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OSCE Comprehensive Pharmacy Review
Prepared by:
Vipul Shah B.Sc. RPH. MBA
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Table of Contents
DESCRIPTION Pg. No
Disclaimer 3
Communication 4
Rx Counselling 9
Brand and Generic names of Rx medications 13
Rx Counselling Cases 23
Information about various products and devices 77
Special instructions regarding various medications 82
Common side effects and their management 85
OTC Counselling 89
Brand and Generic names of OTC products and a few pointers 94
Product pictures 104
OTC counselling cases 128
Questions for some OTC topics 146
Health-care professional stations 155
Disease management cases 188
Hospital based scenarios 194
Device or product demonstration 201
Efficiently using References 215
Non-interactive stations
- Prescription Screening
- Dispensing Check
221
223
235-251
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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
the 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 SolRx INC. **
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Communication
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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 COMMUNCATION
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”
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Key points you need to keep in mind while speaking:
Be loud and clear
Use layman language with patient
Use medical language with health care provider
Be precise, do not be repetitive
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/gist of the individual station.
If you did not hear the first time, ask politely to repeat and do not make assumptions!
NON-VERBAL COMMUNICATION
It’s about delivering a message without talking. It depends basically on your gesture, body language,
look and the way you approach situations.
Posture and Mannerism
Personal space (Maintain at 5-7 meter distance)
Facial expression - Being pleasant excited, or sympathetic as per the condition
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”
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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 types 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:
Not to miss out on important points supplied by the patient
Avoid repeating your questions
Stay organized
Stay focused
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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. Rx counseling
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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)
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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
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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 effectsApart 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 concernsDo 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
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Brand and Generic
names of common
medications
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.
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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
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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
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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
Anti-hyperglycemic 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
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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
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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:
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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
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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
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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
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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
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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, Patient profile
Patient’s Info:
Opening statement: Can I pick up my medication?
Is it for you? Yes. My name is Julia Sanders
Why did you see you Dr: For my low thyroid
Allergy: None
Medications: Rx none
OTC if asked: CaCO3 500mg three times daily
Pregnant: No Breastfeeding: No
Caffeine: No Alcohol: No Smoking: NO Exercise: 30 minutes walk
everyday Diet: Healthy
Question at 5 minute bell: How do I will know that medication’s dose is too low
or too high?
Mannerism: Normal
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Special Note:
XYZ Medical Clinic
Xxxx
Xxx
xxx-xxx-xxxx
Julia Sanders
Xxxx
Rx
Synthroid 75 mcg
Levothyroxine 75 mcg 1 tab OD
M: 90 tabs
R X 1
Dr. R Tan
PATIENT RECORD
PATIENT: Julia Sanders
ADDRESS: xxxx
PHONE: xxxx
AGE: 42 years old
SEX: Female
ALLERGIES: NKA
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COMMENTS: None
PHYSICIAN: Dr. J. Brown
No. Medications - Directions Q DR
Auth Rem Original Refill Last
Filled
1
Synthroid 75 mcg
Levothyroxine 75 mcg
Take One tablet once daily
90 Dr Tan,R 180 90 180 1 Today
Ideal Response:
Ask what made her see the doctor; did he undergo any blood work?
Explain why Synthroid is prescribed
Counsel on Synthroid: Empty stomach (½ hr before BK or 2 hrs after BK)
Effect not right away; several weeks,
S/E: well tolerated: N-V, Head ache: will go away with time:
To see Dr If Clumsiness; coldness; constipation, dry, puffy skin, tiredness and weight gain (Sign of
under dosing, chest pain, fast or irregular heartbeat, restlessness, sweating, weight loss (Sign of over
dose)
Advice to space apart calcium and levothyroxine by at least 2 hours
Answer 5th minute question: Explain symptoms of low and high thyroid to figure out low and high
dose: Dr will ask for blood work to know right dose and that’s why very important not to miss
doctor’s appointment.
Confirm about doctors follow up
Monitoring (Keep regular doctors and lab appointments) improvement seen in symptoms or not
Self-care
Follow up
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Scenario / Background Information: Case 2
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 Wort for faster recovery
Pregnant: No Breastfeeding: No
Caffeine: No Alcohol: No Smoking: NO Exercise: Don’t feel like it
Diet: Not good Poor appetite
Question at 5 minute bell: What happens if I take St. John’s Wort?
Mannerism: Normal
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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
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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 then 2 capsules if no
bothersome side effect.
Effect not right away; several weeks, Physical effects like sleep, appetite and energy level occur
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 yourself.
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
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Few products with important
instructions
For storage, stability, priming
and shaking etc.
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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
Multiplesclerosis in adults.
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MOS = 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)
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
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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 (30mins before)
Etidronate (2h before or after) at night
Risedronate (30mins before)
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)
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DIABETES
Nateglinide (1min before meal)
Tolbutamide
Repaglinide
ASTHMA
Sodium Cromoglycate
Zafirlukast
Budesonide
Aminophylline
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OTC recommendations
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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
INFORMATION GATHERING
MEDICAL INFORMATION:Symptoms and Red FlagsCan 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?
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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?
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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 treatmentI 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 foodThis 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 onsetThis 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
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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
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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.
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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†
Generic Name Brand Name
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
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Product Pictures
Please take a moment and look at the following pictures of
some products.
It is recommended that you familiarize yourself with the
products and how they look in order to be able to give best
recommendation.
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Scenario / Background Information: Case 1
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 her temperature: Yes,Twice, Yesterday and today morning, 39.5
Allergy : None
Medications : Rx NONE
OTC : None
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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
No. Medications - Directions Q Doctor
Auth Rem Original Refill Last
Filled
Ideal Response
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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
Sample
Questions for
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some 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
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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?
Health-care Professionals
Stations
Doctors, Nurses, Care- takers,
Physiotherapist etc.
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Detailed template for Doctor Station
INTRODUCTION
Introduce yourself
Identify the Doctor
Identify the Patient
INFORMATION GATHERING
MEDICAL INFORMATION
Reason for prescribing and medical condition
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Other Medical conditions
Allergies, Severity of allergy
Rx Medications
Herbal, OTC Medications
Renal function
Pregnancy and breastfeeding if women 18 -48
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
Is the drug right for Current Diagnosis,Age, Gender&Weight?
Is the drug right for itsdose frequency?
Route of administration
Is it compatible with current medical conditions?
Allergy?
Current lifestyle and social habits
Once the drug related problem is identified then check how to manage it
Pharmacological alternative
Non-pharmacological alternative
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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
Scenario / Background Information: Case 1
Door Note: Doctor is waiting inside for your suggestions and help, proceed inside and do as you
would do in regular practice
Reference: CPS, Patient profile
Dr’s Info
Opening statement: My name is Dr Tan, I wrote a prescription for Sam Baptist
If ok to dispense go ahead any questions concern I am here to discuss and do necessary
change if needed.
Rx: Ketaconazole 200mg once daily for 2 weeks for systemic candidiasis (Condition only when
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asked)
MC: Everything in profile
Allergy: As per profile
Liver Fn: Normal Kidney Fn: Normal
Medications: As per profile (Cialis 10mg for EDF) If asked
OTC: None
Pregnant: NA Breastfeeding: NA
Life style and social habits: Not known
Question at 5th minute bell: I only want to prescribe Ketoconazole
Mannerism: Normal
Special Note:
XYZ Medical Clinic
Xxxx
Xxx
xxx-xxx-xxxx
Sam Baptist
Xxxx
Rx
Ketoconazole 200mg
One tab once daily for 2 weeks
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Dr. R Tan
PATIENT RECORD
PATIENT: Sam Baptist
ADDRESS: xxxx
PHONE: xxxx
AGE: 42 years old
SEX: Male
ALLERGIES: NKA
MC: ED and Systemic Candidiasis
PHYSICIAN: Dr. J. Brown Live Fn: Normal Kidney Fn: Normal
No. Medications - Directions Q DR
Auth Rem Original Refill Last
Filled
1
Cialis 10mg(Tadalafil)
Take one-tab prn
12 Dr Tan,R 12 8 12 2 8 days
back
Ideal Response:
Ask the condition for what Rx is written
Ask Liver and Kidney function and blood work to confirm systemic candidiasis.
Check CPS for Dose and duration
Suggest checking dose 200mg for 2-4 weeks and mention the response time is 4 weeks
Dr will change his Rx to 4 weeks
Check reference of Cialis and notice an interaction: Mention that ketoconazole is CYP3A4
inhibitor and dose adjustment is needed for Cialis.(Read this)
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“No dose adjustment is required in patients with mild to moderate renal or hepatic
impairment, and those taking protease inhibitors (e.g., ritonavir) or other potent CYP3A4
inhibitors (e.g., ketoconazole). The dosage may be decreased to 2.5 mg/day in these
patients, based on individual tolerability.”
Suggest Dr to change Dose of Cialis from 10mg to 2.5mg as long as he is on this
Document the changes for both
Follow up: Thanks for choosing our pharmacy and if there are any question please call us.
Cases for Disease Management:
SP or SR coming for information only
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You need to check references on
table and deal with the situation
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Hospital based
Scenarios
Demonstration of
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Devices or Products
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Efficiently
using
References
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Non-
Interactive
Stations