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Scenario Tabs
In this scenario, a GP trainee seeks guidance from a pharmacist regarding a patient with type 2 diabetes and resistant hypertension. The pharmacist will conduct a thorough assessment and make recommendations for the next steps in medical management based on the patient’s history, symptoms, medications, contraindications, and interactions.
Please ensure that this scenario and mark scheme align with the most up-to-date UK NICE guidelines and the BNF when using it for your OSCE assessment.
A student pharmacist and an actor playing the role of a trainee doctor are required.
Hypertension
You are a pharmacist. A GP trainee has come to you for advice regarding a 60-year-old female patient with type 2 diabetes and resistant hypertension. Your task is to gather all necessary information through questioning the GP trainee and make a recommendation for the next steps in medical management.
To do
Gather essential patient details, including medical history, current medications, allergies, and lifestyle factors relevant to the scenario
Offer clear, evidence-based advice to the GP on potential next steps, including management options or further diagnostic testing.
You have 10 minutes.
You have access to the BNF.
You are GP Trainee Bob Smith (Bob, Smith).
Opening Statement: “I have a patient, a 60-year-old female with type 2 diabetes, who has resistant hypertension. I was hoping you would be able to provide some advice on what the next steps would be in terms of medical management”
Patient Information:
Provide information when prompted.
Patient demographics:
"Patient demographics are - Joanne Roberts (Jo-anne, Rob-urts), 60 years old, female, Caucasian, BMI 24.5."
Past medical history:
"Past medical history includes type 2 diabetes and resistant hypertension – she is at stage 2."
"She has never experienced any complications of her stage 2 hypertension, including malignant hypertension."
Current signs and symptoms:
“None.”
Medication history:
“Metformin 500 mg Tablets – One tablet twice daily.”
“Ramipril 10 mg tablet - once daily. This is the max dose.”
“Amlodipine 10 mg once daily. This is the max dose.”
“Indapamide 2.5 mg tablets once daily – again, the max dose.”
“Patient has never been put on any other antihypertensive medications in the past.”
“Patient sometimes takes paracetamol over the counter if she experiences a headache when required.”
Allergies
“None.”
Lifestyle:
“Patient is retired. They are an avid gardener.”
“They are a non-smoker; a non-drinker and they say they eat a balanced diet.”
If the pharmacist asks:
"Her average BP readings are 165/109, which have been consistent both at the surgery and at home."
"Her latest HbA1c is 45 mmol/mol, indicating well-controlled diabetes."
"Her QRISK score is 9%
“The patient has very good compliance with their medications and has never missed a dose.”
“Patient has not experienced any side effects of their medication.”
Any criteria marked in red must be met to pass this station.
Achieving at least 50% OR missing specific required marks.