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Solrx Pharmacy review book for Qualifying Exam-2(OSCE)

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International Pharmacy

Graduate Comprehensive

Pharmacy Review Program

For Qualifying Exam -2 (OSCE)

Published by: OSprep INC. Canada’s Leading Pharmacy Review Program

Prepared by:

Vipul Shah B.Sc. RPh. MBA




Table of Content

Sr. No. DESCRIPTION Pg. No

1 Rx Counselling Basic 6-12

2 Brand and Generic names of top drugs 13-21

3 New recently introduced medications 22

4 Rx counselling cases 1 to 19 23-83

5 Few products with important instructions like storage, priming

shaking etc 84-95

6 OTC recommendation - Basic 96-103

7 Most commonly used OTC products 104-113

8 OTC recommendation: Cases 20-41 114-148

9 Basic questions for OTC recommendations for few topics 149-157

10 Health-care cases: Basic 158-160

11 Health-care cases 42-50 161-187

12 Managements cases 51-64 188-204

13 Demonstration of devices and few products: Basic 205-208

14 Cases 65-71 209-219

15 Basic of references used for osce 220-227

16 Rx scanning: Basic 228-230

17 Rx scanning: Cases: 72-106 231-239

18 Dispense checking: Basic 240-241

19 Cases 103-122 242-255




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 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 OSprep

INC. **




Rx counseling




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

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:

O Be loud and clear

o Use layman language with patient

o Use medical language with health care provider

o Be precise, do not be repetitive

o 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/ JIST of the

individual station.

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

NON-VERBAL

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

language, look and the way you approach situations.

o Posture and Mannerisms

o Personal space (Maintain at 5-7 meter distance)

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

o 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 type 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:

o Not to miss out on important points supplied by the patient

o Avoid repeating your questions

o Stay organized

o 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.




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 effects Apart 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 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

top drugs

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

Antihyperglycemic 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(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 worts for faster recovering.

Pregnant: No Breastfeeding: No

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

Diet: No good appetite.

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

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

PHYSICIAN: Dr. J. Brown

No. Medications - Directions Q DR

Auth Rem Original Refill Last

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 than 2 capsules if no

bothersome side effect.

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

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 your self.

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

Multiple sclerosis in adults.

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




NMOS = 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)

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 (30 mins before)

Etidronate (2h before or after) at night

Risedronate (30mins before)

DIABETES

Nateglinide (1min before meal)

Tolbutamide

Repaglinide

ASTHMA

Sodium Cromoglycate

Zafirlukast

Budesonide

Aminophylline

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)




Important to know

Empty Stomach = 1 h before or 2 h after meals with a full glass of liquid, usually water

Before Meals = Usually 15 to 30 min before meals

Empty Stomach Preferably = May be taken with food if gastric upset occurs

With or Without Food = May be given without regard to meals

WITH LOTS OF WATER

Allopurinol

Bisphosphonates

Bisacodyl

Metamucil

Docusate sodium/calcium

Cyclophosphamide (x HS – sit in bladder too long)

Efavirenz (avoid high fat meal)

Indinavir

Lithium(prevent dehydratation)

Fluoroquinolones

Theophylline

Tetracycline

TMP/SMX

Sulphonamides

Clindamycin to prevent oesophageal ulcer

Probenacid




Special Instructions: How to take medication (Adopted from CPS)

Alpha-D-Galactosidase: Swallow, chew or crumble onto food; add only to food cool enough to eat

Amiloride: Food decreases GI side effects; avoid large quantities of potassium-rich foods

Buprenorphine/Naloxone: Sublingual. Place under tongue until dissolved; takes 5 to 10 minutes for

the tablet to dissolve; do not swallow

Captopril: 1 h before meals preferred; may take with food but be consistent

Carvedilol: Food slows rate of absorption and incidence of orthostatic effects especially during

dose titration; take with a glass of water

Cefuroxime Axetil suspension: Food increases absorption; may add to cold milk, lemonade, and

apple, orange or grape juice before administration, drink immediately

Chloral Hydrate: Dilute with 120 mL of water or other liquid, e.g., fruit juice, to reduce gastric

irritation

Chlordiazepoxide/Clidinium: 30 to 60 min before meals to maximize absorption

Cholera Vaccine and Traveler’s Diarrhea — Inactivated: Avoid food and drinks 1 hour before and

after vaccine administration; vaccine is acid labile. Dissolve supplied effervescent granules of

sodium hydrogen carbonate buffer in a glass of water (~150 mL). Mix vaccine with sodium

hydrogen carbonate solution and drink the mixture within 2 hours. Can also store mixture at room

temperature (<27°C) for up to 2 hours

Cholestyramine: Mix with water, milk, fruit juice or other noncarbonated beverage; may also be

mixed with highly fluid soups or pulpy fruits with high moisture content, e.g., applesauce, crushed

pineapple

Colestipol - granule : Add to water, milk, flavored drink, juice, carbonated beverage or any other

liquid; may also add to hot or cold cereals, soups (avoid chunky soups), yogurt, pudding, cottage

cheese or pulpy fruits, e.g., crushed pineapple, pears

Digoxin: Meals high in bran fiber may reduce amount of drug absorbed

Docusate Sodium - drops/syrup: Dilute with milk, fruit juice or infant formula to mask bitter taste

Doxycycline: Food decreases GI side effects; with a glass of water to avoid esophageal ulceration.

Avoid concomitant use of milk, antacids or drugs containing aluminum, calcium, magnesium or iron




Esomeprazole: With a glass of water; may disperse in 120 mL of non-carbonated water — no other

liquids should be used as the enteric coating may be dissolved, stir until tablet disintegrates, drink

the liquid with the pellets within 30 minutes, rinse the glass with 120 mL of water and drink; the

pellets must not be crushed or chewed

Felodipine: With a glass of water; avoid meals rich in carbohydrate or fat — significant increase in

Cmax

Finasteride: Crushed or broken tablets should not be handled by women who are or may become

pregnant

Hydromorphone SR: Swallow whole; may sprinkle contents of capsule onto soft food but do not

chew the beads

Hydroxyurea: With a glass of water; may empty contents of capsule into a glass of water and take

immediately. Do not allow powder onto hands and do not inhale powder

Iron Salts - capsules/tablets: Food, especially dairy products, coffee and tea, decreases absorption

and GI side effects

Iron Salts - liquid: Dilute dose with water or juice (not milk)

Itraconazole - capsules: Swallow whole; with cola beverage if achlorhydria or on acid secretion

suppressor.

Itraconazole - liquid: Swish and swallow; do not rinse after swallowing. Not with grapefruit juice;

see also Drug Administration and Grapefruit Juice section in Clin-Info

Ketoconazole: With cola beverage if achlorhydria or on acid secretion suppressor

Lansoprazole - capsules, delayed release: Before breakfast and/or meals; with a glass of water;

swallow whole; delayed-release capsules can be opened and the intact granules can be sprinkled

on a tablespoon of applesauce and swallowed immediately; do not chew or crush granules;

granules can also be mixed in juice for nasogastric administration (stable for up to 30 min)

Levodopa/Carbidopa - CR: 200/50 strength tablets may be halved

Levothyroxine: Be consistent; can be crushed and suspended in water or mixed with soft food, e.g.,

applesauce; however, do not use foods with a large amount of soybean, fiber or iron for

administration

Linezolid: Avoid foods or beverages with high tyramine content




Metformin - ER: Must be taken with food — optimizes absorption and ensures complete release of

metformin

Montelukast Sodium - granules: Can be taken directly by mouth. May mix granules with a spoonful

of cold or room temperature food, e.g., applesauce; do not chew granules

Morphine - SR: With a glass of water; only 200 mg SR tablet (MS Contin) may be halved along

scored line; may open SR capsule and sprinkle contents onto soft food, e.g., applesauce; do not

chew the pellets

Nicoumalone (Acenocoumarol): Be consistent; avoid abrupt changes in diet to maintain constant

vitamin K intake

Nimodipine: If patient cannot swallow capsule, contents may be aspirated into syringe, emptied

into patient's naso-gastric tube and washed down tube with 30 mL normal saline

Nystatin: Sparingly absorbed

Pancreatic Enzymes - capsules with EC granules: With each meal or snack; with a glass of water;

swallow whole; may open capsule and sprinkle onto soft food, e.g., applesauce, do not chew

granules, take immediately after sprinkling

Potassium Salts - SR capsules: With a glass of water; swallow whole; may sprinkle contents of

capsule onto soft food, e.g., applesauce, and swallow without chewing

Potassium Salts - SR tablets: With a glass of water; may break tablet in half for K-Dur; may also

disintegrate tablet in half glass of water, stir and swallow immediately, rinse any residue on glass

with more water and swallow

Psyllium - powder: With meals for cholesterol-lowering effect; mix dose into water, juice or other

suitable liquid; follow dose with additional glass of liquid

Theophylline - Uniphyl: With or shortly after evening meal; with a glass of water; tablet may be

halved

Topiramate - capsules: Swallow whole; may sprinkle contents of capsule onto soft food, e.g.,

applesauce, swallow without chewing




Common side effects and their management

Retinoids - Photosensitivity : Use sunscreen higher than SPF 30

Chapping of lips and dry skin: Use emollient and lip balm

Triptans - Flushing, bad after taste, Nausea, vomiting

Dizziness: Do not operate heavy machinery or task that require attention

ACE I - Hypotension: Do not change the posture abruptly

Headache: take 1-2 tabs Tylenol if needed. Except: RPS

Champix (Varenicline) - Constipation: Drink minimum of 8 glasses of water

Other GI side effects like nausea vomiting- take with food.

Detrol LA (Tolterodine) - Dry mouth, suck on ice chips, sugarless candies, or chew gum

GI side effects- with food

Flomax (Tamsulosin) - GI side effects – Take with food

Nasal congestion- use steam, Vicks vaporub, and nasal saline.

Rhinitis - Drink lukewarm water; speak to your doctor if bothersome

Headache- take with 1-2 tab of Tylenol if needed

Lamictal (Lamotrigine) – Headache - Take with 1-2 tabs of Tylenol if needed

Drowsiness, dizziness- do not operate heavy machinery or drive

3TC (Lamivudine) - GI side effects- with food

Constipation - Lots of fibres and 8 glasses of water




Lyrica (Pregabalin) - Weight gain - Consult a dietician and exercise

Dry mouth, suck on ice chips, sugarless candies, or chew gum

Drowsiness, dizziness - Do not operate heavy machinery or drive

Constipation - Lots of fibre and 8 glasses of water

Methotrexate - Mouth ulcer: Ask your Dr for folic acid Rx

Photosensitivity – sunscreen higher than SPF 30 and protective clothing

Nausea, vomiting- with food. If bothersome speak to your doctor. Use Gravol

ORS and electrolyte drinks like gastrolyte, or ginger cubes

Plavix (Clopidogrel) - Dizziness - Do not operate heavy machinery or drive

Bleeding - Don’t do any activities where there is chance for cut or fall

Premarin (Conjugated estrogens) - Weight gain - Consult a dietician and exercise

Nausea, vomiting – Take with food

Headache - Take 1-2 tabs Tylenol if needed

Mood changes - Get involved in activities that elevate your mood

Proscar (Finasteride) - Runny nose - Keep tissues handy, if bothersome, visit us or doctor

Dizziness - Don't drive or operate heavy machinery until you are adjusted to the drug

Postural hypotension - Change your posture slowly

Remeron (Mirtazepine) - Dry mouth - Chew gum, sugar free candies, frequent sips of water

Weight gain and increased appetite - Include exercise in your daily routine, increase sleep

Prograf (Tacrolimus) – Headache - If not bearable take Tylenol

Insomnia, increased glucose levels - Keep your regular doctor’s appointment

Avoid grape fruit juice to prevent increased risk of side effects.




Risperdal (Risperidone) – Nausea - Take with food

Tremors and difficulty in movement - Could subside with continuous use

Slow K – Nausea, vomiting, stomach upset - Take it after meals

Xenical (Orlistat) - Bloating, flatulence and oily spotting – Take with or after meals

Increased risk of infection - Yogurt and probiotics (No fat meal - Skip dose)

Zofran (ondansetron)- decrease heart rate, headache, increase LFT keep your lab appointments

(for chronic use only) some stomach upset

SSRIs - Nausea, loss of appetite, weight loss – Maintain a healthy diet with frequent small meals

Sleep disorder - Start in the morning if you feel tired or sleepy switch to bed time

ISDN – Headache - 1-2 tablets of Tylenol however it’s usually transient

Flushing, increased risk of falls - Take it while sitting and change your posture slowly

Antimalarial - Sun sensitivity - Use sunscreen, if any change in vision, contact doctor

Stomach upset - Take with food

Mefloquine could be taken with a glass of milk.

Macrobid - Urine discolouration, transient headache, loss of appetite

Nausea - Take with food

Xalatan (Latanoprost) - Change of eye color, stinging and discomfort, increase in eyelash length

B-blockers - Dizziness ,fatigue - Do not operate machines or drive until you adjust to it

Increased risk of falls - Change posture slowly

Fluctuated glucose levels - Keep regular lab appointments




B-agonist - Heart racing, headache – usually transient, can take Tylenol

Dizziness – Change posture slowly

Estrogen – Nausea, vomiting - Take with food,

Breast tenderness - Self-examine breasts for lumps

Weight gain - Include exercise in your daily routine

Spotting is possible, if you experience ACHES stop using the medicine

Corticosteroids - Oral thrush - gargle after inhalation / swallowing

May deplete calcium - Take calcium and vitamin D

Increased risk of infection - Use probiotics or yogurt

NSAIDs - Acidity, heartburn - Take with food.

Statins - Avoid grape fruit juice except RPS

Dizziness – Change posture slowly

Mild nausea – Take with food

Opioids - Constipation - 8-10 glass of water

Nausea – Take with food

Drowsiness – Caution when driving or operating machinery

Causes dependence and tolerance.

**Exercise: Complete the rest of the most common prescription

list of drugs on your own using the above format as a guide. **




OTC recommendations




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

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:

O Be loud and clear

o Use layman language with patient

o Use medical language with health care provider

o Be precise, do not be repetitive

o 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/ JIST of the individual

station.

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

NON-VERBAL

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

look and the way you approach situations.

o Posture and Mannerisms

o Personal space (Maintain at 5-7 meter distance)

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

o 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 type 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:

o Not to miss out on important points supplied by the patient

o Avoid repeating your questions

o Stay organized

o 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.




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 Flags Can 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 treatment I 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 food This 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 onset This 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†


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




Allergy medications


Loratadine Claritin

Desloratidine Aerius

Diphenhydramine Benadryl

Chlorpheniramine Tripolon

Fexofenadine Allegra

Diphenhydramine Cr. Benadryl Cr.

Hydrocortisone Cr. 1% Hydrocortisone Cr.

Keep in mind:

Desloratidine has anti-allergic and decongestant properties

Loratadine, desloratadine, cetirizine have non-drowsy properties

Benadryl, chlorpheniramine have drowsy properties and should be avoided where alertness is required e.g. Taxi driver

Self-care measures include – Avoiding allergens and maintaining a diary to identify trends and irritants

Eyes and Ears Drops


Polymyxin B + Gramicidin Polysporin Eye/Ear Drops

Polymyxin B + Bacitracin Polysporin Ophthalmic Ointment

Sodium Cromoglycate Opticrom Eye Drops

Arachis oil Cerumol (Removal of ear wax)

Antipyrine + Benzocaine Auralgan (Ear Ache)

Keep in mind:

Stinging and burning on the eyes upon application of eye drops is common, and doesn’t indicate the level of effectiveness of the eye drops.

For ear wax removal, patient can also use vegetable oils that will result in clearing the auditory canal.

Self-care measures for the eye include; apply the drops to both eyes as spreading of the infection to the other eye is very common, avoid rubbing the eyes and use aseptic technique while applying the drops

Self-care measures for the ears; avoid using Q-tips or inserting any objects into the ear to clean it as this may result in damaging the ears




Cold Sores


Docosanol Abreva

Hemorrhoids

Zinc sulfate 0.5% Anusol Ointment

Pramoxine 1% + Zinc sulfate 0.5% Anusol Plus

Shark liver oil 3% Preparation H

Keep in mind:

Self-care measures include - Empty your bowels before applying the medication to maximize the contact time, avoid prolonged sitting on the toilet seat

Avoid spicy food as it may irritate the piles

Constipation


Sodium Picosulfate + Citric acid + Magnesium Sulfate Pico-Salax

Bisacodyl Dulcolax

Sennosides SenoKot

Sennosides + Docusate sodium SenoKot-S

Docusate Sodium/Calcium Stool Softener

Glycerin Suppositories Glycerin Suppositories

Sodium phosphate solution Fleet Enema

Mineral oil Fleet Enema (Mineral oil)

15 gm of Magnesium citrate per 300 ml Citro Mag

PEG 3350 RestroLax

Psyllium Metamucil

Keep in mind:

Metamucil is safe to use in pregnancy to treat constipation Self-care measures include - Drinking plenty of fluids, adding fibers to diet and being

physically active Opioids like Tylenol#3 can cause constipation. Metamucil should not be recommended for

opioid related constipation Use of suppository or enema can help empty the bowel quickly while takes longer for




Metamucil to work

Diarrhea


Loperamide 2 mg tablet or Liquid 2mg/15ml Imodium

Bismuth Subsalicylate Pepto-Bismol

Attapulgite suspension Kaopectate

Oral rehydration solution Gastrolyte (adults) Pedialyte (pediatric)

Probiotics Probiotics

Keep in mind:

Imodium (Loperamide) is not recommended in children less than 12 years Avoid Pepto-Bismol in children under 14 years old with fever (Reye’s syndrome) Avoid Pepto-Bismol in individuals allergic to aspirin Oral rehydration therapy is recommended in diarrhea to avoid dehydration. For children,

Pedialyte can be recommended. Gastrolyte is recommended for adults. Gatorade G30 can be also be recommended

Kaopectate can be recommended in children For Traveler’s Diarrhea: Use of bottled water is recommended. Avoid eating raw food.

Always remember: peel it, boil it, cook it or forget it. Pepto-Bismol can be use both as prophylaxis as well as treatment for Traveler’s Diarrhea

Nausea, Vomiting & Motion Sickness


Dimenhydrinate Gravol (Pink Pack)

Ginger Gravol (Green Pack)

Scopolamine Transderm V

Keep in mind:

Ginger is a non-drowsy option for people who need to avoid drowsiness Gravol is given to children less than 2 years and in pregnancy on advice of physician Transderm V is not recommended to use more than 6 days in total and each patch no more

than 3 days Oral rehydration therapy is an important self-care measure to prevent any dehydration Gravol (dimenhydrinate) has potential for abuse. Watch out for customers asking for large

quantity.




Heartburn


Ranitidine Zantac

Famotidine Pepcid

Chewable Calcium Carbonate Tums

Aluminum Hydroxide and Magnesium Carbonate Gaviscon

Magnesium Hydroxide and Aluminum Hydroxide Maalox

Bismuth Subsalicylate Pepto-Bismol

Aspirin + Sodium bicarbonate + Citric acid Alka-Seltzer

Sodium bicarbonate + Citric acid Eno

Magnesium hydroxide Philips Milk of Magnesia

Keep in mind:

Avoid Bismuth subsalicylate in individuals <18 years old, or those allergic to aspirin Tums - Safe in pregnancy Common irritants include: smoking, alcohol and large & heavy meals Self-care measures include - Avoiding irritants, having smaller meals, avoid meals late at

night, elevating head of the bed

Gas


Simithicone Ovol/Gas-X/Phazyme

Keep in mind:

Gripe water comes in 2 forms: one is alcohol free – recommended for children and infants Avoid talking while eating food. This may help with gas problem

Emergency Contraceptive


Levonorgestrel Plan B (Morning after pill)

Keep in mind:

Now schedule 3 – i.e. available over the counter previously sold as schedule 2 drug Time sensitive: effectiveness depends on how soon you take after unprotected intercourse.

Maximum effectiveness is within first 24 hours and can be used up to 72 hours, but effectiveness decreases.




Premenstrual Syndrome (PMS)


Acetaminophen Tylenol

Ibuprofen Advil/Motrin/Midol

Vaginal Yeast Infection


Fluconazole (one tablet) Diflucan One

Clotrimazole 500 mg tablet or 10% cream Canesten 1

Clotrimazole 200 mg ovule or 2% cream Canesten 3

Clotrimazole 1% cream Canesten 6

Miconazole 1200 mg ovule Monistat 1

Miconazole 400 mg ovule Monistat 3

Miconazole 100 mg ovules Monistat 7

Keep in mind:

Fluconazole 150 mg is now available as OTC product (Diflucan One) 1 day, 3 days or 6/7 days treatment in Canesten or Monistat – the time it takes to resolve

the symptoms is the same but different dosing regimens offers convenience Self-care measures include wearing cotton undergarments, maintaining balanced diet and

avoiding tight clothing

Back Pain


Methocarbamol + Ibuprofen Robax Platinum

Methocarbamol + Acetaminophen Robaxacet

Methocarbamol + Acetylsalicylic acid Robaxisal

Keep in mind:

Methocarbamol is a muscle relaxant and known to cause drowsiness Robaxacet is a better option for people with heartburn or sensitive stomach




Nicotine replacement therapy


Gums Nicorette gum

Inhaler Nicorette Inhaler

Patches Nicoderm

Patch + Gum Combo Quit

Puffer Quick Mist

Keep in mind:

It is common to fail and may take multiple attempts before people can succeed in quitting Patches are available as Step 1, 2 and 3 Gums are available as 2mg and 4 mg Things that can help increase chances of success: setting a quit date, quit on relatively stress

free days and remove smoking paraphernalia like ashtray that will remind you of smoking Also when there is craving – direct your attention somewhere else. Drink water, do physical

activity etc.

Acne


Benzoyl Peroxide Benzagel (2.5% / 5%)

Keep in mind:

Self-care measures include - Avoid using oil base cosmetics, avoid squeezing the pimples and avoid using harsh soaps

Dandruff and Hair Fall


Selenium Sulfate 2.5% Selsun Blue

Ketoconazole 2% Nizoral

Minoxidil 2% Rogaine

Lice treatment


Permethrin Nix

Piperonylbutoxide + Pyrethrins topical R & C




Isopropyl Myristate Resultz

Keep in mind:

Avoid recommending Nix or R&C in patients with chrysanthemum or rag weed allergy Nix can be recommended for children starting 2 months Self-care measures include - Washing washable items in hot water, non-washable items

need to be stored for 2 weeks in sealed bags and using a towel soaked in vinegar and placing it on top of the hair for 30 minutes will facilitate nits removal

Athlete’s Foot


Tolnaftate 1% Tinactin (Powder spray / Cream)

Clotrimazole Canesten

Miconazole 2% Micatin

Plantar Warts


Topical Salicylic acid for warts (liquid) Duo film

Keep in mind:

Avoid touching healthy skin during application Self-care measures include - Soak foot in water for 5 minutes and remove dead skin using

pumice stone, always put on foot wear and avoid walking bare foot in public areas

Insomnia


Diphenhydramine 25mg Sleep Eze

Diphenhydramine 50mg Nytol, Unisom

Keep in mind:

Sleep aids are not recommended for use for more than 14 days a month If the patient needs sleep aids for more than 10 consecutive nights, then they will need to see

their doctor Advice patient about sleep hygiene. (Sleep in a dark sound proof room, avoid physical exercise

before going to bed, avoid caffeine and nicotine before going to bed)




CNS Stimulant


Caffeine 200mg Wake up

Iron Supplement


Ferrous Fumarate Palafer, Eurofer

Polysaccharide iron complex Feramax 150

Topical Anesthetic


Lidocaine 2.5% + Prilocaine 2.5% EMLA Cr.

*Those products come in a huge variety and pack size according to indication. Please take a moment to check them online

or in the closest pharmacy to you.

†Check the pack for those products carefully before dispensing. Same brand name can be either normal saline or an actual

medication.




Scenario / Background Information: Case 20:

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 temp: Yes : two times : Yesterday and today morning: Same : 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

PHYSICIAN: Dr. J. Brown



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




Case 1 - Tylenol liquid (Acetaminophen)

Usual dose 10-15 mg/kg every 4-6 hours when needed

(No greater than 5 doses per day or 65

mg/kg/day)/use wt chart from package

Uses Treatment fever in children

Treatment of pain in children

Major interactions Enzyme inducers: (Phenytoin, Barbiturates,

Carbamazepine, Isoniazid) decrease

acetaminophen levels.

Contraindications Hypersensitivity

Malnutrition / Fasting

Common side effects Generally well tolerated

Serious or rare side effects Overdose symptoms:

Nausea

Vomiting

Hepatotoxicity

Death

Special

Counselling

• What is bothering you? How can I help you? (Pay close attention to their main complaint as you will

need to address it first)

Did you talk to your doctor about it?

Ask the patient relevant questions to rule out red flags

• How long has the fever been present?

• How old is your son/daughter?

• How high is the fever?

• Is the fever associated with stiff neck or seizures, localized pain, redness, swelling or

heat?

• Is your child very ill or excessively fussy?

• Does he/she have persistent wheezing and cough?




• Is he/she confused or delirious?

I recommend that you give them a medication called “TYLENOL” in a liquid form. It contains

“ACETAMINOPHEN” in concentration of 160mg/ml

ACETAMINOPHEN is mainly indicated for:

o Treatment of fever

o Treatment of pain

• You will need to give the dose according to weight. Give ‘x’ ml up to 4 times a day when needed. Don’t exceed 5 doses per day. “ALWAYS READ THE DIRECTIONS ON THE LABEL AND TELL THE PATIENT AS THERE MIGHT BE DIFFERENCES BETWEEN DIFFERENT PACKS AND MANUFACTURERS”. ACETAMINOPHEN can be “Taken with or without food” You can give the medication for up to 3 days (72 hours). If the fever still persists after 3 days or if the fever goes over 40.50C, then I would recommend that you go and see your doctor

• Along with the beneficial effects, it has a few side effects which you may or may not experience SIDE EFFECTS: (TELL 2 COMMON SIDE EFFECTS & THEIR MANAGEMENT AND 1 RARE SIDE EFFECT

AND ITS MANAGEMENT)

o Common side effects include:

Generally very well tolerated

Stomach upset. Take the medication with food

o Rare side effects include:

Severe allergic reaction (EMERGENCY)

“DO YOU HAVE ANY QUESTIONS OR CONCERNS SO FAR?”

• Along with the medication there are few “SELF-CARE MEASURES” that you can take to help with

your condition such as:

o Encourage the child to drink lots of fluids

o Keep the child cool by removing excessive clothing

o Sponge them with tepid water

• Follow up: (Always ask patient’s permission first)

“Would you like me to call you and see how you are doing with the medication?”




Sample

Questions for

some of 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?




Red Flags:

Pain, vision change, injury, any unusual exposure, contact lances, watery discharge without itching

(Viral conjunctivitis), no symptomatic resolution within 2 days, symptoms get worse

DIAGNOSIS:

• Purulent discharge - Bacterial conjunctivitis

• Watery discharge with itching - Allergic conjunctivitis

• Watery discharge without itching - Viral conjunctivitis

3. INSOMNIA

• Tell me more about your lost sleep.

• How much total time you sleep per day including day time and night time?

• Do you awake in between or you have difficulty in going sleep?

• How long have you been experiencing this loss of sleep?

• Is there any recent change in your life that may interfere in your sleep like change in job schedule,

work stress, pain, medication, death in family etc?

• How about coffee, alcohol and smoking?

• Is there anything else that I should be aware of?

Red flags

• Age less than 12 years

• Insomnia associated with any chronic disease like asthma

• OTC ineffective after 3 evenings of therapy and treatment still required, OTC required for more

than 14 consecutive days,

• Confusion develops after self-care therapy in elderly




Health-care Professionals

Stations

Doctors, Nurses, Care- takers,

Physiotherapist etc.




Detailed template for Doctor Station

INTRODUCTION

Introduce yourself

Identify the Doctor

Identify the Patient


o 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

o 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

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

o Is the drug right for its dose frequency?




o Route of administration

o Is it compatible with current medical conditions?

o Allergy?

o Current lifestyle and social habits

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

o Pharmacological alternative

o Non-pharmacological alternative

o 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 assistance, proceed inside and do as you

would do in regular practice.

Reference: CPS, Patient profile

Dr’s Info

Opening statement: My name is Dr Lee. I wrote Rx for Julia Scott

If ok to dispense go ahead and if there are any questions concern I am here to discuss and

make the necessary change if needed.

Rx for AOM (Condition only when asked)

Recurrent only if asked ** Candidate should know from profile (Amoxicillin 15 days back)

MC : Everything in profile if asked weight or any other questions

Allergy : As per profile

Liver Fn: Normal Kidney Fn: Normal

Medications: As per profile

OTC : None

Pregnant: NA Breastfeeding: NA

Life style and social habit: Not known

Question at 5 minute bell:

Mannerism: Normal

Special Note:




XYZ Medical Clinic

Xxxx

Xxx

xxx-xxx-xxxx

Sam Baptist

Xxxx

Rx

Cefprozil suspension

100mg po bid for 5 days

Dr. Lee, Martin

PATIENT RECORD

PATIENT: Julia Scott

ADDRESS: xxxx

PHONE: xxxx

AGE: 18 Months

SEX: Female: Weight: 11kg

ALLERGIES: NKA

MC: AOM

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



Filled

1

Amoxicillin Susp. 250mg/5ml

3.5 ml three times daily for 10 days

Discard rest

150 Dr LEE,M 150ml Zero 150ml Zero 15 days

back




Ideal Response:

Ask the reason for Rx

After going through profile, realise recurrent AOM

Ask about liver/kidney function and culture and sensitivity tests

Ask weight to determine the correct dose

Check reference: TC

From TC found (Management of AOM using a risk factor-based Approach - Figure 1) Doctor

needs to prescribe alternate agent for treatment failure or recurrence within 1 month.

(Foot note)

Alternate from Table 1: Cephalosporin: 3 choices

Doctor wanted Cefprozil; Calculate dose: 30mg/Kg/Day: Comes to 11X30=330/2 so 165mg

bid.

For 10 days (Determine length of treatment from end of the table: Foot note says for less

than 2 years need 10 day treatment)

Tell doctor that the prescription is of lesser dose and should be for 10 days quoting

reference used.

Document: Change to Cefprozil 165mg (3.3ml po bid for 10days), Signature and date.

Follow up




Cases for Management:

SP or SR coming for information only

You need to check references on table

and deal with the situation




Scenario/Background: Case 51

Patient complains that Medication is not working for him.

Reference: PSC, Patient profile

Patient Profile:

No. Medications –

Directions Qty Physician

Repeats Dispensing Intervals

Authorized Remaining Original Refill

Frequency

Last

Filled

1 Apo-Salvent 100 mcg 1 J. Brown 1 0

Upon questioning it was found that the puffer was never shaken prior to use and never used before

workouts.

Ideal Response:

Ask appropriate questions to find out whether the patient is using it in correct way or not.

Explain correct technique of using the puffer

Follow up





A patient is coming with an early refill request

Reference: Patient profile

Patient Profile:

No. Medications –

Directions Qty Physician

Repeats Dispensing Intervals

Authorized Remaining Original Refill

Frequency

Last

Filled

1

Ativan 1 mg

1tab OD HS

30 R Tan 1 1 1 month

ago

2weeks

ago

Ideal Response:

Offer private confidential area

After asking appropriate questions identify the patient has increased the dose from 1tab OD to

2tab OD

Explain the need to visit the doctor

Do not give out the refill, may or may not advance a 3 days pill




Demonstration of

devices or products




Demonstration of Devices

It is expected that a pharmacist is able to demonstrate how to use a device to the patient. The correct

usage of the device can make a difference to patient’s health and may determine the success or failure

of therapy.

It is an important aspect of practice and candidates must try to acquire significant proficiency in this

area.

Taking the guesswork out of the exam

A lot of times, the question is assumed to be: What kind of demonstration can one expect in the exam?

It is not prudent to make a guess. The best way is to try to eliminate guesswork. How many common

devices are there which may need a demonstration? Just prepare all of them. Finally, be prepared to

deal with a situation where you are not familiar with that device.

How to effectively demonstrate a device

There are 2 techniques that if implemented can make your demonstration highly effective, organized

and easy to understand for the patient.

Technique #1: Start with explaining different parts of the device

Before you start demonstrating a device, explain to the patient different parts of the device.

For example: If you are explaining Ventolin inhaler, first explain different parts of the inhaler like:

I am now going to show you how to use the Ventolin inhaler. Before I explain, let me first show you the

different parts of this device. Is that okay?

This part is the canister which has the actual medication in it

This part is called the mouth piece which you put in your mouth and seal with your lips around it

This part is the cover for the mouth piece.

Why is this technique useful?




When you explain the device, patient is not confused when you refer to different parts and hence you

do not have to digress to explain different parts while showing how to use.

Technique #2: Break the demonstration in 3-4 easy steps

Breaking down the demonstration into few simple steps makes it easier for the patient to understand.

Also, it allows you to pause and ask the patient if he/she is following what you are saying.

For example, if you are demonstrating blood glucose monitor, it can be broken down into 4 parts for

ease of understanding

I will now explain you how to use the blood glucose monitor in 4 easy steps:

Preparing yourself to inject & get blood

Preparing blood glucose monitor for reading

Injecting yourself and getting a reading

Safe disposal

Then you can explain each component in detail.

Therapeutic Tips from Real world Practice

If you have never seen the device before, do not panic. Ask the patient to give you a moment and

read the leaflet. If you can easily demonstrate it, great. If not, just break the demonstration into few

simple steps. Read one step at a time and then explain to the patient.

At end of each step, ask patient: Are you with me? Are you following? Do you have any questions

till now?




List of common demonstration devices and further reading

Below is a list of common devices that you should know how to demonstrate. By all means, it is not

complete but covers major devices. Add your own to the list. YouTube® carries demonstration videos for

a lot of devices. Use Google® to print monographs and graphical depiction of usage for different

products.

Demonstration of Devices

Sr. No Type Specific

1 Blood glucose monitor One Touch, Contour

2 Eye drops Fucidin viscous eye drops

3 Inhalation Aero chamber

Ventolin HFA

Adair diskus

Symbicort

Spiriva

Nicotine Inhaler

4 Rectal Proctofoam HC

Anusol suppository and ointment

Entocort Enema

5 Ear drops Ciprodex

Polysporin

6 Transdermal patch Nicotine Patch

Nitro-glycerine patch

Fentanyl patch

7 Pump spray Nitro-glycerine pump

Androgel pump

Estrogel spray

8 Nasal spray Miacalcin Nasal Spray

Zomig Nasal Spray

Omnaris

Migranal

Apo-Butorphanol

9 Misc Insulin pen

Epipen

Twinject

Penlac




Door Note

Person is sitting Inside.

There is no DRP.

Demonstrate as you

would in regular

practice. We picked few devices and highlighted the important points that you need to know about them.

These are key points in patient counseling that you should do in your everyday practice. Do

whatever is not mentioned here on your own:




Case 65. Aero chamber

Aero chamber is a transparent tube which has

two open ends

Check the device for foreign particles before

using it

Remove the mouthpiece from aero chamber as

well as inhaler

Shake the inhaler vigorously

Attach the mouthpiece of inhaler to the rubber end side of aero chamber.

Put the mouth piece of aero chamber in your mouth and cover it with lips.

Breath normally thorough aero chamber

Depress canister once to release 1 puff into aero chamber

Let the patient inhale 4-6 times to take the full dose

Continue breathing in and out through the mouth piece without removing aero chamber mouth

piece from your mouth

If the patient is breathing too fast the device will make a whistling sound, this means slow down

Aero chamber mouth piece is a one way valve, so patient can breathe in and out normally

Wait for a minute between each dose and shake inhaler before each dose

Clean aero chamber once in a week

Never run water through aero chamber. Dismantle rubber ring and cap and put into gentle motion

warm water

Don’t put cotton or tissue inside the aero chamber to dry, let it air dry

After completely drying the aero chamber, place the rubber ring and cap in its original position




Case 66. Epipen

Right before use, remove blue cap (Safety cap)

Avoid touching orange tip (touch sensitive)

Swing and jab into the outer thigh

Designed to be used on top of clothes

(Needle is long and strong)

After firing into the outer thigh, leave it there

for few seconds before removing it

After removal, massage the area

Call 911 and let them know that you have

used an Epipen

Side effect include: Tremors, heart racing,

and sweating

Make sure to check expiry date

Epipen junior to be used by patients less than 30 kg

Stay in hospital proximity within the next 48 hours after experiencing the anaphylaxis shock




Effective use of

Basic

References

&

Non-Interactive




Effective use of Basic References

In this section you will learn about the different common references and the

main purpose and layout of each one of them. It is very important to

practice using these references in order to get used to their layout and how

to retrieve different kinds of information




Compendium of Pharmaceuticals and Specialties known as the CPS. It’s the main reference that you

refer to in Canadian pharmacy practice for various forms of information. It is very important to

understand the different sections in the CPS and the general layout of the book. It’s divided into:

The Green Pages: An alphabetical, cross-referenced index of brand and generic names of

products available in Canada including references to CphA monographs. Also, integrated in this

section are products which are discontinued

The Pink Pages: A listing of diseases and conditions and the generic names of drugs used to

treat them

The Lilac Pages: Valuable clinical information and practice tools to assist health care

professionals use drugs safely and effectively

The Yellow Pages: Contact information for:

o Poison control centers

o Pharmaceutical manufacturers (includes product listings)




o Health organizations published in e-CPS only

The White Pages: They are divided into 4 categories:

o Monographs

o Product identification

o Appendices

o Glossaries

o MONOGRAPHS: The monographs are divided into either one of two:

1. Product Monographs

2. CphA Monographs

1. Product Monographs: The monographs are prepared by the manufacturers and approved by the

Therapeutic Product Directorate, Health Canada. It also includes information to the patient (only in e-

CPS) For instance:

Coumadin® PR - Warfarin sodium (Anticoagulant) Bristol-Myers Squibb

Pharmacology

Pharmacokinetics

Indications

Contraindications: Pregnancy, Hemorrhagic Tendencies or Blood Dyscrasias

Warnings: Lactation

Precautions: e.g. : Periodic determination of PT ratio/INR

Drug Interactions: All kind of medications and other as well

Pregnancy: See contraindications

Adverse Effects: Body as a Whole, Central and Peripheral Nervous Systems, Gastrointestinal,

Liver and Biliary. Tabular form with %

Overdose: Symptoms and treatment

Dosage:




Supplied: 1mg: 1 mg

Each pink, round, biconvex tablet, one side bisected and imprinted with “COUMADIN” and “1”,

And the other side blank, contains: crystalline warfarin sodium 1 mg.

Nonmedical ingredients: D&C Red No. 6 Barium Lake, lactose anhydrous, magnesium

stearate and pre-gelatinized tapioca starch. Bottles of 100, 250 and 1000.

Protect from light and moisture. Store at room temperature (15 to 30°C). Dispense in a tight,

light-resistant container as defined in the USP.

2. CphA Monographs: These individual drug or drug class monographs are written by editorial

staff and reviewed by expert physicians and pharmacists.

Product Identification: Full-color reproductions of products selected by manufacturers whose

monographs appear in the Product Monograph section. This is an essential tool for accurate

identification of pharmaceutical products.

Appendices: Health Canada drug regulatory and monitoring programs reporting and request

forms can be found in the Appendices.

Glossaries: Glossaries of medical, Latin and microorganism abbreviations are located after the

Appendices.

TIP 1: Keep in mind that when you look up a certain medication in the Green Pages, it will not

refer you to a page number, but it will refer you to the name you can find the medication

under. (whether brand name or generic name) Then you will need to go to the corresponding

letters and find your medication. On the top of the page you will find the first few letters, this

way you know where you are looking.

TIP 2: If you are using e-CPS, it will be easier for you to retrieve in information since in the top

of the page you will find all the different sections mentioned in the page according to order.




In this Chapter:

You will learn about different types of non-interactive stations

How to break down each type of the non-interactive to easily

tackle it

Different approaches and principles to find the right answer

There are four main types of non-interactive

stations:

Prescription checking

Dispensing checking

Article reading

Fill in the Blanks

In order to master the non-interactive stations you will need to understand

the different references and how to find the information you need in each

one of them. Also you will need to know where to look to answer your

questions. Please refer to section titled ‘Basic references and How to use

them effectively’




1. Prescription Screening Prescription screening is one of the common non-interactive stations that might come across in your

OSCE exam. In addition to that it is part of the routine work that you will perform in your everyday

practice once you are a fully licensed pharmacist.

But, what is prescription screening?

Basically, it’s checking the appropriateness of each prescription for two main points, legally &

therapeutically.

What do you need to look for?

There are few points that you need to check in each and every prescription that you come across.

These include:

Who wrote it?

Are they authorized to prescribe such medication?

Are they in Canada or USA?

When did they write it?

Is this medication appropriate for the patient (Gender, age, condition)?

Is the direction of use correct?

Is the medication dosage form and strength correct?

All these questions and many other should pop in your mind once you want to check a prescription for

its appropriateness. It might be overwhelming now, but once you see an example, it will help you

understand it more effectively.

TIPS: To master this section you need to practice how to use the CPS effectively. You need to know

where to look in order to find the piece of information you need. Otherwise, it will be very

challenging!!




Read the following example carefully:

Note: Document all errors in case of one or more errors in one Rx.

Doctor’s name

Address XXX XXX

Ontario

Date

Patient’s name

Rx

Lipitor 20mg

Take 1 Tablet Once Daily

Mitte: 100

Dr. Signature

Now in above Rx:

1) What if Lipitor is missing?

Answer: problem

Description: No drug specified.

2) What if 20 mg is missing?

Answer: problem

Description: No strength specified.

3) What if “Take 1 Tablet once daily” is missing?

Answer: problem

Description: No dosing information specified.

4) What if “mitte: 100” is missing?

Answer: problem

Description: No quantity specified.

5) What if everything is perfect?

Answer: No problem-May be processed as written.




6) What if Rx written for more than 1 person in 1 order?

Answer: problem

Description: prescription written for more than one person in one order is illegal.

7) What if written as Lipitor for Hypertension?

Answer: problem

Description: Inappropriate medication / indication.

8) what if written insert Lipitor Per rectally?

Answer: problem

Description: Inappropriate route of administration.

9) What if written Lipitor 200 mg?

Answer: problem

Description: Medication overdose, inappropriate strength / dose specified.

10) In case of narcotic prescription what if refill is given?

Answer: problem

Description: Inappropriate refills specified OR Refills not valid OR Refills are not allowed.

Dispensing

check




This is another form of non-interactive practice that you may come across.

It is very crucial in your everyday practice once you are fully licensed

pharmacist. Basically, you double check everything at the end stage before

dispensing the medication to the patient. Assuming that you ruled out any

type of interaction possible and that it is the right medication for the

patient, you want to double check that the medication labeled matched the

actual prescription and that there is nothing missed in the process.

You usually check and verify:

Doctor’s name (Including spelling mistakes)

Patient’s name (Including spelling mistakes)

Medication dispensed (Strength & brand)

Quantity dispensed

Refills

Physically check that the vial contents match the stock bottle

In this section, you highlight the error, and what is the correction.

The following example should help clear things up:

OSprep Pharmacy

XXXXXXXXXXXX

Date Patient name Dr Name

Medication being dispensed

Sig: XXX

Qty: X

R: X

You need to check the label to your left and verify it with the prescription to your right.

1) If doctor’s name was incorrect?

You write “Doctor Name should be XXX”

2) If patient’s name was incorrect?

Dr.Name Date: Current

Patient: Name Medication XXX Sig: XXX M: X R: X Dr. Signature




You write “Patient name should be XXX”

3) If medication dispensed was incorrect?

You write “Medication dispensed should be XXX”

4) If quantity dispensed is incorrect?

You write “Quantity dispensed should be XXX”

5) If repeats on vial are incorrect?

You write “Repeats authorized should be XXX”

6) If contents of the vial don’t match the stock bottle?

You write “Medication dispensed should be filled from stock bottle”

7) If labels on the vials are reversed?

You write “Labels on vials should be interchanged”

Hopefully by now you get the big picture of what you task is.

Following are some exercises for your own practice. Find the corrections that need to be made, and

match your answer with the answers in the attached appendix. (Assuming the contents of the vial

matches the stock bottle)



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