CSA103 Written assignment 2 Semester 1 2016 PDF

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CSA103 Written Assignment 2, 2016

Question 1: Australian healthcare system (Total marks for Q1 = 8 marks + 1 mark for referencing) The Pharmaceutical Benefits Scheme (PBS) makes many medicines more affordable for Australians. a) Briefly describe the steps that are involved in getting a new medicine listed on the PBS. (3 marks) First, the medicine must be approved by the Therapeutic Good Administration (TGA) to enter the Australian Register of Therapeutic Goods (ARTG) before it can be applied as a PBS medicine. 1 The sponsor of the medicine then applies to be listed in PBS by submitting an application form in accordance to the PBAC Guidelines to the Pharmacy Benefits Advisory Committee (PBAC). 1 The price and the effectiveness of the new medicine will be compared by the PBAC with other medicines or treatments for the similar purpose using evidence from valid clinical trials, economic assessment and Budget impaction before recommending the medicine to be listed on the PBS. 1 Even with the recommendation from the PBAC, the sponsor must still approach the Department of Health to discuss about the finalised cost and other arrangements for PBS listing. 1 The Minister for Health then has the authority to grant the approval unless the net value of the new soon-to-be medicine exceeds $20 million per year.1 If that is the case, the new medicine will need the Cabinet’s approval to be listed on the PBS.1 b) Medicines are sometimes removed from the PBS. List TWO reasons for why this could occur. (2 marks) The medicines removed from the PBS may have a higher cost with a prescription as compared to them being bought directly over the counter.2 Having them removed, approximately half a billion of dollars can be saved by the taxpayers over a period of five years. 2 Other than that, this also provide a chance for those more expensive medicines, which are more unaffordable, to be remained in the PBS list.2 c) State at least THREE circumstances where a prescription for a medicine listed in the PBS must be written as a non-PBS prescription? (3 marks) Medical practitioners, that have yet to be registered as a PBS prescriber, do not have the authority to write a PBS prescription although the medicine may be listed in the PBS. 1 Therefore, it must be written as a non-PBS prescription. If a patient has the need to use a PBS medicine out of its stated restriction, it also cannot be prescribed as a PBS medicine, and must be written as a non-PBS prescription.1 An authority PBS/RPBS prescription should be written as a non-PBS prescription unless if it has been approved by the Department of Human Services or the Department of Veterans’ Affairs.1 Besides, an authority prescription for an Authority required (STREAMLINED) item, without the streamlined security code in the prescription form, is also a non-PBS prescription although the medicine needed is listed.1

Question 2: Pharmacists in the Health Care System (Total marks for Q2 = 9 marks) In the ‘Assessment’ Module in MyLO, you will find a document entitled ‘Professional services in community pharmacy list.’ Read through this information. a) Name THREE services that you would like to offer if you were a pharmacist working in a community pharmacy and explain why you would want to offer them. (3 marks) I would like to offer the Dose Administration Aids (DAA) as I find it helpful for patients with literacy difficulties to intake their medicines safely and effectively without unnecessary misuses. Besides, Pharmacy immunisation is also a service I would like to offer as it may be more accessible to the public compared to only getting immunisation done in certain general practice and hospitals. I find Pharmacy Delivery Service useful too but it will only be offered to the elderly, especially those with disabilities, as it may be inconvenient for them to drop-by the pharmacy every time they need a continued dispensing of medicine. b) Based on this list of professional services that can be offered in community pharmacies, and the web links included in this list, name at least ONE service that would be suitable for each of the following customers and explain why. (6 marks) i)

An elderly lady living at home Home medicine review. This is to review the medications taken by the elderly lady at home, if requested by her GP, to ensure safe, effective use of her medicines and to solve or prevent drug-related harm.

ii) A man with a history of substance abuse A man with a history of substance abuse may have a recurrence if he is drug overdosed so staged supply helps him to handle his medications safely in periodic instalments. iii) A 50 year old lady with her first grandchild on the way Child health nurses may be suitable for a 50-year-old lady with her first grandchild on the way to receive child health advices from registered nurses. iv) A retired Aboriginal man who has difficulty with medication compliance Dose Administration Aids is useful for him as medicines are packed in a calender pack with the right dosage to reduce his difficulty with medication compliance.

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Question 3. Patient Perspectives on Health (Total marks for Q3 = 12, + 1 mark for referencing) a) You are the clinical pharmacist talking to Larry on the hospital ward after he was admitted for extremely high blood pressure. Larry is a divorced, 54 year old who self-manages his diabetes and lives alone. He tells you that he quit smoking two years ago and since then, he has gained some weight. He doesn’t cook at home very much, doesn’t exercise regularly, and has beers most afternoons with his work mates. He takes his medications regularly, but he does admit to missing a day or two every now and then. He has been under a lot of pressure at work over the past few weeks. Define the terms ‘biomedical model of care’ and ‘biopsychosocial model of care’. Describe how the management of Larry’s case would differ under the two different models. (6 marks) ‘Biomedical model of care’ is a healthcare model that only focus on biological factors, which means it focuses only on the physiology, biochemistry and pathology ways to regain good health 3 while ‘biopsychosocial model of care’ is a model that links biological, psychological and socio-cultural factors in healthcare.4 By utilizing the ‘biomedical model of care’, Larry will only be advised by me about his medication information, his medical treatment, exercising regularly, and also to reduce eating sugary and fatty food which may be some factors to his extremely high blood pressure plus diabetes. Under the ‘biopsychosocial model of care’, besides of explaining about his medications, treatments and lifestyle, Larry will also be advised to mix around more with his neighbours and friends, try to talk to some of his close friends about his pressure at work over the past few weeks. He can also be advised to join a healthy cooking class to release his tension at work, and meet new friends while maintaining a healthy diet. b) Reflecting on the Global Perspectives Program: Identify FOUR things you can do to facilitate successful inter-cultural communication in a pharmacy setting. Explain why these approaches are helpful. (6 marks) I)

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Greet people with different culture politely like how all other customers are greeted without any sign of discrimination. By doing so, it allows them to feel more welcome and they may be more willingly to share their purpose of coming to the pharmacy. It is also a way of showing respect to their culture. Instead of voice raising when they do not understand some of the conversation, I will consider to slower my speech down and ask if they understand me. This is to ensure that they understand the advices or counselling given and reduce the chance of being misunderstood by them as me being annoyed. It is important not to use local slangs or jargons with them as they might not understand us. By not understanding us, the possibility of them making the wrong decision and wrong administration of medication used by them is higher. Non-verbal communication such as hand gestures can be used to indicate my point. Hand gestures are a good way of overcoming the language barrier but there are still some risks in using it as hand gestures vary in meaning in different cultures.

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Question 4. Communication (Total marks for Q4 = 16, + 2 marks for referencing) a) Introductions are important when working in community pharmacy. Provide TWO reasons why you think introductions are important. (2 marks) By introducing yourself to the customers or patients, this allows them to know if you are the right person they are coming for or to know who to go to when they have any questions. In some pharmacies, it might be difficult for the customers to differentiate between the pharmacist and the pharmacy assistants so this confusion can be reduced with the presence of introductions. Besides, it also allows the patients to feel safer to open up and share their problems or reasons being in the pharmacy when they know your name and your role in the pharmacy. By knowing in depth for their problems or reasons, the pharmacist may be able to provide the most effective help. b) Explain the difference between verbal and non-verbal communication. Provide at least THREE examples of non-verbal communication and explain how these are especially important in a health conversation. (4 marks) Words and sounds such as languages and voices are used in verbal communication while signs such as tone, pitch, gestures, eye contact, and body languages are displayed in non-verbal communication.5 One example of non-verbal communication is the tone and pitch of voice. It is important not to speak in a monotonous way as it may lack emotions and cause others to think that you are uninterested in the health conversation. Your gestures on the hands, head or body are also important as it may become a way to express yourself and your engagement with the patients. For some cases, when an intercultural conversation is established, gestures can also help to overcome language barrier. Other than that, body postures are a form of non-verbal communication. Body postures can show how engaged and interested you are with your patients. By sitting or standing with an upright posture, this can show that you are listening and welcoming your patients to share their thoughts in a health conversation. c) Mrs Horsham comes into the pharmacy and asks for something to treat diarrhoea. Write a script of an ideal history taking and tailored counselling session between Mrs Horsham and you (the pharmacist). NB: As this will be a tailored counselling session, you can be creative (but sensible) with Mrs Horsham’s history and situation. However, ensure that the counselling is suited to the history and situation you create for Mrs Horsham. (10 marks) Pharmacist: “Hello, I’m Yuen, the pharmacist-on-duty today. How may I help you?” Mrs Horsham: “Hello, I would like to look for something to treat diarrhoea.” Pharmacist: “Is it for yourself?” Mrs Horsham: “No, it is for my son.” Pharmacist: ”May I know how old your son is?” Mrs Horsham: “Sure, he is 19.” Pharmacist: “Is it alright for you to describe his symptoms for me?”

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Mrs Horsham: “No problem. He has been to the loo thrice this morning and he’ll have this watery stool each time. He also complained about having abdominal discomfort.” Pharmacist: “How long has he had these symptoms? Has it just started this morning?” Mrs Horsham: “Yeah, it has just started this morning.” Pharmacist: “Has he tried anything for his symptoms yet?” Mrs Horsham: “Nope.” Pharmacist: “I’ll have to ask you a few more questions as it is necessary for me to provide your son with the best choice of medication.” Mrs Horsham: “It is alright!” Pharmacist: “Is your son taking any other medications?” Mrs Horsham: “No.” Pharmacist: “Does he have any other health conditions or allergies?” Mrs Horsham: “Not that I know of.” Pharmacist: “Do you perhaps know the source that triggered your son’s diarrhoea?” Mrs Horsham: “I think he had this really spicy Indian curry yesterday for dinner so that might be the cause of his diarrhoea. I am not so sure though.” Pharmacist: “I see, that might be it. Based on what you have described so far, I think Imodium capsules are a good choice for him. Has he ever tried Imodium?” Mrs Horsham: “I do not think so.” Pharmacist: “Alright, Imodium capsules are capsules that basically help to relieve diarrhoea, which is what he needs. He should consume 2 capsules initially then reduce to 1 capsule after each loose defaecation or every 4 hours if necessary with a maximum of 8 capsules in 24 hours.” 6 Mrs Horsham: “How long does it take for him to get better?” Pharmacist: “Do not worry, he should be able to feel better in a day. Remember to let him swallow the whole capsule with water without opening the capsule 6 and also not to take more than the recommended dose, which is 8 capsules in 24 hours, as it may increase the possibility of side effects. 6 This medicine should be well tolerated but some people might feel nauseous or bloated after taking this medication. Overall, there should not be any major side effects.”6 Mrs Horsham: “So what if he experiences any side effects?” Pharmacist: “You should probably get him to stop this medication immediately and consult your doctor or a pharmacist again if that happens and he should also get a doctor if his symptoms are not cleared or worsen for more than 3 days.”6 Mrs Horsham: “Alright.” Pharmacist: “So, what other questions do you have for me regarding this capsules for your son?” Mrs Horsham: “I think I am good.” Pharmacist: “Do you mind telling me what I think I have told you, to see if I have missed out anything?” Mrs Horsham: “No worries, he should take 2 capsules as the first dose and reduce to 1 every 4 hours or after each loose bowel motion. Do not take more than 8 capsules in 24 hours, and he should swallow the whole capsule without opening the capsule. Consult a doctor if he does not get well in 3 days or if he experiences any side effects.” Pharmacist: “Yup, and I should also inform you that this medicine is not suitable for young children so do not give it to younger kids if they ever have diarrhoea.”6 Mrs Horsham: “Alright, noted. I should never use it for my 12-year-old daughter then.”

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Pharmacist: “Yeah, it is better to refer to a doctor if that is the case. Besides, you should advise your son to reduce taking spicy food for a couple of days. Do get your son to drink more fluid to prevent dehydration and you may also get him some rehydrating products as well. 7 That is all. Hope he gets well soon and ask him to take care!” Mrs Horsham: “Thanks for your help, bye!”

Question 5. OTC medications (Total marks for Q5 = 75, + 14 marks for referencing) a) State TWO reasons why Schedule 2 medicines are only sold in pharmacies. (2 marks) Schedule 2 medicines are only sold in pharmacies but does not necessarily require a pharmacist to dispense the medicine. Although so, it is only sold in pharmacies to enable the pharmacist-on-duty to monitor the medicines so that people would not buy those medicines more than recommended or required. Besides, pharmacist can also give advices to the people of public to ensure that the customers are getting the best and correct medicines for themselves. Schedule 2 medicines may have a certain toxicity when interacted with certain drugs so by selling them only in pharmacies, the safety and effectiveness of medicines to the public can be ensured. 8 b) List the restrictions in place for supplying Schedule 3 medicines and explain why there are restrictions for the supply/sale of Schedule 3 medicines. (3 marks) S3 medicines can only be supplied by pharmacists or pharmacist interns under a pharmacist supervision in a pharmacy.9 This means that S3 medicines must go through a pharmacist, but a prescription is not necessary, before they are able to be supplied. 9 S3 medicines must be placed behind the dispensary counter, away from the public, which indicates that the public does not have free access to the medicines.9 Besides, the packaging and labelling of S3 medicines must strictly obey the Poison Standard requirements.9 Nevertheless, there are restrictions for the supply/sale of S3 medicines to ensure that the medicines are used safely and effectively by the public, reduce delayed major conditions diagnosis, drug interactions and side effects.9 Most importantly, as some S3 medicines contain addictive substances, the restrictions can reduce the drug “misuses, dependency, abuse or illicit use” risks.9 c) Classify the following products into the appropriate Schedule by using the following entries from The Poisons Standards (the SUSMP):

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i) ‘Cold’n’Flu Buster’ is a new product due to be released in Australia. It will be a box of 50 tablets and each tablet contains phenylephrine 10mg. Which Schedule would ‘Cold’n’Flu Buster’ be assigned to in Australia and why? (2 marks) Schedule 2. If each tablet contains 10mg of phenylephrine and there are 50 tablets in a box, there will be a total of 500mg of phenylephrine in a pack, which is more than 250mg. Besides, it is in a tablet form so it should be for oral preparations.

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ii) ‘Allergy-B-Gone’ is a new product due to be released in Australia. It will be a box of 20 tablets and each tablet contains phenylephrine 10mg plus promethazine 5mg. It will only be marketed and registered for use in adults. Which Schedule would ‘Allergy-B-Gone’ be assigned to in Australia and why? (3 marks) As phenylephrine is an oral decongestant,10 it would mean that promethazine is combined with another therapeutically active substance that is a sympathomimetic decongestant. Furthermore, it is also for the use of adult, not for children under the age of 2. Therefore, ‘Allergy-B-Gone’ would be assigned to Schedule 2. iii) ‘Motion Sickness Evaporator’ is a new product to be released in Australia. It will be a box of 10 tablets and each tablet contains metoclopramide 10mg plus promethazine 5mg. Which Schedule would ‘Motion Sickness Evaporator’ be assigned to in Australia and why? (3 marks) Schedule 4. Although Promethazine is used to treat motion sickness and it contains only 10 tablets in a box, it is combined with metoclopramide. Metoclopramide will only be in Schedule 3 if it is combined with paracetamol but promethazine is not paracetamol so this makes it to be assigned to Schedule 4. d) Mrs Whelan comes into the pharmacy and asks the pharmacist about constipation. i) List the FIVE questions that a pharmacist should always ask every patient with an OTC request and explain why you would ask these questions. (5 marks) I) Is it for yourself? II) Are you taking any other medications? III) Do you have any other health or medical conditions? IV) Can you describe your symptoms and how long have you had them? V) Have you tried anything for your symptoms? Some medication may be unsuitable for some patient groups such as children, elderly, people with hypertension et cetera, and also to prevent any drug interactions which may cause extra harm to the patient. By asking those questions, this can ensure the safety and effective use of medicines in patients. ii) List TWO additional specific questions that you would ask someone that is suffering from constipation and explain why you would ask these questions. (2 marks) I) II)

Does your stool contain hints of mucus or blood? Does your constipation associates with symptoms of persistent or severe abdominal pain and vomiting? These questions should be asked because if they have positive answers for these questions, a referral to their doctors is necessary for further diagnosis. 11 iii) List TWO reasons for referral for someone suffering from constipation and the possible differential diagnosis that may be associated with each reason. (2 marks) I)

When there is a change in bowel pattern which persists for more than two weeks, there might be a chance of it being large bowel cancer.12

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A referral is also necessary for stool with blood or mucus as it may be a symptom of haemorrhoids or anal fissure.12 Haemorrhoids, which is also kno...