PEBC OSCE cheat sheet

Triage priority: red (immediate, life-threatening) > yellow (urgent, can wait 30-60 min) > green (non-urgent). Pharmacy emergencies: anaphylaxis, hypoglycemia, chest pain, stroke symptoms, severe asthma.

Red flags requiring emergency referral: chest pain radiating to arm/jaw, sudden weakness or facial droop, difficulty speaking, severe shortness of breath at rest, systolic BP >180 with symptoms, blood glucose <4 mmol/L with altered consciousness.

Symptom assessment framework: onset, location, duration, character, aggravating/relieving factors, timing, severity (0-10), associated symptoms, previous episodes, current medications, allergies.

Vital signs thresholds for referral: adult HR <50 or >120 bpm; RR <10 or >30/min; temperature >39.5°C or <35°C; SpO2 <92% on room air; systolic BP <90 or >180 mmHg.

Minor ailment triage exclusions (refer): symptoms >10 days without improvement, fever >38.5°C in adults or any fever in infants <3 months, pregnancy, immunocompromised, recent hospitalization, blood in stool/urine, unilateral leg swelling.

Pediatric dosing weight estimate: 1-12 years: weight (kg) = (age in years × 2) + 8. Use actual measured weight when available; do not exceed adult dose.

Pain assessment: use numeric rating scale (0-10) for adults; Wong-Baker FACES for children 3-8 years; FLACC for infants/non-verbal. Reassess 30-60 min after analgesic.

Allergy documentation: distinguish true allergy (urticaria, angioedema, anaphylaxis, bronchospasm) from intolerance (GI upset). Record reaction type and severity; never re-dispense a drug from the same class without verification.

Prescription legal requirements (Canada): patient name, drug name, strength, dosage form, quantity, directions, date, prescriber name and signature, prescriber identifier. Verify all before dispensing.

Therapeutic substitution vs. generic substitution: generic substitution replaces brand with equivalent generic (provincial formulary rules apply); therapeutic substitution changes to a different drug and requires prescriber authorization.

Dose verification: check against approved product monograph, patient age/weight/renal and hepatic function. Pediatric doses must be calculated by weight (mg/kg) and checked against maximum.

Renal dose adjustment: estimate CrCl using Cockcroft-Gault: CrCl (mL/min) = [(140 − age) × weight (kg)] / [0.814 × SCr (µmol/L)] × 0.85 if female. Adjust renally cleared drugs accordingly.

Prescription abandonment/refusal criteria: forged or altered prescriptions, prescriber not licensed in jurisdiction, dose exceeding recognized maximum without justification, duplicate therapy with interaction risk.

Controlled drugs (Canada): verify prescriber authority, check provincial monitoring program (e.g., PMP) for double-doctoring, confirm quantity and directions, follow jurisdiction-specific tamper-resistant prescription requirements.

Dispensing accuracy checks: verify drug, strength, dosage form, quantity, label directions, expiry date, and patient identity. Perform a final check against the original prescription before release.

Refill authorization: confirm remaining refills and prescription expiry. In Canada, most prescriptions expire 1 year from date written unless otherwise specified; narcotics/controlled drugs have shorter limits in some provinces.

Counselling structure (prime-check-close): open with what the patient already knows, provide key information (indication, administration, common side effects, when to seek help), confirm understanding via teach-back, close with follow-up plan.

Inhaler counselling: demonstrate and have patient demonstrate back. MDI: shake, exhale, seal lips, press and inhale slowly, hold breath 10 s, wait 30-60 s between puffs, rinse mouth after ICS. DPI: exhale away from device, forceful deep inhalation, do not shake.

Warfarin counselling: consistent vitamin K intake, avoid alcohol binges, report bleeding/bruising, use soft toothbrush, inform all providers, INR monitoring schedule, drug and food interactions (amiodarone, antibiotics, NSAIDs).

Antibiotic counselling: complete full course, take at prescribed intervals, common side effects (GI upset, diarrhea), report severe diarrhea (C. difficile risk), avoid antacids/dairy with certain agents (tetracyclines, fluoroquinolones).

Opioid safety counselling: take as prescribed, do not crush long-acting forms, avoid alcohol and benzodiazepines, risk of constipation (prophylactic laxative), signs of overdose (slow breathing, pinpoint pupils), naloxone availability.

Diabetes education: hypoglycemia symptoms and treatment (15 g fast-acting carbohydrate, recheck in 15 min), injection technique and site rotation, sick-day management, foot care, HbA1c target (usually ≤7%).

Teach-back method: ask patient to explain in their own words how they will take the medication and what they will do if a dose is missed. Confirms comprehension, not just recall.

Health literacy: use plain language, limit to 3 key points per session, avoid jargon, provide written materials at grade 6-8 reading level, use pictures where possible.

MTM core elements: medication reconciliation, comprehensive medication review, identification of drug therapy problems (indication, effectiveness, safety, adherence), intervention plan, documentation, and follow-up.

Drug therapy problem categories: unnecessary drug, needs additional drug, ineffective drug, dose too high, dose too low, adverse drug reaction, non-adherence.

Adherence assessment: use open-ended questions ("How many doses did you miss in the last week?"), pill counts, refill records (proportion of days covered). Non-adherence causes: cost, side effects, complexity, forgetfulness, beliefs.

Follow-up scheduling: acute conditions 3-7 days; chronic stable conditions every 3-6 months; new medication 1-2 weeks; high-risk drugs (warfarin, insulin, opioids) within 1 week or per monitoring plan.

Monitoring parameters: efficacy (BP, blood glucose, INR, lipid panel, symptom relief) and safety (renal function, liver enzymes, electrolytes, CBC). Set specific targets and review intervals.

Deprescribing principles: identify drugs with no ongoing indication, high risk of harm, or patient goals of care; taper rather than stop abruptly (benzodiazepines, PPIs, opioids, corticosteroids).

Medication reconciliation at transitions: obtain best possible medication history (BPMH) from at least two sources, compare with current orders, resolve discrepancies, communicate to next provider.

Adverse drug reaction reporting: report serious or unexpected reactions to Health Canada (Canada Vigilance). Document in patient record and counsel patient on future avoidance.

SBAR communication: Situation, Background, Assessment, Recommendation. Use for urgent prescriber calls and handoffs. Keep concise and include patient identifiers.

Collaborative practice: clarify roles and scope of practice with physicians, nurses, dietitians, and social workers. Pharmacists in Canada may have prescribing authority for minor ailments and renewals in some provinces.

Conflict resolution: address issues directly and privately, focus on patient safety, use "I" statements, escalate to supervisor or ethics committee if unresolved.

Documentation of interventions: record date, time, prescriber contacted, reason, recommendation, outcome, and follow-up plan in the patient record.

Referral communication: include reason for referral, relevant history, current medications, allergies, and specific question. Follow up to close the loop.

Cultural safety and humility: recognize own biases, use interpreters when needed, respect patient beliefs and preferences, involve family as patient wishes.

Team meetings and rounds: prepare concise patient summaries, highlight medication-related issues, propose actionable recommendations.

Consent: obtain informed consent for services; patient must be competent, informed of risks/benefits/alternatives, and voluntary. Minors: age of consent varies by province (e.g., 16 in some, mature minor doctrine applies).

Confidentiality: protect personal health information per provincial privacy laws (e.g., PHIPA in Ontario, PIPEDA federally). Disclose only with consent or as required by law (reportable diseases, child abuse, court order).

Conflict of interest: disclose gifts, incentives, or relationships that could influence professional judgment. Avoid accepting gifts that could compromise objectivity.

Scope of practice: practice only within competence and legal authority. Refer or consult when outside scope. Maintain competence through continuing education.

Record retention: retain prescription and patient records for the period required by provincial regulatory college (often 10 years from last entry; longer for minors).

Error disclosure: disclose medication errors to patient and prescriber promptly, apologize, document, and implement prevention strategies. Follow mandatory reporting requirements.

Professional boundaries: maintain appropriate therapeutic relationship; avoid dual relationships; do not exploit patient trust for personal gain.

Mandatory reporting: report impaired colleagues, incompetent practice, or unethical conduct to regulatory college as required by law.

Dose calculation: dose = (desired dose / stock strength) × stock volume. For weight-based: dose (mg) = dose (mg/kg) × weight (kg). Always convert units before calculating.

C1V1 = C2V2 for dilutions and concentration adjustments. Example: to make 500 mL of 1% solution from 10% stock: V1 = (1% × 500 mL) / 10% = 50 mL stock, add 450 mL diluent.

Alligation: ratio of parts = (higher % − desired %) : (desired % − lower %). Used for mixing two concentrations to achieve a target strength.

Body surface area (BSA): Mosteller formula: BSA (m²) = √[(height (cm) × weight (kg)) / 3600]. Used for chemotherapy and some pediatric dosing.

IV flow rate: drops/min = (volume (mL) × drop factor (gtt/mL)) / time (min). Infusion rate (mL/h) = volume (mL) / time (h).

Pediatric dose verification: calculate by weight or BSA, compare to adult dose, never exceed adult maximum. Check against pediatric references (e.g., Lexicomp, Harriet Lane).

Compounding: follow USP <795> (non-sterile) and <797> (sterile) standards. Verify calculations, use proper equipment, label with beyond-use date (BUD), and document ingredients and lot numbers.

Percentage concentrations: % w/v = g/100 mL; % w/w = g/100 g; % v/v = mL/100 mL. 1:1000 = 0.1%; 1:10,000 = 0.01%. Convert ratios to percentages before calculating.

Documentation standards: date, time, patient identifiers, reason for encounter, assessment, intervention, outcome, follow-up, and signature. Use objective, factual language; avoid subjective or judgmental terms.

Prescription record: retain original prescription or electronic record per provincial requirements (often 10 years). Include date dispensed, quantity, lot number, expiry, and pharmacist initials.

Medication error documentation: record what happened, when, who was involved, patient outcome, actions taken, prescriber notification, and prevention plan. Report to appropriate authorities.

Counselling documentation: note key points discussed, patient understanding (teach-back), and any barriers identified. Document refusal of counselling.

Privacy and access: patients have right to access their records. Provide copies upon request per provincial privacy law; redact third-party information if necessary.

Electronic records: ensure security, backups, audit trails, and access controls. Comply with provincial e-health standards and privacy legislation.

Adverse drug reaction documentation: record reaction, severity, date, suspected drug, action taken, and report to Health Canada if serious or unexpected. Flag patient profile.

Communication log: document all prescriber and patient communications, including date, time, method, content, and outcome.