Community practice

What is the recommended amount of exercise recommended by NHS? What food most commonly is associated with weight gain?

• 150 minutes of moderate exercise per week

• OR

• 75 minutes of vigorous exercise per week

• Strength train or resistance train for 2 days of the week

• Saturated fats e.g. cakes/ confectionaries due to butter content is associated with weight gain

How do we diagnose hypothyroidism?

• Thyorid function test looking at TSH and FT4 - Functional Thyroxine 4

How would hypothyroidism diagnostic values differ from normal values?

High TSH and low T3/T4 - Most concerned by FT4 as this is functional thyroxine, eventually all T3 is converted to T4

What reasurance should we provide to a patient prescribed 125mcg of levothyroxine per day?

This is an unlicensed dose, so not found in PIL. However, this dose has evidence based behind it so patient should be reassured by clinical evidence behind dose prescribed

Patient accidentally takes 2 x 100mcg instead of 125mcg for 3 days straight, what advice should be given to the patient?

Reassure the patient that the amount taken is very unlikely to cause any problems. Symptoms can take 5 days to appear. Patient should monitor for the following side effects and if they occur they should contact the pharmacist or the GP:

• Tremor

• Sweating

• Weight loss

• Intolerance to heat

• Tachycardia

• Headache

• Flushing

• High temp

Symptoms indicative of hyperthyroidism - may warrant dose reduction or levels to be checked

When prescribing antibiotics in pregnancy, you must check…

• Ensure medicine is suitable for use in pregnancy

What supplementation is required in pregnancy?

Folic acid 400mcg per day until 12 weeks of pregnancy

What supplementation should be avoided in pregancy?

Vitamin A - excessive vitamin A can be teratogenic. Isotretinoin is derivative of vitamin A and hence is not allowed in pregnancy

How are controlled drugs disposed of which have been returned to pharmacy by patient?

CD2,CD3,CD4 should all be destroyed and denatured in the CD denaturing kit to prevent them being abused and reused

If patient returns CD to pharmacy for disposal, does there need to be a witness or documentation?

No, no witness of documentation required - place CD into denaturing kit

When would we need a witness or documentation of destruction of CD?

Only if the CD is stocked in the pharmacy and is out of date, damaged or unwanted would we need an authorised witness and documentation in the CD register

How would we dispose of needles and syringes?

Sharps bin

How would we dispose of cytotoxic medications?

Purple lidded bins

How would we dispose of inhalers and aerosols?

separate disposal - pressurised containers

Where would we put medicine labels?

Confidential waste - includes patient information

If a patient is known to use needles, what information should we provide them?

some pharmacies offer needle exchange service OR some areas require collection by local authority

Name examples of cytotoxics for purple bin

🧬 Chemotherapy agents (main group)

• Methotrexate

• Cyclophosphamide

• Doxorubicin

• Cisplatin

---

💊 Other commonly tested cytotoxic/cytostatic drugs

• Azathioprine

• Mercaptopurine

• Hydroxycarbamide

• Mycophenolate mofetil

---

⚠ Important to remember

These are not just chemo — also include:

• Immunosuppressants

• Some DMARDs