GPhC OTC & Self-Care 3 — Questions and Answers
Question 1: A patient with type 2 diabetes requests an OTC decongestant for a blocked nose. What is the concern?
- Pseudoephedrine and phenylephrine can raise blood glucose and blood pressure (Correct answer)
- No concern — OTC decongestants are safe in diabetes
- Only nasal drops are contraindicated
- Decongestants lower blood glucose
Correct answer: Pseudoephedrine and phenylephrine can raise blood glucose and blood pressure
Oral sympathomimetic decongestants (pseudoephedrine, phenylephrine) can raise blood glucose via glycogenolysis and raise blood pressure, making them unsuitable without medical advice in diabetics.
Question 2: Which OTC product should be recommended for vaginal thrush?
- Clotrimazole pessary and/or cream (Canesten Combi) (Correct answer)
- Metronidazole gel
- Fluconazole 150 mg (only if under Pharmacy scheme)
- Hydrocortisone cream 1%
Correct answer: Clotrimazole pessary and/or cream (Canesten Combi)
Clotrimazole 500 mg pessary and topical cream (Canesten Combi) is the standard OTC treatment for vaginal candidiasis. Oral fluconazole 150 mg is available as a Pharmacy medicine.
Question 3: What is the WWHAM mnemonic used for in OTC consultations?
- Who, What, How long, Action taken, Medication — a framework for OTC symptom consultation (Correct answer)
- Weight, Waist, Height, Age, Medication — a health assessment
- Work, Welfare, Health, Advice, Management
- None of the above
Correct answer: Who, What, How long, Action taken, Medication — a framework for OTC symptom consultation
WWHAM (Who is it for? What are the symptoms? How long? Action taken? Medicines already taken?) is a structured framework pharmacists use to triage OTC requests and assess appropriateness of self-care.
Question 4: A 70-year-old patient requests a sleep aid OTC. Which is the most appropriate recommendation?
- Sleep hygiene advice and referral if persistent; avoid sedating antihistamines in elderly (Correct answer)
- Diphenhydramine 50 mg nightly indefinitely
- Temazepam (prescription only)
- Melatonin OTC in high doses
Correct answer: Sleep hygiene advice and referral if persistent; avoid sedating antihistamines in elderly
Sedating antihistamines (diphenhydramine, promethazine) are on the Beers Criteria as inappropriate for the elderly due to risks of falls, confusion, urinary retention, and next-day sedation. Sleep hygiene and GP referral are preferred.
Question 5: A patient asks about using Gaviscon Advance for heartburn. What is its mechanism?
- It forms a raft on top of stomach contents, reducing acid reflux into the oesophagus (Correct answer)
- It neutralises stomach acid directly like antacids
- It reduces acid production like omeprazole
- It coats the oesophageal lining permanently
Correct answer: It forms a raft on top of stomach contents, reducing acid reflux into the oesophagus
Gaviscon Advance contains sodium alginate and potassium bicarbonate, forming a viscous gel raft on top of gastric contents, acting as a physical barrier against reflux into the oesophagus.
Question 6: Which OTC analgesic is recommended for a patient with chronic renal impairment experiencing mild pain?
- Paracetamol at lowest effective dose (Correct answer)
- Ibuprofen
- Naproxen
- Codeine
Correct answer: Paracetamol at lowest effective dose
Paracetamol is the safest OTC analgesic in renal impairment (used at lowest effective dose). NSAIDs reduce renal perfusion and worsen CKD. Codeine may accumulate with renally-cleared active metabolites.
GPhC OTC & Self-Care 3
A patient with type 2 diabetes requests an OTC decongestant for a blocked nose.
What is the concern?