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What should be prescribed for COPD?
Is my friend’s beauty treatment dangerous?
What’s wrong with this GORD prescription?
Practical Approach: What is causing this hoarseness?
Practical approach: What is this itchy rash, with a sweet smell?
Practical Approach: Effect of exercise on drug activity 15/12/2010
Practical approach: White patches in the mouth
Practical Approach: A question on assisted dying At the Update Pharmacy, pharmacist David Spencer is handing over to Mr Shanks, an elderly gentleman, a 30ml pack of morphine sulphate oral solution 20mg/ml. It has been prescribed for the man’s wife who is terminally ill with cancer and is being nursed at home. Practical Approach: What are these itchy blisters?
Practical Approach: doubts about the MMR vaccination
Practical Approach: What’s causing this blackened tongue? 28/10/2010
Practical Approach: A disabled job applicant
Practical Approach: Weight management and mental illness
Practical approach: Mother’s decline is concerning daughter
Practical Approach: Hormone replacement therapy
Practical approch: Can you treat chronic fatigue syndrome?
Practical approach: Smoking cessation and prescription medicines A diabetic man with heart problems seeks help giving up smoking. What advice could the pharmacist offer and which medication may be affected by the patient giving up smoking. Practical approach: What is my son’s spreading rash?
Practical Approach: What’s the best way to treat cracked heels? 02/09/2010
Practical approach: What’s causing pain around the eyes? 25/08/2010 A woman patient who has just got over a cold is complaining of pain across her forehead between her eyebrows and beneath her eye sockets. What might be the cause and how can the pharmacist help? Practical Approach: Methotrexate patient with a mouth ulcer 18/08/2010
Practical Approach: Can you be sued for a lack of duty of care? 12/08/2010
Practical Approach: What's causing this child's white blotches?
Practical Approach: How do you recognise cannabis addiction? 07/07/2010
Practical Approach: How do you tackle persistent lateness? 30/06/2010
Practical Approach: Advice on preventing osteoporosis 23/06/2010 Brenda is worried about developing osteoporosis as her mother, who underwent the menopause at 40, suffers badly with it. What can Brenda do to limit the chances of suffering the same fate as her mother? Practical Approach: What's causing the brown skin patches? 15/06/2010 A young man has asked at the cosmetic counter for some camouflage cream to disguise brown patches on his chest, arms and thighs. What could be causing this condition? Practical Approach: What’s the cause of the patient’s tiredness? 10/06/2010
Practical Approach: Complementary medicines for arthritis 03/06/2010
Practical Approach: which antihypertensive? 27/05/2010
Practical Approach: Resolving headache from medication overuse 20/05/2010
Practical approach: Can you dispense this prescription? 13/05/2010
Practical Approach: Coping with jet lag 05/05/2010
Practical Approach: Keeping gout under control 29/04/2010
Practical approach: Do you need to agree with exemption claims? 22/04/2010
Practical approach: Treating period pains 15/04/2010
Practical approach: Rules on English proficiency 06/04/2010
Practical approach: A case of chronic diarrhoea 31/03/2010
Practical approach: Prescribing for hypertension 24/03/2010
Practical approach: Setting up an anti-obesity campaign 17/03/2010
Practical Approach: How can you alleviate vomiting in babies? 10/03/2010
Practical Approach: Tired, no appetite and overweight why? 03/03/2010
Practical Approach: Treating tennis elbow 24/02/2010
Practical Approach: Smoking cessation and psychoactive drugs 17/02/2010
Practical Approach: A persistent, barking cough 11/02/2010
Practical Approach: What to do about loss of libido 03/02/2010
Practical approach: A CD script from an independent prescriber 26/01/2010
Practical Approach - Complementary remedies for colds? 22/01/2010 It is the height of the cough and cold season at the Update Pharmacy.
Practical Approach: Changes to clopidogrel dispensing 13/01/2010
Practical Approach - What to do with an itchy ear 11/01/2010
At the Update Pharmacy, a young man with an itchy ear has been referred to pharmacist David Spencer, who asks him about it.
Practical approach: Recruitment: an unhappy applicant 17/12/2009
Practical approach: Problems with oral contraceptives 20/11/2009
Practical Approach: Analgesia for worsening pain in cancer 13/11/2009
Practical Approach: Cystic fibrosis therapy 06/11/2009
Practical Approach: Identifying and treating female hirsutism 30/10/2009
Practical Approach: A facial skin rash 22/10/2009
Practical approach: Statin prescribing 15/10/2009
Practical approach: going on the Hajj 08/10/2009
Practical approach: Getting relief from itchy legs 01/10/2009
Practical Approach: A burning rash: what is the likely diagnosis? 24/09/2009
Practical Approach: prescription medicines in Dubai 17/09/2009
Practical Approach: Communication skills 20/08/2009
Practical Approach: A persistent cough 14/08/2009
Practical Approach: A script-endorsing exercise 06/08/2009
Practical Approach: Is it meningitis? 30/07/2009
Practical Approach: Isotretinoin for a teenage girl 23/07/2009
Practical Approach: Insect bites? 25/06/2009
Practical approach: A mock medication review 11/06/2009
Practical Approach: A 'funny turn' 04/06/2009
Practical Approach: antihistamines for a horse 28/05/2009
Practical Approach: a cardiovascular check 21/05/2009
Practical Approach: Optimum dose timing 14/05/2009
Practical Approach: Exemption declarations 07/05/2009
Practical Approach: Hypertension headache? 30/04/2009
Practical Approach: Once-daily dose timing 23/04/2009
A Practical Approach: Respiratory infections 16/04/2009
A Practical Approach: Prescribing for a dog 09/04/2009
A Practical Approach: Complementary therapies 02/04/2009
A Practical Approach: A facial sore 26/03/2009
A Practical Approach: CD cupboard access 19/03/2009
A Practical Approach: Knobbly knuckles 12/03/2009
A Practical Approach: Asthma treatment 05/03/2009
A Practical Approach: Drinker's rash? 26/02/2009
A Practical Approach: Ibuprofen in the elderly 20/02/2009
A Practical Approach: Once-daily doses 12/02/2009
A Practical Approach: Lack of sleep 05/02/2009
A Practical Approach: Different types of cough 29/01/2009
A Practical Approach: A lunchtime emergency 22/01/2009
A Practical Approach: Strontium ranelate 15/01/2009
A practical approach: Heartburn 08/01/2009
A Practical Approach: Script charge queries 19/12/2008
A Practical Approach: Depression 12/12/2008
A Practical Approach: Stingy Prescriber? 08/12/2008
A Practical Approach: Risperidone side effects 12/11/2008
A Practical Approach: A mystery illness 06/11/2008
A Practical Approach: Painful toes 30/10/2008
Practical Approach: Invitation to work on a formulary
A Practical Approach: Just getting older? 16/10/2008
A Practical Approach: An MUR Request
A Practical Approach: Sexually transmitted infections 25/09/2008
Practical Approach: an unwanted medicine
A Practical Approach: Chloramphenicol Drops Sale
A Practical Approach: Unpaid locum
A Practical Approach: Endorsing Questions
A Practical Approach: Depression or Drunkenness?
A Practical Approach: Cranberry juice
A Practical Approach: Inhaler Non-compliance A mother returns six beclometasone 100mcg inhalers that her son had not used. What steps should the pharmacist take over the boy's non-compliance? A Practical Approach: Roundworm
A Practical Approach: Foot ulcer
A Practical Approach: Malaria prophylaxis 10/07/2008
A Practical Approach: Diabetes epidemic? 03/07/2008
A Practical Approach: Red Eye 27/06/2008
A Practical Approach: Leg Pain 20/06/2008
A practical approach: Dentists' prescriptions 12/06/2008
A Practical Approach: Worsening Asthma 06/06/2008
A Practical Approach: Non-medical prescribing 30/05/2008
Practical Approach: OTC Analgesics 22/05/2008
A Practical Approach: Drug problem 15/05/2008
Under pressure 30/04/2008
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Do you believe in growing pains? A boy of 13 complains of pain mostly in his legs but sometimes in his arms as well. He is a bit moody and off his food. Which condition in children and adolescents is often initially put down to growing pains?
Could you advise a GP about a patient who has COPD and whose current medication doesn’t seem to be working very well?
Would you recognise a bunion and do you know the main causes and treartment options?
A woman of Nigerian origin may have been trying to lighten her skin and a friend has noticed patches of bluish-black tiny pimples appearing on her face. What do you know about skin lightening products and what advice might you give the friend?
A patient presents a prescription for warfarin 3mg tablets, digoxin 125 microgram tablets and omeprazole 20mg capsules. After checking the patient's PMR and talking to the patient, the pharmacist says he must talk to the doctor before he can dispense the prescription items. What is the problem with this script?
A teacher, known for presenting frequent prescriptions for trivial conditions, is worried about the hoarseness that is hanging on after a bout of flu. Are her symptoms likely to indicate anything more serious and how can the pharmacist help?
A young man, living in a student flat, complains of an itchy rash. He tells the pharmacist there is a funny, sweetish smell in the accomodation, almost like almonds. What might have caused the rash, what treatment can you recommend and what would prevent further outbreaks?
Lauren Olsen, a GP trainee at a practice to which David Spencer provides prescribing advice, contacts David to discuss an issue that has been concerning her.
A patient who had a flu-like infection then developed white patches on the inside of her mouth. She has a prescription for prednisolone 5mg soluble tablets. What might the problem be, what is the treatment and the prognosis?
A customer presents with itchy blisters on his hands. In the consultation area the pharmacist sees a series of clear, deep-seated, tapioca-like vesicles on the sides of two or three fingers on both hands and one or two in each palm. What might the cause be and could there be any problems treating the condition?
Would you be able to answer this mother's concerns about the MMR vaccine and her baby's egg allergy? 
A male customer sticks his tongue out at you. The central portion is blackish in colour and the papillae enlarged. What might the problem be and what might have caused it? And what advice might you offer?
An ideal-sounding candidate for a pharmacy technician post turns out to be wheelchair bound. How well do you understand recently introduced legislation that might have a bearing on employing this applicant?
How well could you deal with weight management issues in a mentally ill patient? Apart from BMI, which other physical parameters should be regularly monitored in such patients?
A worried daughter is concerned that her mother is going downhill, and consults David Spencer. The daughter says her mother seems lethargic and groggy. What could be the problem?
Are you up to date on the recent thinking on the risks and benefits of HRT? What advice could you offer a menopausal woman and are there any complementary medicines that could help?
A patient suffering from chronic fatigue syndrome visits the pharmacy "as a last resort" seeking vitamin or something herbal. Which supplements might be helpful and what general advice can be given?
A woman comes into the Update Pharmacy trailing a reluctant young teenage boy behind her. The boy has a flaking rash that is spreading down his face. What advice can pharmacist David Spencer offer?
Mrs Dunstone wants a cream for her sore heels, but assistant Hannah thinks she needs to see the pharmacist. What causes cracked heels and how can they be treated?
A patient suffering from rheumatoid arthritis and taking methotrexate complains of a mouth ulcer. If she also said she was ignoring the prescribed folic acid, how would you respond?
A care home patient is admitted to hospital and the family want to sue David – even though he hasn’t made a dispensing error. Help David discover what happened and who has clinical responsibility in our practice-based scenario 
David Spencer has an angry customer. Her son has come out in white blotches and she's blaming the moisturising cream he was prescribed for his eczema. Could she be right?
Could you spot the tell-tale signs of cannabis use and how much do you know about the effects of addiction? What advice could you give on the management of withdrawal? And are there any medicinal products containing cannabis that are licensed for use in the UK?
A young pharmacist is persistently half an hour late for work. The branch can't function until he turns up and it's upsetting the other staff. Can you just sack him?
An Afro-Caribbean gentleman in his mid-50s with hypertension and a family history of diabetes is complaining of tiredness. What could be the cause?
Pharmacist David Spencer is visiting his elderly uncle Morris, who wants to know about glucosamine and chondoitrin for osteoarthritis. Are they safe for him to take and will they help his condition?
The pharmacist is invited by a local GP prectice to draw up a specific prescribing policy angiotensin-renin system drugs (ARSDs). How much do you know about prescribing rates, cost and Nice recommendations for this group of drugs?
Would you spot the features of medication overuse headache? Do you know what drugs might cause it and how it is treated. Can the pharmacist play a role in treatment?
A pre-registration pharmacist trainee in England keeps a log of problem prescriptions he has come across. All raised queries about dispensing or endorsing under NHS regulations. Could you answer his questions?
A patient comes to you asking for advice about coping with jet lag. He has heard about melatonin, but what can you tell him about its effects in treating jet lag? And what other drugs are used to treat jet lag?
A patient recently diagnosed with gout is asking why a GP has changed his regular prescription. Can you explain why the changes were made? What advice should be given on diet and lifestyle to prevent his gout from flaring up?
Should pharmacy staff have to verify that a patient’s declaration of exemption is genuine? And is it morally right to turn a blind eye to a false declaration of exemption entitlement if a patient genuinely cannot afford to pay?
A doctor prescribes Loestrin-20 tablets for a 15-year-old girl complaining of period pain and PMS. Why are combined hormonal contraceptives prescribed for dysmenorrhoea and are they effective? What OTC treatment(s) might have been helpful, and why?
How many pharmacists from abroad practise in Great Britain and do they have to prove they can speak English? And do you know what qualifications they need and if there is a difference in requirement between EU and non-EU nationals?
A customer asking for something for diarrhoea admits that she has suffered on and off for 15 years and sometimes has bouts of constipation as well. OTC treatment for irritable bowel syndrome didn't work. The pharmacist wonders if the problem is something that runs in her own family - what might the condition be? 
The pharmacist is asked to advise a young, trainee GP on prescribing in primary care. She is working on a case of an asthmatic woman with high blood pressure. How well do you know target blood pressures and is hypertensive treatment necessary in this case?
Could you answer these questions on systems used to measure obesity? And what do you know about weight management and the dangers of being overweight?
A three-month old baby is regularly regurgitating feeds and his mother is concerned. The GP and health visitor try to reassure her but she is still worried. How common, and what is the cause of, baby vomiting? What measures can be tried to alleviate it?
A patient who has been taking amiodarone tablets for six months is reported to be lacking in energy and to have low concentration levels at work. And although he has lost his appetite, he has put on weight. What condition might these symptoms suggest and what are the implications?
A painter and decorator visits the pharmacy for OTC treatment for a painful arm. If this is tennis elbow, can it be treated with OTC medication or might a GP provide more effective treatment? And what might the prognosis be?
A local GP practice is concerned about the effect of smoking on the psychoactive drugs they prescribe, and equally the consequences of patients giving up smoking. So they ask the pharmacist to draw up some guidance on interactions between psychoactive drugs and smoking and stopping smoking.
A tired looking teeenager presents with a persistent, barking cough she has had for two weeks. Could it be whooping cough? What might the GP prescribe and why? And what is the prognosis for the girl's cough?
A female member of the pharmacy staff asks what might cause a loss of sexual desire. Could drugs be the problem and how can the pharmacist help? Could herbal medicines be of use?
A locum dispenses a pharmacist independent prescriber's script for 24 co-codamol 8/500 tablets. This results in a phone call from a Society inspector who says the supply may constitute an offence against the Misuse of Drugs Act 1971. Can you explain why? What could have been done to avoid the situation?
David Spencer, pharmacist at the Update Pharmacy, is drafting a note to send to local GP practices about a recent Drug Tariff change to clopidogrel, which appears to be causing some confusion among prescribers. He decides first to consult GP Mo Merali, to whose practice he supplies prescribing advice.
A careless comment from a counter assistant leads to a solicitor's letter and a claim for sexual discrimination. Pitfalls to be wary of when seeking new staff.
A woman patient is concerned that the low strength combined oral contraceptive that she has been taking for some yearsis affecting her mental and emotional state. What might the problem be and how might the pharmacist help?
The GP asks for advice initially on doses of long acting oral morphine and then for diamorphine hydrochloride by subcutaneous infusion for a terminally ill patient. Where exactly would the pharmacist find the required information?
Questions over Colomycin and Promixin lead to tips that will help you conduct MURs for cystic fibrosis patients
A young Asian woman asks about facial and body hair removal. What questions might the pharmacist ask, and what advice could be offered?
A livestock truck driver complains of a rash which is erythematous and scaly, with ring-like slightly raised lesions, on the man’s cheeks, chin and neck. What might the cause be and what treatments might the pharmacist recommend?
Local GPs say they are awash with advice on statin prescribing and they ask the pharmacist for clear and concise guidance. What key points should the pharmacist cover in their guidance?
What advice might a pharmacist include on vaccination, swine flu and prescription medicines in an information leaflet for patients planning a pilgrimage?
A woman customer asks for antihistamines for her itchy legs. The pharmacist establishes that she has no other symptoms or illnesses and suggests that it isn't an allegy at all. What might be causing the problem and what would be the next step?
An elderly lady has a slightly inflamed band down the right side of her chest, from just under her armpit to just above her navel. But with no spots. What is the likely cause?
A regular patient, who was the victim of a violent mugging, is escaping to Dubai on holiday. Can she take her prescription medicines for post traumatic stress disorder and pain?
A 73-year-old's misuse of medication leads the pharmacist to conside ways of overcoming barriers to effective communication while conducting an MUR
A man with "quite a bit of heartburn" is also complaining of persistent cough. What might be causing it and can the pharmacist help without a GP referral?
Manu Patel, the new pre-reg at the Update Pharmacy, is being introduced to the mysteries of endorsing prescriptions by pharmacist David Spencer.
A worried mother who brought her three-year-old son into the pharmacy the previous day with a runny nose and sore throat is now concerned he has meningitis.
A mother questions the use of isotretinoin for her daughter. What advice can the pharmacist offer on the restrictions associated with this treatment and what are the risks of depression?
A six-year-old boy has spots which a locum doctor thought were insect bites. Pharmacist David Spencer is not so sure. Could they be something more serious?
The pre-reg tries her hand at a mock medication review and is asked what points she should identify and what actions she should take.
A patient says he had a 'funny turn' but the pharmacist is concerned it is more serious. What was the likely cause of the episode and what treatment should be advised?
A stable owner asks for cetirizine for her horses but the locum pharmacist refuses to supply. Was she correct? And how might the situation be resolved?
A cardiovascular check for a customer on a repeat script for atenolol 50mg and enalapril 20mg daily reveals high blood pressure. What might the problem be and what advice might the pharmacist offer?
Pre-reg trainee Joanna is advising local GPs on optimum dose timings for hypoglycaemic agents, asthma treatments and NSAIDs with once-daily doses. What should she cover?
A district nurse presents some unsigned scripts for patients who are on benefit. Can pharmacy staff complete exemption declarations on behalf of patients?
Could a man with high blood pressure be suffering from hypertension headaches? If not, what else might his problem be?
Pre-reg Joanna is giving a talk to GPs about once-daily dose timings for anti-gastric secretion drugs and antidepressants. What are the main points she should cover?
A patient diagnosed with late onset asthma regularly presents scripts for antibiotics to treat a chesty cough. Could the problem have another underlying cause?
A doctor is unhappy about a vet's fees and asks the pharmacist to dispense a prescription for his dog that the he would write out himself. Can he do that?
David Spencer is asked for advice on the safety and efficacy of natural or alternative medicines in the treatment of osteoarthritis. What did the pharmacist advise and where did he find his information?
A sore on the gardener's face catches the pharmacist's attention. It doesn't hurt but seems to be spreading. What might it be and what is the pharmacist's advice?
A worried former pre-reg student asks David Spencer about the legal position over access to CD cupboards. What do the regulations say?
A fellow golfer shows David Spencer his hands. Beneath the skin over each knuckle is a white nodule. What might the problem be?
Pre-reg Joanna is puzzled by a prescription for a salbutamol MDI and a Pulmicort Turbohaler 200mcg. Why does she suggest contacting the asthma sufferer's GP?
An irate patient fumes over a practice nurse's comments about a rash. The pharmacist, who remembers that the customer has recently stopped taking the Pill, has a different view.
When collecting a repeat prescription, a patient's daughter mentions her mother's recent problem with reduced urinary output. She also requests ibuprofen for mum's arthritis but alarm bells ring in the pharmacy.
Pharmacist David Spencer has asked pre-reg trainee Joanna to give a presentation to GPs on timings for antihypertensive drugs taken once daily. What should she cover?
Some common causes of sleep disorder and advice the pharmacist might offer.
The pharmacist tutor has set a new pre-reg trainee a series of scenarios involving cough. Each symptom complex might point to a more serious disease, but which one?
The pharmacist is called to a young woman who has been taken ill in the pharmacy. What was the likely cause and what first aid actions should be taken by the staff?
A patient previously on sodium alendronate sparks debate by bringing in a prescription for strontium ranelate. How can the pharmacist query the prescription without antagonising the GP, who can be hostile?
Should the pharmacist advise a friend with chronic heartburn to see a doctor? What are the contributing factors and how can the pharmacist help?
Yetunde is having a difficult morning, with three patients each bringing in a script for multiple items. How much should she charge and why does one of the scripts need amending?
Mr Harris has asked for St John's wort tablets because he has heard they are as effective as prescription medicines at treating depression. Is he right and what should the pharmacist advise?
Ed Lively thinks his doctor should prescribe him cholesterol-lowering drugs and is asking pharmacist David Spencer whether he should complain. How should David reply?
A patient on Risperidone suddenly exhibits side effects - and suffers an outbreak of athlete's foot. What has happened and what should the pharmacist do?
A scout has returned from camp with what looks like an insect bite, but he develops flu-like symptoms. What was the diagnosis and likely treatment? 
A patient presents with painful and discoloured toes that have also been getting very cold. What is the diagnosis and how can the pharmacist help?
A new local GP asks for help with a practice formulary. What issues would the pharmacist have to consider before giving an answer?
A customer complains about feeling old and has noticed a rash and her skin getting blotchy. She wonders if she needs a holiday back home in the Caribbean. What might the pharmacist suspect the problem is? 
Mrs Booth has asked pharmacist David Spencer if she can have an MUR to explain all the different medicines she is taking. What changes might David recommend as a result?
A holiday in Crete, a fling with a waiter and a sudden panic about an STI. Which diseases may have been contracted and how can the pharmacist help this woman?
A 68-year-old diabetic declines her prescription for metformin which she says was making her ill. What steps should the pharmacist take?
A patient has been advised by an on-call GP to get chloramphenicol eye drops for her eighteen-month-old daughter's itchy eyes. What should relief pharmacist Lydia Allen do?
A pharmacist has reduced the hourly rate for a locum after the work was done - how can the underpayment be recovered and can the RPSGB help?
Trainee dispensing technician Yetunde has been given two prescriptions and is being tested on her knowledge of endorsing. What should her answers be?
Edward O'Mara's daughter-in-law is concerned that he is depressed - and possibly has a drinking problem - since the loss of his mother. What will pharmacist David Spencer do?
A medical student training for a marathon suffers recurrent bouts of cystitis. She wonders if cranberry juice really will help or if it is an old wives tale. What re-assurances can the pharmacist offer?
A worried mum asks for advice about protecting her children from canine roundworm infection. What help can the pharmacist offer?
A customer reports a nasty sore on an elderly neighbour's foot. The pharmacist has some advice on treatment.
The police arrest a man who has three bottles of Valoid tablets on him. What are the repercussions for the supplying pharmacists?
What advice can the pharmacist give on Malaria prophylaxis for a student backpacking through Asia to Australia and New Zealand?
Can the pharmacist explain what appears to be an outbreak of diabetes at a residential care home for the elderly?
A patient with sore eyes thinks he has conjunctivitis and is looking for treatment, but does pharmacist David Spencer agree with his diagnosis?
Sales assistant Claudine is looking for topical analgesics for her dad, who is getting nasty pains in his leg. But what is really causing the trouble?
A trainee dispensing technician is given a list of dentists' scripts and asked whether the prescription can be dispensed, or not, with the reasons in either case
Mr Harding's asthma has got worse: has he been given the wrong inhalers or is a change in his prescription to blame?
In response to questions on who can prescribe what, pharmacist David Spencer asks his dispensing technician to prepare a guide for everyone and he identifies six key headings.
David Spencer is holding a training session and his staff are full of questions about OTC analgesics - but what are the answers?
The pre-registration pharmacist trainee is seen being thrown out of a nightclub for taking ecstasy. What are the possible consequences for her career?
Senior medicines sales assistant Hannah is worried about her mother, who is feeling awful after her GP advised her to stop taking HRT. What should she do?
Evan Normans' BP was nearly 200/120 but tests all came back completely normal. The GP suspects other issues. Can pharmacist David Spencer help?