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    MUR section 3

    Can somebody please HELP! I'm doing the MUR and I'm stuck at section 3.
    I failed once and not really sure where I went wrong. Any suggestions please, as I don't want to fail this a second time.
    Please see my answers and any comments would be very much appreciated!
    Thank you

    CASE 1

    Andy Patterson is a 15 year old boy with asthma. He has been receiving his medication for the last four years from your pharmacy. He and his mother both agree that an MUR would be a good idea. He agrees that his mother can be present.
    During the review he tells you that his breathing has become more difficult in recent months. He has previously demonstrated an accurate technique when using his inhalers and informs you that he regularly uses his 'preventer' and always carries his 'reliever' with him. His mum explains that he is not exactly a sporty boy and much prefers sitting at his computer.
    He has not taken any medicines purchased over the counter in recent months although his mum informs you that she does give him the odd paracetamol tablet if he complains of a headache.

    Quantities dispensed in 28 day period
    Medication Dosage 9/2/15 12/1/15 15/12/14 17/11/14 20/10/14 22/9/14
    Salbutamol 200mcg Accuhaler Inhale one dose when required 1 x 60 dose 1 x 60 dose 1 x 60 dose 1 x 60 dose 1 x 60 dose 1 x 60 dose
    Fluticasone Accuhaler 100mcg Inhale one puff twice a day 2 x 60 dose 2 x 60 dose 2 x 60 dose
    Oxytetracycline 250mg tablets Take two tablets twice a day 112 112 112 112 112 112

    a. Andy's PMR suggests he could be overusing the salbutamol 200mcg accuhaler. F
    b. According to the BTS guidelines, the next step in treating Andy's asthma would involve adding a long-acting beta agonist to his treatment regime. T
    c. When reducing the dose of inhaled corticosteroid, the dose should be decreased by up to 50% every month F
    d. According to the BTS guidelines, it is recommended that treatment be reviewed every three months and if control is achieved than a stepwise reduction of therapy may be possible. T
    e. You should advise the GP to increase the quantity of oxytetracycline to 168 tablets every 28 days. T

    CASE 2

    You are about to conduct an MUR with Abbie Cox, aged 18, whom you have known for a number of years. As a child she was diagnosed with juvenile arthritis and has been to your pharmacy to have her prescriptions for NSAIDs dispensed on a regular basis. The arthritis seems to be reasonably well controlled. However, the side-effects of the NSAIDs have required the addition of Peptac, and more recently, lansoprazole 30mg to her prescription. Recently she has been prescribed Logynon ED.
    Abbie arrives for the MUR in a very excited state showing you and everybody else in the pharmacy her recently acquired engagement ring. She also tells you that she is going on a tropical holiday with her fiancé and would like your advice. Last week she went to the private travel clinic to sort out vaccinations and antimalarials for the holiday and was told she would need to take either mefloquine or doxycycline. Abbie is concerned because one of her friends had 'some nasty side-effects' with mefloquine so she asks you if you think doxycycline would be suitable for herself. You decide to invite her for a prescription intervention MUR.

    Quantities dispensed in 28 day period
    Medication Dosage 9/2/15 12/1/15 15/12/14 17/11/14 20/10/14 22/9/14

    Voltarol Retard 100mg tablets Take one daily with food 28 28 28 28 28 28
    Lansoprazole Fastab 30mg Take one daily 28 28 28 28 28 28
    Peptac Take 10ml four times a day if necessary 500ml 500ml 500ml
    Logynon ED Take one daily 28 28 28 28 28 28

    a. You should inform the private travel clinic that Abbie is being prescribed Logynon ED. F
    b. All travellers should be informed about neuropsychiatric adverse reactions to mefloquine and if they occur they should seek medical advice on an alternative antimalarial before the next dose is due. T
    c. You should advise patients that doxycycline should be chewed before swallowing. F
    d. The advice in the BNF recommends that, wherever possible, NSAIDs should be withdrawn if an ulcer occurs. T
    e. If a patient develops an ulcer whilst taking a non-selective NSAID and the NSAID needs to continue, the ulcer should be treated with a PPI which should be continued at the same dose after healing. T