CSA430 Pharmacy Practice

• The pharmacist must provide counselling that is supported by evidence-based information.
• Pharmacists must provide a range of communication method for effective counselling.
• Tailoring the consumers to the needs.
• Provide the consumer with desired medicine information before it is taken.
• Also, they used written information.
• Oral counselling method to check the consumer[1].

 In such circumstances when there is face to face supply is not possible the pharmacist ensures s an ethical indirect supply service that maintains to ensure the supply is appropriate to patients. The record of contact details of patients accessing the service, which include the telephone number and residential address also establish and record medication history that includes the prescription and non-complementary medicines.

The  Over-the-counter emergency contraceptive drug available is only levonorgestrel which is a progestin-only contraceptive,  also next choice One Dose, My way is some of the OTC  emergency contraceptive drug available as an option. Out of these three OTC drug  “levonorgestrel” is only would be recommended firstly it has lower side effects with other OTC contraceptive drug, secondly, its works best if it is have taken them within three days after sex. And third, it also may work after five days where these other  OTC product drug would not have this time depended on the effect it might take about 6 to seven days.

 Yes, The first consideration would be that pharmacist should provide the consumer with information about the indirect pharmacy service.  The second consideration would be must follow a documented procedure for the indecent supply of medicines [2].

 Exclusive breastfeeding means that an infant typically receives only her, mother breast milk, no other liquids or sledge are providing to the infant, not even water. It is recommended that Breast milk contains all the nutrients (IgM) specifically colostrum, so an infant generally needs breast milk for at least six months of her life. as it would protect Iva from any immune disorder and infection.

“Flucloxacillin” is the most common narrow spectrum penicillinase-resistant penicillin used to treat an infection that is caused by the Staphylococcus aureus it is also used for the treatment exclusively for skin and soft tissue infection such as mastitis. It is normally a safe drug, and it is unlikely to cause any issues if any extra dose is given any mistake. This line of treatment with these drugs would rather have quite common side effects such as nausea, diarrhoea.

 The first suggestion would be the optimising the breast milk drainage if the condition worsens, she should seek a physician immediately. Or must consider using the counter soothing packs like Lansinoh Soothies[3].

 The second suggestion should be to let the nipples air out after feeding the Iva. It might seem strange but just leaving the nipples exposes for few minutes after the feeding can ease the pain that Regina is experiencing.

 The third suggestion would be if pain and discomfort continue then she can take over the counter reliever such as  Tylenol or Motrin.    

 In support to Regina who is unwell and at the same time caring for a young baby would need an extra care effort for her where home care nursing can be provided for her who thus need to care for both Regina and Iva by proving every need of Regina and Iva for proper treatment, and as the time she must seek her consultation with her family physician about the use of medication for her condition.

The best appropriate treatment option to advise Regina would be to rest, to breastfeed the bay frequently and to avoid any leaving long gaps between feeds, She also might take analgesics[4].

The cold chain integrity in these case scenario  can be maintained by following some best practices to maintain the cold chain in the pharmacist are:

 It needs to be seen that the cardboard box (Paper packing or the correct packaging is there or not)Must see there is a pre-cool inventory Must monitor and maintain the trailer temperature during transportation.The order evidence (Receiver- pharmacist) mi=ust keep the products at the correct temperature. The necessary action that is taken when there is a breach of the cold chain is

It must be understood that a cold chain reach is needed and a medicine or vaccine storage temperature that has been outside the recommended range +2 Degree and +8 Degree centigrade.

Action 1:- receptor the current, minimum and maximum temperature of vaccine refrigerator on the char (Twice daily)

Action 2:- Once a week check the temperature that has remained between the +2°C to +8°C range [5].

Action 3:- Annually calibrate the thermometers and change the batteries.

Action 4:- If the breach is identified Do not use or discard the medicine until and unless it has been advised by the public health authority.

Strategies

If temperature has gone below the +2°C to +8°C range. Then isolate the vaccine and do not discard it. Download ted at logger and must investigated (review daily max and min temperature), also way record and maintain a logbook or list for maintaining the temperature of medicine.

Action-  It must be kept safely in a syringe container box.

Management- Must ensure to follow the recommended temperature is recorded in a log sheet.

Action-  It is also kept in a recommended biomedical syringe box.

Management- It is also mentioned in a temperature-controlled manner.

Action- It is recommended that this medication is kept in the fridge for long term use.

Management- It must be kept in cold isolated condition in a deep freezer (cold chain facility)

Action-  This medication is kept in the fridge for long term use.

Management- cold isolated condition in deep freezer (cold chain facility)

Action- kept in recommended temperature as per the drug regulatory standards provided by the manufacturing unit.

Management- cold isolated condition in deep freezer (cold chain facility)

Action- It must be kept safely in a syringe container box.

Management- It is also mentioned for temperature-fashioned manner.

The approach would be to manage  Jessica by administering her or Vaginal antifungals (Fungicides) that might be used for treating candidiasis. Also, topical, and oral azole therapies would be provided which have a cure rate of eighty to eighty-five per cent in the acute case of vulvovaginal candidiasis which might be a cause of  Jessica. The possible differential diagnosis would be due to bacterial vaginosis,  also vulvovaginal candidiasis, or foreign bodies [6].

The general recommended treatment that I would consider for her treatment regimen would to terete with a common antibiotic such as Metronidazole 0375 per cent, which must be put off the epithelial surface intravaginally twice weekly for four to six months. Thus, also a recommended maintenance of Oral fluconazole of about 100 mg should be used for a week to six months. Other antibiotic treatment that is also reality available for the treatment would be erythromycin, ceftriaxone, might also use as an add on treatment side by side.  Thus, if these antibiotic treatment does not show any progress in the minimizing the symptoms than an antibiotic treatment approach would be recommended where she must maintain her vaginal hygiene all the time by washing her vagina twice a day. Also, she is not recommended for any type of sexual intercourse during her treatment regimen. She should follow a healthy diet (recommended diet such as fruits, the green leafy vegetable must be assured all the time). The patient is educated about the ill effects of her condition. She should practise yoga and, she should exercise at least thirty minutes daily. 

1. a) Morphine Liquid- Appropriate Dose- It is about 100 to 30 mg every four hours a. the dosage is a patient depended on a variable with increased dosage would require achieving adequate analgesia. The strength of Morphine liquid oral solution is available as 10 mg per 5ml to 100 mg per 5 ml concentration. For Mrs Pang a 100 mg per 5 ml concentration is usually indicated for the use of opioid-tolerant is recommended [7].
2. b) It is recommended that she should now follow the line of treatment that is (controlled-release morphine liquid) for his rest of her life and would recommend her son Jian if the condition is not got better then she should seek an oncologist and endocrinologist for her further treatment regimen[8].
3. c)

Dosage recommended with Ordine 2 liquid should be prescribed for breakthrough pain would be if it is oral then 1 to 2 mg would be sufficient for once daily. It is recommended that taking  Ordine 2 may result in physical dependence. Thus, physical dependence that the body of the patient may experience withdrawal symptoms. Also, information would be it is not advisable to take these drugs if the patient is having any breathing problems such as acute asthma, respiratory depression, or other obstructive distress[9].

 It is recommended that Jian must ensure that he would not take any other nee controlled released liquid morphine from over the counter as it is a narcotic drug that is extremely dangerous to administer without any prior prescribed physician recommendation.

Recommended treatment for an upper GI bleed would require a blood transfusion should be admitted to Mr Erdstein upper gastrointestinal bleeding who is also having a haemoglobin level of 92 g/L or less[10]. 

Route- Intravenous

Dosage-  It is recommended that 1 unit increases haemoglobin 1 g/dl so for Mr Erdstein about 9 to 10 units is usually required.

Duration-It is usually given over 1-2 hours but not longer than 4 hours.

Atenolol 50 mg daily- Continued, a rational approach is used for treating high blood pressure.

Atorvastatin 20 mg daily- Continued, and rational approach is it is used for treating hypercholesterolaemia which Mr Erdstein is having a condition.

Paracetamol 1 g q6h prn- Withhold. A rationale approach is it is used for treatment for lower temperature or febrile as of now Mr Erdstein upon examination shows temperature is afebrile. (non-feverish)

1. c) Mr Erdstein might have taken more than 30,000 tablets of ibuprofen over the six-month period which has led to overdoes of this drug causing GI bleed.  The mechanism of action of ibuprofen is that it is nonselective and is also a reversible inhibition of cyclooxygenase enzymes COX-1 and COX-2 which is typically encoded by the action of prostaglandin 1 and prostaglandin 2, respectively. Simply it is blocking the production of prostaglandins which helps to minimize the pain [11].
2. d)
3. Any new medication for the treatment of GI bleeding- It is recommended that prokinetics such as erythromycin or metoclopramide are used.
4. Sertraline 50 mg daily- Withhold and rational approach are as Mr Erdstein does not have any depression and panic attacks.
5. Atenolol 50 mg daily- Should be Continued, as his BP is currently 122/88mm Hg.
6. Atorvastatin 20 mg daily- Should be continued lifelong.
7. Ibuprofen 400 mg tds prn-withhold as already a prokinetic is provided
8. Paracetamol 1 g q6h prn- Not continued, but if temperature increase above 100-degree centigrade one dose of 650 mg should be administered.It may have a concern such as the risk of fractures.

• Pneumonia might also be a serious concern.
• Also, there would be a concern for Vitamin B12 deficiency.

1. ii) There should be the lowest dose of frequent that is needed to control the symptoms o it might be needed to stop. It is also recommended that step down therapy treatment is initially tested with a proton pump inhibitor then it is lowered for effective medication type and dosage.

• Issues first: Ms manor main issue is she is having a disease named Alzheimer’s disease.
• Issues second: Ms general issues for her medical condition would an increase in confusion and falls.
• Issues Third: Ms manor also having a concern regarding dizziness and false recently.
• Issues Fourth: Ms Manor has also a problem of high blood pressure
• Issues fifth: Mrs, main simply wants to reduce her medication.
• Issues Six: Ms manor has a problem of depression and osteoarthritis with a Vitamin D deficiency.

For issues first- an ideal recommendation would one-step communication and avoid limit napping and avoiding multiple or prolonged naps over the day. Must create a routine boost for self-esteem[12].

For issues second- gait training management and foot-related problems.

For issues third:- best recommendation would be drinking plenty of water and keeping  hydrated [13].

For issues, fourth- Timely medication must be provided or taken such as beta-blockers or Calcium channel blockers.

For issues fifth- Medication must be taken to provide health issue without gapping any dose.

For issues sixth- management of depression by psychotherapy and for osteoarthritis medication like acetaminophen or other osteoarthritis drugs and diet (food regime) must be changed.

I am sending this letter of recommendation to Ms manor health condition as she has been going through with many underlying conditions of her condition, but thereof a key issues Ms manor is facing hard is his Alzheimer disease condition from early, her condition for high blood pressure and vitamin D deficiency. Also, I had found a recommendation for its solution that I would rather think it would be having to bring down her symptoms to some relief which comprises of recommendation would one-step communication and avoid limit napping and avoiding multiple or plonged naps over the day, taking beta-blockers or Calcium channel blockers and medication like acetaminophen or other osteoarthritis drugs and diet (food regime) must be changed for her vitamin D deficiency. Dr Chamila Abeysinghe I would state to you that please use the above management issues and recommendation with utmost care and as per your bests knowledge provides her with a better regimen to enhance her quality of life should get enhanced [14].     

Reference

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10. Hadayat R, Gul R, Khan AN, Said K, Gandapur A. Endoscopic findings of upper gastrointestinal bleeding in patients with liver cirrosis. Journal of Ayub Medical College Abbottabad. 2015 Jun 20;27(2):391-4.
11. Jang Y, Kim M, Hwang SW. Molecular mechanisms underlying the actions of arachidonic acid-derived prostaglandins on peripheral nociception. Journal of neuroinflammation. 2020 Dec 1;17(1):30.
12. Barbe C, Morrone I, Wolak-Thierry A, Dramé M, Jolly D, Novella JL, Mahmoudi R. Impact of functional alterations on quality of life in patients with Alzheimer's disease. Aging & mental health. 2017 May 4;21(5):571-6.
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14. Karimi M, Brazier J. Health, health-related quality of life, and quality of life: what is the difference?. Pharmacoeconomics. 2016 Jul;34(7):645-9.