Tutorial 10: Case 1

Question 1

Cadence, a 40-year-old, visits the pharmacy today asking to speak privately with the pharmacist. Cadence asks: ‘Can I speak with the pharmacist in private please?’

A) Who is it for?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

G) Allergies

H) Pregnancy/breastfeeding (cos she is a woman…)

Answer 1

A) Myself

B) I have what appear to be hemorrhoids on my bottom that are quite uncomfortable

C) Probably about 4 or so days

D) Nothing as yet, I was hoping they would disappear on their own

E) I have been taking some panadeine extra for a sore back for a few days. I think it contains paracetamol and codeine. Mt back is getting better, so I haven’t used any panadeine extra today.

F) No medical conditions, just the sore back I had for the last few days.

G) None known

H) No

Question 2

Appropriate extended questions

1. Are there any other symptoms?
2. Is the blood bright red/dark?
3. Does the blood appear after you go to the toilet or is it dispersed within your stool
4. Have you had this before
5. What has helped in the past
6. Any change in bowel habits
7. Has anything changed recently? Any activities or changes in diet?

Answer 2

1. The lump and surrounding area appear very itchy at times which can be embarrassing and occasionally when I wipe there is a little blood on the toilet paper.
2. Only a small amount of very pink or bright red blood
3. On toilet paper when I wipe.
4. Yes, I remember after having both of my children about 10 years ago I experienced hemorrhoids
5. I used a cream for a few days after having my children, however, I cannot remember what it was called. It helped with the itch and discomfort, so I would like something like that this time too
6. I am having trouble passing my stool over the last few days and needed to strain when I go to the toilet. I drank some prune juice yesterday and ate lots of fruits and veggies yesterday and seemed to move my bowels easier yesterday and today.

Question 3

What is the diagnosis? Explain reasoning to the patient.

Answer 3

Based on the signs and symptoms you have told me, I believe you have hemorrhoids. The itchy lump in that area, small amount of blood on toilet paper when you wipe and the fact that you have had trouble passing stool over the past few days confirm my diagnosis. Most likely caused by constipation and you straining when you go to the toilet. Constipation could be caused by the medication you were taking.

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

Cinchocaine hydrochloride and hydrocortisone (proctosedyl ointment)

• Indication: Dual action drug. Local anesthetic and corticosteroid which will reduce the pain, swelling, inflammation and itching in that specific area.
• Dosage and directions: Use a 1.5 cm amount tds for a max of 7 days. Wash hands before.
• Adverse effects: May experience a bit of irritation and skin sensitization.
• Duration of treatment, time to recovery, when to refer: use for 7 days, I will refer you to a doctor if the treatment doesn’t work after 7 days. Will also refer you if you start vomiting, get a fever or experience abdominal pain (constipation caused by medication for out of roleplay…)
• Lifestyle/self-care: Drink 2L of water a day, avoid straining, exercise for at least 30 mins a day.

If you need to take codeine-containing medication, take a laxative such as coloxyl with senna to prevent constipation.

I will give you a self care-card for hemorrhoids and a consumer medication information leaflet. Do you have any questions for me?