Weekly Placement Portfolio Semester 2
MENTAL HEALTH
1.
Observe an interaction between pharmacist and patient/customer about ‘sleep’.
2.
Describe the discussion.

Questions about lifestyle and persons sleeping patterns were asked.

If they have any medical conditions

If they are taking any medication

How long have they had issues with sleep
3.
What are the key points in taking a relevant history?
It is important to take a relevant history because there are many conditions or medications which may cause insomnia, hence if the underlying issue is treated and monitored, issues with sleep may improve, and hence further medication to treat the insomnia is not needed.
4.
What are important counselling points when dispensing a benzodiazepine?

They should only be used for the shortest time possible (2-4 weeks)

Daytime drowsiness may occur. If that is the case, a shorter half life benzodiazepine should be used or reduce the dose.

Elderly should take care, as can increase risk of falls, confusion. Excess sedation.

Tolerance and dependence may develop in long term use.

Do not abruptly stop the medication if on long term therapy, as may lead to withdrawal symptoms.


Adverse effects such as fatigue, drowsiness, dry mouth, constipation may occur.
Any drug interactions.
5.
Are there any relevant OTC products?

Blackmore’s Valerian Forte

Blackmore’s Sleep Sound Formula

Blackmore’s Executive B Sleep Formula (insomnia due to stress)

Natures Own Complete Sleep (Lactium and Zizphus Jujuba)

Natures Own Valerian

Brauer Sleep and Insomnia Relief (Oral Spray, tablets and oral liquid)

Dozile Natural

Ethical Nutrients Sleep Enhance

Swisse Sleep

Bioglan Melatonin

Sedating antihistamines (Phenergan, Dozile, Restavit)
6.
What is the level of evidence for their use?

7.
Are their circumstances when they could be recommended?
8.
When should they NOT be recommended for use?
9.
What is ‘good sleep hygiene’?
Term used to describe good sleeping habits, things you can do to give yourself a good refreshing sleep.
10.
What advice would you give to a customer about ways to improve sleep habits?

Sleep in a darkened room, quiet, comfortable, no clock or pets in the room.

Avoid caffeine, nicotine or alcohol within three hours of bedtime

Avoid heavy meals or fluids immediately prior to going to bed.

Avoid daytime naps

Regular daytime exercise with no strenuous exercise prior to bedtime

Go to bed the same time each night
DEPRESSION
11.
What opportunities for counselling about depression and antidepressant medications would you want to have in your pharmacy? How would you facilitate this clinical service?
12.
What are the important counselling points when dispensing an antidepressant medication?

Realistic expectations. They take about a month to get full benefit.

It may not work for you.
13.
If possible, seek permission to interview the patient about their experience of medications.
14.
Preparations of St John’s Wort are commonly sold in pharmacies. List examples of the products.

Blackmore’s St John’s Wort Tablets

Ethical Nutrients Clinical Strength St John’s Wort Capsules

Thursday Plantation Hypericum - St John's Wort Liquid
15.
What is the evidence for benefit for these St John’s Wort preparations? Why is this not a scheduled medication?
16.
What are the important drug interactions with St John’s Wort?

Warfarin (lowered anticoagulant effect)

Digoxin (reduced blood vessels and loss of control of heart rhythm or heart failure)

Cyclosporin, Tacrolimus (risk of transplant rejection, CYP3A4 induction)

Oral Contraceptives (decrease norethisterone and ethinyloestradiol levels)

Anticonvulsants (reduces blood levels, risk of seizures)


Antidepressants and serotonergic drugs (cause additive serotonergic effect and increase risk of adverse reaction)

HIV Protease Inhibitors ( reduces blood levels and possible loss of HIV suppression)
17.
What advice would you give to a customer who seeks to purchase St John’s Wort?
18.
What are the medications in the pharmacy that may be prescribed for patients with a diagnosis of schizophrenia?

Atypical antipsychotics

Typical Antipsychotics
19.
List important counselling points when dispensing these medications.

Realistic expectations, know they take time to go benefit

Issues to look out for, sedation, blood counts, extrapyramidal side effects.

Do not stop taking it or taking it irregularly as it is associated with high risk of relapse and suicide.
20.
Interview a patient with mental health condition.
NEUROLOGY
21.
A customer approaches you for advice regarding a product to treat a headache. What do you need to know about the clinical situation before, as a pharmacist, you can give advice?

If they have any other conditions or are taking other medications

Describe the headache and the symptoms

Do u wear glasses or have any eye problems?

What they have tried for it before and if it worked.

How often do they have a headache?
22.
List the questions you would ask to establish what may be an appropriate product or referral.

Do you have any medical conditions or taking any other medication?

How often do you have the headache?

Describe the symptoms to me.

How often do you need to medicate the headache?

What have you tried for it before and if it worked?

Have you noticed any triggers to your headache?

Is there a pattern to your headache?
23.
List the S3 products in the pharmacy that may be used to treat a headache or to prevent or treat a migraine. When should these products be used?

Agent Place in Therapy
Anagraine – metoclopramide and paracetamol Migraine associated with nausea
Nurofen – ibuprofen
Panamax/Panadol - paracetamol
First line
First line
Disprin - Aspirin
Advil – ibuprofen
Nurofen Plus – ibuprofen and codeine
Panadeine – paracetamol and codeine
Dolased - Paracetamol, codeine phosphate and doxylamine succinate
Mersyndol - Paracetamol, codeine phosphate and doxylamine succinate
First line
First line
When first line doesn’t work.
When first line doesn’t work.
Includes sedating antihistamine. When bed rest is desired.
Includes sedating antihistamine. When bed rest is desired.
24.
What are the differences between headache and migraine?
Headache

Can be a symptom of a serious illness.

Tension type headache: bilateral, pressing/tightening quality, mild or moderate intensity, not aggravated by routine physical activity, no nausea and vomiting.

Sinus headache: one side of face is affected and pain is worse when bending forward or lying down.

Medicine overuse headache: a cycle is set up whereby more frequent and severe headaches lead to increasing use of pain relieving medication which causes more frequent and severe headaches.
Migraine

Severe headache

Unilateral

Migraine with aura or without aura.

Can last from hours to days

Moderate to sever pain, throbbing, nausea and vomiting, sensitivity to light and noise, pain worsens with movement or activity.

Chronic disorder with episodic attacks
25.
What advice could you give regarding prevention of a migraine?

Avoid any known triggers

Good sleep hygiene

Regular exercise

Good hydration and healthy foods
26.
What information or resources in the pharmacy may support your counselling?

Fact cards
27.
If possible interview a patient who has a neurological condition.
28.
If a customer seeks advice about assistance in remembering to take medications, or if there is concern about confusion regarding medications, what can you suggest?

Complete a Patient Medication Profile


Print out a CMI

Place the medication in a place they remember or constantly encounter

Maybe take the medication during normal daily routine or while watching a certain program daily

Suggest a Webster Pack

A family member can remind them to take their medication

7 day pill reminder boxes.
29.
What questions would you ask?

What are your concerns about the medications?

Do you know why you are taking them or what they are used for?

Do you have anyone at home to help you remind to take your medications?
30.
What pharmacy resources or services may be appropriate?

Patient Medication Profile

Webster Pack

CMI

Fact Cards
31.
List what you could do to assist the patient and carer?

Complete a Patient Medication Profile

Print out a CMI

Webster Pack

7 day pill reminder boxes.
EYE AND EAR
32.
Observe the way your pharmacist dispenses an eye or ear drop. How is the product labelled?
Comment on this, are there any potential problems?
The label is put on the bottle. It is flagged because the bottle is too small for the entire label to wrap around it. This is impractical, since it is a small bottle, and when the label is flagged the patient has some trouble handling it and can’t hold it properly to correctly instil the eye drops.
Important information may also be covered.
33.
Which dispensing package do you have? Are there any differences among the computer systems and printers when it comes to dispensing and labelling eye drops?
Fred Dispense. There are no differences among the computer systems and printers when dispensing and labelling eye drops. By law, the label should be on the bottle, but this can be impractical and some people prefer it be on the box. Ensure expiry date and batch number are showing.
34.
Design a label for dispensing eye drops, how could this label be produced?

Same as any other label.
35.
Which resources are available in the pharmacy to assist with giving advice about technique for administering eye drops and ointment, ear drops?

Pharmacy Self Care Fact Cards
36.
Listen to your preceptor counsel some patients on the use of eye drops. What were the eye drops for? Do patients seem to have difficulty with correct techniques?
Eye drops were for red eyes. Yes patients usually seem to have problems with correct techinique.
37.
Counsel one patient on the use of their eye or ear drops. List the questions you asked as well as the main counselling points you gave.

Have you used eyes drops before?

Do you know how to use them?

Need to throw them out after 28 days

Correct technique.
38.
Pick 12 different eye or ear drops or ointments off the shelf and from the fridge and list the ingredients and indications.
NAME
Xalatan Eye Drops
Chlorsig Eye Drops
Kenacomb Otic Ear Drops
BrinzoQuin 1% Eye Drops
Tobrex Eye Ointment
Cerumol Ear Drops
INGREDIENTS

Latanoprost

Timolol

Chloramphenicol




Nystatin
Triaminolone
Brinzolamide
Tobramycin
INDICATION
Glaucoma, hypertension ocular
Infections of the eye and eye lids relieve itching, burning or inflammation of the ear
Glaucoma, hypertension ocular
Infections of the eye and surrounding structures caused by susceptible bacteria
Removal of ear wax
Auralgan Ear Drops
Audiswim Micro spray
Gel Tears
PolyVisc Eye Ointment
Refresh Contacts

Arachis oil (peanut oil)

Chlorobutanol

Benzocaine

Phenazone

Isopropyl Alcohol

Glycerin

Carbomer

Paraffin

Wool fat

Carmellose sodium
Relief of ear pain
Relieve symptoms swimmers ear
Dry eyes
Dry eyes of
Soothes and protects eyes whilst wearing contact lenses

Visine Eye Drops

Tetrahydrozoline HCl Red eyes
39.
Differentiate between bacterial, allergic and viral conjunctivitis and how to treat each type.
CAUSES
DISCHARGE
ASSOCIATED WITH
TREATMENT
BACTERIAL
Bacteria Virus
VIRAL antibiotic drops or ointment
Can’t use antibiotics, goes away with time.
ALLERGIC
Allergen
Exposure to allergen triggers topical, antiinflammatory eyes drops or a topical antihistamine relieve the itching will
40.
If possible, interview a patient with glaucoma.
MUSCULOSKELETAL
41.
There are many different types of NSAID preparations on the market. Make a list of all the different dosage forms and their schedule and describe when they might be useful.
Preparation Potential Use
42.
Observe dispensing of a NSAID. Review the patient’s medication history for any relevant clinical issues. Before supplying a NSAID, what are important clinical conditions and medications that should be considered in the patient’s history?

Any allergic reactions to NSAIDs

Asthma

Coagulation disorders

Bruising (risk with topical NSAIDs)

Stomach ulcers
43.
If possible interview a patient about their arthritis.
44.
Are there any products/devices in your pharmacy that might assist an arthritic patient with their daily activities? Are there any other places that you could refer such a patient?

45.
If possible interview a patient with gout.
ONCOLOGY
46.
Pharmacists have an important role to play in helping people to reduce risk factors which may contribute to development of common cancers including: skin, lung and gastrointestinal cancers. List products available in the pharmacy which you could recommend to assist people to prevent the following cancers (note these may include non-drug and drug strategies): a) Melanoma, squamous cell carcinoma and basal cell carcinoma of the skin

Sun-screen b) Lung Cancer

Smoking cessation therapy c) Colon Cancer

Calcium supplements

Smoking cessation therapy

Folic acid supplements
47.
Mouthwashes which contain alcohol can sting, cause irritation and discomfort to patients receiving chemotherapy affecting the oral mucosal lining. Look at the mouthwashes available in your pharmacy. List mouthwashes which do not contain alcohol. Of these, list three products which you could recommend to a patient who comes into your pharmacy requesting a mouthwash to help relieve symptoms of a sore mouth and mouth ulcers. Include the dose and any special instructions for use in your answer.
Product
Colgate Plax Gentle Care
Dose
20mL
Oral B Tooth and Gum Care
Alcohol Free
Colgate Savacol Alcohol
Free
15mL
10mL
Instructions
Rinse thoroughly for 30 seconds and spit out. Twice a day.
Rinse thoroughly for 30 seconds and spit out. Twice a day.
Rinse thoroughly for 30 seconds and spit out. Three times a day.
48.
It is estimated that more than 50% of patients with a malignant illness are using or taking some form of alternative/complementary therapy. There is evidence to suggest that many patients choose not to discuss taking alternative or complementary therapies with their doctors. Look around your pharmacy, identify at least five treatments which might be used by people with cancer as alternate/complementary therapies. For each product, list how it is used or taken, the dose range which might be being taken, and any concerns and/or interactions which may be associated with your patients using these products.
Product How Used Dose Interactions Side
Effects/Toxicity

Evening Primrose
Oil
Vitamin B6
Ginger
In conjunction with Tamoxifen in breast cancer patients.
Dried powder root for nausea and vomiting
2.8g daily Anticoagulants, phenothiazines
Mild discomfort, indigestion, nausea, headache,
GI softening of stools. anticoagulants Abdominal discomfort, heartburn, diarrhoea, and a pepper-like irritant effect in mouth and throat.
Karicare Food
Thickener
Aperients (for constipation)
Mix it with fluids. Thickens it so don’t vomit it out. For throat cancer patients and Coloxyl senna, metamucil
49.
If possible interview a patient who has been affected by cancer.
50.
Infections may be a complication of the treatment of some malignancies. Depending on the type and severity of the infection, home-based intravenous treatment may be continued out of hospital. Does you pharmacy have any resources or services to support these patients and their carers? If this were the situation for one of your regular patients, how could you assist the patient?
The pharmacy does not have any resources. It would be a coordinated effort between the GP, hospital, pharmacist and community nurse.