self care exam 1 RATs
A 47‐year‐old female is lactose intolerant and is unable to consume dairy products. Her doctor recommended she take a calcium supplement. The patient currently takes rosuvastatin (Crestor) daily for hyperlipidemia, omeprazole 40 mg daily for GERD, and naproxen 500 mg as needed for tension headaches. Which of the following is the most appropriate calcium supplement for this patient? a. She should select a calcium carbonate/vitamin D combination product and take 500mg/400IUs twice daily. b. She should select a calcium carbonate‐only product and take 1000 mg at least 1 hour before her omeprazole dose. c. She should select a calcium citrate/vitamin D combination product and take 500mg/400IUs twice daily. d. She should select a calcium citrate‐only product because the addition of vitamin D can increase her risk of a heart attack.
C. She should select a calcium citrate/vitamin D combination product and take 500mg/400IUs twice daily.
An older female would like to purchase a bottle of Vitamin D3 that contains 800 IUs per tablet. Her doctor told her to pick up some vitamin D at the pharmacy. She would like to know if this is the best product for her to take. She has diabetes, high blood pressure, and chronic kidney disease. Which of the following statements should you include in your consultation with her about vitamin d? a. A nonprescription product that contains Vitamin D2 (ergocalciferol) is preferred for patients with kidney disease. b. Vitamin D3 (cholecalciferol) is the most appropriate formulation for patients with diabetes, but she should only take 400 IUs a day due to kidney disease. c. She can take either a D3 or D2 product, but she will need at least 50,000 IUs per day. d. A nonprescription product is not recommended for patients with kidney disease because they need a hydroxylated form of vitamin D.
D. A nonprescription product is not recommended for patients with kidney disease because they need a hydroxylated form of vitamin D.
Which of the following patients is at the greatest risk for Vitamin B12 deficiency? a. A 3‐month‐old infant breast‐fed by a mother who is a strict vegetarian. b. A 28‐year‐old with diabetes who uses insulin to control his blood glucose levels. c. A 33‐year‐old male who takes lisinopril to control his blood pressure. d. A 45‐year‐old female taking calcium carbonate once or twice a week for heartburn.
a. A 3‐month‐old infant breast‐fed by a mother who is a strict vegetarian.
When recommending topical antimicrobial treatment, which of the following cases would be appropriate for self-treatment? a. A young adult male with a ¾ inch cut on the index finger which occurred while cutting vegetables; there is some bleeding, but it is not deep. b. A mechanic with a puncture wound on his forearm from a screwdriver that slipped; there is significant bleeding when the pressure bandage is removed. c. An adult female who was bitten on the index finger by small dog while at the park. d. A patient with an electrical burn on his left hand.
a. A young adult male with a ¾ inch cut on the index finger which occurred while cutting vegetables; there is some bleeding, but it is not deep.
A 27‐year‐old female approaches the pharmacy counter and says that she has been taking iron as directed by her doctor for anemia, but her most recent labs say that she is still deficient. Her doctor told her to start taking a vitamin that can help increase iron absorption, but she cannot remember which one. Her doctor most likely told her to take which of the following vitamins? a. Ascorbic acid (Vitamin C) b. Cholecalciferol (Vitamin D3) c. Riboflavin (Vitamin B2) d. Pteroylglutamic Acid (Folic Acid)
a. Ascorbic acid (Vitamin C)
After further discussion with Tina from the previous question, you find that she does not take any medications other than an oral contraceptive and a multivitamin with iron every day. When traveling, she usually has trouble falling asleep but no trouble staying asleep. When this occurs, she does not feel rested in the morning and has trouble functioning. Due to work events, she insists that she needs good sleep when going on this trip. What is the most appropriate recommendation for her? a. Diphenhydramine 25 mg for 2-3 nights, then skip a night to reevaluate sleep quality. b. Kava (piper methysticum) 25mg for 2-3 nights, then skip a night to reevaluate sleep quality. c. Use of an OTC sleep aid is contraindicated due to her concomitant use of OCP. d. Use of an OTC sleep aid is contraindicated due to her age.
a. Diphenhydramine 25 mg for 2-3 nights, then skip a night to reevaluate sleep quality.
Various types of dermatitis, such as atopic dermatitis, psoriasis, dandruff, seborrheic dermatitis, and dry skin can be somewhat similar. Which of the following symptoms best matches psoriasis? a. Dry, silvery scales; pinpoint bleeds when scales removed; commonly found around knees and elbows; may be chronic and relapsing b. White and grey scales, diffuse pattern; itching results in flakes; on scalp and crown of head c. Redness, roughness; more common in the elderly and during colder months; "winter itch" d. Yellowish, oily scales; often on hairline; improves during warmer months; called cradle cap in infants
a. Dry, silvery scales; pinpoint bleeds when scales removed; commonly found around knees and elbows; may be chronic and relapsing
A superficial burn involves which of the following layers of the skin? a. Epidermis b. Dermis c. Subcutaneous tissue d. Muscle
a. Epidermis
A 39-year-old male reports feeling fatigue for well over 4 weeks now. His only medications include a daily allergy pill, his nasal spray, and a multivitamin. He follows good sleep hygiene recommendations, as he came to you a few weeks ago to discuss these. He no longer has a problem falling asleep, but he is still waking up in the middle of the night at least about 4 or 5 times a week and struggles going back to sleep. He asks you today about something he can take to help him sleep or stay awake during the day; at this point, he'll try either one. What is the most appropriate recommendation for him currently? a. He is not a candidate for self-treatment and should be referred to his provider b. Diphenhydramine 25-50mg every night for up to 3 nights at a time c. He should continue sleep hygiene for another week before trying an OTC medication for insomnia d. Caffeine 100-200 mg every 3-4 hours as needed
a. He is not a candidate for self-treatment and should be referred to his provider
A 28-year-old male presents complaining of trouble sleeping and feeling tired during the day. He has trouble falling asleep, typically lying awake for at least an hour or more before finally falling asleep. He denies any trouble staying asleep and feels rested upon waking if allowed to sleep for 7 hours or so. This has been going on for about a week. He is prescribed and adherent to his once daily omeprazole for heartburn and loratadine for allergies. He takes all medications at night because it's easiest for him to remember. He drinks 1 or 2 cups of coffee per day after supper to help him study and then does some pushups and sit-ups nightly right before showering and going to bed. What is the most appropriate counseling point for this patient? a. He should avoid using caffeine for at least 4-6 hours before bedtime. b. He should do a more vigorous workout before bed to help tire him out more. c. He should take a Vivarin 200mg every 3-4 hours as needed during the day. d. Discontinue loratadine as it may be causing his insomnia.
a. He should avoid using caffeine for at least 4-6 hours before bedtime.
AM is a 42‐year‐old male that would like to quit smoking. He has smoked ½ ppd (about 10 cigarettes) for the past 8 years. He smokes his first cigarette about 15 minutes after waking up with his cup of coffee. He currently takes lisinopril 40 mg daily and amlodipine 10 mg daily for blood pressure, metformin 1000 mg twice daily for type 2 diabetes, and omeprazole 20 mg daily for GERD. His average blood pressure today is 152/90, which is uncontrolled. His most recent A1C was 8.5%, which is also uncontrolled. In addition to comprehensive counseling on tobacco cessation, what should you recommend for RC? a. He should be referred to his primary care physician as he is not a candidate for self‐care b. Nicotine polacrilex gum 4mg, 1 piece every 1‐2 hours for 6 weeks c. Nicotine polacrilex lozenge 2mg, 1 lozenge every 1‐2 hours as needed for cravings for 6 weeks d. Nicotine transdermal system 21 mg daily for 6 weeks followed by a taper
a. He should be referred to his primary care physician as he is not a candidate for self‐care
The mother from the previous question calls the pharmacy a week later with the same issue. She states that she followed your recommendation, but now her daughter is experiencing some pain and inflammation inside her ear. Which of the following is the most appropriate recommendation? a. Her daughter is not a candidate for self-care and should see her provider b. She should use 4 drops of 95% isopropyl alcohol in the affected ear for another 7 days. c. She should use a 50:50 mixture of acetic acid and isopropyl alcohol to relieve the pain. d. She should use 5 to 10 drops of carbamide peroxide 6.5% in the affected ear for another 7 days.
a. Her daughter is not a candidate for self-care and should see her provider
Identify the most correct statement regarding the use of ketoconazole products. a. Ketoconazole is active against most pathogenic fungi, especially Malassezia. b. Ketoconazole products should be used once daily to be effective. c. Patients using ketoconazole preparations should avoid sun exposure for 24 hours after application due to the potential for photosensitivity. d. Patients should be advised that ketoconazole preparations can result in stains to the skin, hair, and other materials. Patients should use bed linen and clothing that they would not mind being stained.
a. Ketoconazole is active against most pathogenic fungi, especially Malassezia.
Which of the following characteristics would disqualify a patient for self-care and warrant referral for treatment of a suspected wart? a. Cauliflower-textured surface b. Soreness after weight-bearing activity on the lesion c. Rapid growth d. Consistent brown color darker than skin tone
c. Rapid growth
A mother brings her 3-year-old to the pharmacy to seek advice on a wart the toddler developed 2 days ago. The child does not have any known medical conditions, but you remember filling Tamiflu for her last week. You determine it is a self-treatable wart after thorough evaluation. Which recommendation is most appropriate for the mother? a. Occlusion with duct tape, refreshing tape weekly or as needed. b. Cryotherapy with DEMP as directed on packaging. May repeat in 2 weeks if needed c. Salicylic acid 17% solution applied twice daily with dressing after it dries d. Increase the child's dietary zinc uptake. Provide a list of zinc-rich foods to support her immune system.
a. Occlusion with duct tape, refreshing tape weekly or as needed.
A mother brings her 4‐month‐old child to the pharmacy and asks you which product would work best for the child's eczema. The skin of the child's cheeks appears red, scaly and a few lesions are present. She states she has noticed her child rubbing their cheeks more and indicates the irritations began several weeks ago. Which of the following would be the most appropriate recommendation? a. Refer to the pediatrician. The patient is not an appropriate candidate for self‐care. b. Recommend that she use topical lidocaine ointment and limit the number of baths per week. c. Recommend that she apply a thin layer of hydrocortisone 0.5% cream and use an unscented, chemical free laundry detergent. d. Recommend that she give 12.5 mg of diphenhydramine liquid as needed and apply a moisturizer immediately after bathing.
a. Refer to the pediatrician. The patient is not an appropriate candidate for self‐care.
A female in her 20s complains of a toothache. It is difficult for her to talk because of the pain, and she currently has an ice pack covering her left cheek. She describes the pain as throbbing and is at a 4 on a scale of 1 to 10. Upon inspection, the upper left side of her gums are red and swollen. She has not tried anything yet, but her friend told her to get Anbesol. Which of the following is the most appropriate recommendation for her? a. She should be referred to her primary care physician or dentist b. Abreva (Docosanol 10%): Applied 5 times a day for up to 7 days c. Oral pain reliever, like ibuprofen 400 mg PO TID for up to 7 days d. Anbesol Maximum Strength Gel (Benzocaine 20%): Applied 4 times a day for 7 days
a. She should be referred to her primary care physician or dentist
Which of the following excludes a 17-year-old football player from self-treatment of tinea cruris? a. The infection includes genitalia b. The area severely itches, especially after practice c. He has already tried nonpharmacologic measures for 1 week d. He is unsure of which teammate could have spread the infection
a. The infection includes genitalia
A 26-year-old patient presents to the pharmacy for guidance on wound care. The patient cut their index finger while cooking dinner last week and is looking for the best recommendation regarding bandages. The patient cleaned the cut, wrapped it in a regular adhesive bandage, and has kept the same bandage on for the past week. The patient has tried their best to keep it clean. You examine the cut and observe it is noticeably red, swollen, and odiferous. The cut appears to span from the tip of their finger to their distal interphalangeal joint. Which of the following is the most appropriate recommendation for the patient at this time? a. The patient is not a candidate for self-care. Refer them to their primary care physician. b. Saline irrigation and apply triple antibiotic ointment 1-3 times a day for 3 more days. c. Clean the site with tepid tap water and apply Band-aid Cushion Care Adhesive Gauze Pad. d. Flush site with hydrogen peroxide and apply petrolatum prior to dressing application
a. The patient is not a candidate for self-care. Refer them to their primary care physician.
Select the incorrect statement regarding dermatological product ingredients. a. Topical products such as Aveeno Soothing Bath Treatment (colloidal oatmeal), Burrow Solution (aluminum acetate), Caladryl Lotion (calamine), Neutrogena T/Gel Shampoo (coal tar), and hydrocortisone 1% cream are all options for the treatment of poison ivy/oak dermatitis. b. Astringents, such as aluminum acetate soaks or witch hazel, are not useful for moisturizing dry skin. c. Emollients, such as Lubriderm Advanced Therapy Lotion, are useful for many dermatologic conditions, including dry skin. d. Topical salicylic acid can be useful for psoriasis, especially when thick scales are present.
a. Topical products such as Aveeno Soothing Bath Treatment (colloidal oatmeal), Burrow Solution (aluminum acetate), Caladryl Lotion (calamine), Neutrogena T/Gel Shampoo (coal tar), and hydrocortisone 1% cream are all options for the treatment of poison ivy/oak dermatitis.
Symptoms of nicotine withdrawal, such as irritability, anger, depression, and insomnia may precipitate with abrupt discontinuation of nicotine. Typically, when do physiologic nicotine withdrawal symptoms manifest and dissipate? a. Within the first 1‐2 days, dissipating over 2‐4 weeks b. Within the first 1‐2 weeks, dissipating over 6 weeks c. Within the first 3‐4 days, dissipating over 1‐2 weeks d. Within the first week, dissipating over 2 weeks
a. Within the first 1‐2 days, dissipating over 2‐4 weeks
Self-treatment should not continue beyond __ weeks; cryotherapy may be repeated up to 3 times in ___ week intervals. a. 4, 2 b. 12, 2 c. 6, 3 d. 12, 1
b. 12, 2
A female patient presents to the pharmacy with painful lesions around her lips. It began as a small red papule on her upper lip then spread to the surrounding area. Some of the papules have a crust on them. She has a dance coming up and needs a product that will reduce the duration and severity of the symptoms. Which of the following is the most appropriate recommendation for her? a. Apply rubbing alcohol twice a day for up to 10 days b. Apply Abreva (docosanol 10%) 5 times a day for up to 10 days c. Apply Zilactin-B (benzocaine 10%) Gel 4 times a day for up to 10 days d. Apply carbamide peroxide 6.5% once a day and leave on for at least 15 minutes before washing the area with a mild face soap.
b. Apply Abreva (docosanol 10%) 5 times a day for up to 10 days
A 31-year-old patient calls the pharmacy about an hour after burning his arm at work. He is a chef and touched a hot pan against his forearm. He states the burn is smaller than a deck of cards on the inside of his forearm. He is in pain and the burn is red. Small blisters have begun to appear within the last 15 minutes after he stopped running it under the faucet. Which of the following is the most appropriate recommendation for this patient? a. Pop the blisters, clean with tap water, and apply Aquaphor Healing Ointment twice a day b. Clean the skin with cool tap water, pat dry, and apply a Band Aid Hydro Seal hydrocolloid bandage c. Take one 200 mg Ibuprofen tablet by mouth PRN for pain and keep the burn dry with Band Aid Gauze Pads d. Refer to primary care physician because the burn has become infected
b. Clean the skin with cool tap water, pat dry, and apply a Band Aid Hydro Seal hydrocolloid bandage
Which is an important lifestyle counseling point for patients treating warts? a. Keep wart uncovered so it can 'breathe' and heal faster. b. Do not walk barefoot, especially in public places. c. Use only 1 towel to dry off after a shower to protect your household members. d. Soak feet frequently in Epsom salt baths.
b. Do not walk barefoot, especially in public places.
A 45‐year‐old male patient is taking rosuvastatin (Crestor) for hyperlipidemia and lisinopril for hypertension. Both are controlled. His doctor recommended he start taking niacin in addition to the rosuvastatin to help his cholesterol levels. He has been taking it for about a week and complains of facial flushing. He calls your pharmacy asking for your advice. Which of the following statements should you include in your consultation with him? a. He should stop the niacin because facial flushing is a risk factor for Stevens‐Johnson Syndrome, which is a severe side effect of niacin. b. He should try taking aspirin 325 mg by mouth 30 minutes before taking the niacin. c. He should cut the dose in half. d. Taking the niacin with food can reduce the likelihood he will experience the facial flushing.
b. He should try taking aspirin 325 mg by mouth 30 minutes before taking the niacin.
A patient with psoriasis comes into your pharmacy asking for treatment recommendations. Which of the following statements is correct? a. Once weekly lubrication, with an emollient such as Nivea Cream, after a bath or shower is an essential part of therapy. Apply the product within minutes after bathing and reapply at least 3 times daily. b. Hydrocortisone ointment 1% is the nonprescription treatment of choice for bright, red lesions to reduce inflammation . c. Environmental factors, such as physical, UV and chemical injury have no impact on Psoriasis. d. In the majority of cases, psoriasis can be controlled with nonprescription treatment.
b. Hydrocortisone ointment 1% is the nonprescription treatment of choice for bright, red lesions to reduce inflammation .
Which is the most appropriate counseling point for a patient using an ophthalmic ointment? a. Blurred vision is not common with ointments. b. If both drops and ointment are indicated, administer drops before ointment to enhance absorption of the drops. c. Gently squeeze the tube with a sweeping motion while touching the tube to the lower eyelid to administer. d. If irritation occurs, switch to an ointment with a preservative to avoid bacterial growth.
b. If both drops and ointment are indicated, administer drops before ointment to enhance absorption of the drops.
RS is a 60‐year‐old male who has smoked 5‐10 cigarettes a day for 10 years, first cigarette less than 30 minutes after awakening. He has attempted to quit "cold turkey" one time and successfully quit for 3 months. He has temporomandibular joint (TMJ) disease and no allergies. He wants to attempt to quit again with the help of nicotine replacement therapy, but he is not interested in seeing his doctor about it right now. He wants to try by himself first. In addition to comprehensive counseling, what is the most appropriate recommendation for him? a. Initiate nicotine transdermal patch 21 mg/day b. Initiate nicotine transdermal patch 14 mg/day c. Initiate nicotine gum 2mg, 1 piece every 1‐2 hours d. He should be referred to his primary care provider as he is not a candidate for self‐care
b. Initiate nicotine transdermal patch 14 mg/day
A father calls the pharmacy because his infant is teething. His daughter has a low-grade fever, swollen gums, and is excessively drooling. She is 6 months old and has been having trouble sleeping at night due to the discomfort. He would like your advice on what to use. Which of the following is the most appropriate recommendation? a. Use a plastic teething ring; however, boil it for at least 3 minutes before using. b. Apply a benzocaine 7.5% oral gel to the gums twice daily. c. Massage the gums. d. Use a teething necklace at bedtime.
c. Massage the gums.
A 19-year-old male patient comes to the pharmacy with sunburn on the shoulders after spending the afternoon at the beach. His shoulders are slightly red and somewhat painful, but there is no blistering. You recommend that the patient take a cool shower after returning home. To alleviate the pain, you recommend he take some ibuprofen, according to package directions, and apply which of the following topical products? a. Isopropyl alcohol 70% applied to shoulders 4X daily b. Lidocaine 2% gel applied to shoulders 3-4X daily c. Hydrogen peroxide 3% applied to shoulders 4X daily d. Bacitracin, neomycin, and polymyxin B ointment applied to shoulders 2X daily
b. Lidocaine 2% gel applied to shoulders 3-4X daily
Peak nicotine levels are attained within 10 minutes of smoking a cigarette. Which form of NRT achieves peak serum concentrations most rapidly? a. Transdermal Patch b. Nasal Spray c. Lozenge d. Inhaler
b. Nasal Spray
A young female is picking up a new prescription for a prenatal vitamin. She has been taking a Vitamin A supplement for several months to help improve her nighttime vision. She just found out she is pregnant, and her doctor wants her to start the prenatal vitamins. The vitamin A supplement she has been taking contains 8000 IUs of Vitamin A, as Retinyl Palmitate and has a % Daily Value of 160% per capsule. Which of the following statements should you include in your consultation with her about the vitamin A supplement? a. It is okay for her to continue the supplement as the TUL of vitamin A in pregnant females is 25,000IUs per day. b. Pregnant females should not take more than the DRI of vitamin A because of the teratogenic risk. c. She may continue to take the supplement because vitamin A supplementation is vital for spinal cord development in pregnant females. d. It should be discontinued because it can increase the risk of gestational diabetes.
b. Pregnant females should not take more than the DRI of vitamin A because of the teratogenic risk.
A 40-year-old female presents complaining of feeling "fidgety", isn't sleeping like normal, and often feels irritable. She completely quit smoking tobacco cigarettes 4 days ago using only Zyban®(bupropion) which is when her symptoms started. She typically drinks about 4 cups of coffee throughout the day; the last one being after dinner. What should you tell her? a. She should decrease her coffee intake due to the interaction between caffeine and bupropion. b. She should decrease her coffee intake, as smoking increases the clearance of caffeine by 56%. c. She should start diphenhydramine 50 mg 30 minutes prior to bedtime for 3 nights. d. She should be referred to her primary care physician; she is not a candidate for self-care.
b. She should decrease her coffee intake, as smoking increases the clearance of caffeine by 56%.
A young mother presents to the pharmacy with her 6-year-old daughter. Her daughter recently started swimming lessons and has been complaining about her ears feeling funny ever since. Her daughter denies any pain. Another mother on the team recommended isopropyl alcohol. Which of the following should you include in your consultations with her about the use of isopropyl alcohol? a. She should be referred to the pediatrician for a hearing evaluation. b. She should instill 4 drops of isopropyl alcohol and allow it to remain for 1-2 minutes. c. She should instill 5-10 drops of carbamide peroxide 6.5% instead and leave in for up to 15 minutes. d. She should use an ear candle to allow the heat from the candle to dry the ear canal.
b. She should instill 4 drops of isopropyl alcohol and allow it to remain for 1-2 minutes.
Which of the following statements should you include in your consultation with a pregnant female who would like to take a folic acid supplement? a. Doses above 5 mg per day have been shown to increase the risk of preterm labor. b. She should take 400 mcg per day of folic acid in addition to folate obtained from food sources. c. If she has a MTHFR gene mutation, she will need to take at least 15 mg per day. d. Metabolism of folates requires vitamin C, so she will need to select a combination product with 400 mcg of folic acid and 2500 mg of vitamin C.
b. She should take 400 mcg per day of folic acid in addition to folate obtained from food sources.
A patient presents to the pharmacy with mildly red eyes complaining of a sandy feeling. He has tried a warm compress and has had no relief. He would like you to recommend an over-the-counter product. Which of the following is the most appropriate recommendation? a. Visine-A (pheniramine 0.3%, naphazoline 0.025%, BAK 0.01%) 1-2 drops in both eyes QID b. Systane Lubricant Eye Drops PRN and Tears Renewed ointment at bedtime c. Loratadine 10 mg by mouth daily d. He should be referred to his primary care provider or ophthalmologist
b. Systane Lubricant Eye Drops PRN and Tears Renewed ointment at bedtime
Which of the following statements about the nonprescription drug therapy of poison ivy/oak, sumac dermatitis is incorrect? a. Soaks or baths with colloidal oatmeal, such as Aveeno Colloidal Oatmeal, may soothe the affected area and help with itching. b. Topical antihistamines in products such as Benadryl Spray (diphenhydramine) are the preferred choice to treat itching. c. Nonprescription topical hydrocortisone 1% cream is available over‐the‐counter and can treat itching and inflammation in mild cases of poison ivy dermatitis; infections on the face, near the eyes, or on genital areas are not appropriate for self‐treatment. d. Astringent soaks, such as Domeboro Solution (aluminum acetate), can be used to soothe the affected area and reduce drainage from open bullae.
b. Topical antihistamines in products such as Benadryl Spray (diphenhydramine) are the preferred choice to treat itching.
Tom is a 74-year-old male with PMH significant for benign prostatic hyperplasia (BPH), hypercholesterolemia, and depression. His medication profile includes doxazosin, atorvastatin, and citalopram; all his conditions are currently controlled. He also takes Tylenol® PM (containing acetaminophen 325 mg & diphenhydramine 25 mg) 1-2 caplets per dose when he can't sleep (which is most nights) and an OTC laxative (can't remember the name of it) as needed for constipation. Which of the following statements should you include in your consultation with Tom? a. He should take all OTC products daily as to keep consistency in his medications and not interfere with his prescription medications. b. Tylenol® PM should be discontinued as it may be contributing to his constipation and is not appropriate with his current disease states. c. The Beers criteria recommends diphenhydramine as a first line agent for sleep in the elderly, so it may be safely continued. d. Tylenol® PM has a significant interaction with atorvastatin and should be discontinued. He should take doxylamine instead.
b. Tylenol® PM should be discontinued as it may be contributing to his constipation and is not appropriate with his current disease states.
A 30‐something patient calls the pharmacy with concerns over white flakes and itching of their scalp. The patient states that they have noticed small dry patches on their scalp and upon scratching the mildly itchy lesions, they observe small white flakes. The patient is looking for a product to help resolve the issue and prevent it from occurring in the future. Which of the following is the most appropriate recommendation? a. Application of Dermoplast Pain Relieving Spray (benzocaine 20%) to scalp area after shampooing. b. Use of a medicated shampoo, such as DHS Zinc Shampoo daily initially, and titrate down as directed. c. Application of Cortizone‐10 Cream (hydrocortisone 1%) to the scalp area after shampooing. d. Referral to the dermatologist for appropriate diagnosis and treatment.
b. Use of a medicated shampoo, such as DHS Zinc Shampoo daily initially, and titrate down as directed.
A patient comes to the pharmacy asking for an OTC antifungal recommendation. They show you their trunk which has many round lesions that are clear in the center but red around the edges. The patient reports no chronic medical conditions, and they do not take any routine medications. They mention that the condition is decreasing their quality of life, and they would like it resolved as soon as possible. Which OTC product is the most appropriate recommendation? a. Miconazole 2% powder b. Terbinafine 1% cream c. Clotrimazole 1% cream d. Tolnaftate 1% powder spray
b. terbinafine 1% cream
Both bupropion and varenicline should be initiated when? a. The same day that the patient quits all tobacco products b. 3 weeks prior to quitting c. 1 week prior to quitting d. The patient can quit at any point throughout the course of therapy
c. 1 week prior to quitting
A middle-aged male complains of ear fullness and gradual hearing loss over the past week. He does not wear hearing aids; however, upon inspection, both ears have a lot of hair. He does not remember doing anything to his ear and he denies any pain. He has diabetes and hypertension, but they are currently controlled. Other than his typical daily shower, he has not gotten his ears wet recently. Which of the following is the most appropriate recommendation for him? a. 4-5 drops Isopropyl alcohol 95% as needed b. 5-10 drops Hydrogen peroxide 3% for up to 15 mins c. 5-10 drops Carbamide peroxide 6.5% for up to 15 mins d. He should be referred to his PCP for a hearing evaluation
c. 5-10 drops Carbamide peroxide 6.5% for up to 15 mins
All the following are included in the "5 A's Approach" except which one? a. Ask b. Arrange c. Answer d. Assess
c. Answer
Carrie presents to pharmacy counter with a package of NoDoz®. She has a 2-year-old and is pregnant (due in 3 more weeks). Due to discomfort with her pregnancy, she is not sleeping well and therefore feeling incredibly drowsy throughout the day. Regarding the use of caffeine for this patient, you determine: a. Caffeine (above usual dietary amounts) is not needed, as she has drowsiness related to insomnia. She should take diphenhydramine instead. b. Caffeine is an appropriate FDA-approved stimulant for this patient c. Caffeine (above usual dietary amounts) is not recommended for this patient due to her pregnancy status d. The recommended dose of caffeine for this patient is 400mg every 2 hours as needed
c. Caffeine (above usual dietary amounts) is not recommended for this patient due to her pregnancy status
A new patient approaches your pharmacy's consultation window in search of a 'natural' product to treat ringworm on her body. Which alternative treatment is most likely to treat her infection? a. Bitter orange oil b. Tea tree oil c. Garlic cream d. Onion skins
c. Garlic cream
A dad and daughter come into the pharmacy. They were at the park down the road learning to ride a bike when his daughter fell off the bike and scraped her knee and right hand. Her right palm is scraped and a little red, but the skin does not appear to be broken as there is no bleeding. Her right knee is also scraped, but unlike the hand, it is bleeding. Both wounds have some bits of dirt and asphalt around them. She is 10 years old and only takes a fluoride tablet every morning. Which of the following is the most appropriate recommendation? a. Refer to primary care physician. b. Cleanse both wounds with isopropyl alcohol 70%, apply cocoa butter, and cover with an appropriate dressing. c. Irrigate both wounds with tap water, apply Neosporin, and cover with an appropriate dressing. d. Irrigate both wounds with hydrogen peroxide 3% and immediately cover with dressing before the liquid dries.
c. Irrigate both wounds with tap water, apply Neosporin, and cover with an appropriate dressing.
A female patient would like to use vitamin E to help prevent heart disease as her mother recently died from a heart attack. She has selected a product that contains 1000 IUs of vitamin E (about 671 mg of alpha‐tocopherol). She currently has high blood pressure and high cholesterol. Which of the following statements should you include in your consultation with her about vitamin E? a. Although the evidence is conflicting, she should take 4000 IUs a day because that is the dose that may have a benefit. b. It is not safe for her to take vitamin E because it interacts with most cholesterol medications. c. It may increase the risk of hemorrhagic stroke and heart failure and studies have not shown a benefit in reducing the risk of heart disease. d. The recommended dose is 400 IUs per day to decrease the risk of heart disease, but since it is a water‐ soluble vitamin, there is no risk to taking doses above the DRI.
c. It may increase the risk of hemorrhagic stroke and heart failure and studies have not shown a benefit in reducing the risk of heart disease.
Tina (36-year-old) presents to the pharmacy counter with a bottle of Sundown Naturals valerian root. She states that she will be traveling for work for 5 nights and needs something to help her sleep. She normally falls asleep easily and stays asleep for 7-8 hours (feeling rested) but knows she has trouble falling asleep when traveling. Which response is correct? a. Valerian root was shown to significantly reduce time to sleep in multiple clinical trials for acute insomnia b. Valerian root has been deemed a safe and effective sleep aid by the Food and Drug Administration (FDA) c. It will not likely be helpful, as continuous nightly use for several days or weeks is required for effect d. It will not likely be helpful due to the fact that she has chronic insomnia
c. It will not likely be helpful, as continuous nightly use for several days or weeks is required for effect
A 25-year-old female approaches the pharmacy counter complaining of something in her eye. She was out working in the yard when dirt from the garden blew into her face. She used a cloth to wipe her face and eyes, but still feels like something is in her eye. This happened about an hour ago. She wears contacts and is current wearing them. Her left eye appears mildly irritated - there is some redness, and her eye is tearing. There does not appear to be anything large in her eye. What is the most appropriate recommendation for her? a. Instill ketotifen drops every 12 hours to relieve the eye redness and tearing b. Cover eye with dressing and allow to heal c. She should be referred to her PCP or ophthalmologist d. Use Baush and Lomb Eye Wash to flush eye
c. She should be referred to her PCP or ophthalmologist
What the most appropriate counseling point for caffeine use? a. Caffeine can lead to a decreased blood pressure, so patients should be aware of the risk for orthostasis. b. Caffeine withdrawal symptoms are very unlikely and only occur in less than 1% of cases. c. The dose of caffeine is 100-200mg every 3-4 hours as needed. d. When taken before sleep, caffeine increases deep sleep and decreases nocturnal awakenings.
c. The dose of caffeine is 100-200mg every 3-4 hours as needed.
Which of the following fungal infections is treated exclusively with prescription-only therapy? a. Tinea pedis (athlete's foot) b. Tinea corporis (ringworm of the body) c. Tinea unguium (ringworm of nails, onychomycosis) d. Tinea cruris (jock itch
c. Tinea unguium (ringworm of nails, onychomycosis)
LJ is a 39‐year‐old male with type 2 diabetes, hypertension, and depression who is seen in clinic today. He smokes 1 pack per day, starting within 30 minutes of wakening, and is uninterested in quitting. What is the most appropriate intervention at this time? a. Recommend nicotine replacement therapy, such as the transdermal patch for smoking cessation. b. Initiate bupropion SR 150mg today and set a quit date. c. Use motivational interviewing strategies to discuss concerns and benefits of quitting. d. Do not discuss tobacco cessation as he is uninterested in quitting.
c. Use motivational interviewing strategies to discuss concerns and benefits of quitting.
Identify the incorrect statement regarding allergic contact dermatitis from poison oak exposure. a. Contact with a garden tool used previously to dig poison oak plants can be a source of exposure. b. Smoke from burning brush containing poison oak plants can trigger an allergic response. c. Washing the affected area within 24 hours of exposure may remove the urishiol oleoresin and minimize allergic response. d. Fluid from vesicles or bullae may break open and release vesicular fluid, but this fluid does not contain antigenic material and cannot be transferred to other areas on the body or to other people.
c. Washing the affected area within 24 hours of exposure may remove the urishiol oleoresin and minimize allergic response.
According to current wound care standards, which of the following would be most preferred for cleaning an acute wound? a. Polysporin Ointment (polymyxin B sulfate, bacitracin) b. Ethyl alcohol c. Normal saline d. Iodine tincture
c. normal saline
Which of the following patients most likely will require Vitamin A supplementation? a. 65‐year‐old female with osteoporosis b. 25‐year‐old female with epilepsy c. 32‐year‐old male with Lupus d. 45‐year‐old male with Crohn's disease
d. 45‐year‐old male with Crohn's disease
A 41‐year‐old male comes to the pharmacy complaining of itching and redness on his forearm. He thinks it is the result of encountering poison ivy while chopping wood in the woods behind his house. The itching and redness are limited to his forearm and some vesicles/bullae have formed, but are not severe and are still intact. He has no major medical problems, but does take Allegra daily for allergy symptoms. Which of the following is the most appropriate recommendation? a. Use a sterilized needle to open and drain each blister, and then clean the area with rubbing alcohol. b. Application of A & D Ointment (lanolin, petrolatum, cod liver oil) to affected area twice daily. c. Application of Lanacane Spray (benzocaine 20%) to affected area 3‐4 times daily for 5‐7 days. d. Application of Caladryl Lotion (calamine, pramoxine) to affected area 3‐4 times daily for 5‐7 days.
d. Application of Caladryl Lotion (calamine, pramoxine) to affected area 3‐4 times daily for 5‐7 days.
A 21‐year‐old college student comes into the pharmacy complaining of itchy skin. She shows you her hands which are cracking, scaling and red. She states that her legs look the same. She is part of her college's skiing club, and the symptoms started a few weeks ago when they started practicing outside in the colder winter weather. They have a competition next weekend, and she is hoping to get relief before then. Which of the following would be an appropriate recommendation for this patient? a. Increase the frequency of bathing with an emphasis on washing the affected areas thoroughly with hot, soapy water. b. Moisturizers should be applied as sparingly as possible to allow maximum penetration of the emollient into the skin. c. Wash the affected areas with Nizoral AD (ketoconazole) daily for 5‐7 days and use a portable humidifier at night while she sleeps. d. Apply hydrocortisone 1% ointment to the affected areas twice daily for 5‐7 days, then begin regular use of an emollient/moisturizer such as Lubriderm Daily Moisturizing Lotion.
d. Apply hydrocortisone 1% ointment to the affected areas twice daily for 5‐7 days, then begin regular use of an emollient/moisturizer such as Lubriderm Daily Moisturizing Lotion.
A mother presents with her 4-year-old child asking for help. Due to the recent holidays and break from normal routine, her son is staying up too late at night. It is affecting his behavior and activities during the day, and he's gotten in trouble more at school. She asks if it's okay to give him some Benadryl at night to help put him to sleep. The most appropriate response is: a. Diphenhydramine is an appropriate option, but she should be sure to use the children's formulation and follow dosing instructions as labeled. b. Diphenhydramine should not be recommended. Instead, melatonin is preferred in children less than 12 years of age. c. Diphenhydramine should not be recommended. Instead, doxylamine is preferred in children less than 12 years of age. d. Diphenhydramine should not be recommended due to his age. Instead, she should implement 1 or 2 of the principles of good sleep hygiene.
d. Diphenhydramine should not be recommended due to his age. Instead, she should implement 1 or 2 of the principles of good sleep hygiene.
A middle-aged male comes to the pharmacy asking how to take care of a wound on his foot. Through further questioning, you find out he first received treatment for the same wound over a month ago and takes metformin 1000 mg twice a day for diabetes. Which of the following is the most appropriate recommendation for this patient? a. Administer the tetanus vaccine and recommend he keep his foot elevated during the day. b. He should cleanse the wound thoroughly with a mild soap and water, apply Neosporin daily, keep it wrapped during the day and allow the wound to breathe overnight. c. He should cleanse the wound with chlorhexidine gluconate and wrap with gauze. d. He should be referred to his primary care physician or a wound care specialist.
d. He should be referred to his primary care physician or a wound care specialist.
Which of the following is correct regarding good sleep hygiene? a. Daytime napping around 3-5pm for 2 hours helps with sleep duration. b. Exercise, especially 1-2 hours before bedtime, can help induce sleep. c. Sleeping later the weekends helps regulate sleep patterns during the week. d. If hungry, eat a light snack, but avoid eating meals within 2 hours before bedtime.
d. If hungry, eat a light snack, but avoid eating meals within 2 hours before bedtime.
Based on the current concepts for wound care, which of the following counseling statements is INCORRECT? a. Antiseptic agents, such as isopropyl alcohol, hydrogen peroxide, or povidone-iodine solution, should only be used for cleaning around the wound areas and not used directly on the open wound. b. For acute wounds, in order to slow the bleeding, the wound area should be kept above the heart level. c. The wound should be occluded with an appropriate dressing that will keep it as moist as possible throughout the healing process. d. In most cases, a wound dressing should be changed daily even if the area is not dirty or foul smelling.
d. In most cases, a wound dressing should be changed daily even if the area is not dirty or foul smelling.
TO is a 47‐year‐old female trying to quit smoking for the first time. She smokes 1 ppd (20 cigarettes), with her first cigarette about 15 minutes after waking up. Her quit date is in three weeks. You notice she is wearing braces and she mentions she has sensitive skin. In addition to comprehensive counseling, what is the most appropriate initial OTC product recommendation for her? a. Nicotine transdermal system, 21mg per day b. Nicoine polacrilex gum 2mg, 1 piece every 1‐2 hours while awake c. Nicotine polacrilex lozenge 2mg, 1 lozenge every 1‐2 hours while awake d. Nicotine polacrilex lozenge 4mg, 1 lozenge every 1‐2 hours while awake
d. Nicotine polacrilex lozenge 4mg, 1 lozenge every 1‐2 hours while awake
Which of the following patients is NOT excluded from self-care of their skin wound? a. Teenage patient with wound from a human bite on the ear that occurred during a fight. b. Patient with chronic pressure wound due to confinement in bed. c. Patient with a wound that occurred on the lower leg the previous day but now is red, swollen and filled with puss. d. Patient with hypothyroid condition taking Synthroid (levothyroxine) who has a cut on her finger from scissors.
d. Patient with hypothyroid condition taking Synthroid (levothyroxine) who has a cut on her finger from scissors.
Who of the following is a candidate for self-treatment? a. Patient with continuous, dull, throbbing tooth pain and a fever of 102 degrees F b. Patient using a soft-bristled toothbrush with Sensodyne Pronamel twice daily for the past month with no resolution to tooth pain or sensitivity c. Patient with a broken tooth d. Patient with intermittent, mild/moderate tooth pain related to hot, cold or pressure stimuli
d. Patient with intermittent, mild/moderate tooth pain related to hot, cold or pressure stimuli
A known patient to your pharmacy comes in while you are working and asks you for an OTC recommendation to get rid of a plantar wart, he has had for a few days now. You know his past medical history includes high cholesterol, peripheral vascular disease, and obesity. Which of the following is the most appropriate recommendation for your patient? a. Salicylic acid 40% pads: Trim to only cover the wart. Remove and repeat every 48 hours. b. Salicylic acid 17% gel: Place 1 drop on wart and cover with occlusive tape. Repeat twice daily. c. Nitrous oxide: Follow instructions carefully on box, especially waiting until 'halo' forms. d. Refer to PCP. Patient is not self-care candidate.
d. Refer to PCP. Patient is not self-care candidate.
A 26‐year‐old pregnant female is attempting to quit smoking for the first time. She smokes 1 pack per day (ppd) and smokes her first cigarette an hour after awakening. She has a seizure disorder and no known allergies. What is the most appropriate recommendation for her at this time? a. Nicotine transdermal system, initiated with 21 mg/day b. Nicotine gum 2mg, initiated with 2 pieces every 1‐2 hours c. Bupropion SR 150mg, titrated appropriately d. Refer to behavioral counseling as she is not a candidate for self‐care
d. Refer to behavioral counseling as she is not a candidate for self‐care
35‐year‐old male patient comes to your pharmacy after wearing a 21 mg/day nicotine transdermal patch for 7 days. He complains of troublesome dreams and sleep disruptions since starting the patch. However, he notes it is helping because he previously smoked 15 cigarettes/day. He indicates he has already tried nicotine gum and lozenges without success. What is the most appropriate recommendation for him? a. Recommend switching to the 14 mg/day patch, as the 21 mg/day patch was too high of a starting dose b. Recommend OTC diphenhydramine (Benadryl®) for sleep c. Discontinue nicotine patch and initiate nicotine 2 mg gum every 1‐2 hours d. Remove the patch before bedtime and reapply a new one in the morning
d. Remove the patch before bedtime and reapply a new one in the morning
A patient taking warfarin presents to the anticoagulation clinic with a low INR. She has been trying to eat healthier and has significantly increased her intake of spinach and cauliflower since the New Year. Which vitamin/mineral did she ingest that led to a decreased anticoagulation effect? a. Folic Acid b. Vitamin B12 c. Vitamin C d. Vitamin K
d. vitamin K
Aluminum acetate solution can be helpful in treating ___. a. Tinea corporis with small vesicles b. Tinea cruris with well-demarcated lesions c. Tinea corporis with erythema and scaling d. Wet, soggy tinea pedis
d. wet, soggy tinea pedis