1

Acknowledgements
Amar Iqbal
Pre-registration and Student
Support Lead
Fawzia Lokat
Pre-registration Support Officer
Georgia Malesi
Student Support Officer
Bindya Tailor
Communications Officer
Katrina Earle
LPF Events Team
Bijal Tailor
LPF Events Team
Akila Ahmed
LPF Deputy Lead
Ebraheem Junaid
Paediatric Pharmacist
Birmingham Childrens Hospital
Louise Chamberlain
Pre-registration and Student
Support Deputy Lead
Launch:
BNFc Guidance
Make Your Mark 2014
BNFc Quick Reference
Guide (QRG)
Make Your Mark 2014
BNFc QRG
Support Presentation
Make Your Mark 2014
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2
Part 1:
BNF Tagging
Make Your Mark 2014
By: Georgia Malesi,
Amar Iqbal, Fawzia Lokat,
Louise Chamberlain and Bindya Tailor

Common Themes
Introductory sections e.g. palliative care
Colour coding of chapters
Highlighting cautions, side effects, interactions
Useful tables e.g. H. Pylori eradication, TB treatment,
electrolytes,
Stepwise treatments e.g. hypertension, asthma
Equivalent doses e.g. steroids, hypnotics, antipsychotics
Appendices marked
Interactions tagged A-Z
Index tagged A-Z

Useful tables and sections
Opioid equivalents Steroid equivalents
H.Pylori eradication COC and HRT
Hypertension guidelines Iron salts
Warfarin Electrolytes
Antipsychotic equivalents G6PD deficiency
Antiepileptic interactions Acute porphyria
TB Emollient quantities
Malaria
Topical steroid quantities
and potencies
Annotating
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3
GPhC rules for annotation
The text printed may be supplemented by hand-written
(not printed) highlights, tabs, corrections and
comments.
The annotation should complement the purposes of
the adjacent text and therefore the inclusion of
additional material, including photocopies, is not
allowed.
Invigilators will check reference sources on the day of
the assessment and remove additional materials. If
serious misconduct is suspected it may result in you
being awarded a fail

Highlighting and
Underlining
http://www.preregpharm
.co.uk/a-guide-to-
tagging-you-bnf/
Tag your current BNF and get used to
using it and find what works for you
Dont over-tag your BNF
Think carefully about how much you
highlight
Dont forget your BNFc
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4
Part 2:
Drug Tariff
Make Your Mark 2014
By: Amar Iqbal
Pre-registration and Student Support Lead
Which of the following information can be found by looking in the
Drug Tariff?

1. Basic prices of drugs and appliances

2. Details of the reward scheme for fraudulent prescriptions

3. National Out of Hours Formulary
Answer: A
Directions Summarised
A
1, 2, 3
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
The Registration Assessment: Make your mark
Borderline Substances (ACBS) Part XV Appendix 2 (BNF)
Professional fees and charges Part XVI
Exemptions Part XVI
Dental and Nurse Prescribers Part XVII A/B Back of BNF
Black list Part XVIII A
Selected List Scheme (SLS) Part XVIIII B
Some of the information may be found in another open book reference source (No change to question)
Some questions can be answered without an open book reference source (No change to question)
The information cannot be found in reference source (Question changed to add factual detail)
Question unanswerable without a reference source (Question removed)
The Registration Assessment: Make your mark
CD2
CD3
CD4-1
CD4-2
POM
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5
Which of the following is not a substance which is reimbursable
when prescribed for the dietary management of phenylketonuria?

A. Easiphen
B. Milupa PKU 3-advanta
C. PK Foods Orange Jelly
D. PKU Start
E. Sno-Pro

Answer: C
(see BNF)
Borderline Substances

In certain conditions some food and toiletry preparations have characteristics of drugs
and the Advisory Committee on Borderline Substances advises as to the circumstances
in which such substances may be regarded as drugs. Prescriptions issued in accordance
with the Committee's advice and endorsed "ACBS" will normally not be investigated.
The Registration Assessment: Make your mark
Preparing for the exam
ACBS
See BNF
Appendices
Individual
monograph
You receive a lilac coloured prescription in your pharmacy. The new
student technician asks you what type of prescription it is as he has not
seen one previously. You tell him that it is a:

A. FP10-SS
B. FP10-MDA
C. FP10-D
D. FP10-HP
E. FP10-CN
Answer: E
Each of the questions or incomplete statements in this section is
followed by three responses. For each question ONE or MORE of the
responses is/are correct. Decide which of the responses is/are
correct. Then choose:




You receive a prescription from your local nurse practitioner, which of
the following items are you legally able to dispense for this prescriber?

1. Aciclovir Oral Suspension BP (200mg/5mL)
2. Choline Salicylate Dental Gel BP
3. Ibuprofen Tablets BP


Answer: C
(see BNF Appendices)
Directions Summarised
A
1, 2, 3
B
1, 2 only
C
2, 3 only
D
1 only
E
3 only
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6
You receive a prescription from Mr JS, who is not exempt from
paying charges. The prescription is for the following items:

Phenoxymethylpenicillin 250mg Caps (Mitte 56)


How much money does Mr JS have to pay for this item?

A. 7.10
B. 7.20
C. 7.65
D. 7.85
E. 8.00
Answer: D
You receive a prescription for the following items:

Amoxicillin 250mg Caps (Mitte 21)
Microgynon 30 Tablets (Mitte 21)

How many professional fees and charges apply?

A. 1 professional fee, 1 charge
B. 1 professional fee, 2 charges
C. 2 professional fees, 1 charge
D. 2 professional fees, 2 charges
E. 1 professional fee, 0 charges
Answer: C
The Registration Assessment: Make your mark
Single Multiple
Same drug/prep is supplied in >1 container

Different strengths of the same drug are ordered
separately on the same Rx

>1 appliance of the same type (other than
hosiery) is supplied

A set of parts making up a complete appliance is
supplied

Drugs are supplied in a powder form with a
solvent separate for subsequent admixing (e.g.
Zineryt)

A drug is supplied with a dropper, throat brush or
vaginal applicator

Several flavours of the same preparation are
supplied
Different drugs, types of dressings or appliances
are supplied.

A single preparation of more than one formulation
is supplied (e.g. Premique Cycle contains two
different tablets: Conjugated Oestrogen and
Medroxyprogesterone Acetate)

>1 piece of elastic hosiery is supplied.

Different formulations or presentations of the
same drug or preparation are prescribed and
supplied.

Additional parts are supplied together with a
complete set

Current charge 7.85 (England) for each prescription item, preparation or type of appliance
including each anklet, legging, knee-cap, below-knee, above knee or thigh stocking.
Professional fees and charges

Which of the following items when dispensed on an FP10
prescription would attract an additional fee?

1. Pethidine 50mg tablets

2. 1 pair below knee, class 1 stockings

3. Betnovate 10% in Unguentum Merck

Answer: A
Directions Summarised
A
1, 2, 3
B
1, 2
only
C
2, 3
only
D
1
only
E
3
only
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7

First
Statement

Second
Statement

Directions Summarised


A
B
C
D
E
True
True
True
False
False
True
True
False
True
False
2nd statement is a correct explanation of the first
2nd statement is NOT a correct explanation of the first
The following question relates to Mrs JM who presents to your
pharmacy with a prescription for Carbimazole 5mg OD (Mitte 28).

FIRST STATEMENT SECOND STATEMENT
Mrs JM is exempt from
prescription charges for this
prescription.
Hypothyroidism requiring
hormone replacement is a valid
reason for exemption under the
NHS Act 2006.
Answer: D

First
Statement

Second
Statement

Directions Summarised


A
B
C
D
E
True
True
True
False
False
True
True
False
True
False
2nd statement is a correct explanation of the first
2nd statement is NOT a correct explanation of the first
The following question relates to Mr FN who presents to your
pharmacy with a prescription for Ondansetron 4mg BD (Mitte 10).
Mr FN tells who that he is entitled to free prescriptions as he is
having the medication following his chemotherapy.

FIRST STATEMENT SECOND STATEMENT
Mr FN is exempt from
prescription charges for this
prescription.
Prescription charges do not
apply to those who are receiving
medication for the effects of
cancer treatment.
Answer: A
"No charges shall be payable by a person with a
valid exemption certificate issued by the Secretary
of State on the ground that the person is
undergoing treatment for

(i) cancer;

(ii) the effects of cancer; or

(iii) the effects of cancer treatment".

The Registration Assessment: Make your mark
Exemption from charges

Provided that the appropriate declaration is received, a charge is not payable to the pharmacist,
appliance contractor or dispensing doctor for drugs or appliances, including elastic hosiery, supplied for:

Children aged under 16, and young people aged 16, 17 or 18
in qualifying full-time education;

Contraceptive purposes (where marked appropriately)

People aged 60 and over.

People holding a valid exemption certificate or either have or
are one of the following:

> JSA, IS, or ESA
> A partner on Pension Credit Guarantee Credit
> An HC2 certificate
> expectant mothers;
> women who have borne a child or women who have given
birth to a child in the last 12 months;

War pensioners holding a War Pension exemption certificate
for prescriptions needed for treating their accepted disablement;

Released prisoners who present an FP10 or FP10 (MDA) will
not have to pay a prescription charge if:

> `HMP', the prison name, address and the prison telephone
number is printed in the box provided for the practice address on
the front of the form, with the prescribing code and responsible
Primary Care Trust code.

People who have purchased a PPC, which is valid at the point
of dispensing.

People suffering from the following specified conditions who
have a valid medical exemption certificate:

> permanent fistula (e.g. colostomy or ileostomy) requiring
continuous surgical dressing;

> a form of hypoadrenalism (e.g. Addison's) for which specific
substitution therapy is essential;

> diabetes insipidus and other forms of hypopituitarism;

> diabetes mellitus, except where treatment is by diet alone;

> hypoparathyroidism;

> myasthenia gravis;

> myxoedema (that is, hypothyroidism requiring thyroid hormone
replacement);

> epilepsy requiring continuous anti-convulsive therapy;

> a continuing physical disability which means they cannot go
out without the help of another person;

> cancer

NHS
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8
The Registration Assessment: Make your mark
Part XVIIIA - drugs, medicines and other
substances not to be ordered under a
General Medical Services contract.
Blacklist
NHS
The Registration Assessment: Make your mark
Drug Patient Purpose
Clobazam Any Epilepsy
Cyanocobalamin Tabs Vegan or proven Vit. B12 deficiency
Treatment or prevention of
Vit. B12 deficiency
Locabiotal Aerosol Any
Infection and inflammation of
the oropharynx
Niferex Elixir Paed (30mL) Premature infants
Prophylaxis in treatment of
iron deficiency
Nizoral Cream Any
Seborrhoeic dermatitis and
pityriasis versicolor
Oseltamivir; Zanamivir
At risk adult patients (e.g. chronic respiratory disease, CV disease,
renal disease, immuno-compromised, DM, or >65yrs)
Prophylaxis or treatment of
influenza
Alprostadil
Apomorphine
Moxisylyte
Sildenafil
Tadalafil
Thymoxamine,
Vardenafil
Started treatment prior to the 14 Sept 1998, a man suffering from:

DM, MS, PD, polio, prostate cancer, severe pelvic injury, single gene
neurological disease, or spinal cord injury (incl. spina bifida)

OR
Receiving treatment for renal failure by dialysis

OR
Who has had any of the following types of surgery: prostatectomy,
radical pelvic surgery, renal transplant
Treatment of erectile
dysfunction
Part XVIIIB - drugs, medicines and other substances that may be ordered only in
certain circumstances
Selected List Scheme

The Registration Assessment: Make your mark
Exemptions

Know who is exempt from prescription
charges and why they are exempt.

Professional fees and charges

Be aware of the current prescription
charge.

Make sure you know how many fees
and charges are reimbursed depending
on the product(s) prescribed.

Be aware of any simple professional
fees.
KEYPOINTS
ACBS

Be aware of ACBS products and where
to find them in the BNF.
Drug Tariff

Remember this is no longer an open book
reference source but you may still be asked
questions on it.

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9
Part 3:
Medicines, Ethics, and Practice
Make Your Mark 2014
By: Louise Chamberlain
Deputy Pre-registration and Student Support Lead
Hospital Pharmacist SWBH NHS Trust
The MEP is no longer a
reference source for the
exam BUT contains
important information on
the legal and professional
aspects of pharmacy that
can be tested.
Core concepts and clinical skills
Professionalism and professional judgement
Clinical check
Medication histories
Just culture

Legislation and professional issues
P meds
POM to P switches
Pseudoephedrine and ephedrine
EHC
Cough and colds in children

POMs
General prescription requirements
Private prescriptions
Labelling
Exemeptions
EEA and Swiss prescribers
Self prescribing

Legislation and professional issues
Wholesale dealing

Additional issues
Child resistant locks
Expiry dates
Homeopathic and herbal meds
Electronic cigarettes
Social media
Collection by children

Veterinary medicines
Prescription requirements
Labelling
Cascade
Record keeping
Legislation and professional issues
Controlled drugs
Prescription requirements
Private prescriptions
Requisitions
Safe custody
Registers
Destruction


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10
Conduct, ethics and performance
CPD
Confidentiality
Consent
Raising concerns
Maintaining sexual boundaries
Religious/moral beliefs
Responsible pharmacist
Dealing with complaints and concerns
Appendices: GPhC Standards and Guidance

Which of the following is the maximum number of
paracetamol 500mg capsules that can be sold
from a registered pharmacy without a
prescription?
a. 16
b. 32
c. 64
d. 100
e. 120


See appendix 11: GPhC guidance on responding to
complaints
You are working as a community pharmacist, you
realise that on the previous day when you were not on
duty atenolol was dispensed instead of allopurinol.
What would be your first course of action?
a. Contact the GPhC for advice
b. Contact the NPA for advice
c. Leave a note for the pharmacist involved to deal with it
d. Complete a dispensing error form
e. Contact the patient to inform them of the error

section 3.2.5 in MEP
A 4 year old child presents to the community pharmacy.
Her mother states that she has had a runny nose, sore
throat and dry cough for the past couple of days. Which of
following would you advise?
a. Pholcodeine linctus
b. Otrivine (xylometazoline) child nasal drops
c. Paracetamol and ibuprofen
d. Paracetamol
e. Benylin childrens night coughs (contains levomenthol
and diphenhydramine)




A B C D E
Subject to prescription
requirements
Yes Yes Yes No No
Subject to safe
custody
Yes Yes No No Yes
Requires CD register
to be kept
Yes No No Yes No
Select from A to E which one of the above descriptions applies to the
following medicines:

1. Temazepam 10mg tablets
2. Buprenoprhine 400microgram sublingual tablets
3. Sativex oromucosal spray
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11
Directions summarised
A
1,2,3
B
1,2
only
C
2,3
only
D
1
only
E
3
only
Mr Taylor a regular patient at your community pharmacy has run out
of Novomix 30 Flexpens and asks for a supply without a prescription
Looking at his PMR you can see that he has these as a regular
repeat medication. You make the supply, which of the following
apply?

1. A full pack of 5 pens should be supplied
2. The words emergency supply need to be on the dispensing label
3. An entry must be made in the POM register
Miss Green, aged 28, presents with a prescription for isotretinoin 25mg daily.
Which of the following apply when supplying isotretinoin?





Directions summarised
A
1,2,3
B
1,2
only
C
2,3
only
D
1
only
E
3
only
1. The prescription has an expiry date of 6 months.
2. A maximum of 60 days can be supplied
3. The patients age does not need to be on the prescription
Directions summarised
First Second
statement statement
A
B
C
D
E
True
True
True
False
False
True
True
False
True
False
2
nd
statement is a correct explanation of the first
2
nd
statement is NOT a correct explanation of the first

Mr Ludwig is on holiday in the UK. He presents a prescription to you
that has been written in his home country, Germany (an EEA country).
No patient address has been written on the prescription.

First Statement Second Statement
A legal supply can be made The patients address is not a legal
against this prescription as it stands requirement for prescriptions issued
by a doctor registered in an EEA country

Directions summarised
First Second
statement statement
A
B
C
D
E
True
True
True
False
False
True
True
False
True
False
2
nd
statement is a correct explanation of the first
2
nd
statement is NOT a correct explanation of the first

You are preparing to destroy the out of date and patient returned
controlled drugs that have been kept in the CD cupboard. 10 morphine
sulphate MR 60mg capsules have been returned by Mrs Watson as she
no longer needed them.
First Statement Second Statement
Destruction must take place in the Morphine is a schedule 2 controlled
presence of an authorised witness drug


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12
Part 4:
Over the counter sales
Make Your Mark 2014
By: Fawzia Lokat
Pre-registration and Student Support Officer
Community Pharmacist (Boots UK Ltd)
Todays session
Overview of OTC topics
Topics that the GPHC commonly ask questions from
Quiz / Scenarios
Childhood diseases
Licensing indications
Vitamins
POM to P
Reference sources
Questions
Respiratory
Cold + Flu
Cough
Sore throat
Allergic Rhinitis

GI
Heartburn/Indigestion
Constipation/Diarrhoea
IBS
Motion sickness/ N+V
Hemorrhoids
Mouth ulcers

Womens Health
Cystitis
Thrush
EHC



Eye/Ear
Childhood Conditions
Colic
Head lice
Threadworms
Childhood rashes
Fever
Skin
Eczema/Dermatitis
Psoriasis
Acne
Fungal infections
Cold sores
Warts/Verrucas
Scabies
Hair loss
Pain
Musculoskeletal
Headaches








Responding to symptoms: Overview of topics Commonly covered topics by the GPHC

Sale of Hydrocortisone
Thrush vaginal and oral
Use of products in pregnancy
Skin conditions
Childhood skin conditions
Eczema/dermatitis and Psoriasis
Eye conditions
Conjunctivitis and the sale of chloramphenicol
Viral, allergic and bacterial eye conditions
Heartburn and indigestion
Cough and cold referral
Warm up quiz
Question 1
Which viral pathogen is responsible for the majority
of viral conjunctivitis cases?

A. The rhinovirus
B. The Epstein-Barr virus
C. The adenovirus
D. The Norwalk-virus
E. The rotovirus

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13
Question 2
Which of the following products contains peanut
oil?

A. Otex
B. Earcalm
C. Earex
D. Molcer
E. Exterol

Question 3
Questions 1 and 2 concern the following skin conditions:

A. Acne vulgaris
B. Herpes zoster
C. Molluscum contagiosum
D. Seborrhoea capitis
E. Tinea corporis

Select from A to E which one of the above can be recognised
by the dermatological sign(s) described below:

1) Isolated erythrematous scaly lesions with defined edges, often round
or oval in shape

2) A vesicular rash, occurring unilaterally over the scalp and forehead,
extending to the eye on



Question 4
A patient comes in your pharmacy asking for an antacid.
Which of the following medicines, would be affected by an
antacid leading to reduced absorption of the drug?

A. Amiodarone
B. Disopyramide
C. Digoxin
D. Verapamil
E. Propanolol



Question 5
What is the name of the virus that causes warts?

A. Rotavirus
B. Rhinovirus
C. Human papilloma virus
D. Coltivirus
E. Baculovirus



Question 6
Questions 1 to 3 concern the following ingredients often included in
cough mixtures:

A. Diphenhydramine
B. Theophylline
C. Guafenesin
D. Dextromethorphan
E. Pseudoephedrine

Select from A to E which one of the above:

1. Has a sedative effect which is enhanced by alcohol
2. Interacts with MAOIs with the risk of a dangerous rise in blood
pressure
3. Interacts with quinolones to cause an increase risk in convulsions





Childhood Health and
Diseases
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14
Paracetamol doses (popular GPhC question)
Age How
much
How often
3 months up to 6 months 2.5ml Up to 4 times in any 24 hours

Leave at least 4 hours between
doses
6 months up to 2 years 5ml
2 years up to 4 years 7.5ml
4 years up to 6 years 10ml
Dont give more than 4 times in any 24 hours
Age How much How often
6 years up to 8 years 5ml Up to 4 times in any 24 hours

Leave at least 4 hours between
doses
8 years up to 10years 7.5ml
10 years up to 12 years 10ml
12 years up to 16 years 10ml -15ml
Adults and children aged 16
and over
15ml 20ml
Dont give more than 4 times in any 24 hours
Paracetamol
250mg/5ml
Paracetamol
120mg/5ml
Fever
When to refer:
< 3months old, as diagnosis is difficult
Associated stiff neck or febrile convulsions
Prolonged fever or unresponsive to medicines


Antipyretics should be given to reduce fever. The childs fluid
intake should be increased to avoid dehydration from excessive
sweating. Any prolonged fever should be referred.

Diarrhoea
When to refer:
Referral to a doctor is based on age of child and duration of diarrhoea

<1 year old > 24 hours duration = referral
<3 years old > 48 hours duration = referral
>3 years old / adults > 72 hours duration = referral


In most cases the condition is self limiting and does not exceed 2-3
days

FIRST LINE: increase fluid intake with possible addition of oral
rehydration salts (ORS)


Question 1
Questions 1 to 3 concern the following conditions:

A. Chicken pox
B. Epidemic parotitis
C. Rubella
D. Herpes virus
E. Pertusssis


Select from A to E which one of the above is:

1. Whooping cough
2. Mumps
3. German measles

Image taken from NHS choices 2014
Childhood diseases: BRIEF overview
Question 2
Questions 1 to 4 concern the following childhood diseases:

A. Mumps (epidemic parotitis)
B. German measles (rubella)
C. Measles
D. Chicken pox (herpes zoster)
E. Whooping cough (pertussis)

Select, from A to E, which one of the above fits the following statements:
1. The vesicles produced by this disease contain large quantities of the virus

2. Women who are pregnant should avoid contact with people infected with this
disease because of risk of congenital abnormalities

3. Vaccination against this disease is routinely given during the first year of life
in the form of a combined vaccine with diptheria, tetanus, Haemophilus
influenza type b and polio

4. The disease causes characteristic white spots surrounded by a red ring
(koplik spots) on the inner cheek and gum

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15
Licensing Indications
Common OTC licensing indications you
should be aware of

o Hydrocortisone 1% cream
o Clotrimazole thrush cream
oDaktarin gel contraindications and age
restrictions
o All POMs to Ps
o Diclofenac
o Constipation in pregnancy

Licensing continued..

Aciclovir
Products will be P unless the following
conditions are met:

For external use
For the treatment of HSV of the lips
and face (Herpes Labialis)
Max Strength: 5%
Min pack size: 2g

Additional product information
requirements:

The leaflet should advise the patient to
consult a pharm/doctor if in any doubt
as to whether the sore is a cold sore,
and to consult the doctor if the cold
sore becomes severe.


http://www.mhra.gov.uk/Howweregulat
e/Medicines/Licensingofmedicines/Leg
alstatusandreclassification/Listsofsubst
ances/index.htm
Vitamins
Question 1
Questions 1 to 3 concern the following vitamins

A. Vitamin A
B. Vitamin B12
C. Vitamin C
D. Folic acid
E. Vitamin E

Select from A to E which one of the above vitamins

1. Aids intestinal absorption of iron from plant sources
2. Is present in vegetable oils
3. Is not absorbed from the gut in patients with pernicious anaemia





Question 2
Questions 1 to 4 concern the following vitamins

A. Vitamin A
B. Vitamin C
C. Vitamin D
D. Vitamin E
E. Vitamin K

Select, from A to E, which one of the above vitamins is referred to in the
following statements:

1. It leads to an increased risk of birth defects if taken in excess during
pregnancy

2. A deficiency contributes to the development of osteoporosis

3. It effects the time it takes for blood to clot

4. It is produced by the action of ultraviolet light on the skin





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16
POM to P Switches
1. Omeprazole
2. Tranexamic Acid
3. Chloramphenicol
4. Simvastatin
5. Orlistat
6. Sumatriptan
7. Tamsulosin
8. Azithromycin
9. Amorolfine
10.Levonorgestrel
11.Diclofenac

www.rpharms.com

Tamsulosin
What do I need to know before I supply?

Indication: Benign prostatic hyperplasia in men aged 45-75 years

Symptoms: difficulty when starting urinating, urinating for longer or more
frequently, needing to urinate again within in a short period of time, needing
to get up to urinate several times a night

Symptoms need to have been present for a minimum of 3 months
Ask if patient takes any other medication or suffers from any other
medical condition
Good practice to use the International Prostate Symptom Score to
assess symptoms of BPH


Tamsulosin
When should it not be supplied?

Symptoms present for less than 3 months


Patient has had prostate surgery


There is unstable or potentially undiagnosed diabetes (e.g. characterised by
excessive thirst and tiredness)


The patient has problems with their liver, kidney or heart


The patient reports fainting, dizziness or weakness when standing (postural
hypotension)


Cataract surgery is planned


The patient has recent blurred or cloudy vision that has not been examined by a GP
or optician (as cataracts may be indicated)


The patient has allergy or hypersensitivity to tamsulosin


If the patient takes any antihypertensive medicines with significant alpha blocking
activity e.g. doxazosin, indoramin, prazosin, terazosin, verapamil.



Tamsulosin
Key points for sale:

You can make a 2 week initial supply to patients with BPH symptoms.

If there has been an improvement in urinary symptoms, you can make a
further 4 weeks OTC supply of tamsulosin.

If there are contraindications or symptoms are not relieved or are getting
worse after the first 2 weeks then the patient must be referred to a doctor.

Patients must be advised to see their doctor within 6 weeks of starting
treatment for assessment of their symptoms and confirmation they can
continue to take OTC tamsulosin



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17
Case Scenarios
Question 1
A 48 year old woman asks you to recommend a treatment for itching, The
itchiness is widespread over her body and started about 2 days ago. She
had a yellow-brown tanned appearance and has returned from a holiday in
Turkey 2 weeks ago. On questioning she reveals that she feels generally
unwell and has difficulty sleeping. She does not take any medication and
since returning from holiday she had not changed her diet, or used any
new cosmetics or detergents.

Which one of the following courses of action is the most appropriate for
you to take?


A. Advise her to take Piriton (chlorphenamine / chlorpheniramine maleate 4 mg)
tablets
B. Advise her to use calamine lotion
C. Advise her to use hydrocortisone cream 1%
D. Advise her to use a soap substitute such as emulsifying ointment
E. Advise her to see her GP

Question 2
A woman visits your pharmacy asking to buy something to relieve her
symptoms as she is needing to pass urine more frequently than usual, and
is experiencing a burning sensation when doing so. She has no other
symptoms, is otherwise healthy, and takes no regular medication.

Which one of the following would it be appropriate for you to recommend?


A. Advise that she uses Canestan (clotrimazole) cream Advise her to use
calamine lotion
B. Advise that she takes Cystopurin (potassium citrate) sachets
C. Advise that she takes Diflucan One (fluconazole capsule 150 mg)
D. Reassure her and advise that the condition will improve on its own without
any intervention
E. Refuse the sale and advise that she makes an appointment to see her GP
urgently
Question 3
A patients father comes into the pharmacy requesting treatment for his 10
year old son. You have confirmed the patient has active head lice. He has
asthma and uses ventolin 100mcg evohaler and seretide 125 mcg
evohaler.

Which of the following would be the most appropriate treatments?


A. Malathion 1% cream shampoo, applied to the hair for 10 minutes before
rinsing and repeating in 114 days time
B. Dimeticone 4% lotion, applied to the hair for 8 hours before rinsing and
repeated after 7 days
C. Permethrin 1% creme rinse applied to the hair for 10 minutes before rinising
and repeated after 7 days
D. Malathion 1% cream shampoo, applied to the hair for 10 minutes before
rinsing and repeated after 7 days
E. Phenothrin 0.2% lotion, applied to the hair for 12 hours before rinsing and
repeat in 7 days
Question 4
Mrs L asks you to recommend something for her irritating dry
cough. She is otherwise well, and takes no regular medication. It
would be most appropriate for you to recommend a non-
prescription product containing:

A. Ammonium chloride
B. Dextromethorphan
C. Squill
D. Ipecacuanha
E. Guaifenesin
Question 5
A patient aged 30 years comes into the pharmacy. She tells you
that she would like you to recommend something for her
headaches that she has recently been getting. She explains that
the pain is across her forehead and around the back of her head.
The headaches have been occurring several times a week, for
several weeks. There are no GI symptoms associated. After
questioning any lifestyle changes it was identified that she has
recently started a new job.

Which of the following most describes the headache the patient is
suffering from?

A. Migraine
B. Tension headache
C. Subarachnoid Hemorrhage
D. Trigeminal neuralgia
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18
References



Community Pharmacy: Symptom, diagnosis and treatment, 2e [Paul Rutter
Bpharm MRPharmS PhD]

Symptoms in the Pharmacy: A Guide to the Management of Common Illness, 6
th

Edition Alison Blenkinsopp, P. Paxton and J. Blenkinsopp 2009 Alison
Blenkinsopp, Paul Paxton and John Blenkinsopp.

British National Formulary 64

The Ultimate GPhC Registration Assessment Exam Guide book; by Wojtek Michael
Bereza, MpharmS, Founder of Pharmacycpa.com and School of Pharmacy London.

www.emc.co.uk

www.rpharms.co.uk

www.nhschoices.co.uk






ADVICE
Keep calm

Answer the question thinking about how you
would respond when working in a pharmacyas a
PHARMACIST

Take your time and READ the question

Dont over think the question

If there is an OTC question in open book,
remember to look at the footnotes in the BNF
Make Your Mark 2014
Finally.....
For revision


Section Title
BNF and BNFc
BNFc guide
MEP
OTC directory
Responding to symptoms textbook
RPS POM to P switches QRG
RPS pharmacy law and ethics QRG
GPhC sample papers (take care with archived ones)
GPhC practice questions
Calculation papers
Your own notes!!

Top Tips


o Book your time off for the exam now
o Make a revision plan
o Practice exam papers in exam conditions
with reference sources tagged
o Base your revision around the GPhC
syllabus
o With RPS membership , you will have 1
months access to TP On Track, giving you
access to exam like questions to practice.
o Make use of free CPPE on line learning
http://www.cppe.ac.uk
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19
Section Title
What next


Section Title
Contact details
Section Title
Amar Iqbal
amariqbal@fastmail.fm

Louise Chamberlain
louise.chamberlain@live.co.uk

Fawzia Lokat
fawzia.lokat@boots.co.uk
lokat_f_786@hotmail.com

Georgia Malesi
gmalesi@hotmail.com

Bindya Tailor
bindya.tailor@hotmail.co.uk


Make Your Mark 2014 Birmingham & Solihull LPF
No part of this document may be reproduced without prior permission of the author(s).