Professional Documents
Culture Documents
Osce Revision
Osce Revision
11.
Address of patient if patient doesnt have a fixed address (e.g.
homeless or witness protection scheme) no fixed abode/NFA is
acceptable
12.
Dental prescriptions for dental use only
13.
Instalment direction where the prescription is intended to be
supplied in instalments a valid instalment direction is required
Categories of Veterinary Medicines
- POM-V Prescription-only medicines that can only be prescribed by a
veterinary surgeon
and supplied by a veterinary surgeon or pharmacist
with a written prescriptions
- POM-VPS Prescription-only medicines that can be prescribed and
supplied by a veterinary surgeon, a pharmacist or a suitably qualified
person or an oral or written prescription
- NFA-VPS A category of medicine for non-food animals that can be
supplied by a veterinary surgeon, a pharmacist or a suitably qualified
person; a written prescription is not required
- AVM-GSL An authorised veterinary medicine that is available on
general sale
Veterinary Cascade
- Where available it is a legal requirement to: supply a licensed
veterinary medicine
- Only where above is not possible: an existing licensed veterinary
medicine for another species or different condition can be
considered
- Only where above is not possible: a licensed human medicine or an
EU-licensed veterinary medicine can be considered
- Only where the above is not possible: extemporaneous or specifically
manufactured medicines can be considered
Prescription requirements for POM-V, POM-VPS and medicines
supplied under the veterinary cascade:
1. Name, address, telephone number, qualification and signature of
the prescriber
2. Name and address of animal owner
3. Identification and species of the animal and its address (if
different from owners address)
4. Date valid for 6 months or shorter if indicated by the prescriber
(Sch 2, 3 and 4 CDs are valid for 28 days)
5. Name, quantity, dose and administration instructions of required
medicine
6. Any necessary warnings and if relevant the withdrawal period
7. Where appropriate a statement highlighting that the medicine is
prescribed under the veterinary cascade
8. Where Sch 2 or 3 CDs have been prescribed a declaration that
the item has been prescribed for an animal/herd under the care
of a veterinarian
9. If prescription is repeatable the number of times it can be
repeated
Clinical check:
- Check drug is suitable for indication
Accuracy check:
1. Label against prescription
2. Product against prescription
3. Label against product
1. Label and Prescription
a. Name of patient prefix e.g. Mr./Mrs./Miss. Etc
b. Name of the medicine
c. Dose
d. Strength
e. Formulation
f. Quantity
g. Duration
h. Directions
i. Label warnings/specific medicine warnings
2. Product and Prescription
a. Name of medicine
b. Correct product inside the box
c. Correct PIL inside box
d. Strength
e. Formulation
f. Drug release type
g. Correct quantity
h. Expiration date
i. Spoon if liquid dosage form
3. Label and Product
a. Name of medicine
b. Strength
c. Formulation
d. Quantity
e. Duration
f. Drug release type
g. Direction
h. Expiration date
Counselling
Dispensing a prescription overall:
1. Introduction and confirm the correct patient
2. What is the medicine and why they are taking it
3. Dosage
4. Medicine related advice side effect, cautions, best way to take
5. Lifestyle habits contributing to health, exercise, diet, smoking, alcohol
6. Any questions
Dispensing a prescription in detail:
1. Introduce yourself as the pharmacist
2. Explain the purpose of the consultation
3. Confirm identity of patient by asking name and address or date of birth
4. Ask about allergies
5. Ask if they take any other medicines
6. Ask if they have taken the medication before
7. Explain why they are taking the drug
8. Any specific medicine related points
9. Explain correct dosing
10.If you forget to take a dose, miss the dose and continue as prescribed the
next dose, DO NOT take a double dose
11.If there are any changes see your doctor or pharmacist
12.Side effects at least 3 inform doctor
13.State if they need to take with water/before or after food etc.
14.Explain any warning side effects which need to be reported or looked out
for
15.Suggest healthy lifestyle advice exercise, diet, smoking, alcohol
16.Refer patient to PIL
17.Do they understand
18.Ask if the patient has any questions
Responding to symptoms:
1. Introduce yourself as the pharmacist
2. Recap and confirm the symptoms
3. Explain the diagnosis
4. Explain the proposed cause of symptoms
5. Explain type of treatment and how to use it
6. Explain what the type of treatment does
7. Suggest one preparation
8. Propose additional advice
9. Other specific condition related advice
10.
11.
12.
13.
14.
Chicken Pox
Observed behaviours
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MA
RK
Cradle Cap
Observed behaviours
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MA
RK
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Colic
Observed behaviours
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MA
RK
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Teething
Observed behaviours
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MA
RK
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Diagnosis
- Establish the patients current bowel habit compared to normal
- This will establish if the patient is suffering from constipation
- Then concentrate on determining the cause blood present? Pain on
passing stool? Other symptoms? Changes in diet? Lifestyle?
Diarrhoea
- An increase in frequency of the passage of soft or watery stools
relative to the usual bowel habit for that individual
- Acute less than 7 days
- Persistent more than 14 days
- Chronic more than a month
Symptoms
- Passing of frequent, soft watery stools
- Irritation of stomach lining
- Stomach cramps
- Nausea
- Fever
- Loss of appetite
- Dehydration
Causes of Diarrhoea
- Infective causes most likely
o Bacterial
Shingella, Salmonella, E.coli, Bacillus
Contaminated food/drink
Travellers diarrhoea E.coli
o Viral
Acute gastroenteritis
Rotavirus
o Protozoa tropical
- Non infective cases
o Anxiety
o Emotional upset
o Medication - likely
Metformin, iron
o Alcohol
o Coffee
o Sweets high in sorbitol content
- IBS, giardiasis, faecal impaction unlikely
- Ulcerative colitis and Crohns disease, colorectal cancer,
malabsorption syndromes very unlikely
Diagnosis and Specific Questions
- Frequency and nature of the stools
o What does it look like watery without blood, or is there blood and
mucus present?
o Watery without blood shows that it is infective and so self limiting
Treatments
- Maintain oral hygiene wash hands regularly to prevent spread
and transmission
- Oral rehydration therapy is 1st line dioralyte
o Can be given to all age groups
o Small light meals
o No side effects
o Over 1 year old
o Glucose 75mmol/L
o Sodium 75mmol/L
o Potassium 20mmol/L
o Chloride 65mmol/L
o Citrate 10mmol/L
- OTC provide symptomatic relief for social reasons
- Loperamide 2nd line
o Opioid analogue, slows intestinal tract time by decreasing bowel
motility through action on opioid receptors in the guy
o Can increase fluid absorption and electrolytes
o Over 12 years
- Bismuth subsalicylate
o Effective in travelers diarrhoea
o Reduces intestinal motility
o Over 16 years
- Kaolin and morphine
o Utilises the constipating side effect of morphine and adsorbent
properties of kaolin
Dyspepsia
- An umbrella term used generally used by healthcare
professionals to refer to a group of upper abdominal symptoms
that arise from five main conditions
o Non ulcer/functional indigestion
o Gastro-oesophageal reflux disease (GORD, heartburn)
o Gastritis
o Duodenal ulcers
o Gastric ulcers
- Extremely common 25-40% in western hemisphere experience symptoms
- Higher in women than men
Causes
- Non ulcer/functional dyspepsia when no specific cause can be found
for a patients symptoms
- GORD - decreased muscle tone leading to oesophageal sphincter
incompetence
- Gastritis - increased acid production attributable to H. pylori infection or
acute alcohol ingestion
- Duodenal (95%) and gastric (80%) ulceration H. Pylori, it produces
toxins that stimulate the inflammatory cascade, NSAIDs and low dose
aspirin can medically induce ulcers
Clinical features of Dyspepsia
- Vague abdominal discomfort (aching) above the umbilicus associated with
belching
- Bloating
- Flatulence
- A feeling of fullness
- Nausea and/or vomiting
- Heartburn
- Retrosternal heartburn is the classic symptoms of GORD
Diagnosis and specific questions
- Age
o Incidence increases with age, young adults dyspepsia with no
specific pathology, older specific pathology
- Location
o Pain above umbilicus and centrally located in the epigastric area
o Pain below the umbilicus will not be due to dyspepsia
o Pain behind sternum/breastbone most likely to be heartburn
o If patient can point to specific area in abdomen unlikely to be
dyspepsia
- Nature of pain
Persistent vomiting
Referred pain
Treatment
- Lifestyle
o Dont eat before bedtime
o Stress reduction
o Smaller portions
o Eat slowly
o Give enough time for food to digest before undertaking activities
o Dont wear tight fitting clothes that hold the stomach in
o Extra pillows when sleeping elevate the head
o Alcohol reduction/smoking cessation
- OTC treatments
o Alginates gaviscon, 5-10mL after meals and bed time
1st line treatment for GORD
Sponge like matrix that floats on top of stomach contents
Often in combination with antacid to help neutralize acids
Not to be used in children, no likely side effected
OK if pregnant
o Antacids rennies, 2 tabs chewed 1 hour after meal and at
bedtime, no more than 12 tablets in 24 hours
Neutralize stomach acids
Relatively fast acting 1hour
Good for isolated symptoms
May have some interactions
OK if pregnant
o H2 Antagonists Ranitidine (zantac), over 16, 1 tablet whole
when needed, if symptoms persist for more that an hour
can take another, max 2 tablets in 24 hours, no more than 6
days
Block actions of histamine which activates signal cells in
stomach to release HCl acids
Fast acting 1 hour
Abdominal pain, diarrhoea and constipation
OK if pregnant, can cause diarrhoea if breast feeding
o PPIs Zanprol (omeprazole), over 18, 2 tabs once daily
before food, see GP if still needed after 4 weeks or not
working after 2 weeks
Inhibit the H+/K+-ATPase enzyme of parietal cells which
secrete HCl acids
Eye Conditions
Red
-
Eye
Conjunctivitis inflammation of the conjunctiva
Characterised by redness, irritation, itching and discharge
Redness of eye and conjunctivitis is the most common ophthalmic
problem
- Can be viral or bacterial (collectively infective) or allergic
Treatments
- Viral conjunctivitis
o No OTC products
o Highly contagious so follow stict hygiene measures
o No sharing of towels and wash hands frequently
- Bacterial conjunctivitis
o Self limiting, 65% have a clinical cure in 2-5 days without treatment
o Chloramphenicol Drops/ointments (GOLDEN EYE
ANTIBIOTIC DROPS/OINTMENT, OPTREX INFECTED EYE
DROPS/OINTMENT)
Licensed in children 2+
Drops 1 drop every 2 hours for the first 48 hours, then 4
times a day for a maximum of 5 days treatment
Ointment if used with drops, only 1cm to inside of eyelid at
night
Ointment if used alone then 3-4 times daily
Avoid in those with blood and bone marrow problems
Avoid if pregnant
Blurring of vision, transient stinging, burning warn about
driving or operating machinery
Stop wearing soft contact lenses as preservatives can
damage them
Store in fridge but remove for a while before administering to
warm up to room temperature
o Propamidine isethionate 0.1% (GOLDEN EYE DROPS) 1 or 2
drops upto QDS, 12 years +, refer if no improvement
o Dibromopropamidine isethionate 0.15% (GOLDEN EYE
OINTMENT) apply once or twice daily, 12 years +, refer if not
improvement
- Allergic conjunctivitis
o Mast cell stabilisers Sodium cromoglicate
Prophylactic agent
referral list
Associated vomiting
Photophobia
Clouding of the cornea glaucoma
True eye pain
Redness caused by a foreign body
Irregular shaped pupil
Abnormal reaction of pupil to light
Redness localised around the pupil
Distortion of vision
Ear/Octic Conditions
Otitis Media - common
- Rapidly accumulating effusion in middle ear
- Most common in children aged 3-6
- In older children, pain/earache is predominant feature and is throbbing
- In young children, pain is manifested as irritability and ear
tugging/rubbing
- Fever/loss of appetite
- Physical presentation of red/yellow, bulging tympanic membrane
- Pain resolves on the rupture of tympanic membrane releasing
mucopurulent discharge
- Mostly resolves in 3 days with no treatment
- Should be managed with analgesia Paracetamol or ibuprofen
- Unless systemically unwell or under 2 years of age and have discharge
referral to GP
Otitis Externa most common, caused by trauma
- Refers to generalised inflammation throughout the EAM
- Often associated with infection
- Usually acute but may become chronic (3 months +) in children
- Incidence increases during the summer
- People who swim are 5 times more likely to develop it
- More common in adults and women
- Primary infection, contact sensitivity can both cause it
- Local causes include trauma, discharge from middle ear, general causes
e.g. seborrhoeic dermatitis, psoriasis and skin infections
- Common with ear wax impaction
Associated symptoms
o Dizziness and tinnitus indicate inner ear problem so refer
o Ear wax impaction rarely causes tinnitus, vertigo or true pain
History of trauma
o Check if person has recently tried to clean ears
o This often leads to wax compaction
Use of medicines
o If a patient has used an OTC medication correctly this would require
referral for further investigation
Colic
- Excessive crying usually in the
first few weeks of life and
usually resolves by age of 3-5
months
Defined as crying for more than 3 hours a day for more than 3 days a
week for more than 3 weeks
Patients parents/carer may not necessarily wait for 3 weeks as it can be
very distressing
Symptoms of Colic
- Excessive high pitched crying usually in late afternoon/evening (6pm)
- Face may appear flushed
- May pass gas when crying
- Clench their fists
- Arching of the back
- Drawing up of knees to their tummy
- Bloated tummy
- Crying outbursts are not harmful the baby will continue to feed and gain
weight as normal
Causes
Reduced urine
output
Pale skin
High fever
referral
weight
Chickenpox
- Mild, common childhood illness
- Caused by the varicella zoster virus
- Transmitted by droplet infection coughing and sneezing and, due to fluid
from blisters
- Remains dormant in the body for upto 14 days before any symptoms are
seen incubation period
- Spotty blistering red rash then appears which can cover the whole body
- These normally appear in clusters behind ears, face, scalp, chest, belly,
arms and legs
- Appear as small red lumps which turn into fluid filled blisters and then
crusted spots
- Most infectious period is when red rash appears
- When spots have crusted it is no longer contagious
Before the rash appears there are flu like symptoms nausea, fever,
aching, headache, feeling unwell, loss of appetite
Most infectious 1-2 days after the rash appears (1-2 days) until all blisters
have crusted over (5-6 days)
Treatments of Chickenpox
- No known cures
- Clears without the need for treatment
- Symptomatic treatments exist fever, pain and high temperature
o Mild painkiller Paracetamol, Calpol NSAIDs 2nd line due to
potential skin problems
o Itching soothing emollient creams calamine lotion
o Itching sedating antihistamines chloramphenamine
piriton
General advice
- Itching
o Ensure the child has short clean fingernails so doesnt infect or scar
from scratching
o Put socks on hands overnight
- Fever
o Wear loose, smooth, cotton clothes
o Avoid sponging with cool water may irritate further
- Hydration
o Maintain a high fluid intake
o Sugar free ice lollies
Prevention of spread
- Keep at home for at least 5 days
- Stay at home until the blister has crusted over
- Avoid contact with pregnant women, new borns or those with weak
immune systems
- Maintain hygiene wipe down toys, and surfaces
- Wash bedding/clothes more regularly
Referral of Chickenpox
- Suspected meningitis
- Signs of infection
- Rash for over 2 weeks
- Fever lasting longer than 24 hours
- Vomiting
- Neck stiffness
Cradle Cap
- Appears as large yellow, greasy scales and crusts on the scalp
- This can become thick and cover the whole scalp
- Can affect other areas such as the face and napkin area
- Common harmless condition doesnt usually itch or cause discomfort
Causes of Cradle Cap
- Characterised by increased cell turnover rate
- Cause linked to overactive sebaceous glands
Babies may also retain their mothers hormones for several weeks/months
making the babies glands more active
Excessive sebum causes old cells to stick to the scalp instead of drying
and falling off
It is not contagious and isnt caused by poor hygiene or allergy
Symptoms
- Harmless condition
- Doesnt itch or cause discomfort to the baby
- Occurs on scalp, face, nose, groin, ears, neck, skin folds, knees and
armpits
- Greasy yellow patches on scalp
- Scales eventually start to flake and effected area appears red
- Hair can come away with the scales/flakes
Treatment
- Most cases clear in own time
- Gently washing with shampoo can help prevent build up
- Baby oil, natural oil, almond oil, olive oil can be used to loosen
crusts
- Wash more frequently, dont pick as it can cause infection
- Stronger shampoos can help loosen it
o Dentinox Cradle Cap shampoo 2 applications repeated at
each bath time until scalp is clear then use as necessary
o Contains sodium lauryl sulfate which is a cleaning agent
that de-greases the skin
o Wash hair 2-3 times a week
Referral
- Speak to GP in case of uncertain diagnosis
- Severe cradle cap
- Swelling
- Bleeding
- On face or body
- Inflamed/infected
- OTC treatment failure
Teething
- Teething is when a babys milk teeth come through the gums at around
the age of 6 months causing irritation
Symptoms of Teething
- May have no pain or discomfort
- Gum can be sore or red
b. Quantity
c. Formulation
d. Strength of medicine supplied
5. Prescriber details
a. Name and address of practitioner
b. GMC number
c. Telephone number
6. Patient details
a. Name and address of patient
Controlled Drugs Register
1. Class - look for drug subtitle in the BNF
2. Name of Drug/Brand what is written on prescription/BNF
3. Strength
4. Form drug formulation on prescription
5. Date supplied todays date
6. Name and address of person/firm supplied patient name/address
7. Prescribers details prescriber name and address
8. Person collecting/representative patient name/address
9. Proof of identity yes
10.Proof of identity of person collecting provided yes
11.Quantity supplied quantity on the prescription
12.Balance take away the quantity supplied from total
13.Name of pharmacist Vivek Patel, UCL SoP, London, WC1 XXX, (GPhC
number)
14.If a mistake is made sign, date and GPhC number
Diabetes
- Type 1 diabetes mellitus: the body's failure to produce sufficient insulin
- Type 2 diabetes mellitus: resistance to the insulin, often initially with
normal or increased levels of circulating insulin
- Gestational diabetes: pregnant women who have never had diabetes
before but who have high blood sugar (glucose) levels during pregnancy
are said to have gestational diabetes
Driving
- Drivers with diabetes may be required to notify the Driver and Vehicle
Licensing Agency (DVLA) of their condition depending on their treatment,
the type of license, and whether they have diabetic complications
- If hypoglycaemia occurs, or warning signs develop, the driver should:
o Stop the vehicle in a safe place;
o Switch off the ignition and move from the driver's seat;
o Eat or drink a suitable source of sugar;
o Wait until 45 minutes after blood glucose has returned to normal,
before continuing journey.
Type 2 Diabetes
- First line treatment life style interventions including diet and exercise
- If this doesnt control glucose levels after 3 months use metformin or
sulphonylureas
- Metformin is the drug of first choice in overweight patients in whom strict
dieting has failed to control diabetes, may also be considered as an option
in patients who are not overweight
- Sulfonylureas are considered for patients who are not overweight, or in
whom metformin is contra-indicated or not tolerated
- When combination of strict diet and drug therapy fails use a
combination of metformin and sulfonylurea
Metformin
- Increases sensitivity of cells to insulin allowing the body to make better
use of lower insulin levels
- Drug of 1st choice in overweight patients in whom strict dieting
has failed to control diabetes, also considered in those who are
not overweight
- When combination of strict diet and metformin treatment fails combine
with sulfonylurea
- Usually once daily with breakfast may be increased to twice daily
- Take tablet with or immediately after a meal at the same time each
day
- Side effects nausea, diarrhoea, abdominal pain, weight loss
- Complications lactic acidosis
- Contra-indications renal impairment, ketoacidosis, low BMI
- If a dose is missed, take as soon as you remember unless it is
close to the next dose time
Sulfonylureas Glibenclamide, Gliclazide, Glimepiride, Glipizide,
Tolbutamide
- Augment insulin secretion and are only effective when there is some
pancreatic beta cell activity present
- Considered for patients who are not overweight or in whom metformin is
contra-indicated or not tolerated
- When combination of strict diet and sulfonylurea treatment fails
combine with metformin
Use sun screen (may make skin sensitive to sunlight), wash face regularly,
be careful with what products you use in case it aggravates the skin
Long term medication so maintain regular contact with your GP for check
ups
Lifestyle
o Stop smoking? Greatly increases risk of blood clotting
o Eat healthily reduce levels of saturated fats, less fried
foods, grilled meats etc, include 5 portions of fruit and veg,
reduce salt intake
o Exercise gradually increase exercise brisk walking,
climbing stairs etc