SF Pharmacy 2022-23, Extemporaneous & ULM

SF Pharmacy 2022-23. Disp & Pt Care 2.4 GROUP A&B

Student number: ______________________ Computer number: ________

Raw marks Penalties, if any Final mark
(before
penalties)
Q.1 ex 45
Q.2 ex 45
Verbal counselling practice (demonstrator ex 10
mark)
Total marks ex 100
Total percentage (rounded to nearest integer) % ex 100
SEVEN RIGHTS
For all medicines you supply, you must ensure that the ‘seven rights’ of the patient are
respected: Right patient, right drug, right dose, right route, right time, with the right information
and right documentation.

In this practical you are required to play the role of a pharmacist. You may introduce yourself as a
pharmacist and undertake (or describe undertaking), activities that are reserved for pharmacists
or that require pharmacist supervision, where relevant to the case(s) presented. You are reminded
that such role play is only permitted when explicitly indicated (as here), during and for the purpose
of an educational simulation that is clearly recognized as such by all involved, including anyone in
the role of a patient.

Outside these limited simulations, there are no circumstances under which you (a pharmacy
student) may indicate that you are a pharmacist, imply that this is the case, let someone else
persist in a mistaken belief that you are a pharmacist, undertake an activity reserved for
pharmacists, or undertake an activity required to be supervised by a pharmacist without
appropriate supervision. Any misrepresentation or inappropriate activity may lead to a Fitness to
Practise case and/or prosecution under relevant legislation.

Take note of the patient profiles, prescriptions and stock for each case on Blackboard.
Then please answer the questions below.

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Case 1. Prepare the labels for both products and provide counselling on the BMX For staff use
medication. only
Sarah Anderson has just collected her daughter’s prescription (Ivy Anderson d.o.b.

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23/02/2013) at her GP’s surgery, after being transcribed from a consultant-initiated hospital
prescription. Your counter-assistant took in this prescription from the mother and left it on the
dispensary bench for you to dispense.

Dr Geraldine Gunn LRCP&SI

Reg. 64725
10 Ballacor Road, D7
Tel./Fax 01 112 3345
GMS # 91919

01/11/2022

Rx:

BMX Mouthwash
Sig. 10 mL t.d.s. p.o. before meals
Mitte 240 mL

Ondansetron
Sig. 4mg t.i.d. prn p.o.
Mitte 5/7

DR. NO. Dr G. Gunn

91919 10 Ballacor Road, D7.

Ivy Anderson
B223317C
22 Cedar Court, Dublin 7. Geraldine Gunn
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Q.1 (a) Issues to be addressed and action taken

Are there any legal, clinical, administrative or ethical/professional problems with this Ex 10 marks
prescription? For each problem (if any), please state how you would address the issue.

Legal Legal appraisal

(correct/incorre
Ivy is under 12 (aged 9) and her name is not on the prescription. ct)
BMX is an unlicensed medicine. ❑❑❑

Clinical Clinical
Ivy is a child and Ondansetron syrup may be more suitable, rather that Ondansetron 4mg film- appraisal
coated tablets should be a suspension (correct/incorr
ect)
❑
❑❑
C/I
Interacti
on
Allergy
Drug
Formula
tion
Dose
Regimen

Ethical/Professional Ethical/prof.
appraisal
N/A (correct/incorr
ect)
❑
❑❑

Administrative Admin.
appraisal
BMX is an unlicensed (extemporaneous) product, and it should be written on separate (correct/incorre
prescriptions. ct)
❑❑❑

Intervention made for this prescription

N/A

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Q.1 (b) Details of dispensing

Ex 10 marks
Product name Drug(s) in product Strength(s) Quantity Expiry
(specific Dispensing
(correct/
product)
incorrect)
BMX Benylin Cough - Diphenhydramine 240ml 24/11/202 ❑❑
❑
mouthwash medicine Syrup hydrochloride 2
Maalox 14mg/5ml
200mg/175mg per Levomenthol
5ml Oral Suspension 1.1mg/5ml
Xylocaine 2%w/v - Magnesium hydroxide
solution for injection (200mg/5ml)
Aluminium
hydroxide
m(175mg/5ml)
- Adrenaline
(Epinephrine)
(1:200,000)

Ondansetron - Ondansetron. - 4mg/5ml 100ml 9/01/2023

(60 days
after
opening).

Legal class Number of occasions Intervals at which repeated Rx returned

Count today and any future (e.g. monthly; appropriate or retained?

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Q.1 (c) Labelling Ex 15 marks

Label(s)
(correct/
incorrect)
❑❑ ❑
If incorrect:
Drug
Strength
Product
Quantity
Direction
s
Warnings
Patient
Scheme/
Dr
Legible/
neat
Checked
Other

Q.1 (d) Key counselling points

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BMX (magic) mouthwash Ex 10 marks

- Introduce yourself and greet the patient.
- Confirm the patients name address and age, as Ivy is under 12. Counselling
- Inform them that the mouthwash is called BMX mouthwash and it contains 3
Identity/
ingredients: B= Benylin Cough Medicine Syrup (B) purpose
M= Maalox Suspension (M) Dosage
X= Xylocaine (Lidocaine) 2% w/v soln. for injection (X) Timing
- Tell the mother that BMX is an extemporaneous product (unlicensed) product in Warnings
Ireland, but it is widely used in the UK and is safe. S-Es/
- Inform her that the medicine can still be obtained on the GMS scheme monitor
- BMX indication (directed to the child): pain and swelling in her mouth (mucositis). Non-drug
Ask Ivy’s mother/Ivy what kind of treatment Ivy is undergoing and how she is info
feeling. Other
- Ask the mother if Ivy has any allergies or medical conditions or if she is on any other
medication: and clarify with Ivy, that her mum didn’t miss anything.
Allergies: sugar intolerances (B), magnesium and aluminium hydroxide.
Medicine: medicines containing diphenhydramine, anti-depressants, CNS
depressants e.g. opioid analgesics(B). Aspirin (Maalox shouldn’t be taken with other
medicines) (M). Beta-blockers, medicines to treat mental problems e.g.
chlorpromazine and local anaesthetics amongst others(X)
Medical Conditions: epilepsy (B), diabetes and porphyria(M)
- Purpose: to help with the pain and swelling in her mouth (mucositis)
- Dose duration and frequency: (directed to ivy): shake well before use. Gargle 10ml
(using a measuring cup, that will be supplied by the pharmacy) 3 times daily, 30
seconds - 1 minute before meals/fluid and wait or drinking, to allow for the
absorption of the active ingredients.
Teeth should be brushed before using the mouthwash.
Inform Ivy that BMX doesn’t have to be used for 8 days, it is just until the pain stops
( within the eight-day span). However, it can’t be used after 2 weeks.
Inform Ivy that if she has pain in her throat, she should swallow the mouthwash and
if not, she can spit it out.
Teach Back: remind me of how I told you to take the medication.
- Side effects: dizziness (B and X) and tiredness (B), constipation, diarrhoea, stomach
pain (M). Nausea, vomiting and pins and needles(X)
- Tell your doctor if: increased heart rate, trouble sleeping (B)
- Signs of an allergic reaction: difficulty breathing/ chest pain, swelling of eyelids,
face, mouth, or tongue.
- Storage: room temperature
- Disposal: in the pharmacy
- Nondrug information and managing side-effects:
Constipation: grapes, plums, pears, broccoli, sweet potatoes.
Diarrhoea: BRAT, banana, rice, applesauce, toast.
Nausea and vomiting: sip cold water. Ice chips.
Stomach pain: warm compress on the stomach.
- Avoid spicy and salty food (to prevent increasing the pain Ivy is feeling).
- Eat ice pops to numb the pain.
- Good oral hygiene (brush teeth twice daily), due to the sucrose content in Benylin.
- Ask the patient if they have any questions.
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- Arrange a follow-up.

Ondansetron
- Introduce yourself and greet the patient.
- Confirm the patient’s name address and age, as Ivy is under 12.
- Inform Ivy that Ondansetron is a drug (oral syrup) that helps prevent
nausea/vomiting caused by chemotherapy.
- Inform the mother that Ondansetron is covered by the GMS scheme.
- Ask the mother if Ivy has any allergies or medical conditions or if she is on any other
medication: and clarify with Ivy, that her mum didn’t miss anything.
Allergies: ondansetron,
Medicine: antibiotics e.g. erythromycin, tramadol, heart medication, depression or
anxiety medication.
Medical Condition: heart problems, liver problems, severe constipation, intolerance
to sugars or issues with salt levels in the blood.
- Dose: Give 5ml by syringe three times daily for 5 days. Do not mix ondansetron with
anything before swallowing it, not even water.
- If too much ondansetron is taken, contact the doctor and go to the hospital, with
the pack of medicine.
- If a dose is forgotten and the patient feels sickly, but if it is nearly time for the next
dose, skip that dose and take the next one.
If a dose is forgotten but the patient does not feel sickly, the patient should take
the dose as soon they remember, but if it is nearly time for the next dose, skip that
dose and take the next one.
- Drug interactions: tramadol, apomorphine, depression medication (SSRIs),
phenytoin (amongst others)
- Side effects: headache, constipation, feeling of warmth/flushing
- Signs of an allergic reaction: difficulty breathing/ chest pain, swelling of eyelids,
face, mouth, or tongue.
- Teach Back: can you remind me of how I told you to take the medicine?
- Storage: Do not use this medicine if the solution becomes discoloured or appears to
be going off- contact your pharmacist.
Use it within 60 days of opening.
Keep this medicine out of the sight and reach of children (Ivy’s mother should store
the medicine away from Ivy)
- Disposal: Bring the medicine to the pharmacy for disposal (do not dispose of it in
wastewater)
- Nondrug information:
Vomiting: ice chips/sipping cold water if the patient vomits. BRAT diet: banana, rice,
applesauce, toast
Nausea: sipping cold water/ flat seven up.
- Ask the patient if they have any questions.
- Arrange a follow-up.

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Case 2.
Jane Acheson presents this GMS prescription at your community pharmacy for her
daughter Amy (d.o.b. 01/07/2019) who suffers from urinary tract infections. She has been
to visit a consultant urologist who initiated the treatment and the family have had the
consultant’s prescription transcribed onto a GMS prescription by their GP.

Amy Acheson
G222351A
16 Bramble Close
Dublin 3.

Dr. A. P. CURRY MB BCH BAO

IMC REG. 16114
27 AINESFORTH STREET,
DUBLIN 2
TEL./FAX 01 286 4311
GMS 65444
01/11/2022 3 4

Rx
Nitrofurantoin 5mg/mL suspension
Give 3 mL nocte
Mitte 200 mL

DR. NO. DR A. CURRY

65444 27 AINESFORTH ST, D2. Anita Curry

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DR. No. DR G. GUNN

91919 10 BALLACOR ROAD, D7
Geraldine

Q.1 (a) Issues to be addressed and action taken

Are there any legal, clinical, administrative or ethical/professional problems with this
prescription? For each problem (if any), please state how you would address the issue. Ex 10 marks

Legal Legal appraisal

Nitrofurantoin is an unlicensed medicine. (correct/incorre
ct)
❑
❑❑

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Clinical Clinical
According to the EMC (electronic medicines compendium, the dose for children and infants appraisal
over 3 months is 3mg/kg/day. (correct/incorr
ect)
❑
❑❑
C/I
Interacti
on
Allergy
Drug
Formula
tion
Dose
Regimen
Ethical/professional Ethical/prof.
appraisal
n/a (correct/incorr
ect)
❑
❑❑

Administrative
Admin.
appraisal
n/a (correct/incorr
ect)
❑
❑❑

Intervention made for this prescription

Ivy’s weight can be checked, to confirm the dose is appropriate.

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Q.1 (b) Details of dispensing

Ex 10 marks
Product name (specific Drug (generic name) Strength Quantity Expiry
product)
Dispensing
Nitrofurantoin 25MG/5ML Nitrofurantoin 25MG/5ML 200ml Use (correct/
oral suspension within incorrect)
30 days ❑❑
❑

after If incorrect:
first
openin
g
(EMC)

Legal class Number of occasions Intervals at which repeated Rx returned

Count today and any (e.g. monthly; appropriate or
future occasions (e.g. 1, 6, intervals > 5 days; n/a) retained?
suitable number within
6/12)
POM: 1 n/a retained

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Q.1 (c) Labelling

Ex 15 marks

Label(s)
(correct/
incorrect)
❑
❑❑

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Q.1 (d) Key counselling points Ex 10 marks

Counselling
Nitrofurantoin (anti-biotic)(extemporaneous, unlicensed medicine)
Exc VG G
Poor
- Introduce yourself and greet the patient.
If substandard,
- Confirm the name, age and address of the patient (talk to the child and mother). lacks:
- Inform the mother that Nitrofurantoin is an extemporaneous, unlicensed medicine
Identity/
in Ireland, but it is widely used in the UK and is safe. purpose
It contains nitrofurantoin and xantham gum (suspending agent) Regimen
- Tell Molly that Nitrofurantoin is to help prevent urinary tract infections, that she Warnings
has experienced. Non-drug
- Ask Molly’s mother if Molly has any: info
Allergies: nitrofurantoin, nitrofuran, xantham gum Other
Medication: typhoid vaccine (as nitrofurantoin is an anti-bacterial)
Medical conditions: blood disorder and Glucose 6 phosphate dehydrogenase
deficiency.
- Caution: diabetes, anaemia, vitamin B deficiency.
- Dose: shake well before use.
Give 3ml by syringe once daily (in the evening) Take with food or milk, to prevent
stomach upset.
Ask Amy’s mother if the doctor said how long Amy will be using Nitrofurantoin?
Inform her that the medicine expires after 30 days, but the dose the doctor will
require use for 67 days, so she would need to contact her doctor if a repeat would
be suitable.
Action if a dose is missed: if you don’t remember that day, just take the next dose
the following day.
- Overdose: consult the doctor/pharmacist and go to the hospital, with the packet
of medicine.
- Interactions: Medicines that slow the movement of food through the stomach, e.g.
atropine, quinolamines, medicines for raised pressure in the eye (glaucoma) e.g.
acetazolamide (not exhaustive).
- Side effects: dizziness and tiredness, stomach pain, colour in the urine (inform the
guardian, that this is not causing for concern).
If you experience: jaundice, blue or purple discolouration of the skin, symptoms of
fever or flu amongst other side effects, contact your doctor.
- Signs of an allergic reaction: difficulty breathing/ chest pain, swelling of eyelids,
face, mouth, or tongue.
- Teach Back: can you remind me of how I told you to take the medicine?
- Storage: store in the original packaging (protect from light and moisture)
Disposal: Bring the medicine to the pharmacy for disposal.
- Non-drug information:
Try to avoid food that is low in fibre: white bread, white pasta, low-fibre cereal.
Eat foods higher in fibre: oatmeal and banana
- Ask the patient if they have any questions.
- Arrange a follow-up

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PLEASE PASTE THE STAFF REVIEW OF YOUR

BMX COUNSELLING HERE

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