RATS- EXAM 2

An elderly female says that in her later years she has been experiencing more vaginal dryness and wants to know the best product to use. Which of the following is the most appropriate recommendation? a. A glycerin-based product b. Petroleum jelly c. Insert tampon with gentian violet d. Mineral oil

a. A glycerin-based product

Amy Robinson calls the pharmacy seeking help for her 3-year-old son. She states her son has a productive cough, and she has Vicks VapoRub (Camphor/Menthol/Eucalyptus) at home. She would like information on how to apply the medication as her pediatrician is closed for the day. How would you counsel her on the medication? a. Apply a thick layer and rub on the throat and chest, may repeat up to 3x/per day as needed b. Apply a thick layer and rub inside nostril, may repeat up to 3x/per day as needed c. Apply a thick layer and rub on the throat and chest, cover with a warm cloth, may repeat up to 3x/per day as needed d. Apply a thick layer and rub in the mouth and chest, may repeat up to 3x/per day as needed

a. Apply a thick layer and rub on the throat and chest, may repeat up to 3x/per day as needed

Which of the following statements regarding vulvovaginal candidiasis is true? a. Broad-spectrum antibiotic use is a risk factor for developing VVC. b. Patient should try a different OTC antifungal if symptoms do not improve with first course of treatment c. A 7-day course of antifungal therapy is more effective than a 3-day course. d. Patient should expect complete resolution within 3 days after starting antifungal treatment.

a. Broad-spectrum antibiotic use is a risk factor for developing VVC.

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, 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 39-year-old man states that he was stung repeatedly by wasps in the parking lot before he entered the pharmacy. You notice that he has multiple red marks along his arms and face that appear to begin swelling. While you are asking more questions about his symptoms, you notice that hives are beginning to appear near stinger sites and the man appears to be having more difficulty talking and catching his breath. What is the best recommendation to treat the stings? a. Call 911 for immediate medical assistance. b. Apply topical Benadryl cream (diphenhydramine HCl 2%) to affected areas. Reapply 3 to 4 times a day. c. Apply an ice pack to affected areas in 10-minute intervals. Wrap the pack in a washcloth. d. Apply Solarcaine Pain Relieving aerosol spray (lidocaine 0.5%, aloe) to affected areas. Reapply 3 to 4 times a day.

a. Call 911 for immediate medical assistance.

Which of the following is the MOST correct regarding acne treatment products? a. Gels are the most effective formulations and are best for oily skin. b. Ointments are best for dry or sensitive 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.

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

John is a 22-year-old male who woke up 2 days ago with a sore throat. He shows no other symptoms besides difficulty swallowing. He has not tried any medications and would like to avoid medicines if possible. What is your treatment recommendation? a. Hot tea with lemon and honey b. Saline nasal sprays c. Milk should be avoided d. Vicks vaporub

a. Hot tea with lemon and honey

JW is a 17-year-old male on a high school football team. This afternoon at practice, he was hit pretty hard 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 a 5/10 and he complains of numbness in his left arm and hand. What is the most appropriate recommendation for JW? a. Recommend he visit a physician as he is not a candidate for self-care. b. Recommend the use of RICE (rest, ice, compression, elevation) and naproxen 220 mg twice a day for up to 10 days. c. Recommend rest, heat therapy and the use of a transcutaneous electrical nerve stimulation (TENS) device for up to 3 days. d. Recommend diclofenac sodium 1% topical product applied to left shoulder four times a day, scheduled around the clock, for up to 10 days.

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

A 33-year-old female calls the pharmacy asking for help. She tripped and fell down the last 2 steps of the staircase in her home about an hour ago. Her right ankle is painful (pain scale: 4/10) and 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 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 10 days. b. Recommend the use of rest and heat for the next 1 to 3 days and acetaminophen 1000 mg every 4 to 6 hours as needed (max daily dose of 4000mg) 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 she see a physician as she is not a candidate for self-care.

a. 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 10 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 45-year-old woman presents to the pharmacy counter with complaints of thick mucus drainage and nasal congestion. She does not complain of sneezing or itching, but she is coughing quite a bit at night. She tried some Allegra (fexofenadine 60 mg) that she had at home for about a week, but she did not really notice a change in her symptoms. What is the best recommendation for this patient? a. Refer to primary care provider b. Switch to fluticasone nasal spray 2 sprays in each nostril daily c. Add on pseudoephedrine 60 mg by mouth every four hours d. Switch to cetirizine 10 mg taken by mouth every day

a. Refer to primary care provider

A 46-year-old male comes in to talk with a pharmacist about recommendations for a headache. He describes the pain as pulsating from the top of his head down. He reports having controlled hypertension, which is treated with lisinopril 20mg daily and amlodipine 5mg daily. He states that the headache started yesterday morning before work, around 8:30am, and was very mild, and by the time he left for work around 9:00am the pain was around 8/10. He does not have a history of headaches previously and has no medication allergies or significant past medical history to report. Which of the following would be an appropriate recommendation for him? a. Referral to healthcare provider b. Ibuprofen 200-400mg PO every 4-6 hours as needed, not to exceed 1,200mg/day c. Acetaminophen 325mg PO every 4-6 hours as needed, not to exceed 3,250mg/day d. Acetaminophen/Caffeine 500mg/65mg PO every 6 hours as needed, not to exceed 6 tablets daily

a. Referral to healthcare provider

A 36-year-old pregnant female presents to the pharmacy complaining of a headache that has been mild, but persistent for the last 13 days. They have progressively gotten worse, and she is beginning to have some visual disturbances, so she wants a recommendation for an over-the-counter product to use. She has never had a headache before so she does not know what to take over the counter. She reports using a cold compress while sitting in a dark room, and she has tried localized peppermint oil, but both have only temporarily improved symptoms with no more than 10 minutes of relief at a time. Which of the following is not an exclusion that she has to self-care? a. She has not taken an OTC analgesic in the past to treat a headache b. New headache during pregnancy c. Headache that persists for 10 days, with or without treatment d. Neurologic change with headache

a. She has not taken an OTC analgesic in the past to treat a headache

A 34-year-old female has been experiencing symptoms of allergic rhinitis for the last week. She states her runny nose is becoming more bothersome and she wishes to purchase a product that will provide quick relief. She has been taking cetirizine 10 mg daily with only minimal relief of symptoms. She does not want to miss any workdays, as it is important that she stay on schedule for her bus route. What is the most appropriate recommendation for her? a. Switch to triamcinolone nasal spray 2 sprays in each nostril daily b. Switch to chlorpheniramine 4 mg tablets PO every 4 to 6 hours c. Add on cromolyn nasal spray 1 spray in each nostril 3 to 6 times a day d. Refer to primary care provider

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

Derrick calls the pharmacy to inquire about symptoms and onset of the common cold. He states his son came home from science camp ~3 days ago. They received a call this morning about a common cold outbreak among the kids at camp. The dad is worried about catching a cold as he has an upcoming business trip. What would you tell the dad concerning the sequential order of symptom occurrence? a. Symptom onset about 1-3 days after infection, the first symptom to occur is sore throat followed by nasal symptoms b. Symptom onset about 2-4 days after infection, the first symptom to occur is sore throat followed by nasal symptoms c. Symptom onset about 1-3 days after infection, the first symptom to occur is sore throat followed by cough d. Symptom onset about 2-4 days after infection, the first symptom to occur is nasal symptoms followed by sore throat

a. Symptom onset about 1-3 days after infection, the first symptom to occur is sore throat followed by nasal symptoms

Which of the following would be the best non-pharmacologic recommendation for families calling about lice infestations? a. Vacuum carpet and furniture throughout the house. Vacuum frequently over the next 7 days. b. Wash all clothing and bedding in hot water. Allow to air dry. c. Use a lice comb to remove nits from the hair shaft after appropriate treatment. Use the same comb for all affected family members. d. Seal pillows and stuffed animals in plastic bags for 2 weeks. Spray other toys and items with an insecticidal spray.

a. Vacuum carpet and furniture throughout the house. Vacuum frequently over the next 7 days.

Meredith is in her second trimester of pregnancy and complains of a cold. She reports symptoms of nasal congestion and would like something over the counter. Which of the following is the most appropriate treatment for Meredith? a. Vicks sinex nasal spray (oxymetazoline 0.05%) b. Neo-synephrine mild strength nasal spray (phenylephrine 0.25%) c. Mucinex D tablets (pseudoephedrine 60 mg / guaifenesin 600 mg) d. Sudafed 12 Hour tablets (pseudoephedrine 120 mg)

a. Vicks sinex nasal spray (oxymetazoline 0.05%)

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. Wear a hat with a long-sleeved shirt. She should also wear sunscreen with an SPF of 50+ to prevent sunburn. b. Maximize sun exposure between 10am and 4pm. She needs a minimum of SPF 4 to prevent skin cancer. c. 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. 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.

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

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. 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 c. Wait to shower until the morning after the competition d. Wear tight-fitting, non-breathable clothing

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

A woman brings her 5-year-old son to your pharmacy to request your recommendations to treat mosquito bites on his forearms. What is the best recommendation? a. Apply a warm compress to insect bites for 10 minutes. Wait 10 minutes between applications. b. Apply topical Benadryl cream (diphenhydramine HCl 2%) to affected areas. Reapply 3 to 4 times a day. c. Apply Campho-Phenique gel (camphor 10.8%, phenol 4.7%, eucalyptus oil) to all affected areas 3 to 4 times a day. Cover with bandages. d. Refer the boy to his primary care provider for treatment

b. Apply topical Benadryl cream (diphenhydramine HCl 2%) to affected areas. Reapply 3 to 4 times a day.

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. Frequent diaper changes b. Diarrhea due to Norovirus c. Use of breast milk d. Use of disposable diapers

b. Diarrhea due to Norovirus

What would you include in your advice regarding treatment of head lice? a. Apply lice treatment to all areas of the body containing hair, including eye lashes and chest hair. b. Exposure to topical lice treatments may cause skin irritation and redness. c. Topical lice treatments will kill all lice and nits with one application. d. Topical lice treatments work best if applied to dry hair and left on hair overnight.

b. Exposure to topical lice treatments may cause skin irritation and redness.

A mother of a 4-year-old little girl, Alison, comes to your pharmacy for help with choosing an allergy medication. She states that they saw their family physician yesterday, and Alison was diagnosed with allergic rhinitis. The physician instructed her to pick something up at the pharmacy to control her daughter's symptoms, which include itchy eyes and runny nose. Which of the following is the safest and most appropriate recommendation? a. Diphenhydramine 25 mg taken by mouth every 4 hours b. Fluticasone nasal spray 1 spray in each nostril daily c. Loratadine 5mg taken by mouth every 12 hours d. Budesonide nasal spray 2 sprays in each nostril once daily

b. Fluticasone nasal spray 1 spray in each nostril daily

Diane Fox is a 52-year-old woman with a chest cold. She has a low-grade fever (oral temp = 99.5 oF) and complains of a productive cough. What is the most appropriate treatment for Diane Fox? a. Refer to primary care provider b. Guaifenesin 200 mg every four hours as needed c. Codeine 120 mg every four hours as needed d. Dextromethorphan 30 mg every four hours as needed

b. Guaifenesin 200 mg every four hours as needed

A 47-year-old 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. The non-prescription TENS device should be used only once a day. b. He should avoid placing the electrodes around the chest, throat, or head. 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.

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

A 64-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 is happy with his current pain regimen, but complains that his osteoarthritis occasionally bothers him when his hip becomes stiff. Which of the following is the most appropriate recommendation for him? a. Increase 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.

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 4000 mg/day d. Naproxen 500mg q12 hours prn; max 1500 mg/day

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

A 43-year-old patient stops by the pharmacy to ask for recommendations for a headache that he's had for the past few days. He reports being "stopped up", his face feels tender around his nose, and he has a dull headache that seems persistent, but only about a 3/10 on the pain scale. He is frustrated by the headache because he is a construction worker and works very long hours around loud equipment, which he reports makes it worse. His past medical history is significant for spinal surgery last year and he only takes cetirizine 10mg daily. What would you recommend? a. Ibuprofen 200-300mg every 4-6 hours as needed, not to exceed 1,200mg in 24 hours b. Ibuprofen/Pseudoephedrine 200mg/30mg every 4-6 hours as needed c. Referral to provider d. Acetaminophen/diphenhydramine 325mg/12.5mg every 4-6 hours as needed

b. Ibuprofen/Pseudoephedrine 200mg/30mg every 4-6 hours as needed

A 29-year-old female approaches your pharmacy and complains of a thick white vaginal discharge along with vaginal itching and irritation. She does not complain of an odor. Which of the following is the most appropriate treatment regimen? a. Vagisil® Maximum Strength Anti-Itch Crème (benzocaine 20%, resorcinol 3%) applied externally 3 to 4 times a day for 7 days b. Monistat 7 ® vaginal cream (miconazole nitrate 2%) inserted vaginally once daily and applied externally as needed for 7 days c. Povidone/iodine 0.3% vaginal douche used twice daily for 7 days d. Tea Tree Therapy® Vaginal Suppositories (tea tree oil 200 mg) inserted vaginally inserted vaginally once daily for 5 days

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

A 22-year-old patient complains about mood changes about a week before her period. She cries a lot and is easily angered to the point her friends and boyfriend have started complaining about her behavior. She also experiences a lot of bloating, sugar cravings, and insomnia. She says her symptoms go away around day 3 of her period. The patient is experiencing... a. Moderate to severe premenstrual symptoms (PMS) b. Premenstrual dysphoric disorder (PMDD) c. Vulvovaginal Candidiasis d. Secondary Dysmenorrhea

b. Premenstrual dysphoric disorder (PMDD)

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. Proactive+® Pore Targeting Treatment Cream (benzoyl peroxide 2.5%) c. Clean & Clear® Advantage 3-in-1 Exfoliating Cleanser (benzoyl peroxide 5%) d. Clean & Clear Persa-Gel® 10 (benzoyl peroxide 10%)

b. Proactive+® Pore Targeting Treatment Cream (benzoyl peroxide 2.5%)

A 21-year-old man asks for help with acne treatments. He tends to eat more fried foods and sugary treats while home from college 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 benzoyl peroxide 2.5% cream and wash his face with a mild soap no more than twice daily c. Recommend that he try glycolic acid 3% facial wash and warn him not to pick at or squeeze pimples d. Recommend that he try sulfur 10% lotion and caution him to avoid extended time in the kitchen at work

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

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 alter her diet to minimize intake of high glycemic foods and wash her face with a mild soap twice daily c. 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. d. Recommend that she practice stress relieving techniques and try using a facial scrub once a day

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

A 16-year-old presents to the pharmacy for a recommendation regarding new onset headaches. She read online that her headaches could potentially be hormonal, but she reports that she has never really had this issue in the past. When asked about her symptoms, she reports significant fatigue for about 12 hours before her headache, with pulsating pain around her head like a band. Today she is reporting significant neck stiffness and all-over pain in her head (scaled 7/10). What do you recommend to her? a. Take ibuprofen 200-400mg now for the headache and start taking ibuprofen 1-2 days before menstruation to prevent headaches related to hormones b. Referral to provider c. Naproxen 220mg PO every 6-8 hours, up to 880mg daily. Not to exceed 3 days per week to avoid medication overuse headaches d. Recommend aspirin/caffeine 500mg/40mg. They are new onset and have been occurring regularly, and caffeine in combination with an NSAID is more effective

b. Referral to provider

A man calls your pharmacy to ask for your assistance regarding a tick he found still attached to his teenage son's leg. What is the best recommendation? a. Apply nail polish to the tick to suffocate the tick until it falls off b. Use a set of fine tweezers to gently remove the tick including its mouthparts c. Squeeze the tick tightly and pull quickly to remove the tick as fast as possible d. Hold a lit match as close as possible to the tick to burn it off

b. Use a set of fine tweezers to gently remove the tick including its mouthparts

Which of the following patients would be appropriate to provide recommendations for self-care? a. 59-year-old man with intense itching and multiple red streaks or burrows located around fingers and wrist with complaints of itching throughout genital area b. 34-year-old woman who admits that she just spent the weekend hiking with itching around a single erythematous site on her ankle that appears to look like a bull's eye c. 12-year-old boy who just started a landscaping business with itching and red papules localized around multiple sites on his legs without fever or systemic symptoms d. 18-year-old woman who spent last week serving as a camp counselor at a rural camp with a fever and pain, redness, and ulceration localized around puncture wound.

c. 12-year-old boy who just started a landscaping business with itching and red papules localized around multiple sites on his legs without fever or systemic symptoms

A young college student presents into your pharmacy with allergic rhinitis. She says that she currently takes loratadine 10 mg once daily and fluticasone propionate nasal spray two sprays in each nostril once daily. This usually controls her symptoms, but she has had some nasal congestion for the past 3 days. What is the most appropriate recommendation for him? a. Referral to primary care provider b. Increase the dose of loratadine to 10 mg BID c. Add on pseudoephedrine 60 mg as needed for congestion d. Switch loratadine 10 mg to levocetirizine 5 mg QAM

c. Add on pseudoephedrine 60 mg as needed for congestion

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. Advise her that her acne will worsen before it gets better 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. Advise her that her acne will worsen before it gets better and allow 8 to 12 weeks for improvement

Which of the following criteria is not associated with increased prevalence of tension headaches or migraines? a. Female gender b. Lack of other healthcare conditions c. Asian ethnicity d. Overuse of commonly used NSAIDs or other analgesics

c. Asian ethnicity

A 39-year-old male, Fred, presents to the pharmacy with symptoms of allergic rhinitis. He recently moved to Columbia. It is springtime and the pollen is in full force. Fred says that he has tried to stay inside, but he just can't stop sneezing. He has hypertension and diabetes and admits to "not being as good as he should" with taking medications and following lifestyle recommendations. What is the best recommendation for Fred? a. Pseudoephedrine 120 mg PO BID b. Diphenhydramine 25-50 mg PO every 4 - 6 hours c. Budesonide nasal spray 2 sprays in each nostril daily d. Refer to primary care provider

c. Budesonide nasal spray 2 sprays in each nostril daily

A patient has been using a capsaicin cream product three times daily for her arthritis. She states she has been using this product for a week now with no relief of her pain. What is the most appropriate counseling point for her at this time? a. The capsaicin product is not working and she should switch to a different topical counterirritant, such as a menthol 10% gel. b. Continue to apply this capsaicin cream product three times daily, but after application tightly wrap the area to enhance absorption. c. Capsaicin commonly takes 14 days to a few weeks to work. She should continue to use the product three times daily. d. She should be referred to her primary care physician as she is still having pain despite treatment for 7 days.

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

A twenty-something male, walks up to your pharmacy counter asking for "some Sudafed." After speaking with him for a few minutes, you find out he just moved to South Carolina 2 weeks ago for a job. Since moving here, he has been suffering from itchy, watery eyes, congestion, rhinorrhea, and repetitive sneezing. His nose and the back of his throat itches, as well. He is not currently taking any medications and has no known drug allergies. Which of the following is the most appropriate recommendation? a. Fexofenadine 180 mg po QAM and chlorpheniramine 4 mg QHS b. Refer to primary care provider c. Cetirizine 10 mg and pseudoephedrine 240 mg po daily d. Diphenhydramine 25 mg po q 6-8 h and oxymetazoline nasal spray q 4-6 h

c. Cetirizine 10 mg and pseudoephedrine 240 mg po daily

A 27-year-old firefighter complains of itchy nose and watery eyes. He said that he sometimes has a post-nasal drip throughout the day. He mentions that last year he was diagnosed with allergic rhinitis and was told to use Zyrtec (cetirizine 10 mg) once daily which seemed to work. Because of his busy work schedule, he has not been taking it. What is the most appropriate recommendation for him? a. Budesonide nasal spray 2 sprays in each nostril BID b. Refer to primary care provider c. Cetirizine 10 mg by mouth once daily d. Diphenhydramine 25-50 mg by mouth 4 - 6 times daily

c. Cetirizine 10 mg by mouth once daily

A woman asks for your opinion regarding various insect repellants as she prepares for an upcoming family camping trip. They plan to spend as much time outside as possible. What is the best recommendation? a. Choose a product that combines an insect repellant with sunscreen to prevent sunburn as well. Apply to all exposed areas of the body. b. Choose a product with permethrin 0.5%. Apply to all arms and legs. c. Choose a product with 20-35% DEET to repel both insects and ticks. Do not apply directly to face. d. Choose a product with pyrethrin 0.33% and piperonyl butoxide 4%. Apply from the neck down.

c. Choose a product with 20-35% DEET to repel both insects and ticks. Do not apply directly to face.

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.

Jamie is 42-years-old and works in a garden center. Today, she presents to the pharmacy with complaints about her intermittent allergic rhinitis. She states that whenever her symptoms (itchy eyes, nasal congestion) start, she takes diphenhydramine 25 mg up to 4 times a day. It helps relieve her symptoms, but she feels sluggish and drowsy. She wants help finding a product that will help her symptoms now that will also not make her feel so sleepy. What would be the best recommendation? a. D/C diphenhydramine and start cromolyn nasal spay b. Refer to primary care provider c. D/C diphenhydramine and start triamcinolone nasal spray d. Add on phenylephrine for congestion

c. D/C diphenhydramine and start triamcinolone nasal spray

Emily Jane is a 32-year-old female who presents to the pharmacy seeking help for her cough. She states she has a dry hacking cough that started about 2 days ago. She has been managing the cough with lozenges, but she is unable to get any sleep due to the cough at night. What is your recommendation for Emily Jane? a. Guaifenesin 400 mg every four hours as needed b. Refer to primary care provider c. Dextromethorphan 30 mg every four hours as needed d. Pseudoephedrine 30 mg every four hours as needed

c. Dextromethorphan 30 mg every four hours as needed

A 21-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. Apply heat for 15-20 minutes 3-4 times per day. b. Ice the injured area for 1 hour 3-4 times per day. c. Elevate the site of injury above the level of the heart. d. Use a TENS device for 15-30 minutes 3 to 4 times a day.

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

A 24-year-old male has been experiencing itchy eyes and nose, sneezing, and runny nose for the past week. He states that these symptoms have become very bothersome and asks for your help in purchasing a product that will provide him some relief. He has no other disease states and is not on any medications. What is the most appropriate recommendation for him? a. Mucinex (guaifenesin 600 mg) 1 tablet PO every four hours b. Refer to primary care provider c. Flonase (fluticasone 50 mcg) nasal spray two sprays IEN daily d. Sudafed PE (phenylephrine 10 mg) 1 tablet PO every four hours

c. Flonase (fluticasone 50 mcg) nasal spray two sprays IEN daily

Which of the following is classified as a cough expectorant? a. Codeine b. Dextromethorphan c. Guaifenesin d. Diphenhydramine

c. Guaifenesin

An elderly woman brings in her 32-year-old daughter who just had a baby in the last 3 months. She is currently breastfeeding the baby, and she was told during pregnancy that all she could take for fever and pain was acetaminophen. She received her annual flu vaccine during pregnancy, around 5 months ago. She currently has a mild fever with an oral temperature of 101.7 F. Which of the following is the safest over the counter antipyretic/analgesic for her to use as a breastfeeding mother? a. Acetaminophen is still the safest in breastfeeding. Ensure that she takes approximately half the dose to prevent the baby from having too much b. Aspirin is the safest in breastfeeding. It is found in breastmilk but has been shown to improve development of the kidneys and heart in infants. c. Ibuprofen is the safest analgesic and antipyretic. It has low concentrations in breast milk and few adverse reactions in infants. d. Naproxen is an appropriate medication for breastfeeding mothers and is extremely effective for analgesia and fever reduction

c. Ibuprofen is the safest analgesic and antipyretic. It has low concentrations in breast milk and few adverse reactions in infants.

Which of the following is the most appropriate nonpharmacologic treatment option for PMS? a. Consuming more simple sugars, like chocolate candy bars b. Avoiding dairy products c. Implementing stress reduction strategies d. Reducing the amount of exercise throughout the week

c. Implementing stress reduction strategies

A 20-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. Repeat the dose as soon as her stomach can tolerate. c. It is not necessary to repeat the dose. d. Wait 24 hours, then repeat the dose.

c. It is not necessary to repeat the dose.

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 26-year-old female had unprotected sex last night (~18 hours ago) and comes to the pharmacy to inquire about the use of an emergency contraceptive. She has a prescription for Yasmin® but admits to not using it for the past 2 months. What is the most appropriate recommendation? a. Fill the Yasmin®, take double the dose for 2 days, and then resume normal schedule b. Povidone/iodine 0.3% vaginal douche used twice daily for 3 days c. Next Choice One Dose (levonorgestrel 1.5 mg) tablet PO once d. Refer to primary care provider

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

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. Oxybenzone d. Zinc oxide

c. Oxybenzone

Erin is a 2.5-month-old baby girl with nasal symptoms and a cough that started about 5 days ago. What is the best treatment option for Erin? a. Phenylephrine tablets - 2.5 mg every 4 hours b. Phenylephrine nasal drops - 2 drops every 4 hours c. Refer to primary care provider d. Pseudoephedrine tablets - 15 mg every 4 hours

c. Refer to primary care provider

Freddy Hill is a 16-year-old male, who complains of a productive cough that started about 4 days ago. His mom has been giving him Guaifenesin 400 mg every four hours but symptoms continue to worsen. The mom would like to try something else. What is your recommendation for Freddy Hill? a. Guaifenesin 400 mg every four hours as needed b. Dextromethorphan 30 mg every four hours as needed c. Refer to primary care provider d. Diphenhydramine 25 mg every 4 hours as needed

c. Refer to primary care provider

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 with a medicated cleanser and follow with a facial toner 3 times a day. b. Encourage her to continue using the exfoliating cleanser but reduce to 2 times a day. c. She should wash her face no more than 1-2 times a day with a mild soap and soft cloth. d. Advise her to change to a non-soap cleanser and continue washing her face 3 to 4 times a day

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

A 46-year-old man presents to your pharmacy complaining of pain across his upper back, between his shoulder blades. He reports that he had a heart attack a few years ago and started going to the gym regularly. He thinkshe pushed himself too far lifting weights yesterday. He rates his painat a3/10. He mentions that he's going on a blinddate tonight andwould like immediate relief; howeverhedoesn't wantto use aproduct that will make him smell"like aretirement home."Which of thefollowing is the most appropriate recommendation? a. While wearing gloves, apply capsaicin 0.025% 3 to 4times per dayas needed. Washhands thoroughly after application. b. Applymenthol 5% to skin 3 to 4times daily as needed. c. Take acetaminophen 500mg by mouth every 4to 6hours, not toexceed 3,000 mg per24 hours. d. Take ibuprofen 400mg by mouth every 6 hours as needed,notto exceed 1,200 mg per24 hours.

c. Take acetaminophen 500mg by mouth every 4 to 6 hours, not toexceed 3,000 mg per 24 hours.

A 31-year-old male is seeking a barrier method contraceptive that protects him from STIs and prevents his female partner from getting pregnant. He also has a documented allergy to latex. Which method do you suggest he try? a. Trojan Naturalamb (lamb cecum) b. Calendar Rhythm Method c. Trojan Supra (polyurethane) d. Contraceptive Sponge

c. Trojan Supra (polyurethane)

A temperature of 99.3 F is indicative of a fever when taken from which part of the body? a. Mouth b. Forehead c. Under the arm d. Rectum

c. Under the arm

A 7-year-old boy runs to your pharmacy counter in tears that he was just stung by a bee outside the building. You see that the stinger is still attached to the boy's arm. Besides being upset and complaining about the pain from the sting, the boy does not appear to have any hives and appears to be breathing normally. What is the best response? a. Refer the boy to his primary care provider b. Use tweezers to gently remove the stinger c. Use a credit card to scrape away the stinger d. Leave the stinger in his arm and apply Solarcaine Pain Relieving aerosol spray (lidocaine 0.5%, aloe) to the area. The stinger will fall out on its own.

c. Use a credit card to scrape away the stinger

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. Apply heat (such as a heating pad) to the area where a topical analgesic product has been applied. c. When applying a topical analgesic, avoid wounded or broken skin. d. Bandage the area tightly so the medication is absorbed thoroughly and doesn't rub off on other areas of the body or clothing.

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

A young mother brings in her 2-year-old boy to the pharmacy. She is concerned that he has a mild , oral fever of 100.4, and it started about 6 hours ago. She reports that he is still eating, drinking, and playing, although he is a bit more fussy than normal. He has a bit of a runny nose, but no cough, vomiting, or other alarming symptoms. She is asking for acetaminophen, an anti-pyretic to help with fever, but she does not know which dose is appropriate for her 28 -pound child. Select the most appropriate recommendation. a. 280mg PO every 4-6 hours as needed, up to 2,100mg daily b. 65mg PO every 4-6 hours as needed, up to 325mg daily c. Refer to pediatrician. He is not a candidate for self-care d. 165mg PO every 4-6 hours as needed, up to 950mg daily

d. 165mg PO every 4-6 hours as needed, up to 950mg daily

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

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

Which of the following patients would be appropriate for self-treatment of head lice? a. 12-year-old girl with an allergy to chrysanthemums and ragweed b. 1-month-old girl with head lice shared by her older brother c. 32-year-old pregnant woman whose children brought lice home from school d. 9-year-old boy with head lice from sharing baseball caps with his friends

d. 9-year-old boy with head lice from sharing baseball caps with his friends

You have received multiple calls from parents regarding a recent lice outbreak at the local elementary school. What is the best recommendation to eliminate the lice? a. Apply LiceMD (dimethicone 100%) to wet hair. Leave treatment in overnight. Rinse to remove in the morning. b. Apply Nix Lice Killing Cream Rinse (permethrin 1%) to dry scalp. Rinse to remove in 10 minutes. Reapply in 7 days. c. Apply a compounded product of 10% tea tree oil and 1% lavender oil to wet hair daily for 7 days. d. Apply A-200 Lice Killing Shampoo (pyrethrins 0.33%, piperonyl butoxide 3%) to dry hair. Rinse to remove in 10 minutes. Reapply in 7 to 10 days.

d. Apply A-200 Lice Killing Shampoo (pyrethrins 0.33%, piperonyl butoxide 3%) to dry hair. Rinse to remove in 10 minutes. Reapply in 7 to 10 days.

A patient is currently taking naproxen 220 mg twice 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 naproxen b. Ranitidine c. Capsaicin d. Esomeprazole

d. Esomeprazole

Which of the following patients is a candidate for self-treatment of allergic rhinitis? a. NA, a pregnant woman experiencing sneezing and watery eyes for the first time b. JS, a 19-year-old male who has asthma, an itchy throat and is currently wheezing c. JL, a 49-year-old woman who was recently diagnosed with COPD d. FD, a 28-year-old male with a post-nasal drip, sinus and throat pain

d. FD, a 28-year-old male with a post-nasal drip, sinus and throat pain

A 19-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

Which of the following is an appropriate treatment for a 6-month-old with nasal congestion? a. Breathe right nasal strips b. Vicks VapoRub c. Tea with lemon and honey d. Nosefrida

d. Nosefrida

Which of the following thermometers is acceptable for use in a 6-month-old child? a. Digital probe oral thermometer, used for 5-30 seconds b. Rectal thermometer, used while the parent is fully supervising the child c. Color-changing thermometer, used on the forehead since that area most accurately reflects body temperature d. Pacifier thermometer, used for 2-6 minutes

d. Pacifier thermometer, used for 2-6 minutes

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 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 and hot flushed dry skin. 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 22-year-old approaches your counter and needs help selecting an OTC for what she thinks is just a yeast infection like she has had before. She says she has a couple of partners, and she takes Sprintec as her only form of birth control. She mentions that her vaginal discharge is a yellowy-green color, and she is experiencing pain when she pees. 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 28-year-old female strained her back earlier in the day while playing with 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 recommendation at this time? a. RICE therapy to relieve her back pain; follow up in 7 days. b. A systemic analgesic such as ibuprofen or acetaminophen. c. A topical analgesic applied to affected area as needed after soaking in a bath with Epsom salts. 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.

You are counseling a 14-year-old girl about OTC acne treatment. Which of the following counseling points would be MOST accurate? a. She should try a product with salicylic acid as it is more effective than a product containing benzoyl peroxide 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. Use caution with benzoyl peroxide as it may bleach fabrics

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

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

Which of the following would be the best counseling advice to provide when recommending use of adapalene? a. Beneficial effects can be seen within the first 2 weeks of therapy b. Adapalene does not cause redness, dryness, or burning like benzoyl peroxide and salicylic acid c. Adapalene is safe to use through pregnancy d. Use sunscreen to protect the skin as adapalene increases sensitivity to the sun

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