OTC Flashcards
Mrs Khan wants to purchase a stimulant laxative. This laxative can be purchased from the pharmacy for age 12 years and over:
Docusate sodium
Lactulose solution
Macrogol sachets
Prucalopride
Senna
E
RATIONALE: SENNOSIDE TABLETS ARE LICENSED FOR
PURCHASE FOR INDIVIDUALS ABOVE THE AGE OF 12
Miss Ramsay, a 28-year-old lady, has constipation due to IBS. She asks for some advice on laxatives that she can purchase over the counter. Which one of the osmotic laxatives would you not recommend?
Docusate sodium
Glycerol suppositories
Ispaghula Husk
Lactulose
Senna
D
RATIONALE: LACTULOSE IS NOT RECOMMENDED IN
PATIENTS WITH IBS DUE TO ITS BLOATING EFFECT THAT
IS OFTEN EXPERIENCED IN PATIENTS WITH IBS.
Mr Thomas, a 22-year-old, suffers from hay fever. He tells you he has had mild symptoms every year for the past 2 years and usually purchases an antihistamine from the pharmacy. He wants to purchase the same one again as it has been effective, but he cannot remember the name. He remembers he must take it 3 times a day. Which one of the above has he most likely purchased in the past?
Acrivastine
Cetirizine
Chlorphenamine
Desloratadine
Loratadine
A
RATIONALE: CETIRIZINE, LORATADINE AND DESLORATADINE
ARE ALL ONCE DAILY DOSING. CHLORPHENAMINE IS TAKEN
EVERY 4 TO 6 HOURS. ACRIVASTINE IS TAKEN THREE TIMES
DAILY.
You are a community pharmacist who often conducts consultations prior to patients purchasing what are classed as “P” medicines. One of these p medicines is sildenafil, a medication used to treat erectile dysfunction in men. In which patient would the sale of sildenafil be deemed appropriate?
A 60-year-old who has been taking midodrine for postural hypotension for the past month
A 55-year-old gentleman who takes sildenafil 10mg three times a day and is already stabilised on this dose
A 45-year-old gentleman who following discharge from the cardiac ward at a local hospital has been started on isosorbide mononitrate
A 65-year-old who normally has a blood pressure of 135/82mmHg and monitors this regularly at home
A 29-year-old on a tablet known as lenalidomide
D
RATIONALE: SILDENAFIL CANNOT BE SOLD OVER THE COUNTER IN
PATIENTS WITH HYPOTENSION, PATIENTS WHO HAVE RECENTLY HAD A
CARDIAC COMPLICATION, HAVE SICKLE CELL ANAEMIA (AN
ABNORMALITY OF RED BLOOD CELLS), LEUKAEMIA (CANCER OF BLOOD
CELLS) OR MULTIPLE MYELOMA (CANCER OF BONE MARROW). WHILST
OPTION B IS ALREADY TAKEN SILDENAFIL, THAT DOSING IS NOT FOR
ERECTILE DYSFUNCTION, RATHER FOR PULMONARY HYPERTENSION.
As a community pharmacist, it is important that you are vigilant in observing for possible signs and symptoms of abuse of over-the-counter medications. Which of the following is the least likely to be a possible warning sign and symptom of medication abuse?
Appearing uncomfortable or hostile when answering questions
Asking for specific products
Becoming impatient or angry very quickly
Excessive frequent requests for medications
Requesting large quantities of medications
B
RATIONALE: ASKING FOR SPECIFIC PRODUCTS MAY INDICATE
ABUSE, HOWEVER IT COULD ALSO BE INDICATIVE OF A
PATIENT WHO HAS BENEFITED FROM A SPECIFIC ACTIVE
INGREDIENT AND WANTS HELP IN FINDING THE SAME ONE.
ALL OF THE OTHER OPTIONS ARE MORE LIKELY TO BE
INDICATIVE OF MEDICATION ABUSE - REMEMBER THAT THIS
IS ALL CONTEXTUAL, AND AS A PHARMACIST, YOU CANNOT
RELY ON GENERALISATIONS.
A patient presents to your community pharmacy explaining that she has a cough. She explains that this cough has been quite bothersome; she’s tried drinking plenty of fluids and sucking boiled sweets or pastilles but to no avail. She would like you to recommend something for her cough. Upon asking about medication, she takes paracetamol, ibuprofen, ramipril and senna. What is the best recommendation?
Dextromethorphan cough syrup
Guaifenesin cough syrup
Glycerol suspension
Refer the patient to her GP
Simple linctus syrup
D
RATIONALE: WHILST COUGH REMEDIES MAY PROVE USEFUL,
IN THIS CONTEXT, THE COUGH IS LIKELY CAUSED BY THE
PATIENT’S RAMIPRIL WHICH CAUSES A COUGH THROUGH THE
BUILD UP OF BRADYKININ. NO OTHER COUGH SYRUP WILL
ADDRESS THIS MECHANISM OF ACTION - A REFERRAL TO THE
GP TO SWITCH MEDICATIONS WOULD BE MORE APPROPRIATE.
What is the active ingredient in most antifungal creams used to treat athlete’s foot, jock itch, and ringworm that can be purchased over the counter?
Clotrimazole
Hydrocortisone
Ketoconazole
Miconazole
Terbinafine
A
RATIONALE: CLOTRIMAZOLE TENDS TO BE USED AS AN
ANTIFUNGAL. ALL THE OTHER OPTIONS ARE EITHER NOT
AVAILABLE OVER THE COUNTER OR ARE STEROIDS.
A 65-year-old patient with a history of glaucoma presents to your community pharmacy. The patient explains that he’s been suffering from severe hay fever and would like to purchase some antihistamines. He mentions that his doctor told him though that there were some medications he could not take due to his glaucoma, and he can’t remember which ones they were. Which antihistamine can you safely recommend to this gentleman to purchase over the counter?
Buclizine
Chlorphenamine
Diphenhydramine
Fexofenadine
Promethazine hydrochloride
D
RATIONALE: APART FROM FEXOFENADINE, ALL OF THE OTHER
ANTIHISTAMINES ARE OLD GENERATION WITH ANTICHOLINERGIC SIDE
EFFECTS WHICH ARE CONTRAINDICATED IN GLAUCOMA.
A young woman presents to your pharmacy presenting with a complaint of a headache. She would like to buy some soluble paracetamol as she finds the film coating troublesome to tolerate. The maximum number of paracetamol soluble tablets (500mg) that you can sell this patient in a pharmacy is:
16 tablets
32 tablets
There is no legal limit
96 tablets
100 tablets
C
RATIONALE: THE LEGAL RESTRICTION FOR PARACETAMOL
STIPULATES THAT NO MORE THAN 100 NON EFFERVESCENT
TABLETS OR CAPSULES CAN BE SOLD TO A PERSON AT ANY
ONE TIME. HOWEVER, THERE ARE NO LEGAL LIMITS ON THE
QUANTITY OF OVER THE COUNTER EFFERVESCENT TABLETS,
GRANULES OR LIQUIDS THAT CAN BE SOLD; PROFESSIONAL
JUDGEMENT SHOULD BE USED TO DEDICE THE APPROPRIATE
QUANTITY TO SUPPLY AND WHAT LIMITS TO IMPOSE.
A 25-year-old gentleman presents to your pharmacy stating that he has been feeling unwell and proceeds to try and pay for two packs of Sudafed decongestant tablets (pseudoephedrine hydrochloride). Each pack contains 12 x 60mg tablets. You explain that you can only sell him one pack; the patient becomes quite irritable and impatient, demanding an answer as to why you cannot sell him both packs. The legal reason that you cannot make this supply is because:
It is unlawful to supply a combination of products that contain more than 720mg of pseudoephedrine without a prescription
It is unlawful to supply a combination of products that contain more than 180mg of ephedrine without a prescription
The patient’s age may be indicative of potential abuse of pseudoephedrine for illicit purposes
The patient’s request for a large quantity is indicative of potential abuse of pseudoephedrine for illicit purposes
The patient’s irritable behaviour and impatience is indicative of potential abuse of pseudoephedrine for illicit purposes
A
RATIONALE: WHILST IRRITIBLE BEHAVIOUR AND IMPATIENCE
ARE BOTH POTENTIAL INDICIATORS OF SUBSTANCE MISUSE,
THIS WOULD NOT BE LEGAL GROUNDS TO REFUSE SUPPLY,
THIS WOULD FALL UNDER PROFESSIONAL JUDGEMENT. AGE
AND GENDER ARE ALSO NEVER A REASON TO ASSUME ONE
MAY BE USING OTC PRODUCTS ILLEGALLY. THE PRODUCTS IN
QUESTION CONTAIN PSEUDOEPHEDRINE RATHER THAN
EPHEDRINE, SO OPTION B IS NOT RELEVANT.
What is the primary active ingredient in most cough drops, and sore throat lozenges used for the temporary relief of sore throat and cough?
Benzocaine
Dextromethorphan
Diphenhydramine
Menthol
Phenylephrine
A
RATIONALE: BENZOCAINE (A LOCAL ANAESTHETIC) AND
MENTHOL TEND TO BE ACTIVE INGREDIENTS IN COUGH DROPS
AND SORE THROAT LOZENGES
An eighteen-year-old male presents to your community pharmacy complaining of musculoskeletal pain in their right knee. The patient normally uses Fostair 100/6 one puff to be inhaled twice a day, and salbutamol to be used as and when required. Which analgesic would be the least appropriate option for this patient?
Diclofenac 1.26% gel
Ibuprofen 400mg tablets
Ibuprofen 5% gel
Ibuprofen 10% gel
Paracetamol 500mg tablets
B
RATIONALE: NSAIDS AREN’T A HARD CONTRAINDICATION IN
ASTHMA, BUT THEY ARE ADVISED AGAINST; IN THIS CASE,
SYSTEMIC NSAIDS ARE THE LEAST APPROPRIATE. TOPICAL
NSAIDS HAVE VERY LITTLE SYSTEMIC ABSORPTION SO THIS
WOULD BE ACCEPTABLE FOR LOCAL ACTION.
Ms B takes Buscopan (hyoscine butylbromide) tablets for occasional abdominal cramps that she suffers from. Which of the following side effects is not a likely side effect from Buscopan?
Blurred vision
Constipation
Diarrhoea
Dry mouth
Urinary retention
C
RATIONALE: HYOSCINE BUTYLBROMIDE, OR BUSCOPAN, HAS
ANTICHOLINERGIC SIDE EFFECTS I.E. BLURRED VISION,
CONSTIPATION, DRY MOUTH AND URINARY RETENTION.
DIARRHOEA IS NOT AN ANTICHOLINERGIC SIDE EFFECT.
Which of the following medications is not classed as a General Sales License (GSL) medicine?
Acriflex cream
Cetirizine tablets
Cetavlex cream
Cialis Together tablets
Loratadine tablets
D
RATIONALE: CIALIS TOGETHER (OR TADALAFIL) IS CLASSED
AS A “P” MEDICINE, WHICH CAN BE BOUGHT FROM A
PHARMACY, BUT NOT FROM A REGULAR STORE (GSL).
Miss L presents to your community pharmacy complaining of nausea. On further questioning, you can ascertain that she is six weeks pregnant. Which of the following would be the most appropriate course of action?
Supply cyclizine 50mg tablets
Supply Gaviscon Advance Aniseed suspension
Supply ginger tablets
Supply promethazine oral tablets
Supply nothing and encourage self-care
E
RATIONALE: NONE OF THE OTHER OPTIONS WOULD BE
APPROPRIATE. SELF CARE IS THE MOST APPROPRIATE
OPTION.
Mr T presents to your community pharmacy complaining of a sore throat which he has had for the past five days. Upon further questioning, you can find out that he has not tried anything apart from paracetamol which only offered temporary relief. He has done some reading and would like to try Difflam spray, which contains benzydamine hydrochloride, a local anaesthetic. You ask him whether he takes any other medication, and he responds that he was recently started on carbimazole. Which of the following would be the most appropriate course of action?
Explain to the patient that self-care with paracetamol and hydration should suffice, and that his sore throat is likely viral in nature
Refer the patient urgently to his GP
Supply the patient with dispersible aspirin which he can use to gargle with for his throat
Supply the patient with Difflam spray which he can use every 1.5 to 3 hours when required for pain relief
Supply the patient with simple linctus syrup
B
RATIONALE: A SORE THROAT COULD BE INDICATIVE OF
THROMBOCYTOPENIA, OR ANOTHER BLOOD DYSCRASIA. A
REFERAL TO THE GP URGENTLY WOULD BE MOST
APPROPRIATE FOR A BLOOD TEST AND THEN FURTHER
MANAGEMENT.
Miss A presents to your community pharmacy complaining of diarrhoea which started two days ago. After interviewing her, you are able to ascertain that she has just come back from a family trip in Ghana. Which of the following would be the most appropriate choice of action in this case?
Do not supply the patient anything but explain that this is likely viral that can be managed with adequate hydration
Refer the patient to their GP urgently
Supply loperamide
Supply Dioralyte
Supply Pepto-Bismol
B
RATIONALE: BACTERIAL INFECTION IS THE MOST COMMON
CAUSE AND IS THOUGHT TO ACCOUNT FOR 80–90% OF
CASES OF TRAVELLERS’ DIARRHOEA. THE CLINICAL PICTURE
MAY VARY DEPENDING ON THE INFECTING PATHOGEN.
REFERRAL WOULD BE THE MOST APPROPRIATE OPTION.
Mr CS presents to your community pharmacy complaining of what feels like a cold sore. After examining his lip, you determine it would be appropriate to sell him Zovirax (acyclovir) topical cream. How often does Mr CS need to apply the cream?
Once daily
Twice daily
Three times daily
Four times daily
Five times daily
Five times daily
Mr. Z is a night security guard with fay fever. He would like a non-drowsy antihistamine and is not on any other medication. You deem it appropriate to sell him an antihistamine, but which antihistamine would be the least appropriate choice of antihistamine?
Acrivastine
Cetirizine
Chlorphenamine
Fexofenadine
Loratadine
C
RATIONALE: CHLORPHENAMINE IS A FIRST GENERATION
ANTIHISTAMINE AND IS CONSEQUENTLY FAIRLY SEDATING.
THIS WOULD BE THE LEAST APPROPRIATE CHOICE.
Mr B explains that he has had a runny nose and a bad cold for the past few days and would like to know what he can do to remedy this. You ask him what medication he takes, and he explains that he takes ramipril and doxazosin. Which of the following suggestions would be the most appropriate?
Beecham’s All-In-One (Paracetamol and Phenylephrine)
Nurofen Cold and Flu (Ibuprofen and Pseudoephedrine)
Sinutab (Paracetamol and Pseudoephedrine)
Sudafed (Pseudoephedrine)
Steam inhalation with paracetamol and menthol crystals
E
RATIONALE: ALL OF THE OTHER OPTIONS ARE CONTRAINDICATED DUE
TO THEIR CONTAINING OF STIMULANTS WHICH WOULD INCREASE
THIS PATIENT’S BLOOD PRESSURE. STEAM INHALATION WITH
PARACETAMOL AND MENTHOL CRYSTALS WOULD BE THE MOST
APPROPRIATE CHOICE.
- Which of the following ingredients has been subject to a safety warning by the MHRA and is no longer available to purchase over the counter?
Dextromethorphan
Glycerol
Guaifenesin
Levomenthol
Pholcodine
E
RATIONALE: PHOLCODINE-CONTAINING COUGH AND COLD MEDICINES
ARE BEING WITHDRAWN FROM THE UK MARKET AS A PRECAUTION
FOLLOWING A REVIEW WHICH FOUND THAT THEIR BENEFITS DO NOT
OUTWEIGH THE INCREASED RISK OF THE VERY RARE EVENT OF
ANAPHYLAXIS TO NEUROMUSCULAR BLOCKING AGENTS (NMBAS) USED
IN GENERAL ANAESTHESIA
Mr E Winters, a 39-year-old, has constipation. He wants you to recommend a laxative that is quick acting. Which one of the above rectal preparations would take 15-30minutes to work?
Docusate sodium capsules
Glycerol suppositories
Lactulose solutions
Macrogol sachets
Senna tablets
B
RATIONALE: GLYCEROL SUPPOSITORIES ARE THE FASTEST ACTING
CHOICE ON THIS LIST. DOCUSATE SODIUM AND MACROGOL SACHETS
CAN TAKE 24-48 HOURS TO REACH FULL EFFECT. LACTULOSE CAN
TAKE 72 HOURS TO REACH FULL EFFECT. SENNA TAKES ROUGHLY 8
HOURS TO TAKE EFFECT
A 20-year-old gentleman presents with a small patch of ringworm on his arm. He is otherwise well and not on any medication. Which of the following medications is most suitable?
Clotrimazole 1% cream
Clotrimazole 2% cream
E45 cream
Hydrocortisone 1% cream
Hydrogen Peroxide 1% cream
A
RATIONALE: CLOTRIMAZOLE 1% IS THE ONLY CHOICE HERE
THAT IS LICENSED FOR THE USE OF RINGWORM.
CLOTRIMAZOLE 2% IS NOT LICENSED FOR THIS INDICATION.
For which of these indications can over the counter hydrocortisone 1% cream be sold?
An insect bite on a 9-year-old boy
A nappy rash for an 18-month year old toddler
A shaving rash on a 34-year-old
A 53-year-old with a nickel rash allergy on a wrist
A vulval rash on a 42-year-old woman
D
RATIONALE: HYDROCORTISONE 1% CREAM IS ONLY SUITABLE
FOR THOSE OVER THE AGE OF 10. OPTION C IS NOT
APPROPRIATE AS A SHAVING RASH COULD SUGGEST AN
OPEN WOUND, ON WHICH STEROIDS SHOULD NOT BE USED.
A VULVAL RASH MAY BE INDICATIVE OF AN STI, WHICH
WOULD REQUIRE FURTHER INVESTIGATION.
