OTC final cases and Student Questions With Complete
Solutions
16. JB is a 62-year-old businessman who is
currently experiencing a flare-up of his
hemorrhoids, a condition he has been evaluated for
by his physician in the past. He will be leaving the
next day for a business conference, and is looking
for a product to soothe the pain and irritation so
that he can endure his 6-hour flight without a
problem. He reports he is allergic to penicillin and
currently takes the combination
hydrochlorothiazide 25 mg and lisinopril 20 mg
once daily for hypertension, pravastatin 40 mg
once daily for dyslipidemia, and aspirin 81 mg daily
for heart attack prevention. Describe
nonpharmacologic and pharmacologic
recommendations to alleviate JB's symptoms.
Correct Answers Nonpharmacologic interventions
for treating hemorrhoids include increasing dietary
fiber intake, maintaining good anal hygiene and
toileting practices, and utilizing warm water soaks
to soothe the affected area. In the case of JB,
consider recommending OTC therapies to alleviate
his symptoms, such as astringents, topical
anesthetics, or protectants. Depending on the
selected product, many of these agents can be
applied as needed up to 6 times per day and have
minimal side effects secondary to limited systemic
absorption. JB's hypertension would preclude him
,from using topical vasoconstrictors, such as
phenylephrine, which may be systemically
absorbed when administered rectally and could
exacerbate his condition. Topical vasoconstrictors
should only be used under the advice of his
physician.
A 26-year-old white male comes into your
pharmacy asking for help choosing an OTC
nutritional drink. He states that he has been trying
to gain muscle and has increased his exercise
routine to lifting heavy weights. He wants to
eventually become a bodybuilder, so he is looking
for a product that has low calories, but a larger
amount of protein content. What product would
you recommend? Correct Answers boost high
protein
A 28-year-old pregnant woman approaches the
pharmacist seeking a recommendation. She is
suffering from a head cold and her associated
symptoms include headache, nasal congestion,
and clear nasal drainage. For treatment of cold
symptoms prior to becoming pregnant, she would
normally reach for a cocktail of a systemic
antihistamine, nasal decongestant, and
guaifenesin; however, now that she is pregnant,
she is not sure which treatment option is best. She
has no known allergies and takes a prenatal
vitamin once daily. What recommendations should
,the pharmacist provide? Correct Answers In this
case, because cold symptoms are not life-
threatening, many health care providers would
recommend nonpharmacologic treatment options
for symptom relief, including the use of a
humidifier and elevation of the head while
sleeping. In addition, saline nasal spray can be
used to alleviate nasal congestion. If these
interventions fail or medication is deemed
necessary, pregnant patients have several options
for relieving their symptoms. First-generation
antihistamines diphenhydramine and
chlorpheniramine have consistently been shown to
be safe during pregnancy. Systemic
decongestants, however, including
pseudoephedrine, have demonstrated an increased
risk of fetal malformations and should be avoided
during pregnancy. For headache relief,
acetaminophen is generally considered safe for
use. In this case, educate the patient on
implementing nonpharmacologic interventions for
symptom relief. If pharmacologic treatment is
desired or her symptoms are deemed severe,
recommend the use of a first generation
antihistamine for the shortest term at the lowest
effective dose and that she discuss this with her
obstetrician.
A 53 year old, African-American, female patient
approaches your pharmacy counter with a Vitamin
, D supplement bottle in her hand. After completing
a Quest analysis, you determine she's an
appropriate candidate for self-care. She tells you
that her doctor reported her to be slightly Vitamin
D deficient. She wants to know if there's any
additional information she might need to know so
she can be better educated on Vitamin D. Which of
the following is INCORRECT in regards to Vitamin
D? Correct Answers an adequate amount of Vit D
can be achieved from food alone
A 64-year-old woman comes to the pharmacy
looking for a recommendation to alleviate her cold
symptoms. She is suffering from a head cold and
has been unable to sleep comfortably for the past
several nights due to nasal congestion. She has a
medical history of anxiety, dyslipidemia, and
hypertension. She reports taking an antidepressant
for the anxiety and a statin for her cholesterol
level. She has been told that her blood pressure is
difficult to control despite numerous medications,
the names of which she cannot recall. Because of
her blood pressure, she has been told to avoid
certain OTC medications. She would prefer to avoid
all drugs, if possible, and use something natural or
drug-free to alleviate her congestion and sleep
better. What advice would be reasonable to share
with her? Correct Answers Recommend that she
maintain adequate hydration, particularly with
warm liquids, and nutrition; elevate the head of her
Solutions
16. JB is a 62-year-old businessman who is
currently experiencing a flare-up of his
hemorrhoids, a condition he has been evaluated for
by his physician in the past. He will be leaving the
next day for a business conference, and is looking
for a product to soothe the pain and irritation so
that he can endure his 6-hour flight without a
problem. He reports he is allergic to penicillin and
currently takes the combination
hydrochlorothiazide 25 mg and lisinopril 20 mg
once daily for hypertension, pravastatin 40 mg
once daily for dyslipidemia, and aspirin 81 mg daily
for heart attack prevention. Describe
nonpharmacologic and pharmacologic
recommendations to alleviate JB's symptoms.
Correct Answers Nonpharmacologic interventions
for treating hemorrhoids include increasing dietary
fiber intake, maintaining good anal hygiene and
toileting practices, and utilizing warm water soaks
to soothe the affected area. In the case of JB,
consider recommending OTC therapies to alleviate
his symptoms, such as astringents, topical
anesthetics, or protectants. Depending on the
selected product, many of these agents can be
applied as needed up to 6 times per day and have
minimal side effects secondary to limited systemic
absorption. JB's hypertension would preclude him
,from using topical vasoconstrictors, such as
phenylephrine, which may be systemically
absorbed when administered rectally and could
exacerbate his condition. Topical vasoconstrictors
should only be used under the advice of his
physician.
A 26-year-old white male comes into your
pharmacy asking for help choosing an OTC
nutritional drink. He states that he has been trying
to gain muscle and has increased his exercise
routine to lifting heavy weights. He wants to
eventually become a bodybuilder, so he is looking
for a product that has low calories, but a larger
amount of protein content. What product would
you recommend? Correct Answers boost high
protein
A 28-year-old pregnant woman approaches the
pharmacist seeking a recommendation. She is
suffering from a head cold and her associated
symptoms include headache, nasal congestion,
and clear nasal drainage. For treatment of cold
symptoms prior to becoming pregnant, she would
normally reach for a cocktail of a systemic
antihistamine, nasal decongestant, and
guaifenesin; however, now that she is pregnant,
she is not sure which treatment option is best. She
has no known allergies and takes a prenatal
vitamin once daily. What recommendations should
,the pharmacist provide? Correct Answers In this
case, because cold symptoms are not life-
threatening, many health care providers would
recommend nonpharmacologic treatment options
for symptom relief, including the use of a
humidifier and elevation of the head while
sleeping. In addition, saline nasal spray can be
used to alleviate nasal congestion. If these
interventions fail or medication is deemed
necessary, pregnant patients have several options
for relieving their symptoms. First-generation
antihistamines diphenhydramine and
chlorpheniramine have consistently been shown to
be safe during pregnancy. Systemic
decongestants, however, including
pseudoephedrine, have demonstrated an increased
risk of fetal malformations and should be avoided
during pregnancy. For headache relief,
acetaminophen is generally considered safe for
use. In this case, educate the patient on
implementing nonpharmacologic interventions for
symptom relief. If pharmacologic treatment is
desired or her symptoms are deemed severe,
recommend the use of a first generation
antihistamine for the shortest term at the lowest
effective dose and that she discuss this with her
obstetrician.
A 53 year old, African-American, female patient
approaches your pharmacy counter with a Vitamin
, D supplement bottle in her hand. After completing
a Quest analysis, you determine she's an
appropriate candidate for self-care. She tells you
that her doctor reported her to be slightly Vitamin
D deficient. She wants to know if there's any
additional information she might need to know so
she can be better educated on Vitamin D. Which of
the following is INCORRECT in regards to Vitamin
D? Correct Answers an adequate amount of Vit D
can be achieved from food alone
A 64-year-old woman comes to the pharmacy
looking for a recommendation to alleviate her cold
symptoms. She is suffering from a head cold and
has been unable to sleep comfortably for the past
several nights due to nasal congestion. She has a
medical history of anxiety, dyslipidemia, and
hypertension. She reports taking an antidepressant
for the anxiety and a statin for her cholesterol
level. She has been told that her blood pressure is
difficult to control despite numerous medications,
the names of which she cannot recall. Because of
her blood pressure, she has been told to avoid
certain OTC medications. She would prefer to avoid
all drugs, if possible, and use something natural or
drug-free to alleviate her congestion and sleep
better. What advice would be reasonable to share
with her? Correct Answers Recommend that she
maintain adequate hydration, particularly with
warm liquids, and nutrition; elevate the head of her
