LPN INTENSIVE CLINICALS�� CHAPTER 7 – GENITO-URINARY SYSTEM WORKBOOK��� INTENSIVE GPHC Exam revision � programme

LONDON PHARMACIST NETWORK (LPN)

INTENSIVE REVISION FOR

GPHC EXAM.

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CHAPTER 7 WORKBOOK

WRITE OUT YOUR ANSWERS FOR SCENARIOS

1 TO 6

Scenarios 1 - 3

• Pinky , An 18-year-old who have never taken contraceptives before . Starts a new pack of microgynon but missed a dose within the first 7 days and UPSI occurred during that same period. What advice would you give this patient.

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• Sharon , A 25-year-old woman who has been taking Rigevidon regularly for the past 6 months. Reports that she missed a tablet yesterday- within the first 7 days of a new pack and unprotected sexual intercourse occurred last night. What advice would you give this patient.

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• Mrs. Happy a 35-year-old woman takes Microgynon regularly, starts Micrigynon on day one of her cycle. She had unprotected sex yesterday(day 6 of cycle ) . She has not missed a pill but worries and would like to know what to do .

Scenarios 4 - 6

• A 46-year-old patient wants the morning after pill (levonelle) . She had unprotected sexual intercourse yesterday. She tells you she also takes salbutamol, carbamazipine and allopurinol. What advice would you give this patient.

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• A 16-year-old patient who wants the morning after pill and informs you that they were sexually abused by their partner two days ago . What advice would you give this patient.

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• A 15-year-old patient who wants Ella one for EHC. Which guidelines would you use to ascertain her mental capacity before suppling the medication ? …………………………

SCENARIO 7

• A transgender man visits your pharmacy for advice following an episode of unprotected sexual intercourse with their male partner 4 days ago. They tell you that they are worried that they will become pregnant. The man also feels very embarrassed about this situation and does not wish to see another healthcare professional.
• What is the most appropriate further action in this situation?
• A.) Refer to a sexual health clinic for a IUD device as it is the most effective emergency contraception.
• B.) Supply Ella one
• C.) Supply levonelle
• D.) Explain to the man that it is impossible for them to get pregnant and that they should not worry about getting pregnant.
• E.) Refer to the GP

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SCENARIO 8

• A 36-year-old woman comes into your pharmacy for the ‘morning after pill’ following sexual intercourse two days ago. You take her into the consultation room and she tells you that she is currently breastfeeding and has a 6-month-old child who only accepts breastmilk. Also, she mentions that she is worried about getting pregnant again after having four children. What would be the most appropriate advice to give her?
• A. Take one Levonelle tablet immediately and avoid breastfeeding for a week
• B. Take one ellaOne tablet immediately and avoid breastfeeding for a week
• C. Take one Levonelle tablet immediately after feeding and avoid breastfeeding for at least 8 hours.
• D. Take one ellaOne tablet immediately after feeding and avoid breastfeeding for at least 5 days.
• E. Emergency contraception is not required for this patient.

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SCENARIO 9

• Maria a 50-year-old woman comes to the pharmacy requesting Gina 10 micrograms (estradiol) vaginal tablets OTC. She is experiencing vaginal atrophy and has heard these tablets might help with her symptoms. Upon questioning, she states that she has had a hysterectomy and her periods stopped around 2 years ago. She reports no significant medical history and takes no other medication.
• Which of the following would be the most appropriate action for the pharmacist to take?
• A. Advise that her symptoms are normal and will get better with time
• B. Refer to her GP as Gina tablets are not suitable for her.
• C. Refer to her GP for a blood test before selling OTC
• D. Refuse the sale as Gina vaginal tablets are not indicated for vaginal atrophy
• E. Sell her a pack of Gina over the counter

SCENARIO 10

• Mr. Ramsey , a 51-year-old man who suffered a stroke 5 years ago, comes into the pharmacy asking to speak to the pharmacist regarding the purchase of Viagra Connect® (sildenafil 50mg tabs). You speak to the patient in the consultation room and ask questions to determine whether you can make a supply. After questioning, you decide to refer Mr. Ramsey to his GP as you are unable to supply the medicine.
• Which of the following is the most likely reason that would make the supply for Mr. Ramsey inappropriate?
• A. He drinks alcohol
• B. He suffered a stroke 5 years ago
• C. He is currently taking Erythromycin
• D. He is currently taking solifenacin
• E. He is a smoker

QUESTION 11

• Mrs D has recently been prescribed hormone replacement therapy (HRT). She is concerned about the side effects of HRT and would like you to give her more information. During your discussion, you mention side effects that may occur, in which she should stop her HRT immediately.
• Which of the following is NOT  a reason to stop treatment with HRT?
• A.                  sudden severe chest pain 
• B.                  sudden breathlessness
• C.                  unexplained swelling or severe pain in calf of one leg;
• D.             Hyperhidrosis   
• E.                    Jaundice

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QUESTION 12

• You work in a community pharmacy . A 51-year-old lady would like to buy GINA for vagina atrophy. Her symptoms include hot flushes, sweating, vaginal dryness and vaginal burning. She is otherwise healthy and had her last period 6 months ago.

What would be your next line of action ?

• A. Refer her to A and E
• B. She qualifies for OTC GINA., 6 months' supply
• C. Refer her to another pharmacy as you do not have any stock of GINA currently.
• D. Refer her to her GP.
• E. Supply for 3 months only

QUESTION 13

• You work in a community pharmacy . A 61-year-old man would like to buy Viagra connect 50mg tablets over the counter. He takes two regular medication. Which of the following is a suitable reason to refuse sale ?
• A. He had a stroke 2 years ago
• B. He currently takes duloxetine
• C. He is a heavy smoker
• D. His GP advised him to avoid strenuous physical activity.
• E. He currently takes Finasteride

QUESTION 14

• You work in a community pharmacy . A 46-year-old woman would like to buy Evana (tranexamic acid 500mg) over the counter for heavy menstrual bleeding. Which of the following statements is false ?
• A. Refer to doctor if taking warfarin.
• B. Refer her to the doctor due to her age.
• C. Evana cannot be sold to pregnant women.
• D. Evana can be sold to women taking contraceptives.
• E. Maximum daily dose of EVANA is 4g (8 tablets)

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QUESTION 15

• Mrs. Drama is a 54-year-old female and has been taking Oestrogel® for the past year. She is going on a 12-week trip to Turkey and would like to organise her medication in advance.
• Her current dose is 3 mg daily. Each Oestrogel® pump actuation delivers 1.25 g of gel, which contains 0.75 mg of estradiol.
• How many packs of 80 g Oestrogel® will the patient require to provide enough supply for her 12-week trip?
• A. 2 packs
• B. 4 packs
• C. 6 packs
• D. 8 packs
• E. 10 packs

ANSWERS

1. Pinky, An 18-year-old who have never taken contraceptives before . Starts a new pack of microgynon but missed a dose within the first 7 days and UPSI occurred during that same period. What advice would you give this patient.

- Take missed dose, abstain from sex for 7 days or use condoms for 7 days and take EHC. Brand new patient on the drug. Hence no protection built.

2. Sharon , A 25-year-old woman who has been taking Rigevidon regularly for the past 6 months. Reports that she missed a tablet yesterday- within the first 7 days of a new pack and unprotected sexual intercourse occurred last night. What advice would you give this patient.

- - Take missed dose even if it means taking 2 doses together and continue as normal as patient has been taking the drug for six months, hence has built an adequate plasma concentration.

3. Mrs. Happy a 35-year-old woman takes Microgynon regularly, starts Microgynon on day one of her cycle. She had unprotected sex yesterday(day 6 of cycle ) . She has not missed a pill but worries and would like to know what to do .

- Advice to continue as normal. No missed dose, no EHC.

- NB – Again this patient has been taking the drug regularly. hence, has built an adequate plasma concentration.

ANSWERS

4. A 46-year-old patient wants the morning after pill (levonelle) . She had unprotected sexual intercourse yesterday. She tells you she also takes salbutamol, carbimazole and allopurinol. What advice would you give this patient.

Refer to a walk in centre or sexual health clinic as patient is on an enzyme inducer carbimazole.

5. A 16-year-old patient who wants the morning after pill and informs you that they were sexually abused by their partner two days ago. What advice would you give this patient.

Supply the morning after pill and report to the child protection officer in the local area!!

6. A 15-year-old patient who wants Ella one for EHC. Which guidelines would you use to ascertain her mental capacity before supplying the medication?

FRASER GUIDELINES

7. B.) Supply Ella one – Unprotected sex 4 days ago. Ella-one works within 5 days !! Also patient does not want to see another healthcare professional.

8. C. Take one Levonelle tablet immediately after feeding and avoid breastfeeding for at least 8 hours. NB – ELLA-ONE is not suitable as affects breastfeeding for 5 days and the child needs to be breastfed.

ANSWERS

9. E. Sell her a pack of Gina over the counter. She is eligible!

10. C. He is currently taking Erythromycin. Erythromycin can increase plasma concentration of sildenafil. AVOID concomitant use!

11. D. Hyperhidrosis is not a factor.

12. D. she had a period within the last year. Must be 12 months without period.

13. D. His GP advised him to avoid strenuous physical activity.

14. D. Evana can be sold to women taking contraceptives. Do not sell to women who take contraceptives due to increased risk of blood clots.

15. C. 6 packs 84 days/16 days = 5.25 packs (the number needed is just over 5, and less than 6) .Therefore, she needs 6 packs of Oestrogel® to have enough for 84 days.

THE END

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