Practice Questions Flashcards
(8 cards)
A man in his 50s comes into the pharmacy with a cold. He reports nasal congestion for 3 days, for which he has been taking oxymetazoline, but now reports a wet cough that keeps him from resting.
PMH: HTN
Allergies: none
Medications: HCTZ 25 mg po daily and lisinopril 10 mg po daily both for HTN.
His blood pressure is slightly above his blood pressure goal.
A. Discontinue the oxymetazoline and start pseudopehdrine.
B. Discontinue the oxymetazoline and start a short course of naproxen.
C. Continue the oxymetazoline and add guaifensin.
D. Continue the oxymetazoline and add nasal strips and saline.
E. Refer this patient to a physician.
B. Discontinue the oxymetazoline and start a short course of naproxen.
Don’t give pseudophedrine because he has high blood pressure.
Guaifensin does not have evidence to support its use.
Disontinue oxymetazoline so that he does not get rebound congestion.
A 70 year old females comes into your clinic with complaints of running nose, congestion (nasal and chest), fatigue and a cough. Three days ago she started with a sore throat and a runny nose.
PMH: post-menopausal, intermittent allergic rhinitis, history of breast cancer ( in remission)
Allergies: sulfa (nausea)
Medications: cetirizine 10mg po daily
A. Initiate 1st generation antihistamine + long acting pseudoephedrine.
B. Initiate intranasal corticosteroids and honey.
C. Initiate intranasal decongestant and nasal saline.
D. Initiate oral antitussives.
C. Initiate intranasal decongestant and nasal saline.
She is too old (over 65) because the cause sedation, falls, and confusion.
Corticosteroids are not approved to be used in cold.
There is no evidence to support the use of antitussives.
Could do an oral decongestant. Short-acting drugs.
A pregnant patient in her 1st trimester says she has a cold with nasal congestion for the last 2 days. She has tried saline nasal spray but it has not helped. She still has nasal pressure and discomfort. She said she went to her doctor and he told her she had a cold and to get something OTC. She asks for your recommendation. She denies a fever, sore throat, or rhinorrhea. She has NKDA and no other medical conditions. A. Initiate ibuprofen B. Initiate an oral decongestant C. Initiate intranasal cromolyn D. Initiate intranasal oxymetaozline E. Initiate chlorpheiramine
D. Initiate intranasal oxymetaozline
chlorpheniramine - is for a runny nose and she doesn’t have one.
oral decongestants cause bad things for babies
cromolyn is only for allergic rhinitis
If she had not seen the doctor she would need to be seen by a doctor first.
An 8 y/o male child comes to the pharmacy with his mother to get something for his allergies. They went to his doctor today and were told to buy a non-prescription antihistamine for his allergies. The child has sneezing that is worse in the morning and worse at night. He also has a runny nose and congestion throughout the day. He has had this for going on 5 months and they have not tried anything at this time. You notice the child do the "allergic salute" while talking with his mother. The child has no other health conditions and takes no other medications. A. Initiate montelukast B. Initiate intranasal cromolyn. C. Initiate intranasal triamcinolone. D. Initiate diphenhydramine
C. Initiate intranasal triamcinolone.
Cromolyn is started for prevention and the efficacy is lower.
He is classified as moderate.
montelukast is not OTC
allergic salute may be itching or rhinorrhea
You would have chosen a 2nd generation antihistamine. Wouldn’t choose a 1st generation because you have to dose it more often and it may lead to sleepiness or hyperactivity.
Always listen to the diagnosis from the doctor but rely on your own knowledge for drug therapy.
Which patient should be referred to a medical provider?
A. An otherwise healthy 10 year old male with nasal and ocular itching and sneezing.
B. An otherwise healthy 72 year old female with complaints of rhinorrhea and sneezing.
C. A 42 year old male with diabetes, hypertension and high cholesterol with sneezing and nasal congestion.
D. A 32 year old female with polycystic ovarian syndrome with rhinorrhea and nasal itching.
A. An otherwise healthy 10 year old male with nasal and ocular itching and sneezing. - because the child is less than 12
A 34 year old female presents to your pharmacy and has just discovered she is 3 weeks pregnant. She suffers from previously diagnosed mild intermittent allergic rhinitis. Her main symptoms are sneezing and rhinorrhea. These are currently controlled with her medication, loratadine. She would like your recommendation on whether this medication is safe during pregnancy. What is your best response?
A. This medication is not safe in pregnancy because it is a category B.
B. This medication is safe in pregnancy because it is a category B.
C. You should stop taking this medication and use a nasal saline spray instead.
D. You should see a medical provider.
B. This medication is safe in pregnancy because it is a category B. - She has already been diagnosed with allergic rhinitis and OTC treatment is approved by PCP.
Category A and B are good in pregnancy.
Select All of the following patients that warrant physician referral for the treatment of cough?
A. A 76 year old male with a 2 day cough with wheezing and history of COPD.
B. A 32 year old female with a 3 day cough who is in the 3rd trimester of pregnancy.
C. A 3 year old with a 2 day history of cough.
D. A 28 year old with an 8 day history of cough who is otherwise healthy.
E. An 83 year old with a 5 day cough with a history of hypertension and diabetes.
A. A 76 year old male with a 2 day cough with wheezing and history of COPD. - because of the COPD
D. A 28 year old with an 8 day history of cough who is otherwise healthy. - because it is longer than 7 days
The 3 year old would need non-pharm treatment.
What counseling point about topical antitussives is correct?
A. Do not rub ointment into broken skin or mucous membranes.
B. Apply a thin layer of ointment
C. Lozenges should be chewed
D. Do not use in pregnancy
A. Do not rub ointment into broken skin or mucous membranes. - this includes blisters.
