RATs Exam 2

Which of the following patients should NOT use sunscreen? a. 4-month-old boy going to the beach for the first time b. 25-year-old woman with fair skin and a history of a blistering sunburn c. 55-year-old man with a history of melanoma d. 65-year-old woman taking a photosensitizing medication

a. 4-month-old boy going to the beach for the first time

What is the best option for self-treating a headache in a patient with a past medical history of a myocardial infarction and hypertension? a. Acetaminophen b. Naproxen c. Ibuprofen d. He is not a candidate for self-treatment.

a. Acetaminophen

Your child has developed a red shiny rash on his bottom. You are trying to remember from your favorite pharmacy class, Self-Care, which ingredients would be best to help soothe his rash. Which of the following products would be the BEST option? a. Bum Wrap Ointment [Active = zinc oxide; Inactive = Aloe, dimethicone, mineral oil, water, vitamin E, white petrolatum, white wax] b. All Natural Baby Cream [Inactive ingredients = Sweet Almond oil, water, lanolin, beeswax, alcohol, glyceryl linoleate, Calendula Officinalis flower extract, fragrance] c. Bottoms Up Baby Cream [Active = Zinc oxide; Inactive = Boric acid, castor oil, mineral oil, paraffin, Peruvian balsam, petrolatum, triple antibiotic ointment] d. Baby Got Rash Medicated Powder [Active = Menthol, zinc oxide; Inactive = Talc, acacia, eucalyptol, methyl salicylate, salicylic acid, zinc stearate]

a. Bum Wrap Ointment [Active = zinc oxide; Inactive = Aloe, dimethicone, mineral oil, water, vitamin E, white petrolatum, white wax]

A 51-year-old teacher has been suffering from intermittent allergic rhinitis. She has been taking chlorpheniramine 4 mg as needed when she has symptoms (itchy, watery eyes and nasal congestion). However, she is experiencing significant drowsiness during the day. What is the most appropriate recommendation for her? a. D/C chlorpheniramine and start fluticasone proprionate nasal spray b. D/C chlorpheniramine and start pseudoephedrine c. Add cromolyn nasal spray d. Referral to primary care provider

a. D/C chlorpheniramine and start fluticasone proprionate nasal spray

A 33-year-old female sprained her ankle while walking her dog and would like to know what to do. What is the most appropriate recommendation? a. Elevate the site of injury above the level of the heart. b. Apply heat for 15-20 minutes 3-4 times per day. c. Ice the injured area for 1 hour 3-4 times per day. d. Use a TENS device for 15-30 minutes 3 to 4 times a day.

a. Elevate the site of injury above the level of the heart.

A 54-year-old female patient complains of a chronic dry cough. She takes the following medications: atorvastatin, enalapril, hydrochlorothiazide, and aspirin. What medication is most likely causing her cough? a. Enalapril b. Atorvastatin c. Hydrochlorothiazide d. Aspirin

a. Enalapril

A middle-aged male, comes to you inquiring about an at-home transcutaneous electrical nerve stimulation (TENS) device he saw advertised on TV. He has a PMH of hypertension and osteoarthritis, which are both controlled. He has no drug allergies and takes lisinopril 10 mg and celecoxib 200 mg daily. He wants to purchase a TENS device today to help his sore, aching muscles that happen occasionally. Which of the following is the MOST appropriate counseling point for him? a. He should avoid placing the electrodes around the chest, throat, or head. b. The non-prescription TENS device should be used only once a day. c. He should use the device for at least 60 minutes three times a day. d. Patients with hypertension should not use a TENS device without speaking with their physician first.

a. He should avoid placing the electrodes around the chest, throat, or head.

JM is a 46 year old male that would like to quit smoking. He has smoked ½ pack per day (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 500 mg twice daily for type 2 diabetes, and Prilosec 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 JM? a. He should be referred to his primary care physician. 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. Generic Nicotine Transdermal System 21 mg daily for 6 weeks.

a. He should be referred to his primary care physician. He is not a candidate for self-care.

A 52 year old male smoker has decided to use the nicotine transdermal patch to quit smoking. Which of the following is the correct counseling point for the nicotine patch? a. It does not have to be removed while swimming. b. It does not have to be removed during an MRI scan. c. Cutting the patch in half before applying can help reduce skin irritation. d. The patch should be changed every 72 hours.

a. It does not have to be removed while swimming.

A 33-year-old female presents to the pharmacy counter complaining of a thick, white vaginal discharge. She states the discharge does not have an odor, but she is experiencing external itching and vaginal irritation. Which of the following is the most appropriate treatment regimen? a. Monistat 7 ® vaginal cream (miconazole nitrate 2%) inserted vaginally once daily and applied externally as needed for 7 days b. Povidone/iodine 0.3% vaginal douche used twice daily for 7 days c. Tea Tree Therapy® Vaginal Suppositories (tea tree oil 200 mg) inserted vaginally once daily for 5 days d. Vagisil® Maximum Strength Anti-Itch Crème (benzocaine 20%, resorcinol 3%) applied externally 3 to 4 times a day for 7 days

a. Monistat 7 ® vaginal cream (miconazole nitrate 2%) inserted vaginally once daily and applied externally as needed for 7 days

Which of the following would be the best counseling advice to provide when recommending use of salicylic acid? a. Reduce application to once daily or every other day if dryness or peeling occurs. b. Salicylic acid is not likely to absorbed systemically so does not have the potential for drug-drug interactions c. Salicylic acid does not cause redness, dryness, or burning like benzoyl peroxide or adapalene d. Salicylic acid is harsher and more effective than benzoyl peroxide and adapalene.

a. Reduce application to once daily or every other day if dryness or peeling occurs.

A 6-week-old female patient (weight: 10 lbs.) has a temperature of 101 degrees F (measured rectally) for the last 4-6 hours. She is fussier than normal but continues to breastfeed regularly every 3 to 4 hours. What is the most appropriate recommendation? a. Refer patient to primary care provider b. Acetaminophen 70 mg q 4 hours as needed c. Ibuprofen 35 mg q 6 hours as needed d. Alternate doses of acetaminophen 45 mg q 4 hours, then ibuprofen 23 mg q 6 hours scheduled

a. Refer patient to primary care provider

A 23-year-old female presents with rhinorrhea, nasal congestion, and watery eyes for the past 3 days. She tells you that she is in her second trimester of pregnancy and has not seen a doctor yet. What is the most appropriate recommendation? a. Referral to a primary care provider b. Intranasal cromolyn c. Diphenhydramine d. Triamcinolone nasal spray

a. Referral to a primary care provider

Which of following is one of the 5 R's technique to motivate resistant patients in smoking cessation? a. Reward b. Rewind c. Reach out d. Reassess

a. Reward

A 23-year-old female experiences abdominal cramping, breast tenderness, decreased concentration, irritability, fatigue, and depressed mood associated with her menstrual period. She states she is too depressed and tired to go to class and hang out with her friends. Which of the following is the most appropriate recommendation? a. She has PMDD and should be referred to her physician for further evaluation. b. She has PMDD and should take naproxen 220 mg PO q 12 hours and increase her rest. c. She has PMS and should be referred to her physician for further evaluation. d. She has PMS and should take naproxen 220 mg PO q 12 hours and increase her rest.

a. She has PMDD and should be referred to her physician for further evaluation.

You are counseling a 14-year-old girl about OTC acne treatment. Which of the following counseling points would be MOST accurate? a. Use caution with benzoyl peroxide as it may bleach fabrics b. Use of benzoyl peroxide will provide skin protection from the sun c. Maximum effectiveness of benzoyl peroxide will occur in 3-4 days d. She should try a product with salicylic acid as it is more effective than a product containing benzoyl peroxide

a. Use caution with benzoyl peroxide as it may bleach fabrics

Which of the following would be the best counseling advice to provide when recommending use of adapalene? a. Use sunscreen to protect the skin as adapalene increases sensitivity to the sun b. Beneficial effects can be seen within the first few weeks of therapy c. Adapalene does not cause redness, dryness, or burning like benzoyl peroxide and salicylic acid d. Adapalene is safe to use through pregnancy

a. Use sunscreen to protect the skin as adapalene increases sensitivity to the sun

A middle-aged female complains of cold symptoms. Her symptoms started with a sore throat and have now progressed to nasal congestion. She doesn't complain of any other symptoms. Her temperature this morning (checked temporally) was 100 degrees F. She doesn't have any medical conditions and doesn't take any medications. What is the most appropriate recommendation? a. Vicks Sinex (oxymetazoline 0.05%) Nasal Spray, 2-3 sprays into each nostril BID for < 3 days b. Vicks VapoDrops Cherry lozenges (menthol 1.7 mg) as needed for ≤ 14 days c. Maximum Strength Mucinex Fast-MAX (dextromethorphan 20 mg/guaifenesin 400 mg per 20 mLs), 20 mLs PO Q4H for ≤ 5 days d. Refer to primary care provider.

a. Vicks Sinex (oxymetazoline 0.05%) Nasal Spray, 2-3 sprays into each nostril BID for < 3 days

Systemic decongestants are suitable for which of the following patients: a. 58-year-old male with hypertension (patient does not know last BP reading) and benign prostatic hypertrophy b. 25-year-old female who uses Differin gel daily for acne c. 12-month-old male with no significant medical history or medications d. 30-year-old male who wants to purchase 3 boxes of Sudafed

b. 25-year-old female who uses Differin gel daily for acne

After diagnosis of allergic rhinitis by a primary care provider, first-generation antihistamines are safe and appropriate for use in a: a. 8-month-old boy b. 30-year-old pregnant woman c. 25-year-old lactating woman d. 67-year-old man with narrow-angle glaucoma

b. 30-year-old pregnant woman

A mother of a 9-year-old girl is worried that her daughter tends to develop a heat rash every time she competes in a weekend long dance competition. What recommendations can you provide to PREVENT the development of prickly heat? a. Wait to shower until the morning after the competition b. Apply cornstarch or talc powder to skin prior to competition to prevent wetness c. Wear tight-fitting, non-breathable clothing d. Apply hydrocortisone cream to skin throughout the day to prevent redness

b. Apply cornstarch or talc powder to skin prior to competition to prevent wetness

A patient is using Capzasin-HP Arthritis Pain Relief Cream (capsaicin 0.1%) four times daily for diabetic neuropathy pain. He complains that he's been using the cream for 5 days and hasn't felt any pain relief. Which of the following statements should you include in your consultation with him? a. The capsaicin product is not working so he should switch to a different topical counterirritant, such as Bengay Ultra Strength Pain Relieving Patch (menthol 5%). b. Capsaicin commonly takes 14 days to a few weeks to work. He should continue to use the product three times daily. c. Continue to apply this capsaicin cream product three times daily, but after application tightly wrap the area to enhance absorption. d. He should be referred to his primary care physician as he is still having pain despite treatment for 7 days.

b. Capsaicin commonly takes 14 days to a few weeks to work. He should continue to use the product three times daily.

A mom presents to your pharmacy counter worried about the bright red rash on her daughter's bottom that is limited to the diaper area. Her daughter is 10-months-old and still in disposable diapers that mom changes frequently throughout the day. She drinks about 48 to 64 ounces of breast milk a day and is eating some solid foods that are introduced every few days. The baby is recovering from diarrhea due to Norovirus from her daycare. Which of the following would be MOST likely to contribute to the baby's skin reaction? a. Use of breast milk b. Diarrhea due to Norovirus c. Use of disposable diapers d. Frequent diaper changes

b. Diarrhea due to Norovirus

Which of the following is the MOST correct regarding acne treatment products? a. Ointments are best for dry or sensitive skin. b. Gels are the most effective formulations and are best for oily skin. c. Medicated cleansing products are the most effective as they penetrate the pores better than creams and lotions. d. Apply product 2 to 3 times daily initially then decrease frequency as acne blemishes improve.

b. Gels are the most effective formulations and are best for oily skin.

A 62-year-old male has a past medical history of atrial fibrillation, osteoarthritis of the hip, and type 2 diabetes. His current medications include warfarin 2.5 mg daily, metformin 1000 mg BID, and acetaminophen 500 mg q6h. His only allergies are pollen (seasonal) and aspirin. He complains that his osteoarthritis occasionally bothers him (mostly after physical activity). Which of the following is the most appropriate recommendation for him? a. Increase the dose of acetaminophen to 1000 mg q4h. b. Heat therapy (such as heating pad or warm compress) 15-20 minutes, 3-4 times per day. c. Add Arthritis Hot Cream (Methyl salicylate 15%; menthol 10%) d. Switch to Ibuprofen 400 mg PO q6h.

b. Heat therapy (such as heating pad or warm compress) 15-20 minutes, 3-4 times per day.

Which of the following medications puts a 38 year old female with a 10 year history of smoking 2 packs per day at substantially higher risk for stroke when combined smoking cigarettes? a. Alprazolam (Xanax) b. Hormonal contraceptive patch (Ortho Evra) c. Ropinirole (Requip) d. Tiotropium (Spiriva)

b. Hormonal contraceptive patch (Ortho Evra)

A 32-year-old woman who presents to the pharmacy with occasional tension-type headaches that are work-related. She would like to know what medication would be the most appropriate to treat these headaches when they occur. Her PMH is significant for acne (controlled with a product containing sulfur and benzoyl peroxide) and depression (which is currently controlled with escitalopram 10 mg daily). What is the most appropriate recommendation for her headaches? a. Refer patient to primary care provider b. Ibuprofen 400mg q6-8 hours prn, max 1200 mg/day c. Acetaminophen 1000mg q4-6 hours prn; max 6000 mg/day d. Naproxen 500mg q12 hours prn; max 1500 mg/day

b. Ibuprofen 400mg q6-8 hours prn, max 1200 mg/day

A 17-year-old female patient felt nauseated and vomited four hours after taking Plan B One-Step. What is the most appropriate recommendation? a. Refer to primary care provider for pregnancy testing. b. It is not necessary to repeat the dose. c. Repeat the dose as soon as her stomach can tolerate. d. Wait 24 hours, then repeat the dose.

b. It is not necessary to repeat the dose.

A mother of a 4-year-old little girl comes to your pharmacy for advice on choosing an allergy medication. Her daughter saw her pediatrician yesterday and was diagnosed with allergic rhinitis. The mother was instructed to come to pick something up at the pharmacy to treat her symptoms. Her daughter has a runny nose, a history of ear infections, and currently takes a liquid multi-vitamin once daily. She weighs 40 lbs. (checked at pediatrician office yesterday). Which of the following would be the most appropriate recommendation? a. Diphenhydramine HCl 25mg PO q 4-6 h b. Loratadine 5mg PO q 24 h c. Cetirizine 10mg PO q 12 h d. Budesonide nasal spray 1 spray in each nostril daily

b. Loratadine 5mg PO q 24 h

A 22-year-old female had unprotected sex last night (~14 hours ago) and comes to the pharmacy to inquire about the use of an emergency contraceptive. She has a prescription for Ortho-Tri-Cyclen but admits to not using it for the past 2 months. What is the most appropriate recommendation? a. Fill the Ortho-Tri-Cyclen and take double the dose for 3 days and then resume normal schedule b. Next Choice One Dose (levonorgestrel 1.5 mg) tablet PO once c. Povidone/iodine 0.3% vaginal douche used twice daily for 3 days d. Refer to primary care provider

b. Next Choice One Dose (levonorgestrel 1.5 mg) tablet PO once

KT is a 32 year old female patient who is ready to quit smoking. Her quit date is set for two weeks from today. She has smoked 2 packs (~40 cigarettes) a day for the past 10 years and smokes her first cigarette with her morning coffee within 15 minutes of waking up. This is her first attempt at quitting and would like your help selecting an over-the-counter nicotine replacement product. In addition to comprehensive counseling on tobacco cessation, which of the following OTC products is the most appropriate option for KT? a. Nicotine Polacrilex Gum 2mg, 1 piece every 1-2 hours while awake for 6 weeks. b. Nicotine Polacrilex Lozenge 4mg, 1 lozenge every 1-2 hours while awake for 6 weeks. c. Nicotine nasal spray, 1-2 sprays every hour, not to exceed 80 sprays in one day. d. Generic Nicotine Transdermal System, 14mg per day for 2 weeks, then 7 mg per day for 2 weeks.

b. Nicotine Polacrilex Lozenge 4mg, 1 lozenge every 1-2 hours while awake for 6 weeks.

A middle-aged female started using Robitussin Severe Multi Symptom Cough Cold and Flu (containing phenylephrine 10mg, acetaminophen 650mg, dextromethorphan 20mg, guaifenesin 400mg) yesterday to treat her cold symptoms. She complains of jitteriness and heart palpitations and denies overusing the medication. What active ingredient is most likely causing her symptoms? a. Guaifenesin b. Phenylephrine c. Dextromethorphan d. A medication is not causing her symptoms; the jitteriness and palpitations are signs she has the flu.

b. Phenylephrine

A 17-year-old woman states that she is frustrated with the few blemishes on her face. She has been washing her face 3 to 4 times daily with an exfoliating cleanser to try to improve her skin. Which of the following is the best advice to give her? a. She should wash her face and follow with a facial toner 3 times a day. b. She should wash her face no more than 1-2 times a day with a mild soap and soft cloth. c. Encourage her to continue using the exfoliating cleanser but reduce to 2 times a day. d. Advise her to change to a non-soap cleanser and continue washing her face 3 to 4 times a day.

b. She should wash her face no more than 1-2 times a day with a mild soap and soft cloth.

A 25-year-old male who presents with headaches that have increased in frequency. He began taking Goody's ® Cool Orange Powders (aspirin 500 mg, APAP 325 mg, caffeine 65 mg) about six months ago and estimates that he uses 2 packets daily for 4 days throughout each week. He says the medication must have stopped working for him because now he wakes up most mornings of the week with a headache. What is the most appropriate recommendation for him? a. Stop taking Goody's ® immediately to relieve headache b. Slowly taper down use of Goody's ® with eventual goal of discontinuation c. Add ibuprofen 200mg q4-6h prn; max 1200mg/day d. Change to Excedrin Extra Strength ® (acetaminophen 250mg, ASA 250 mg, caffeine 65 mg) max 8 tablets/day

b. Slowly taper down use of Goody's ® with eventual goal

GR is a 26 year old male who recently tried to quit smoking over the past month using the 2mg nicotine polacrilex lozenges, but has been unsuccessful. According to GR, the lozenges made him extremely irritable, anxious, unable to sleep, and caused him to crave cigarettes even more. He currently smokes about 15-20 cigarettes per day and doesn't have his first cigarette until his first break at work, around 10am. In addition to comprehensive counseling on tobacco cessation, what would be the most appropriate recommendation for GR at this point in time? a. He should be referred to his primary care physician since he has failed current OTC therapy. b. Switch to the nicotine transdermal system 21 mg per day plus the nicotine polacrilex gum 2 mg as needed for cravings. c. Continue the nicotine polacrilex gum 2 mg. It takes at least 6 weeks for the withdrawal symptoms to cease. d. Switch to the nicotine transdermal system 14 mg daily as needed for cravings. He should continue smoking for the first week of use.

b. Switch to the nicotine transdermal system 21 mg per day plus the nicotine polacrilex gum 2 mg as needed for cravings.

Which of the following is an important counseling point when recommending a topical analgesic product? a. If pain, swelling or blistering occurs, alternate ice and heat on the affected area after applying the product. b. When applying a topical analgesic, avoid wounded or broken skin. c. Apply heat (such as a heating pad) to the area where a topical analgesic product has been applied. d. Bandage the area tightly so the medication is absorbed thoroughly and doesn't rub off on other areas of the body or clothing.

b. When applying a topical analgesic, avoid wounded or broken skin.

A 38-year old female complains of mild pain in her left shoulder after arm day at the gym this morning. She states it is a dull, aching pain (3/10 on a pain scale) that started towards the end of her workout. She doesn't have any medical conditions and doesn't take any medications. What is the most appropriate recommendation for pain relief? a. Naproxen 220 mg every 8 hours as needed (max daily dose of 660 mg) and apply heat every 30 minutes until pain subsides. b. Ibuprofen 400 mg every 6 hours as needed (max daily dose of 1200 mg) and apply capsicum to affected area post-workout c. Acetaminophen 500 mg every 4-6 hours as needed (max daily dose of 3000 mg) and apply ice to affected area in 15-20 min increments. d. She should be referred to her primary care physician as she is not a candidate for self-care.

c. Acetaminophen 500 mg every 4-6 hours as needed (max daily dose of 3000 mg) and apply ice to affected area in 15-20 min increments.

A patient is currently taking ibuprofen 400 mg three times a day for osteoarthritis. She has had significant improvement in her pain since she started taking it 6 weeks ago. However, her doctor told her she is at an increased risk for ulcers while taking it and he recommended she get something over the counter to help protect her stomach. Which of the following medications/recommendations can help prevent the GI complications from chronic use of NSAIDs? a. Alternating acetaminophen with the ibuprofen b. Taking the ibuprofen with food c. Adding esomeprazole 40 mg PO daily d. Adding capsaicin cream applied to affected area three times daily

c. Adding esomeprazole 40 mg PO daily

A 22-year-old male graduate student recently moved to the area. He is living in an older apartment and has noticed allergy symptoms for the last week (runny nose, slight congestion, mild headache). He is still sleeping okay and can make it through his classes, but he does describe the symptoms as "bothersome." He does not take any medications and has no medical conditions. What is the most appropriate recommendation? a. Ibuprofen 200 mg / Pseudoephedrine 60 mg PO Q6H PRN b. Guaifenesin 600 mg / Pseudoephedrine 120 mg PO BID c. Budesonide nasal spray 2 sprays in each nostril daily d. Cetirizine 10 mg PO daily

c. Budesonide nasal spray 2 sprays in each nostril daily

A 16-year-old female states that she is experiencing fatigue and irritability 5 days prior to her menstrual period and lower back pain and abdominal cramping the day of her period. The symptoms usually resolve by day 3 of menses. The symptoms are mild and do not prevent her from performing daily activities. She is most likely experiencing: a. Moderate to severe Premenstrual symptoms (PMS) b. Premenstrual dysphoric disorder (PMDD) c. Combined Primary Dysmenorrhea and PMS d. Combined Secondary Dysmenorrhea and PMS

c. Combined Primary Dysmenorrhea and PMS

A group of college-aged women ask for your opinion on the best sunscreen to prevent sunburn. Several have a family history of skin cancer and would like the best skin protection possible. They plan to spend the day at the beach. What is the BEST recommendation for this group? a. Bullfrog® Water Armor Sport Super Lotion SPF 30. The product ingredients and formulation are designed to withstand extended exposure to water to minimize the need for sunscreen application. Apply 15 to 30 minutes prior to sun exposure. May reapply every 6 hours. b. Banana Boat® Triple Defense for Men SPF 30 sunscreen spray. The product contains Active Protect Technology for a broader protection from UVA and UVB exposure. Apply 15 to 30 minutes prior to sun exposure. Reapply every 4-6 hours. c. Coppertone® Wet 'n Clear Continuous Spray SPF 50+. The product is designed for intermittent exposure to water as it penetrates water droplets to adhere to the skin. Considered water resistant. Apply 15 minutes prior to sun exposure. Reapply every 40-80 minutes. d. Hawaiian Tropic® Royal Tanning Clear Spray SPF 0. The product sprays on clear for an easier application and contains skin-nourishing antioxidants for better skin protection. Apply every 2 hours or every 40 minutes after water exposure.

c. Coppertone® Wet 'n Clear Continuous Spray SPF 50+. The product is designed for intermittent exposure to water as it penetrates water droplets to adhere to the skin. Considered water resistant. Apply 15 minutes prior to sun exposure. Reapply every 40-80 minutes.

A 43-year-old male patient complains of excessive fatigue and muscle aches for the last 2 days. He also reports a fever of 101.5°F, a mild sore throat and nonproductive cough. This patient's presentation is most consistent with: a. Allergic rhinitis b. Common cold c. Influenza d. Pneumonia

c. Influenza

Which of the following is the typical presentation of a common cold? a. Initial cough, sore throat by day 2, and rhinorrhea by day 4 b. Initial rhinorrhea and sneezing, nasal congestion by day 2, cough by day 7 c. Initial sore throat, nasal congestion by day 3, and cough by day 5 d. Initial sore throat and cough, followed by rhinorrhea and nasal congestion by day 5

c. Initial sore throat, nasal congestion by day 3, and cough by day 5

A young mother of an infant requests more recommendations to reduce the risk of diaper dermatitis when changing her daughter's diapers. What is the BEST recommendation? a. Use the front of the diaper to wipe the baby's bottom during diaper changes b. Use baby wipes with lavender to soothe the baby's skin c. Let the baby's bottom dry before putting on the next diaper d. Wait until the baby's diaper is full before changing

c. Let the baby's bottom dry before putting on the next diaper

A 16-year-old female complains of a headache. Her symptoms, which started 2 days ago, are some nausea and throbbing on the left side of her head. She is mostly likely experiencing what type of headache? a. Tension-Type b. Migraine with aura c. Migraine without aura d. Sinus headache

c. Migraine without aura

A 49 year old female is trying to quit smoking for the first time. She smokes half a pack of cigarettes (10 cigarettes) a day, with her first cigarette about 45 minutes after waking up. Her quit date is in three weeks. Her PMH is significant for asthma 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, 14mg per day b. Nicotine Polacrilex Lozenge 4mg, 1 lozenge every 1-2 hours while awake c. Nicotine Polacrilex Gum 2mg, 1 piece every 1-2 hours while awake d. Nicotine nasal spray 1-2 sprays every hour in each nostril, not to exceed 80 sprays in one day

c. Nicotine Polacrilex Gum 2mg, 1 piece every 1-2 hours while awake

A 20-something-year-old man approaches your counter requesting a good product to treat the 3-4 acne blemishes on his face. His biggest concern is his DRY skin. Which of the following products would be BEST AND MOST EFFECTIVE to recommend as an initial treatment for his acne? a. PanOxyl® Acne Cleansing Bar (benzoyl peroxide 10%) b. Clean & Clear® Advantage 3-in-1 Exfoliating Cleanser (benzoyl peroxide 5%) c. Proactive+® Pore Targeting Treatment Cream (benzoyl peroxide 2.5%/glycerin) d. Clean & Clear Persa-Gel® 10 (benzoyl peroxide 10%)

c. Proactive+® Pore Targeting Treatment Cream (benzoyl peroxide 2.5%/glycerin)

A 38-year-old male patient has a chief complaint of a cold for the past 3 days. He states that his most bothersome symptom is the nasal congestion. His past medical history includes a diagnosis of hypercholesterolemia which is currently controlled with rosuvastatin 10 mg daily. What is the most appropriate treatment for this patient? a. Diphenhydramine HCl 25 mg Q6H b. Phenylephrine 10 mg Q4H c. Pseudoephedrine ER 120 mg Q12H d. Dextromethorphan 30 mg Q8H

c. Pseudoephedrine ER 120 mg Q12H

A 21-year-old man asks for help with acne treatments. He works at a local fried chicken restaurant during summer break. His face is mostly covered in non-inflammatory acne lesions. His acne seems to flare up every summer. He has also been gently washing his face four or five times daily. What is the most appropriate initial recommendation for him? a. Recommend that he try a sulfur 3%-resorcinol 2% cream twice daily and continue with current face washing plan b. Recommend that he try glycolic acid 3% facial wash and warn him not to pick at or squeeze pimples c. Recommend that he try benzoyl peroxide 2.5% cream and wash his face with a mild soap no more than twice daily d. Recommend that he try sulfur 10% lotion and caution him to avoid extended time in the kitchen at work

c. Recommend that he try benzoyl peroxide 2.5% cream and wash his face with a mild soap no more than twice daily

What is the most appropriate type of thermometer for a 2-month-old child with a suspected fever? a. Oral b. Tympanic c. Rectal d. Axillary

c. Rectal

A 21-year-old female patient visits your pharmacy numerous times throughout the last month to purchase emergency contraceptives. After questioning, you determine that she is sexually active, is not in a monogamous relationship, and currently does not use any other form of contraception. What is the most appropriate recommendation? a. Use of a fertility awareness-based method b. Routine use of coitus interruptus ("pull out" method) and continue to use emergency contraception as needed for pregnancy prevention c. Routine use of male condoms and referral to primary care provider to discuss prescription contraceptives (oral, patch, ring) d. Refer to primary care provider to discuss prescription contraceptives (oral, patch, ring)

c. Routine use of male condoms and referral to primary care provider to discuss prescription contraceptives (oral, patch, ring)

A female patient has been using the nicotine transdermal system 21mg patch daily for the past 2 weeks and it is working well. She is very happy that she has been smoke free during this time. Her only complaint is that she is having trouble sleeping since starting the patch. What is the most appropriate response for her at this time? a. She can start diphenhydramine 25mg by mouth 30 minutes before bedtime. b. She can switch to either the lozenge or gum, 2 mg every 1 to 2 hours while awake. c. She can remove the patch before bedtime and reapply a new one upon awakening. d. She should be referred to her primary care physician.

c. She can remove the patch before bedtime and reapply a new one upon awakening.

A patient returns to your pharmacy quite disappointed that her mild acne has worsened since you recommended adapalene gel a week ago. What is your response? a. She needs to consider medical referral as self-treatment is not working b. Advise her to try another product as the initial recommendation is ineffective c. She needs to be patient and allow 8 to 12 weeks for improvement d. Advise her to increase application to 2 to 3 times daily to reduce time to therapeutic benefit

c. She needs to be patient and allow 8 to 12 weeks for improvement

A 32-year-old male has been experiencing symptoms of allergic rhinitis for the last week. He states his runny nose is becoming more bothersome and he wishes to purchase a product that will provide quick relief. He has been taking fexofenadine 180 mg daily with only minimal relief of symptoms. He does not want to miss any workdays, as it is important that he stay on schedule for his truck route. What is the most appropriate recommendation for him? a. Add on cromolyn nasal spray 1 spray in each nostril 3 to 6 times a day b. Switch to chlorpheniramine 4 mg tablets PO every 4 to 6 hours; max of 24 mg in 24 hours c. Switch to triamcinolone nasal spray 2 sprays in each nostril daily d. Refer to primary care provider

c. Switch to triamcinolone nasal spray 2 sprays in each nostril daily

A 21-year-old woman with fair skin and red hair presents to the pharmacy with a bottle of SPF 8 sunscreen. She is going to the Bahamas for Spring Break, and she does not want to get a sunburn but does want to spend a lot of time in the sun. Without sunscreen, she usually develops a sunburn very quickly. Her only medication is Ortho Tri-Cyclen daily. What is the most appropriate recommendation for her? a. Maximize sun exposure between 10am and 4pm. She needs a minimum of SPF 4 to prevent skin cancer. b. Visit a tanning bed prior to her vacation to obtain a base tan. Sunscreen with an SPF of 8 will offer enough protection once she has a base tan. c. Wear a hat with a long-sleeved shirt. She should also wear sunscreen with an SPF of 50+ to prevent sunburn. d. Keep her body submerged in the pool while in the sun. She will not need to apply sunscreen until she is out of the water.

c. Wear a hat with a long-sleeved shirt. She should also wear sunscreen with an SPF of 50+ to prevent sunburn.

Without regard to thermometer selection, fever is defined as a core body temperature greater than: a. 102 degrees F b. 98.6 degrees F c. 101 degrees F d. 100 degrees F

d. 100 degrees F

A 4-month-old female patient (weight: 18 lbs) has a temperature of 102 degrees F (rectally measured) for the last 4 hours. The patient is fussy but continues to drink formula regularly and is refusing solid foods (rice cereal, pureed fruit). What is the most appropriate treatment? a. Refer patient to primary care provider b. Alternate doses of acetaminophen 100 mg q 6 hours, then ibuprofen 80 mg q 6 hours scheduled c. Ibuprofen 80 mg q 6-8 hours as needed d. Acetaminophen 100 mg q 4-6 hours as needed

d. Acetaminophen 100 mg q 4-6 hours as needed

A twenty-something male patient's allergic rhinitis has been controlled on loratadine 10 mg once daily and fluticasone furoate nasal spray two sprays in each nostril daily for the last year. On high pollen count days, he experiences nasal congestion that lasts 1-2 days. In addition to nasal rinsing, what would be the most appropriate recommendation for him? a. Increase dose of fluticasone nasal spray to three times a day b. Increase dose of loratadine to 20 mg daily c. Add on diphenhydramine as needed for congestion d. Add on pseudoephedrine as needed for congestion

d. Add on pseudoephedrine as needed for congestion

Which of the following is the most appropriate recommendation for a patient presenting with symptoms consistent with atrophic vaginitis? a. Insert tampon saturated in gentian violet b. Insert acetaminophen suppository vaginally c. Apply petroleum jelly product d. Apply glycerin-based lubricant

d. Apply glycerin-based lubricant

Which drug is correctly matched with its most common or serious side effects? a. Cromolyn: nausea/vomiting b. Fluticasone: constipation c. Diphenhydramine: edema d. Cetirizine: sedation

d. Cetirizine: sedation

A 34-year-old male complains of an itchy nose and sneezing. He also has a runny nose with some postnasal drip and nasal congestion. All his symptoms occur periodically throughout the day. These symptoms started 3 days ago and have gradually been getting more bothersome. His PCP diagnosed him with seasonal allergic rhinitis some years ago and he has used fexofenadine in the past with success but hasn't been using anything recently. What is the most appropriate recommendation? a. Refer to primary care provider b. Cromolyn 1 spray in each nostril 3-6 times daily c. Pseudoephedrine 120 mg tablets by mouth twice a day d. Fexofenadine 180 mg tablets by mouth once daily

d. Fexofenadine 180 mg tablets by mouth once daily

A 20-year-old female feels tired and moody 4 days prior to her menstrual period. She also has mild to moderate abdominal cramps at the beginning of her period but does not have cramps after day 2 or 3. She denies experiencing any bloating or weight gain. She is not sexually active. What is the most appropriate treatment regimen for her? a. Referral to primary care physician b. Pamabrom 25 mg PO q 6 hours + Calcium 1200mg/Vitamin D 600 IU PO daily c. Ibuprofen 400 mg PO q 6 hours + Vitamin B6 200mg PO daily d. Naproxen 220mg PO q 12 hours + Calcium 1,200mg/Vitamin D 600 IU PO daily

d. Naproxen 220mg PO q 12 hours + Calcium 1,200mg/Vitamin D 600 IU PO daily

LS is a 22 year old female who comes to your pharmacy asking for advice on which OTC NRT she should try to stop smoking. She smokes 1 pack per day (about 20 cigarettes) and smokes her first cigarette approximately 20 minutes after waking up. She tried to quit smoking 6 months ago with the Nicoderm CQ 21 mg patch; however the adhesive gave her a rash even with rotating application sites. In addition to comprehensive counseling on tobacco cessation, what is the most appropriate recommendation for LS? a. She should be referred to her primary care physician. She is not a candidate for self-care. b. Nicotine Polacrilex Lozenge 6mg, 1 lozenge every 1-2 hours as needed for cravings. c. NicoDerm CQ 14 mg patch daily for 4 weeks. d. Nicotine Polacrilex Gum 4mg, 1 piece every 1-2 hours for 6 weeks.

d. Nicotine Polacrilex Gum 4mg, 1 piece every 1-2 hours for 6 weeks.

Which of the following nicotine replacement therapies may be most appropriate for someone who wants to quit smoking but still needs to experience the hand-to-mouth ritual? a. Nicotine nasal spray b. E-cigarettes c. Nicotine gum d. Nicotine inhaler

d. Nicotine inhaler

A 7-year-old boy presents with an allergic skin rash that the mom is convinced is related to sunscreen use. Which of the following ingredients would be most likely the cause for skin sensitization? a. Ecamsule b. Titanium dioxide c. Zinc oxide d. Oxybenzone

d. Oxybenzone

Which of the following products would be the best ingredient to include in a product to treat diaper rash NOT supervised by a health care provider? a. Hydrocortisone ointment b. Methyl salicylate/menthol cream c. Antibacterial cream d. Petrolatum

d. Petrolatum

A 27-year-old male is looking for a barrier method that protects him from STIs and prevents his female partner from getting pregnant. He has a documented latex allergy (reaction: anaphylaxis). What is the most appropriate option? a. Referral to physician b. Calendar Rhythm Method c. Lamb cecum male condom d. Polyurethane male condom

d. Polyurethane male condom

A male teenager is on his high school tennis team. This afternoon at doubles practice, he was hit hard on accident by his partner and fell at an awkward angle on his neck and left shoulder. He comes to the pharmacy and shows you a bruised and swollen shoulder and asks what he can purchase to help relieve the pain and swelling. The shoulder is not visibly deformed, but it is swollen. His pain is only 3/10 when he is still, but it increases to a 5 or 6 when he tries to move it. He also complains of numbness in his left arm and hand. What is the most appropriate recommendation for him? a. Recommend the use of RICE (rest, ice, compression, elevation) and naproxen 220 mg twice a day for up to 10 days. b. Recommend rest, heat therapy and the use of a transcutaneous electrical nerve stimulation (TENS) device for up to 3 days. c. Recommend a capsaicin 0.15% topical product applied to left shoulder three times a day, scheduled around the clock, for up to 10 days. d. Recommend he visit a physician as he is not a candidate for self-care.

d. Recommend he visit a physician as he is not a candidate for self-care.

An 18-year-old woman presents to the pharmacy complaining of four pimples on her chin. She eats a diet consisting of junk food, pizza, and sugary breakfast cereal. She has a summer job working as a waitress at a seafood restaurant. In an attempt to eliminate the acne, she has been vigorously washing her face three or four times a day. Which of the following is the most appropriate recommendation for her? a. Recommend that she visit a physician; she is not a candidate for self-care b. Recommend that she avoid unnecessary contact between her hands and face and wash her face with an exfoliating pad and mild soap three or four times daily. c. Recommend that she practice stress relieving techniques and try using a facial scrub once a day d. Recommend that she alter her diet to minimize intake of high glycemic foods and wash her face with a mild soap twice daily

d. Recommend that she alter her diet to minimize intake of high glycemic foods and wash her face with a mild soap twice daily

A 28-year old female twisted her ankle while doing a Zumba class this morning. Her pain is about a 4 on a pain scale of 1 to 10 and her ankle is swollen. She states that her ankle does not look deformed - just swollen. She can move it, but that causes more pain. The swelling has gotten worse, so she wants to know if she should go to the emergency room. Other than propping her ankle up on a chair, she hasn't tried anything yet. She doesn't have any medical conditions and doesn't take any chronic medications. What is the most appropriate recommendation for her? a. Recommend she see a physician as she is not a candidate for self-care. b. Recommend the use of rest and heat for the next 1 to 3 days and acetaminophen 650 mg every 4 to 6 hours as needed (max daily dose of 3250mg) for up to 14 days. c. Recommend the use of a topical counterirritant, such as methyl salicylate, applied three times daily followed by 15-20 minutes of heat therapy for up to 10 days. d. Recommend the use of RICE (rest, ice, compression, elevation) for the next 1 to 3 days and ibuprofen 400 mg every 4 to 6 hours as needed (max daily dose of 1200mg) for up to 7 days.

d. Recommend the use of RICE (rest, ice, compression, elevation) for the next 1 to 3 days and ibuprofen 400 mg every 4 to 6 hours as needed (max daily dose of 1200mg) for up to 7 days.

A 30-year-old complains of a headache with increased pressure behind her eyes. She also complains of constant nasal congestion and discharge. The symptoms have been occurring for 2 weeks without relief from her current prescription pain medication, Ultram 50 mg, which she takes twice daily as needed for pain. Yesterday she had a fever of 102 degrees F, but she hasn't checked her temperature today. Which of the following is the most appropriate recommendation for her? a. Continue the Ultram and add aspirin 650 mg every 6 hours b. Discontinue the Ultram and add naproxen 220 mg every 8 hours c. Switch to two tablets of Excedrin Migraine™ (acetaminophen 250mg, caffeine 65mg, and aspirin 250mg per tablet) once daily d. Refer patient to primary care provider

d. Refer patient to primary care provider

A 15-month-old patient, weighing 12 kg, has had a fever for the last 36 hours and it persists despite treatment with acetaminophen 120 mg given orally every 6 hours. What is the most appropriate recommendation at this time? a. Acetaminophen 180 mg q 6 hours. If fever persists for another 12 hours, then seek medical attention. b. Continue Acetaminophen 120 mg q 4-6 hours. If fever persists for another 24 hours, then seek medical attention. c. D/C acetaminophen, start ibuprofen 120 mg q 6-8 hours as needed. If fever persists for another 24 hours, then seek medical attention. d. Refer patient to primary care provider.

d. Refer patient to primary care provider.

A 63-year-old female presents with symptoms of rhinorrhea with thick mucus drainage. She also complains of nasal congestion and a loss in sense of smell. She states these symptoms are constant throughout the day/night and seem to be getting worse because she's having recurrent nosebleeds. She has tried loratadine 10 mg daily without much relief. What is the most appropriate recommendation for her? a. Switch to fluticasone proprionate nasal spray 2 sprays in each nostril daily b. Switch to cetirizine 10 mg tablets PO daily c. Add on pseudoephedrine 120 mg PO twice daily d. Refer to a primary care provider

d. Refer to a primary care provider

An 18-year-old male complains of a cough accompanied by purulent secretions and a sore throat. He states his secretions are thick, yellow in color and have a foul odor. He took an oral temperature at home this morning and it read 102oF. He denies any medical conditions. What is the most appropriate recommendation for this patient? a. Guaifenesin 400 mg Q4H prn; Acetaminophen 500 mg Q4H prn b. Dextromethorphan 60 mg Q6H prn; max daily dose of 240 mg c. Codeine 120 mg Q4H and menthol lozenges as needed d. Refer to primary care provider

d. Refer to primary care provider

A young woman would like a recommendation to treat a rash along her abdomen and legs that she thinks is due to wearing leather outfits nightly when she plays in an 80's rock band. She has been scratching frequently as she explains why her skin appears red and blistering. She has had symptoms for 2 weeks but has just become concerned because she now has a fever. What is the BEST recommendation to treat her prickly heat based on her symptoms today? a. Colloidal oatmeal bath nightly after she plays b. Application of a menthol gel to soothe the irritation c. Application of topical benzocaine twice a day d. Referral for medical treatment

d. Referral for medical treatment

A 19-year-old female comes to the pharmacy with symptoms of increased vaginal discharge that is thin and watery with a foul fish-like odor. What is the most appropriate recommendation? a. Topical gentian violet applied vaginally for 3 days b. Topical azole antifungal applied vaginally for 3 days c. Topical propylene glycol applied vaginally for 7 days d. Referral to physician

d. Referral to physician

A mother calls the pharmacy regarding her young child (10 weeks old weighing 15 lbs) who has a runny nose, mild cough and sneezing with a rectal temperature of 101.2 degrees F this morning. She indicates that the cough and sneezing started this morning around 3:00am. What is the most appropriate recommendation? a. Saline nasal spray prn and nasal suction b. Steam vaporizer in the child's bedroom during naps and at bedtime c. Acetaminophen 60 mg every 4 hours as needed & dextromethorphan 2.5 mg every 4 hours prn d. Referral to primary care provider

d. Referral to primary care provider

A 28-year-old female strained her back earlier in the day while picking up one of her kids. She is looking for the best option for her pain. You do a quick initial assessment of her pain and find out that her pain is an 8/10 and she can barely move. What is the most appropriate initial recommendation? a. RICE therapy to relieve her back pain; follow up in 7 days. b. A systemic analgesic such as ibuprofen or acetaminophen. c. A systemic analgesic in combination with heat therapy. d. Referral to primary care provider, as she is not a candidate for self-care.

d. Referral to primary care provider, as she is not a candidate for self-care.

An 18-month old male patient presents with a wet/chesty cough, nasal congestion and rhinorrhea. His father indicates his symptoms started about 3 days ago with a slight runny nose. It has since progressed to include the cough and congestion. His father denies any fever and states his child continues to eat and drink regularly. He has no medical conditions and takes no medications. What is the most appropriate recommendation? a. Oxymetazoline 0.05% nasal spray applied Q12H prn b. Pseudoephedrine 30 mg PO Q6H prn c. Dextromethorphan 10mg PO Q4H prn d. Saline nasal spray prn and nasal suction

d. Saline nasal spray prn and nasal suction

Which of the following would be the best non-pharmacologic recommendation for a 21-year-old woman with mild acne? a. Stress does not affect acne b. Wear a headband or hat to reduce acne flare-ups around the hairline c. Pick or squeeze pimples to hasten clearing of blemishes d. Use non-comedogenic, oil-free makeup

d. Use non-comedogenic, oil-free makeup