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OSCE Comprehensive Pharmacy Review

Prepared by:

Vipul Shah B.Sc. RPH. MBA

Copyright SolRx Inc. 2017. www.solrx.ca Email:[email protected] Phone: 1-888-483-8914

Table of Contents

DESCRIPTION Pg. No

Disclaimer 3

Communication 4

Rx Counselling 9

Brand and Generic names of Rx medications 13

Rx Counselling Cases 23

Information about various products and devices 77

Special instructions regarding various medications 82

Common side effects and their management 85

OTC Counselling 89

Brand and Generic names of OTC products and a few pointers 94

Product pictures 104

OTC counselling cases 128

Questions for some OTC topics 146

Health-care professional stations 155

Disease management cases 188

Hospital based scenarios 194

Device or product demonstration 201

Efficiently using References 215

Non-interactive stations

- Prescription Screening

- Dispensing Check

221

223

235-251


Important Disclaimer

This book is not reviewed by Pharmacy Examining Board of Canada or any other organization. The book

is not recommended by Pharmacy Examining Board of Canada or any regulatory body.

The purpose of the book is to provide orientation towards the Qualifying Exam - 2 (OSCE) conducted by

Pharmacy Examining Board of Canada. The exam structure or assessment criteria may be changed by

the board and hence, the same information and orientation provided in this book may not be relevant in

future.

The authors and publishers assume no liability for any loss due to use of this book. While care has been

taken to ensure that the information provided herein is accurate and up to date, it is recommended that

in case of any doubt, matter should be referred to a professional or the regulatory body.

The authors and publishers do not have access to the exam stations of Pharmacy Examining Board of

Canada and any stations or cases mentioned in the book should not be assumed as a part of upcoming

or previous exams.

On the author’s part, it required significant amount of interpretation & extrapolation of the information

provided by Pharmacy Examining Board of Canada on its website. This means that the expectation set

out by the authors and the board may vary significantly. The author and publishers assume no liability

for this.

Finally, this book does not guarantee a PASS. The purpose of this book is to help orient you towards the

exam.

** PEBC is a trademark of Pharmacy Examining Board of Canada and NOT related to SolRx INC. **


Communication


COMMUNICATION

The literal meaning of communication is an interchange of thoughts, opinions or information by speech,

writing or signs.

38% of your score will be based on your communication for OSCE exam.

OSCE is not only about your knowledge, but about the application of knowledge in health care

setting to ensure complete patient care through an interaction.

Interactions require communication: written and/or verbal.

So what is communication in relevance to OSCE?

The ‘Total’ presentation you deliver in your interaction with the patient or other healthcare providers.

VERBAL COMMUNCATION

It’s all about what you say and how you say it.

SPEAKING

It’s very important to pay special attention, when you communicate with your patients. Sometimes

your gestures you think as normal could be extremely offensive, or simply wrong, and vice versa.

Choose your words carefully as blurting out wrong words can simply cause you trouble or unnecessary

embarrassment.

Example 1:Choice of words may HARM the patient?

While counseling for Prozac 20 mg:

Pharmacist: “Your doctor prescribed you this medication to treat your DEPRESSION”

Patient: “I DO NOT HAVE DEPRESSION. I ONLY HAVE LOW MOOD. I AM NOT GOING TO TAKE THIS

MEDICATION!!!”

Here, the pharmacist should have started by asking why the doctor prescribed the medication.

Example 2:While counseling for ACE inhibitor:

Pharmacist: “Your doctor has prescribed you this medication for hypertension”

Patient: starts using the medication when he feels stressed out or when he has tension.

The Pharmacist should have used simple layman language. “High Blood Pressure Medication”

instead of “Hypertension”


Key points you need to keep in mind while speaking:

Be loud and clear

Use layman language with patient

Use medical language with health care provider

Be precise, do not be repetitive

BE CONFIDENT!

LISTENING

It is a key component to successfully passing each individual station.

Pay special attention to the opening statement – it will give you the theme/gist of the individual station.

If you did not hear the first time, ask politely to repeat and do not make assumptions!

NON-VERBAL COMMUNICATION

It’s about delivering a message without talking. It depends basically on your gesture, body language,

look and the way you approach situations.

Posture and Mannerism

Personal space (Maintain at 5-7 meter distance)

Facial expression - Being pleasant excited, or sympathetic as per the condition

Eye contact

EMPATHY

The intellectual identification of feelings, thoughts, or attitudes of another person’s experience OR the

ability to put oneself in other person’s shoes.

It has to be GENUINE AND APPROPRIATE.

Do not say that you “UNDERSTAND” instead use words like “APPRECIATE” or “IMAGINE”

Example 1: A patient comes into the pharmacy complaining about pain

“I can see that it is really bothering you”

“I will definitely try to help to relieve your pain”

“I will surely help you with that”


Example 2: A patient comes in complaining about lack of sleep

“I can see that you look tired today”

“It must be hard for you”

“I hope this medication gives you the restful sleep you deserve”

LESS IS MORE

In communication, less is more. Listening is as important part of communication as speaking. Even while

you speak, remind yourself to be as precise as possible. Do not keep repeating yourself.

OPEN ENDED VERSUS CLOSED ENDED QUESTIONS

Both types of questions have their importance. Usual way of starting communication is to ask open

ended questions to gather information and then follow up with closed ended question to come to a

conclusion.

Example: Patient comes in for recommendation on cough and cold

You start with open ended questions: “Tell me more about your problem.”

“What else should I know? Is there anything else that I should know of?”

After basic information gathering, you can quickly reach a conclusion by asking closed ended

questions like:” Any fever? Any form of allergies?”

FOLLOWING THE TEMPLATE

It is important to follow a template to ensure your success in the exam. The template allows you to

gather all relevant information quickly and completely. It also allows you to communicate in an

organized way in interactive stations.

The template allows you to:

Not to miss out on important points supplied by the patient

Avoid repeating your questions

Stay organized

Stay focused


You will find out more about templates in the coming chapter. It takes a lot of practice to be able to

deliver what you mean and how you want the patient to understand it.

Also stay alert, because it is an art to pick up on verbal and non-verbal clues from the patient. Rx counseling


Detailed template for Rx stations

INTRODUCTION

Introduce yourself:Hello. My name is _____ I am the pharmacist on duty today. How may I help you?

Identify the Patient: Is this prescription for you?

Are you Mr. (Last Name)? Is it ok if I address you as (First Name?)

Offer privacy and confidentiality:To ensure the accuracy of this prescription and provide proper

counseling, I need to ask you a few questions. Is that okay with you? Please be seated in our private

counseling area and whatever we discuss will be confidential. Please feel free to ask me any questions

you may have.

INFORMATION GATHERING

MEDICAL INFORMATION: Reason for visiting the doctor:What made you see the doctor?

Has this medication been used before:Have you ever tried this medication before?

Have you tried anything else to treat this condition before?

Medical Conditions: Do you have any medical conditions that I should know of?

Besides this, do you have any other medical conditions? (Continue until patient runs out of all his/her

conditions)

Allergies, Severity of allergy:Do you have any known drug allergies? Any environmental or food

allergies? (If yes) What happened when you got the allergic reaction? (Distinguish between true allergy

and Intolerance/side effect)

Rx Medications: Are you taking any prescription medications? (If yes) How are you doing with them?

(Continue until the patient runs out of medications)


Herbal, OTC Medications:Are you taking any over the counter medications like Tylenol or Advil? Are you

taking any herbals, vitamins or mineral supplements?

Pregnancy and Breastfeeding if women 18 - 48:Some medications may not be indicated in pregnancy or

breastfeeding. So, can you let me know if you are pregnant or breastfeeding.

SOCIAL HABITS AND LIFESTYLE INFORMATION: [NOTE: Ask patient permission if you can ask them

questions about their lifestyle]Sometimes, our lifestyle may affect the disease and the way medications

work. May I ask you a few questions about your lifestyle?

Caffeine:Can you tell me if you take any caffeinated beverages like coffee, tea or cola?(If yes) May I ask

how many per day?

Alcohol:Do you consume alcohol? If yes, how many drinks per week?

Smoking:How about smoking? How many packs per day?

Exercise:Do you find time to exercise regularly?

Diet:How would you describe your diet?

(If the patient’s lifestyle is good and healthy, it is a good idea to appreciate it)

CHECKING REFERENCE

[NOTE: Ask permission to look at reference and get back to the patient] Is it okay, if I check my reference

and come back to you?

COUNSELING

What information did the doctor give about the medication: What did the doctor tell you about this

medication?

Drug: brand name, generic name, strength, dosage and duration of treatment:The doctor has prescribed

(Brand name) which contains (Generic name) in the strength of _____. Your doctor wants you to take

(dosage e.g. one tablet once a day at roughly the same time every day.). Continue taking for ____ days.

With or without food:This medication is best taken before/after food. (Give reason). You can take this

medication with or without food, either ways it works fine.

Purpose of medication, how it works and onset:This medication is for _____________. It works by

_______ and thereby controls/helps with _________. It will provide immediate effect/ it may take some


time up to _____before you can see the effect. It must be taken every day for it to be effective. / It

should be taken as and when needed

Side effects: Common side effects and rare side effectsApart from the beneficial effects this medication

has some side effects. You may or may not observe them. Common side effects include _____ and some

rare but important side effects are _____.

Management of side effects: These side effects can be managed by ____ E.g. Since, it may cause

constipation, drink about 8-10 glasses of water every day. E.g. Since, it may cause drowsiness, please do

not drive or operate machinery under its influence. E.g. Since, it is hard on the stomach, make sure you

take it with food and avoid alcohol.

Warning for Anaphylaxis: Since you are taking this medication for the first time, if you get hives all over

the body or shortness of breath or swelling of the lips and tongue you may be allergic to this medication.

Stop taking it and immediately go to the emergency department.

Monitoring/when to see a doctor: You should start feeling better in about ____ days. If not, please

contact your doctor.

Self-care measures: Apart from this medication, there are some self-care measures that you can take to

help your condition. ____________________________

Ask if they have any questions or concernsDo you have any questions or concerns?

Follow up with patient Can I give you a call in ________ days to see how you are doing on this

medication?

Additional optional points depending on each station

Disease management and education

Storage

Demonstration of Device


Brand and Generic

names of common

medications

In this section, you will find a list of some of the very common medications

that you come across in practice. It is recommended that you orient yourself

with these medications and to learn about their importance.


Antiepileptic Therapy:

BRAND GENERIC

Lamictal Lamotrigine

Dilantin Phenytoin

Tegretol Carbamazepine

Migraine Therapy:

BRAND GENERIC

AMERGE NARATRIPTAN

IMITREX SUMATRIPTAN

ZOMIG ZOLMITRIPTAN

Neuropathic Pain Therapy:

BRAND GENERIC

LYRICA PREGABALIN

Antidepressant Therapy:

BRAND GENERIC

PAXIL PAROXETINE

PROZAC FLUOXETINE

REMERON MIRTAZAPINE

CIPRALEX ESCITALOPRAM

CELEXA CITALOPRAM


WELLBUTRIN BUPROPION

Antipsychotic Therapy:

BRAND GENERIC

ABILIFY ARIPIPRAZOLE

RISPERDAL RISPERIDONE

LITHIUM LITHIUM

Parkinson’s Therapy:

BRAND GENERIC

PROLOPA LEVODOPA – BENSERAZIDE

Alzheimer’s Therapy:

BRAND GENERIC

EBIXA MEMANTINE

REMINYL ER GALANTAMINE

Anxiolytic Therapy:

BRAND GENERIC

VALIUM DIAZEPAM

ADHD Therapy:

BRAND GENERIC

STRATERRA ATOMOXETINE

CONCERTA METHYLPHENIDATE

RITALIN METHYLPHENIDATE

Smoking Cessation Therapy:

BRAND GENERIC

CHAMPIX VARENICLINE


Asthma, COPD and Seasonal Allergy Therapy:

BRAND GENERIC

PULMICORT BUDESONIDE

FLOVENT HFA FLUTICASONE

VENTOLIN SALBUTAMOL

NASONEX MOMETASONE

SINGULAIR MONTELUKAST

ADVAIR DISKUS SALMETEROL – FLUTICASONE

OMNARIS CICLESONIDE

ATROVENT IPRATROPIUM

UNIPHYLL THEOPHYLLINE

AVAMYS FLUTICASONE

SYMBICORT BUDESONIDE – FORMETROL

Anti-hyperglycemic Therapy:

BRAND GENERIC

JANUVIA SITAGLIPTIN

GLUCOPHAGE METFORMIN

ACTOS PIOGLITAZONE

DIABETA GLYBURIDE

GLUCAGEN GLUCAGON

HUMALOG INSULIN LISPRO

HUMALIN INSULIN NPH

LANTUS INSULIN GLARGINE

LEVEMIR INSULIN DETEMIR

Dyslipidemia Therapy:

BRAND GENERIC

CRESTOR ROSUVASTATIN


LIPITOR ATORVASTATIN

Antihypertensive Therapy:

BRAND GENERIC

LASIX FUROSEMIDE

HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE

ALTACE RAMIPRIL

RASILEZ ALISKIREN

Antianginal & Cardiotonic Therapy:

BRAND GENERIC

LANOXIN DIGOXIN

NITRO DUR NITROGLYCERIN

NITROLINGUALPUMPSPRAY NITROGLYCERIN

Anticoagulant Therapy:

BRAND GENERIC

COUMADIN WARFARIN

PLAVIX CLOPIDOGREL

Antiemetic Therapy:

BRAND GENERIC

DICLECTIN DOXYLAMINE – PYRIDOXINE

ZOFRAN ONDANSETRON

METOCLOPRAMIDE METOCLOPRAMIDE

Peptic Ulcers & GERD Therapy:

BRAND GENERIC

HP PAC LANSOPRAZOLE – CLARITHROMYCIN – AMOXICILLIN

NEXIUM ESOMEPRAZOLE


IBD &Crohn’s:

BRAND GENERIC

ASACOL 5-ASA

REMICADE INFLIXIMAB

Obesity Therapy:

BRAND GENERIC

XENICAL ORLISTAT

Contraceptives & Hormonal therapy:

BRAND GENERIC

EVRA NORELGESTROMIN - ETHINYL ESTRADIOL

YAZ DROSPIRENONE - ETHINYL ESTRADIOL

SEASONALE LEVONORGESTREL - ETHINYL ESTRADIOL

ESTROGEL ESTRADIOL-17Β

NUVARING ETONOGESTREL - ETHINYL ESTRADIOL

ALESSE LEVONORGESTREL - ETHINYL ESTRADIOL

ANDROGEL TESTOSTERONE

PLAN B LEVONORGESTREL

PREMARIN CONJUGATED ESTROGENS

Acne Therapy:

BRAND GENERIC

ACCUTANE ISOTRETINOIN

CLINDOXYL CLINDAMYCIN – BENZOYL PEROXIDE

Osteoporosis Therapy:


BRAND GENERIC

ACTONEL RISEDRONATE

DIDROCAL ETIDRONATE – CALCIUM CARBONATE

FOSAMAX ALENDRONATE

EVISTA RALOXIFENE

BPH Therapy:

BRAND GENERIC

FLOMAX TAMSULOSIN

PROSCAR FINASTERIDE

Erectile Dysfunction Therapy:

BRAND GENERIC

CIALIS TADALAFIL

VIAGRA SILDENAFIL

Antibacterial, Antiviral & Antifungal:

BRAND GENERIC

CIPRO / CIPRO XL CIPROFLOXACIN

AMOXICILLIN AMOXICILLIN

ZITHROMAX AZITHROMYCIN

BIAXIN / BIAXIN XL CLARITHROMYCIN

AVELOX MOXIFLOXACIN

LEVAQUIN LEVOFLOXACIN

METRONIDAZOLE METRONIDAZOLE

FUCITHALMIC (VISCOUS EYE DROP) FUSIDIC ACID

CIPRODEX CIPROFLOXACIN – DEXAMETHASONE


MACRO BID NITROFURANTOIN

CLINDAMYCIN CLINDAMYCIN

TAMIFLU OSELTAMIVIR

PENLAC CICLOPIROX

NIZORAL KETOCONAZOLE

Antimalarial:

BRAND GENERIC

MEFLOUINE MEFLOQUINE

MALARONE ATOVAQUONE

QUININE QUININE

Vitamins and Minerals:

BRAND GENERIC

SLOW K POTASSIUM CHLORIDE

PALAFER FERROUS FUMARATE

PREGVIT FOLIC 5 MULTIPLE VITAMINS AND MINERALS

Opioids and opioid agonists:

BRAND GENERIC

DURAGESIC FENTANYL

SUBOXONE BUPRENORPHINE – NALOXONE

REVIA NALTREXONE

METADOL METHADONE

OXYNEO OXYCODONE

Anorectal& Wart Therapy:

BRAND GENERIC

ALDARA IMIQUIMOD

PROCTOFOAM – HC HYDROCORTISONE – PRAMOXINE


WARTEC PODOFILOX

HIV Therapy:

BRAND GENERIC

3TC LAMIVUDINE

KALETRA LOPINAVIR – RITONAVIR

Others:

BRAND GENERIC

DDAVP MELT DESMOPRESSIN

DETROL LA TOLTERODINE

CELLCEPT MYCOPHENOLATE MOFETIL

METHOTREXATE METHOTREXATE

PROPECIA FINASTERIDE

SERC BETAHISTINE

PREDNISONE PREDNISONE

PERIDEX CHLORHEXIDINE

EPIPEN EPINEPHRINE

PATANOL OLOPATADINE

XALATAN LATANOPROST

DUKORAL ORAL INACTIVATED TRAVELLERS’ DIARRHEA AND CHOLERA

VACCINE

PROGRAF TACROLIMUS

CELEBREX CELECOXIB

SYNTHROID LEVOTHYROXIN


Recent medications that have been added to the Canadian market

Brand Generic Class or Uses

Zenhale MDI Mometasone&Formoterol Long-Acting Beta2-

Agonist

Vaniqa Eflornithine Hair Growth Inhibitor

Dexilant Dexlansoprazole Proton Pump Inhibitor

Emend Aprepitant Chemotherapy induced

vomiting

Enablex Darifenacin Treatment of overactive

bladder

Invega Paliperidone Antipsychotic

Inspra Eplerenone Aldosterone Antagonist

Olmetec Olmesartan Angiotensin Receptor

Blocker

Onglyza Sexagliptin Antihyperglycemic agent

Staxyn Vardenafil Treatment of erectile

dysfunction

Sublinox Zolpidem Hypnotic agent

Vimpat Lacosamide Antiepileptic agent


Zeldox Ziprasidone Antipsychotic

Zytram XL Tramadol Opioid Analgesic

Zyvoxam Linezolid Antibacterial

Scenario / Background Information: Case 1

Patient is coming to pick up new medication. Respond as you would in everyday practice.

Reference: eCPS, Patient profile

Patient’s Info:

Opening statement: Can I pick up my medication?

Is it for you? Yes. My name is Julia Sanders

Why did you see you Dr: For my low thyroid

Allergy: None

Medications: Rx none

OTC if asked: CaCO3 500mg three times daily

Pregnant: No Breastfeeding: No

Caffeine: No Alcohol: No Smoking: NO Exercise: 30 minutes walk

everyday Diet: Healthy

Question at 5 minute bell: How do I will know that medication’s dose is too low

or too high?

Mannerism: Normal


Special Note:

XYZ Medical Clinic

Xxxx

Xxx

xxx-xxx-xxxx

Julia Sanders

Xxxx

Rx

Synthroid 75 mcg

Levothyroxine 75 mcg 1 tab OD

M: 90 tabs

R X 1

Dr. R Tan

PATIENT RECORD

PATIENT: Julia Sanders

ADDRESS: xxxx

PHONE: xxxx

AGE: 42 years old

SEX: Female

ALLERGIES: NKA


COMMENTS: None

PHYSICIAN: Dr. J. Brown

No. Medications - Directions Q DR

Auth Rem Original Refill Last

Filled

1

Synthroid 75 mcg

Levothyroxine 75 mcg

Take One tablet once daily

90 Dr Tan,R 180 90 180 1 Today

Ideal Response:

Ask what made her see the doctor; did he undergo any blood work?

Explain why Synthroid is prescribed

Counsel on Synthroid: Empty stomach (½ hr before BK or 2 hrs after BK)

Effect not right away; several weeks,

S/E: well tolerated: N-V, Head ache: will go away with time:

To see Dr If Clumsiness; coldness; constipation, dry, puffy skin, tiredness and weight gain (Sign of

under dosing, chest pain, fast or irregular heartbeat, restlessness, sweating, weight loss (Sign of over

dose)

Advice to space apart calcium and levothyroxine by at least 2 hours

Answer 5th minute question: Explain symptoms of low and high thyroid to figure out low and high

dose: Dr will ask for blood work to know right dose and that’s why very important not to miss

doctor’s appointment.

Confirm about doctors follow up

Monitoring (Keep regular doctors and lab appointments) improvement seen in symptoms or not

Self-care

Follow up



Patient is coming to pick up new medication. Respond as you would in everyday practice.

Reference: eCPS(Zoloft), Patient profile, Print out of CMTA (Depression)

Patient’s Info:

Opening statement: Can I pick up my medication?

Is it for you? Yes. My name is Michelle Snow

Why did you see you Dr: For my low mood

Age: 23-Female Allergy : None

Medications: Rx none

Planning to start St John’s Wort for faster recovery

Pregnant: No Breastfeeding: No

Caffeine: No Alcohol: No Smoking: NO Exercise: Don’t feel like it

Diet: Not good Poor appetite

Question at 5 minute bell: What happens if I take St. John’s Wort?

Mannerism: Normal


Special Note:

XYZ Medical Clinic

Xxxx

Xxx

xxx-xxx-xxxx

Michelle Snow

Xxxx

Rx

Zoloft 25mg (Brand only)

Take 1 capsule every night for 1 week and then If tolerated take

2 capsules every night.

M: 30 days’ supply

Make sure to see me after 1 month; Take appointment now.

Dr. R Tan

PATIENT RECORD

PATIENT: Michelle Snow

ADDRESS: xxxx

PHONE: xxxx

AGE: 24 years old

SEX: Female

ALLERGIES: NKA


COMMENTS: None




Filled

1

Zoloft 25mg (Brand only)

Take 1 capsule every night for 1 week

and then If tolerated take 2 capsules

every night

53 Dr Tan,R 53 Zero 53 Zero Today

Ideal Response:

Express empathy: Sorry to hear about your low mood. I will try to help you in this regard.

Rule out pregnancy and breast feeding

Respond to St John wort’s taking for faster recovery: We will talk about this later.

Counsel on Zoloft: With food. 1 cap for 1 week before going to bed and then 2 capsules if no

bothersome side effect.

Effect not right away; several weeks, Physical effects like sleep, appetite and energy level occur

sooner.

S/E: Dryness of mouth: try sugarless gum, constipation: Include fibre food in diet.

Reduced sexual desire.

Continue taking medication even if you feel well and not to stop any point to prevent withdrawal

effect.

To see Dr ASAP is any S/E bother day to day activity. Any thoughts of harming yourself.

Call 911 for severe allergic reaction because first time.

Not to use St John’s wort because of interaction with Zoloft.

Answer 5th minute question: It can lead to Serotonin syndrome: mild (shivering and diarrhea) to

severe (muscle rigidity, fever and seizures). Severe serotonin syndrome can be fatal if not

treated.Checking from CMTA print out.

Convey Dr’s note: To see him after 30 days and book an appointment.

Self-care: Socialising, Joining Gym etc.

Follow up


Few products with important

instructions

For storage, stability, priming

and shaking etc.


Active ingredient Brand name Store at 2* - 8* C

Maximum days at room temp

Prime Shake Indication

Ipratropium Nasal Spray Atrovent Nasal Spray N A N N Allergic Rhinitis

Latanoprost Xalatan Eye Drops Y 6 Weeks N N Glaucoma

Latanoprost/Timolol Xalacom Eye Drops Y 10 Weeks N N Glaucoma

Trifluridine Viroptic Eye Drops Y 30 Days N N Keratoconjunctivitis

Zolmitriptan Nasal Spray Zomig Nasal Spray N A N N Migraine Headache

Sumatriptan Nasal Spray Imitrex Nasal Spray N A N N Migraine Headache

Calcitonin Salmon Nasal Spray

Miacalcin Nasal Spray Y 4 Weeks (<25 *C)

Y N

Acute pain of vertebral fracture,

Osteoporosis

Butorphanol Nasal Spray Stadol Nasal Spray N A Y N

Xylometazoline Nasal Spray Otrivin Nasal Spray N A Y N Allergic Rhinitis

Nitroglycerine Nasal

Spray Y N

Budesonide Aqueous Nasal Spray

Rhinocort Nasal Spray N A Y Y Allergic Rhinitis

Fluticasone propionate Nasal Spray

Flonase Aqueous Nasal Spray

N Between 4 to 30 *C

Y Y Allergic Rhinitis

Mometasone Nasal Spray Nasonex Nasal Spray N A Y Y Allergic Rhinitis

Traimcinolone Nasal Spray Nasacort Nasal Spray N A Y Y Allergic Rhinitis

Levocabastine Nasal Spray Livostine Nasal Spray N A Y Y Allergic Rhinitis

Delta-9-tetrahydrocannabinol (THC)

- cannabidiol (CBD) Sativex Buccal Spray Y 28 Days Y Y

Treatment for the symptomatic

relief of neuropathic pain in

Multiplesclerosis in adults.


MOS = No More Shaking but requires PRIMING:

N = Nitroglycerine

M = Miacalcin Nasal Spray

O = Otrivin Nasal Spray

S = Butorphenol (Stodol) Nasal Spray

Medication where the SHELL comes out in Stool

CONCERTA

ASACOL (5 ASA)

SLOW K

ADALAT (NIFEDIPINE XL)

DETROPAN XL (OXYBUTININ)

Betoxolol Betoptic S N A N Y Glaucoma

Ciclesonide Alvesco

Levocabastine Eye Drops Livostin Eye Drops N Y

Stop if no improvement seen

in 3 days, discard after one month

Desmopressin Acetate DDAVP Nasal Solution Y A Enuresis

DDAVP Nasal Spray y Enuresis

Benzamycin Topical Gel Benzyl Peroxide/

Erythromycin Y Acne

Clindoxyl Gel Clindamycin gel Y

Acne. After Dispensing write 3

months expiry months


DRUGS TO BE TAKEN ON AN EMPTY STOMACH

GASTRO INTESTINAL

Lansoprazole (PPI)

Sucralfate (1h before)

5-Aminosalicylic acid

Domperidone

Metoclopramide

Mineral oil (2h before)

Bisacodyl

Phosphates Solution

CARDIOVASCULAR

Captopril (1hr before preferred)

Perindopril

Cholestyamine

Dialtiazem regular

Dipyridamole (1h before)

Gemfibrozil (30 mins before)

Isosorbide Dinitrate regular

Sotalol (1-2 h before)

ANTIINFECTIVE

Ampicillin

Cloxacillin

Chloramphenicol

Efavirenz

Didanosine — EC

Norfloxacin

Itraconozole liquid

Metronidazole ER

Demiclocycline

Tetracycline

MUSCULOSKELTAL

Alendronate (30mins before)

Etidronate (2h before or after) at night

Risedronate (30mins before)

ANTI-RETROVIRAL

Didanosine (30 mins before or 2 hr after)

Imprenavir

Efavirenz

VACCINES

Cholera vaccine (1hr before & after)

Typhoid vaccine (1 hr before)

CNS

Zalepelon, Diethylpropion (1h before) used in

obesity

Miscellaneous

Mycophenolate tabs/caps/liquid (in organ

transplantation)

Phosphate solution

Bethanechol (for urinary retention)


DIABETES

Nateglinide (1min before meal)

Tolbutamide

Repaglinide

ASTHMA

Sodium Cromoglycate

Zafirlukast

Budesonide

Aminophylline


OTC recommendations


Detailed template for OTC stations

INTRODUCTION

Introduce yourself:Hello! My name is _____ I am the pharmacist on duty today. How may I help

you?

Identify the Patient:Is it for yourself? (Depending on what patient /actor says)

Offer privacy and confidentiality:To ensure that I make an appropriate recommendation, I need

to ask you few questions. Is that okay with you? Please be seated in our private counseling area

and whatever we discuss will be confidential. Please feel free to ask me any questions you may

have


MEDICAL INFORMATION:Symptoms and Red FlagsCan you please tells me the symptoms in

detail?What else?Ask quantity, severity etc.?

E.g.: How many vomits? Since when did it start etc. on a pain scale of 1-10 with 10 being most

unbearable, where would you rate your pain?)

Rule out red flags

Is there anything else you would like to share?

3 essential questions

Did you speak to your doctor about this condition? If yes, what did he advice?

Is it the first time you are experiencing this symptoms? If no, how did you manage it before?

Have you tried any medication for it before coming to pharmacy?

Medical Conditions:Do you have any medical conditions that I should know? Besides this, do you

have any other medical condition? (Continue till patient runs out of all his conditions) Are all you

medical condition under control?


Allergies, Severity of allergy:Do you have any known drug allergies? Any environmental or food

allergies? (If yes) So what happened when you got the allergic reaction? (Distinguish between

true allergy and sensitivity/side effect)

Rx Medications: Are you taking any prescription medications?(If yes) How are you doing with

them?(Continue until they run out of medications)

Herbal, OTC Medications:Are you taking any over the counter medications likes Tylenol or Advil?

Are you taking any herbals, vitamins or mineral supplements?

Pregnancy and breastfeeding if women 18 -48:Some medications may not be indicated in

pregnancy or breastfeeding. So, can you let me know if you are pregnant or breastfeeding

SOCIAL HABITS AND LIFESTYLE INFORMATION

[Ask patient permission if you can ask them questions about their lifestyle]

Sometimes, our lifestyle may affect the disease and the way medications work. May I ask you a

few questions about your lifestyle?

Caffeine:Do you consume caffeinated beverages like coffee, tea or cola?(If yes) May I ask how

many per day?

Alcohol: Do you consume alcohol? If yes, how many drinks per week?

Smoking:How about smoking? How many packs per day?

Exercise:Do you find time to exercise regularly?

Diet:How would you describe your diet?

(If the patient’s lifestyle is good and healthy, it is a good idea to appreciate it)

CHECKING REFERENCE

Ask permission to look at reference and get back to the patient is it okay, if I check my reference

and come back to you?


COUNSELING

Offer choice if available; tablet, liquid, different flavours. Also ask if you have any product in

mind.

Drug: brand name, generic name, strength, dosage and duration of treatmentI am

recommending you (Brand name) which contains (Generic name) in the strength of _____. You

need to take (dosage e.g. one tablet once a day at roughly the same time everyday): Continue

taking this medication for ____ days

With or without foodThis medication is best taken before/after food (Give reason).OR, you can

take this medication with or without food, either ways it works fine.

Purpose of medication, how it works and onsetThis medication is for _____________. It works

by _______ and thereby controls/helps with _________. It will provide immediate effect OR, It

may take some time up to _____before you can see the effect. It must be taken every day for it

to be effective. It should be taken as and when needed

Side effects: Common side effects and rare side effects Apart from the beneficial effects this

medication has some side effects. You may or may not experience them. Common side effects

include _____ and some rare but important for you to be aware of are _____

Management of side effects:These side effects can be managed by ____

Eg1: Since it may cause constipation, drink about 8-10 glasses of water every day

Eg2: Since it may cause drowsiness, please do not drive or operate machinery under its influence

Eg3: Since it is hard on the stomach, make sure you take it with food and avoid alcohol

Warning for Anaphylaxis:Since you are taking this medication for the first time, if you experience

hives all over the body or shortness of breath or swelling of the lips and tongue you may be

allergic to this medication. Stop taking it and immediately go to the emergency department

Monitoring/when to see a doctor: Mention monitoring parameter and when to contact your

doctor


Eg1: In case of fever; if the fever goes above 40.5 c or does not come down in 24 hours or does

not go away in 3 days then make sure you see your doctor

Self-care measures: Apart from this medication, there are some self-care measures that you can

perform to help with your condition ________

Ask if they have any questions or concerns:Do you have any questions or concerns?

Follow up with patient:Can I give you a call in ________ days to see how you are doing on this

medication?

Additional optional points depending on each station

Disease management and education

Storage

Demonstration of Device


Brand and Generic

names of most

commonly used OTC

drugs

The following is a list of over the counter medications that you need to be

aware of. They are scheduled according to different medical conditions

where they can be recommended. Also, study the common things to keep

in mind for each group.


Cold & Flu

Generic Name Brand Name

Acetaminophen 80mg/ml Tempra drops (Infants)

Acetaminophen 160/ml Tylenol Susp. (2-11 years)

Ibuprofen 100/5ml Advil Susp. (2-12 years)

Dextromethorphan &Guaifenesin Robitussin DM

Others Benylin, Buckley’s, Neocitran, Nyquil, Tylenol, Advil*

Keep in mind:

Do not recommend NSAIDs to patients with high blood pressure Accurate dose is usually derived based on weight rather than age Advil (NSAID) is usually taken with food to reduce any gastric irritation NSAIDs are to be avoided in children with asthma Aspirin is not recommended for the treatment of fever in children Self-care measures include:Drinking plenty of fluids, rest and avoid exertion. Also try

to avoid over bundling the child with too many clothes

Nasal Congestion†

Generic Name Brand Name

Pseudoephedrine 30mg Sudafed

Cromolyn Sodium Rhinaris CS

Oxymetazoline Dristan, Drixoral, Otrivin

Saline Otrivin. Salinex, Rhinaris

Loratidine Claritin Nasal Pump

Keep in mind:

Pseudoephedrine should be avoided in hypertensive and diabetic patient. It should not be taken in pregnancy

Some nasal decongestants should not be used beyond few days to avoid rebound nasal congestion

Self-care measure include: Using inhalation steam and using saline water drops for clearing the nasal passage


Product Pictures

Please take a moment and look at the following pictures of

some products.

It is recommended that you familiarize yourself with the

products and how they look in order to be able to give best

recommendation.



Person is coming for OTC recommendation. Respond as you would in everyday practice.

Reference: Print out from CMTC (Fever algorithm and Patient’s Information), Patient profile

Patient’s Info:

Opening statement: What do you recommend for fever?

Is it for you? No. For my daughter Julia Sanders

First time: Yes Did you see your Dr? No Did you try anything : No

Can you describe symptoms in detail: Since yesterday Julia is running a fever and not going down till

morning

Upon asking: Age: 5 years: Weight : 44 LBS

No other symptoms : Everything : No

Did you measure her temperature: Yes,Twice, Yesterday and today morning, 39.5

Allergy : None

Medications : Rx NONE

OTC : None


Pregnant: NA Breastfeeding: NA

Caffeine: NA Alcohol : NA Smoking: NA Playful: Yes, Active Diet: Healthy

Question at 5th minute bell: What can happen if fever is not controlled?

Mannerism: Normal

Special Note:

PATIENT RECORD

PATIENT: Julia Sanders

ADDRESS: xxxx

PHONE: xxxx

AGE: 5 years old

SEX: Female

ALLERGIES: NKA

COMMENTS: None


No. Medications - Directions Q Doctor


Filled

Ideal Response


Empathy: Sorry to hear about Julia’s fever: It must be hard for you. I will try to help you

Initially ask open ended questions for symptoms and not going through her profile

Closed ended questions for fever (Without checking reference): Stiff neck, cough, recent

traveling, any dental procedure, vaccination, ear pain

Check reference: ask any other questions remaining

Recommend Tylenol: Ask for flavour choice(2 on table). Also ask Julia’s between chewable

tablet and liquid. Show chart on package and give according to weight and not age.

Complete counseling for Tylenol: Dose, every 4-6 hours, max 5 times daily. S/E, Allergic

reaction: Emergency

Monitoring: When to see Dr - If fever not going down in spite of Tylenol in 24 hours, if fever

exceeds 40.5, if fever persists more than 3 days or any other symptoms develop like ear

pain, coughing etc.

Answer 5th minute question: If not controlled may lead to seizure known as “Febrile seizure”

Recommend self-care measures: Give her plenty of fluids, avoid excessive clothing, tepid

water sponging

Follow up

Sample

Questions for


some OTC

topics “Asking the right question, in the right form, at the right time, LEADS TO

THE ANSWER”

1. SMOKING CESSATION

QUESTIONS TO BE ASKED BEFORE RECOMMENDATION

How soon after waking up do you smoke?

How many cigarettes a day do you smoke?

What is the nicotine content of your cigarette?

Which is your most satisfying smoke of the day like early in the morning, after eating or any

other?

When do you smoke the most?

What trigger your smoking habit?

How often do you inhale smoke?

Reference: www.nicorette.ca


BEFORE SELECTING NRT GUM, PATCH OR INHALER, GIVE PATIENT A CHOICE

Do you smoke at regular intervals? If yes, then patch

Are you looking for once a day convenience? If yes, then patch

Do you want something specifically for your craving? If yes, then gum

Do you have difficulty in controlling the hand to mouth reflexes? If yes, then inhaler

2. RED EYE

Describe your red eye condition.

How long have you been experiencing this?

Is there any pain or vision change recently?

Is it due to some kind of injury like chemical exposure, foreign body exposure or heat

exposure?

Do you wear contact lenses?

Is there any discharge coming out from the affected eye?

How is the discharge? Is it purulent or watery?

If it’s watery then does eye feel itchy?

Do you feel gritty or sandy particles in your eyes?

Health-care Professionals

Stations

Doctors, Nurses, Care- takers,

Physiotherapist etc.


Detailed template for Doctor Station

INTRODUCTION

Introduce yourself

Identify the Doctor

Identify the Patient


MEDICAL INFORMATION

Reason for prescribing and medical condition


Other Medical conditions

Allergies, Severity of allergy

Rx Medications

Herbal, OTC Medications

Renal function

Pregnancy and breastfeeding if women 18 -48

LIFESTYLE INFORMATION (If the doctor knows)

Caffeine,Alcohol,Smoking,Exercise,Diet

CHECKING REFERENCE

Ask permission to look at reference and get back to the Doctor

STEPS TO FOLLOW IF IT IS A DRUG RELATED PROBLEM AND RECOMMEND AN

ALTERNATIVE

Is the drug right for Current Diagnosis,Age, Gender&Weight?

Is the drug right for itsdose frequency?

Route of administration

Is it compatible with current medical conditions?

Allergy?

Current lifestyle and social habits

Once the drug related problem is identified then check how to manage it

Pharmacological alternative

Non-pharmacological alternative


For pharmacological alternative:Look in the reference available.Algorithms

Guidelines for treatment of particular condition

*** Inform doctor of why prescribed drug is not appropriate choice and give your

recommendation as follows:

Name of drug, strength, dosage and duration of treatment

*** Document neatly on the sheet provided


Door Note: Doctor is waiting inside for your suggestions and help, proceed inside and do as you

would do in regular practice

Reference: CPS, Patient profile

Dr’s Info

Opening statement: My name is Dr Tan, I wrote a prescription for Sam Baptist

If ok to dispense go ahead any questions concern I am here to discuss and do necessary

change if needed.

Rx: Ketaconazole 200mg once daily for 2 weeks for systemic candidiasis (Condition only when


asked)

MC: Everything in profile

Allergy: As per profile

Liver Fn: Normal Kidney Fn: Normal

Medications: As per profile (Cialis 10mg for EDF) If asked

OTC: None

Pregnant: NA Breastfeeding: NA

Life style and social habits: Not known

Question at 5th minute bell: I only want to prescribe Ketoconazole

Mannerism: Normal

Special Note:

XYZ Medical Clinic

Xxxx

Xxx

xxx-xxx-xxxx

Sam Baptist

Xxxx

Rx

Ketoconazole 200mg

One tab once daily for 2 weeks


Dr. R Tan

PATIENT RECORD

PATIENT: Sam Baptist

ADDRESS: xxxx

PHONE: xxxx

AGE: 42 years old

SEX: Male

ALLERGIES: NKA

MC: ED and Systemic Candidiasis

PHYSICIAN: Dr. J. Brown Live Fn: Normal Kidney Fn: Normal



Filled

1

Cialis 10mg(Tadalafil)

Take one-tab prn

12 Dr Tan,R 12 8 12 2 8 days

back

Ideal Response:

Ask the condition for what Rx is written

Ask Liver and Kidney function and blood work to confirm systemic candidiasis.

Check CPS for Dose and duration

Suggest checking dose 200mg for 2-4 weeks and mention the response time is 4 weeks

Dr will change his Rx to 4 weeks

Check reference of Cialis and notice an interaction: Mention that ketoconazole is CYP3A4

inhibitor and dose adjustment is needed for Cialis.(Read this)


“No dose adjustment is required in patients with mild to moderate renal or hepatic

impairment, and those taking protease inhibitors (e.g., ritonavir) or other potent CYP3A4

inhibitors (e.g., ketoconazole). The dosage may be decreased to 2.5 mg/day in these

patients, based on individual tolerability.”

Suggest Dr to change Dose of Cialis from 10mg to 2.5mg as long as he is on this

Document the changes for both

Follow up: Thanks for choosing our pharmacy and if there are any question please call us.

Cases for Disease Management:

SP or SR coming for information only


You need to check references on

table and deal with the situation


Hospital based

Scenarios

Demonstration of


Devices or Products


Efficiently

using

References


Non-

Interactive

Stations

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