets 2 hours before travel

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13
Q

If a specific brand is stated on a prescription (e.g. Losec capsules- Omeprazole) can you give the generic if you run out of the branded?

A

No

Must legally prescribe that brand unless you ask the prescriber to change the Rx to generic

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14
Q

What does sodium Citrate do to the pH of urine?

A

Cystitis sachets

It increases the pH- makes urine more alkaline

Acidic urine in cystits- hence the burning feeling

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15
Q

Can pseudoephidrine cause drowsniess?Can guaifenesin cause drowsiness?Can dextromethorphan?

A

No

Remember pseudoephidrine (SUDAFED) can be abused- stimulating- side effects include restlessness and insomnia, and hallucinations!

Guaifenesin does not cause drowsiness

Dextromethorphan can cause a little bit of drowsiness

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16
Q

Children under __ should not be given cough and cold medication OTC containing PSEUDOEPHEDRINE
PHENYLEPHRINE
DEXTROMETHORPHAN
PHOLCODINE
GUAIFENESIN
Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.

A

Children under 6 years old

Medicines containing:

ANTITUSSIVES (suppressants) (DEXTROMETHORPHAN
PHOLCODINE)

Expectorants (GUAIFENESIN, ipecacuanha)

Nasal decongestants (pseudo, phenylephrine, ephedrine, oxymetazoline, xylometazoline)

Antihistamines: Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.

For use in 6-12 years they should be SECOND LINE and be used for no more than 5 DAYS

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17
Q

A patient with a productive cough for the last week requests a product containing dextromethorphan because they have heard good things. What do you do?

A

They may have requested Benylin Dry Cough

Similar product: Benadril Tickly Cough containing Pholcodine

These are cough SUPPRESSANTS

Should NOT suppress a productive cough- need to get the mucous out- so recommend an expectorant (Guaiphenesin)

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18
Q

It is recommened people include oily fish in their diet to help reduce CV risk. Can you think of any examples of these?

A

Mackerel

Salmon

Sardines

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19
Q

What is the organism causing athletes foot? How is athletes foot treated?

A

TINEA PEDIS

Topical imidazole (Miconazole) can be used- Apply twice daily and continue for 10 days after the lesions have healed

Bnf states under topical antifungals: to prevent relapse these should be continued for 1-2 weeks after healing

Could also consider Griseofulvin

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20
Q

Amorolfine (Curanail, Loceryl) can be used for fungal nail infections. What is the directions for this?

A

Apply 1-2 times a week for:

6 months for finger nails

9- 12 months for toe nails

Apply after filing and cleansing

BNF age limit: 12, OTC age limit: 18. 3 ml pack is a P

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21
Q

Why has the safety of using medicines containing codeine to treat coughs and colds in children younger than 18 been reviewed?

A

Because of the potential for serious problems like slowed or difficult breathing.

Children, especially those who already have breathing problems, may be more prone to these effects

Differences in metabolism of codeine: codeine is converted to Morphine in the body, this cause cause respiratory difficulties.

This use in under 18’s only applies to codeine linctus for colds/ cough; codeine containing products for pain relief can still be used in > 12 years, sold to > 16 years.

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22
Q

What do we use to treat Oral thrush?

A

Topical Miconazole gel- Daktarin oromucosal gel

(Nystatin 2nd line, Fluconazole 3rd line if topical preps can’t be used/ patient has a dry mouth)

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23
Q

What is Lyme disease caused by? What does the rash present as?

treated with?

A

Caused by bacterial infection from Tick bites

An early symptom of this condition is a characteristic “bulls eye on a dartboard” rash (called erythema migrans) that isn’t itchy

Usually treated with Doxycycline, amoxicillin or cefuroxime for 2-4 weeks

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24
Q

Is sunlight a good cure for cold sores?

A

Sunlight can trigger cold sores so direct sunlight should be avoided and sun screen should be applied.

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25
Q

How many days of co-codamol 30/500mg tablets could you give maximum as an emergency supply?

A

5 days max

As co-codamol contains codeine 30mg which is a schedule 5 CD!

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26
Q

Orlistat impaires the absorption of Fat soluble vitamins. Which are the Fat soluble vitamins?

A

A

D

E

K

Water soluble: B, C

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27
Q

Can GTN be bought OTC?

A

YES

Both sub-lingual tablets and spray are P medicines

NB: Their effects last for 20-30 minutes, but in an emergency situation, repeat dose after 5 mins if no relief.

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28
Q

Can nursing homes bring their waste medicines to your pharmacy to dispose of?Can the public: what will you do with the waste?

A

No- must use their own waste disposal

Only the public can bring it to the pharmacy: this is an essential service for the pharmacy to act as a collection point for waste medicines: sort it into solids, liquids and ampoules and arrange for waste contractor to pick it up.

Must not store waste for longer than 6 months, or over 5 cubic meters

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29
Q

What does ‘Freshly prepared’ mean? What does ‘Recently prepared’ mean?

A

Freshly prepared: 24 HOUR EXPIRY

Recently prepared: 28 day expiry

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30
Q

What is information governance? How often do community pharmacies need to provide IG assurances to the NHS?Does the Information Governance lead need to be a pharmacist?

A

IG is all to do with confidentiality and how to handle patient sensitive data.

Pharmacies need to submit IG assurances annually.

The lead does not need to be pharmacist but needs enough authority to make changes in information handling

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31
Q

Pseudoephidrine is contra-indicated in which condition?What about phenylephrine?

A

Pseudoephedrine: Hypertension, coronary artery disease, MAOI’s in the last two weeks

Phenylephrine: diabetes (as may increase glucose) and CV disease

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32
Q

Eye drops containing a lubricant only (e.g. propylene glycol) will expire in _____

A

6 months

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33
Q

Co-amoxiclav oral suspension will have an expiry of ____ once it is made up

A

7 days

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34
Q

Most eye drops will have an expiry of _____. What expiry do chloramphenicol eye drops have, considering they contain an antibiotic?

A

28 days

still 28 days for chloramphenicol- it it just reduced to 14 days on wards at slam. Patients are still advised to discard the drops 5 days after opening (after finishing the course)

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35
Q

Oramorph 20 mg/mL solution- schedule? Expiry?

A

Schedule 2 CD

Anything over 2.6mg/ml (13mg/5ml) is schedule 2

4 month expiry

The lower strength (2mg/ml) has a 3 month expiry

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36
Q

Which emollient does not contain Urea?

A

hydromol

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37
Q

The mainstay of treatment OTC of travel sickness involves antihistamines:Cinnarizine
Meclozine
Cyclizine
Promethazine: Promethazine Hydrochloride (Phenergan) and Promethazine Teoclate (avomine)OR Anticholinergics:
Hyoscine Which one of these has a 24 hour duration of action?Which one causes most sedation?Which is the most effective for the prevention of motion sickness?

A

24 hour duration: Promethazine Teoclate

Most drowsiness: Promethazine Hydrochloride (Phenergan)

Most effective: Hyoscine hydrobromide

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38
Q

What are the likely side effects of the antihistamines/ anticholinergics used in travel sickness?

A

Dry mouth!

Sedation

be careful with other medication that can cause sedation: alcohol, TCA’s, opioids

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39
Q

Which travel sickness medication would be most appropriate for a young child, 4 years old?

A

Hyoscine hydrobromide (licesned for over 3 years [joy rides]) or meclozine for over 2 years

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40
Q

How does plaque psoriasis present?

A

Silvery white scales, when scraped away pinpoint bleeding occurs from the capillaries

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41
Q

What is the only contact lense solution that can be applied whilst contact lenses are still in the eye?

A

Re-wetting solution

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42
Q

If a patient has recently had their tonsills out (tonsillectomy) or adrenal glands out (adrenectomy) what OTC drug is cautioned?

A

If they have sleep apnoea (i.e. find it hard to breathe at night) then CODEINE is cautioned as can cause respiratory problems which can be fatal (Fatal ADRs reported)

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43
Q

What presents as the following image accompanied by sore throat, headache, high temperature?

A

Scarlet fever

Antibiotics needed- refer

With treatment, most people recover in about four to five days and can return to school 24 hours after starting antibiotic treatment. Without treatment, you’ll be contagious for one to two weeks after symptoms appear.

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44
Q

Where should Latanoprost eye drops be stored?

A

In the fridge

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45
Q

Where does the new inhaler, Fostair Nexthaler, containing steroid Beclometasone and LABA formoterol, need to be stored?

A

At room temp

Its the old fostair (inhalation solution) that needs to be kept in a fridge

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46
Q

Which eye drops used in glaucoma can cause a change in eye colour?

A

Prostaglandin analogues:

BIMATOPROST
LATANOPROST
TRAVOPROST

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47
Q

What do the yellow and what do the pink Migraleve tablets contain, and what is the max of each to be taken in 24 hours?

A

Pink: Paracetamol, codeiene, Buclizine

Yellow: Paracetamol, codeine

Max in 24 hours: 2 pink + 6 yellow

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48
Q

What is a buldging spot on a babies forehead accompanied by vomiting, fever, cold hands likely to indicate?

A

early signs of meningitis- refer to A and E!

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49
Q

What are the signs and symptoms of Otitis externa?

A

itching

irritation

Some discharge

Oedematous (fluid build up) leading to conductive hearing loss
Ear canal/ external ear are red, swollen and eczema like

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50
Q

What does treatment of Otitis externa involve?

A

ACETIC ACID (earcalm spray)- one spray to the affected ear TDS, max frequency 2-3 hours, continue for 2 days after symptoms gone

Choline salicylate drops- Earex Plus

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51
Q

Referral symptoms for ear conditions? (Considering Otitis Externa and Ear wax are the only ones that can be treated OTC!- Need to rule out otitis media- infection of inner ear)

A

Mucopurulent discharge (pus)- otitis media

Pain on palpitation of the mastoid area

Generalised inflammataion of the pinna

Impaired hearing in a CHILD

Slow-growing growths in elderly

Symptoms present over 4 days

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52
Q

What are simeticone drops indicated for?

A

Infant colic- excessive, frequent crying in a baby

One week trial of simeticone drops recommended: drops are designed to help release bubbles of trapped air in your baby’s digestive system.

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53
Q

How is allergic rhinitis differentiated from the common cold? What are reatment options OTC for this?

A

Allergic rhinitis presents as: sneezing, rhinorrhoea and nasal itching

Could use:

Loratidine- 1st line

2nd line: Sodium cromoglicate nasal drops (but take 1-2 weeks to work)- a mast cell stabiliser

Or steroid nasal spray (over 18’s)

Other options:

Azelastine- the only nasally administered antihistamine OTC

chlorphenamine (antihistamines)

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54
Q

Can you get monoxidil on NHS prescription?

A

NO

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55
Q

If patients are using several topical agents, when should the emolient be applied?How often can emollients be applied?

A

Before…. Leave at least 5 mins between applying to allow absorption.

emollients contain no active so can be applied as many times.. but general guidance is 2-3 times a day.

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56
Q

We say that stimulant laxative are not first line constipation remedies, however when may we chose to recommend it?

A

If someone has been constipated for a while e.g. 10 days (refer if over 14 days) as these work quickly (6-12 hours) so may be appropriate for one-off use.

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57
Q

Can Gaviscon be used in pregnant women suffering from gastro-oesophagul reflux ?

A

Yes: remember your acronym APPLE: A= Antacids

Acid reflux is common in preganancy when the baby gets larger towards the end: they respond well to Alginate products like Gaviscon- can take through the day and night

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58
Q

If a patient using Benzoyl Peroxide experiences drying, burning or peeling of the face, should they stop using the product?

A

Just advise reducing the frequency of administration- stop using for a day or two then reduce to OD or use on alternate days

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59
Q

We know codeine should be avoided for pain in children 12-18 years where possible. Who would you chose to give codeine to out of a 24 year old ethiopian man and a 31 year old Norweigan man?

A

The norweigan man

African/ ethiopian and middle eastern people are more likely to be ultra-rapid metabolisers of codeine so do not give to these patients.

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60
Q

What condition presents with a rash, white coating of the tongue, plus headache and fever leading up to it?

A

Scarlet fever

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61
Q

Minimum age to buy Clamelle (azthromycin for chlamydia) OTC?

A

16 years

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62
Q

Hydrocortisone (hc45) 1 % cream?

A

10 yearsMax 15g tube

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63
Q

Eurax HC (hydrocortisone 0.25%) cream?

A

10 years

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64
Q

Clobetasone (eumovate) 0.05% cream?

A

12 years

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65
Q

Tamsulosin 400mcg tablets (FloMax)?Age range

A

45 years - 75 years

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66
Q

Naproxen 250mg tablets (Feminax Ultra)?Age range

A

15 - 50 years

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67
Q

Ibuprofen?

A

Suspension or suspension sachets- 3 monthsTablets: 12 years

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68
Q

Mebendazole?

A

2 years

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69
Q

Chloramphenicol eye drops/ eye ointment?

A

2 years

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70
Q

Loperamide?

A

12 years

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71
Q

Aspirin?

A

16 years

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72
Q

Pseudoephedrine?

A

6 years(Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)

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73
Q

Tranexamic acid? For menorrhagia (heavy bleeds)

A

18 years

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74
Q

Paracetamol?

A

2 months

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75
Q

Sumatriptan?Age range

A

18 years - 65 years

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76
Q

Cetirizine?Loratidine?

A

2 years

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77
Q

Levornorgestrel?

A

16 years

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78
Q

Amorolofine?

A

18 years

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79
Q

Simple linctus (pead)?

A

1 year

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80
Q

Co-codamol?

A

12 yearsBut guidance states codeine containing products for pain relief should only be used in over 12’s when ibuprofen and paracetamol have failed. Codeine containing cough remedies should only be used in over 18 years as risks (of respiratory problems/ dependence) outweigh benefits

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81
Q

Steroid nasal sprays (beconase, flixonase)?

A

18 years

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82
Q

Esomeprazole, Pantoprazole, Omeprazole?

A

18 years

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83
Q

Guafenesin?

A

6 years(Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)

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84
Q

Dexomethorphan?

A

6 years (Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)

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85
Q

Cough cold remedies containing chlorphenamine, promethazine, diphenylhydramine, tripolidine (antihistamines)?

A

6 years (Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)

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86
Q

Ranitidine?

A

16 years

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87
Q

Clotrimazole 2% cream? Age range?

A

16 - 60 years when used for thrush

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88
Q

Antihistamines:Chlorphenamine liquid? (piriton syrup)

A

Liquid: over 1 years (safest choice for young children

Chlorphenamine Tablets: 6 years

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89
Q

Acrivastine? (antihistamine) Age range

A

12 - 65 years

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90
Q

Senna?

A

12 years

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91
Q

Ispaghula Husk (Fybogel)?

A

6 years

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92
Q

Fluconazole capsule 150mg?

A

Used for thrush so16 - 60 years (refer outside of this range)

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93
Q

Minoxidil 2% + 5%? (Regain)Age range

A

18 years- 65 yearsOTC Hair loss treatment

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94
Q

Age range for Thrush treatments?

A

Clotrimazole 2% creamClotrimazole 10% internal creamClotrimazole pessaryFluconazole 150mg capsuleAll 16- 60 years

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95
Q

Clotrimazole 1% cream

A

For fungal skin infections (e.g. ring worm)Can be used in adults and children (no licensed age mentioned)

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96
Q

Daktarin oral gel (Miconazole)

A

licensed from 3 months

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97
Q

Ulipristal Acetate

A

Licensed for any girl of child bearing age

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98
Q

Minimum age Benzoyl Peroxide can be used in?

A

12 yearsAcne treatment

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99
Q

H2 antagonists e.g. ranitidine. What age can you sell them to OTC?Can you sell them to pregnant and breastfeeding women?

A

Over 16 yearsNo

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100
Q

What is max dose of ranitidine OTC?

A

75 mg tabletsDo not take more than 2 in 24 hours

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101
Q

True or false:Being overweight can contribute to dyspepsia

A

True

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102
Q

True or false:Smoking can contribute to dyspepsia

A

True

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103
Q

In what group of patients is orlistat licensed for OTC?

A

> 18 yearsBMI > 28

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104
Q

What is the OTC omeprazole dose and how long can they be used for and when would you refer?

A

10mg/20mg OD 4 weeks maximumHowever, if symptoms have not resolved in 2 weeks, referAny danger symptoms e.g. unexplained weight loss, refer

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105
Q

What age can you sell OTC omeprazole to?

A

>18 years

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106
Q

What age can you sell esomeprazole to?

A

>18 years

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107
Q

What age can you sell OTC esomeprazole to?

A

>18 years

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108
Q

What is the dose of OTC esomeprazole, and what is the max time it can be used for?

A

20mg OD2 weeks maximum

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109
Q

What is colic?

A

When a baby cries with no obvious causeLinked to disorder of GI tract, post partum depression, anxious parentsAffects babies < 6 months old

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110
Q

How can you treat colic OTC?

A

Anti-foaming agents e.g. simethicone (Dentinox, infacol)Gripe waterEffectiveness is lacking however and it should resolve by itself in time

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111
Q

What are symptoms of colic?

A

High pitched cryingOften at same time of dayDrawing knees up to stomach

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112
Q

When would you refer with colic?

A

Failure to put on weightOTC treatment failure Danger symptomsOver anxious parentsSymptoms have not resolved past 4 months of age

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113
Q

What is 1st line for constipation?

A

Lifestyle measures

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114
Q

Generally, laxatives should be avoided in constipation as first line and lifestyle measures should be tried. What exemptions would you want to treat with laxatives?

A

If straining would exacerbate a condition e.g. angina Or increase bleeding risk e.g. haemorrhoids

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115
Q

Why must bulk forming laxatives be taken with adequate fluids?

A

To avoid intestinal obstruction

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116
Q

Frequent use of stimulant laxatives can lead to what?

A

Fluid and electrolyte imbalance

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117
Q

How long does it take for glycerol suppositories to work?

A

Within 30 mins

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118
Q

What are the preferred type of laxative in children?

A

OsmoticBulk forming

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119
Q

What are the safest laxatives to use in pregnancy and breastfeeding?

A

Bulk forming and osmotic

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120
Q

Why are stimulant laxatives not really recommended in breastfeeding and pregnancy?

A

Not advisable in the third trimester as it may induce uterine contractions. Senna enters the breast milk, so may cause colic and diarrhoea in the infant.

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121
Q

At what point is constipation classed as chronic?

A

Lasting 6 weeks or more

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122
Q

If a patient has constipation along with tiredness, what could be underlying causes?

A

HypothyroidismAnaemia

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123
Q

How long does it take for bulk forming laxatives to work?

A

12- 72 hours

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124
Q

What age can you sell Senna OTC to?

A

>12 years

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125
Q

What age can you sell Sodium picosulphate (Dulcolax pico liquid) OTC to?

A

> 10 years

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126
Q

What age can you sell ispaghula husk OTC to?

A

>6 years

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127
Q

Is Movicol is licensed for acute, chronic or both types of constipation?

A

Chronic

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128
Q

What are danger symptoms in a diarrhoea patient that prompts a referral?

A

Confusion

Drowsiness

Passing little urine

Dry mouth

Sunken eyes

Duration of 3 days or longer in adults

>24 hours in babies

>48 hours in young chuldren

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129
Q

What is the difference between Diarolyte and Diarolyte Relief?

A

Relief contains rice power and normal diarolyte is glucose based

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130
Q

What age can you sell loperamide OTC to?

A

12 years and over

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131
Q

What is the maximum dose of GSL loperamide a day?

What is the maximum dose of P medicine loperamide a day?

A

12mg (6 caps a day) for GSL

16mg (8 caps a day) for P

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132
Q

Does rectal bleeding from haemorrhoids need to be referred?

A

No unless excessive bleeding occurs or has occurred for more than 3 weeks

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133
Q

What kind of laxative should be used for IBS?

A

Bulk forming

134
Q

What age can you sell mebeverine OTC?

A

> 18 years

135
Q

What age can you sell Buscopan OTC?

A

12 years and over

136
Q

What age can you sell Colpermin IBS relief capsules OTC? (peppermint oil)

A

15 years and over

137
Q

What are the symptoms of haemorrhoids?

A

Bleeding, perianal itching, mucus discharge and pain

138
Q

How many days max should you use Anusol HC plus ointment OTC?

A

7 days max(contains hydrocortisone)

139
Q

Can you use anusol HC plus ointment OTC in pregnancy and breastfeeding?

A

No

140
Q

A cough for how many weeks would prompt a referral?

A

Longer than 3 weeks

141
Q

What is croup?

A

Croup in children is caused typically by the parainfluenza virus. It often starts with a cold and develops into a characteristic barking cough

142
Q

What time of the day are symptoms of croup the worst?

A

At night

143
Q

How can you treat croup?

A

No medical treatment as it is viral but can offer antipyretic treatment if fever is present

144
Q

Systemic decongestants should be used with caution in what group of patients?

A

They should be used with caution in people with diabetes, hypertension, hyperthyroidism, raised intraocular pressure, prostatic hypertrophy, hepatic or renal impairment, or ischaemic heart disease.

145
Q

Systemic decongestants are contraindicated in patients taking what medicine class?

A

MAOIsRisk of hypotensive crisis

146
Q

What is a purpuric rash?

A

One which does not blanch white on pressure

147
Q

Bonjela preparations containing choline salicylate is unsuitable for which age group?

A

Under 16 years

148
Q

What is the licensed age range for sumatriptan OTC?

A

18-65

149
Q

What is the maximum dose of OTC sumatriptan?

A

Single 50mg dose stat

Can take another 50mg tablet but has to be at least 2 hours after taking the first tablet

Max 100mg in 24 hours for the same attack BUT symptoms have to have improved after taking the first tablet

If there is NO response to the first tablet, should not take a second tablet

150
Q

What groups of patients is sumatriptan OTC unsuitable for?

A
  • Previous myocardial infarction- Ischaemic heart disease, e.g. angina- Peripheral vascular disease- Cardiac arrhythmias (including Wolff-Parkinson-White syndrome)
151
Q

What is 1st line for pregnancy in threadworm?

A

Strict hygiene measures Refer if this has not worked

152
Q

What is the dosing instructions for mebendazole in threadworm?

A

Once only doseCan be repeated after 2 weeks if it has not cleared upEveryone in the house should be treated

153
Q

What age group is mebendazole not suitable for?

A

<2 years

154
Q

What is recommended as first line for head lice treatment in pregnancy and BF?

A

Wet combing If treatment needed, Dimeticone e.g. Hedrin

155
Q

What is recommended as first line for head lice treatment in asthma and eczema?

A

Wet combing If treatment needed, Dimeticone e.g. Hedrin

156
Q

How many times should you apply head lice treatment and how many days should you leave between each treatment course?

A

TwiceAt least 7 days between

157
Q

What is first line for scabies?

A

Permethrin 5% w/w cream (Lyclear®)

158
Q

What is first line for scabies in pregnancy and BF?

A

Permethrin 5% w/w cream (Lyclear®)

159
Q

Where should you apply scabies lotion?

A

All over the body

160
Q

What is 1st line for athlete’s foot in pregnancy and breastfeeding?

A

Topical imidazoles e.g. Daktarin Gold

161
Q

What is the minimum age for Lamisil OTC (terbinafine) for athelete’s foot (tinea pedis)?

A

> 16 years

162
Q

What is the maximum number of nails you can treat OTC for fungal nail infection?

A

2 If more than this, need to refer

163
Q

Amorolfine lacquer is licensed OTC for what condition and what is the age restriction?

A

Fungal nail infection18 years and over

164
Q

How can ringworm (tinea corpis) and jock itch (tinea cruris) be treated OTC?

A

Most local infections can be treated adequately with topical antifungal preparations. Imidazoles (clotrimazole, econazole, miconazole) or terbinafine are suitable first-line treatments for groin infections and skin ringworm.

165
Q

How can sweat rashes be treated OTC?

A

Topical imidazoles e.g. Daktarin

166
Q

What should you do if someone comes into the pharmacy with impetigo?

A

Usually needs a prescription to treat it so refer

167
Q

What age groups should be referred in vaginal thrush?

A

<16 years>60 years

168
Q

True or false:Poorly controlled diabetes is linked with thrush

A

True

169
Q

Women who have had more than how many episodes of thrush in 6 months- when should you refer to GP?

A

More than 2 episodes in last 6 months

170
Q

Can you treat a pregnant person OTC for thrush?

A

No- refer

171
Q

What NSAID (stronger than ibuprofen) is available OTC for primary dysmenorrhoea?

A

Feminax ultra 250mg naproxen

172
Q

What age range is Feminax ultra licensed for?

A

15-50 years

173
Q

What age would you refer for bacterial conjunctivitis?

A

<2 years

174
Q

Can you treat bacterial conjunctivitis OTC for pregnancy and breastfeeding?

A

No- refer

175
Q

An ulcer lasting than more than how many weeks should be referred?

A

More than 3 weeks- exclude oral cancer

176
Q

What is the minimum age to use Difflam mouthwash?

A

12 years

177
Q

What is the minimum age to use Difflam spray?

A

6 years

178
Q

What is a common side effect on the teeth if a patient is having chlorhexidine mouthwash?

A

Stains teeth brown

179
Q

What is the minimum age to use miconazole 2% oral gel for oral thrush?

A

>4 months

180
Q

Should miconazole oral gel be applied before or after meals?

A

After and held in the mouth as long as possible

181
Q

What anticoagulation interacts with miconazole oral thrush gel and prompts a referral?

A

Warfarin

182
Q

If a patient has diabetes and presents to the pharmacy with oral thrush, what should you do?

A

Refer

183
Q

What is angular stomatitis?

A

Cracked fissures in the corners of the mouth

184
Q

What can you offer OTC for angular stomatitis?

A

Clotrimazole 1% cream

185
Q

True or false:Diuretics can cause dry eyes

A

True

186
Q

What is the minimum age to use hydrocortisone 1% cream OTC?

A

10 years

187
Q

What is the maximum number of days to use OTC steroid cream?

A

7 days

188
Q

What steroid creams are available OTC?

A

Hydrocortisone 1% and clobetasone butyrate 0.05%

189
Q

What areas can you not put OTC steroid cream?

A

Facial skin, broken skin, genitalsYou can put it on ears as this does not count as your face

190
Q

Can you give steroid creams OTC to pregnant women?

A

No

191
Q

Are OTC steroid creams licensed for psoriasis flare ups?

A

No

192
Q

What age range is OTC tranexamic acid licensed for in heavy periods?

A

18-45 year olds

193
Q

At what age are you eligible for the free flu vaccine?

A

65 years and older

194
Q

Coughing up thin and frothy mucous can suggest what?

A

Left ventricular failure

195
Q

What age can you sell OTC guaifenesin cough syrup?

A

>6 years (Benylin chesty cough for children)

196
Q

What age can you sell OTC diphenhydramine cough syrup?

A

> 6 years (Benylin children’s night cough)

197
Q

What age is otrivine child nasal drops licensed in?

A

6-12 years Contains xylometazoline

198
Q

What age are Tyrozets (benzocaine) lozenges licensed in?

A

> 3 years

199
Q

Is Ella One recommended in a patient with severe uncontrolled asthma?

A

No, especially if being treated with an oral glucocorticoid

200
Q

Tamsulosin 400mcg capsules can be sold to what group of patients over the counter?How long can they take this before assessment is needed by a doctor?

A

Treatment of functional symptoms of benign prostate hyperplasia in men ages 45-75 yearsCan be taken for up to 6 weeks before clinical assessment by a doctor

201
Q

What is the patient advice surrounding sunlight and cold sores?

A

Sunlight can trigger cold sores so direct sunlight should be avoided and sun screen should be applied.

202
Q

Is oral lidocaine for children (Anbesol, Bonjela):- P medicine- GSL - POM?

A

P medicineChanged from GSL in late 2018 Max pack size 10g

203
Q

What is the MHRA advice surrounding the sale of oral lidocaine for children?

A
  • Gone from GSL to P medicine- Restriction of pack size of 10g- Moved to second line after non-pharmacological management
204
Q

What advice would you give to breastfeeding women being treated for scabies?

A

Breastfeeding women should remove the treatment from the nipples before feeding, and reapply afterwards.

205
Q

Buccastem is licensed for what age OTC?

A

18 years

206
Q

Anusol Plus HC is licensed for what age OTC?

A

18 years

207
Q

Corticosteroid nasal sprays are licensed for what age OTC?

A

18 years

208
Q

Tranexemic acid is licensed for what age OTC?

A

18 years

209
Q

Canesten thrush cream is licensed for what age range OTC?

A

16-60 years

210
Q

Azithromycin (OTC for chlamydia) is licensed for what age?

A

16 years

211
Q

Nytol is licensed for what age OTC?

A

16 years

212
Q

Feminax ultra OTC is licensed for what age?

A

15-50 years

213
Q

Voltarol gels OTC are licensed for what age?

A

14 years

214
Q

Rennie is licensed for what age OTC?

A

12 years

215
Q

Gaviscon is licensed for what age OTC?

A

12 years

216
Q

Woodwards Gripe water OTC is licensed for what age range?

A

1 month- 1 year

217
Q

Calpol OTC is licensed from what age?

A

2 months

218
Q

Nurofen OTC is licensed from what age?

A

3 months

219
Q

Daktarin 2% oral gel is licensed from what age otc?

A

4 months

220
Q

Hedrin and Derbac liquid is licensed from what age OTC?

A

6 months

221
Q

Piriton OTC (chlorphenamine) is licensed from what age?

A

1 year

222
Q

What age is Diarolyte relief OTC licensed for?

A

1 year(Under this age needs medical advice)

223
Q

OTC choramphenicol is licensed for what age?

A

2 years

224
Q

Mebendazole OTC is licensed for what age?

A

2 years

225
Q

Lyclear cream OTC is licensed for what age?

A

2 years (Under this age needs medical advice)

226
Q

Loratadine OTC is licensed what from age?

A

2 years (as long as they weigh more than 30 kg)

227
Q

Phenergan OTC is licensed from what age?

A

2 years

228
Q

What is the active ingredient in Joy Rides?

A

Hyoscine hydrobromide

229
Q

Joy Rides OTC is licensed from what age?

A

3 years

230
Q

Kwells OTC is licensed from what age?

A

4 years

231
Q

Sturgeon (cinnarizine) is licensed from what age?

A

5 years

232
Q

What are the 6 stages of transtheoretical model of change?

A
  1. Pre-contemplation2. Contemplation3. Preparation4. Active5. Maintenance6. Relapse
233
Q

Is evaluation a stage in the transtheoretical model of change?

A

No

234
Q

What is tranexamic acid licensed for?

A

Heavy menstrual bleeding over several cycles with regular cycles

235
Q

What are the dosing instructions for tranexamic acid OTC?

A

Taken only once heavy bleeding has started 2 500mg tablets TDS until symptoms are alleviated (Can be increased to 8 tablets a day 4g for heavier periods)It will not work properly if taken before menstruationIt should not be taken for more than 4 consecutive days

236
Q

What is the max number of days you should use tranexamic acid OTC for?

A

4 days

237
Q

If a patient comes in asking for tranexamic acid OTC for heavy periods, but is on warfarin/DOAC, what should you do?

A

Refer Heavy period may be due to anticoagulation

238
Q

What is the supply criteria for sumatriptan OTC?

A
  • >18 years- Needs to have a migraine diagnosis by doctor/pharmacist- Established pattern of migraine - history of 5 or more attacks over a period of at least a year - Have tried simple analgesia and it hasn’t worked
239
Q

If a patient comes in asking for sumatriptan but is on an SSRI/TCA, what should you do?

A

ReferRisk of serotonin syndrome if used together

240
Q

If a patient comes in asking for sumatriptan but is on an a MAOI, what should you do?

A

Refer

241
Q

Can sumatriptan be used as a prophylactic for migraines?

A

No- it is for acute attacks

242
Q

What is the supply criteria for tamsulosin OTC?

A

Male patients 45-75 years- Had symptoms for a minimum of 3 months- 2 weeks supplied initially and then if there is an improvement in symptoms, a further 4 weeks can be supplied

243
Q

How many weeks of tamsulosin is supplied initially?

A

2 weeks

244
Q

After how many weeks of tamsulosin OTC does the patient have to get assessed by a doctor?

A

6 weeks and they can agree whether further supplies are appropriate Then an annual review after this

245
Q

If a male patient asks for tamsulosin OTC but mentions he suffers from postural hypotension, what should you do?

A

ReferCan cause postural hypotension

246
Q

What are the dosing instructions for chloramphenicol eye drops?

A

Total 5 days One drop into affected eye every 2 hours for the first 48 hours and every 4 hours after

247
Q

What are the dosing instructions for chloramphenicol ointment?What about if used with the eye drops?

A

Apply 3-4 times a day for 5 daysEye drops during the day, and the ointment just one application at night

248
Q

What are the storage requirements for chloramphenicol i) Eye dropsii) Ointment

A

Store eye drops in the fridgeOintment does not need to be in the fridge but store at no more than 25°C

249
Q

If a patient presents to the pharmacy with bacterial conjunctivitis, but wears contact lenses, what should you do?

A

Refer - needs to be advised chloramphenicol on the advice of a doctor / contact lens practitioner Hard contact lens users and disposable contact lens users can start using their lenses again after successfully completing a course of treatment.Soft contact lens wearers should wait 24 hours after completing a course of treatment before starting to use their lenses again.

250
Q

Is it recommended that a child with bacterial conjunctivitis does not go to school?

A

No - should still go to school

251
Q

What is the minimum age for pantoprazole OTC?

A

18 years

252
Q

What is the dose for pantoprazole OTC?

A

20mg OD

253
Q

Do PPIs provide immediate relief?

A

No- start to work after a day or soIf a patient needs immediate relief, an antacid or alginate is more appropriate

254
Q

At what age would you refer a patient if they requested a PPI for first time dyspepsia symptoms?

A

55 years(Refer those over 45 years of age who suffer from long term recurrent symptoms of indigestion or heartburn)

255
Q

What is Onychomycosis?

A

Fungal nail infection

256
Q

What is the dosing instruction for amorolfine for fungal nail infections?What time scale for toenails and fingernails?

A

Apply to the nail once weeklyHas to be applied regularly until all the affected nail has grown out6 months for fingernails9-12 months for toenails

257
Q

A non blanching rash can be a symptom of what?

A

MeningitisThe rash does not fade when pressed with a glass

258
Q

How long before symptom onset is chickenpox contagious for?

A

Usually from 2 days before spots appearUntil the spots have crusted over- considered contagious until no new lesions have appeared for 24 hours

259
Q

How soon do you get symptoms after coming into contact with chickenpox?

A

1-3 weeks

260
Q

Can you catch shingles from someone with chickenpox?

A

No

261
Q

Can you catch chickenpox from someone with shingles?

A

Yes if you have not had chickenpox before

262
Q

How may hours after unprotected sex is Ulipristal Acetate licensed for?

A

120 hours (5 days)

263
Q

How may hours after unprotected sex is Levonorgestrel licensed for?

A

72 hours (3 days)

264
Q

What age is levonorgestrel licensed for OTC?

A

16 years and over

265
Q

What is the dose of ulipristal acetate for EHC?

A

30mg

266
Q

What is the dose of levonorgestrel for EHC?

A

1500 micrograms

267
Q

True or false:Ulipristal EHC is not recommended for patients who have taken CYP3A4 enzyme inducing medicines or herbal products in the last 4 weeks

A

True

268
Q

If a patient has taken CYP3A4 enzyme inducing medicines or herbal products in the last 4 weeks, and an IUD is not suitable, what EHC and what dose should they have?

A

2 tablets of levonorgestrel 1500 micrograms should be taken within 72 hours of unprotected sex

269
Q

Levonorgestrel is less effective in women with a BMI over what?

A

26 - may need a double dose as per FSRH advice

270
Q

What is the advice surrounding EHC levonorgestrel and vomiting?

A

If the patient vomits within 3 hours of taking levonorgestrel, she should repeat the same dose she took previously.

271
Q

Can you take a second dose of levonorgestrel within the same cycle?

A

EMC does not advise it as it can disturb the woman’s period

272
Q

If a patient has taken EHC, after how any days of an overdue period must they do a pregnancy test?

A

More than 5 days overdue

273
Q

What is the advice surrounding EHC ulipristal and vomiting?

A

If vomiting occurs within 3 hours another tablet should be taken as soon as possible

274
Q

In what clinical conditions is the use of EHC ulipristal not recommended?

A

Severe hepatic impairmentAsthma which is being treated by oral glucocorticoids

275
Q

In what clinical conditions is the use of EHC levonorgestrel not recommended?

A

Severe malabsorption syndrome e.g. Crohn’s Severe hepatic impairment

276
Q

What is the advice regarding ulipristal EHC and breastfeeding?

A

After using ulipristal breast feeding is not recommended for a week because it is present in breast milk.During this time expressing and discarding the milk is advised to maintain lactation.

277
Q

What is the advice regarding levonorgestrel EHC and breastfeeding?

A

Potential exposure of an infant to levonorgestrel can be reduced if the breast-feeding woman takes the tablet immediately after feeding and avoids nursing at least 8 hours following Levonelle

278
Q

Children under what age are legally too young to consent to sexual activity?

A

13 years

279
Q

What is the dosing instruction for naproxen OTC for painful periods?

A

On the first day 2 tablets (500 mg) should be taken initially and then one tablet (250 mg) after 6 to 8 hours if needed.Max 3 tablets in a dayMax number of days for treatment is 3 days

280
Q

What is the max duration of days is licensed for OTC naproxen for painful periods?

A

3 days

281
Q

Viagra OTC is licensed from what age?

A

18 years

282
Q

What is the dosing instruction for Viagra?

A

One 50 mg tablet taken with water approximately one hour before sexual activity - max of one tablet in 24 hoursIf Viagra Connect is taken with food, the onset of activity may be delayed compared to the fasted state

283
Q

If a patient presents to the pharmacy with subconjuctival haemorrhage, what you recommend??What would warrant a referral?

A

There should be no pain and the patient should be reassured that symptoms will resolve in 10 to 14 days without treatment. However, a patient with a history of trauma should be referred to exclude ocular injury.

284
Q

Psuedoephedrine is cautioned in what conditions?

A

DiabetesHypertensionHeart diseaseAngle-closure glaucoma

285
Q

Miss W is a 19 year old patient who has developed several painful red lumps and patches (that measure 1-5 cm) on her lower legsWhat advice should you give?

A

These lumps are characteristic of erythema nodosum. Treatment is usually rest and painkillers such as NSAIDs.- The bumps and patches last about two weeks before fading like a bruise.

286
Q

How many levels of healthy living pharmacy is there?

A

Level 1, 2 and 3Need to be on the HLP register

287
Q

What does Level 1, 2 and 3 healthy living pharmacies entail?

A

Level 1- Promoting health, wellbeing and self-care (profession-led)Level 2 - Providing services (commissioner-led)Level 3 - Providing treatment (commissioner-led)

288
Q

What is the dose of paracetamol for a 2 month old?

A

30-60mg TDS

289
Q

What is the dose of paracetamol for 3-5 months?

A

60mg QDS

290
Q

What is the dose of paracetamol for 6 months-2 years?

A

120mg QDS

291
Q

What is the dose of paracetamol for 2-3 years?

A

180mg QDS

292
Q

What is the dose of paracetamol for 4-5 years?

A

240mg QDS

293
Q

What is the dose of paracetamol for 6-7 years?

A

250mg QDS

294
Q

What is the dose of paracetamol for 8-9 years?

A

375mg QDS

295
Q

What is the dose of paracetamol for 10-11 years?

A

500g QDS

296
Q

What is the dose of paracetamol for 12-15 years?

A

480-750mg QDS

297
Q

Discharge coming out the ear can indicate what?

A

Ear infection- refer

298
Q

A patient has severe itchy hands, particularly at night. You notice silver lines with a dot at the end in the webs of her fingers.What is this?

A

Scabies

299
Q

Which illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?

A

Measles

300
Q

Rubella is also known as what?

A

German measles

301
Q

The difference between German measles and measles (morbilli) is what?

A

Measles manifests itself with white spots in the mouth.

302
Q

What are the symptoms of Reye’s Syndrome?

A
  • Vomiting repeatedly- Tiredness and lack of interest or enthusiasm- Rapid breathing- SeizuresAs the condition progresses, the symptoms may get more severe and more wide-ranging, and can include:-Irritability, or irrational or aggressive behaviour-Severe anxiety and confusion that’s sometimes associated with hallucinations- Coma (loss of consciousness)
303
Q

Apart from if the child is very young, after how many days should a child see their GP with a fever?

A

If it hasn’t reduced after 5 daysAny other warning signs e.g. if it isn’t reduced by paracetamol, if they have a rash etc

304
Q

Should Hedrin (dimeticone) be applied to wet or dry hair?

A

Dry

305
Q

Scarlet fever is caused by what?

A

Group A strep

306
Q

What are the symptoms of scarlet fever?

A

Sore throat, fever, extensive red rash (sandpaper like as it is rough)The rash usually starts on the trunk before spreading. NO rash on the face but cheeks can be flushed Strawberry tongue - red papillae and white coating

307
Q

What is the likely diagnosis and what would you do if a child presented with this in community pharmacy?

A

Scarlet Fever
Refer as it is caused by Strep A and need antibiotics

308
Q

A rash like this indicates what?

A

Chicken pox

309
Q

A rash like this indicates what?

A

Scarlet fever - refer

310
Q

How long does acute otitis media usually last?When would antibiotics be indicated?

A

3 days (can be up to a week)

If symptoms do not improve by themself after 3 days or if patient is systemically unwell, consider antibiotics (amoxicillin)

311
Q

In patients with blepharitis, can their eyelids stick together?

A

Yes, can also be itchy and have a build up of debris

312
Q

What is the advice for patients with blepharitis?

A

Maintain good eyelid hygiene (BD then OD)
Remove debris from eyelids, can use baby shampoo to do this
Warm compress
Eye make up can make the condition worse

313
Q

What is this?

A

Blepharitis

314
Q

What is this?

A

Bacterial conjuctivitis

315
Q

What is this?

A

Allergic conjuctivitis

316
Q

Is allergic conjuctivitis contagious?

A

No

317
Q

What are the main differences of presentation for viral and allergic conjuctivitis?

A

Viral can be bilateral or unilateral
Allergic is bilateral, red and gritty

318
Q

What age is acetic acid (EarCalm) licensed in?

A

12+

319
Q

When should you stop using EarCalm and what is the maximum number of days you can use it OTC?

A

Treatment should be continued until two days after symptoms have disappeared but no longer than 7 days

320
Q

Constipation lasting how long with no identifiable cause prompts a referral?|

A

2 weeks

321
Q

What age should you refer someone with constipation?

A

<18 to rule out underlying causes

322
Q

How does the afe licensing of OTC loperamide differ in the following indications:

i) Acute diarrhoea
ii) Acute diarrhoea associated with IBS

A

i) 12 years and older
ii) 18 years and older if associated with IBS, and need to have diagnosis by the doctor

323
Q

What is this?

A

Angular stomatitis

324
Q

What are the symptoms of oral thrush?

A

Patches of curd-like, white or yellowish plaques that can occur anywhere in the mouth, especially the cheeks, gums, palate, and tongue. These are easily removed, revealing an underlying red base that is not usually painful.

325
Q

True or false:
In oral thrush, white patches cannot be removed easily from the tongue

A

False- they can be removed easily leaving a red base

326
Q

What should you recommend if a pregnant or breastfeeding lady comes in with oral thrush?

A

Refer

327
Q

What would be first line for a sprain? What is second line?

A

Paracetamol or TOPICAL NSAID

If no improvement after 48 hours of injury, use an oral NSAID

328
Q

What does Otrivine Extra Dual Relief nasal spray contain and what is it used for?

What is the age licensing for OTC?

A

Symptomatic treatment of nasal congestion and rhinorrhea in connection with common colds.

Ipratropium bromide

xylometazoline hydrochloride

> 18 years

329
Q

What would be first line for period pains (primary dysmenorrhoea)?

A

NSAID

Can offer paracetamol as well or if NSAID contraindicated

330
Q

How long should daktarin gel be applied for?

A

During symptomatic period and for 7 days after symptoms have cleared up

Pre Reg 2021 Darush (21 decks)

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