Safe over-the-counter cold treatment
MediumSafe Cold Treatment for Hypertensive Patient
Setting: Community pharmacy consultation room. Your role: Pharmacist
Mr Ben Thompson, a 34-year-old warehouse supervisor, has approached the pharmacy seeking advice on over-the-counter cold remedies. He mentions he's been feeling unwell for a few days and is concerned about potential interactions with his prescribed medication for high blood pressure.
- Greet Mr Thompson and confirm his reason for seeking advice on cold symptoms and medication.
- Gather a focused history regarding his current cold symptoms (onset, duration, severity), any self-treatment attempts, and details about his blood pressure medication (Amlodipine 5mg, dosage, duration of treatment).
- Clarify his understanding of his hypertension, its management, and any other relevant medical history.
- Explain the potential risks of certain cold remedies, specifically decongestants, with his Amlodipine, and propose a safe, effective treatment plan for his cold symptoms.
- Confirm Mr Thompson's understanding of the advice and agree on the next steps for managing his cold while safely continuing his blood pressure medication.
Practise this cardSafe child pain relief dosing
HardChild Paracetamol Dosing During Ramadan
Setting: Discharge medicines counselling room. Your role: Pharmacist
Mr Ravi Patel is the parent of 10-year-old Anika, who has been discharged after treatment for an ear infection. She has been prescribed paracetamol for pain relief. Mr Patel is unsure about the correct dosing and frequency, especially as it is Ramadan and he is observing a fast.
- Listen carefully to Mr Patel's concerns regarding administering Anika's paracetamol during Ramadan while he is fasting, without making assumptions about his beliefs.
- Understand the cultural and religious context of Ramadan fasting for Mr Patel and its impact on his ability to administer medication to his daughter, asking clarifying questions with respect.
- Assess the clinical feasibility of adjusting Anika's paracetamol dosing schedule (e.g., concentration, frequency, timing) to accommodate Mr Patel's fasting, while prioritising safe and effective pain relief for her ear infection.
- Propose a clear, clinically sound paracetamol dosing plan for 10-year-old Anika (who weighs 30kg), explaining the appropriate dose for a 250mg/5mL concentration every 6 hours, and suggesting how to manage it in light of Mr Patel's Ramadan fasting, potentially offering alternative solutions or seeking further guidance if appropriate.
- Confirm with Mr Patel that the proposed paracetamol dosing schedule and any accommodations are acceptable to him and that he feels confident in administering the medication safely.
Practise this cardMetformin use and stomach side effects
MediumMetformin Side Effects Review
Setting: Community pharmacy consultation room. Your role: Pharmacist
Mrs. Rachel Green, a 52-year-old hairdresser recently diagnosed with type 2 diabetes, has started taking Metformin 500mg twice daily. She is experiencing significant nausea and mild stomach upset since starting the medication and has come to you for a second opinion on her doctor's advice to 'stick with it'.
- Acknowledge Mrs. Green's right to seek a second opinion regarding her metformin side effects and reassure her that this is a normal and acceptable practice.
- Withhold any judgement or criticism about the previous doctor's advice, focusing instead on the patient's current experience and symptoms.
- Review Mrs. Green's current Metformin regimen (500mg twice daily for one week), her symptoms (nausea, mild stomach upset), and her medical history to fully understand the clinical question.
- Share an independent assessment of her Metformin regimen, explaining potential causes for her nausea and offering appropriate pharmaceutical advice, such as dose titration or considering a Modified-Release (MR) formulation.
- Support Mrs. Green's ultimate decision regarding her treatment plan, whether she chooses to continue with the current advice, explore alternatives, or discuss changes with her doctor.
Practise this cardMultiple medicines and simplification
HardSimvastatin Deprescribing Second Opinion
Setting: Community pharmacy consultation room. Your role: Pharmacist
Mr. George Wilson, a 72-year-old retired mechanic, is seeking your advice. His GP, Dr. K, recently suggested discontinuing his simvastatin, which he has been taking for 15 years. Mr. Wilson is hesitant and anxious about this change, wanting a second opinion.
- Acknowledge Mr. Wilson's right to seek a second opinion regarding Dr. K's advice on his simvastatin and reassure him that this is a normal and responsible step.
- Withhold any judgement or negative comments about Dr. K's professional advice, focusing solely on the clinical question of Mr. Wilson's medication.
- Review Mr. Wilson's current medication list (8 different medicines), medical history, and specific concerns regarding Dr. K's suggestion to discontinue his simvastatin.
- Share an independent assessment of the benefits and risks of continuing versus discontinuing simvastatin for Mr. Wilson, explaining the reasoning based on current evidence and his individual health profile.
- Support Mr. Wilson in his final decision regarding the simvastatin, ensuring he feels fully informed and comfortable with the chosen path for his medication management.
Practise this cardUsing prescribed eye drops
MediumEye Drop Administration for Glaucoma
Setting: Community pharmacy consultation room. Your role: Pharmacist
Mr. Samuel Reed, carer for his 78-year-old father Mr. Arthur Reed, has come to the pharmacy. His father was recently prescribed eye drops for glaucoma, and Samuel is finding it challenging to administer them correctly, specifically concerning the technique, spacing between drops, and his father's head position.
- Greet Mr. Reed and confirm the reason for his visit regarding his father's eye drop administration.
- Gather a focused history regarding Mr. Arthur Reed's eye drop regimen, current difficulties (technique, spacing, head position), and any related concerns Samuel has.
- Clarify Samuel's current technique for administering the eye drops, potentially asking him to describe or demonstrate his method.
- Explain common difficulties with eye drop administration, demonstrate the correct technique (including head position and drop spacing), and outline a clear plan for Samuel to follow.
- Confirm Samuel's understanding of the correct technique and plan, and agree on any necessary follow-up or resources.
Practise this cardWarfarin use and bleeding precautions
HardWarfarin and Traditional Herbal Tea Interaction
Setting: Community pharmacy consultation room. Your role: Pharmacist
You are a pharmacist. Ms Priya Shah has brought her 85-year-old mother, Mrs Asha Shah, to pick up a new prescription for Warfarin, which she has just started for atrial fibrillation. Ms Shah is concerned about how the medication might interact with her mother's long-standing cultural practices and daily routines.
- Listen carefully to Ms. Shah's specific concern regarding her mother's traditional herbal tea and its importance.
- Understand the cultural and personal significance of the herbal tea to Mrs. Shah, exploring its ingredients with curiosity and without judgment.
- Assess the potential clinical feasibility of continuing the herbal tea alongside Warfarin, considering Mrs. Shah's age, condition, and INR stability.
- Propose a specific, practical, and culturally sensitive accommodation or compromise to manage the herbal tea consumption safely with Warfarin.
- Confirm with Ms. Shah that the proposed plan is acceptable and addresses both her mother's cultural needs and clinical safety concerns.
Practise this cardAnti-inflammatory medicine safety
MediumNSAID Safety Follow-up: Mr. Brooks
Setting: Discharge medicines counselling room. Your role: Pharmacist
You are a pharmacist in a discharge medicines counselling room. Mr. Alan Brooks, 60, a security guard with a history of mild heart failure (NYHA Class II) and stage 3 chronic kidney disease, is returning for a follow-up. Last week, he presented with acute knee pain and was advised to avoid NSAIDs like ibuprofen, instead receiving advice on paracetamol and non-pharmacological pain management. Your goal is to assess his progress and adjust his plan.
- Assess Mr. Brooks' response to the paracetamol and non-pharmacological advice for his knee pain, specifically inquiring about current pain levels (e.g., on a 0-10 scale), swelling, and overall impact on his daily activities.
- Review any changes in his knee pain symptoms, frequency and effectiveness of paracetamol use, and any new observations or concerns Mr. Brooks has noticed since the last consultation, including his perception of ibuprofen's role.
- Adjust the pain management plan if necessary, taking into account his kidney and heart conditions, and clearly explain the reasoning behind any changes or continued recommendations regarding NSAID avoidance.
- Reinforce effective strategies, such as specific non-pharmacological methods or appropriate paracetamol use, that have helped manage his knee pain without exacerbating his underlying conditions.
- Schedule a follow-up review for Mr. Brooks to monitor the effectiveness and safety of the adjusted plan, linking the timing to a specific clinical milestone or re-evaluation period for his chronic conditions.
Practise this cardDirect oral anticoagulant use
HardRivaroxaban Adherence Challenges
Setting: Discharge medicines counselling room. Your role: Pharmacist
Mrs. Aisha Rahman, 41, a busy restaurant owner, was recently discharged after a DVT and prescribed Rivaroxaban (a new DOAC) 15mg twice daily for 3 weeks, then 20mg once daily. She has come for a follow-up, and you have noted from her dispensing history that she has not been consistently refilling her prescription, or she has expressed difficulty adhering to the regimen.
- Explore Mrs. Rahman's challenges with taking her new Rivaroxaban 15mg twice daily as prescribed, focusing on her demanding daily routine as a restaurant owner, without judgment.
- Validate the practical difficulties of managing medication with an unpredictable work schedule, while gently reinforcing the critical importance of consistent DOAC use for DVT prevention and prevention of further clots.
- Co-design a revised medication routine for her Rivaroxaban, integrating it into her unique work and irregular eating patterns, and discussing practical strategies for managing missed doses and bleeding precautions.
- Safety-net by advising Mrs. Rahman on whom to contact (e.g., pharmacy, GP) and what immediate steps to take if she continues to struggle with adherence or experiences any significant side effects despite the new plan.
- Schedule a specific follow-up phone call or in-person visit within one week to review the effectiveness of the revised plan and address any emerging concerns related to her DOAC therapy.
Practise this card
