So Opium

Question 1

Suzana, 24, a UT student, visits your pharmacy complaining of elbow pain. She played tennis daily in Florida and now complains of right elbow pain, swelling, and tenderness. She is taking Alesse 28®, vitamin C 500 mg daily, Tylenol Cold and Sinus Extra Strength®, and extra acetaminophen. She is allergic to sulphonamides but otherwise healthy. What is the most relevant sign or symptom in the differential diagnosis?

a) Severity of pain

b) Quality of pain

c) Number of joints involved

Answer: a)

Question 2

Her most urgent drug therapy problem is:

a) Vitamin C is not effective for the treatment of colds

b) At risk of liver injury secondary to an excessively high dose of acetaminophen

c) At risk of pregnancy secondary to a drug interaction between Alesse and Vitamin C

Answer: b)

Question 3

The most appropriate recommendation to improve current signs and symptoms:

a) Stop Tylenol Cold and Sinus; start RICE therapy x 48 hours; continue acetaminophen 1000 mg qid x 3 days

b) Stop all acetaminophen products; start RICE therapy x 48 hours; start ibuprofen 200 mg tid prn x 3 days

c) Stop Tylenol Cold and Sinus; start RICE therapy x 48 hours; start topical diclofenac gel tid prn x 7 days

Answer: b)

Question 4

A 56-year-old man complains of lower back pain that worsens with bending forward. Pain has been ongoing for months with no systemic symptoms. What is the most relevant sign or symptom in the differential diagnosis?

a) Description of the pain

b) Duration of the pain

c) Belief that the pain is harmful

Answer:b)

Question 5

A 74-year-old man twisted his ankle with swelling and mild bruising. He can bear weight and rates his pain 4/10. The most appropriate recommendation is RICE therapy plus:

a) Ibuprofen 400 mg tid x 48 hours then reassess

b) Topical diclofenac gel tid x 1 week then reassess

c) Acetaminophen 1000 mg qid prn x 48 hours then reassess

Answer: b)

Question 6

Which parameter indicates a need to alter treatment?

a) Swelling continues beyond 72 hours despite treatment

b) No improvement in pain after 7 days despite treatment

c) Bruising worsens after 48 hours despite treatment

Answer b)

Question 7

A 31-year-old pregnant woman has lower back pain after lifting her son. The most appropriate recommendation is:

a) Maintain usual activity; acetaminophen 500 mg tid

b) Decrease usual activity; acetaminophen 500 mg tid

c) Maintain usual activity; ibuprofen 400 mg tid

Answer: a)

Question 8

She has ibuprofen at home. Can she use it?

a) As ibuprofen is contraindicated in pregnancy, she should use acetaminophen instead

b) She can take ibuprofen 400 mg tid x 3-4 days then reassess

c) Naproxen is safer in pregnancy; she can take naproxen 220 mg bid x 3-4 days then reassess

Answer: a)

Question 9

If you recommended an NSAID, what key change in monitoring parameters indicates a need to alter the drug choice?

a) Insomnia

b) Fatigue

c) Dyspepsia

Answer: c)

Question 10

Which option would be effective to improve her back pain?

a) Bed rest

b) Acupuncture

c) Spinal manipulation

Answer: c)

Question 11

A 73-year-old female with a swollen ankle requests a prescription. She has mild GERD managed with Tums. She wants to try flurbiprofen. You advise:

a) Can provide localized pain relief, however associated with cardiovascular risks.

b) Effective for pain relief, but potential gastrointestinal and renal side effects.

c) Effective for pain and inflammation but less commonly used due to safer alternatives.

Answer: b)

Question 12

In addition to non-drug measures, an appropriate and safe option would be:

a) Acetaminophen 500-1000 mg every 6 hours as needed for pain

b) Ibuprofen 400-800 mg every 8 hours as needed for pain and inflammation

c) Naproxen 500 mg every 8 hours for 3-7 days, continue as needed for pain

Answer: a)

Question 13

Sue, 16, presents with VVC symptoms. She wants immediate relief for internal and external symptoms. Best recommendation:

a) Clotrimazole 1-day therapy

b) Clotrimazole combi pack

c) Refer to a physician

Answer: b)

Question 14

Which are tips for prevention of uncomplicated VVC?

a) Increase consumption of yogurt

b) Wear loose clothing

c) Avoid use of tampons

Answer: b)

Question 15

What is the most common symptom of VVC?

a) Frothy white discharge

b) Strong odor

c) Pruritus

Answer: c)

Question 16

Which is a risk factor for VVC?

a) Pregnancy

b) High-risk sexual behavior

c) Hormone replacement therapy

Answer: a)

Question 17

Jane took levonorgestrel emergency contraception yesterday. Important side effect to tell her now:

a) Spotting

b) Nausea/vomiting

c) Headache

Answer: b)

Pam, non-compliant with birth control pills, asks if she can finish her current pack after taking emergency contraception. Best advice:

a) Take the remaining pills tomorrow

b) Start a new pack of pills tomorrow

c) Wait until she gets her period before restarting birth control pills

Answer:a)

Question 19

Which information is important to tell a patient purchasing ECP?

a) Take it with food

b) Menstrual spotting/bleeding means the medication worked

c) You may consider seeing a physician for STI screening

Answer: c)

Question 20

Which is a contraindication to using emergency contraception?

a) Breastfeeding

b) Less than 14 years old

c) Pregnancy

Answer: c)

Question 21

Kate, a 17-year-old female, has been missing school due to cramps around her period. She is not sexually active. Best recommendation:

a) Yoga

b) Naproxen

c) Aerobic Exercise

Answer:b)

Question 22

Betty has heavy menstrual periods and experiences breast tenderness about a week prior to her period. She prefers natural remedies. Best suggestion:

a) Calcium Carbonate

b) Reduce caffeine use

c) Naproxen

Answer: a)

Question 23

Which is not a common symptom of PMS?

a) Acne

b) Anxiety

c) Diarrhea

Answer: c)

Carol, 30, experiences typical PMS symptoms for about 10 days each month. Best recommendation:

a) Calcium carbonate

b) Vitamin B6

c) Folic acid

Answer: a)

Question 25

Suzy, 41, feels moody, tired, and forgetful daily. She suspects PMS. Best advice:

a) Calcium Carbonate

b) Cyclic SSRI

c) Refer to MD

Answer: c)

Question 26

Linda experiences bloating and cramps before her period and recently became sexually active. Best recommendation:

a) Hot water bottle

b) Restrict sodium intake

c) Refer her for contraception

Answer: c)

Question 27

Terri takes OTC NSAIDs for cramps but was told not to use them beyond 72 hours. What is the best advice for continued cramps?

a) Hot water bottle

b) Take another day's worth of NSAID

c) Switch to hormonal contraception

Answer: c)

Question 28

Naomi, a model, developed a lip sore after sun exposure. Most likely cause:

a) Contact dermatitis to facial blush powder

b) Canker sore from toothbrush

c) Cold sore triggered by sunburn

Answer: c)

Question 29

Other triggers for herpes outbreaks include all EXCEPT:

a) Drinking sugar-containing carbonated drinks

b) Dental procedures

c) Common cold

Answer: a)

Question 30

Additional trigger for herpes outbreaks:

a) Extreme cold weather

b) Vomiting if bulimic

c) Overheating during hot yoga sessions

Answer: a)

Question 31

One factor that is not a risk:

a) She is female

b) She has hypertension

c) If she experiences fever

Answer: b)

Question 32

You reassure her there are treatments available. You advise:

a) Oral famciclovir will eliminate the lesion if taken within 7 days

b) Topical docosanol will eliminate the lesion in 48 hours

c) 2 Gm of valacyclovir repeated in 8 hours may speed healing

Answer: c)

Question 33

She complains about the burning, stinging, tingling pain and wonders if there is a quick treatment she can purchase in the pharmacy. You advise:

a) Acetaminophen 500 mg qid can be used for 3 days

b) Topical benzocaine can be used tid for one week

c) Naproxen 200 mg bid can be used for one week

Answer: b)

Question 34

You know that it is important to stress key points in patient education. The most relevant to ensure goals of therapy will be met would be:

a) Expect resolution in 3 days or go to your family doctor

b) Avoid topical anesthetics containing benzocaine

c) Do not touch or pick at the lesion as it heals

Answer: c)

Question 35

Other things she should avoid include:

a) Washing the lesion with mild soap and water

b) Cleanse with hydrogen peroxide or alcohol

c) Rinse lesion with saline

Answer: b)

Question 36

Naomi wonders if this will continue to be an issue during her modeling career. You tell her:

a) She should be virus free after one month

b) She should be virus free after six months

c) She will always harbour the latent virus

Answer: c)

Question 37

Mirah is a 26-year-old influencer who needs to demonstrate products online. What claim could she accurately provide about a product containing menthol, camphor, phenol, and stannous fluoride?

a) Menthol and camphor can provide temporary relief by numbing the area

b) Phenol can help alleviate pain and reduce the risk of cold sore infection

c) Stannous fluoride is useful due to its anti-inflammatory and antibacterial properties

Answer: a)

Question 38

A product for cold sores contains lidocaine and prilocaine in a lip balm. She might accurately say:

a) This lip balm will lessen the pain of cold sores safely due to its double action

b) This product could be safely used together with a sunscreen lipstick

c) Before using this product ensure there are no open lesions

Answer: c)

Question 39

A product she might recommend as an effective treatment would be:

a) Xerese (acyclovir and hydrocortisone) cream

b) Hydrocortisone 1.0% cream

c) Abreva (docosanol) cream

Answer: c)

Question 40

Mirah could assist others in determining what to do if they have cold sores or another 'imitator.' Which condition would require urgent referral to a primary care provider?

a) Aphthous stomatitis

b) Erythema multiforme

c) Impetigo

Answer: b)

Question 41

Noella is breastfeeding her 3-week-old infant and has developed a painful red rash around her nipples with stabbing pains deep within the breast. Most relevant assessment question:

a) Does her infant have white spots in his mouth?

b) Is she on an oral contraceptive?

c) Is she using a lanolin containing moisturizer?

Answer: a)

Question 42

The baby completed a course of amoxicillin for an ear infection. Noella wonders if he needs further treatment. You advise:

a) No further treatment is needed; lesions should resolve in a few days

b) Refer to a physician for ketoconazole

c) Sterilize the baby's teething ring; give sterilized water instead of breastfeeding

Answer: b)

Question 43

Most relevant OTC treatment plan for Noella:

a) Nystatin cream tid to both breasts for 10 days; ibuprofen 400 mg qid for pain

b) Clotrimazole cream applied to both breasts bid for 2-3 weeks; acetaminophen 500 mg daily for pain

c) Clotrimazole vaginal tablets dissolved in mouth bid for 1-2 weeks; naproxen 200 mg bid for pain

Answer: b)

Question 44

Most appropriate non-drug measure to recommend to Noella:

a) Apply a cold saline compress, one minute on, one minute off tid

b) Apply a warm saline soak for 20 minutes tid

c) Apply a warm antiseptic soak for 20 minutes tid

Answer: b)

Question 45

Important patient education recommendation for Noella:

a) Wean the baby; use cow's milk-based infant formula

b) Apply cornstarch powder to pads inside nursing bra

c) Limit the amount of sugar-containing foods

Answer: c)

Question 46

If Noella develops oral candidiasis, you would prescribe:

a) 400,000 to 600,000 units (4-6 mL) po qid for 7-14 days, at least for 2 days after symptoms resolve

b) Clotrimazole vaginal troches held in mouth till dissolved, used bid x 10 days

c) Fluconazole 100-200 mg orally once daily for 7-14 days

Answer: b)

Question 47

Noella asks if probiotics might be useful to prevent candidiasis. You tell her:

a) Probiotics may exhibit antifungal properties against Candida

b) There's limited scientific evidence to support the efficacy of probiotics

c) Probiotics inhibit growth of Candida and restore microorganisms balance in the mouth

Answer: b)

Question 48

Noella asks if herbals can be used to prevent or treat candidiasis. You tell her:

a) There is some reliable evidence supporting efficacy and safety for treating oral candidiasis

b) Goldenseal, cinnamon, and oregano have shown antifungal activity in human studies

c) Berberine and eugenol have shown antifungal activity in laboratory studies

Answer: c)

Question 49

Noella's 4-year-old son has developed small oozing blisters on his face. Most relevant question to ask:

a) Did either child inherit her atopic dermatitis?

b) Is the older child complaining of pain?

c) Do his lesions dry with a honey-coloured crust?

Answer: c)

Question 50

You suggest treatment for the 4-year-old's lesions:

a) Apply topical Polysporin ointment to the lesions

b) Refer to a physician for topical 2% fusidic acid cream (Fucidin)

c) Soak the lesions for 20 minutes with warm saline; apply topical 2% miconazole cream

Answer: b)

Question 51

You inform Noella:

a) This is not contagious; the baby is not at risk for developing these lesions

b) This is highly contagious; ensure no physical contact between siblings

c) This may be contagious; monitor the baby and yourself for lesion development

Answer: c)

Question 52

Jessie, 30 years old, presents to the pharmacy with three painful shallow sores at the base of her right gum. Most important fact to ask about:

a) Is she gluten intolerant?

b) Recently suffered an infection?

c) Experiencing significant stress?

Answer: c)

Question 53

A reasonable treatment for Jessie would include:

a) Acetaminophen 500 mg qid

b) Topical anesthetic containing lidocaine

c) Saline rinses several times a day

Answer: c)

Question 54

In educating Jessie about her lesions, you would tell her:

a) Use an electric toothbrush with a firm brush

b) Avoid foods or beverages that are spicy or acidic

c) Licorice extract may prevent flares

Answer: b)

Question 55

Angela, a 27-year-old female, has recurrent painful oral ulcers. Best assessment step:

a) Elicit information to assess for anemia and hematologic abnormalities

b) Refer to a dental specialist for oral examination

c) Assess medical history and review potential triggers for aphthous stomatitis

Answer: c)

Question 56

Best non-drug treatment for Angela:

a) Carboxymethylcellulose paste

b) Oral rinses with topical antiseptic solution

c) Sodium lauryl sulfate-free toothpaste

Answer: c)

Question 57

Most appropriate drug treatment for Angela:

a) Topical triamcinolone

b) Lidocaine viscous gel

c) Chlorhexidine oral rinse

Answer: a)

Question 58

Important educational points to discuss:

a) Emphasize the importance of maintaining good oral hygiene

b) Advise the patient to avoid spicy or acidic foods

c) Instruct on proper application of topical medications

Answer: c)

Question 59

Most appropriate follow-up or monitoring plan:

a) Schedule a follow-up appointment in one month

b) Refer the patient to a gastroenterologist

c) Advise the patient to return if symptoms worsen or do not improve within a week

Answer: c)

Question 60

A patient brings a basket of items for minor ailments for a trip. Which product is most concerning?

a) Dimenhydrinate 50 mg tablets with ginger

b) Electric heating pad

c) Topical NSAID (Voltaren double strength)

d) Topical Preparation H with shark oil

Answer: b)