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IS is a 55 year old male with chronic lower back pain who comes to your pharmacy with a prescription for Percocet.  His past medical history is significant for depression and anxiety. He has no known drug allergies.  DRPs: 1) Safety > Adverse Drug Reaction > Dose too high Patient potentaill exceeds daily limit of 4 grams of Tylenol (acetaminophen).  Counsel the patient to stop taking the OTC Tylenol because he will exceed the maximum daily dose of Tylenol if he continues to take it the way he was prior. Recommend the patient to only take the Percocet if he has pain continuously. 2) Adherence > Adherence Patient is not adherent to his medications/refilling his medications on time.  Suggest alternatives including a weekly pill holder and use his cell phone alarm to remind him when to take his medications daily. 3) Indication > Unnecessary Drug Therapy > No indication at this time Suggest the patient talk to his MD about discontinuing his Aspirin regimen. There is no indication for him to be on Aspirin.  , Community, 1 item on Rx, Do not dispense, Patient questions, AttachmentsUniversity of Kentuckydispensing-exercisedose-too-high oxycodone-acetaminophen-5-325-mg-tabuniversity-of-kentucky
RC is a 57 year old male who comes to your pharmacy with a new prescription for Viagra.  In addition to his newly diagnosed ED, RC has a past medical history of chlamydia, stable angina, alcoholism, and chronic back pain.  OUTCOME:  drug-drug interaction., , , , , , Community, 1 item on Rx, Do not dispense, Fact finding, Patient questions, AttachmentsUniversity of Kentuckydispensing-exerciseacetaminophen-oxycodone-325-mg-5-mg-tab atenolol-50-mg-tab doryx-100mg-cap drug-drug-interaction lisinopril-10-mg-tab nitrolingual-pumpspray sildenafil-50-mg-tabuniversity-of-kentucky
MM, a 37 year old male, brings a new prescription for Lyrica to your pharmacy. He has a past medical history significant only for type 2 diabetes and occasional heart-burn (less than 3 times per month). He has no known drug allergies. Earlier today, MM saw his PCP and was diagnosed with fibromyalgia. The patient tells you he has not received any immunizations since the start of collegewhen he was 18 years old. OUTCOME: too high a starting dose for Lyrica., Community, 1 item on Rx, Do not dispense, Fact finding, Patient questions, AttachmentsUniversity of Kentuckydispensing-exercisefibromyalgia pregabalin-225-mg-capuniversity-of-kentucky
  KD is a 24 year old female that comes to your pharmacy regularly. One day while you are working, KD rushes to your counter to pick up a prescription for Ortho Tri‐Cyclen Lo. KD is crying excessively at the counter, stating that her medications are ruining her life. She complains of increased confusion and has gained thirty pounds in the last two months (current BMI 41). KD has no additional complaints and states that her knee pain is well controlled on her current regimen.  DRPs: 1) Safety > Adverse Drug Reaction > Drug-Drug Interaction NSAIDs used in combination with Lithium increase the serum concentration of lithium resulting in toxicity. Could alternatively alternatively suggest APAP. Therapeutic levels for Lithium are 0.6-1.2mEq/L and this patient’s levels are well over normal range. Since you haven’t had this in IDD yet, here is a reference: 1.5-2mEq/L – GI complaints/tremor 2-2.5mEq/L – confusion/somnolence >2.5mEq/L – seizures/death Monitoring Parameters: Serum lithium every 4-5 days during initial therapy; draw lithium serum concentrations 8-12 hours post-dose; renal, thyroid, and cardiovascular function; fluid status; serum electrolytes; CBC with differential, urinalysis; monitor for signs of toxicity; beta-hCG pregnancy test for all females not known to be sterile. Reference Range: …, , Community, 1 item on Rx, Do not dispense, Fact finding, Patient questions, AttachmentsUniversity of Kentuckydispensing-exerciseestradiol ethinyl-estradiol-norgestimate-25-mcg-25-mcg-tab nsaiduniversity-of-kentucky
Your long‐time patient, CA, is referred to your services for medication therapy management (MTM). CA is a 79 year old female with a past medical history of osteoporosis, GERD, occasional constipation and anxiety.  She has no significant social or family history and no known drug allergies.  Because the patient is elderly, there is a higher risk of adverse effects with diazepam than with other benzodiazepines that have shorter half lives. The patient should be counseled on these risks and to avoid operating machinery or doing anything that requires full attention until she knows how the medication affects her., , Community, 1 item on Rx, Do not dispense, Fact finding, Patient questions, AttachmentsUniversity of Kentuckydispensing-exercisebenzodiazepine diazepam elderlyuniversity-of-kentucky
EJ is a 55 year old male who comes to your pharmacy with a new prescription for Carvedilol 25mg BID.  He has a past medical history significant for hypertension, GERD, and hyperlipidemia. He has no known  drug allergies. Of note, the patient has been complaining of a persistent dry cough for the past few months that will not go away. FEEDBACK 1) Dose too high: Wrong dose: Patient has a prescription for Carvedilol 25mg BID which is the therapeutic dose of Carvedilol, but too high to initiate on. The patient must be started on 6.25mg BID for 1-2 weeks, then increase to 12.5mg BID for 1-2 weeks, then increase to 25mg BID as tolerated by the patient. 2) Inappropriate adherence: Does not understand directions: Patient’s last refill of HCTZ is late. this means he has been missing doses of his medication. Counsel patient on proper techniques to make sure he takes his medicine on time (pill boxes, reminders, etc.) 3) Adverse drug reaction: Undesirable effect: Patient’s lisinopril is causing ACE-inhibitor induced cough. Suggest switching to an ARB with appropriate dose. 4) Needs additional therapy: prophylactic therapy: flu shot and Tdap for vaccines. this patient is also a candidate for Aspirin …, , , Community, 1 item on Rx, Do not dispense, Patient questions, AttachmentsUniversity of Kentuckydispensing-exercisecarvedilol-25-mg-tab gerd hyperlipidemia lisinopriluniversity-of-kentucky
RA is a 30 year old female that you recognize from your pharmacy. You see her lingering in the vitamin section today while waiting for a prescription refill, so you ask if there is something you can help her find. She says that lately she has felt cold, fatigued, and “run down” emotionally. DRPs: 1) Effectiveness > Dosage too low > Drug Interaction Interaction with calcium and levothyroxine. Assessment: patient is experiencing symptoms of hypothyrodism because of reduced bioavailability of levothyroxine. Resolution: Space out calcium and levothyroxine by 4 hours. Reassess TSH levels in 6-8 weeks to determine if you need to change the dose of levothyroxine. 2) Indication > Needs Additional Drug Therapy subtherapeutic dosing/condition Assessment: patients A1c is not at goal (<7% or 6.5% per ADA/AACE). Recommendation: Patient should be initiated on a second medication such as a sulfonylurea, thiazolidinedione, or another alternative therapy. Recommend follow-up with doctor to assess. 3) Indication > Needs Additional Drug Therapy > Preventative Therapy Assess immunization needs., , , Community, 2 items on Rx, Dispense, Fact finding, Patient questions, AttachmentsUniversity of Kentuckydispensing-exercisecalcium-500mg-tab ergocalciferol-50000-iu-liq-cap hypothyrodism levothyroxineuniversity-of-kentucky
VA is a 24 year old female with newly diagnosed depression, who comes to your pharmacy with a new prescription for Bupropion SR 150mg at bedtime from Dr. Anthony Fleming.  DRPs: 1) Safety > Adverse Drug Reaction > Unsafe drug for patient The use of bupropion is contraindicated in patients with a history of bulimia. This medication cannot be dispensed to this patient, therefore the doctor must be called to make him aware of this. Another antidepressant may be suggested such as fluoxetine, which will not interact with her current medications and is not contraindicated in patients with a history of bulimia. 2) Effectiveness > Dosage too low > Dose too low This patient has inadequate blood pressure control. Her most recent blood pressure was 140/88, which is not within the goal of <140/90. Therefore, the hydrochlorothiazide could be titrated up to 25 mg PO daily. 3) Effectiveness > Dosage too low > Dosage too low This patient has trouble sleeping even though she is taking diphenhydramine 25 mg at bedtime. The  dose of diphenhydramine for patients with insomnia is up to 50 mg PO at bedtime. Consider 50 mg of diphenhydramine PO at bedtime. 4) Indication > Needs Additional …, , , Community, 1 item on Rx, Do not dispense, Fact finding, Patient questions, AttachmentsUniversity of Kentuckydispensing-exerciseadverse-drug-reaction bupropion-sr depression insomniauniversity-of-kentucky
This exercise has three validation tasks: (Methylphenidate ER 27mg Tab; Outcome – Dispense – no problems with this prescription.); (Acetaminophen / Oxycodone 325 mg-7.5 mg; Outcome – Do Not Dispense; There are no refills allowed on CII prescriptions.); (Amphetamine salts 10 mg Tab; Outcome – Dispense – this prescription can be filled)., , CommunityUniversity of Kentuckyvalidation-exerciseacetaminophen-oxycodone-325-mg-7-5-mg amphetamine-salts-10-mg-tab methylphenidateuniversity-of-kentucky
There are three tasks in this validation exercise: (Oxycodone / Acetaminophen 7.5/325 mg; Outcome Do Not Dispense; date error); (Pregabalin 100 mg Cap; Outcome – dispense; Rx is OK); (Oxycodone 5 mg Tab; Outcome – Do Not Dispense; an APRN can only prescribe 3 days of a CII in the state of Kentucky)., , CommunityUniversity of Kentuckyvalidation-exerciseoxycodone-acetaminophen oxycodone-5-mg pregabalinuniversity-of-kentucky
Burn area on the arm, only on the top layer of the skin. About 3 inches long and 1 inch wide.   NSAID’s will help with the pain and swelling, and a skin protectant will keep the area protected and moisturized., Community, Recommend medications, Fact finding, AttachmentsUniversity of Kentuckyotc-exerciseburn nsaiduniversity-of-kentucky
Patient is presenting to the pharmacy counter with a terrible headache.   Tylenol is the best choice for a pregnant woman because it is Pregnancy Category B, so it will not harm the baby., , Community, Recommend medications, Fact finding, Patient questions, Patient medicationsUniversity of Kentuckyotc-exerciseheadache pregnancy tylenoluniversity-of-kentucky
Patient is looking for something to help with a burning sensation in the chest. Is there anything you recommend?  OUTCOME – Patient has symptoms that need to be treated by another health professional.  The patient needs to see his PCP because his chronic use of Ibuprofen could be causing him to have formed a stomach ulcer- a problem more serious than a simple OTC recommendation., Community, Do not recommend, Fact finding, Patient questions, Patient medicationsUniversity of Kentuckyotc-exerciseheartburn ibuprofenuniversity-of-kentucky
Pt has burning sensation in lower chest, about twice a week. It gets worse after meals and Tums has not help alleviate his symptoms.  In this case, a PPI would be the best recommendation to help relieve the patient’s heartburn., Community, Recommend medications, Fact finding, Patient questions, Patient medicationsUniversity of Kentuckyotc-exerciseheartburn ppiuniversity-of-kentucky
This exercise aims to evaluate the students ability to identify contraindications for and appraise the appropriateness of commonly encountered medications when treating diabetes. AA is a 74-year old, non-smoking, white man comes to the pharmacy to pick up his prescriptions. His past medical history includes: DM2, HTN, dyslipidemia, and peptic ulcer disease. His physical exam was unremarkable. He shows you his vitals and fasting lab results obtained this month (03/01/17). You can view AA’s labs in the [Additional Documents] window. He said that he wants to take only oral medications at this time, not injections. He reports that he measures BP and HR at home and, for the past 3 months, they have run 142-156/72-78 mmHg and 52-62 bpm, respectively. He regularly eats 3 meals per day and reports 100% adherence to his medications and lifestyle changes. He has no complaints and denies any hypoglycemic episodes, weakness, fatigue, dizziness, lightheadedness, abdominal pain, or muscle pain. He uses only your pharmacy. To receive full credit, the student must complete two tasks: 1) Evaluate the medications AA is currently taking by viewing his patient profile in the computer. If you determine any of the medications to be inappropriate, identify them in the …, , Community, 3 items on Rx, Do not dispense, Fact finding, AttachmentsUniversity of Kentuckydispensing-exercisediltiazem-cd-240mg glyburide-5-mg-tab niacin-extended-release-500-mguniversity-of-kentucky
Mr. Peppers, a patient well-known to your pharmacy, comes to the counter with a new prescription.  This patient has 12 dispensing records (Cymbalta 60mg cap and Effexor XR 150mg cap). The prescriber needs to be contacted based on the drug-drug interaction., Community, 2 items on Rx, Fact finding, Patient questionsUniversity of Kentuckydispensing-exercisedesvenlafaxine-50mg quetiapine-50-mguniversity-of-kentucky
This exercise assesses the student’s ability to do the following: (1) dispense appropriate medication, (2) identify patient allergy to prescribed drug, (3) contact prescriber for appropriate alternative antibiotic.  When consulted about the allergy the prescriber responds “Oh, I didn’t know that. Thanks for contacting me and letting me know about this. Change to Zpak, you know the directions, right?”., , Community, 1 item on Rx, Dispense, Fact findingUniversity of Kentuckydispensing-exerciseallergy azithromycin-250-mg zpakuniversity-of-kentucky
This exercise assesses the student’s ability to do the following: (1) dispense appropriate medication, (2) identify and fix a dosing error that would otherwise result in a toxic overdose.   AJ approaches your pharmacy counter to get a prescription filled. He is traveling to Honduras in 5 days for one month and his doctor wrote a script for malaria prophylaxis.  Student is required to contact prescriber regarding the dose (should be once per week instead of once per day)., Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Kentuckydispensing-exercisechloroquine-500-mg dosing-erroruniversity-of-kentucky
Patient comes to the pharmacy counter requesting to have their prescription filled. They are about to leave the country and desire their sleeping pills before they depart. Date is missing from prescription. Student should contact the physician and request clarification/date authorization., Community, 1 item on Rx, Do not dispense, Fact findingUniversity of Kentuckydispensing-exerciseerror-on-rx zolpidemuniversity-of-kentucky
Mr. James Rawson comes to your pharmacy with a new prescription for azithromycin.  You can dispense medication after discussing the dosing error with physician. Inform Mr. Rawson about the dose change., Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Michigandispensing-exerciseazithromycin dosing-erroruniversity-of-michigan
Mrs. Jenny Johns is a 46 years old female with history of atrial fibrillation who comes to your pharmacy to fill warfarin.  Patient asks”Can I take over the counter herbal product St. John’s wort because Dr. Oz says it is good for depression?”  There is a drug interaction between these two products. Taking St. John’s Wort with warfarin can result in warfarin not working as well which places the patient at risk for clots., Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Michigandispensing-exercisest-johns-wort warfarinuniversity-of-michigan
Mr. Peter Dawsin comes from his PCP office with a prescription for Bactrim DS Q12H for 3 days for urinary tract infection.  Mr. Dawsin has documented allergy to co-trimoxazole. It is not safe to dispense this medication. In addition, patient is taking warfarin for atrial fibrillation that can interact with Bactrim., Community, 1 item on Rx, Do not dispense, Fact findingUniversity of Michigandispensing-exercisebactrim sulfamethoxazole-trimethoprimuniversity-of-michigan
Problem in the case – pregnant while taking ACE-inhibitor.  The questions that must be asked include: allergies, other medications, and pregnancy status (25 year old female)., Community, 1 item on Rx, Do not dispense, Fact findingUniversity of Michigandispensing-exerciselisinopril pregnancyuniversity-of-michigan
Mrs. Mia Gleadow is a 50 y.o. patient with type II diabetes who comes to you pharmacy to refill her Lantus.  Patient states: “I had low sugar about 2-3 times the past week. I ran out of Lantus syringe and borrowed some regular syringes from her neighbor a week ago. The low blood sugars happened after I used the new syringes.” and “Should I ask my doctor to write a prescription for insulin syringes?”, Community, 1 item on Rx, Dispense, Patient questionsUniversity of Michigandispensing-exerciselantus syringeuniversity-of-michigan
Mr. Dafydd Davies is a regular customer at your pharmacy. Today he comes in to refill his blood pressure medication Diovan HCT. When you review his medication profile, you identify that there may be an opportunity to improve medication adherence.  Adherence is an issue because the patient does not like metformin because it caused bad diarrhea and he had to go to the bathroom 3-4 times a day. He knows it is important to control his blood sugar. Can you recommend another medication that causes less diarrhea?, , Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Michigandispensing-exerciseadherence diarrhoea metforminuniversity-of-michigan
This validation exercise has three tasks. Students review the prescriptions to determine if they should be dispensed or not dispensed based on Michigan and Federal law. Prescription 1: Zolpidem Extended Release 6.25 mg Tab (Outcome Do Not Dispense due to refill too soon); Prescription 2: Ibuprofen 600 mg Tab (Outcome Do Not Dispense due to incomplete patient name); Prescription 3: Alendronate 70 mg Tab (Outcome Do Not Dispense due to date error)., , Community, Do not dispenseUniversity of Michiganvalidation-exercisealendronate ibuprofen zolpidemuniversity-of-michigan
Students need to distinguish if the patient is a candidate for self-treatment and being able to notice what skin condition the patient has by using the picture provided.  RECOMMENDED MEDS include: Cortizone-10 Maximum Strength Anti-Itch Cr; Hydrocortisone Cr. COUNSELING:  Name and strength of medication along with amount of medication, route of administration and maximum amount of medication per day (if appropriate) Administration information Onset of action/ expected time to see effect Common and severe side effect and what to do to manage them, if appropriate General counseling points and follow up, Community, Recommend medications, Fact finding, Patient questions, Patient medications, AttachmentsUniversity of Michiganotc-exerciseatopic-dermatitis dermatologyuniversity-of-michigan
Students must help an elderly man choose a product to relieve his opioid-induced constipation with the approval of his physician. Recommended medications include: Dulcolax Tab; Senokot Tab. A stimulant laxative is beneficial for opioid-induced constipation., , Community, Recommend medications, Fact finding, Patient questionsUniversity of Michiganotc-exerciseconstipation dulcolax senokotuniversity-of-michigan
A woman comes into the pharmacy. She appears to be fatigued and slightly irritable with slightly sunken eyes. Patient symptoms: – 3 unformed stools per day – down 4 lbs from baseline weight – low grade fever – signs of dehydration (sunken eyes, increased thirst) – cool extremities Recommended medications include: Imodium A-D Caplets; Pepto-Bismol Cherry Chewable Tablets. The patient is an appropriate candidate for the self-treatment of her diarrhea., , Community, Recommend medications, Fact finding, Patient questionsUniversity of Michiganotc-exercisedehydration diarrhoea immodiumuniversity-of-michigan
The student is expected to make a recommendation for an acne product for the patient’s acne.  PREFERRED MEDICATIONS DEFINED: Benzoyl Peroxide 2.5% Cr; Oil-Free Acne Stress Control Top soln; Oxy Pads Pad; Differin Gel.  HARMFUL MEDICATIONS DEFINED: Benzoyl Peroxide Sol; Benzoyl Peroxide 10% Gel; Zapzyt Acne Treatment Gel Top gel.   COUNSELING: Adapalene gel is the preferred agent for mild acne. Patients could also try benzoyl peroxide 2.5% or salicylic acid 0.5% if treatment with adapalene fails or patient prefers not to use adapalene or has allergy to that medication., , , , , Community, Recommend medications, Fact findingUniversity of Michiganotc-exerciseacne adapalene-gel benzoyl-peroxide dermatology differin-gel zapzyt-acne-treatmentuniversity-of-michigan
Advanced OTC exercise.  Students should be able to distinguish whether or not a patient is a candidate for self-treatment.  A mother presents with her child who has a fever. Three preferred medications are defined: Children’s ibuprofen oral suspension Susp; Childrens Tylenol Susp; Acetaminophen Childrens Susp.  Non-pharmacological counseling points: Give 2-3 non-pharmacological counseling points.   Pharmacological counseling points: Name and strength of medication along with amount of medication, route of administration and maximum amount of medication per day (if appropriate) Administration information Onset of action/ expected time to see effect Common and severe side effect and what to do to manage them, if appropriate General counseling points and follow up, , , , Community, Recommend medications, Fact finding, Patient questionsUniversity of Michiganotc-exerciseacetaminophen fever ibuprofen pediatrics tylenoluniversity-of-michigan
Patient wants to quit smoking.   This patient has 8 dispensing records (Losartan 50 mg Tab, Amlodipine 5 mg Tab, Clindamycin hydrochloride 300 mg Cap) COUNSELING:   Non-pharmacologic counseling points: – Provide a minimum of 2-3 counseling points Pharmacological counseling points: – Name and strength of medication along with amount of medication, route of administration and maximum amount of medication per day (if appropriate) – Administration information – Onset of action/ expected time to see effect – Common and severe side effect and what to do to manage them, if appropriate General counseling points and follow up, , Community, Recommend medications, Fact finding, Patient questions, Patient medicationsUniversity of Michiganotc-exercisesmoking tobacco tobacco-cessationuniversity-of-michigan
Two validation tasks – 1. Prescription for Metformin 500 mg Tab (outcome do not dispense due to incorrect medication).  2. Prescription for Insulin Glar Solo 100u Inj (outcome do not dispense due to sub-therapeutic dose), Community, Do not dispenseUniversity of Michiganvalidation-exerciseinsulin-glargine metforminuniversity-of-michigan
Simple dispensing exercise with two items on the script: Lisinopril 40 mg Tab and Citalopram 10 mg Tab. Patient is also taking another blood pressure medication, hydrochlorothiazide., , Community, 2 items on Rx, Dispense, Fact finding, Patient questionsUniversity of Michigandispensing-exercisecitalopram-10mg-tab hydrochlorothiazide-25mg-tab lisinopriluniversity-of-michigan
A simple dispensing exercise with no issues. Montelukast 10 mg Tab prescribed for asthma attack, shortage of breath & wheezing., Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Michigandispensing-exerciseasthma montelukast-10-mg-tabuniversity-of-michigan
This exercise has THREE validation tasks: 1. Amoxicillin (outcome – do not dispense, insufficient quantity prescribed) 2. Simvastatin (outcome – do not dispense, bad directions causing overdose) 3. Metoprolol succinate (outcome – do not dispense, incorrect medication), , Community, Do not dispenseUniversity of Michiganvalidation-exerciseamoxicillin metoprolol-succinate simvastatinuniversity-of-michigan
Patient is elderly and has just been prescribed a new medication. The patient also has history of arthritis so she is going to the pharmacist to buy her usual NSAID pain relief, Advil, but wants to know if she can still take it with her new medication.  Student is able to understand interactions of OTC pain relievers with prescription medications. Explain to tell patient that NSAIDs interfere with warfarin (Coumadin) and that acetaminophen is the preferred option for pain relief but should still be careful not to use in excess. NSAIDs or aspirin increase a patient’s risk for serious bleeding while you are on anticoagulant therapy (taking Coumadin). The maximum dosing for OTC acetaminophen in normal patients is 3000 mg.  A patient taking warfarin should try and aim to not exceed 2000 mg a day until INR is stable and full effects are realized.  Make sure they continue to see their primary healthcare provider to check their INR (International Normalized Ratio) to make sure that taking acetaminophen isn’t interfering with their anticoagulation therapy. The patient should also be counseled in potential non-pharamcologic treatments for their arthritis such as physical therapy and occupational therapy to help improve their daily activities., Community, Recommend medications, Fact finding, Patient medicationsUniversity of Connecticutotc-exercisearthritis painuniversity-of-connecticut
A patient comes in looking for an OTC pain reliever for her daughter to take. Her daughter sprained her wrist yesterday and wants a pain reliever on hand in case her daughter can’t handle the pain from her sprain.   Be able to dose OTC analgesics to children based on weight and understand when it should be taken. Since the doctor recommended they take an OTC pain relief, you could suggest an non-steroidal anti-inflammatory (NSAID) containing ibuprofen. However, these drugs can have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally, not everyday. Some non-pharamcologic remedies for a wrist sprain, since this one is minor, are to rest your wrist for at least 48 hours, ice your wrist to reduce pain and swelling, do it for 20-30 minutes every 3-4 hours for 2-3 days, or until the pain is gone, elevate your wrist above your heart on a pillow or back of a chair, as often as you can.Community, Recommend medications, Fact findingUniversity of Connecticutotc-exercisepainuniversity-of-connecticut
Patient is presenting to the pharmacy counter with a terrible headache and is looking for a recommendation. Acetaminophen is the best choice for a pregnant woman because it is Pregnancy Category B, so it will not harm the baby. -Take 2 caplets (1000 mg) by mouth every 6 hours as needed for pain -Do NOT exceed 6 caplets (3000 mg) in 24 hours -max dose is 3000 mg for self-care, , Community, Recommend medications, Fact finding, Patient questions, Patient medicationsUniversity of Connecticutotc-exerciseanalgesic headache painuniversity-of-connecticut
A patient comes to the counter to look for relief for her 8 month old baby’s fussiness due to teething pain. The mother wants to give her baby what she personally uses for pain, baby Bayer aspirin.   Be able to understand the indication and side effects of OTC analgesics, specifically the differences in side effects/dosing for infants and toddlers.  Patients under 12 years old SHOULD NOT take apsirin, unless consulted upon by a doctor.  However, aspirin is one of the cuases of poisoning in children.  By giving aspirin, even in a low dose, you are putting the child in danger of getting Reye’s Disease., , Community, Do not recommend, Fact finding, Patient medicationsUniversity of Connecticutotc-exerciseanalgesic apsirin painuniversity-of-connecticut
A patient approaches counter complaining of itchy feet.  Intensely itchy feet, red and scaly between toes.  It is recommended that you use a topical antifungal foot cream to treat your infection. Apply cream to affected area twice each day. Be sure to kep area clean and dry. It is recommended to change socks often, and wear ventilated shoes to help ease symptoms. After using the product for a month, if symptoms do not resolve talk to a PCP., Community, Recommend medications, Fact finding, Patient questionsUniversity of Connecticutotc-exerciseantifungal athletes-footuniversity-of-connecticut
Upon further questioning KK reports some pain at the site only. KK was wearing bright colored clothing and scented lotion/perfume when she was stung by a honey bee in the field. She denies dizziness, weakness, nausea, vomiting, and difficulty breathing. This is her first bee sting and denies any previous family history of significant reaction to bee stings.  Medication will provide relief of itching and irritation caused by insect bites. The medication should help relieve both pain and itching associated with the sting. It does not commonly cause adverse drug reactions although contact dermatitis can occur. Should the patient develop hives, dizziness, weakness, nausea, vomiting or difficulty breathing, seek medical attention immediately., Community, Recommend medications, Fact finding, Patient questions, AttachmentsUniversity of Connecticutotc-exercisebite stinguniversity-of-connecticut
A patient was stung by an insect.  Pain at site of sting, nausea, dizziness, SOB.  Patient has symptoms that need to be treated by another health professional.  OTC treatment is not appropriate here due to the severity of the patient’s symptoms following an insect sting. Referring the patient to the ER immediately is the correct recommendation here because the patient could be experiencing anaphylaxis., , Community, Do not recommend, Fact finding, Patient questions, Patient medicationsUniversity of Connecticutotc-exerciseanaphylaxis dermatology stinguniversity-of-connecticut
Burn area on the arm, only on the top layer of the skin. About 3 inches long and 1 inch wide.  An NSAID like Ibuprofen or Naproxen would be best for the patient’s pain. Any type of skin protectant ointment like Calmoseptine is also needed., , Community, Recommend medications, Fact finding, AttachmentsUniversity of Connecticutotc-exerciseburn dermatology nsaiduniversity-of-connecticut
A patient comes into the pharmacy and is looking for an OTC medication that could help with his dry, hacking cough so he could sleep at night.   Identify OTC medications that can be used to suppress a cough. Recommend an antitussive OTC medication.  Antitussives could be dextromethorpan.  Antitussives help your cough by deterring you cough reflex.  If the patient needs help “getting rid” of his cough so he can fall asleep having an OTC product that works by blocking this could be useful/beneficial. Optional: recommend a lozenge and counsel the patient to drink lots of fluids, especially water, to ease up on any soreness of throat caused by the dry cough., , Community, Recommend medications, Fact findingUniversity of Connecticutotc-exerciseantitussive cold coughuniversity-of-connecticut
Patient has a stuffy nose and is looking for an OTC product for relief. Patient heard from a friend that nasal sprays can work the fastest for relief.  Identify potential risk in taking inhalant OTC products for sinus congestion relief and counseling/educating the potential dangers of using nasal sprays too long. Recommend Afrin nasal spray.  Nasal sprays can be used to relieve the symptoms of a stuffy nose or nasal congestion.  They can reduce the inflammation and histamine production in the nasal production.  Afrin works directly on nasal membranes, giving you nasal congestion relief in second and lasts up to 12 hours. Make sure with recommending this product, the patient is counseled on the duration and how to use the product., , , Community, Recommend medications, Fact findingUniversity of Connecticutafrin cold sinus stuffy-noseuniversity-of-connecticut
Patient presents to the counter to ask about a medication that he hopes will alleviate his chesty cough with phlegm. Advise him on if this medication is correct for his condition and counsel on how to use it.  Help patient identify illness, advise the patient on a correct route for medication to manage this illness, and educate/counsel the patient on this method of medication. Advise patient to take a cough medicine that works as an expectorant like Mucinex/Mucinex 12 hr/Robitussin Chest and Cough.  Since the cough is chesty with phlegm and congestion so these medications have expectorants, specifically guaifenesin, in them that breaks up and thins out mucus to clear the airways and make cough more “productive” to alleviate the mucus load by loosening it. Non-pharmacological remedies: investing in a humidifier, staying hydrated, gargle salt water., , Community, Recommend medications, Fact findingUniversity of Connecticutotc-exercisecold cough non-pharmacological-remediesuniversity-of-connecticut
Patient comes in looking for a solution to her elderly (80 year old) mother’s her mother has a chesty cough with phlegm. Her mother has had a cold for the last several days. She brings up Mucinex D, which she always uses, and asks if this is okay to help alleviate her mother’s cough.  Be able to distinguish active ingredients in OTC products and recommend the correct OTC to treat their problem but will not exacerbate any conditions the patient has. It is important to ask patient if their mother has high blood pressure.  She does because she is on lisinopril. Recommend an OTC product that does not have psuedophedrine which can make high blood pressure worse.  This OTC could be Mucinex DM which uses dextramethrophan and guaifenesin which does not have any interactions with lisinopril and doesn’t affect high blood pressure.  So you woud not recommend Mucniex D for this patient. Make sure to note that you could still use another OTC product.  The cough is not due to her heart medication, but due to a cold that she’s had for the last several days, so an OTC can and should be recommended to help alleviate her cough from a cold., , Community, Do not recommend, Fact finding, Patient medicationsUniversity of Connecticutotc-exercisecold cough hypertensionuniversity-of-connecticut
Patient presents to the counter to ask the pharmacist about his constipation. He is trying to figure out why he is constipated and how to treat it. Patient informs you that he eats mostly meat and carbs and because he is retired, only goes outside to get the mail.   Student will recommend lifestyle changes for constipation., , Community, Recommend medications, Fact finding, Patient questionsUniversity of Connecticutotc-exerciseconstipation miralax sennauniversity-of-connecticut
Patient presents to the counter to ask about a medication that she hopes will alleviate her diarrhea. Advise her on if this medication is correct for her condition and counsel on how to use it.  Student must identify potential medication problem and recommend new therapy.   Loperamide can be recommended because the patient is experiencing acute diarrhea (diarrhea lasting less than 2 weeks). If the patient’s diarrhea does not improve in 2 days, or if diarhea returns for more than 2 weeks, then they should see a medical provider. Do not take more than 16mg in 24 hours. Do not do activities that require alertness until effects are realized. Diarrhea should not be used in patients with a fever or when infection is expected. Along with this product, maintain proper hydration – 8 eight-ounce glasses. Non pharmacologic solution can include Oral Rehydration Therapy (pedialyte, etc.) and temporarily eating the BRAT diet: bananas, rice (white), applesauce and toast until the diarrhea resolves and then slowly incorporating fiber into the diet, , Community, Recommend medications, Fact finding, Patient questionsUniversity of Connecticutotc-exercisediarrhoea gastrointestinal loperamideuniversity-of-connecticut
A patient approaches the counter with a burning sensation in his chest seeking your help. He approaches the counter with 3 products and needs counseling on which one would be best for his situation.   In this case, a proton pump inhibitor (PPI) would be the best recommendation to help relieve the patient’s heartburn due to the frequency of symptoms. These are best taken about 30 minutes before the first meal of the day. It is important to take this medication consistently for best results. Take tablet whole. Do not take medication for more than 14 days, if smptoms have not improved see a health care provider. Antiemetics are used to treat nausea. Antacids are used to neutralize acid and provide fast relief for infrequent symptoms and histamine 2 receptor antagonists (H2RA) decrease acid secretion and are longer lasting than antacids., Community, Recommend medications, Fact finding, Patient questions, Patient medicationsUniversity of Connecticutotc-exercisegastrointestinal prilosecuniversity-of-connecticut
This exercise has an error on the RX and requires the student to work with the physician to get the correct medication.    , , Community, 1 item on Rx, Dispense, Fact findingUniversity of Connecticutdispensing-exerciseclindamycin-hydrochloride dental prescriber-fact-findinguniversity-of-connecticut
This question assesses the student’s ability to do the following: (1) accurately dispense a medication from an oral prescription. Mr. Randy Roldolph wishes to pick up his medication that his physician called into your pharmacy. This exercise uses a voicemail file, so a device that can playback the audio is required., Community, Fact findingUniversity of Connecticutdispensing-exercisetriamcinolone-0-1-oint voicemailuniversity-of-connecticut
This exercise assesses the student’s ability to do the following: (1) dispense appropriate medication, (2) provide patient counseling. To receive full credit for this exercise, at a minimum students must include the following in your counseling: Include the following: (1) directions for use and storage and the importance of compliance with directions; and (2) precautions and relevant warnings, including common severe side or adverse effects or interactions that may be encountered. Should you deem it warranted in the exercise of your professional judgment, you may include additional information. HOW TO USE: This product should only be applied to healthy, normal skin. Do not apply to skin that is broken or irritated. Dosage is based on your medical condition and response to therapy. Remove the protective liner and apply the patch to the skin area that is most painful. Apply the prescribed number of patches, usually only once a day for up to 12 hours or as directed by your doctor. Do not apply more than 3 patches once a day or leave any patch on for longer than 12 hours in any 24-hour period. If a smaller patch is needed, it may be cut with scissors before the liner is …, Community, 1 item on Rx, Fact finding, Patient questionsUniversity of Connecticutdispensing-exerciselidocaine-patch transdermaluniversity-of-connecticut
This exercise assesses the student’s ability to do the following: (1) dispense appropriate medication, (2) provide patient counseling To receive full credit for this exercise, at a minimum students must include the following in their counseling: (1) directions for use and missed dose, storage and the importance of compliance with directions; and (2) precautions and relevant warnings, including common severe side or adverse effects or interactions that may be encountered., Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Connecticutdispensing-exerciseethinyl-estradiol-norethindrone womens-healthuniversity-of-connecticut
This exercise assesses the student’s ability to do the following: (1) dispense appropriate medication, (2) provide patient counseling. To receive full credit for this exercise, at a minimum students must include the following in their counseling: Include the following: (1) directions for use and storage and the importance of compliance with directions; and (2) precautions and relevant warnings, including common severe side or adverse effects or interactions that may be encountered.Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Connecticutdispensing-exerciserosuvastatinuniversity-of-connecticut
This exercise walks students through helping a patient who has a new prescription for her blood pressure, and also has an allergy.   This patient is allergic to lisinopril, and Zestorectis is a combination product that contains lisinopril and HCTZ.  , Community, 1 item on Rx, Do not dispense, Fact finding, Patient questionsUniversity of Connecticutdispensing-exerciselisinopril zestorectisuniversity-of-connecticut
This question assesses the student’s ability to do the following: (1) dispense the correct medicine to the patient, (2) provide patient counselling. Mr Dawson presents this script to you at the pharmacy to be filled. His daughter is with him, and he seems to be a little hard of hearing. Demonstrate how to instill eye drops. These eye drops can cause some side effects: Your irises may change color. Your eyelid skin may darken. Your eyelashes may get longer, thicker or change color. Your eyes may get red or inflamed, or you may get teary eyes. If this happens, call your ophthalmologist. If you miss a dose, just continue treatment the next evening. Keep this medication in your refrigerator until it is opened, then store at room temperature away from heat and light.Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Connecticutdispensing-exerciselatanoprostuniversity-of-connecticut
This exercise assesses the student’s ability to do the following: (1) dispense appropriate medication, (2) validate a prescription for a controlled substance. Advise the patient to read the FDA-approved patient labeling (Medication Guide). Instruct patients how to properly take MS Contin, including the following: Swallowing MS Contin tablets whole Not crushing, chewing, or dissolving the tablets Using MS Contin exactly as prescribed to reduce the risk of life-threatening adverse reactions (e.g., respiratory depression) Not discontinuing MS Contin without first discussing the need for a tapering regimen with the prescriber MS Contin may cause orthostatic hypotension and syncope. Advise patients of the potential for severe constipation, Community, 1 item on Rx, Dispense, Fact findingUniversity of Connecticutdispensing-exercisecontrolled-substance ms-continuniversity-of-connecticut
This exercise assesses the student’s ability to do the following: (1) dispense appropriate medication, (2) provide patient counseling. To receive full credit for this exercise, at a minimum the student must include the following in their counseling: (1) directions for use and storage and the importance of compliance with directions; and (2) precautions and relevant warnings, including common severe side or adverse effects or interactions that may be encountered. To gain the most benefit, take every night at dinner and do not miss doses. Take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not take 2 doses at the same time or extra doses. Store at room temperature. Store in a dry place. Do not store in a bathroom. Swallow whole. Do not chew, break, or crush. Take as you have been told, even if you feel well. Low blood sugar may occur. Signs may be dizziness, headache, feeling sleepy, feeling weak, shaking, a fast heartbeat, confusion, hunger, or sweating. Keep glucose tablets or liquid glucose on hand for low blood sugar. It is common …, Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Connecticutdispensing-exercisediabetes metformin-extended-release-500-mg-tabuniversity-of-connecticut
This question assesses the student’s ability to do the following: (1) calculate the appropriate dose of antibiotic for the patient, (2) dispense the correct medicine to the patient, (3) choose the appropriate ancillary labels for the medicine to be dispensed (4) answer patient queries regarding dosing of pediatric tylenol., , Community, 1 item on Rx, Dispense, Fact finding, Patient questionsUniversity of Connecticutdispensing-exercisecalculations cefaclor-125mg-5ml pediatricsuniversity-of-connecticut
Prescription is for Januvia 100 mg Tab (Sitagliptin 100 mg Tab). Outcome is DISPENSE Students should identify that everything on this prescription is correct., , Community, DispenseUniversity of Connecticutvalidation-exercisediabetes endocrinology sitagliptinuniversity-of-connecticut
Prescription is for Atorvastatin 20 mg Tab (Atorvastatin 20 mg Tab). Outcome is DISPENSE Students should identify that everything on this prescription is correct., , Community, DispenseUniversity of Connecticutvalidation-exerciseatorvastatin cardiology hyperlipidemiauniversity-of-connecticut
Prescription is for Ranitidine 15 mg/ mL Oral syr (Ranitidine 15 mg/ mL Oral syr). Outcome is DISPENSE. Students should identify that this is correctly written, including appropriate dose for child., , , , Community, DispenseUniversity of Connecticutvalidation-exercisegastroenterology gerd pediatrics special-populations suspensionuniversity-of-connecticut
Prescription is for Furosemide 20 mg Tab (Furosemide 20 mg Tab). Outcome is DO NOT DISPENSE Students should identify that an omission occurred; missing physician signature and this cannot be dispensed without resolving., , Community, Do not dispenseUniversity of Connecticutvalidation-exercisecardiology furosemide-20-mg hypertensionuniversity-of-connecticut
Prescription is for Metoprolol succinate 50 mg ER tab (Metoprolol succinate 50 mg ER tab). Outcome is DISPENSE This is a legal prescription and no errors or ommissions can be found, , Community, DispenseUniversity of Connecticutvalidation-exercisecardiology hypertension metoprolol-succinateuniversity-of-connecticut
Prescription is for TEGRETOL 200mg Tab (Carbamazepine 200mg Tab). Outcome is DO NOT DISPENSE This is NOT a valid prescription because it is missing the quantity., , , , Community, Do not dispenseUniversity of Connecticutvalidation-exerciseanti-epileptic anticonvulsant carbamazepine neurology seizure-disorderuniversity-of-connecticut
Prescription is for Acetaminophen / Hydrocodone 300 mg-5 mg Tab (Acetaminophen / Hydrocodone 300 mg-5 mg Tab). Outcome is DISPENSE. This is a valid prescription, contains all of the prescription requirements (CGS20-614, 20-615, 21a-249), correct DEA #, and APRN allowed to write for controlled substances in CT. CGS 20-87a; CGS 20-101c; CGS 21a-252). A 5-day limit for 1st outpatient opioid Rx is required (Public Act No. 17-131; 2017.https://www.cga.ct.gov/2017/ACT/pa/pdf/2017PA-00131-R00HB-07052-PA.pdf), , Community, DispenseUniversity of Connecticutvalidation-exerciseaprn controlled-substance deauniversity-of-connecticut
Prescription is for Acetaminophen / Oxycodone 325 mg-5 mg Tab (Acetaminophen / Oxycodone 325 mg-5 mg ). Outcome is DO NOT DISPENSE Students should identify that this prescription may be invalid because it is > 1 yr old, , , Community, Do not dispenseUniversity of Connecticutvalidation-exerciseacetaminophen-oxycodone acute-pain controlled-substance potential-abuseuniversity-of-connecticut
Prescription for NAPROSYN SR 1GM 1g Tab (Naproxen Ph 1g Tab). Outcome is DO NOT DISPENSE. This strength is both unavailable in US but also is an overdose. Maximum daily dose is 1250 mg/day., , Community, Do not dispenseUniversity of Connecticutvalidation-exerciseacute-pain naproxen neurologyuniversity-of-connecticut
Prescription for Amoxicillin/clavulanic acid 200 mg/ 5 mL-28.5 mg / 5 mL Pwd susp Outcome is DO NOT DISPENSE. Student should identify this as an incorrect (too high) dose for this patient., , , , Community, Do not dispenseUniversity of Connecticutvalidation-exerciseamoxicillin-clavulanic-acid antibiotic calculations suspension upper-respiratory-infectionuniversity-of-connecticut
Prescription for VENTOLIN HFA 90 mcg / actuation Inh (Albuterol Sulfate 90 mcg / actuation Inh). Outcome is DISPENSE. This prescription is correct as written. Based on the laws regarding required components of the prescription record (CGS 20-614, CGS 20-615, CGS 21a-249), if a non-controlled substance has PRN or ad lib for refills, this is okay to dispense., , , Community, DispenseUniversity of Connecticutvalidation-exercisealbuterol asthma refills respiratoryuniversity-of-connecticut
Prescription for ACCUPRIL 10mg Tab (Quinapril HCl 10mg Tab) Outcome is DO NOT DISPENSE because the strength of the tablet is missing, which is required on all prescriptions (CGS20-614, 20-615, 21a-249), Community, Do not dispenseUniversity of Connecticutvalidation-exercisequinapril-hcl strength-missinguniversity-of-connecticut
Prescription for OxyContin 10 mg ER tab (Oxycodone 10 mg ER tab). Outcome is that prescription is correct as written., , Community, DispenseUniversity of Connecticutvalidation-exercisechronic-pain controlled-substance oxycontinuniversity-of-connecticut
Students should identify that long-acting opioids should not be prescribed as PRN thus is a subtherapeutic dose., , , , Community, Do not dispenseUniversity of Connecticutvalidation-exercisechronic-pain controlled-substance neurology oxycontin wrong-directionsuniversity-of-connecticut
Verification exercise for ointment. Students should identify that the strength of the ointment is missing. Strength is required in all prescriptions (CGS20-614, 20-615, 21a-249), , , Community, Do not dispenseUniversity of Connecticutvalidation-exercisedermatologic-condition dermatology ointment strength-missinguniversity-of-connecticut
This validation exercise has one task. The task outcome should be DO NOT DISPENSE. The error is that long-acting opioids should not be prescribed as PRN thus is a subtherapeutic dose., , Community, Do not dispenseUniversity of Connecticutvalidation-exercisecontrolled-substance ms-contin wrong-directionsuniversity-of-connecticut
C-IV medication prescription presented to the pharmacy; practice filing and labeling controlled substance Tramadol is a C-IV medication that should not be filled if 6 months has passed since the day it was written., , Community, 1 item on Rx, Do not dispense, Fact findingUniversity of Connecticutdispensing-exerciseback-pain rx-expired tramadol-50-mg-tabuniversity-of-connecticut
A patient approaches the counter with a burning sensation in his chest, wondering if OTC therapy is appropriate due to his other current conditions. “I’ve been taking my Ibuprofen as needed- usually about 4 times a day for my arthritis pain.”   This patient is not a candidate for just an OTC recommendation. He needs to see his PCP because of his chronic Ibuprofen use. This could be the underlying factor for his symptoms, causing a stomach ulcer or something more serious than an OTC recommendation., Community, Do not recommend, Fact finding, Patient questionsUniversity of Connecticutotc-exerciseibuprofen stomach-ulceruniversity-of-connecticut
Insomnia and nausea 3 This exercise involves dispensing a prescription, whilst taking into consideration a patient request. There is an additional request for an Emergency supply of Temazepam to manage jet lag. This exercise will allow for a wider discussion about the criteria that surrounds Emergency supply and what options are available to the pharmacist There are added challenges when counselling someone who is picking up a prescription on behalf of a patient. In this scenario it would seem the patient’s son may be distracted by his own concerns about receiving an emergency supply for Temaze. This challenge should not discourage you from asking whether the patient has any concerning symptoms or requires any information about their current medication. It is always approrpriate to double check if a patient is having any issues using eye drops, as it can be challenging for the elderly (e.g. due to dexterity issue and arthritis), , , , Community, 3 items on Rx, Recommend medications, Fact findingMonash Universitydispensing-exerciseezetimibe-10mg-tab insomnia latanoprost-50mcg-ml-2-5ml-eye-dr nausea pravastatin-40mg-tabmonash-university
Insomnia and nausea 2 This exercise involves dispensing a prescription whilst considering patient preferences. There is no errors or issues with this prescriptions and it should be dispensed. As the patient has been taking their current medication for some time, it is important to tailor the counselling to the patient’s current circumstances. Certain trigger factors can affect the stability of a patient suffering from Bipolar disorder. These include a lack of sleep (which can also be a sign a manic episode), sensory overload (dealines), stress (e.g. work related), illicit drugs or alcohol (3-4 glasses of wine after dinner). Given that some of these factors relate to the patients current circumstance, it would appropriate to highlight these to the patient so they can reflect on their current daily activities. It would also be important to promote good sleep hygiene. This might inlcude: limiting caffiene late in the day limiting screen time late in the day, , , Community, 2 items on Rx, Recommend medicationsMonash Universitydispensing-exerciseinsomnia lithium-carbonate-450mg-sr-tab nausea sodium-valproate-200mg-ec-tabmonash-university
Insomnia and nausea This exercise involves dispensing a prescription, whilst taking into consideration patient concerns. There are no errors with this prescription, however the exercise may open a wider discussion about the side effects of a medication and how they are managed. Even though the patient has presented a prescription for Eliquis and Isoptin, the counselling provided may focus on the patient’s nausea. It is important to emphasise the importance of taking Flagyl with food, as it may help to settle the patient’s nausea. Further, also reiterate the need to abstain from drinking alcohol as the patient may have a severe reaction if alcohol is consumed with taking Flagyl., , , Community, 2 items on Rx, Recommend medications, Fact findingMonash Universitydispensing-exerciseapixaban-5mg-tab insomnia nausea verapamil-180mg-sr-tabmonash-university
Women’s health 3 This exercise involves dispensing a prescription according to the patient preferences. This is no errors with this prescription and it should be dispensed. Even though the patient has taken the medication previously, it is still appropriate to ensure that the medication is well tolerated and achieving the desired outcome., , , Community, 3 items on Rx, Recommend medications, Fact findingMonash Universitydispensing-exerciseatorvastatin-40mg-tab hydrochlorothiazide-25mg-tab irbesartan-150mg-tab womens-healthmonash-university
Women’s health 2 This exercise involves dispensing a prescription according to the patient preferences. This is no errors with this prescription and it should be dispensed. When taking a COC it is important to always reiterate the following: If any of the following symptoms occur while on the pill, stop taking it and seek urgent medical advice: severe and sudden pain in the chest, severe headache, sudden blurred vision or loss of sight, unexplained tenderness or pain and swelling in one leg. The above information is important to pass on to the patient given that they smoke cigarettes “every now and then”. Effectiveness may be reduced by: some medicines; check with your doctor or pharmacist before starting or stopping any medicines, including herbal (particularly St John’s wort) and over-the-counter products vomiting or diarrhoea (which also may be caused by some medications) or forgetting to take an active pill, , Community, 2 items on Rx, Recommend medications, Fact findingMonash Universitydispensing-exercisecitalopram-10mg-tab drospirenone-ethinyloestradiol-3mg-20mcg womens-healthmonash-university
Women’s health 1 This exercise involves dispensing a prescription whilst considering patient preferences and previous tolerance of medication. There is no errors or issues with this prescriptions and it should be dispensed. It may be appropriate to create a note that Janumet is a new medication for the patient When a patient starts a new mediction it important to cover the following details: Purpose of medication Directions for use (dose, freq, route) Duration of use Any expected S/E Lifestyle advice Follow up advice More specific counseling for Janumet might involve: Take with or after food to reduce stomach upset. Tell your doctor immediately if you have loss of appetite, nausea, vomiting, abdominal pain, cramps, fatigue, diarrhoea or weight loss. Drinking alcohol can affect control of your diabetes. It can also increase the risk of serious side effects. Limit your alcohol intake, avoid binge drinking and have something to eat when you drink alcohol. Specific counseling for this patient may involve: A discussion around diabetes control and management. For some patients vaginal thrush may be result of poor diabetes management. As a once off, thrush may not be a concerning condition. Although, with appropriate counseling, if symptoms reoccur the patient would …, , , Community, 1 item on RxMonash Universitydispensing-exercisenausea new-medication sitagliptin-metformin-50mg-500mg-tab womens-healthmonash-university
Eye conditions 3 This exercise involves dispensing a prescription whilst considering patient preferences. There are no errors or issues with this prescriptions and it should be dispensed. Eventhough the medication has been taken previously, some topics could be important to discuss with the patient includes: Checking the patient’s compliance with Progout. As a preventative medication, it must be taken everyday even when no gout attack is occuring; Ensure that the patient continues to take Progout even while he is having an attack (as he is taking the medication); reiterating the directions of lengout (as there is are many details to remember), , , Community, Recommend medications, Fact findingMonash Universitydispensing-exerciseallopurinol-300mg-tab colchicine-500mcg-tab eye-condition goutmonash-university
Eye conditions 2 This exercise involves dispensing a prescription whilst considering patient preferences. There is no errors or issues with this prescriptions and it should be dispensed. There is a minor issue from this prescription in that the patient’s OTC request may be as a side effect of the Estraderm (i.e. dry eyes), but could simply be from the menopause alone. Even though the patient has taken the medication before, she is experiencing symptoms that may warrant further investigation and counseling. Estradot (estradiol) can cause side effects of concern (dry eye being one of them!). Hence further counseling should involve expressing to the patient to monitor the timing of her symptoms, the development of any new symptoms, and the effectiveness of her medication., , Community, 2 items on Rx, Fact findingMonash Universitydispensing-exerciseestradiol-25mcg-24hrs-8-patch eye-condition quinapril-5mg-tabmonash-university
Eye conditions 1 This exercise involves dispensing a prescription whilst considering patient preferences. There is no errors or issues with this prescriptions and it should be dispensed. Given that the medication is being picked up by the patient’s wife and has been taken before, counseling on the medication may not seem required. However the student pharmacist should still open the dialogue for any questions regarding the medication. Further suggesting her mother can call the pharmacy if she has any queries., , Community, 2 items on Rx, Fact findingMonash Universitydispensing-exerciseeye-condition paracetamol-665mg-sr-tab sertraline-50mg-tabmonash-university
Skin infections 3 A prescription is presented to be be dispensed. According to the patient history a dispensing error occurred on a previously for the same item. The prescription. The student should not dispense the prescription before speaking to the Doctor. Counselling would involve indicating to the patient that an error has previously occured. You would ask if they either currently or previously expierenced any unusual side effects or symptoms. Further ways to manage the dialogue would involve following a guide (e.g. PDL) to managing a dispensing error: Ensure the complaint is handled by a pharmacist Check alleged error and replace offending item An apology couched in the correct way will NOT constitute an admission of liability (e.g. “I am sorry this has happened to you”) Determine if the wrong medication has been used or any harm suffered? Has any expense been incurred? DO NOT OFFER COMPENSATION. DO NOT MENTION INSURANCE. Show empathy to the patient. At all times remain calm, sympathetic and co-operative. Telephone insurance to report the problem or gain advice. Record the details in the patient’s dispensing history If a complaint is initiated by correspondence, it is most important to not reply without contacting your insurance first …, Community, 1 item on Rx, Do not dispense, Fact findingMonash Universitydispensing-exercisemicrogynon skin-infectionmonash-university
Skin infections 2 This exercise involves dispensing a prescription according to the patient preferences. This is no errors with this prescription and it should be dispensed. This patient has 5 dispensing records for Motilium, Keflex and Amoxil Appropriate counselling would involve explaining the: Purpose of medication, Directions for use (dose, freq, route), Duration of use, Amount to apply, Any expected S/E, Lifestyle advice, Follow up advice., , Community, 2 items on Rx, Recommend medications, Fact findingMonash Universitydispensing-exercisemometasone-0-1-45g-cr mometasone-0-1-45g-oint skin-infectionmonash-university
Skin infections 1 This exercise involves dispensing a prescription whilst considering patient preferences. There are no errors or issues with this prescriptions and it should be dispensed. This patient has 9 dispensing records. Given that the medication is being picked up by the patient’s daughter and has been taken before, counseling on the medication may not seem required.   However the student pharmacist should still open the dialogue for any questions regarding the medication. Further suggesting her mother can call the pharmacy if she has any queries., , , Community, 3 items on Rx, Recommend medications, Fact findingMonash Universitydispensing-exerciseamlodipine atorvastatin olmesartan skin-infectionmonash-university
Folate deficiency Patient requests folic acid tablets as per her GPs instructions for folate deficiency A My Health Record is attached to this exercise, Community, Recommend medications, Fact finding, AttachmentsMonash Universityotc-exercisefolate folic-acidmonash-university
Iron deficiency   Patient requests multivitamin tablets iron deficiency, but GP had asked her to buy iron tablets   A My Health Record attachment is included with this exercise Pt has one dispensing record for ACTONEL ONE A WEEK 35mgCommunity, Recommend medications, Fact findingMonash Universityotc-exerciseiron-deficiencymonash-university
B12 injections Patient requests vitamin B12 injections as per her GPs instructions for vitamin B12 deficiency  , Community, 1 item on Rx, Fact finding, AttachmentsMonash Universitydispensing-exerciseb12-injection hydroxocobalamin-1mg-mlmonash-university
Nocturnal hypoglycaemia. Rx has two items – Metformin XR 1g Tab and Insulin glargine 100 IU/ml Inj. Can dispense metformin but consider changing the Lantus. Consider changing the Lantus Solostar to Toujeo. Toujeo is a concentrated version of insulin glargine (Lantus). The concentration of Toujeo is three times that of Lantus., , Community, 2 items on Rx, Do not dispense, Fact findingMonash Universitydispensing-exercisehypoglycaemia insulin-glargine metforminmonash-university
Diabetes – Continuous dosing. Rx for Insulin Detemir 100u/mL, 3mL Inj and Insulin Aspart 100units/mL, 3ml Inj. This patient has 12 dispensing records, showing use of (LEVEMIR PENFILL) and (NOVORAPID FLEXPEN) over time. Outcome is that pharmacist can dispense as pt still requires meds but can consider recommending pt to see his doctor/diabetes educator about switching from multiple daily injections to insulin pump therapy., , Community, 2 items on Rx, Do not dispense, Fact finding, Patient questionsMonash Universitydispensing-exercisediabetes insulin-aspart insulin-detemirmonash-university
A rather tired looking patient has had diarrhoea overnight from contaminated food. They are weak, tired, no energy, dry mouth, confused, faint. they have chosen an inappropriate product to buy., Community, Hospital, Recommend medications, Fact finding, Patient questions, Patient medicationsMonash Universityotc-exercisediarrhoea gastroenteritismonash-university
It’s October in Melbourne and a woman is waiting for some advice from the pharmacist. She has had a blocked and itchy nose for 2 days. Sneezing., Community, Fact finding, Patient questions, Recommend medicationsMonash Universityotc-exerciseazep-5ml-nasal-spr hayfevermonash-university
Patient with constipation who presents with a product request after Metamucil is ineffective., Monash Universityotc-exerciseconstipation metamucilmonash-university
Patient presents with mild Tinea pedis. They have already selected a product from the shop front., , Monash Universityotc-exerciselamisil-cream solveasy-tinea-cream tinea-pedismonash-university
Patient with constipation who presents with a product request.CommunityMonash Universityotc-exercisecoloxyl-with-sennamonash-university
Mrs Dawson has been prescribed Mogadon to help her sleep. Community. Outcome: Dispense. 3 items on Rx, , , , , , Monash Universitydispensing-exercisebenzodiazepine coumadin digoxin lanoxin mogadon nitrazepam warfarinmonash-university
Patient with constipation who presents with a product request. Outcome is recommend medication with basic feedback. Patient symptoms: difficult to defecate, tight stomach.CommunityMonash Universityotc-exerciseconstipationmonash-university