PROCUREMENT, STORAGE AND DISTRIBUTION OF PHARMACEUTICAL PRODUCTS
A1. In the facility where you work, the average monthly consumption for Enervit® is 3 packets. The minimum that you should have on your shelve at any given time is 2 packets. The wholesaler delivers within 48 hours after ordering and you place an order every 2 weeks. The representative for Enervit® visits the pharmacy. They have a deal for the next three weeks – If you buy 6 packets you get 3 packets free. Would you order the deal?
Answer
To decide whether to order the deal or not, we need to consider several factors:
1.Current Consumption Rate: The average monthly consumption is 3 packets. This means that in two weeks (the time between each order), you would typically consume 1.5 packets.
2.Minimum Stock Requirement: You need to have at least 2 packets on your shelf at all times.
3.Delivery Time: The wholesaler delivers within 48 hours after ordering.
4.Deal Offer: If you buy 6 packets, you get 3 packets free. Given these factors, let's analyze the situation:
Consumption and Stock
In two weeks, you consume 1.5 packets. Therefore, to maintain the minimum stock requirement of 2 packets, you would need to order at least 3.5 packets every two weeks. However, since you can't order half a packet, you would need to order 4 packets every two weeks.
Deal Analysis
The deal offers 9 packets (6 bought + 3 free) for the price of 6. If you take the deal, you would have enough stock for 12 weeks (9 packets / 1.5 packets per two weeks).
However, this would mean that you would have a surplus of packets for the next three orders (since you order every two weeks and the deal provides enough for 12 weeks). This could potentially lead to wastage if the packets have a short expiry date.
Conclusion
If the packets have a long expiry date and you have enough storage space, it would be beneficial to take the deal as it provides a lower cost per packet. However, if the packets have a short expiry date or if you have limited storage space, it might be better to stick to your regular ordering schedule.
A2. You are the responsible pharmacist at Care Pharmacy. On 15 January 2011, Emile Laing filled a prescription the following prescription at the pharmacy. Rx Ventolin® inhaler 2 puffs every 4-6 hours prn Repeat x6. He paid cash for the prescription. On 22 January he comes into the pharmacy to have a repeat filled for the Ventolin®. What advice and information do you need to provide?
Answer
:
Providing Advice and Information for a Ventolin®
Prescription Refill
As a responsible pharmacist, it's crucial to provide accurate and comprehensive advice and information when a patient comes in for a prescription refill. In the case of Emile Laing refilling his Ventolin® inhaler prescription, here are the key points to consider:
1. Medication Usage
Ensure that Emile is using the inhaler correctly. Ventolin® should be used as a 'reliever' medication, meaning it's used when needed to alleviate symptoms, not on a regular schedule.
Ask Emile if he's been using the inhaler as prescribed (2 puffs every 4-6 hours as needed).
If he's using it more frequently, it may indicate that his asthma is not wellcontrolled, and he may need a review of his asthma management plan.
2. Side Effects
Inform Emile about potential side effects of Ventolin®, which can include:
Shaking or tremors
Nervousness or anxiety
Headaches
Muscle cramps
3. Prescription Refill
Emile's prescription has 6 repeats. Since he's refilling it on 22 January, this is his first repeat.
Remind him that he has 5 more repeats left after this one.
Explain that each refill should last him a certain period, depending on his usage. If he's using it more frequently, he should consult his doctor.
4. Storage and Expiry
Ventolin® inhalers should be stored in a cool, dry place, away from direct heat and sunlight.
Remind Emile to check the expiry date on the inhaler.
Advise him to discard the inhaler if it's past the expiry date, even if there's still medication left.
5. Emergency Situations
Emphasize that Ventolin® is for managing symptoms but it's not a replacement for medical attention in severe cases.
If Emile finds that the Ventolin® is not relieving his symptoms or he's needing to use it more frequently, he should seek immediate medical attention.
A3. Sally Williams hands in the following prescription. Rx Yasmin® tablets 1x OP Repeat x 5 months What information do you need to provide her with if this is the first time that she will be using this medication?
Answer :
Information to Provide When Starting Yasmin® Tablets
When starting a new medication like Yasmin® tablets, it's important to understand how to use it, what to expect, and any potential side effects. Here's the information Sally Williams should be provided with:
How to Use Yasmin® Tablets
Yasmin® is a daily oral contraceptive pill. It should be taken at the same time each day.
The pill pack contains 21 active pills (with hormones) and 7 inactive pills (without hormones). Start by taking the active pills and then continue with the inactive ones.
If a dose is missed, it should be taken as soon as remembered. If it's close to the time for the next dose, skip the missed dose and go back to the regular dosing schedule. Do not take two doses at the same time or extra doses.
What to Expect
Yasmin® is used to prevent pregnancy. It does this by preventing ovulation (the release of an egg from an ovary) and causing changes in the cervical mucus and the lining of the uterus.
It may take some time for the body to adjust to the medication. Some women may experience spotting or light bleeding, or may feel sick to their stomach during the first 1-3 months.
Potential Side Effects
Common side effects include nausea, vomiting, headache, bloating, breast tenderness, or weight change.
Serious side effects are rare but may include severe migraines, chest/jaw/left arm pain, confusion, sudden dizziness/fainting, changes in vision, slurred speech, or weakness on one side of the body.
Precautions
Yasmin® does not protect against sexually transmitted diseases (STDs). Use a barrier method of contraception (e.g., condoms) for protection against STDs.
Inform the healthcare provider about any medical history, especially of blood clots, high blood pressure, abnormal breast exam, cancer, high cholesterol or triglyceride levels, depression, diabetes, gallbladder problems, severe headaches, heart problems, jaundice during pregnancy or while using hormonal birth control, kidney disease, liver disease, stroke, swelling (edema), thyroid problems, unexplained vaginal bleeding.
Interactions
Yasmin® may interact with other medications, which can affect how it works or increase the risk of serious side effects. Make sure to inform the healthcare provider about all the products being used (including prescription drugs, nonprescription drugs, and herbal products).
PROVIDING PHARMACIST INITIATED CARE TO THE PATIENT AND ENSURING THE OPTIMAL USE OF MEDICINES
A4. Linda Jonas asks for your advice on her 8 year old daughter, Tracey. She has lost weight over the past 2 months and the child is complaining of constant tiredness, abdominal pain and scratching near the anal area. What specific advice and treatment will you give her?
Answer :Based on the symptoms described, it’s possible that Tracey may have a condition such as pinworms1. Pinworms are a common type of worm infection, especially in children, and can cause itching around the anal area1. Weight loss, tiredness, and abdominal pain could potentially be related to this or another type of parasitic infection1. However, these symptoms could also be related to other conditions. For example, chronic abdominal pain in children can sometimes be due to functional abdominal pain, and itching can be a symptom of various skin conditions or even liver damage.
Given the range of possible causes, it’s important that Tracey be evaluated by a healthcare provider. They can perform a physical examination, ask more detailed questions about her symptoms, and potentially order tests to determine the cause of her symptoms.
If Tracey does have pinworms, treatment typically involves medication that kills the worms1. Everyone in the household may need to be treated, because pinworms can easily spread from person to person1. The healthcare provider can give specific advice on this.
In the meantime, here are some general advice:
Encourage Tracey to wash her hands regularly, especially before eating and after using the toilet, to prevent the spread of potential infections
Try to discourage her from scratching the itchy area, as this can lead to skin infections
Ensure she is getting a balanced diet and enough rest, as weight loss and tiredness can sometimes be signs of poor nutrition or overexertion
If Tracey’s symptoms worsen or she develops new symptoms, seek medical attention immediately.
A5. Claudia Mabongo is going on a boat trip from Durban to Mozambique. Her family will be joining her. She wants something to prevent motion sickness. What information do you need from the patient before you can recommend anything? What will you recommend?
Answer : Information Needed from the Patient
Before recommending any medication or treatment for motion sickness, it's important to gather the following information from Claudia:
1.Medical History: Any existing medical conditions, especially related to the heart, liver, kidney, or neurological disorders.
2.Allergies: Any known allergies to medications.
3.Current Medications: Any medications she is currently taking, including over-the-counter drugs, herbal supplements, and prescription medications.
4.Pregnancy or Breastfeeding: If she is pregnant or breastfeeding, certain medications may not be suitable.
5.Age of Family Members: The age of her family members who will be joining her on the trip. Some medications are not suitable for children or elderly people.
Recommendations for Motion Sickness
Based on the information provided, the following are some general recommendations for preventing motion sickness:
Over-the-Counter Medications
Dramamine (Dimenhydrinate): This is a common over-the-counter medication used to prevent and treat motion sickness. It should be taken 30 minutes to 1 hour before travel.
Bonine (Meclizine): This is another over-the-counter medication used for preventing and treating motion sickness. It's less likely to cause drowsiness compared to Dramamine.
Prescription Medications
Scopolamine Patch (Transderm Scop): This is a prescription medication that is applied behind the ear at least 4 hours before travel. It can prevent motion sickness for up to 3 days.
Non-Drug Methods
Ginger: Some studies suggest that ginger can help prevent and treat motion sickness. It can be taken as a capsule, tea, or in candied form.
Acupressure Bands: These bands apply pressure to a point on the wrist and can help some people prevent motion sickness.
PROMOTING COMMUNITY HEALTH AND PROVIDING RELATED INFORMATION
A6. The organisation Mothers-to-be asks you to give a talk on the use of medicine in pregnancy. What would be the main ideas that you would include?
Answer :
Main Ideas
Understanding the Basics
Definition of Teratogens: Teratogens are substances that can cause birth defects. Many medications fall into this category and should be avoided during pregnancy.
Pregnancy and Drug Classification: The FDA classifies drugs into categories (A, B, C, D, X) based on their safety during pregnancy.
Category Description
A No risk in controlled human studies
B No risk in animal studies
C Risk not ruled out
D Positive evidence of risk
X Contraindicated in pregnancy
Safe Medications
Safe Over-the-Counter Medications: Some over-the-counter medications are generally considered safe during pregnancy, such as acetaminophen for pain relief and loperamide for diarrhea.
Safe Prescription Medications: Certain prescription medications, like prenatal vitamins and some antibiotics, are safe and often necessary during pregnancy.
Medications to Avoid
Unsafe Over-the-Counter Medications: Certain over-the-counter medications, like ibuprofen and certain cold medicines, should be avoided during pregnancy.
Unsafe Prescription Medications: Some prescription medications, such as isotretinoin for acne and warfarin for blood clots, are known to be harmful during pregnancy and should be avoided.
Consultation with Healthcare Providers
Importance of Consultation: It's crucial to consult with healthcare providers before starting, stopping, or changing any medication regimen during pregnancy.
Role of Pharmacists: Pharmacists can provide valuable advice on the safety of over-the-counter medications during pregnancy.
PRACTISING PHARMACY IN A PROFESSIONAL AND ETHICAL MANNER
A7. You are the responsible pharmacist at Chempharm pharmacy. You also have a qualified post basic pharmacist assistant helping you in the dispensary. If you leave the pharmacy, what measures should you have in place?
Answer :
Responsibilities of a Pharmacist
As a responsible pharmacist, you have a duty to ensure the safe and effective running of the pharmacy, even in your absence. Here are some measures you should have in place:
1. Delegation of Duties
Ensure that the post-basic pharmacist assistant is competent and understands their role and responsibilities. They should be able to handle basic tasks such as dispensing medication, providing advice to patients, and managing stock.
2. Standard Operating Procedures (SOPs)
Develop and implement Standard Operating Procedures (SOPs) for all tasks performed in the pharmacy. This will provide a guide for the assistant on what to do in various situations.
3. Emergency Contact
Provide your contact information for emergencies. This will allow the assistant to reach you if they encounter a situation they cannot handle.
4. Supervision
Arrange for a locum pharmacist or another qualified individual to supervise the assistant if you will be away for an extended period.
5. Training
Regularly train and update the assistant on new medications, procedures, and regulations.
6. Documentation
Keep a record of all activities performed in the pharmacy. This will allow you to review and monitor the assistant's work.
Here is a table summarizing the measures:
Measures
Delegation of Duties
Standard Operating Procedures (SOPs)
Emergency Contact
Supervision
Description
Ensure the assistant is competent and understands their role
Develop and implement SOPs for all tasks
Provide your contact information for emergencies
Arrange for a locum pharmacist or another qualified individual to supervise
Training Regularly train and update the assistant
Documentation
Keep a record of all activities performed As the responsible pharmacist, you are ultimately accountable for the safe and effective operation of the pharmacy.
A8. -The pharmacy where you work is opening an immunisation clinic. You have to design a template for the patient records that you will be keeping. What information would you include on the record sheet?
-What important aspects regarding the storage of vaccines are important
Answer :
Patient Record Sheet Template
When designing a patient record sheet for an immunisation clinic, it's important to include the following information:
1.Patient Information
Full Name
Date of Birth
Contact Information (Phone number, Email, Address)
Emergency Contact Information
2.Medical History
Known Allergies
Current Medications
Past Immunisations
Chronic or Serious Illnesses
3.Immunisation Information
Name of Vaccine
Date of Administration
Dosage
Route of Administration
Name of the Healthcare Provider who administered the vaccine Here's a simple table to illustrate the layout:
Patient Information Medical History Immunisation Information
Full Name Known Allergies Name of Vaccine
Date of Birth Current Medications Date of Administration
Contact Information Past Immunisations Dosage
Emergency Contact Chronic Illnesses Route of Administration
Healthcare Provider
Vaccine Storage
Proper storage of vaccines is crucial to maintain their efficacy. Here are some important aspects to consider:
1.Temperature Control: Vaccines should be stored within the temperature range recommended by the manufacturer, typically between 2°C and 8°C.
2.Storage Equipment: Use pharmaceutical refrigerators designed for vaccine storage. Domestic refrigerators are not recommended as they may not maintain the required temperature range.
3.Temperature Monitoring: Regularly monitor and record the storage temperature. Use a digital data logger for accurate readings.
4.Stock Rotation: Follow a 'first-expiry, first-out' policy to ensure that the oldest stock is used first.
5.Emergency Plan: Have a plan in place for power outages or equipment failures to prevent vaccine wastage.
A9.a. Cindy Clarke is a newly appointed pharmacist assistant in the facility where you work. She will be responsible for the care and monitoring of the cold chain items. What are the important aspects that she needs to know in order to carry out her duties?
A9.b The institution where you work, manufactures a preparation containing l-amino acids 80g/100ml for parenteral nutrition. You need to design a label for this preparation. What information would you put on the label?
Answer A9.a
As a pharmacist assistant responsible for the care and monitoring of cold chain items, Cindy Clarke needs to understand the following important aspects:
1.Understanding of Cold Chain: Cold chain refers to the process used to maintain optimal conditions during the transport, storage, and handling of vaccines, drugs, tests, and other pharmaceutical products. It involves maintaining a temperature between 2°C and 8°C.
2.Temperature Monitoring: Regular monitoring and recording of the temperature of the refrigerators is crucial. Any deviation from the required temperature range should be immediately reported.
3.Proper Storage: Items should be properly arranged to allow for air circulation. Overstocking should be avoided.
4.Handling of Items: Cold chain items should be handled as little as possible to prevent temperature fluctuations.
5.Power Outages: In case of power outages, a contingency plan should be in place to prevent spoilage of items.
6.Expiration Dates: Regularly check the expiration dates of the items and remove expired items promptly.
7.Training: Regular training on cold chain management should be undertaken to stay updated on best practices.
8.Documentation: Maintain proper records of all activities related to the cold chain items.
Answer A9.b
When designing a label for a preparation containing l-amino acids 80g/100ml for parenteral nutrition, the following information should be included:
Information
Product Name
Description
The name of the product, in this case, "L-Amino Acids
80g/100ml"
Usage "For Parenteral Nutrition"
Ingredients
Concentration
Storage Instructions
Expiry Date
Batch Number
Manufacturer's Name and Address
List of all the ingredients used in the preparation
The concentration of the active ingredient, i.e., "80g/100ml"
How the product should be stored, e.g., "Store at room temperature"
The date after which the product should not be used
The batch number for tracking and recall purposes
The name and address of the institution where the product was manufactured
PROCUREMENT, STORAGE AND DISTRIBUTION OF PHARMACEUTICAL PRODUCTS
A10. You are the responsible pharmacist at a district hospital. On opening the order which has just arrived from the pharmaceutical depot, one of the pharmacists brings a container of a medicine used in the treatment of TB to you. She says that ‘there is something odd about the tablets and thinks that they may be a counterfeit’. Explain what is meant by a counterfeit medicine .
Answer :
Definition of Counterfeit Medicine
A counterfeit medicine is a medication that is deliberately and fraudulently mislabeled with respect to identity and/or source. Counterfeiting can apply to both branded and generic products and counterfeit medicines may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient active ingredients or with fake packaging.
Characteristics of Counterfeit Medicines
Counterfeit medicines may exhibit several characteristics that differentiate them from genuine products:
Packaging: Counterfeit medicines often have packaging that is nearly identical to the genuine product, but may contain small differences in color, size, or spelling errors.
Physical properties: The tablets or capsules may differ in appearance, taste, or texture from the genuine product.
Performance: Counterfeit medicines may not produce the expected therapeutic effect, or may cause unexpected side effects.
Risks of Counterfeit Medicines
The use of counterfeit medicines can pose several risks:
Health risks: Since counterfeit medicines may contain incorrect or harmful ingredients, they can pose serious health risks.
Economic risks: Counterfeit medicines represent a financial loss for patients and healthcare systems, as they pay for a product that does not provide the expected therapeutic benefit.
Actions to Take
If you suspect a medicine to be counterfeit:
Do not dispense the medicine.
Report the issue to the relevant regulatory authority.
Preserve the suspected counterfeit product for investigation.
Action Description
Do not dispense If you suspect a medicine to be counterfeit, do not dispense it to patients. Report Report the issue to the relevant regulatory authority.
Action Description
Preserve Keep the suspected counterfeit product for investigation.
A11. You are working in a primary health care clinic. The average monthly consumption of paracetamol tablets 500mg (10s) in the clinic is 45 packs. The clinic may place orders every two weeks. The current stock is 60 packs. The lead time is 4 weeks. The maximum stock factor is 2. The reorder factor is 3. Is it necessary to order paracetamol 10’s? If it is necessary to order how much should be ordered? Give reasons for your answer.
Answer :
Calculation of Stock Levels
To determine whether it is necessary to order more paracetamol and how much should be ordered, we need to calculate the minimum stock level, maximum stock level, and reorder level.
Minimum Stock Level
The minimum stock level is the amount of stock that must be maintained at all times. If the stock reaches this level, reordering should be done. The formula to calculate the minimum stock level is:
Minimum Stock Level = Reorder Level – (Normal Consumption x Normal
Reorder Period)
Maximum Stock Level
The maximum stock level is the amount of stock beyond which the stock level should not normally be allowed to go. The formula to calculate the maximum stock level is:
Maximum Stock Level = Reorder Level + Reorder Quantity – (Minimum Consumption x Minimum Reorder Period)
Reorder Level
The reorder level is the level of stock at which the next order should be placed. The formula to calculate the reorder level is:
Reorder Level = Maximum Consumption x Maximum Reorder Period
Calculation for Paracetamol
Given that the average monthly consumption of paracetamol is 45 packs, the clinic places orders every two weeks (0.5 months), the current stock is 60 packs, the lead time is 4 weeks (1 month), the maximum stock factor is 2, and the reorder factor is 3, we can calculate the following:
Reorder Level
Reorder Level = Maximum Consumption x Maximum Reorder Period
= 45 packs/month x 1 month
= 45 packs
Minimum Stock Level
Minimum Stock Level = Reorder Level – (Normal Consumption x Normal Reorder Period)
= 45 packs – (45 packs/month x 0.5 month)
= 45 packs – 22.5 packs
= 22.5 packs
Maximum Stock Level
Maximum Stock Level = Reorder Level + Reorder Quantity – (Minimum Consumption x Minimum Reorder Period)
= 45 packs + (45 packs x 2) – (45 packs/month x 0.5 month)
= 45 packs + 90 packs – 22.5 packs
= 112.5 packs
Conclusion
Since the current stock of 60 packs is more than the minimum stock level of 22.5 packs and less than the maximum stock level of 112.5 packs, it is not necessary to order more paracetamol at this time. However, once the stock level reaches the reorder level of 45 packs, an order should be placed.
A12. Mrs van der Merwe comes into the pharmacy with the following prescription. Digoxin 0.25mg tablets (30) Take one daily Furosemide 40mg tablets (56) Take one twice daily Captopril 25mg tablets (28) Take ½ tablet twice daily Explain, in detail, how you would counsel this patient, who is taking these medicines for the first time. Pay particular attention to when and how the medicines prescribed should be taken, and also to possible side effects, their management and to the storage conditions for each product.
Answer :
Digoxin 0.25mg tablets
How to take: Take one tablet daily. It's best to take it at the same time each day.
Side effects: Possible side effects include nausea, vomiting, loss of appetite, and fatigue. If these persist or worsen, contact your doctor immediately. Serious side effects like fast/irregular/pounding heartbeat should be reported to a doctor right away.
Storage: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Furosemide 40mg tablets
How to take: Take one tablet twice daily. Try to take it at the same time each day.
Side effects: This medication may cause dehydration, so drink plenty of fluids unless your doctor directs you otherwise. Other side effects include dizziness, lightheadedness, headache, or blurred vision. If these effects persist or worsen, notify your doctor promptly.
Storage: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Captopril 25mg tablets
How to take: Take half a tablet twice daily. It's best to take it on an empty stomach one hour before meals.
Side effects: You may experience cough, loss of taste, or dizziness. If these persist or worsen, notify your doctor. Serious side effects like fainting, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat) should be reported to a doctor right away.
Storage: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets. Note: Always remember to take your medication as prescribed by your doctor. Do not stop taking your medication without consulting your doctor as this may have serious health implications. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
A13. Mrs Mbeki comes into the Pharmacy where you are working with a prescription for Nexiam® 20mg daily. Explain how you would fulfil your obligations relating to generic substitution with regard to this prescription.
Fulfilling Obligations Relating to Generic Substitution
Generic substitution refers to the practice of replacing a prescribed brandname drug with a chemically equivalent generic drug. This is often done to save costs, as generic drugs are typically cheaper than their brand-name counterparts. However, it's important to follow certain steps to ensure that the substitution is appropriate and safe for the patient.
Here's how you would fulfill your obligations relating to generic substitution for Mrs. Mbeki's prescription of Nexiam® 20mg:
Step 1: Check the Active Ingredient
First, you need to confirm that the generic drug has the same active ingredient as the brand-name drug. Nexiam® is a brand-name drug whose active ingredient is esomeprazole.
**Brand-name drug:** Nexiam®
**Active ingredient:** Esomeprazole
Step 2: Verify the Dosage
Next, verify that the generic drug comes in the same dosage as the prescribed brand-name drug. In this case, the dosage is 20mg.
**Prescribed dosage:** 20mg
Step 3: Consult the Patient
Before making the substitution, it's important to consult with the patient. Explain to Mrs. Mbeki that a generic version of Nexiam® is available, and discuss the potential cost savings.
"Mrs. Mbeki, there's a generic version of Nexiam® available that could save you some money. It has the same active ingredient and dosage as Nexiam®. Would you be okay with us substituting the brand-name drug with the generic version?"
Step 4: Obtain Consent
If Mrs. Mbeki agrees to the substitution, obtain her consent in writing. This is a crucial step in fulfilling your obligations.
**Patient consent:** Obtained
Step 5: Document the Substitution
Finally, document the substitution in the patient's medical record. This ensures that all healthcare providers involved in Mrs. Mbeki's care are aware of the change.
**Substitution:** Nexiam® 20mg replaced with generic esomeprazole 20mg
By following these steps, you can ensure that you're fulfilling your obligations relating to generic substitution in a way that is safe and beneficial for the patient.
PROVIDING PHARMACIST INITIATED CARE TO THE PATIENT AND ENSURING THE OPTIMAL USE OF MEDICINES
A14. Shani Gibbs who is writing her final Matric exams comes into the pharmacy. She says that she felt an itchy tingling feeling on the corner of her lip the day before yesterday. She now has an inflamed cluster of red blisters on her lip.
A14.1 What is the most likely cause of Shani’s signs and symptoms?
A14.2 What trigger factors can lead to the development of this condition?
A14.3 What advice would you give to Shani with regard to the treatment of her lip and the prevention of further symptoms of this nature?
Answer :
A14.1 Diagnosis
Based on the symptoms described, the most likely cause of Shani's signs and symptoms is Herpes Simplex Virus Type 1 (HSV-1), commonly known as a cold sore or fever blister.
A14.2 Trigger Factors
Several factors can trigger the development of this condition:
Stress: Both emotional and physical stress can trigger an outbreak.
Fatigue: Lack of sleep or exhaustion can weaken the immune system and trigger an outbreak.
Illness: Any form of illness that weakens the immune system can trigger an outbreak.
Sun exposure: Excessive exposure to sunlight can cause an outbreak.
Hormonal changes: Changes in hormone levels, such as those during menstruation, can trigger an outbreak.
A14.3 Treatment and Prevention
Here is the advice for Shani regarding the treatment and prevention of further symptoms:
Antiviral creams: Apply antiviral creams as soon as you feel the tingling sensation before the blister appears. This can help reduce the severity and duration of the outbreak.
Avoid touching the sore: Touching the sore can spread the virus to other parts of the body or to other people.
Avoid triggers: Try to identify and avoid potential triggers, such as stress and sun exposure.
Maintain good hygiene: Wash your hands regularly, especially after touching the sore.
Use sun protection: Apply a lip balm with SPF to protect your lips from sun exposure.
Boost your immune system: Maintain a healthy lifestyle with a balanced diet, regular exercise, and adequate sleep to strengthen your immune system and prevent outbreaks.
Remember, while these measures can help manage and prevent outbreaks, there is currently no cure for HSV-1. The virus remains in the body and can cause recurrent outbreaks.
PROVIDING EDUCATION AND INFORMATION ON HEALTH CARE AND MEDICINE
A15. As a retail pharmacist in the community explain to Mrs Gonzales who is 23 years old and has just got married how to use a vaginal tablet.
Answer :
Instructions for Using a Vaginal Tablet
Hello Mrs. Gonzales, congratulations on your marriage. I understand you need guidance on how to use a vaginal tablet. Here's a step-by-step guide:
Step 1: Wash Your Hands
Before you start, make sure to wash your hands thoroughly with soap and water. This is to prevent any potential infection.
Step 2: Prepare the Tablet
Remove the tablet from its packaging. Do not touch it more than necessary to avoid contamination.
Step 3: Position Yourself
Find a comfortable position. Most women find it easiest to insert the tablet while lying on their back with their knees bent, or standing with one foot raised on a chair.
Step 4: Insert the Tablet
Hold the tablet between your thumb and index finger. With your other hand, open the labia (the outer and inner skin folds) and insert the tablet into the vagina as far as it will comfortably go. Do not force it.
Step 5: After Insertion
After inserting the tablet, remain lying down for a few minutes to prevent the tablet from coming out.
Step 6: Wash Your Hands Again
After you have inserted the tablet, wash your hands again. Note: It's often easiest to insert the tablet at bedtime, so it stays in place and gets absorbed while you sleep.
Possible Side Effects
Like all medications, vaginal tablets can have side effects. These may include:
Irritation or burning sensation in the vagina
Increased vaginal discharge
Itching
If you experience any of these side effects or have any other concerns, please contact your healthcare provider.
Important Reminders
Do not use tampons, douches, or other vaginal products while using vaginal tablets.
If you are pregnant, or think you might be, tell your healthcare provider before using any medication.
Always follow the prescribed dosage and schedule. Do not use more or less than instructed.
PROMOTING
A16. You are asked to do a talk to a parents’ meeting at a primary school. The subject of the talk is ‘Head lice and your child’. What key messages would you include in your talk to explain what action a parent should take if he or she discovers that his or her child has head lice?
Answer :
Introduction
Head lice are a common issue among children, especially in primary schools. They are small insects that live on the scalp and feed on human blood. They can cause itching and discomfort, but they are not dangerous and do not spread disease. Here are some key points to consider if your child has head lice.
Detection
Head lice are often hard to see, but their eggs (nits) can be found attached to the hair, close to the scalp.
Common symptoms include itching, a feeling of something moving in the hair, and sores on the head caused by scratching.
Treatment
Over-the-counter treatments are available at pharmacies. These usually involve applying a lotion or spray to the hair.
It's important to follow the instructions on the packaging carefully. Some treatments need to be repeated after a week to kill any newly hatched lice.
Wet combing can also be effective. This involves using a special fine-toothed comb to remove lice and nits from wet hair.
Prevention
Regularly check your child's hair for lice and nits, especially if there is an outbreak at school.
Teach your child to avoid head-to-head contact with other children, as this is how lice are most commonly spread.
There's no need to keep your child off school if they have head lice. However, you should let the school know so they can alert other parents to check their children's hair.
Myths and Misconceptions
Head lice are not a sign of poor hygiene. They can affect anyone, regardless of how clean their hair is.
Lice cannot jump or fly. They spread by crawling from one head to another.
Pets cannot catch or spread head lice.
Conclusion
Remember, head lice are a common part of childhood and nothing to be embarrassed about. With the right treatment and precautions, they can be quickly and effectively dealt with.
PARTICIPATING IN RESEARCH TO ENSURE THE OPTIMAL USE OF MEDICINE
A18. The hospital where you are appointed as the responsible pharmacist is overspent on the budget for medicine. Explain to the CEO how an ABC analysis could be used to address the problem.
Answer :
Introduction to ABC Analysis
ABC analysis is a method of categorizing items into three categories: A, B, and C. This is based on their importance, with 'A' being the most important and 'C' being the least. In the context of a hospital's pharmacy, this could refer to the cost, usage rate, or criticality of the medicines.
Applying ABC Analysis to Pharmacy Budget Management
Step 1: Categorize Medicines
First, we need to categorize all medicines into A, B, and C groups based on their cost and usage:
A-Items: High-cost medicines or those used frequently.
B-Items: Medium-cost medicines or those used moderately.
C-Items: Low-cost medicines or those used infrequently.
Step 2: Analyze Spending
Next, we analyze the spending on each category. Typically, A-items account for a significant portion of the total cost, despite being a small percentage of the total items.
Step 3: Implement Cost
Control Measures
After the analysis, we can implement cost control measures:
A-Items: Strict control measures should be applied. This could include negotiating better prices with suppliers, reducing waste, or finding cheaper alternatives.
B-Items: These items require moderate control measures. We could look for discounts or bulk purchase deals.
C-Items: These items require minimal control measures. However, we should ensure that we are not overstocking these items.
Conclusion
By using ABC analysis, we can identify where most of our pharmacy budget is being spent and implement appropriate cost control measures. This will help us to better manage our budget and potentially reduce overspending.
PRACTISING PHARMACY IN A PROFESSIONAL AND ETHICAL MANNER
A19. Mrs Marais who is a 56 year old patient who you know well received a prescription for 30 diazepam 5mg tablets last month. She takes one tablet at night for sleep. She approaches you for a repeat. You issue 7 more tablets and offer to telephone her medical practitioner later for a prescription. Comment on the legality of this action.
Answer :
Legality of Issuing Repeat
Prescription
The legality of issuing a repeat prescription without a doctor's authorization varies depending on the jurisdiction and the specific regulations of the country or state. However, in many places, it is generally not legal for a pharmacist to issue a repeat prescription for a controlled substance like diazepam without a new prescription from a doctor.
Diazepam and Controlled Substances
Diazepam is a benzodiazepine, a class of drugs that are often controlled substances due to their potential for abuse and dependence. In many jurisdictions, these drugs require a new prescription for each refill.
Pharmacist's Role
Pharmacists are responsible for ensuring that all prescriptions they fill are legal and appropriate. This includes verifying that the prescription is valid, that the medication is appropriate for the patient's condition, and that the patient is using the medication correctly. If a pharmacist issues a repeat prescription without a doctor's authorization, they could potentially be held liable for any harm that comes to the patient as a result.
Conclusion
In the case of Mrs. Marais, it would be more appropriate for the pharmacist to contact her medical practitioner before issuing the repeat prescription. This would ensure that the prescription is still necessary and appropriate, and that Mrs. Marais is not developing a dependence on the medication. It would also protect the pharmacist from potential legal repercussions.
A20. You receive a prescription written by a podiatrist, for an antifungal agent. The indication, dose and duration of treatment mean that this is a Schedule 4 medicine .
Answer :
Understanding Schedule 4 Medicines
Schedule 4 (S4) medicines, also known as prescription-only medicines, are substances or preparations for therapeutic use that:
Are required to be prescribed by a registered medical practitioner, dentist, or veterinarian.
Are available from a pharmacist on prescription. These medicines are deemed to have a higher level of control due to their potential harm if used inappropriately.
Prescription from a Podiatrist
In many jurisdictions, podiatrists are authorized to prescribe a limited list of Schedule 4 medicines. This typically includes antifungal agents, which are commonly used in the treatment of conditions affecting the feet.
Antifungal Agent Prescription
The prescription you received from the podiatrist for an antifungal agent falls under the Schedule 4 category. This means that the medicine:
Must be prescribed by a registered healthcare professional (in this case, a podiatrist).
Can only be dispensed by a pharmacist.
Requires appropriate indication, dose, and duration of treatment.
Key Points to Remember
When dealing with a Schedule 4 prescription, it's important to:
Verify the prescriber's authority to prescribe the medicine.
Ensure the prescription contains all necessary information (patient's name, address, medicine name, strength, dosage, quantity, directions for use, date, prescriber's name, address, and signature).
Dispense the medicine in accordance with the prescription.
Keep a record of the prescription and the supply of the medicine. Here is a simple table to summarize the key points:
Key Point Description
Prescriber's Authority Verify the prescriber is authorized to prescribe the medicine.
Prescription Details Check all necessary information is included on the prescription.
Dispensing Dispense the medicine as per the prescription.
Record Keeping Keep a record of the prescription and the supply of the medicine.
A21. You are approached by a young man asking for emergency contraceptives for his sister who he says is very worried because she had unprotected intercourse last night. Without asking for any additional information, you sell him a pack and record the details as required in terms of the Medicines Act. Comment on the legality of this approach.
Answer :
Legality of Selling Emergency Contraceptives
The legality of selling emergency contraceptives without a prescription varies by country and state. In many places, emergency contraceptives are available over-the-counter without a prescription. However, it's important to note that the pharmacist's professional responsibility extends beyond just the legality of the sale.
Ethical Considerations
Even if it's legal to sell emergency contraceptives without a prescription, there are several ethical considerations to keep in mind:
Patient Confidentiality: It's important to respect the privacy of the individual who will be using the medication. In this case, the young man is buying the medication for his sister, which could potentially breach her privacy.
Patient Counseling: Pharmacists have a responsibility to provide counseling and information about the medication. This includes potential side effects, proper usage, and follow-up care. In this scenario, the pharmacist is unable to provide this information directly to the person who will be using the medication.
Verification of Need: Without asking for additional information, the pharmacist cannot verify the need for the medication. This could potentially lead to misuse or unnecessary use of the medication.
Legal Requirements
In terms of the Medicines Act, there are several requirements that must be met when selling medication:
Record Keeping: The pharmacist must record the details of the sale. This includes the name and address of the purchaser, the name and quantity of the medicine, and the date of the sale.
Labeling: The medicine must be properly labeled with the name and address of the pharmacy, the name of the medicine, and the directions for use. In this scenario, the pharmacist has met these legal requirements. However, they have potentially failed in their ethical responsibilities.
Ethical Consideration Met?
Patient
Confidentiality No
Patient Counseling No
Verification of Need No
Legal Requirement Met?
Record Keeping Yes
Labeling Yes
In conclusion, while the sale of the emergency contraceptive may be legal, it's important for pharmacists to consider their ethical responsibilities as well.
STATE WHAT YOUR APPROACH WOULD BE AND/OR THE ACTION YOU WOULD TAKE IN EACH OF THE FOLLOWING SCENARIOS. GIVE REASONS TO SUPPORT YOUR DECISION.
A22. Mr Manno approaches you for advice. He shows you a cream that he uses for psoriasis. He says that he buys it from a shop in town that he says sells only Chinese herbal medicine. The label is in Chinese. After several months of use, he has noticed that his skin is becoming hypopigmented (losing its colour) in the areas on which he applies the cream, and that small blood vessels seem to be more visible in these areas, which bruise easily. He has also noticed what look like stretch marks in his skin. How would you advise Mr Manno and what do you think has caused his problem?
Answer :
Possible Cause of the Problem
Based on the symptoms described, it seems that the cream Mr. Manno is using may contain a potent corticosteroid. Corticosteroids are often used in the treatment of psoriasis, but they can cause side effects with prolonged use, especially on thin-skinned areas. These side effects can include:
Hypopigmentation: This is the lightening of the skin color, which can occur due to the suppression of melanin production.
Telangiectasia: This is the visibility of small blood vessels near the surface of the skin.
Skin atrophy and bruising: Thinning of the skin can make it more susceptible to damage and bruising.
Striae: These are stretch marks that can occur due to the thinning and weakening of the skin.
Advice for Mr. Manno
1.Stop using the cream: It's important to stop using the cream immediately to prevent further damage to the skin.
2.Consult a healthcare professional: Mr. Manno should consult a dermatologist or a healthcare professional who can provide a proper diagnosis and treatment plan.
3.Use of regulated products: It's advisable to use only regulated products prescribed by a healthcare professional. The contents and safety of unregulated products can be uncertain.
4.Skin care: Gentle skin care practices should be followed to help the skin recover. This includes avoiding harsh soaps and moisturizing the skin regularly. Note: This advice is based on the symptoms described and is not a definitive diagnosis. It's crucial to consult a healthcare professional for an accurate diagnosis and treatment.
A23. Mrs Jenkins who has been a client at your pharmacy for the last five years comes to tell you that she thinks she is pregnant. Her home pregnancy test gave a positive result and she is worried about the outcome of the test. You know that she has a history of ectopic pregnancies and is going through menopause. Explain what advice you would give to Mrs Jenkins.
Answer :
Advice for Mrs. Jenkins
Firstly, it's important to reassure Mrs. Jenkins that it's normal to feel worried and anxious after a positive pregnancy test, especially given her medical history. Here's the advice I would give:
Confirm the Pregnancy
The first step is to confirm the pregnancy. Home pregnancy tests are usually accurate, but it's always a good idea to get a confirmation from a healthcare professional. She should make an appointment with her doctor or a local clinic to get a blood test, which is the most accurate way to confirm a pregnancy.
Discuss Ectopic Pregnancy Risks
Given her history of ectopic pregnancies, it's crucial that she discusses this with her healthcare provider. An ectopic pregnancy is when the fertilized egg implants outside the uterus, most commonly in the fallopian tubes. This can be a serious, life-threatening condition if not treated promptly. Symptoms can include sharp or stabbing pain, light vaginal bleeding, and gastrointestinal symptoms.
Menopause and Pregnancy
Menopause itself doesn't necessarily prevent pregnancy. If Mrs. Jenkins is still having periods, even irregularly, it's possible for her to become pregnant. However, pregnancy during menopause can come with increased risks, including a higher chance of miscarriage and chromosomal abnormalities. It's important that she discusses these risks with her healthcare provider.
Next Steps
If the pregnancy is confirmed and is in the correct place, Mrs. Jenkins will need to start prenatal care. This includes regular check-ups, a healthy diet, and possibly prenatal vitamins. She should also avoid alcohol, tobacco, and any medications not approved by her healthcare provider. Here's a summary table of the advice:
Step Action
1 Confirm the pregnancy with a blood test
2 Discuss ectopic pregnancy risks with healthcare provider
3 Discuss menopause and pregnancy risks with healthcare provider
4 If pregnancy is confirmed and in the correct place, start prenatal care
STATE WHAT YOUR APPROACH WOULD BE AND/OR THE ACTION YOU WOULD TAKE IN EACH OF THE FOLLOWING SCENARIOS. GIVE REASONS TO SUPPORT YOUR DECISION.
A24. You are the only pharmacist working in a small hospital. It is 16h30 on a Friday afternoon. The young medical officer on duty has decided to initiate an intravenous loading dose of phenytoin in a male patient with a head injury who is experiencing uninterrupted generalized tonic-clonic seizures. He asks for your assistance. a. On examination the patient appears to weigh about 60kg. You have no information about his previous medicine use, but there is no indication that he is a known epileptic or that he is currently taking phenytoin.
What dose should he be given intravenously? b. Describe how you would administer this loading dose. Specify the drip rate that you would use. You have standard 50ml, 200ml and 1000ml vacolitres of normal saline and 15 drops/ml giving sets available.
Answer
a. Phenytoin Loading Dose Calculation
Phenytoin is often used as a first-line treatment for acute seizures. The loading dose of phenytoin is typically calculated based on the patient's weight. The standard loading dose is 15-20 mg/kg. Given that the patient weighs approximately 60 kg, the loading dose would be calculated as follows:
15 mg/kg * 60 kg = 900 mg
20 mg/kg * 60 kg = 1200 mg
Therefore, the patient should be given a loading dose of 900-1200 mg of phenytoin intravenously.
b. Administration of Phenytoin Loading Dose
Phenytoin should be administered slowly to prevent complications such as hypotension and arrhythmias. The maximum rate of administration for phenytoin is 50 mg/min.
Here's how you would administer the loading dose:
1.Dilute the phenytoin in normal saline. Phenytoin is typically diluted in a ratio of 1 mg of phenytoin to 1 ml of normal saline. Therefore, if you're administering a 900 mg dose, you would dilute it in 900 ml of normal saline. If you're administering a 1200 mg dose, you would dilute it in 1200 ml of normal saline.
2.Set the drip rate. Given that the maximum rate of administration is 50 mg/min, you would set the drip rate as follows:
900 mg / 50 mg/min = 18 min
1200 mg / 50 mg/min = 24 min
Therefore, the drip rate would be set to administer the entire dose over 18-24 minutes.
Note: Always monitor the patient closely during administration for signs of adverse reactions. If the patient shows signs of hypotension, slow the rate of administration or stop the infusion.
A25. Mrs Sampson a 25 year old woman has recently given birth to a baby girl Daniella. The baby is breast fed. Three (3) weeks after delivery Mrs Smith has been diagnosed with a vaginal infection and prescribed the following drugs. Ciprofloxacin 500 mg stat Metronidazole 2gm stat Doxycyline 100mg I capsule bd—x14 What advice would you give to Mrs Sampson and/or her doctor?
Answer : Advice for Mrs. Sampson and her Doctor
For Mrs. Sampson:
1.Breastfeeding and Medication: It's important to know that some medications can pass into breast milk and may have potential side effects on a nursing infant.
2.Ciprofloxacin: This antibiotic is generally considered safe for nursing mothers. However, it's always best to monitor the baby for any changes in behavior or health.
3.Metronidazole: This medication is also considered safe for breastfeeding mothers. However, some sources suggest waiting 12-24 hours after a single large dose before resuming breastfeeding to allow the drug to clear from the mother's system.
4.Doxycycline: This antibiotic is generally not recommended for breastfeeding mothers as it can affect the baby's teeth and bone development.
For the Doctor:
1.Ciprofloxacin and Metronidazole: These are generally safe for breastfeeding mothers. However, it's always best to advise the mother to monitor the baby for any changes in behavior or health.
2.Doxycycline: This antibiotic is generally not recommended for breastfeeding mothers as it can affect the baby's teeth and bone development. Consider prescribing an alternative antibiotic that is safe for breastfeeding mothers.
Drug Advice for Breastfeeding Mothers
Ciprofloxacin Generally safe, monitor baby for changes
Metronidazole Generally safe, consider waiting 12-24 hours after a single large dose before resuming breastfeeding
Doxycycline Not recommended, can affect baby's teeth and bone development
ADDITIVE QUESTIONS WITHOUT ANSWERS
State whether the given statement is true or false. Aspirin more potently inhibits prostaglandin synthesis and has greater anti-inflammatory effects than other salicylates.
All of the following are true of Acetaminophen except A- Weakly inhibits cyclooxygenase BMetabolized in the liver via glucuronidation C- Analgesic, antipyretic and anti-inflammatory effects D- Interacts with Coumadin
Correct statements concerning aspirin include all of the following except: a) It inhibits mainly peripheral COX. b) It does not have an anti-inflammatory effect. c) It inhibits platelet aggregation. d) It stimulates respiration by a direct action on the r
All of the following are true of NSAID's except: A. Provide analgesia at 50% of the antiinflammatory dose. B. Reversibly inhibit the COX system. C. Are typically only well absorbed in the duodenum. D. Are highly plasma-protein binding.
Describe the side effects associated with non-steroidal anti-inflammatory drugs.
True or false. The inhibition of COX-1 by NSAIDs causes unwanted gastrointestinal reactions, such as stomach irritation and ulcers.
Which of the following property combinations is peculiar to the majority of NSAIDs? a) Antihistaminic, antipyretic, analgesic b) Immunodepressive, anti-inflammatory, analgesic c) Antipyretic, analgesic, anti-inflammatory d) Anti-inflammatory, immunode
Which of the following NSAIDs is a selective COX-2 inhibitor? a) Piroxicam b) Indomethacin c) Celecoxib d) Diclofenac
Indicate the non-narcotic analgesic which lacks an anti-inflammatory effect: a) Naloxone b) Paracetamol c) Metamizole d) Aspirin
Which of the following is true about Hydrocone? A. Contraindicated with ibuprofen B. Commonly in cough preparations C. Sever adverse effects with APAP D. Lower abuse potential than Tylenol
Aspirin and other nonsteroidal anti-inflammatories (NSAIDs) are often used to control the manifestations of chronic inflammatory conditions such as arthritis. Explain their mechanism of action in terms of controlling the inflammatory response.
Which of the following NSAID drugs has a poor antipyretic effect? a) Ketorolac b) Naproxen c) Ibuprofen d) Diflunisal
Select the correct answer. Why is it that Acetaminophen does not have anti - inflammatory effects? A. It is a selective Cox - 2 inhibitor. B. It is a selective Cox - 1 inhibitor. C. Because of it's effects on prostaglandins. D. Because of central, not per
The effect of anticoagulants can be potentiated by taking which of the following? a. Vitamin K b. Thiazide diuretics c. Nonsteroidal anti-inflammatory analgesics d. Vitamin C
Which one of the following non-narcotic agents inhibits mainly cyclooxygenase (COX) in CNS? a) Paracetamol b) Ketorolac c) Acetylsalicylic acid d) Ibuprofen
Which of the following drugs is a 5-lipoxygenase (5-LOG) inhibitor? a) Ibuprofen. b) Zileuton (Zyflo). c) Metamizole (Analgin). d) Diclofenac.
Which of the following drugs is a leukotreine D_4 receptor (LTD_4) blocker? a) Ibuprofen. b) Zileuton (Zyflo). c) Zafirleukast (Accolate). d) Diclofenac.
Which of the following NSAIDs are used primarily to treat Rheumatoid Arthritis and Osteoarthritis? a) Naproxen and Indomethacin b) Ibuprofen and Acetaminophen c) Ketoprofen and Phenylbutazone d) Ketorolac and Diflunisal
What are the analgesic actions of NSAIDs? a. Decreased PG generation means less sensitization of nociceptive nerve endings to inflammatory mediators b. Decreased PG-mediated vasodilation (in headache relief) c. All of the above
Most of non-narcotic analgetics have: a) Anti-inflammatory effect b) Analgesic effect c) Antipyretic effect d) All of the above
All of the following statements regarding diuretics are true except: a) Furosemide (Lasix) can increase the likelihood of digitalis toxicity b) Chlorthalidone (Hygroton) can decrease the excretion of lithium c) Ibuprofen can increase the antihypertensive
Which of the following is NOT an option for the treatment of gout? a-Inhibiting uric acid synthesis b-Increasing uric acid secretion c-Inhibiting leukocyte migration into the joint d-General antiinflammatory and analgesic effects f-All of the above
An injury becoming red and sore is a sign of which of the following? a. Humoral immunity, which results from infiltrating B-cells b. Humoral immunity, which results from antibody release c. Inflammation, which results from histamine release d. Inflammatio
Anti-inflammatory effect of glucocorticoids is caused by a) Reducing the prostaglandin and leukotriene which results from inhibition of phospholipase A2 b) Reducing macrophages migration into the site of inflammation c) Decreasing capillary permeabilit
Which NSAID does not inhibit neutrophil activation? a. Indomethacin b. Celecoxib c. Acetaminophen
Which of the following statements is correct for levodopa? a) Tolerance to both beneficial and adverse effects develops gradually. b) Levodopa is most effective in the first 2-5 years of treatment. c) After 5 years of therapy, patients have dose-related d
Which of the following NSAIDs is a propionic acid derivative? a. Ibuprofen b. Indomethacin c. Metamizole (Analgin) d. Diclofenac
Which of the following options is correct? Whenever the body is re-exposed to an allergen, the binding of IgE antibodies causes a. degranulation and inflammation. b. the release of antihistamines. c. the suppression of the inflammatory response. d. the p
What can be done to prevent the GI side effects of NSAIDs? a. Co-administration of NSAID with PPI. b. Enteric-coated tablets. c. Prescribe CINODs instead. d. All of the above.
The oxicams (piroxicam, tenoxicam, and meloxicam) are similar to the salicylates except they: a. Do not possess anti-inflammatory actions. b. Do not possess analgesic actions. c. Do not possess antipyretic actions. d. Have less GI side effects.
Select the correct answer. Which of the following is not classified as an NSAID? A. Bropheneramine (Veltane) B. Indomethacin (Indocin) C. Naproxen D. Fenamic acid
Which of the following statements is accurate? a. Hormone levels produced during the menstrual cycle are under the influence of both positive and negative feedback mechanisms. b. The corpus luteum will degenerate in the absence of FSH. c. Estrogen and pro
Select the correct answer. Which of the following drugs is used in the treatment of rheumatoid arthritis? a. Naproxen b. Allopurinol c. Colchicine d. Sulfinpyrazone e. Leflunomide
Which of the following is not true of HMG CoA reductase inhibitors? a. They are also called statins. b. They have few adverse reactions. c. The lowering of cholesterol and LDL with these medications is dose dependent. d. They may be discontinued when lipo
Which of the following NSAIDs is an indol derivative? a) Ibuprofen b) Indomethacin c) Meclofenamic acid d) Diclofenac
Which goal of treatment of inflammation is not met by NSAIDs? a. Arrest tissue damaging processes that accompany chronic inflammation. b. Relief of symptoms and maintenance of function. c. Both are met by NSAIDs
Which of the following is not a result of inflammation? a. Warmth b. Redness c. Pain d. Coolness e. Swelling
Which of the following is not a result of inflammation? 1) Warmth 2) Redness 3) Pain 4) Coolness 5) Swelling
Which of the following anti-enzymes is an aromatase inhibitor used in cancer therapy? a) Physostigmine b) Allopurinol c) Aminocaproic acid d) Aminoglutethimide
State whether the given statement is true or false. In patients taking almost any antibacterial drug, diarrhea with fever and abdominal cramps may indicate pseudomembranous colitis.
Which of the following describes osteoarthritis? a. There is an inflammation and fibrosis at the joints. b. It causes an inflammatory erosion of the sites where tendons and ligaments attach to bone. c. It results in a degeneration of articulating cartilag
Select the correct answer. Which of the following is a controlled substance antitussive? A. Dextromethorophan B. Hydrocodone C. Celecoxib (Celebrex) D. Meloxicam (Mobic)
Which of the following statements about drug dependence treatment is false? a) Chemical dependence treatment programs usually involve medications to alleviate withdrawal symptoms. b Detoxification is usually the first step in a drug treatment program. c
Which of the following statements is true? a. Manufacturers of dietary supplements must inform the FTC about negative health reports that may have resulted from the use of their products. b. The FDA can recall a dietary supplements when there is evidence
Which of the following statements about drugs is false? a. Toxicity is the dosage level of a prescription. b. Drugs can be injected into the body intravenously, intramuscularly, or subcutaneously. c. Drug misuse is the taking of a drug for a purpose other
Which of the following statements about progestins is true? a) Progesterone is rapidly absorbed following administration by any route b) In the liver, progesterone is metabolized to pregnanediol and conjugated with glucuronic acid c) Significant amount
Which of the following NSAIDs is an oxicam derivative? a) Piroxicam b) Indomethacin c) Meclofenamic acid d) Diclofenac
Which of the following statements about alcoholism treatment is true? a. Inpatient treatment has been shown to be more effective than outpatient treatment. b. Alcoholism can be cured by detoxifying or ridding the body of all traces of alcohol. c. Antab
State whether the given statement is true or false. Most of the adverse effects associated with \ alpha/ \beta-adrenergic blocking drugs are mild and do not require discontinuation of the drug.
Indicate whether the following statement is true or false. An estrogen-receptor-negative breast carcinoma is usually treated with the drug tamoxifen, which blocks estrogen receptors.
Select the correct answer. All of the following are true of aspirin except: A. High albumin binding.
B. May decrease effects of ACE inhibitors. C. Reversibly inhibits thromboxane. D. Absorption is decreased with higher pH.
The inflammatory response can cause A) pain and a local decrease in temperature. C) increased blood flow to the wounded area. C) antibodies to bind to antigens. D) None of the above
A BDS student while answering the question about ciprofloxacin gave various statements; which of the following statements was rejected by the examiner? a. Clinical antagonism occurs when used with Co-trimoxazole. b. Post-antibiotic effects are similar to
State whether the given statement is true or false. Patients taking vulvovaginal antifungal drugs may experience local irritation, redness, stinging, or abdominal pain.
An NSAID that does not inhibit COX in the GI mucosa: A. Aspirin B. Acetaminophen C. Nalbumetone (Relafin) D. Ibuprofen
Salicylates can displace all of the following drugs except: a. Tolbutamide b. Methotrexate c. Penicillins d. Phenytoin e. Warfarin f. Ibuprofen
Select the correct answer. One of the effects of \mathrm{H_{1 receptor blocker drugs on serotonin receptors is? a. Decreased appetite b. Increased appetite c. Urinary retention d. Polydipsia
Which of the following regarding clinical trials of new drugs is true? a. The FDA conducts clinical trials of all new drugs b. Clinical trials detect all harmful side effects of new drugs c. The best method of testing a new drug in a clinical trial is
State whether the given statement is true or false. The severity of many adverse reactions associated with cholinergic-blocking drugs often depends on the dose.
Which statement is false? a. Acupuncture has been shown to control nausea in patients after chemotherapy. b. Chiropractic has been shown to relieve acute lower-back pain. c. People can learn to control involuntary functions through biofeedback. d. Naturop
Fill in the blank. It is thought that the analgesic action of the salicylates is caused by the inhibition of ____________.
Select the correct answer. Which of the classification of a drug used to relieve a mild allergic reaction? A. Anticonvulsant B. Anticoagulant C. Antihistamine D. Antiinflammatory
Which of the following medications is a depolarizing neuromuscular blocker? Why would you avoid the use of an acetylcholinesterase inhibitor with this medication? A. Rocuronium. B. Vecuronium. C. Succinylcholine. D. Atracurium.
Which COX enzyme is naproxen and diclofenac more selective for? a. COX-1 b. COX-2 c. They are equally selective for COX-1 and COX-2.
Which of the following statements is correct for lithium? a. Stimulates dopamine and betaadrenergic receptors b. Decreases catecholamine-related activity c. Stimulates the development of dopamine receptor supersensitivity d. Decreases cholinergic activit
State whether the given statement is true or false. Topical corticosteroids exert anti-infective activity.
State whether the given statement is true or false. Cranberry juice and capsules have no contraindications, no known adverse reactions, and no drug interactions.
The inflammatory response can cause: a. pain and a local decrease in temperature. b. increased blood flow to the wounded area. c. antibodies to bind to antigens. d. None of the above.
Hydromorphone (Dilaudid) is notable for which of the following? A. Adjunct in pulmonary edema B. Anti-inflammatory and analgesic properties C. Increased risk of addiction D. Good choice for "seekers
What drug has a mode of action that weakly inhibits cylo-oxygenase? A- Aspirin BAcetaminophen C-Ibuprofen D- Naproxen
Determine whether the following statement is true or false: Tolerance is promoted by oral introduction of antigen.
Which of the following antidepressants is an unselective MAO blocker and produces extremely long-lasting inhibition of the enzyme? a. Moclobemide b. Tranylcypramine c. Selegiline d. Fluoxetine
Which NSAID is a pro-drug? a. Ibuprofen b. Aspirin c. Acetaminophen d. Nabumetone e. Meclofenamate
Which of the following is/are false? a-Ranitidine - Zantac b-Misoprostol - Prilosec c-SulcralfateCarafate d-Cimetidine - Tagamet e-All are true
Give the mechanism of action and the result for each of the following therapeutic agents used to treat type I hypersensitivity reactions. a. antihistamines b. cromolyn sodium c. theophylline epinephrine d. cortisone
Which of the following statements regarding iron deficiency anemia is not true? A. May result from bleeding ulcer B. May result from excessive blood donations C. May result from deficiency of vitamins required for efficient iron absorption D. May result f
State whether the given statement is true or false. Extrinsic or allergic asthma causes the immunoglobulin (IgE) inflammatory response.
Which of the following statements about off-label use of a drug is false? A. About 20 percent of medications are prescribed for off-label use. B. Many off-label uses are safe. C. It occurs when a drug is approved by the FDA for one purpose and then prescr
Which one of the following is not true? Tablets are often coated: a) to protect the drug from the external environment. b) to mask bitter tastes. c) to increase friability. d) to make swallowing easier.
Which of the following side effects for the given drugs is wrong? a. Phenytoin - gum hypertrophy b. Ethosuximide - hirsuitism c. Phenobarbital - enzyme induction d. Carbamazepine - ataxia e. Valproate - idiosyncratic hepatic toxicity
Indications of glucocorticoids are following, EXCEPT: a. Gastrointestinal diseases (inflammatory bowel disease) b. Postmenopausal hormonal therapy c. Inflammatory conditions of bones and joints (arthritis, bursitis, tenosynovitis) d. Skin diseases (at
What are three common myths surrounding pain medications? How do these medications potentially affect therapy and clinical response to the patient?
State whether the given statement is true or false. A patient who has recently received radiation therapy may experience additive bone marrow depression when given chloramphenicol.
State whether the given statement is true or false. Cholinergic drugs administered orally or parenterally are not selective in their action like those that are administered topically.
Which statement about reproductive and urinary tract infections is false? a. Yeast infections can be treated with nonprescription drugs. b. Symptoms of UTIs include burning urination, chills, fever, and blood in the urine. c. Three times as many women as
How do NSAIDs cause an anticoagulation effect? a. By binding already formed platelets and preventing aggregation. b. By vasodilating the vessels. c. By inhibiting platelet thromboxane A2 production.
Are non-steroidal anti-inflammatory drugs harmful to the stomach when taken parenterally, for example by intravenous or intramuscular routes? Is it safe to give a patient with a past history of bleeding peptic ulcer aspirin in an antiplatelet dose of 75-3
A variety of drugs with ability to reduce inflammation are available. Comment on the danger of misuse of these anti-inflammatory drugs.
Which statement is true about the long-term use of antianxiety drugs? a) Long-term use may result in dependence but not tolerance. b) Long-term use may result in tolerance but not dependence. c) Long-term use may result in both dependence and tolerance
Determine whether the following statement is true or false: Tolerance is promoted by high doses of antigen.
Which, if any, of the following statements is true about the regulation of calcium levels in the blood? a. If calcium levels experience a significant drop, PTH levels can be expected to rise. b. If calcium levels experience a significant drop, PTH levels
State whether the given statement is true or false. Corticosteroids are effective in the acute treatment of bronchospasms.
Which of the following drugs given preoperatively is used to prevent postoperative pain caused by succinylcholine? a. Dantrolene. b. Tubocurarine. c. Diazepam. d. Lidocaine. e. Baclofen.
Select the correct answer. Which of these histamine receptor blocking drugs is used in the treatment of stomach ulcers? a. Chlorpheniramine b. Loratidine c. Famotidine d. Azelastine
Select the incorrect statement regarding the inflammatory response. A. The alarm signals can be histamines or prostaglandins. B. The inflammation response is a localized specific response to infection or injury. C. Neutrophils spill chemical in the area
Correct statements concerning lidocaine include all of the following except a) It is an universal anesthetic b) It has esteratic linkage c) It is widely used as an antiarrhythmic agent d) It is metabolized in the liver
Indicate whether the following statement is true or false. Contraceptive pills predispose to an ectopic pregnancy.
Which of the following antidepressants is a selective short-acting MAO-A inhibitor? a. Maprotiline b. Amitriptyline c. Moclobemide d. Selegiline
Which of the following is a direct serotonin agonist? a. Fluoxetine. b. Amitriptylline. c. Moclobemide. d. Ondansetron. e. Sumatriptan.
Which of the following statements about Disseminated Intravascular Coagulation (DIC) is NOT CORRECT? a. During DIC there is a mixture of 'bleeding' and 'clotting' as evidenced by the patient's low platelet count and prolonged bleeding times (both PT and
STATE WHAT YOUR APPROACH WOULD BE AND/OR THE ACTION YOU WOULD TAKE IN EACH OF THE FOLLOWING SCENARIOS. GIVE REASONS TO SUPPORT YOUR DECISION.
1 .You are a Pharmacist working in the tablet department. One of the Operators in your department is about to commence the compression of a batch of Sleep Well tablets on the 32 punch compressing machine. He informs you that one tablet produced per rotation is thicker than the other tablets and falls outside the thickness limits allowed. What is the possible cause of the problem? Would you be able to continue compressing the batch? Motivate your answer
Answer : Possible Cause of the Problem
The problem of one tablet being thicker than the others could be due to several reasons:
1.Uneven Die Fill: If the die fill mechanism is not working properly, it could lead to uneven distribution of the powder, resulting in some tablets being thicker than others.
2.Punch Adjustment: The upper and lower punches of the compressing machine might not be correctly adjusted. If one punch is set deeper than the others, it could cause the tablet to be thicker.
3.Wear and Tear: If the punches or dies are worn out or damaged, they could produce tablets of inconsistent thickness.
Continuation of Compression
As a pharmacist, it is crucial to ensure the quality and consistency of the tablets produced. If one tablet per rotation is falling outside the thickness limits, it indicates a problem with the compression process that needs to be addressed.
Continuing to compress the batch without resolving the issue could lead to:
Inconsistent dosage delivery
Potential stability issues
Quality control problems
Therefore, it is not advisable to continue compressing the batch until the issue has been identified and resolved.
Steps to Resolve the Issue
1.Check the Die Fill Mechanism: Ensure that the powder is being evenly distributed into the dies.
2.Adjust the Punches: Check the settings of the punches and adjust them if necessary.
3.Inspect the Punches and Dies: Look for signs of wear or damage and replace any components if needed.
4.Re-calibrate the Machine: If the problem persists, it might be necessary to re-calibrate the compressing machine.
Remember, the goal is to produce tablets that are consistent in size, shape, and dosage. Any deviation from the set parameters should be addressed promptly to ensure the quality and safety of the product
2.1 Reconciliation is conducted during the manufacture of a batch of tablets. At which stages is the batch reconciled and why?
2.1.2 Once the packaging components have been reconciled, what components would you return to stock and what components would you destroy? Motivate your answer.
Answer :
2.1 Reconciliation in Tablet Manufacturing
Reconciliation is a critical process in pharmaceutical manufacturing, including the production of tablets. It involves verifying that the quantities of input materials match the expected output. This process is crucial for quality control, ensuring compliance with regulatory standards, and minimizing waste.
The reconciliation process in tablet manufacturing typically occurs at the following stages:
1.Raw Material Reconciliation: This is done after the dispensing stage to ensure that the correct amount of each raw material has been used.
2.In-process Reconciliation: This is done during various stages of the manufacturing process, such as granulation, compression, and coating, to ensure that the expected quantity of product is being produced.
3.Finished Product Reconciliation: This is done after the final product has been packaged and labeled to ensure that the correct number of tablets is in each package and that the total number of packages matches the expected output.
2.1.2 Reconciliation of Packaging Components
After the reconciliation of packaging components, certain components may be returned to stock, while others may need to be destroyed.
Return to Stock: Components that have not been used, are not damaged, and have not been exposed to any potential contamination can be returned to stock. These might include excess bottles, caps, labels, or cartons that were not needed for the current batch of tablets.
Destroy: Components that have been used, are damaged, or have potentially been exposed to contamination should be destroyed. This might include partially used labels, damaged bottles or caps, or any components that have come into direct contact with the tablets.
The decision to return or destroy components is based on ensuring the quality and safety of the product. Any risk of contamination or error in future batches due to reused components must be avoided.
