GPhC OTC & Self-Care 1 — Questions and Answers
Question 1: A mother asks for something to treat her 4-year-old child's fever. Which product is most appropriate?
- Paracetamol suspension (120 mg/5 mL) or ibuprofen suspension (Correct answer)
- Adult aspirin tablets
- Codeine-containing liquid
- Adult paracetamol 500 mg tablets
Correct answer: Paracetamol suspension (120 mg/5 mL) or ibuprofen suspension
Paracetamol (120 mg/5 mL) and ibuprofen suspensions are appropriate for children aged ≥3 months. Aspirin is contraindicated under 16 (Reye's syndrome risk). Adult formulations are inappropriate doses.
Question 2: A customer asks about using ibuprofen for their cold symptoms. Which patient should NOT receive ibuprofen without medical advice?
- A patient with a history of peptic ulcer disease (Correct answer)
- A 25-year-old with no medical history
- A healthy adult with mild headache
- A patient with mild seasonal allergies
Correct answer: A patient with a history of peptic ulcer disease
NSAIDs like ibuprofen are contraindicated or cautioned in patients with peptic ulcer disease due to risk of GI bleeding and mucosal damage through prostaglandin inhibition.
Question 3: What is the recommended first-line OTC treatment for head lice in the UK?
- Dimeticone (Hedrin) — physical insecticide coating (Correct answer)
- Malathion (Derbac-M) — organophosphate insecticide
- Permethrin shampoo
- Wet combing alone as per NICE
Correct answer: Dimeticone (Hedrin) — physical insecticide coating
NICE and PHE recommend dimeticone (e.g., Hedrin) as first-line for head lice. It physically coats and suffocates lice, avoiding insecticide resistance issues. Wet combing is an alternative if no products preferred.
Question 4: A customer requests emergency hormonal contraception. They had unprotected sex 60 hours ago. Which product is appropriate?
- EllaOne (ulipristal acetate 30 mg) — effective up to 120 hours (Correct answer)
- Levonelle (levonorgestrel) — effective up to 72 hours
- Combined oral contraceptive pill
- No OTC product effective after 48 hours
Correct answer: EllaOne (ulipristal acetate 30 mg) — effective up to 120 hours
Levonelle is licensed up to 72 hours, but is less effective after 72 hours. EllaOne (ulipristal) is licensed and effective up to 120 hours post-intercourse, making it the appropriate choice at 60 hours.
Question 5: A patient taking ibuprofen OTC also takes warfarin. What advice should the pharmacist give?
- Avoid ibuprofen — recommend paracetamol instead; ibuprofen increases bleeding risk (Correct answer)
- Ibuprofen is safe with warfarin
- Use a reduced dose of ibuprofen
- Take ibuprofen at a different time to warfarin
Correct answer: Avoid ibuprofen — recommend paracetamol instead; ibuprofen increases bleeding risk
NSAIDs including ibuprofen displace warfarin from protein binding and inhibit platelet function, significantly increasing bleeding risk. Paracetamol is the safer OTC analgesic choice for anticoagulated patients.
Question 6: Which symptom would prompt a pharmacist to refer a patient with a cough to their GP rather than recommend OTC treatment?
- Coughing up blood (haemoptysis) (Correct answer)
- A cough present for 5 days
- A cough with clear sputum
- A cough worsened by cold air
Correct answer: Coughing up blood (haemoptysis)
Haemoptysis (blood in sputum) is a red flag symptom requiring urgent medical referral as it may indicate serious pathology including malignancy, pulmonary embolism, or tuberculosis.
GPhC OTC & Self-Care 1
A mother asks for something to treat her 4-year-old child's fever.
Which product is most appropriate?