Advice & Insight From Pre-Registration Recruitment Exam Specialists
You are a pre-registration pharmacist in community pharmacy, and the responsible pharmacist has decided to go out for her lunch break today, as it is relatively quiet today. A patient comes into the pharmacy and wants to pick up his prescription medication (eczema emollient). He also wants to buy some Sudafed Decongestant liquid to help with his cold.
Choose the THREE most appropriate actions to take in this situation.
A. Do not hand out the prescription item and do not sell the Sudafed Liquid.
B. Ask the counter assistant to sell the Sudafed so you don’t get into trouble and hand out the prescription item as it has already been checked by the pharmacist.
C. Hand out the patient’s prescription item but do not sell the Sudafed Liquid.
D. Sell the Sudafed as it is not a prescription item but do not hand out the checked prescription item.
E. Hand out the patient’s prescription medication and sell the Sudafed Liquid.
F. Advise the patient that it is against the law to supply either of the medications as the pharmacist is off the premises.
G. Advise the patient that you are almost a pharmacist so you can hand out the prescribed medication only as it has already been checked by the pharmacist.
H. Advise the patient to either wait for the pharmacist or come back later.
Answer & Explanation: A, F & H
This question is testing your knowledge on what actions can be performed within the pharmacy in the absence of the responsible pharmacist.
Option E is incorrect as according to regulations, when the responsible pharmacist (RP) is absent from the pharmacy, only retail sales of general sale list (GSL) may continue. Therefore, prescription only medicines (POMs) cannot be handed out, and Sudafed – a Pharmacy (P) medication, cannot be sold.
Similarly, option G is inappropriate, even if POMs have already been checked by a pharmacist, the RP must be on site for it to be permitted to be handed out.
Therefore, option B is also incorrect (and counter assistant would also not be able to sell) – it is inappropriate to ask the counter assistant to do something that is unlawful and incorrect.
Option C is incorrect as the prescription cannot be sold due to above reasons; it is correct however to not sell Sudafed.
Option D is incorrect as mentioned, it is a P med.
NB – Sudafed contains pseudoephedrine. There are restrictions on how much can be sold to a patient. “It is unlawful to sell or supply a product or products containing more than 720mg of pseudoephedrine salts or more than 180g ephedrine base (or salts) to a person at any one time (i.e. in one transaction) except in accordance with a prescription.”
Of the correct options, option A is correct as you are not able to hand out POM medications without the RP on site, and you are also unable to sell P medications. Option F would be helpful to the patient for him to understand why you refuse to give him his medication. Patients can be advised to wait or come back later (H)
It is the first few weeks of working as a pre-registration pharmacist and as you haven’t had any pharmacy experience, you are placed on the healthcare counter to become more familiar with responding to symptoms. A customer approaches you in absolute rage claiming to have been miss-sold a product; blephaclean eyelid wipes which states for use in blepharitis. The patient claims that they have never been diagnosed with blepharitis and they just wanted something for dry, itchy eyelids. They point out to your colleague who carried out the transaction.
Choose the THREE most appropriate actions to take in this situation
A. Pull your colleague over to the discussion and question them on what happened
B. Explain how the wipes can help their condition and if they would like to try them or offer to advise another product of similar nature
C. Agree with the customer to calm him down and offer a refund
D. Inform the patient that they don’t need to be diagnosed with blepharitis to use the wipes
E. Offer a refund and sell them some eye drops instead
F. Your first response is to diffuse the situation immediately by listening attentively to the customers complaint and concerns, apologise that they feel they were miss-sold a product and that you will inform your colleague of the discussion
G. Inform them that you are unable to refund the product and call your store manager to deal with the situation
H. Explain to the customer that the symptoms they described to your colleague were indicative of an eyelid condition that may or may not have been blephartis, however the wipes sold were to treat any eyelid condition that presents with these symptoms and is not exclusive to blepharitis alone
Answer & Explanation: F, H & B
This question is testing your ability to handle a situation that has been brought to you by a customer who is frustrated and upset about the service they received from your pharmacy. It assesses how you are able to react in a professional, empathetic way so as to not make the customer feel you are not taking sides but instead supporting their request.
Of the options available; A would not be appropriate in front of the customer at that time as it creates a feeling of undermining what the customer is saying but also loses focus on helping them with their enquiry. You may want to consider options C and E, but thinking about how the patient already feels incorrectly served by another member of staff this may not be the correct choices for them, ideally you want to explain and resolve their initial complaint. Options D and G could frustrate the customer even further as they may see these approaches as untoward and a sense of unwillingness to help them.
Of the correct responses; F indicates the need to immediately diffuse the situation; by offering an apology you are trying to calm the patient down and show a willingness to resolve the matter for them which in turn will capture their attention to listen to what you are saying and trust this information also. You are then able to explain to the customer what the wipes can be used for and how they were sold them on the basis of their symptoms (H), confirming if they would like to try them before offering a refund or suggesting another product (B).
A methadone patient in the community pharmacy has not been in to collect his methadone for the last 3 days (missed doses). However, he shows up to the pharmacy today to collect his dose. He also wants to get some Viagra Connect OTC. The pharmacist asks you what steps need to be taken.
Choose the THREE most appropriate actions to take in this situation.
A. Dispense his dose as he has missed 3 days already. He should not miss any more.
B. Refer the patient to the GP to get a new methadone script.
C. Sell Viagra Connect to the patient.
D. An assessment of illicit drug use is recommended before restarting substitution therapy as the patient missed 3 days.
E. Call the methadone clinic to advise that the patient needs to see his keyworker as he has missed 3 days.
F. Cancel the methadone script. Advise the patient that he needs to make an appointment with his clinic to get a new prescription. The dose may need to be reduced.
G. Cancel the methadone script. Advise the patient that he needs to make an appointment with his clinic to get a new prescription. The dose may need to be increased.
H. Do not sell Viagra Connect to the patient and refer to the GP.
Answer & Explanation: E, F & H
This question tests how to deal with missed doses in substance abuse patients, as well as considering drug interactions with methadone.
Option A is incorrect as this would be unsafe to dispense the dose following 3 missed doses. Patients who miss 3 days or more of their regular prescribed dose of opioid maintenance therapy are at risk of overdose because of loss of tolerance (as stated in the BNF).
Option D is incorrect because assessment of illicit drug use is recommended if the patient has missed 5 days or more, before restarting substitution therapy – this is particularly important for patients taking buprenorphine because of the risk of precipitated withdrawal.
Option B is inappropriate as patients do not obtain substitution therapy prescriptions from GPs – it is usually through a specialised clinic (and prescribed on blue scripts)
Option G is incorrect as although the script should be cancelled, the dose would most likely need to be reduced – not increased.
Option C is incorrect as there is a severe drug interaction with sildenafil and methadone (both prolong QT interval).
Of the correct options, option F is required to ensure that the script is cancelled, and it is likely that the patient’s dose would need to be reduced due to being at risk of overdose (loss of tolerance). Option E is also important to inform the clinic that the patient will need an appointment with the keyworker to discuss change in dosage. Option H is correct as it would be unsafe to sell due to the interaction, however, further treatment options could be discussed with the GP.
You are close to completing your pre-registration year and only have 8 weeks until you sit your exam. Your pharmacy is a midnight pharmacy and you have been asked by the manager to work every other night of the week until midnight as they are short-staffed. He requested that this would only be for 2 weeks but each week asks you to repeat the same pattern of shifts as he is still unable to recruit for the position. You now only have 3 weeks until your exam and are worried of the impact of these shifts upon your work/life balance.
Rank in order the following actions in response to this situation
(1 = Most appropriate; 5 = Least appropriate)
A. Simply refuse to work anymore shift patterns like this and tell the manager he will need to look for cover for them
B. Politely explain to the manager that you only have a short amount of time left until your exam and these shift patterns are affecting your study time outside of work as you are unable to get into a stable routine
C. Tell the manager that you are not obliged to work these late nights under any circumstances
D. Request for your shifts to be changed back to normal 9-6pm from the next day as you are exhausted
E. Explain to the manager that you have done more than a few weeks already of these shift patterns and that they are now affecting your personal routine
Answer & Explanation: B, E, D, C & A
When trying to answer this question, you are required to think and act as a professional to challenge others that are putting you in a difficult position, regardless of their authoritative figure. If a working environment is having an impact on your practice, it is important to be able to recognise this and act to change it, this would be the case for any scenario where you are placed in a difficult situation that has an impact on your work/life balance.
In this particular case, option B clearly but politely outlines the impact that working this way is having on your study plans getting closer to your exam, it also mentions that your routine is being affected which has to be taken into account. Option E notes that you have done more than what was expected of these shifts, however, when approaching this situation we want to maintain the professionalism involved in the discussion with your manager. Options D and C can be considered an unprofessional way of dealing with this as you are not in a position to demand or make demands. Option A; simply refusing also comes across as an unprofessional first approach to responding to this situation.
Learn the best Pre-Reg Oriel strategies and practice with reflective questions & worked solutions.
You are a pre-registration pharmacist on your final rotation. The pharmacy department is short of staff today, so you have been asked to cover your ward until the pharmacist can get there. You are told to prioritise the most urgent tasks which can be signed off once the pharmacist arrives. If there are any urgent medications that require screening, the drug chart can be sent to the dispensary for a pharmacist to check.
Rank in order the following actions in response to this situation
(1= Most appropriate; 5= Least appropriate).
A. Order IV levofloxacin for a patient with a complicated skin infection and send the drug chart to the dispensary so that it can be screened and dispensed/checked ASAP.
B. Order eye drops for a patient with dry eyes which can be checked by the pharmacist when she arrives at the ward.
C. Review the drug chart for a new patient and complete the patient’s drug history.
D. Screen the discharge summary for the patient who is being discharged today.
E. Review the drug chart for a patient that you reviewed yesterday.
Answer & Explanation: A, D, C, B & E
This question tests your ability to prioritise daily tasks whilst working on a ward, and how you would work independently, whilst recognising your limitations as a trainee.
Option A is the most urgent as it is an IV antibiotic and anti-infectives should be treated as urgent medications to order from pharmacy. This is to ensure that no doses are delayed or missed.
Option D is next most urgent, as it is important to prioritise discharges as soon as possible for the ward and pharmacy to follow with the next steps in the discharge process.
Option C is the next task to complete as it is more important to review a new patient’s chart than a chart of a patient that you have reviewed the day before. Also, it is so important for drug histories to be completed as soon as possible, to ensure that any regular medications the patient takes have been prescribed or if not appropriate – a doctor can make the clinical decision.
Option B is a not so urgent item to order, so this can be done after the previous tasks have been completed. You are waiting for the ward pharmacist to arrive and check what you have ordered anyway.
Option E is the least urgent, as it is more important to prioritise new patients and other more urgent tasks, especially when you have recently reviewed this patient.
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