Weekly Placement Portfolio Semester 2 MENTAL HEALTH Observe

Weekly Placement Portfolio Semester 2
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
 Ask questions about person sleeping habits
 Any allergies
3. What are the key points in taking a relevant history?
Taking history is important as medications or conditions may be the underlying cause of the
insomnia. If the cause of the issue is found and diagnosed then sleep may improve therefore
reducing the need of taking further medication
4. What are important counselling points when dispensing a benzodiazepine?
 Use for short time (2-4 weeks unless told by doctor)
 Daytime drowsiness or “hangover” can occur. In this case use a shorter half life
 Dependence and tolerance can develop in long term use
 Elderly patients should beware as it can increase risk of falls excess sedation and
 Do not abruptly stop this medication if on long term therapy as it may lead to
withdrawal symptoms. Patients must be tapered off
 Any drug interactions and avoid use with alcohol
 Fatigue drowsiness dry mouth constipation side effects
5. Are there any relevant OTC products?
Melatonin containing products
Valerian containing products
Sedating antihistamines in S3 section of dispensary
6. What is the level of evidence for their use?
 Not a lot of evidence but it may help in alleviating symptoms but not definitively
7. Are their circumstances when they could be recommended?
 Recommended before use of medicated therapy
8. When should they NOT be recommended for use?
 In combination therapy with benzodiazepines and some other drugs
9. What is ‘good sleep hygiene’?
Sleeping habits and regular sleeping times. Getting a refreshed feeling in the morning
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
 Go to bed the same time each night
 Avoid daytime naps
 Regular daytime exercise with no strenuous exercise prior to bedtime
 Avoid heavy meals or fluids immediately prior to going to bed.
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?
Make sure it is in a private area with no other patients able to hear. Be able to schedule time
for appointments when patients need to talk/discuss. If further advice is needed have a
mental shrink readily available to be referred to or to the doctor
12. What are the important counselling points when dispensing an antidepressant medication?
 May or not work for the patients
 Take a while for medication to take full effect and symptoms may proceed to get worse
before they get better
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
 Blackmore’s St John’s Wort Tablets
 Thursday Plantation Hypericum - St John's Wort Liquid
 Ethical Nutrients Clinical Strength St John’s Wort Capsules
15. What is the evidence for benefit for these St John’s Wort preparations? Why is this not a
scheduled medication?
Evidence is strong for the use of St. John’s Wort but its level of efficacy is variable. Some
formulations are as efficacious as benzodiazepines but some are not. More research needed.
16. What are the important drug interactions with St John’s Wort?
 Warfarin (lowered anticoagulant effect)
 Anticonvulsants (reduces blood levels, risk of seizures)
 Cyclosporin, Tacrolimus (risk of transplant rejection, CYP3A4 induction)
 Digoxin (reduced blood vessels and loss of control of heart rhythm or heart failure)
Antidepressants and serotonergic drugs (cause additive serotonergic effect and increase
risk of adverse reaction)
Oral Contraceptives (decrease norethisterone and ethinyloestradiol levels)
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?
Try it. It may or may not work. First consult with a doctor before use of this medication and
do not combine with other anti depressants.
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
 Do not stop taking it or taking it irregularly as it is associated with high risk of relapse
and suicide.
 Issues to look out for, sedation, blood counts, extrapyramidal side effects, LFT’s, weight
gain, depression.
20. Interview a patient with mental health condition.
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?
 On any other medications?
 Tried anything for the headache
 What are the symptoms felt?
 Have any eye conditions ?
 How long has the headache presented itself and how often?
 Any aura felt before the headache?
 Bilateral or unilateral?
 Sound and light sensitivity at all?
22. List the questions you would ask to establish what may be an appropriate product or referral.
 How often is the headache?
 What are the symptoms?
 Taken any medications for the headache and did they work?
 Any patterns or triggers for the 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?
Anagraine – metoclopramide and paracetamol
Nurofen – ibuprofen
Panamax/Panadol - paracetamol
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
Place in Therapy
Migraine associated with nausea
First line
First line
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?
 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. all over the head and tightening
feeling over the head. Not aggravated by
movement and no nausea vomiting
associated with the pain.
 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. A cycle
where patient takes medications for
headache and it doesn’t go away so
patient takes more drugs and the
headache gets worse.
 Sinus headache: one side of face is
affected and pain is worse when moving
around, bending forward or backwards.
 Severe headache
 Unilateral
 Migraine with aura or without aura.
 Can last from hours to days
 Moderate to severe 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
Sleep hygiene
Regular exercise
Good hydration and healthy foods
Limited alcohol
Avoid known triggers
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 on the drugs they will be taking
 Place the medication in a place they remember or constantly encounter to enhance
 Webster Pack system provided by pharmacy
 A family member can remind them to take their medication or alarm clock
 7 day pill reminder boxes.
29. What questions would you ask?
 What are your concerns about the medications?
 Are you on any other 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?
 Webster Pack
 Fact Cards
 Patient Medication Profile
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.
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 and is flagged. This is sometimes dangerous as it is a small bottle
and when the label is flagged the patient may have some trouble handling it the bottle. A CMI is
printed with the product and the label is made sure it is not covered on top of the expiry date.
Another label is put on the box to make sure the patient can read the product instructions.
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?
Aquarius dispensing software. There is no difference 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?
By a printer
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
 Pharmacist themselves teaching the patient how to use the medication
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 for patient with conjunctivitis. Chlorsig was supplied and patient was counselled
about technique. The patient did not have any difficulty with technique
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 and how often to use the drops.
 Signs of allergy if it occurs.
38. Pick 12 different eye or ear drops or ointments off the shelf and from the fridge and list the
ingredients and indications.
Xalatan Eye Drops
 Latanoprost
 Timolol
Chlorsig Eye Drops
Infections of the eye and eye
 Chloramphenicol
Kenacomb Otic Ear Drops
relieve itching, burning or
 Nystatin
inflammation of the ear
 Triaminolone
BrinzoQuin 1% Eye Drops
 Brinzolamide
Tobrex Eye Ointment
Infections of the eye and
 Tobramycin
surrounding structures caused
by susceptible bacteria
Cerumol Ear Drops
Removal of ear wax
 Arachis oil (peanut oil)
 Chlorobutanol
Auralgan Ear Drops
Relief of ear pain
 Benzocaine
 Phenazone
Audiswim Micro spray
 Isopropyl Alcohol
swimmers ear
 Glycerin
Gel Tears
Dry eyes
 Carbomer
PolyVisc Eye Ointment
Dry eyes
 Paraffin
 Wool fat
Refresh Contacts
Soothes and protects eyes
 Carmellose sodium
whilst wearing contact lenses
Visine Eye Drops
Red eyes
 Tetrahydrozoline HCl
39. Differentiate between bacterial, allergic and viral conjunctivitis and how to treat each type.
Yes – yellow crusty Yes – clear or white Yes – itchy eyes with
discharge with lots of constant tearing
Exposure to allergen
antibiotic drops or Can’t use antibiotics, topical,
goes away with time.
drops or a topical
relieve the itching
40. If possible, interview a patient with glaucoma.
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.
Nurofen – ibuprofen (Tablet)
Naprogesic – naproxen (Tablet)
Voltaren – (Emulgel ointment)
Pain away – (liquid Spray)
Potential Use
Analgesic and anti-inflammatory for all range of
Analgesic and anti inflammatory for all ranges of
pain. This particular formulation is targeted for
period pain
Analgesic and anti inflammatory for muscular pain.
Ointment is applied over affected area and works
at site of action
Sprayed at site of action for local effects
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
 Coagulation disorders
 Asthma
 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?
 Glucosamine tablets.
 Panadol Osteo
 Refer to aerobic classes in a swimming pool to assist with training the muscles around
the area arthritis affected area.
45. If possible interview a patient with gout.
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
 Wear a Hat
 Advise on proper clothing and times of day to avoid outdoor activities
b) Lung Cancer
 Smoking cessation therapy
 Quit line
 Champix
c) Colon Cancer
 Calcium supplements
 Folic acid supplements
 Smoking cessation therapy
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.
Colgate Plax Gentle Care
Oral B Tooth and Gum Care
Alcohol Free
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.
How Used
Evening Primrose In conjunction
with Tamoxifen
in breast cancer
Vitamin B6
root for nausea
and vomiting
Side Effects/Toxicity
Anticoagulants, Mild GI discomfort,
phenothiazines indigestion,
headache, softening of
Abdominal discomfort,
and a pepper-like irritant
effect in mouth and
Food Mix
fluids. Thickens
it so don’t vomit
it out. For throat
cancer patients
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?
This pharmacy does not have any resources that do the above criteria. It would be a coordinated
effort between the GP, hospital, pharmacist and community nurse.
51. List FIVE topical products that may be recommended by a pharmacist and list the conditions,
with signs and symptoms that would be treated appropriately
Product (Generic name of drug and
Betadine ointment - Iodine Ointment 1%
Savlon – chlorhexidine 1mg/g, cetrimide
Hydrozole - hydrocortisone 1%, clotrimazole
Derm Aid – Hydrocortisone 0.5%
Hirudoid – Heparinoid 3mg/g
Conditions (signs and symptoms)
Antibacterial for cuts and grazes
Antibacterial for cuts and grazes
Fungal infection of skin with inflammation
For inflamed itchy skin but do not apply to
broken skin
For bruises