OTC counselling and minor ailments

23 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on OTC counselling and minor ailments, part of Clinical Pharmacy and Therapeutics. The first 23 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   What is the maximum adult daily dose of paracetamol for self-medication?

   1. A6 g in 24 hours
   2. B10 g in 24 hours
   3. C2 g in 24 hours
   4. D4 g in 24 hours

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   Answer: D · 4 g in 24 hours

   Adults may take 500 mg to 1 g every 4-6 hours, up to a maximum of 4 g in 24 hours. Lower limits (for example 2-3 g) apply in chronic liver disease, malnutrition, chronic alcohol use and low body weight.

   • A: 6 g exceeds the safe maximum and risks liver injury.
   • B: 8 g is a toxic dose.
   • C: 2 g is the limit for high-risk patients, not the standard.

   Remember this

   The usual adult paracetamol maximum is 4 g daily, lower in liver disease or low weight.

2. Question 2 · Medium

   A pregnant woman asks to buy cod liver oil capsules. What advice is correct?

   1. AThey are the best dietary source of folate
   2. BAvoid them, as excess vitamin A is teratogenic
   3. CTake them only during the third trimester
   4. DTake two daily to get extra vitamin D and calcium

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   Answer: B · Avoid them, as excess vitamin A is teratogenic

   Cod liver oil is rich in preformed vitamin A. Excess retinol in pregnancy, above about 10,000 IU a day, is linked with congenital malformations, so supplements containing vitamin A are avoided. Safer alternatives provide vitamin D without vitamin A.

   • A: Cod liver oil is not a folate source.
   • C: Excess vitamin A is harmful at any stage.
   • D: Doubling the dose raises vitamin A intake.

   Remember this

   Pregnant women should avoid vitamin A supplements, including cod liver oil.

3. Question 3 · Hard

   A woman taking carbamazepine for epilepsy requests emergency contraception 24 hours after unprotected intercourse, and declines an intrauterine device. Which oral choice is best?

   1. AUlipristal acetate 60 mg as a single dose
   2. BLevonorgestrel 1.5 mg as a single dose
   3. CLevonorgestrel 3 mg as a single dose
   4. DUlipristal acetate 30 mg as a single dose

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   Answer: C · Levonorgestrel 3 mg as a single dose

   Carbamazepine induces CYP3A4 and lowers the effect of emergency contraceptives. Guidance is a copper IUD, or if declined a doubled dose of levonorgestrel of 3 mg. Ulipristal is also metabolised by CYP3A4 and is less effective with inducers.

   • A: A higher ulipristal dose is not recommended.
   • B: Standard-dose levonorgestrel may fail with enzyme induction.
   • D: Ulipristal is also affected by inducers.

   Remember this

   With enzyme inducers, offer a copper IUD or double-dose levonorgestrel (3 mg).

4. Question 4 · Hard

   A patient taking phenelzine for depression asks for a cold remedy containing pseudoephedrine. What is the main risk?

   1. AHypertensive crisis
   2. BHypoglycaemia
   3. CSerotonin syndrome only
   4. DAgranulocytosis

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   Answer: A · Hypertensive crisis

   MAO inhibitors block the breakdown of noradrenaline stored in nerve terminals, and a sympathomimetic such as pseudoephedrine releases it, causing severe hypertension, headache and arrhythmias. The combination is contraindicated, and patients should avoid tyramine-rich foods too.

   • B: Hypoglycaemia is not a feature.
   • C: Serotonin syndrome is a risk with serotonergic drugs, not decongestants.
   • D: Agranulocytosis is not linked to this combination.

   Remember this

   Sympathomimetic decongestants with MAO inhibitors can cause hypertensive crisis.

5. Question 5 · Medium

   A customer has had a cough for 4 weeks with night sweats and weight loss. What should the pharmacist do?

   1. ARecommend a stronger cough suppressant syrup
   2. BSell a double course of an expectorant mixture
   3. CAdvise rest and review again in another two to three weeks
   4. DRefer to a doctor, including assessment for tuberculosis

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   Answer: D · Refer to a doctor, including assessment for tuberculosis

   A cough lasting more than 3 weeks with night sweats and weight loss is a red-flag presentation that needs assessment for tuberculosis, lung cancer and other serious causes. Symptomatic products would only delay the diagnosis.

   • A: Suppressants delay diagnosis.
   • B: Expectorants do not treat serious disease.
   • C: Waiting risks spread of infection and delayed treatment.

   Remember this

   Refer a cough lasting over 3 weeks with weight loss or night sweats.

6. Question 6 · Medium

   A 68-year-old man with benign prostatic hyperplasia has a blocked nose and cold. Which advice is best?

   1. ATake pseudoephedrine tablets to clear the blocked nose and relieve pressure
   2. BUse saline nasal spray and avoid oral decongestants and sedating antihistamines
   3. CTake diphenhydramine syrup to help the cough and sleep
   4. DTake chlorphenamine tablets at night to help the cold symptoms

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   A customer reports a red, painful eye with blurred vision and sensitivity to light. What should the pharmacist do?

   1. ASell chloramphenicol eye drops and ask her to review in 2 days
   2. BAdvise cold compresses for a week and review
   3. CRefer urgently to an eye specialist or emergency department for assessment today
   4. DSell artificial tears and advise resting the eyes

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   A customer buys co-codamol every day for headaches, and has done so for months. What is the most likely explanation and advice?

   1. AA drug allergy; advise stopping all analgesics
   2. BMedication-overuse headache; refer for supervised withdrawal
   3. CMigraine; add a triptan to the co-codamol
   4. DTension headache; supply a larger pack to last the whole month

   Answer and explanation in LearnFree account

9. Question 9 · Hard

   A man with heart failure and chronic kidney disease asks for effervescent soluble tablets for pain. What is the pharmacist's best advice?

   1. AUse them only together with potassium supplements
   2. BChoose plain tablets because soluble tablets contain a large amount of sodium
   3. CEffervescent tablets are low in sodium and are safe for him to use daily
   4. DTake double the dose dissolved in water

   Answer and explanation in LearnFree account

10. Question 10 · Easy

    Which ingredient is appropriate for a dry, tickly cough?

    1. AGuaifenesin
    2. BChlorphenamine
    3. CPseudoephedrine
    4. DDextromethorphan

    Answer and explanation in LearnFree account

11. Question 11 · Easy

    Which over-the-counter product should be avoided in a customer with uncontrolled hypertension?

    1. ALoratadine
    2. BParacetamol
    3. CSaline nasal spray
    4. DPseudoephedrine

    Answer and explanation in LearnFree account

12. Question 12 · Hard

    A woman stable on levothyroxine starts buying ferrous sulfate and calcium carbonate supplements. What should the pharmacist advise?

    1. AStop levothyroxine for the duration of the supplements
    2. BTake all three together with breakfast to improve absorption
    3. CTake levothyroxine 30 minutes after the supplements each day
    4. DKeep levothyroxine 4 hours apart and recheck TSH

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    A man taking warfarin with a past peptic ulcer asks for something for back pain. What is the best recommendation?

    1. AIbuprofen
    2. BNaproxen
    3. CAspirin
    4. DParacetamol

    Answer and explanation in LearnFree account

14. Question 14 · Easy

    A woman asks for emergency contraception 24 hours after unprotected intercourse. Levonorgestrel 1.5 mg should be taken:

    1. AAs a single dose as soon as possible
    2. BWith a pregnancy test result 2 weeks later
    3. CIn two doses 12 hours apart
    4. DOnly after the next period starts

    Answer and explanation in LearnFree account

15. Question 15 · Medium

    A smoker of 25 cigarettes a day, who has his first cigarette within 5 minutes of waking, asks about nicotine replacement. Which regimen is most suitable?

    1. ANo treatment until he has cut down his smoking
    2. BA 21 mg/24 h patch plus a short-acting product
    3. CA 7 mg/24 h patch used alone for 12 weeks
    4. DA short-acting lozenge for 1 day only, then stop

    Answer and explanation in LearnFree account

16. Question 16 · Medium

    A woman (BMI 33) had unprotected intercourse 4 days (about 96 hours) ago and asks for emergency contraception. Which oral option is most suitable?

    1. AMifepristone 200 mg
    2. BLevonorgestrel 1.5 mg
    3. CUlipristal acetate 30 mg
    4. DCombined pill taken twice

    Answer and explanation in LearnFree account

17. Question 17 · Medium

    An adult has diarrhoea with fever and visible blood in the stool, and asks for loperamide. What should the pharmacist do?

    1. ARecommend an antispasmodic only
    2. BSupply double doses to stop the diarrhoea quickly
    3. CSupply loperamide 4 mg then 2 mg after each loose stool
    4. DRefuse loperamide and refer for medical assessment

    Answer and explanation in LearnFree account

18. Question 18 · Medium

    A long-distance lorry driver in Muscat wants a hay fever tablet. Which is the most suitable option?

    1. APromethazine
    2. BDiphenhydramine
    3. CChlorphenamine
    4. DLoratadine

    Answer and explanation in LearnFree account

19. Question 19 · Hard

    A man taking lisinopril and furosemide for heart failure asks for ibuprofen for knee pain. What is the main concern?

    1. ASevere hypotension caused by ibuprofen on its own
    2. BAcute kidney injury risk with the ACE inhibitor and diuretic
    3. CNo interaction exists with either of his regular heart medicines
    4. DReduced diuretic effect only, with no risk to the kidneys

    Answer and explanation in LearnFree account

20. Question 20 · Medium

    A woman taking a combined oral contraceptive asks for St John's wort for low mood. What should the pharmacist advise?

    1. ATake it only on the pill-free days of each cycle
    2. BAvoid it, because it induces enzymes and can cause contraceptive failure
    3. CTake it at a different time of day from the pill
    4. DSafe, because herbal products never interact with any medicines

    Answer and explanation in LearnFree account

21. Question 21 · Medium

    A customer starting ferrous sulfate tablets for iron deficiency asks how to take them. Which advice is best?

    1. ATake with a strong cup of tea to improve the absorption of the iron
    2. BTake with milk or an antacid to settle the stomach upset
    3. CTake with a calcium supplement to protect the stomach lining
    4. DTake with vitamin C-containing juice and keep apart from antacids and tetracyclines

    Answer and explanation in LearnFree account

22. Question 22 · Medium

    A mother asks for paracetamol for her 8-week-old baby, who has a temperature of 38.5 C. What is the correct action?

    1. AGive ibuprofen syrup
    2. BRefer urgently for medical assessment
    3. CGive paracetamol and review in 2 days
    4. DSell a cooling gel

    Answer and explanation in LearnFree account

23. Question 23 · Easy

    What is the first-line OTC treatment for a child with mild acute watery diarrhoea?

    1. AKaolin mixture after each loose stool
    2. BOral rehydration solution
    3. CLoperamide syrup three times daily
    4. DCiprofloxacin suspension twice daily

    Answer and explanation in LearnFree account