Case scenarios
Monday:
Scenario 1:
- UTI, no accompanying symptoms
- Took something (few years ago and it worked) but patient cannot remember what
- On the table: citravescent, Ural, cranberry tablets, canestan, monistat
- Use: Ural + cranberry tablets
Scenario 2:
- patient suffers from chronic back pain
- taking paracetamol and Zoloft prescribed by GP
- specialist prescribes amitriptyline (Endep) with instructions “25mg increasing to
50mg”
- patient asks how to increase dose
- SEROTONIN SYNDROME
- Needs wash-out period … for how long?
- Signs to watch out for?????
- On table: Nurofen
Scenario 3:
- 9 month old baby with mom
- mom wants a bottle of Phenergan for baby
- friends recommended it (they used it and say it works) .. mother is convinced
- it usually ‘calms’ the baby down as he’s always crying
- on tablet: Paracetamol syrup
- Solution: do NOT give Phenergan to kids under 2 yrs old
- Recommend see doctor
- Coz baby could be crying for another reason altogether!!!!!!!!!!
Tuesday
Scenario 1:
- patient on Moduretic and Diamicron 80mg bd
- comes in with new Rx for Coversyl Plus one daily
- Rx is fine .. everything is good, correct doctor and dose etc
- Problem: Moduretic is K+ sparing diuretic and Coversyl Plus s/e is hyperkalaemia.
Also too much diuretic dose in the whole combination
- Solution: Call GP to cease Moduretic
Scenario 2:
- patient on warfarin and Ranitidine 150mg bd
- wants daktarin oral gel (recommended by nurse for husband who has oral thrush)
- Problem: Increase in INR therefore increased risk of bleeding
- Solution: what has he tried before? - Nilstat drops
Scenario 3:
- patient wants to de-worm whole family
- 2 little kids have worms … show symptoms .. 18month old son and 7 year old son
- (therefore cannot use mebendazole)
- Wife is pregnant .. do NOT treat .. refer her to doctor if she has symptoms.
- Solution: Combantrin oral liquid for whole family except mom
- On table: Ventolin inhaler, Panadol, nurofen, combantrin, Vermox, infacol
Wednesday
Scenario 1:
- 20’s over girl with headache comes in with nurofen plus
- nurofen plus has codeine which if used too often can cause rebound headache.
-
She has been using it every month … could be causing chronic headache
What to give her?
See doctor?????
On table: Mylanta, panamax, nurofen, nurofen plus, Gaviscon
Scenario 2:
- girl has vaginal thrush
- no diabetes, etc
- on table: canestan 1 day cream, 3 day cream, 6 day cream, diflucan, postinor
- Solution: canestan 6 day cream
Scenario 3:
- amiodarone Rx one tablet tds
- Solution: call doctor to ask about dose .. should be one tablet bd
- On table: phone
Thursday
Scenario 1:
- 60yr old woman came in and asked for ranitidine tablet.
- Had ranitidine before (from a fren/relative). Tried Mylanta before.
- Need to assess symptoms carefully due to her age.
- Suspected peptic ulcer  referral to doctor
Scenario 2:
- A mum of 4 yr old boy came in enquiring about her son’s fever.
- Has fever for 2 days, fatigue, irritable, tucking the ear, and earache.
- Given panadol 5-6 times daily (overdose!)
- Otitis media.
- Solution: refer for antibiotic course
Scenario 3:
- An old man came in with a prescription for Ms Contin.
- Wants to know how to take Ms-Contin 30mg one bd.
- History: ordine mixture (forgot the strength) q4-6h prn. (taking it at 9.30am according
to wai lam)
- Need to counsel on how to switch over.
- Check other medications, other medical conditions.
Interview questions
Monday
- name as many beta-blockers as possible
- function?
- Packing of dosette
- A) simvastatin one daily
- B) fosamax
- C) moclobemide one bd
- D) frusemide one bd
- ACE inhibitor and NSAID function  where do they work in kidney?
- Can a pharmacy advertise that they ‘fill’ scripts the fastest in town?
- Golfer comes in for diclofenac tabs (ask background  hypertension)
- Explain restricted, unrestricted, authority PBS scripts
- Someone calls claiming to be doctor .. ask to give patient Kapanol 20 tabs .. what do
you do?
- Legal requirements for dispensing S4 drugs
-
Where do u get list of drugs that will discolour urine?
Tuesday
- list of ACE inhibitors
- function
- patient on metronidazole and warfarin
- counselling on metronidazole
- PRF report for family .. what’s legal requirements
- List of drugs that discolour urine
- What is ESR?
- When can you give owing S4?
- What causes a cough? How to treat?
- Staff member cuts herself  what do you do?
- Database of patient’s profile  advantages and disadvantages
Wednesday
- statins -> why don’t take with grapefruit juice?
- Ethical issues behind supplying S4 drugs without a script
- Supplying asmol/ventolin without a script
- Where do you look up doses for hydrocortisone oral tabs
- What are the desirable lipids?
- Verify authenticity of a script
- Advantages & disadvantages of central linking patient’s drug information amongst all
health professionals involved
- Name as many calcium channel blockers
- Function?
- Counselling for metronidazole
- Pharmacy assistant comes in late for work  makes mistakes .. what do you do?
Thursday
- Name five TCAs.
- What is authority script, restricted benefit and unrestricted benefit?
- Who are entitled to get fosamax on authority n how to get it? Call the doctor to get the
authority for a customer.
- Drunken pharmacist, n u r pharmacist in charge, how u handle the situation?
- Injury at workplace, wht need to be done?
- Can a pharmacy advertises in the paper as the pharmacy with the fastest scripts
processing? N why?
- Webster packing, disadvantages, n advantages.
Medications n the appropriate slots in the webster packing.
- why statin need to be taken preferably at night?
- Where do u find information regarding drugs in pregnacy, herbal medicines n
immunisation?
- What is the protocol in supplying promethazine (Phernergan)?
- How many days for emergency supply of medication?
- requirements for DD Rx
- fosamax: what are the requires for authority.
- Name as many TCA as I can
- Label 11, why?
- Medicopak: what time should be given? Breakfast, lunch, dinner? – warfarin, rocaltrol,
lipex.