If you are a Foundation Year Pharmacist and need one-to-one support and training then we are here to help!

Drawing on the extensive experience held by our Lead Tutor, Dr Davies, we can support you with examination preparation and evidence submission.

We have a bank of GPhC questions at our disposal and the know-how as to where to find the answers in relevant reference texts (i.e. the BNF).

Here is a second example on our Blog page as to how we can help…

2. A 71 year old female patient comes into your pharmacy with a repeat prescription for her warfarin. She has been prescribed warfarin 1 mg tablets for a period of 3 weeks at a dose of one tablet per day. The patient’s GP has advised that her regular prescription for amiodarone be stopped and this change in therapy was undertaken 3 weeks ago. When collecting her warfarin prescription the patient complains of frequent nosebleeds. She is due to have her next blood test in 3 weeks time. Which one of the following is most appropriate in terms of patient advice?

a) Reduce the overall warfarin dose by taking 1 mg on alternate days

b) Nosebleeds are a common side effect from warfarin, provide management advice

c) The dose of warfarin may need to be increased and the patient should see her GP

d) The nosebleeds could be due to an interaction between warfarin and amiodarone. Book a GP appointment soon to discuss

e) Stop the warfarin immediately and book an appointment with the GP

The answer is d) The nosebleeds could be due to an interaction between warfarin and amiodarone. Book a GP appointment soon to discuss

The relevant section of the BNF is ‘Chapter 2: Cardiovascular System’ —> ‘Arrhythmias’ —> ’Anti-arrhythmic Drugs’ which states:

“Amiodarone hydrochloride has a very long half-life (extending to several weeks) and only needs to be given once daily.”

From that point, the Pharmacist would check the interaction between warfarin and amiodarone in the BNF and would find that:

“Amiodarine increases the anticoagulant effect of warfarin. Manufacturer advises monitor INR. Severe, study.”

Thus, although the amiodarone has been stopped 3 weeks ago there may still be some in the system as a result of the long half-life and this can therefore interact with the warfarin to potentiate the effect of the drug (i.e. nosebleed presentation). A discussion with the GP would be sensible to make a plan for the near-term future. Direct intervention by the Pharmacist (other that GP referral) would not be suitable.

If the Foundation Year, and all of the material contained within, feels overwhelming then why not book with Dr Davies today? Here, at www.pharmascholar.co.uk we know all of the standard questions posed by the GPhC and importantly how to handle them!