W24 SPE

Question 1

Rana, a patient well known to you, attends the pharmacy and asks to have a quiet word with you.

You take her to the consultation room to discuss this in private.
She would like to buy the morning-after pill.

• Rana is 32 years old. She has no PMH and NKDA.
• She had unprotected sex after a party a week ago.
• She has not sought advice before now as she is embarrassed and has found it hard to have the courage to attend today.
• Her last period was no different than usual.

Answer 1

What was her last period like?

Ella One- can be taken up to 5 days after unprotected sex
Levonelle and Cu IUD- Can be used within 72 hours after

None of these are suitable (and won’t be effective) as she has passed the window.
She needs to see her GP and sexual health clinic (risk of STI)

Reassure her that she did the right thing coming to the pharmacy. Speak in a consultation room

Question 2

EHC for unprotected sex 4 days ago:

Answer 2

ellaOne could be supplied. See PIL for full info. Still risk of STI so needs to be referred to sexual health clinic.

Question 3

You are working as a pharmacist in a busy community pharmacy. Mr Philip Jeff, a 25-year-old male patient approaches you and seeks your advice on a rash that has been bothering him, particularly at night. He started to see wavy, thread-like whitish-grey lines on the surface of his skin. He found them on the fingers, wrists and penis.

1. What are the differential diagnosis?
2. What is the actual diagnosis?
3. What are the main symptoms?
4. What questions would you ask?
5. Management, what OTC product could you supply?
6. What is the appropriate counselling in this case for:
   a) Self-management
   b) Using the product
   Provide safety nets and close consultation

Answer 3

1. Eczema, Atopic dermatitis, Scabies, Impetigo, Scarlet fever, herpes, psoriasis, mosquito bites
2. Scabies
3. Symptoms:
   Intense itching, especially at night. A raised rash or spots. The spots may look red. They are more difficult to see on dark skin, but you should be able to feel them.
4. How long? Do you live with others? What are your living conditions like? How old are you?
5. No OTC products available. POM only (Permethrin 5% w/w cream)
6. a) Self-management-
   b) Applied to the whole body from the chin and ears downwards. Apply to cool dry skin
   Anyone that he had sexual contact with in the past 8 weeks should also be treated. Wash bedding, clothing towels at high temperatures and drying in a hot dryer/dry cleaning. Put clothing that cannot be washed in a bag for 3 days until the mites die.

Question 4

You are working as a pharmacist in a busy community pharmacy. An 18-year-old
visits the pharmacy. Her temperature is 38C. White spots on mouth.

1. What are the possible causes?
2. What is the actual diagnosis?
3. What are the main symptoms?
4. What questions would you ask?
5. Management, what OTC product could you supply?
6. What is the appropriate counselling in this case for:
   a) Self-management
   b) Using the product
   Provide safety nets and close consultation

Answer 4

1. Viral or bacterial infection, tonsilitis, glandular fever, laryngitis
2. Sore throat
3. A painful throat, especially when swallowing
4. Other medicines, other symptoms, chronic conditions
5. Difflam spray, paracetamol, ibuprofen.
   6a. Gargle with warm, salty water, drink plenty of water, and eat cool or soft foods
   b. Difflam throat spray

Question 5

You are working as a pharmacist in a busy community pharmacy. A 43-year-old man visits the pharmacy and complains of cracks at the corners of the mouth, not tasting things properly, having unpleasant taste in the mouth, a sore tongue and finding it
difficult to eat and drink. You ask him a few questions and examined his tongue.

1. What are the differential diagnoses?
2. What are the possible causes?
3. What is the actual diagnosis?
4. What are the main symptoms?
5. What questions would you ask?
6. Management, what OTC product could you supply?
7. What is the appropriate counselling in this case for:
   a) Self-management
   b) Using the product
   Provide safety nets and close consultation

Answer 5

1. Measles, Scarlett fever, Koplik spots,
2. Steroid inhalers, diabetes, immunocompromised
3. Oral thrush (candida infection)
4. cracks at the corners of the mouth, not tasting things properly, an unpleasant taste in the mouth, pain inside the mouth (for example, a sore tongue or sore gums)
   difficulty eating and drinking
5. Regular medicines, medical conditions e.g. diabetes and asthma, hygiene? dentures?
6. Daktarin oral gel (miconazole 2%). Nystatin if there are any medicines that contraindicate.
7. a)
   b) Oral use only.

Daktarin interacts with statins and warfarin (inc risk of bleeding).Nystatin doesnt get absorbed into bloodstream so cannot interact.

Question 6

You are working as a pharmacist in a busy community pharmacy. Mrs Abeni Oluwafemi, a 30-year-old woman visits you and seeks your advice for her 6-year-old son who was suffering with loose bowel for the last 2 days.

1. What are the possible causes?
2. What is the actual diagnosis?
3. What are the main symptoms?
4. What questions would you ask?
5. Management, what OTC product could you supply?
6. What is the appropriate counselling in this case for:
   a) Self-management
   b) Using the product

Answer 6

1. IBS, Stomach bug, Change of environment, Antibiotics, Food poisoning
2. Diarrhoea
3. Change in bowel habits, abdominal pain, systemically unwell
4. No. of loose stools, blood in stools, signs of dehydration, other symptoms e.g. travel abroad, vomiting
5. Dioralyte sachet/ Loperamide
6. a) Stay at home and get plenty of rest, do not have fruit or fizzy drinks, drink lots of fluids
   b) Mix with a full glass of water, make up solution immediately before use.

Question 7

You are working as a pharmacist in a busy community pharmacy. Miss Chu Hua Zhou, a 27-year-old woman visits you and seeks your advice. She is complaining of
sneezing, blocked nose, runny nose.

1. What are the possible causes?
2. What is the actual diagnosis?
3. What are the main symptoms?
4. What questions would you ask?
5. Management, what OTC product could you supply?
6. What is the appropriate counselling in this case for:
   a) Self-management
   b) Using the product

Answer 7

1. Hayfever, cold and flu
2. (Allergic) Rhinitis or hayfever
3. cold-like symptoms, sneezing,
4. Have you got hayfever?
5. Azelastine Nasal solution
   6a. Regularly cleaning nasal passages with a salt water solution (nasal douching)
   6b. Nasal spray- One spray twice daily. To be administered into each nostril.
   OR Oral antihistamine 10mg once a day, cetirizine dihydrochloride.