Self Care-Exam 1 RATS
Which of the following characteristics would disqualify a patient for self-care and warrant referral for treatment of a suspected wart?
Rapid growth (could be sign of melanoma)
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?
Garlic cream
Both bupropion and varenicline should be initiated when?
1 week prior to quitting
Self-treatment should not continue beyond __ weeks; cryotherapy may be repeated up to 3 times in ___ week intervals.
12, 2 *For cryotherapy make sure to avoid tissue around and over 4 years old
Which of the following patients most likely will require Vitamin A supplementation? Why?
45‐year‐old male with Crohn's disease. Crohns would lead to malabsorption so can't retain vitamin A
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?
5-10 drops Carbamide peroxide 6.5% for up to 15 mins
Which of the following patients is at the greatest risk for Vitamin B12 deficiency?
A 3‐month‐old infant breast‐fed by a mother who is a strict vegetarian.
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 nonprescription product is not recommended for patients with kidney disease because they need a hydroxylated form of vitamin D.
When recommending topical antimicrobial treatment, which of the following cases would be appropriate for self-treatment?
A young adult male with a 3⁄4 inch cut on the index finger which occurred while cutting vegetables; there is some bleeding, but it is not deep.
All the following are included in the "5 A's Approach" except which one?
Answer
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?
Application of Caladryl Lotion (calamine, pramoxine) to affected area 3‐4 times daily for 5‐7 days.
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?
Apply Abreva (docosanol 10%) 5 times a day for up to 10 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?
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 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?
Ascorbic acid (Vitamin C) (too much calcium can inhibit iron absorption)
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:
Caffeine (above usual dietary amounts) is not recommended for this patient due to her pregnancy status
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?
Clean the skin with cool tap water, pat dry, and apply a Band Aid Hydro Seal hydrocolloid bandage
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?
Diphenhydramine 25 mg for 2-3 nights, then skip a night to reevaluate sleep quality.
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:
Diphenhydramine should not be recommended due to his age. Instead, she should implement 1 or 2 of the principles of good sleep hygiene.
Which is an important lifestyle counseling point for patients treating warts?
Do not walk barefoot, especially in public places
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?
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?
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?
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?
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 1⁄2 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?
He should be referred to his primary care physician as he is not a candidate for self‐care
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?
He should be referred to his primary care physician or a wound care specialist.
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?
He should try taking aspirin 325 mg by mouth 30 minutes before taking the niacin.
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?
Her daughter is not a candidate for self-care and should see her provider (worsening of symptoms after treatment)
A patient with psoriasis comes into your pharmacy asking for treatment recommendations. Which of the following statements is correct?
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?
If both drops and ointment are indicated, administer drops before ointment to enhance absorption of the drops.
Which of the following is correct regarding good sleep hygiene?
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?
In most cases, a wound dressing should be changed daily even if the area is not dirty or foul smelling.
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?
Initiate nicotine transdermal patch 14 mg/day
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?
Irrigate both wounds with tap water, apply Neosporin, and cover with an appropriate dressing (more recommended for an ointment because they maintain the most moisture)
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?
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. (More than 400 IU is not beneficial)
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?
It will not likely be helpful, as continuous nightly use for several days or weeks is required for effect
Identify the most correct statement regarding the use of ketoconazole products.
Ketoconazole is active against most pathogenic fungi, especially Malassezia.
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?
Lidocaine 2% gel applied to shoulders 3-4X daily
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?
Massage the gums.
Peak nicotine levels are attained within 10 minutes of smoking a cigarette. Which form of NRT achieves peak serum concentrations most rapidly?
Nasal Spray
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?
Nicotine polacrilex lozenge 4mg, 1 lozenge every 1‐2 hours while awake
According to current wound care standards, which of the following would be most preferred for cleaning an acute wound?
Normal saline
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?
Not a candidate for self care (Plantar wart)
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? Why?
Occlusion with duct tape, refreshing tape weekly or as needed. -Can't do cryotherapy because not 4 years old -Salicyclic acid could cause salicalate absorption from the drug interaction with tamiflu
Which of the following patients is NOT excluded from self-care of their skin wound?
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?
Patient with intermittent, mild/moderate tooth pain related to hot, cold or pressure stimuli
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?
Pregnant females should not take more than the DRI of vitamin A because of the teratogenic risk.
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 dis
Refer to behavioral counseling as she is not a candidate for self‐care (she is pregnant but even if she wasn't she should stay away from bupropion because of seizure disorder)
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?
Refer to the pediatrician. The patient is not an appropriate candidate for self‐care.
A 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?
Remove the patch before bedtime and reapply a new one in the morning
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?
She should be referred to her PCP or ophthalmologist (contacts)
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?
She should be referred to her primary care physician or dentist
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?
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?
She should instill 4 drops of isopropyl alcohol and allow it to remain for 1-2 minutes.
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? Why?
She should select a calcium citrate/Vitamin D combination product and take 500 mg/400 Its twice daily If they are on a chronic acid therapy (omeprazole) they need to be on a citrate form
Which of the following statements should you include in your consultation with a pregnant female who would like to take a folic acid supplement?
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?
Systane Lubricant Eye Drops PRN and Tears Renewed ointment at bedtime
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?
Terbinafine 1% cream (Can be used for 1 week while clotrimazole takes 4 weeks, powders do not adhere to skin)
What the most appropriate counseling point for caffeine use?
The dose of caffeine is 100-200mg every 3-4 hours as needed.
Which of the following excludes a 17-year-old football player from self-treatment of tinea cruris?
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?
The patient is not a candidate for self-care. Refer them to their primary care physician.
Which of the following fungal infections is treated exclusively with prescription-only therapy?
Tinea unguium (ringworm of nails, onychomycosis)
Which of the following statements about the nonprescription drug therapy of poison ivy/oak, sumac dermatitis is incorrect?
Topical antihistamines in products such as Benadryl Spray (diphenhydramine) are the preferred choice to treat itching.
Select the incorrect statement regarding dermatological product ingredients
Topical products such as Aveeno Soothing Bath Treatment (colloidal oatmeal), Burrow Solution (aluminum the incorrect statement regarding dermatological product ingredients. 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. (Coal tar is NOT one)
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?
Tylenol® PM should be discontinued as it may be contributing to his constipation and is not appropriate with his current disease states.
LJisa 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?
Use motivational interviewing strategies to discuss concerns and benefits of quitting.
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?
Use of a medicated shampoo, such as DHS Zinc Shampoo daily initially, and titrate down as directed.
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?
Vitamin K
Identify the incorrect statement regarding allergic contact dermatitis from poison oak exposure.
Washing the affected area within 24 hours of exposure may remove the urishiol oleoresin and minimize allergic response. (Suggested to wash within 30 minutes)
Aluminum acetate solution can be helpful in treating ___.
Wet, soggy tinea pedis
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?
Within the first 1‐2 days, dissipating over 2‐4 weeks