Congratulations to the RPSGB Preregistration students that passed this the prereg exam

For more on the RPSGB Prereg Exam visit www.pharmacyknowledge.co.uk

Friday was another day of results for RPSGB preregistration students in the UK. Another 272 people passed this Autumn exam. Congratulations for those that passed for the first time, and those taking it the second time, you must be relieved its all over. Now you can enjoy the rest of the year.

With the inclusion of new pharmacy schools in the uk the amount of new pharmacist available every year is increasing. How many pharmacists jobs are there actually in the UK?

What to do next
Now that you've passed the preregistration exam and soon be registered, what should you do next? Some of you may already have jobs lined up, if not here are some things you should consider:

1) Take a break
The pharmacy preregistration year is a though year, you work full time and have to study in the evenings. But guess what, being an actual pharmacist is more stressful, you'll be wondering if you made any mistakes every night. Take a break, organise yourself, your personal life, your finances ect. If you jump straight into a job you'll feel great for the first week cause you can give medicines out yourself, but after that you will wish for a break.

2) Get MUR certificate
For everyone that has just passed the RPSGB preregistration exam, you should try to get a certificate to allow you to do MUR's as soon as possible, get it out the way. Most employers and locum agencies want you to be able to do MUR's. If you do not have a MUR certificate this will decrease your chances of getting a job and locum jobs. Do it while all the prereg exam knowledge is still in your brain.

3) Locum
Register with a locum agency and get some experience. I know it may be scary cause your gonna be thrown in the deep end, but have confidence, be careful and get some experience. This is the best way to earn some money and get a whole load of experience. I personally went straight into a full time job after my prereg, I still haven't got any locuming experience cause I'm too knackered by the weekend, and feel it's too risky to work when your tired. So I recommend everyone to get some locum experience before you get locked in a job. One of the best things about being a qualified pharmacist is that if all goes wrong, you can locum.

Essential Knowledge for the RPSGB pharmacy Exam

Following my post of my notes from my exam on CSM warnings from the BNF. I have updated pharmacyknowledge.com with new pages with this information.

Essential reading for RSPGB Exam CSM Warnings page 1

Essential reading for RSPGB Exam CSM Warnings page 2

RPSGB Pharmacy Exam revision help: BNF BLUE BOX

After writing my previous post I remember I still got the BNF BLUE BOX document I saved, here it is for everyone(NOTE:this is from an older BNF new content may have been added in the new BNF, so remember to read your current BNF aswell), listed in order that it appeared in the BNF:


BNF BLUE BOXED CSM Warnings

Low Na+
The words low Na+ added after some preparations indicate a sodium content of less than 1 mmol per tablet or 10ml dose.

Infliximab for Crohn’s disease
Infliximab is recommended for Crohn’s disease (with or without fistulae) when treatment with immunomodulating drugs and corticosteroids has failed or is not tolerated and when surgery is inappropriate. Treatment may be repeated if the condition responded to the initial course but relapsed subsequently. Inflixamab should be prescribed only by a gastroenterologist.

Aminosalicylates (Sulfasalazine
Blood disorders
Patients receiving aminosalicylates should report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia.

Laxative
For children with chronic constipation, it may be necessary to exceed the licensed doses of some laxatives. Parents and careers of children should be advised to adjust the dose of laxative given in order to establish a regular pattern of bowel movements in which stools are soft, well-formed, and passed without discomfort.

Clopidogrel
Clopidogrel with aspirin appropriate for management of non-ST-segment elevation acute coronary syndrome in those at moderate to high risk of myocardial infarction or of death.

Lipid-regulating drugs MUSCLE EFFECTS
The CSM has advised that rhabdomyolsis associated with lipid-regulating drugs such as the fibrates and statins appears to be rare(apporx. 1 case every 100 000 treatment years) but may be increased in those with renal impairement and possibly in those with hypothyroidism. Concomitant treatment with drugs that increase plasma-statin concentration increase muscle-toxicity; concomitant treatment with a fibrate and a statin may also be associated with an increased risk of serious muscle toxicity.

Formoterol and salmeterol
To ensure safe use, the CHM has advised that for the management of chronic asthma, long-acting beta2 agonists (formoterol and salmeterol) should:
Be added only if regular use of standard-dose inhaled steroids has failed to control asthma adequately;
Not be initiated in patients with rapidly deteriorating asthma;
Be introduced at a low dose and the effect properly monitored before considering dose increase;
Be discontinued in the absence of benefit;
Be reviewed as clinically appropriate;stepping down thereapy should be considered when good long-term asthma control has been achieved
Aminophylline, Fentanyl, Remifentanil
To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal weight for height.


Antipychotics
IM injection of antipychotics can differ from oral dose, im has increased absorbtion especially if the patient is very active. The dose for antipsychotic for emergency use should be reviewed at least daily. Injections for depot must be titrated according to the patients response.

Lithium
Patients on lithium require a lithium card

Hyponatreamia and antidepressant therapy
Hyponatreamia (usually in the elderly and possibly due to inappropriate secretion of antidiuretic hormones) has been associated with all types of antidepressants; however, it has been reported more frequently with SSRIs than with other antidepressants. The CSM has advised that hyponatreamia should be considered in all patients who develop drowsiness, confusion, or convulsion while taking an antidepressant.

SSRI’s for children
Not recommended in children as it may provoke suicidal thoughts.
Products unfavourable for under 18’s: citalopram, escitalopram, paroxetine, sertraline.
Product that is favourable: FLUOXETINE.

Drugs used in status epilepticus
If seizures recur or fail to respond with 30 minutes:
PHENYTOIN, PHENOBARBITAL, FOSPHENYTOIN should be used
If these measures fail to control seizure with 60 minutes, anaesthesia with thiopental, midazolam, or in adults, a non-barbiturate anaesthetic such as propofol should be instituted with full intensive care.

Fosphenytoin sodium
Precriptions for fosphenytoin sodium should state the dose in terms of phenytoin sodium equivalent(PE); fosphenytoin sodium 1.5mg = phenytoin sodium 1mg

Fibrotic reactions
The CSM has advised that ergot-derived dopamine receptor agonists, bromocriptine, cabergoline, lisuride[discontinued], and pergolide, have been associated with pulmonary, retroperitoneal, and pericardial fibrotic reactions. Before starting treatment with these ergot derivatives it may be appropriate to measure the erythrocyte sedimentation rate and serum creatine and to obtain a chest x-ray. Patients should be monitored for dyspnoea, persistent cough, chest pain, cardiac failure, and abdominal pain or tenderness. If long-term tests may also be helpful.

Sudden onset of sleep
Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and dopamine receptor agonists. Driving warning, drowsiness warning.

Nicotine and bupropion
Only give 2 weeks supply after the stop date, or 3-4 weeks supply of bupropion. Patients are only allowed to claim NHS supplied smoking cessation thereapy within 6 months of an unsuccessful cessation attempt.

Bupropion
The CSM has issues a reminder that bupropion is contra-indicated in patients with a history of seizures or of eating disorders, CNS tumour, alcohol and benzodiazepine withdrawal. Increases the risk of seizures with ANTIDEPRESSANTS, ANTIMALARIALS(MEFLOQUINE AND CHLOROQUINE), ANTIPSYCHOTICS, QUINOLONES, SEDATING ANTIHISTAMINES, SYSTEMIC CORTICOSTEROIDS, THEOPHYLLINE, TRAMADOL. And conditions including diabetes, alcohol abuse, head trauma, and use of stimulated and anorectics.

Methadone and buprenorphine
For opiod dependence, should be administered under supervision for 3 months, until compliance is assured,

Flucloxacillin
Cholestatic jaundice and hepatitis may occur up to several weeks after treatment with flucloxacillin has been stoppened.Administration for more than 2 weeks and increasing age and risk factors. CSM has reminded that:
Flucloxacillin should not be used in patients with a history of hepatic dysfunction associated with flucloxacillin
Flucloxacillin should be used with caution in patients with hepatic impairment;
Careful enquiry should be made about hypersensitivity reactions to beta-lactam antibacterials

Linezolid
Refer symptoms of visual impairment, and blood disorders

Co-trimoxaole
Drug of choice for: Pneumocystis jiroveci (Pneumocystis carinil)
Toxoplasmosis and nocardiasis
If no other alternative consider for:
Acute exacerbations of chronic bronchitis
Urinary tract infections
Acute otitis media in children

Quinonlones (e.g ciprofloxacin)
Tendon damage (including rupture) has been reported in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment.
Quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use
Elderly patients are more prone to tendonitis
The risk of tendonitis rupture is increased by the concomitant use of corticosteroids
If tendonitis is suspected, the quinolone should be discontinued immediately

Urineary tract infections
Whenever possible specimen of urine should be collected for culture and sensitivity testing before starting antibacterial therapy. The antibacterial chosen should reflect current local bacterial sensitivity to antibacterials.

Itraconazole
Following rare reports of heart failure, the CSM has advised caution when prescribing itraconazole to patients at high risk of heart failure. Those at risk include:
Patients receiving high doses and longer treatment courses
Older patients and those with cardiac disease
Patients receiving treatment with negative inotropic drugs, e.g calcium channel blockers

Inhaled insulin
Not to be used for the routine treatment of type 1 or 3 diabetes. May be used:
With evidence of poor glycaemic control despite other interventions and
Who require insulin but are unable to use subcutaneous insulin because of either a diagnosed phobia of injections, or severe or persistent problems with injection sites.

Treatment should continue beyond 6 months only if there is evidence of improvement og HBA12.

Insulin glargine
Insulin glargine should be available as an option for patients with type 1 diabetes.
Insuline glargine is not recommended for routine use in patients with type 2 diabetes who require insulin but it may be considered in type 2 diabetes for those:
Who require assistance with injecting their insulin or
Whose lifestyle is significantly restricted by recurrent symptomatic hypoglycaemia or
Who would otherwise need twice-daily, basal insulin injections in combination with oral antidiabetic drugs

Thiazolidinediones
Pioglitazone or rosiglitazone as second-line therapy added to either metformin or a sulphonylurea is not recommened except for:
Patients who are unable to tolerate metformin and sulphonylurea in combination therapy, or
Patients in whom either metformin or a sulphonylurea is contra-indicated.
In such case thiazolidinedione should replace whichever drug in the combination is poorly tolerated or contra-indicated.

Carbimazole
Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazzole and the need to stop treatment promptly.
Patient should be asked to report symptoms and signs suggestive of infection, especially sore throat.
A white blood cell count should be performed if there is any clinical evidence of infection
carbimazole should be stopped promptly if there is clinical or laboratory evidence of neutropenia

Steroid SEs – risk of sever chickenpox/measles, immunosuppression, adrenal suppression, mood changes, gi affects.

Osteoporosis
Those at risk of osteoporosis should maintain an adequate intake of calcium and vitamin D and any defieciency should be corrected by increasing dietary intake or taking supplements.

Bisphosphonates (Alendranate, risadronate)
Bisphosphonates are recommended as treatment options for the secondary prevention of osteoporotic fractures in susceptiblepostmenopausal women. In women who cannot take a bisphosphonate or who have suffered a fragility fracture despite treatment for a year and whose bone mineral density declines below the pre-treatment level, the selective oestrogen receptor modulator raloxifene is an alternative. The parathyroid hormone fragment teriparatide is recommended for women over 65 years who cannot take a bisphosphonate (or in whom bisphosphonates has failed to prevent a fracture) and have:
either an extremely low bone mineral density
or a very low bone mineral density, sufferent more than 2 fractures, and have other risk factors for fractures (e.g body mass index under 19kg/m2, premature menopause, prolonged immobility, history of mineral hip fracture under the age of 75 years)


Induction of labour
Dinoprostone is preferable to oxytocin for induction in women with intact membranes, regardless or parity or cervical favourability.

Parental progesterone-only contraceptive
The CSM has advised that:
in adolescents, medroxyprogesterone acetate (Deop-provera) be under only when other methods of contraception are inappropriate.
In all women, benfits of using medroxyprogesterone beyond 2 years should be evaluated again risks.
In women with risk factors for osteoporosis a method of contraception other than medroxyprogesterone acetate should be considered.

Spermicial contraceptives
Products such as petroleum jelly (Vaseline), baby oil and oil-based vaginal and rectal preparations are likely to damage condoms and contraceptive diaphragms made from latex rubber, and may render them less effective as a barrier method of contraception and as a protection from sexually transmitted diseases (including HIV).

CRM guildelines on handling cytotoxic drugs:
Trained personnel should reconstitute cytotoxics;
Reconstitution should be carried out in designated area;
Protective clothing (including gloves) should be worn;
The eyes should be protected and means of first aid should be specified;
Pregnant staff should not handle cytotoxics
Adequate care should be taken in the disposal of waste material, including syringes, containers, and absorbent material.

Most cytotoxic drugs are teratogenic and all may cause life-threatening toxicity; administration should, where possible be confined to those experienced in their use.
Because of the complexity of dosage regimens in the treatment of malignant disease, dose statements have been omitted from some of the drug entries in this chapter. In all cases detailed specialist literature should be consulted.
Presciptions should not be repeated except on the instructions of a specialist.

Ciclosporin
Because of differences in bioavailability, the brand of oral ciclosporin to be dispensed should be specified by the prescriber.

Anastrozole
The aromatase inhibitors anastrazole, exemestane, and letrozole, within their licensed indications, are recommended as options for the adjuvant treatment of early oestrogen-receptor-postitive invasive breast cancer in postmenopausal women.

Drugs with definite risk of haemolysis in most G6PD-deficient individuals (from Afriva, Asia, Oceania, and from south Europe):
Dapson and other sulphones, Methylthionium chloride, Nitrofurantion, Pamaquin, Primaquin, Quinolones, Sulphonamides.
Possible risk:
Aspirin, Chloroquine, Menadione, Probenecid, Quinidine, Quinine


Thiamine
Although potentially serious allergic adverse reactions may rarely occur during, or shortly after, parenteral administration, the CHM has recommended that:
This should not preclude the use of parenteral thiamine in patients where this route of administration is required, particularly in patients at risk of Wenicke-Korsakoff syndrome where treatment with thiamine is essential;
Intravenous administration should be by infusion over 30 minutes;
Facilities for treating anaphylaxis (including resuscitation facilities) should be available when parental thiamine is administered.

Pyridoxine Hydrochloride
Pyridoxine is used to treat isoniazid neuropathy. However prolonged use of pyridoxine in dose of 10mg daily is considered safe but the long-term use of pyridoxine in a dose of 200mg or more daily has been associated with neuropathy. The safety of long-term pyroxidine supplements with doses above 10mg daily has not been established.

NSAIDS and cardiovascular events
COX-2 selective inhibitors are associated with an increased risk of thrombotic events (e.g MI and stroke) and should not be used in preference to non-selective NSAIDS except when specifically indicated (i.e for patients at a particularly high risk of developing gastroduodenal ulceration or bleeding) and after assessing their cardiovascular risk.
Non-selective NSAIDs may also be associated with a small increased risk of thrombotic evens particularly when used at high doses and for long-term treatment. Diclofenac (150mg daily) and ibuprofen (2.4g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen is associated with an increased risk of myocardial infarction. A small increased thrombotic risk cannot be excluded for other NSAIDs.
The lowest effective dose of NSAID or COX-2 selective inhibitor should be prescribed for the shortest period to control symptoms and that the need for long-term treatment should be reviewed periodically.

Piroxicam
The CHMP has recommended restrictions on the use of piroxicam because of the increased risk of gastro-intestinal side effects and serious skin reactions. The CHMP has advised that
Piroxicam should be initiated only by physicians experienced in treating inflammatory or degenerative rheumatic diseases
Piroxicam should not be used as first-line treatment
In adults, use of piroxicam should be limited only to the symptomatic relief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis
Piroxicam dose should not exceed 20mg daily
Piroxicam should no longer be used for the treatment of acute painful and inflammatory conditions
Treatment should be reviewed 2 weeks after initiating piroxicam and periodicallt therafter
Concomitant administration of a gastro-protective agent should be considered
Topical preparations containing piroxicam are not affected by these restrictions

Tiaprofenic acid
May cause sever cystisis, stop treatment if symptoms occur.

Methotrexate
In view of reports of dycrasias (including fatalities) and liver cirrhosis with low-dose methotrexate, the CSM has advised:
Full blood count and renal and liver function tests before starting treatment and repeated weekly until theraphy stabilised, thereafter patients should be monitored every 2-3 months
That patients should be advised to report all symptoms and signs suggestive of infection, especially sore throat.
Treatment with folinic acid(calcium folinate) may be required in acute toxicity.

The patient must be warned to report immediately the onset of any feature of blood disorders (e.g sore throat, bruising, and mouth mulcers), liver toxicity (e.g nausea, vomiting, abdominal discomfort, and dark urine), and respiratory effects (e.g shortness of breath)

Co-cyprindiol
Venous thromboembolism occurs more frequently in women taking co-cyprindiol than those taking a low-dose combines oral contraceptive. The CSM has reminded prescribers that co-cyprindiol is licensed for use in women with severe acne which has not responded to oral antibacterials and for moderately severe hirsutism; it should not be used solely for contraception. It is contra-indicated in those with a personal or close family history of venous thromboembolism. Women with severe acne or hirsutism may have an inherently increased risk of cardiovascular disease.
Contra-indicated in pregnancy and a predisposition to thrombosis.

Sun-screen
For optimum photoprotection, sunscreen preparations should be applied thickly and frequently (approx 2 hourly). In photodermatoses, they should be used from spring to autumn. As maximum protection from sunlight is desirable, preparations with the highests SPF should be prescribed.

Pharmacy Preregistration Exam: September Exam

The next RPSGB pharmacy preregistration exam takes place on the last friday of september. For everyone thats taking the exam for the first time be prepared and get tips from anyone that took the exam in June, for those who failed the June RPSGB Preregistration exam, hopefully your working hard and learnt from your mistakes, hope everyone passes.

Here are some tips which I found might be useful for those that are retaking or taking for the first time:

1. Know your BNF
When I was studying for the exam my tutor told me to read the whole BNF AT LEAST twice. I know the BNF is a long and very boring book but doing this gives you many advantages:
a) you will know content better, if you've read it you will at least retain some information.
b) it helps greatly for the open book paper, many of us read things and forget it, but if you've seen it somewhere then you know where to look it up again, reading the BNF twice at least means your gonna know if something is in the BNF or not.
c) BLUE BOXES - In the BNF you'll come across some CSM information in blue boxes, this information more likely than not is something important and you should know it. My revision technique was to copy all of the blue boxes down so I can read through it quickly and remember these things without looking through the whole BNF.
d) while reading the BNF highlight the things that you think are important, especially figures such as oxygen percentages and uses, Cholesterol numbers, and important therapeutic concentrations ect.

2.Calculations
Be confident with calculations and learn how to time them.
Calculations can be a tricky thing and many people struggle with it, learn calculation well, cause you could get stuck on one and be looking at it for ages knowing you can get the answer while wasting alot of valuable time.

3. Practice, practice practice
Practice as many past exam papers as possible and disect the answers fully. Also remember to do timed practices so you can get you timing right.

Swine Flu situation in the UK

I know I am a bit late posting this but do you know what you need to know about swine flu?

I didn't until it became apparent to me early last month that it's getting serious, so many people have got it and they say nearly everybody will have it after the winter.

Is Swine flu as dangerous as they say

The answer is YES and NO.

Swine flu technically is like most other flu's, people CAN recover from it, and they can recover from it without using medication. This will be partly dependent on the individuals immune system, you can even have it for a day feeling abit tired and your body fights it out.

However, swine flu is also killing people, not everyone has a immune system like superman. It's true that swine flu seems to be hitting the people hardest when they have other health problems, but its still dangerous to individual that don't. Also, to look at it one the other side, I know some one with endless health problems, and they got swine flu, I was very worried about this person, praying they will be ok, and in the end TAMIFLU done it's job and the swine flu was gone. The best precaution is to stay at home, and call the helpline when you are suspected of having it, and take the TAMIFLU if they give it to you.

Can you get SWIN FLU twice or more than once?

Yes, it is possible but the risks are lower, your immune system would have built some kind of resistance to the virus and will be able to fight it for effectively. But, can you get swine flu more than once, yes it is possible so don't let your guard down.

Hand gel and thermometers

Everyone seems to be on a mad rush buying hand gels and thermometers is it really necessary... Don't get obsessed about getting these things but get them if you can. Hand gels will help hygeine and thus reduce the risk. Thermometers can also show a fever when you don't feel it yourself.

How to get tamiflu and what to do if you think you got swine flu

I'll just give a quick guidance, don't go to your doctors, dont go outside and put people at risk. Call the helpline that has now been put into place 0800 1 513 100.

I wont go into all the guidance on swine flu you can get it online from the government website or NHS website.

RPSGB Prereg Exam mistake - Good News for prereggers

The 2009 RPSGB Prereg exam open book paper had questions which were impossible to look up in the reference sources, BNF, Drug Tariff, and MEP.

The RPSGB Pharmacaceutical society sent out letters to all pharmacy prereg students to notify them of mistakes in the exam. I personally haven't read the letter but I have heard from the prereg in my shop that, according to the letter, the open book paper had questions in it that didn't have any way to reference and find the answers in the reference sources allowed to be taken into the exam. This means that pharmacy prereg students in the UK could have been wasting valuable time looking and searching for something that wasn't there.

From feed back from many pharmacy prereg students in the UK, this year was supposebly the hardest exam, everyone seems to think they failed and was complaining about the exam.

I will try to get a copy of the letter and have a proper read.

The RPSGB is looking to rectify the problem. How? well, we will probably never know, but we can make a few guesses:

1) The RPSGB will definitely not pass everbody because of this mistake.

2) The RPSGB as far as the letter seems to perceive, all student will not have to retake the exam

3) The closed book paper marks will not be affected.

4) The RPSGB will have to standarise the marks somehow.

Well, at least theres abit more hope for prereg students.

Good luck to everybody.

For more articles and revision guide check out http://www.pharmacyknowledge.co.uk/

RPSGB Pharmacy Prereg exam results 2009

Congratulations to all the prereg students that took part in the pharmacy rpsgb exam today. This day, the 26th of June 2009 the last of the late nights studying, you can enjoy yourself now. Today is definitely a day to remember, not only did you take the exam of your life, Michael Jackson also died. At least you got a landmark occasion to remember it by. Now all you have to do is wait for the RPSGB Pharmacy Prereg exam results.

I still remember the day when I took the prereg exam, it was a mixture of relief and fear. Everybody will feel the same, everyone feels like "I definitely failed that exam" "the open book was too hard" "I spent too much time on calculations". Remember over 90% of students pass the prereg exam, could you really be part of that 10% that failed? I thought I failed, and in the end passed. You have to be truly confident to feel that you passed 100%.

Well, you have to wait 3 weeks before you can completely relax, before you can say "I'm a pharmacists". Good Luck to all pharmacy prereg students today, I hope you all pass.

RPSGB Prereg Exam Revision Books

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Alli fat pill for weightloss from GSK

Alli is the new fat pill from GSK that everyone is talking about, the next big thing to hit pharmacies since the morning after pill. Everyone wants Alli anti-fat and weight loss pill to get slim. Alli's active ingredient is Orlistat which has been available as Xenical (by Roche) on prescription for years.

Before a pharmacist can dispense Alli over the counter (OTC) the patient must meet some criteria:

- The patient is eligible to buy Alli if their Body Mass Index (BMI) is 28 or above.
-- BMI is worked out by ...
-- If your BMI is under 28 that means your are not overweight enough and Alli will do more harm than good.
- The patient must come and ask for the medication themselves.
-- This is so the pharmacists can make a judgement if the patient is telling the truth about their BMI.

Alli weight loss pill contraindications and interactions
- Malabsorption
- Hypersensitivity to orlistat
- Reduced gallbladder function (e.g. after cholecystectomy)
- Pregnancy and breastfeeding
- Use caution with: obstructed bile duct, impaired liver function, and pancreatic disease
- If you are on other medication please check which the pharmacist for interactions

Alli Side-effects
The main side effect of taking Alli is if they eat a fatty meal then their will be uncontrolled diarrhoea. Alli works by stopping/reducing the absorption of fat, therefore more of a percentage of the fat you eat will just pass through your system and is not absorbed. If you eat low fat meal then the fat that is not absorbed will mix with the stool and you will not get this side effect from Alli. If you eat a fatty meal e.g burger and chips, then the fat will just leak out, yes leak out! and this is uncontrollable. So before you take Alli make sure you are willing to start a low fat diet and are willing to stick to it.

The second significant side effect of Alli is Vitamin deficiency. As mentioned earlier Alli reduces the absorption of fat, however some vitamins are fat soluble (A, D, E, K), these fat soluble vitamins are usually absorbed with fat. Alli reduces the absorption of fats and therefore reduced the absorption of these vitamins. To counter this problem patients are encourage to take multivitamin tablets while on Alli.

Alli is not a magic pill for weight loss, it is clinically proven on prescription, and it does help, but like anything losing weight on Alli still requires hard work and dedication.

For more information on Alli check out http://pharmacyknowledge.co.uk/

Pharmacy RPSGB Exam - everyone keep calm

To all the pharmacy pre registration prereg trainees in the UK ready to sit the exam on June 26th. Everyone be prepared for the exam of your life. I know the pressure will be immense and all your 22 years of education come down to this moment. What you have to do is keep calm, check you've revised everything and don't panic.

Closed Book Exam:
Everyone initially thinks this one is gonna be the hardest, because you have nothing to refer to exept your brain. Actually it's easier than the Closed Book. If you've covered the material then it will come up, there aren't many suprises, you will see similar questions from what you've seen in past papers. The quantity of is double the practice exams, but this is an advantage, it actually means the questions you get wrong will count for less a percent. There will be more questions you know believe me.

Open Book Exam:
The open book is the hardest and pressurised exam you'll get. You know the answers are in front of you but you have no time to find them. Theres no way to prepare properly for it because they ask you questions that you will definetely need to look up. You just need to tag your BNF in the right places. Practice past papers and tag are you do them e.g theres always a question about infusions, interactions, etc. Tag as key chapters.

The calculations are also something that scares people. Some people have a natural talent in maths, and some don't. If you don't, then you need to work 5 times as hard to make sure you can get the RPSGB prereg calculations questions right, as you have to get 70% in this section otherwise you fail.

The night before the RPSGB Prereg Exam:
The night before the exam is the scariest of all. Just keep calm and try to absorb any extra informaiton that you can get, pay attention to details. Some people that live far away from the examination venue will book a hotel the night before, this mean you have no worries about travelling in the morning, and you can get a better nights sleep.

Hope this advice helps and good luck.

visit: http://www.pharmacyknowledge.co.uk/ for last minute revision guidance

RPSGB Laws: Responsible Pharmacist

Heres a round up on the new legal reguilations for the "responsible pharmacist" by the RPSGB:

Display a notice: The responisble pharmacist must display a notice with their name, registration number, and something that states that they are the responsible pharmacist in charge of the pharmacy.

Pharmacy record: A pharmacy record must be kept of the responsible pharmacist for any given day, the record must include: Name of responsible pharmacist, registration number, date and time of being responsible, date and time of stop being responsible, date and time of absence from the pharmacy including, the leaving work and entering. (This record must be kept by the pharmacy owner/superintendant for 5 years).

The responsible pharmacist must ensure standard operating procedures are being carried out correctly.

For more pharmacy information for students check our site RPSGB Prereg exam revision site

Sun Protection - Part 1 - Benefits, Risks, Photosensitivity

It is important to know about sun protection, skin disorders and treament required due to sunlight. As summer is coming up I thought it would be appropriate for this topic.

Benefits
Exposure to sunlight can improve skin disorders such as eczema and psoriasis. Sunlight can contribute to healthy skin and causes the body to produce vitamin D (which will aid calcium absorption allowing healthy bones and other calcium dependant mechanisms the body uses).


Risks
Sunlight can also be harmful, the main risk after exposure to sunlight is skin cancer. This is because sunlight is also electromagnetic radiation, UV radiation, which causes damage and react with the skin, and can lead to cancer.

Sunlight comes in different forms of radiation, the form of radiation that can cause sunburn is UVB.


Pigment protection
The pigment in the skin Melanin is responsible for stopping sunlight from getting deeper into the epidermis, and also mops up free radicals(free radicals are partly responsible for reacting with the skin and causing cancer).

Photosensitivy
Sunlight is also responsible for a number of photosensitive reactions, which are defined as adverse cutaneous reactions that occur when a drug or other agent is taken or applied and a person is exposed to UV radiation or visible light. Many drugs can react with sunligh with this outcome. A table from the PJ is shown at the top of the page listing the drugs which may cause photosensitivity. It is important to learn these as this is a common question that has come up in past papers of RPSGB pharmacy exam.

Photosensitive reactions can be phototoxic (causing damage) or photo-allergic (allergy like reactions).

Management of photosensitive reactions
- Finding the agent/drug which has cause the photosensitivity and removing it or avoiding sunlight if the medication has to be taken regualrly.
- Use topical corticosteroids or systemic steroids if the reaction is more severe.
- Use sunscreen and sunprotection.

Part 2 on treatments and sun protection/lotions will be posted soon

Pharmacy Recommended Reading update

Pharmacyknowledge.co.uk has now teamed up with amazon to give you easier access to the recommended reading and let you browse through our essential selection of books for the pharmacy RPSGB prereg exam and Amazon's full range of pharmacy and medical books.

check out the new recommended reading page at

http://www.pharmacyknowledge.co.uk/Books/Recommendedreading.htm

Past Exam question - Worked example 1

Regarding paracetamol, which one of the following statements is true?
A it has significant anti-inflammatory activity
B it inhibits cyclo-oxygenase (Cox) 1 and 2
C it is excreted largely unchanged by the kidneys
D it can be given by intravenous infusion
E it is contraindicated in pregnancy

A FALSE - Paracetamol does not have anti-inflammatory activity. Paracetamol has anti-pyretic activity (reduces fever, and temperature control), and can help with pain (mechanism not clear). NSAIDs not paracetamol have anti-inflammatory activiy

B FALSE - Paracetamol does not inhibit cyclo-oxygenase (Cox) 1 and 2 - This is also the activity of NSAIDs, not paracetamol

C FALSE - Paracetamol is changed by the kidneys

D TRUE Paracetamol can be given by intravenous infusion.

E FALSE Paracetamol is safe in pregnancy.

If anyone wants more details on the answers please comment and I will try my best to answer in more detail.

Pharmacy Prereg NHS Brief

The prereg exam is coming up, and I hope I can post as much useful information as I can to help leading up to the exam.

One part of the syllabus that everyone neglects is the part about the NHS roles and history ect. To pass the exam you need to give yourself every chance you can, that means revising everything (or as much as you can), don't leave anything out otherwise you'll regret it when it comes up. Make sure you read the NHS brief file from the RPSGB website.

NHS Brief contents:
- Responsibilities towards clients and society.
- NHS History
- Current NHS structure and Functions in ENGLAND
- Health Secretary
- Department of Health
- MHRA role
- NHS Connecting for health
- NHS Purchasing and Supply Agency
- Special Health Authorities
• Health Protection Agency (HPA)
• The NHS Institute for Innovation and Improvement
• Mental Health Act Commission
- NICE

If you can't find it on the RPSGB website then heres a link.... NHS Information Pack