Mixed Deck — All PSI Topics Flashcards

A patient on digoxin for heart failure reports nausea, yellow-green visual disturbances and palpitations. The pharmacist should:

Answer: Suspect digoxin toxicity — advise urgent GP/A&E attendance and not to take another dose

Yellow/green visual disturbances (xanthopsia), nausea and palpitations are classic signs of digoxin toxicity. This requires urgent plasma level measurement and cardiac monitoring — potentially life-threatening arrhythmias can follow.

Which ethical principle requires pharmacists to act in the best interest of the patient?

Answer: Beneficence

Beneficence means actively doing good for the patient — the duty to promote health and wellbeing. It forms a core pillar of pharmacy ethics alongside non-maleficence, autonomy and justice.

Which label requirement is mandatory on all dispensed medicines in Ireland?

Answer: Patient's name, medicine name/strength/form, dose instructions, pharmacy name and date

Irish pharmacy regulations require labels to include: patient name, drug name, strength, form, directions for use, quantity, pharmacy details and dispensing date at minimum.

A Monitored Dosage System (MDS) such as a Dosette box is most appropriate for:

Answer: Patients with poor adherence or cognitive impairment taking multiple medicines

MDS organises medicines by time of day and day of week. They are indicated for patients struggling with complex regimens due to cognitive impairment, polypharmacy or disability.

Which type of error occurs when the correct drug is given to the wrong patient?

Answer: Patient identification error

A patient identification error is a dispensing/administration error where the correct medicine is given to the incorrect patient. Two patient identifiers (name + DOB) should always be confirmed before dispensing.

Which important counselling point applies to all patients using topical corticosteroids long-term on the face?

Answer: Avoid prolonged use — risk of skin atrophy, telangiectasia, perioral dermatitis and steroid-induced rosacea

Facial skin is thin and absorbs corticosteroids more readily. Prolonged use causes skin thinning (atrophy), visible blood vessels (telangiectasia), and steroid rosacea/perioral dermatitis — all difficult to reverse.

Which PSI standard requires that a pharmacist must personally supervise the dispensing process?

Answer: PSI Standard for the Operation of Pharmacy Services

PSI's Standards for the Operation of Pharmacy Services require pharmacist supervision of all dispensing. Dispensing staff may perform technical tasks but a pharmacist must check and clinically verify.

What is the pharmacist's role in pharmacovigilance?

Answer: To monitor the safety of medicines in everyday use, detect new or changing safety signals, report adverse events, and contribute to the ongoing assessment of medicine benefit-risk profiles

Pharmacovigilance (the science of monitoring drug safety) is a responsibility shared by all healthcare professionals. Pharmacists contribute by reporting ADRs to the HPRA, monitoring patients for drug safety issues, educating patients about potential adverse effects, and staying informed about drug safety alerts.

Which key counselling message is most important for a patient newly diagnosed with type 2 diabetes starting metformin?

Answer: GI side effects (nausea, diarrhoea) are common at the start — take with food and they usually resolve; do not stop without speaking to your pharmacist/GP

GI intolerance is the most common reason for early metformin discontinuation. Taking with or after food and titrating the dose slowly significantly reduces GI side effects. Metformin does not cause hypoglycaemia alone.

What is 'conscientious objection' in pharmacy practice?

Answer: A pharmacist's right to decline providing certain services based on personal moral or religious beliefs, provided the patient is referred to another provider without delay

Pharmacists may exercise conscientious objection to certain services (e.g., emergency contraception) based on genuine moral or religious beliefs. However, they must not impose their beliefs on patients, must inform the patient and refer them to another pharmacist who can provide the service without delay.

A patient on warfarin asks about taking cranberry juice. The pharmacist should advise:

Answer: Avoid large amounts — cranberry juice may inhibit CYP2C9, raising warfarin levels and INR

Cranberry juice, especially in large quantities, may inhibit CYP2C9 (warfarin's main metabolic pathway), increasing INR and bleeding risk. Case reports and pharmacovigilance data support caution with regular large intakes.

What health screening services can pharmacists provide in Ireland?

Answer: Blood pressure monitoring, blood glucose testing, cholesterol screening, BMI assessment, and health risk assessments

Community pharmacists increasingly provide accessible health screening services including blood pressure measurement, blood glucose testing, cholesterol checks, BMI calculation, and general health assessments. These services improve early detection of conditions like hypertension and diabetes.

A patient demands their repeat prescription before the due date, claiming they are going on holiday. The pharmacist should:

Answer: Use professional judgement, verify the reason and consider a partial early supply if clinically appropriate

Professional judgement is required. Early supply may be justified for holidays — the pharmacist may dispense a limited early quantity. For CDs, contact with the prescriber and extra caution is needed.

What is the pharmacist's role in managing minor ailments in the community?

Answer: Assessing symptoms, recommending appropriate OTC treatments, providing self-care advice, and referring to a GP when symptoms suggest a more serious condition

Pharmacists manage common minor ailments (colds, headaches, hayfever, mild skin conditions) by assessing symptoms, recommending appropriate OTC treatments, providing lifestyle and self-care advice, and making appropriate referrals. This reduces pressure on GP services and provides convenient healthcare access.

Proton pump inhibitors (PPIs) like omeprazole work by:

Answer: Irreversibly inhibiting H+/K+ ATPase in gastric parietal cells

PPIs are prodrugs activated in the acidic canaliculi of parietal cells. Active drug covalently binds and irreversibly inhibits H+/K+ ATPase (the proton pump), suppressing acid secretion.

The ABCDE approach in responding to a medical emergency in a pharmacy stands for:

Answer: Airway, Breathing, Circulation, Disability, Exposure

The ABCDE framework is a systematic approach to medical emergencies: Airway (patent?), Breathing (rate, effort), Circulation (pulse, BP), Disability (consciousness, glucose), Exposure (full assessment). Used in BLS and advanced life support.

Which OTC topical preparation is used to treat cold sores (herpes labialis) and should be applied at the first sign of tingling?

Answer: Aciclovir 5% cream

Topical aciclovir 5% cream inhibits herpes simplex virus DNA polymerase. Application at the prodromal tingling/itching stage (before vesicles form) is most effective in limiting lesion size and duration.

Which approach best supports medication adherence in an elderly patient with multiple daily medicines?

Answer: Simplify regimen, use once-daily formulations where possible, provide clear labelled blister packs, and arrange regular medicine reviews

Regimen simplification, modified-release formulations, compliance aids, and regular review all improve adherence in older patients. Complexity is the biggest adherence barrier — reducing the number of daily doses helps significantly.

A pharmacy receives a medicine at the wrong storage temperature during delivery. The pharmacist should:

Answer: Quarantine the product, refuse acceptance and raise a deviation report with the supplier/HPRA if needed

Cold-chain breaks compromise product quality. The pharmacist must quarantine the affected stock, refuse or document the deviation, contact the supplier and report significant cold-chain failures to the HPRA.

A patient presents a forged prescription. The pharmacist's immediate obligation is to:

Answer: Retain the prescription, refuse to dispense and notify the relevant authorities

Prescription fraud is a criminal offence. The pharmacist should retain the prescription (do not return it), refuse to dispense, and report to Garda and the prescribing practice if appropriate.