PSI Clinical Pharmacy & OTC 4 — Questions and Answers
Question 1: Which blood pressure reading is classified as hypertensive crisis requiring immediate referral?
- Systolic ≥180 mmHg and/or diastolic ≥120 mmHg, especially with symptoms (Correct answer)
- 130/85 mmHg
- 140/90 mmHg
- 150/95 mmHg
Correct answer: Systolic ≥180 mmHg and/or diastolic ≥120 mmHg, especially with symptoms
A reading of ≥180/120 mmHg, especially with symptoms (headache, visual disturbance, chest pain), represents hypertensive crisis or emergency, requiring same-day emergency assessment.
Question 2: Which OTC nicotine replacement therapy formulation has the fastest onset of action for craving relief?
- Nicotine mouth spray (reaches peak levels in 10–15 minutes) (Correct answer)
- Nicotine patch
- Nicotine lozenge
- Nicotine inhaler
Correct answer: Nicotine mouth spray (reaches peak levels in 10–15 minutes)
Nicotine mouth spray (e.g., Nicorette Quickmist) provides rapid buccal absorption, achieving peak nicotine levels in 10–15 minutes. Patches provide slow sustained release.
Question 3: Which clinical question is most important when counselling a patient purchasing OTC omeprazole?
- Have you had these symptoms before and have you seen your GP if they are new or persisting? (Correct answer)
- Are you over 18?
- Are you vegetarian?
- Do you have a preference for capsule or tablet?
Correct answer: Have you had these symptoms before and have you seen your GP if they are new or persisting?
New or persistent dyspeptic symptoms — especially in patients over 55 — may indicate serious pathology (gastric cancer, oesophageal cancer). Pharmacists must screen for alarm features before recommending OTC PPIs.
Question 4: Which vitamin supplement is recommended by Irish health authorities for all adults during autumn and winter?
- Vitamin D 400–1000 IU daily (Correct answer)
- Vitamin C 1000 mg daily
- Vitamin B12 daily
- Zinc 15 mg daily
Correct answer: Vitamin D 400–1000 IU daily
Due to Ireland's northern latitude, sunlight is insufficient for cutaneous vitamin D synthesis from October to March. HSE and FSAI recommend vitamin D supplementation for all adults during this period.
Question 5: A mother asks for cough medicine for her 18-month-old child with a wet cough. The pharmacist should advise:
- OTC cough medicines should not be used in children under 6 years — advise honey (over 12 months) and fluids instead (Correct answer)
- Give adult cough linctus at a reduced dose
- Codeine linctus is safe for toddlers
- Antihistamine cough preparation is appropriate
Correct answer: OTC cough medicines should not be used in children under 6 years — advise honey (over 12 months) and fluids instead
In Ireland/UK, OTC cough and cold medicines are not recommended for children under 6 (some say under 12). Honey (not before 12 months) and adequate hydration are safe, evidence-supported alternatives.
Question 6: Which clinical assessment tool can a pharmacist use to evaluate whether a sore throat requires antibiotic referral?
- Centor/FeverPAIN score (fever, tonsillar exudate, anterior cervical lymphadenopathy, absence of cough) (Correct answer)
- CURB-65 score
- Wells criteria
- CHA2DS2-VASc score
Correct answer: Centor/FeverPAIN score (fever, tonsillar exudate, anterior cervical lymphadenopathy, absence of cough)
The Centor/FeverPAIN criteria stratify risk of streptococcal pharyngitis requiring antibiotics. A high score suggests bacterial infection warranting GP referral; low scores suggest viral aetiology and self-limiting illness.
PSI Clinical Pharmacy & OTC 4
Which blood pressure reading is classified as hypertensive crisis requiring immediate referral?