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Examples of fraudulent use of PBS by patients or pharmacist

a. 1. The three examples of fraudulent use of PBS by patients or pharmacist are as follows:

  1. Obtaining prescription as Pharmaceutical benefit in spite of having another prescription for the same purpose and acquiring medicine from the pharmacist
  2. Illegal selling of PBS medicine by the pharmacist to the patients who are not eligible for benefits of PBS
  3. The pharmacist providing medicine for a prescription dating back which might not contain the medicine item in the list

a. 2. The 10 risk factor that pharmacist can help by educating patient about indication of the type of cancer caused by the risk factor are as follows:

  1. Diet – Maintaining proper diet would help to reduce the risk of cancer
  2. Smoking –It is one of the main cause for lung cancer
  3. Alcohol consumption- may increase the risk of liver cancer in an individual
  4. Obesity – Excessive body weight may result from kidney, oesophageal, pancreases, colorectal and ovarian cancer
  5. Tobacco- Excessive use of tobacco might result from developing lung cancer
  6. Sunlight - it is one of the main reason of basal cell and squamous cell cancer
  7. Cancer causing substance- There are certain substances using which can cause cancer
  8. Insufficient exercise- Another important reason for developing certain cancer
  9. recreational drug – excessive use might result from developing cancer
  10. Birth control and hormone replacement therapy- these factors may result from ovarian cancer in women

a. 3a.The three chronic diseases that are listed in the report are:

  1. Respiratory disease like asthma –16% Indigenous Australians and 12% Non Indigenous Australians suffered from asthma.
  2. Cardiovascular disease - 38% Indigenous Australians and 26% Non Indigenous Australians suffered from Cardiovascular vascular disease 
  3. Chronic obstructive pulmonary disease - 56% Indigenous Australians and 28% Non Indigenous Australians suffered from Chronic obstructive pulmonary disease

a. 3b. Three modifiable risk factor for the chronic disease includes:

  1. Smoking- can reduce the chances of chronic Respiratory disease among the individual
  2. Healthy diet- would maintain healthy lifestyle and prevent cardiovascular disease in the population
  3. Exposure to tobacco – may reduce the chances of COPD and respiratory disease in individual

b.1. One of the most important services that is offered by community pharmacy is MedsCheck. MedsCheck refers to the consumer centred service provided by the community pharmacies that helps to improve the use of medications with the help of educating the patient about the medicine. Sometime patient do not understand the use of medicine and their purpose. MedsCheck helps to educate the patient about the medicine, its impact on the medical conditions by identification of the problems faced by the medicines. It is an important service that helps to improve the medical use and health issues in the population.

b. 2a. The service provided to a 70 year old man who is being treated for hypothyroidism and reflux disease and suffered from heart attack last year is the Ongoing screening or monitoring service. With this service, the pharmacies would provide monitoring of his blood pressure and thyroid level. Frequent monitoring of blood pressure and thyroid level is important for older people. They also provide combined monitoring of different health parameters under Health check service. Therefore, the pharmacy can provide opportunity to the old man with monitoring service to avoid any unfavourable conditions.

b. 2b The service provided to the 55 year old lady, who would initiate taking care offer two month old grandchild at home is pharmacy delivery service. In order to look after the two month old baby, the lady would not be able to step out of the house as no one will be accompanying her. In case she required any medicine, she will face a mobility issue as she cannot leave her grandchild alone in the house and visit the pharmacy. That is why pharmacy delivery service would be a helpful service for her if she has any requirement of medicine.

b. 2c. The service provided to the 70 year old man suffering from type 2 diabetes is Diabetes MedsCheck. It was evident that he was not taking his heart medicines properly because he was unaware about the reason for his medications. With this service, the pharmacists would be able to explain the importance of the medicine and provide education about the disease and associated complications. He should be informed about the consequences of heart problems associated with diabetes if the medicine is not taken properly.

b. 2d. The service provided to the homeless lady with an end stage lung cancer is staged supply of medicines. Following this service, the pharmacist would be able to provide medicine at different stage, since she is a homeless lady and she do not have any space to keep the medicines. Therefore, staged supply of medicine would be helpful for her to keep the minimum amount of medicine with her. This service would benefit her as sometimes medicine are damaged if not kept properly which can cost her much more than the usual.

10 risk factors that pharmacist can educate patient about indication of cancer caused by the risk factor

b. 2e. The service provided to the 65 years old Aboriginal and Torres Strait Islander lady is Indigenous Dose Administration Aids Program. This service would help the woman to manage her medication and improve the audience towards her medicine. This service aims for helping the Aboriginal and Torres Strait Islander to understand about health problems and medicines in their own languages. It makes easier for them to understand the importance of medicine for the stated health problem. Since the program is specific for them, the language barrier is reduced for better communication with them.

c. 1. The advice provided to Ted based on the “biopsychosocial model” of care is he should Maintain a healthy lifestyle as it is one of the major risk factor for diabetes. Ted has Obesity and do not have any kind of physical activity. He has a stressful lifestyle as well, so he must workout for atleast 1 hour and should avoid frozen meals. Biomedical model of care is a disease specific care, which fails to meet the requirements of patients suffering from diabetes. So, care for diabetes cannot be performed excluding the biopsychosocial model of care.

c. 2. The three examples that demonstrate cultural capabilities of the pharmacists are:

  1. Showing respect – informed consent was taken before initiating any treatment procedure
  2. Seeking cultural knowledge – the knowledge about the culture of the patient must be recorded before initiating any kind of procedure
  3. Demonstration of reciprocity – learning process must go on from both the sides demonstrating reciprocity
  4. Engaging community accompaniment – allies and mentors must be engaged for the treatment process from the community
  5. Recording personal knowledge – the cultural identity of the patient including location, believes and wellness is recorded

c. 3. The four ways to explain the dosage to the elderly woman for taking her prednisolone tablets are as follows:

  1. Dispensing label – it is a label attached to the prescribed medicine for proper understanding the dose of medicine
  2. Verbal communication – information about the dose of the medicines must be explain verbally to the lady
  3. Written instruction – the dosage must be clearly written in the prescription provided to the patient
  4. Clear explanation – the bifurcation of the medicine dose must be instructed to the patient.
d. 1. 
  1. Clotrimazole for Athlete’s Foot Cream 10mg/g, 50gm – applied at night, must be stored in pharmacy and is allowed to advertise
  2. Dexchlorpheniramine 2mg, 30 tablets. – used at night after dinner, should be kept in pharmacy and is not allowed to advertise
  3. Folic Acid 500mcg (recommended dose 1 tablet daily), 150 tablets – must be taken after meal, should be kept in pharmacy and is not allowed to advertise
  4. Hydrocortisone Cream 0.5%, 30gm - applied at night, must be stored in pharmacy and is allowed to advertise
  5. Levonorgestrel 1.5mg, 1 tablet – after unprotected sexual activity, must be stored in pharmacy and is allowed to advertise
  6. Low Dose Aspirin 100mg, 28 tablets – must be taken at night must be stored in pharmacy and is not allowed to advertise
  7. Metoclopramide 10mg, 25 tablets – must be taken after breakfast and after dinner, must be stored in pharmacy and is not allowed to advertise
  8. Naloxone Nasal Spray 2.2mg/spray – must be taken four times a day, can be stored in professional area and is allowed to advertise
  9. Nystatin Oral Drops, 24mL – four times a day with 6mL per dose, must be stored in pharmacy as well as dispensary and is allowed to advertise
  10. Pantoprazole 20mg, 7 tablets – must be taken in morning on empty stomach, must be stored in pharmacy as well as dispensary and professional area and is allowed to advertise
  11. Paracetamol modified release 665mg, 96 caplets – during fever or maximum 2 times a day, must be stored in pharmacy, dispensary or any professional area and is allowed to advertise
  12. Sumatriptan 50mg, 24 tablets – during pain or headache, must be stored in pharmacy, dispensary or professional area and is allowed to advertise

d. 2a. The five important questions are:

  1. When was the first time you noticed the ulcer?
  2. For how long the ulcer has been present? 
  3. Did you notice any morphological change in the lesions? 
  4. Is the lesion associated with pain? 
  5. Did you feel numbness inside the mouth? 

d. 2b. The medications for mouth ulcer include antimicrobial mouthwash, antibiotics and doxycycline as one of its component of corticosteroid ointment .

Mr. Jones must take the antibiotic twice daily after breakfast and dinner, he should wash his mouth the oral wash twice a day and should apply the ointment twice a day.

d. 2c. Four lifestyle measure for curing mouth ulcer are:

  1. Should wash the mouth with mouth wash after every meal
  2. Should not drink hot tea or coffee and acidic drinks as well
  3. Avoiding consumption of spicy, oily and fried foods
  4. Avoiding the use of chewing gums

d. 3a. The Three questions that would be asked for determining the correct diagnosis of Mrs. Williams are as follows:

  1. For how long are you suffering from the pain? 
  2. Are you suffering from double vision? 
  3. Is the pain bilateral or unilateral?

d. 3b. The five points that must be included in the counselling for Mrs. Williams for ensuring safe and effective intake of medicine are:

  1. the dosage of the prescribe medicine Must be explained to her.
  2. she must be explained about the regularity for taking the medicine which would reduce her pain effectively
  3. She should take her medicine everyday at same time
  4. Should explain the dosage of medicine that must be maintained along with the dosage of other medicines
  5. She should avoid taking medicine on her will without seeking permission from the physician

d. 4a. The questions that would be asked to Mr. Shadbolt are as follows:

Do you have abdominal pain and vomiting tendency?

With this condition chances of stomach cancer can be excluded is the answer to these are negative .

Do you have pain in the right shoulder or pain between shoulder blades?

with this question the chances of gallstones can be excluded with a negative answer for the same.

Do you have any abdominal pain that is spread towards your back portion?

by asking this question the chance of pancreatitis can be excluded.

Do you have Constipation with inability of bowel movement or passing gas?

If the answer to these questions is negative, chances of intestinal obstruction is excluded from the diagnosis.

Do you have false smelling stool and bloated abdomen with persistent constipation or diarrhoea?

This would exclude the chance of celiac disease in him.

d. 4b. The OTC medicine prescribed to him for treating indigestion is Proton pump inhibitor that contains substance which would help to profound and prolong the reduction of stomach acid production.. Excessive release of acid in the stomach causes indigestion in an individual. They work by inhibiting H+/K+ ATPase proton pump in stomach irreversibly. That is why Mr. Shadbolt is prescribed with proton pump inhibitor containing that would reduce stomach acid production for longer period of time.

Pharmacist services including MedsCheck and ongoing monitoring services

d. 4c. The lifestyle recommendations suggested for Mr Shadbolt are :

  1. He must not sleep just after having meal and must wait at least two hours before lying down.
  2. He must not over it during his meal and should take small portions four or five times a day instead of taking big meals
  3. he must eat slowly and chew the food well that helps to digest the food in the system
  4. He should have healthy diet and avoid spicy and oily foods.
  5. He must avoid drinking hard drinks and soft drinks which may cause indigestion
  6. Products with caffeine must be avoided which can increase indigestion.

d. 5a. OTC Pain relievers containing acetaminophen can be recommended for the three year old boy that would give relief from headache. He can be administered with 80 mg of acetaminophen twice a day. For blocked nose, saline nasal spray can be administered that would give relief to him by reducing the congestion in the air passage.

d. 5b. OTC Pain relievers that contain acetaminophen can be prescribed to the lady who is 10 week pregnant that would provide relief from the headache. She can take 500 mg of the capsule every six hours if the pain is persistent. On the other side, for nasal blockage she can use saline nasal spray that would help to clear the congestion in her air passage.

d. 5c. OTC Pain relievers that contain hydroxyzine can be prescribed to the 76 year old man with hypertension that would provide relief from the headache. He can take 100 mg of the capsule for four times in a day, if the pain is persistent. Along with this, for nasal blockage he can use decongestants spray that contains oxymetazoline as a component, which would give relief from the blockage. It can be used twice in a day with 12hours interval between the two dose.

d. 6. A non steroid gel anti inflammatory drugs can be used for rapid relief of lower back pain for Mr Davidson. Cambia is one such medicine that can reduce back pain.

The generic name of Cambia is diclofenac.

It is used because it reduces the hormones, which is responsible for the inflammation or the pain in the body.

Diclofenac gel can be used for almost 7 days and the medicine can be taken orally twice a day for not more than 3 days.

The eight self care advice includes:

  1. He must stay active
  2. He must stretch first trending though back muscle
  3. He must maintain good posture to avoid unwanted strains
  4. He must maintain proper weight
  5. He must try ice and heat during pain
  6. He must take hot bath
  7. He must drink plenty of water
  8. Must avoid stress on backside

d. 7. The medicine containing tropical steroid can be used for treating skin rashes. Lidex 0.05% cream can be used for the treatment.

The generic name of Lidex 0.05% cream is Fluocinonide, that helps to provide relieve as it is an anti inflammatory glucocorticoids Steroid.

It can be applied on the skin up to four times a day until the skin rash is cured.

Self care for skin rashes includes:

  1. The affected area must not be scratched
  2. Hygiene must be maintained specially on the infected area
  3. mild cleansing agents can be used
  4. The affected area must be kept away from heat

References

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Sadeghi, H., Rafei, M., Bahrami, M., Haghdoost, A., & Shabani, Y. Attributable risk fraction of four lifestyle risk factors of thyroid cancer: a meta-analysis. Journal of Public Health, 2018.40(2), e91-e98.

Gardiner, F. W., Rallah-Baker, K., Dos Santos, A., Sharma, P., Churilov, L., Donnan, G. A., ... & Worley, P. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine, 2021.42, 101181.

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TasleemAbitha, S., & Mathew, M. G. KNOWLEDGE AND AWARENESS OF ORAL ULCERS AMONG DENTAL STUDENTS. PalArch's Journal of Archaeology of Egypt/Egyptology, 2020.17(7), 1275-1286.

Piacentini, M., Borghetti, R. L., Zancanaro de Figueiredo, M. A., Cherubini, K., & Gonçalves Salum, F. Doxycycline: An option in the treatment of ulcerated oral lesions?. Journal of clinical pharmacy and therapeutics, 2019.44(6), 838-843.

Mirzababaei, A., Khorsha, F., Togha, M., Yekaninejad, M. S., Okhovat, A. A., & Mirzaei, K. Associations between adherence to dietary approaches to stop hypertension (DASH) diet and migraine headache severity and duration among women. Nutritional neuroscience, 2020.23(5), 335-342.

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