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Pharmacy Practice 2 Exam > PP2 exam > Flashcards

PP2 exam Flashcards

1
Q

For Irritant Contact Dermatitis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Characterised by dry, red, itchy skin which you have as a result of the inflammation
  • It occurs soon after exposure to irritating substances on the first or subsequent exposure
  • I can see papules, vesicles, broken skin from scratching which results in dermatitis (the shape of the affected area tells me that it is ICD)
  • Irritants that can precipitate ICD: Detergents and soaps, solvents, jewellery, strapping, acids –> if patient mentions how they got it, you can say this is something that will trigger ICD
  • Your job may cause it (occupational history), you might see an improvement on holiday from work

B)

Treatment choices to consider: Avoid irritant, topical corticosteroids, regular emollient use, antihstamines, tar preparations

  • I would give hydrocortisone which is an corticosteroid provided the patient is not diabetic or immunocompromised (or younger than 2). Hydrocortsione reduces swelling, itching, redness.
  • Or give pinetarsol gel which is a tar preparation. Anti-puritic (relieves itching), weakly antiseptic and moisturising effect. (Pinetarsol gel used in the shower by applying directly to wet skin, leaving a few minutes and briefly rinsing)

C)

IDARL for corticosteroid

  • Indication: anti-inflammatory, immunosuppressive
  • Directions: Apply by FTU (1 FTU= sufficient to cover an area of skin same size as both palms of your hands). Apply bd to control flare-ups for max of 7 days
  • Adverse effects: Delayed wound healing, skin may itch, stretch marks
  • Referral points: Spreading dermatitis, treatment failure >2 weeks
  • Lifestyle/Self care: Avoid direct heat, avoid stress, use moisturiser bd
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2
Q

For Allergic Contact Dermatitis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Characterised by dry, red, itchy skin which you have as a result of the inflammation
  • I can see popules, vesicles, broken or weeping skin from scratching (the shape of the affected area tells me that it is ACD)
  • You have had re-exposure to the substance, you need to have prior exposure and prior sensitisation
  • Irritants that can precipitate ACD: Jewellery, cosmetics, rubber –> if patient mentions how they got it, you can say this is something that will trigger ACD
  • If lesions appear within 6-12 hours of contact

B)

  • Treatment choices to consider: Avoid irritant, topical corticosteroids, regular emollient use, antihstamines, tar preparations
  • I would give hydrocortisone which is an corticosteroid provided the patient is not diabetic or immunocompromised (or younger than 2). Hydrocortsione reduces swelling, itching, redness.
  • Or give pinetarsol gel which is a tar preparation. Anti-puritic (relieves itching), weakly antiseptic and moisturising effect. (Pinetarsol gel used in the shower by applying directly to wet skin, leaving a few minutes and briefly rinsing)

C)

IDARL for corticosteroid

  • Indication: anti-inflammatory, immunosuppressive
  • Directions: Apply by FTU (1 FTU= sufficient to cover an area of skin same size as both palms of your hands). Apply bd to control flare-ups for max of 7 days
  • Adverse effects: Delayed wound healing, skin may itch, stretch marks
  • Referral points: Spreading dermatitis, treatment failure >2 weeks
  • Lifestyle/Self care: Avoid direct heat, avoid stress, use moisturiser bd

​

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3
Q

For Atopic Dermatitis (genetic factors)

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Someone in your family or you have atopy (eczema, hayfever, asthma). This results in atopic dermatitis
  • Shape of lesions tell me its atopic dermatitis (lesions are often symmetrical)
  • Characterised by dry, red, itchy skin which you have as a result of the inflammation
  • Most common form of dermatitis in children which the patient is
  • If lesions appear within 6-12 hours of contact

B)

  • Treatment choices to consider: Avoid irritant, topical corticosteroids, regular emollient use, antihstamines, tar preparations
  • I would give hydrocortisone which is an corticosteroid provided the patient is not diabetic or immunocompromised (or younger than 2). Hydrocortisone reduces swelling, itching, redness.
  • Or give pinetarsol gel which is a tar preparation. Anti-puritic (relieves itching), weakly antiseptic and moisturising effect. (Pinetarsol gel used in the shower by applying directly to wet skin, leaving a few minutes and briefly rinsing)

C)

IDARL for corticosteroid

  • Indication: anti-inflammatory, immunosuppressive
  • Directions: Apply by FTU (1 FTU= sufficient to cover an area of skin same size as both palms of your hands). Apply bd to control flare-ups for max of 7 days
  • Adverse effects: Delayed wound healing, skin may itch, stretch marks
  • Referral points: Spreading dermatitis, treatment failure >2 weeks
  • Lifestyle/Self care: Avoid direct heat, avoid stress, use moisturiser bd
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4
Q

For Infantile Seborrheic Dermatitis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Yellow, greasy scalp
  • Rash is not itchy
  • There is no family history which tells me its infantile seborrheic dermatitis
  • Very common in infants >3 months
  • Nappy area/face can become involved
  • It will usually clear up within weeks or months, exact cause is not known

B)

Treatment choices include:

  • Olive oil, vegetable oil, baby oil to remove scale (Soften scales for removal)
  • Salicylic Acid e.g. Egozite cradle cap solution (keratolytic plus softening)
  • Choose salicylic acid as it gets rid of the dermatitis faster

C)

IDARL for salicylic acid (egozite)

  • Indication: keratolytic (dissolves the substance that holds the skin cells together –> makes it easier to shed skin cells)
  • Directions: Apply bd for 3-5 days without washing. After this period, rinse away with mild shampoo
  • Adverse effects: No adverse effects
  • Referral points: Spreading dermatitis, duration >2 weeks, treatment failure
  • Lifestyle/Self care: avoid direct heat, avoid stress, adequate moisturising bd
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5
Q

For Adult Seborrheic Dermatitis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Mildly Itchy
  • Flaky skin, red rash, greasy loking scales
  • Inflammation of the eyelid (blepharitis)
  • Area which is affected is the scalp (can be other areas), but if patient has scalp seborroheic dermatitis, say it is the result of seborroheic dermatitis
  • Can case dandruff

B)

Treatment Choices to consider: Salicylic acid shampoo, Zinc pyrithione shampoo, ketoconazole shampoo, selenium sulfide shampoo, topical hydrocortisone, hydrocortisone plus antifungal cream (ketoconazole)

  • Use the salicylic acid shampoo, it is a keratolytic which dissolves the substance that holds the skin cells together –> makes it easier to shed skin cells. It is used for mild-moderate infections
  • For nonscalp area use, ketoconazole and hydrocortisone cream/spray. Anti-inflammatory and anti pruritic

C)

Salicylic acid shampoo IDARL

  • Indication: keratolytic which dissolves the substance that holds the skin cells together –> makes it easier to shed skin cells.
  • Dosage and directions: Use 3x a week
  • Adverse effects: Stinging may occur
  • Referral: Speading dermatitis, treatment failure, duration >2 weeks
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6
Q

For Psoriasis (inflammation and hyper-proliferative disease of the skin)

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Not itchy
  • Lesion is in a symmetrical distribution
  • Clearly defined red patches of skin covered with dry, silvery scales commonly known as plaques
  • Male > Female?
  • Area affected, can tell if its psoriasis if it plaques are on elbows or knees

B)

Treatment options for Psoriasis: Soap substitutes, moisturisers, topical corticosteroids, tar preparation, keratolytics

  • For plaques on body use Pinetarsol gel –> tar preparation. Anti-puritic (relieves itching), weakly antiseptic and moisturising effect.
  • For scalp psoriasis –> salicylic acid and coal tar. Keratolytic, antipuritic, antiseptic and moisturising effect

C)

IDARL for plaque psoriasis

  • Indicaton: Anti-puritic (relieves itching), weakly antiseptic and moisturising effect.
  • Dosage and directions: Pinetarsol gel used in the shower by applying directly to wet skin, leaving a few minutes and briefly rinsing
  • Adverse effects: none
  • Referral: Pustular psoriasis, extensive lesions with moderate to severe itching, no family history of psoriasis
  • Lifestyle/self care: Soap substitutes, moisturise, avoid scratching lesions
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7
Q

For Acne

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Caused by excess oil production in the skin
  • Area affected (face. chest, upper back)
  • Signs of comedones, papules and pustules (whiteheads, blackheads, red-tender bumps with white pus, tender bumps)
  • Common in teenagers
  • Stress and poor diet are contributing factors

B)

Treatment choices for acne: Azelaic acid, benzoyl peroxide, triclosan

  • Choose azelaic acid –> anti-inflammatory, keratolytic and is bactericidal
  • Azelaic acid is safe to use in pregnancy
  • Most common and used type

C)

IDARL for azelaic acid

  • Indication: Anti-inflammatory, keratolytic, bactericidal (kills bacteria)
  • Directions: Apply a.a. morning and night
  • Adverse reaction: hypopigmentation with dark complexions
  • Referral: OTC treatment failure >6months, Rosacea (inflammation of skin follicles)
  • Self-care: Avoid stress, exercise, good diet
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8
Q

For Nappy Rash (irritant contact dermatitis)

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Diarrhoea would cause nappy rash
  • Acidic foods would cause nappy rash
  • Can coincide with teething which your son/daughter has
  • Red, burn-like red rash in nappy area only
  • Not in the folds of the skin

B)

Treatment choices to consider for nappy rash: Zinc oxide, lanolin, liquid parrafin, chlorhexidine

  • Choose zinc oxide (QV baby cream) which has soothing properties and can relieve irritation the fastest, also repels water

C)

IDARL for zinc oxide (QV baby cream)

  • Indication: Soothing properties, form a barrier ontop of the skin which protects area from moisture and irritants
  • Dose and direction: Apply QV Baby Barrier Cream to affected skin at every nappy change
  • Adverse effects: generally well tolerated but may have some redness
  • Referral: broken skin, signs of infection, other body areas affected
  • Lifestyle/self care: changy nappy ASAP, consider diet, nappy free time (allow nappy area to breathe and dry)
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9
Q

For Chickenpox

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Intense itching and red,small blisters followed by crusting
  • Mainly on face and trunks
  • Very common in young children which your son/daughter is
  • Fever, headache, sorethroat which your son/daughter is experiencing as a result of the chicken pox
  • It is caused by the varicella zoster virus –> it is an acute viral infection

B)

Treatment choices to consider for chickenpox: Paracetamol, tar preparation, flare both oil, oatmeal bath, hydrating gels, seadating antihistamine

  • Use Dexchlorpheniramine (sedating antihistamine), can be used at night to help with itchiness
  • Safe to use in pregnancy and in children >2 yo

C)

  • Indication: Antipruritic (reduces itchiness)
  • Dose and directions: 1 tablet a night for adults, or use syrup for kids >2 yo
  • Adverse effects: Sedation, dry mouth, dizziness, hangover effect
  • Referral: Vomitting, high fever, severe headache
  • Self care: bed rest, avoid scratching, cover mouth if coughing/sneezing
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10
Q

For Tinea Pedis (dermatophyte)

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Caused by fungal infection (dermatophyte) and can be contagious
  • If the patient regularly shares communal showers, locker rooms –> they will contract atheletes foot
  • Wear gym shoes frequently
  • If they have excessive sweating
  • Occupation e.g. farmers, gym instructors
  • If they play contact sports
  • Area affected is interdigital space

B)

Treatment choices to consider for tinea pedis: Imidazole antifungals, allylamines, tolnaftate

  • Use allylamine (terbinafine) as its more effective than imidazoles
  • Its fungicidal against dermatophytes e.g. directly kills fungi
  • Shorter treatment course than imidazoles

C)

IDARL for terbinafine

  • Indications: fungicidal against dermatophyte –> directly kill fungi
  • Directions: Use one off aplication for tinea pedis (don’t wash area for 24 hours after application)
  • Adverse effects: redness, itching and irritation
  • Referral: extensive area, diabetic, immunocompromised
  • Lifestyle/self-care: Keep feet clean and dry, expose area to sunlight wear clean cotton socks
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11
Q

For Tinea cruris

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Caused by fungal infection (dermatophyte) and can be contagious
  • Affects groin and inner thigh area
  • Intensely itchy
  • Men are more affected then women which tells me you as a male are more likely to have it
  • Can spread to buttocks or lower thighs
  • Common in people who sweat a lot e.g. atheletes

B)

Treatment choices to consider for tinea cruris: Imidazole antifungals, allylamines, tolnaftate

  • Use allylamine (terbinafine) as its more effective than imidazoles
  • Its fungicidal against dermatophytes e.g. directly kills fungi
  • Shorter treatment course than imidazoles

C)

IDARL for terbinafine

  • Indications: fungicidal against dermatophyte –> directly kill fungi
  • Directions: Once daily for one week
  • Adverse effects: redness, itching and irritation
  • Referral: extensive area, diabetic, immunocompromised
  • Lifestyle/self-care: Wear loose fitting cotton underwear, do not share clothes, wash hand after touching the area
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12
Q

For Tinea Corporis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Caused by fungal infection (dermatophyte) and can be contagious
  • Itchy
  • Usually on exposed area - torso, arms or legs which is where the ringworm is on you
  • Common in children which your son/daughter is
  • Appearance is that of a ringworm (reddened edge with a central clearing)
  • small bumps on the skin (papules)

B)

Treatment choices to consider for tinea corporis : Imidazole antifungals, allylamines, tolnaftate

  • Use allylamine (terbinafine) as its more effective than imidazoles
  • Its fungicidal against dermatophytes e.g. directly kills fungi
  • Shorter treatment course than imidazoles

C)

IDARL for terbinafine

  • Indications: fungicidal against dermatophyte –> directly kill fungi
  • Directions: Use once daily for one week
  • Adverse effects: redness, itching and irritation
  • Referral: extensive area, diabetic, immunocompromised
  • Lifestyle/self-care: Expose area to sunlight, do not share clothes + hairbrushes + towels, children with tinea should stay away from school until the day after appropriate antifungal treatment has commenced
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13
Q

For Fungal Nappy Rash

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Bright red rash in nappy area with well defined edges, may be shiny and moist
  • In the folds of the skin and groin
  • Urine or faeces (diarrhea) from wet or dirty nappies may causes it
  • Yeast infection caused by fungal organism candida albicans

B)

Treatment choices to consider for Fungal nappy rash: Imidazole antifungals, allylamines, tolnaftate

  • Use imidazoles as its a candida infection. Azoles are fungistatic which inhibits fungal growth
  • Terbinafine (allylamine ) is only fungistatic against candida

C)

IDARL for daktorin (contains miconazole and zinc oxide)

  • Indication: Fungistatic, inhibits fungal growth and soothing properties
  • Directions: Apply at every nappy change, make sure area is dry
  • Adverse effect: Generally well tolerated
  • Referral: broken skin, other body areas affected, signs of infection
  • Lifestyle/self-care: change nappy asap, nappy free time (allow area to breathe and dry), consider diet
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14
Q

For Vaginal Thrush

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Itching + soreness of the vulval lips
  • Burning
  • Discharge that you have told me about —> white curd-like (cottage-cheese like)
  • Pain when urinating (dysuria)
  • Discomfort during intercourse
  • Diabetes
  • Yeast infection caused by fungal organism candida albicans
  • Pregnancy

B)

Treatment choices to consider for Vaginal thrush: Imidazole antifungals (clortimazole, miconazole, fluconazole), allylamines, nystatin, tolnaftate

  • Use clotrimazole, most efffective and most common treatment that is used
  • Fungistatic - inhibits fungal growth
  • Safe to use during pregnancy (use pessary)

C)

IDARL for Clotrimazole (canesten)

  • Indication: fungistatic - inhibits fungal growth
  • Directions: insert pessary at night, use in conjunction with cream applied externally at night
  • Adverse effects: Vaginal irritiation
  • Referral: Women <16 years or >60, coloured or smelly discharge, first occurrence
  • Lifestyle/self-care: wipe front to back, eat healthy diet, plain loose-fitting cotton underwear
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15
Q

For Cystitis (inflammation of the bladder)

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Caused by bacteria ascending the urethra into the bladder
  • Pregnancy and diabetes is a RF
  • Dysuria (pain/burn when urinating)
  • Urinary frequency and urgency
  • Haematuria (blood in urine)
  • May have low back pain

B)

Treatment choices for cystitis: Urinary alkalising agents, hexamine hippurate, cranberry juice/capsules

  • Use urinary alkalinsing agents, reduce acidity of urine and decreases burning sensation in urine
  • Potasssium citrate, sodium citrate, sodium bicarbonate, citric acid, tartaric acid all increases pH of urine

C)

Alkalinising agents IDARL (ural, citravescent)

  • Indication: Increases pH –> symptom relief
  • Directions:

Adult: 1-2 sachets in 1/2 glass of water 3-4 times daily (sip slowly)

Children: 1 sachet in 1/2 glass of water 2-3 times daily

  • Adverse effects: gastric irritation (limit treatment to 2 days)
  • Referral: Post menopausal women, duration > 7 days, vaginal discharge
  • Lifestyle/self-care: Wipe front to back, drink enough H20 to keep urine light coloured, dont delay urination
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16
Q

For Sunburn

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Inflammation, pain and redness
  • overexposure to UV in sunlight –> primarily UVB
  • Skin is warm to touch
  • Headache, fever, nausea and fatigue is the sunburn is severe

B)

Treatment choices for sunburn: Topical cooling agents (aloe vera), local anaesthetics, topical hydrocortisone

  • Local anaesthetics contain ingredients such as lignocaine, chlorhexidine, cetrimide –> numbs the area, antiseptic and disinfectant
  • Spray avoids the need for rubbing tender skin
  • Provides fast acting relief and helps to prevent infection

C)

Idarl for local anaesthetics (soov spray)

  • Indication: anaesthetic –> numbs the area, provides pain relief
  • Direction: Apply to affected area 2-4 times daily to unbroken skin
  • Adverse effects: Stinging may occur
  • Triggers for referral: over large area of skin, headache, fever, vomitting
  • Lifestyle/self care: moisturise with aloe vera, drink extra water, leave blisters alone
17
Q

For Head Lice

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Head lice are tiny, parasitic insects that live on the scalp
  • Live lice (brown specks) are diagnostic and indicates that the patient has active head lice
  • Nits (cream/white egs) may not represent current infection
  • Head lice is contragious, examine all household members and close contacts
  • Very common in young children
  • Stay away from school until all live head lice has been removed, he/she can return when only nits are present

B)

Treatment options for head lice: neurotoxic insecticides(permethrin), physical insecticides(dimeticone), 10 day conditioner treatment, electric combing

  • Use physical insecticide Dimeticone 4% –> coats lice, disrupts water balance = gut rupture and death
  • Effective against lice resistant to neurotoxic insecticide
  • Repeat treatment after 7 days
  • Safe in children >6 mo, pregnancy and breast feeding

C)

IDARL for dimeticone (nitwits)

  • Indication: coats lice, disrupts water balance = leads to gut rupture and death
  • Directions: Apply to dry hair, allow to dry, leave 8hrs, rinse with warm water

> Remove eggs and lice with fine-toothed comb

> Re-treat after 7 days

  • Adverse effects: Well tolerated, itch
  • Referral: Diagnosis is uncclear, signs of infection, multiple treatment failure
  • Self-care: Dont share hats, hairbrushes, avoid head to head contact. Soak combs and hairbrushes that have been exposed to lice in hot water.
18
Q

For Scabies

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Pruritic skin condition caused by parasitic mite
  • Infestations more common in closed communities (e.g. nursing homes, dorm rooms, shared houses)
  • Intense itching –> worsens when body is warm (while in bed, after hot showers)
  • Spead by skin-to-skin contact with a person already infested with scabies (easily spread to sexual pertners, sharing clothing, towels and bedding)
  • I can see the burrows/scrapings in your skin –> red papular rash
  • Itch is diffuse not localised

B)

Treatment choices to consider for scabies: Premethrin 5%, benzyl benzoate 25%, crotamiton

  • Use premethrin 5%, it acts on nerve cell membranes of mites –> subsequent paralysis
  • Treatment of choice: low toxicity, high efficacy, well tolerated
  • Safe to use in pregnancy
  • Must treat patient and all household/ close contacts at the same time

C)

IDARL for premethrin 5% (lyclear cream)

  • Indication: Acts on nerve cell membrane of the lice –> subsequent paralysis
  • Directions: Apply to clean skin from chin down, best applied at night and left on for 8 hours, repeat in 7 days

> Adults: Upto 1 x 30g tube/adult body

> 5-12 years old: Upto 1/2 of a 30 g tube

  • Adverse effect: Well tolerated but may temporarily increase the itching, redness and swelling of the infestation
  • Referral: babies, unclear diagnosis, treatment failure (>4 weeks)
  • Lifestyle/self-care: Improvement of symptoms within 1-2 days of Tx, however itch may last upto 2-3 weeks, refer if >4 weeks
19
Q

For Cold Sores

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Caused by herpres simplex virus (HSV)
  • Infection results from direct contact with sores (e.g. kissing)
  • Infection results from indirect contact (sharing cutlery, drink bottles, napkins)
  • Cold sores typically occur around the mouth
  • Stress, fatigue, sunlight, menstruation, illness, local trauma may cause it

B)

Treatment choices to consider for cold sores: Aciclovir, penciclovir, betadine, virasolve

  • Use Aciclovir, antiviral medication that stops spread of herpes virus around the body
  • Reduce time for healing (by 24 hours) and reduces pain experienced from lesion
  • Safe in pregnancy and breastfeeding

C)

IDARL for aciclovir

  • Indication: Antiviral, stops spread of herpes virus and decreases pain experienced from the lesion
  • Directions: Treatment should be started as soon as symptoms are felt, apply 5 times a day for 5 days
  • Adverse effects: May cause transient stinging sensation after application
  • Referral: babies and young children, lesions within the mouth, lesions that spread rapidly over the face
  • Lifestyle/self care: Wash hand after applying tx to cold sore, avoid kissing, avoid oral sex
20
Q

For Mouth Ulcers

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Common causes include infection, food hypersensitivities, trauma, stress, nutritional deficiencies (vitamin B12, zinc iron), medications (NSAID)
  • More common in women
  • Minor aphthous ulcer (roundish, small, painful, tongue margin, inside lips and cheeks –> will heal in 7-14 days)
  • Major aphthous ulcer (large lesions, crops of 10 or more –> heal in 10-30 days)

B)

Treatment options for mouth ulcers: Local analgesics (choline salicylate), corticosteroids (triamcinolone)

  • Use choline salicylate, anti-inflammatory and pain reliever
  • Safe to use in pregnancy unlike triamcinolone

C)

IDARL for choline salicylate (bonjela)

  • Indication: anti-inflammatory and analgesic
  • Directions: Apply 1 cm every 3 hours prn
  • Adverse effects: generally well tolerated
  • Referral: Painless ulcer, duration >14 days, ulcers in crops of 10 or more
  • Self care/lifestyle: Quit smoking, healthy diet, suck on ice
21
Q

For Oral Thrush

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Oral thrush is a candida infection (fungal infection) which affects the surface of the tongue and insides of the cheeks
  • Painful and sore
  • Very young and the very old are more likely to suffer from oral thrush
  • Creamy-white patches –> resemble white curds (can be wiped off revealing underlying red mucosa)
  • Diabetes/immuocompromised are risk factors

B)

Treatment choices for oral thrush: Nystatin, miconazole

  • Use nystatin as its a antifungal medication, stops the growth of the fungus
  • Safe to use in pregnancy and breastfeeding

C)

IDARL for nystatin (nilstat) oral drops

  • Indication: antinfungal medication, stops the growth of the fungus
  • Direction: 1 mL QID after food in adult and children, use 1mL dropper in box, liquid should be swished in mouth for as long as comfortable before swallowing, can be dropped onto nipple after feed if breastfeed child with oral thrush

> Continue to use after 2 days after symptoms disappear

  • Adverse effects: Well tolerated but may experience nause, vomitting, diarrhoea
  • Referral: White painless patches, treatment failure, recurrent infection, diabetic, immuno-compromised patients
  • Lifestyle/self care: Clean dentures out, replace toothbrush, sterilise

> If breastfeed infant is affected, both baby and mother need to be treated (antifungal product applied to nipples after each feed and continue for 7 days post symptoms)

>If Oral thrush in baby –> check for nappy rash –> treat both simultaneously

22
Q

For Plantar wart (verucca)

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Caused by Human Papilloma (virus)
  • It is transmitted via direct skin contact on contact with infected skin cells
  • The apperance of the infected area tells me its plantar warts (cauliflower shape with hard outer edge)
  • Location of the wart being on the soles of the feet (ball off foot, bottoms of toes, heel) tells me that it is most likely plantar warts
  • Will clear spontaneously most of the time

B)

Treatment choices to consider for plantar wart: Salicylic acid, Glutaraldehyde, Podophyllum resin, cryotherapy

  • Treat with salicylic acid –> 1st line treatment choice.
  • Keratolytic which dissolves the substance that holds the skin cells together –> makes it easier to shed skin cells
  • Safe to use in pregnancy

C)

IDARL for salicylic acid (duofilm)

  • Indication: Keratolytic which dissolves substance that holds the skin cells together (easier to shed skin cells)
  • Directions: Apply od or bd (soak area in warm water for 5-10 mins beforehand)
  • Adverse effects: Well tolerated
  • Referral: large painful warts, uncertain diagnosis, facial warts, oozing/bleeding/itching
  • Lifestyle/self-care: keep warts covered, avoid sharing towels, wear thongs in communal areas
23
Q

For Otitis Media

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Common in young children 3 to 6 years old
  • Inflammation of the ear due to a bacterial infection or in some rare cases, a viral infection
  • Common in children folllwing a cold. H.influenzae bacteria causes this
  • Associated symptoms are pain, fever, irritability, hearing loss
  • May have purulent discharge if the drum perforates
  • Winter months may contribute to AOM
  • Spontaneous resolution
  • Exposure to tobacco and smoke can cause AOM

B)

Treatment choices for otitis media: Paracetamol, NSAID (ibrupofen), antibiotics for 7-10 days (refer)

  • Use paracetamol for symptomatic treatment for pain and/or fever
  • If child >1 month old, its appropriate to use
  • Use antibiotics if symptoms such as fever and vomiting occur

C)

IDARL for paracetamol

  • Indication: Analgesic, relieves fever
  • Directions: 15 mg/kg every 4-6 hors
  • Adverse effects: Generally well tolerated
  • Referral: Complications are suspected and response to antibacterial is poor
  • Lifestyle/self-care: Warm pack or cold pack to help relieve ear pain, avoid swimming with a blocked nose
24
Q

For allergic conjunctivitis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Inflammation and infection of the conjunctiva (tissue that lines the inside of the eyelids)
  • If acute –> bilateral = hayfever/seasonal e.g. grass and plant pollen
  • If chronic –> unilateral = perennial e.g. animal fur and dust mites
  • Itchiness, redness and watery discharge are all normal symptoms

B)

Treatment choices to consider for allergic conjunctivitis: Identify triggers and avoid if possible, sodium chloride 0.9% bd, vasoconstrictors, antihistamines, mast cell stabilisers, antihistamine (mast cell stabiliser)

  • Use naphazoline (vasoconstrictor), vasoconstrictors compress blood vessels in the eye to reduce redness.
  • Naphazoline is a decongestant used to relive redness and itchy/watering eyes –> alpha receptor agonist

C)

IDARL for naphazoline (do not use regularly for >5days)

  • Indication: Decongestant and vasoconstrictor –> relieves redness and itchy/watering eyes
  • Dosage and directions: One drop every 6-12 hrs as required. Wash hand first, tilt your head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over the eye and place 1 drop into the pouch. Look downward and gently close your eyes for 1 to 2 minutes. Place one finger at corner of eye near nose and apply gentle pressure. Do not blink and dont rub the eye
  • Adverse effects: Stinging in the eye, blurred vsion
  • Lifestyle/self-care: avoid triggers where possible, apply lubricating eye drops to soothe eyes
25
Q

For Viral Conjunctivitis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Inflammation and infection of the conjunctiva (tissue that lines the inside of the eyelids)
  • Caused by: adenoviruses and enteroviruses
  • Caused by common cold, viruses present in swimming pools
  • Acutely red eye, watery discharge, irritation, unilateral than bilateral which are symptoms your child is experiencing (very normal)
  • Highly contagious, common in children

B)

Treatment choices for viral conjunctivitis: Topcical vasoconstrictors (symptomatic treatment), cold compresses, hygiene very important to stop spreading.

  • Use naphazoline (vasoconstrictor), vasoconstrictors compress blood vessels in the eye to reduce redness.
  • Naphazoline is a decongestant used to relive redness and itchy/watering eyes –> alpha receptor agonist

C)

IDARL for naphazoline (do not use regularly for >5days)

  • Indication: Decongestant and vasoconstrictor –> relieves redness and itchy/watering eyes
  • Dosage and directions: One drop every 6-12 hrs as required. Wash hand first, tilt your head back, look upward, and pull down the lower eyelid to make a pouch. Hold the dropper directly over the eye and place 1 drop into the pouch. Look downward and gently close your eyes for 1 to 2 minutes. Place one finger at corner of eye near nose and apply gentle pressure. Do not blink and dont rub the eye
  • Adverse effects: Stinging in the eye, blurred vsion
  • Lifestyle/self-care: dont share eye drops, dispose of tissues carefully, stay home from school until symptoms clear
26
Q

For Acute Bacterial Conjunctivitis

A) How would you explain your diagnosis to your patient?

B) Discuss treatment choices you would consider, then choose one option to recommend to the patient and outline the rationale for the choice (discuss in terms of active ingredient rather than brand names)

C) Provide counselling on your treatment choice as well as general lifesytle advice relavant to the diagnosis

A

A)

  • Inflammation and infection of the conjunctiva (tissue that lines the inside of the eyelids)
  • Caused by bacteria (s.aureus, s.pyogenes, h.influenzae)
  • Irritation, purulent discharge, eyelids are stuck together in the morning (wet, sticky, mucopurulent), no pain. This are symptoms that you have told me that points to bacterial conjunctivitis
  • Sx: Unilateral then bilateral (1 eye to both eyes) –> very contagious
  • Most cases go away on their own

B)

Treatment options for bacterial conjunctivitis: Antiseptic (propamidine) eye drops, Chloramphenicol (chlorsig)

  • Use chlormamphenicol, more effective than propamidine. It is an antibiotic that is primarily bacteriostatic –> inhbits bacterial protein synthesis.
  • Primary choice for bacterial conjunctivitis

C)

IDARL for chloramphenicol

  • Indication: Bacteriostatic
  • Directions and dose: 1-2 drops every 2 hours initially, decreasing to every six hours. Eyes should be wiped clean of all debris and pus before using eye drops or ointment

> Continue after at least two days after the eyes appear normal

>Keep in fridge, avoid touching tip with eyelid, wash hands before and after use

  • Adverse effects: eye irritation (itching or burning), skin rashes or blisters
  • Self care: Do not share eye drops, dispose of tissues carefully

Pharmacy Practice 2 Exam (1 decks)

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