PSI Clinical Pharmacy & OTC 1 — Questions and Answers
Question 1: Which OTC medication is first-line for mild-to-moderate pain in a patient with no contraindications?
- Paracetamol 500–1000 mg every 4–6 hours (max 4 g/day) (Correct answer)
- Codeine 30 mg every 4 hours
- Ibuprofen 400 mg every 4 hours
- Aspirin 300 mg every 4 hours
Correct answer: Paracetamol 500–1000 mg every 4–6 hours (max 4 g/day)
Paracetamol is first-line OTC analgesia — effective, widely tolerated and safe across most patient groups including children, pregnant women and the elderly when used as directed.
Question 2: Ibuprofen is contraindicated OTC in patients with:
- Active peptic ulcer, third trimester of pregnancy, or severe renal impairment (Correct answer)
- Mild seasonal allergy
- Controlled hypertension only
- Age over 60 with no other issues
Correct answer: Active peptic ulcer, third trimester of pregnancy, or severe renal impairment
NSAIDs including ibuprofen are contraindicated in active GI ulceration (risk of bleeding), third trimester pregnancy (premature ductus arteriosus closure), and severe renal impairment (risk of acute kidney injury).
Question 3: Which antihistamine is classified as non-sedating and is suitable for OTC hay fever treatment?
- Cetirizine (Correct answer)
- Chlorphenamine
- Promethazine
- Hydroxyzine
Correct answer: Cetirizine
Cetirizine (and loratadine) are second-generation antihistamines with minimal CNS penetration, providing hay fever relief without significant sedation. First-generation antihistamines like chlorphenamine cause sedation.
Question 4: MUPS (Medicines Use Points System) in Ireland — in which OTC recommendation should pharmacists ALWAYS refer to a GP without treating?
- Red flag symptoms such as unexplained weight loss, dysphagia or blood in stool with indigestion (Correct answer)
- Simple heartburn after a large meal in an otherwise healthy adult
- Occasional acid reflux only
- Mild bloating in an adult with no other symptoms
Correct answer: Red flag symptoms such as unexplained weight loss, dysphagia or blood in stool with indigestion
Red flags such as unexplained weight loss, dysphagia, rectal bleeding or persistent indigestion in patients over 55 may indicate oesophageal or gastric cancer — these require urgent GP/hospital referral.
Question 5: Which OTC treatment is appropriate for athlete's foot (tinea pedis) caused by dermatophytes?
- Topical clotrimazole 1% cream for 2–4 weeks (Correct answer)
- Oral fluconazole OTC dose
- Hydrocortisone cream alone
- Povidone-iodine solution
Correct answer: Topical clotrimazole 1% cream for 2–4 weeks
Topical imidazole antifungals (clotrimazole, miconazole, econazole) are first-line OTC treatment for tinea pedis. Treatment should continue for 2 weeks beyond symptom resolution to prevent recurrence.
Question 6: Which symptom combination in a child under 2 with a cough and cold requires immediate referral?
- Respiratory rate >50 breaths/min, subcostal recession, or cyanosis (Correct answer)
- Runny nose alone
- Mild cough without fever
- One night of disturbed sleep
Correct answer: Respiratory rate >50 breaths/min, subcostal recession, or cyanosis
Signs of respiratory distress in young children — fast respiratory rate, subcostal recession (sucking in below ribs), cyanosis or poor feeding — indicate serious illness requiring immediate emergency assessment.
PSI Clinical Pharmacy & OTC 1
Which OTC medication is first-line for mild-to-moderate pain in a patient with no contraindications?