PSI Clinical Pharmacy & OTC 3 — Questions and Answers
Question 1: Which clinical indicator suggests a urinary tract infection (UTI) in a woman can be managed with OTC advice and does NOT need immediate GP referral?
- Uncomplicated lower UTI symptoms (dysuria, frequency, urgency) in a healthy non-pregnant woman aged 16–65 (Correct answer)
- Loin pain and fever (suggesting pyelonephritis)
- UTI symptoms in a pregnant woman
- Haematuria with UTI symptoms in a man over 50
Correct answer: Uncomplicated lower UTI symptoms (dysuria, frequency, urgency) in a healthy non-pregnant woman aged 16–65
Uncomplicated lower UTI in a healthy, non-pregnant woman is the only scenario where OTC management (cranberry, increased fluids) or pharmacy-only trimethoprim supply under a PGD may be appropriate in Ireland.
Question 2: Which mineral supplement is recommended in pregnancy to prevent neural tube defects?
- Folic acid 400 mcg daily (started before conception and continued to 12 weeks) (Correct answer)
- Iron only
- Vitamin D only
- Calcium tablets
Correct answer: Folic acid 400 mcg daily (started before conception and continued to 12 weeks)
Folic acid supplementation starting pre-conception and continuing until 12 weeks gestation reduces neural tube defect (spina bifida, anencephaly) risk by up to 70%. High-risk women need 5 mg daily.
Question 3: Which sign indicates that a pharmacist should refer a patient with chest pain to emergency services immediately?
- Central crushing chest pain radiating to the jaw or left arm, with sweating and breathlessness (Correct answer)
- Mild heartburn after a heavy meal only
- Musculoskeletal pain on palpation
- Pleuritic chest pain in a young otherwise healthy patient
Correct answer: Central crushing chest pain radiating to the jaw or left arm, with sweating and breathlessness
Central crushing chest pain with radiation to jaw/arm, diaphoresis and dyspnoea are classic symptoms of acute myocardial infarction. This is a 999/112 emergency — no OTC treatment, call ambulance.
Question 4: Oral rehydration salts (ORS) are recommended as first-line management for which condition?
- Mild-to-moderate dehydration due to gastroenteritis (Correct answer)
- Severe dehydration requiring IV fluids
- Chronic diarrhoea of unknown cause
- Antibiotic-associated diarrhoea in elderly patients only
Correct answer: Mild-to-moderate dehydration due to gastroenteritis
ORS (glucose-electrolyte solutions) use glucose-facilitated sodium absorption to correct fluid and electrolyte losses in mild-moderate gastroenteritis dehydration. They are the WHO-recommended first-line approach.
Question 5: Which OTC product is recommended for the management of mild allergic contact dermatitis on the skin?
- Hydrocortisone 1% cream applied sparingly for up to 7 days (Correct answer)
- Betamethasone 0.1% cream OTC
- Antihistamine cream (topical diphenhydramine)
- Antifungal cream
Correct answer: Hydrocortisone 1% cream applied sparingly for up to 7 days
Hydrocortisone 1% is the only topical corticosteroid available OTC in Ireland. It is appropriate for mild, localised inflammation (dermatitis, insect bites) for up to 7 days. Stronger steroids require prescription.
Question 6: A patient on warfarin asks to buy St John's Wort for mild depression. The pharmacist should advise:
- Do not take — it is a potent CYP3A4/P-glycoprotein inducer that significantly reduces warfarin levels and INR, increasing clot risk (Correct answer)
- It is fine as it is natural
- Take a lower warfarin dose to compensate
- Monitor INR monthly only
Correct answer: Do not take — it is a potent CYP3A4/P-glycoprotein inducer that significantly reduces warfarin levels and INR, increasing clot risk
St John's Wort induces CYP3A4, CYP2C9 and P-glycoprotein, dramatically increasing warfarin metabolism and reducing INR. This poses a serious risk of sub-therapeutic anticoagulation and thromboembolic events.
PSI Clinical Pharmacy & OTC 3
Which clinical indicator suggests a urinary tract infection (UTI) in a woman can be managed with OTC advice and does NOT need immediate GP referral?