Station 1 : 24 Male come to pharmacy to get advice from pharmacist

Que: will Truvada help me..? How long i need to take...?

When asking :: he has partner who as aids. And since last month they were planing for sexual relation..
but do not have still
His concern:: will Truvada prevent the transmission. He is gay.
On 5 Min: what is the success rate...?

Pre exposure prophylaxis..

Do a complete assessment
Is the partner taking Tx
Viral load of yourself & the partner, adherent to medication, monitoring
Hx of sexual relation with HIV pt

Reco to start Truvada: good for Pre-exposure prophylaxis.

Duration to take Truvada: At least 20d or longer depending on Dr.’s reco & continue for the duration of
relation
Will Truvada prevent transmission: Yes, it reduces the risk of transmission, use with safer sex
practice/barrier & continue monitoring every 3mo for HIV testing
Routine immunization Hx like T.B, Pneumococcal, Influenza

Station 2: 23 female come pharmacy to get something for vaginal infection..

Up on asking
History: 3rd episode in last six month
Last episode was before three month
Last time she used clotrimazole
She is also doing douching: NO need to douche to keep the vagina. Vaginal has its own cleaning
mechanism. It should NOT be used as a birth Ctrl. DO Not douche 24hr before vaginal exam or 6hr after
sex
Can we give clotrimazole? n/a
On 5 min: how can i prevent this and what is the reason..?
Reason for infection? Possible OVER-douching or risks of vaginal candidiasis: age, sexual history,
contraceptive method, pregnancy, menstruation, antibiotic use, vaginal trauma (e.g., surgery) and even
tampon use
Prevention: genital hygiene, wear loose clothes, use sanitary pads over tampons, ↓ sugar & eat yogurt
containing probiotics (lesser evidence)

Station 3: simple counselling for Trifluridine eye drops for 8 yr child

Mother come to pharmacy
On 5 min: how can we prevent transmission
Viral Conjunctivitis: Very contagious, DO NOT go to school or swimming pool
Non-pharm & prevention: Cold compresses may increase patient comfort.18 Instruct patients to avoid
direct contact with other persons for at least 14 days after the onset of symptoms or until the eyes are no
longer red and weeping.17 Children should be kept out of school until there is no ocular discharge
(approximately 1 week)
Monitoring: 1 wk of initiating therapy

Station 4: 55 yr male come to pharmacy to get hydromorphone tablet

History:
He is taking tylenol 3 since last six month for back pain and since last week he is taking maximum tablet
for back pain but not effective since last week (back injury while moving furniture in last week)
He has rx on hold for hydromorphone since six month so he came to pharmacy to get it now for pain
Upon 5 min: what should i do for pain..?
3 questions for pain:
Pain scale
Relief from tylenol3
Sxs of Pain
What was the reason for Hydromorphon 6mo ago?
DO NOT fill hydromorph b’coz it was a different indication

Station 5: non interactive

Unit dose dispence check and rx review for indoor patient for lorazepam 8 mg and levofloxacin 750 BID

STATION 6:
27 yr female patient
Breast feeding
Come pharmacy for advice if she can use ginseng for her sinus.. she has sore throat and nasal
congestion and she already take ginseng one time in morning
On what 5 min: what should i do for sore throat..? fluids, honey, lozenges
Psueudoephedrine: NOT use in pregnancy & breastfeeding
Ginseng: NOT adviced to use in pregnant
Non-pharm: awash hands, bed rest, good hydration, humidity > 50%
For referral: If the cumulative score is ≥2 points, refer the patient for culture and possibly antibiotics.

Station 7: non interactive dispense check

Station 8: resident dr come pharmacy to get rx

For patient dependant on benzodiazepine

Up on asking :: patient is taking lorazepam equivalent to diazepam 40 mg in day
Ongoing SE: like falls, long term memory loss, psychiatric illness,
For a pt who is on highest dose regime, it needs to be tapered down
From T.C: Dosage tapering or inadvertent discontinuation (e.g., forgotten doses on admission to hospital)
can precipitate withdrawal. Such effects can also emerge in the early morning following bedtime
administration of a short-acting agent. In addition, an increase in daytime anxiety and/or restlessness may
occur between doses of short-acting agents. Rebound or re-emergence of symptoms may occur after as
little as 4–6 weeks of therapy and are more likely if the drug is short-acting, taken regularly for >3 months
and abruptly discontinued. Symptoms may be similar or more intense than those experienced by the
patient prior to initiation of the benzodiazepine.

Choice of withdrawal regimen may depend on the setting of detoxification, severity of dependence and
concurrent drug or substance abuse. Patients should follow a structured discontinuation program. In
patients on prolonged benzodiazepine therapy, dosage should be gradually decreased over about 6–12
weeks, especially in patients with a history of seizures or epilepsy, regardless of their concomitant
antiepileptic drug therapy.
Station 9: med check
Currnt medical history
Patient taking statin, acetaaminophen and two more medicine.. and patint has mild muscle pain

upon asking
He is taking double dose of statin since last 20 days as his cardiologist recommended to do that

Station 10:
Patint having dysphagia
Nurse is coming
Rx
Prolapa can’t be crushed, can be switched to Sinemet
Celexa can be crushed
Senna can be crushed

Que: shold i break prolopa and dissolve in water and give to patient? NO

On 5 min: what is the alternative..? Sinemet, start with 20% of Equivalent Levodopa dose of previous Rx.
A dosage of SINEMET should be used that will provide approximately 20% of the previous levodopa daily
dosage; this can be started in the morning after the day in which the treatment with levodopa has been
stopped. For example, if a patient is receiving 4000 mg of levodopa per day, the dosage of SINEMET
should not provide more than 750 mg of levodopa per day divided into four to six doses.

Station 11: Long term care dr come to pharmacy get advice.?

Que: what is the use of marijuana in CINV.?

What are the benefit and what are the risk factor..of using marijuana..? does relief emesis, RISK = habit
forming, amnesia, variable P.K/P.D
On 5 min: Can i use marijuana in my all patient for CINV? Dizziness, dry mouth, nausea, fatigue,
somnolence

Station 12: 40 male patient coming pharmacy to get advice

Que : do u think i should take insulin.. ? What are the other alternative in oral? Sulfonylureas, DPP-4 inhi

History:
Diet and exercise is good
Metformin 750 mg bid since last two yr..
And Lifestyle is very good but still diabetes is progressing ... so dr decided to start insulin
Blood sugar data given
Fasting and A1C is not controlled(slighly above the normal)
PPG is in control

On 5 min: shoul i take insulin or not.? If not needle phobia => USE insulin, If needle fear, go for using
sulfonylurea or DPP-4 inhi based on results of A1C

Drug Uses S.E. D.I./C.I

Echinacea cold remission Diabetes I, auto-immune Dx like M.S
St. John Wart Depression pregnancy
Garlic reduce LDL • ASA/blood thinners => Bleeding
• C.I. with pregnancy
Gingko Biloba memory enhance C.I. with blood thinners
Witch Hazel hemorrhoids itching,
irritation, burning relief,
 added to sitz bath
Devil’s claw O.A., CYP459 inhi. Hence, increases level of
Lipitor
Saw-Palmetto BPH WORSENS in HTN & CVS Dx
Cranberry Juice U.T.I D.I with Warfarin
Grapefruit Juice Dyslipidemia D.I. with Statins [EXCEPT Rosuvastatin],
Sildenafil/Tadalafil, Nife/Felo-dipine,
Colchicine
Colchicine Gout Statins have a D.I.=> Myopathy
Coffee ↑ effect of Ciproflox
Chondroitin causes Dyspepsia
Smoking ↓ Theophylline
Digoxin ↓ absorption by Acarbose
Marijuana for CINV Insufficient evidence
Ginseng C.I. in pregnancy/breastfeeding