Name: Medication Review 4
Creator: Leya Luhar
Keywords: Communication,Medicine Optimisation,Sexual Health,Women\\\\\\\\\\\\\\\'s Health

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Scenarios

By Leya Luhar • October 27, 2026 • Last reviewed: 2026-10-27 •

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Summary Expert

A patient attends a booked medication review with the pharmacist at her GP practice.

The student must review her medicines with her and agree a plan.

You will need a student pharmacist and an actor playing the patient for this scenario.

Revision Topics

Be aware, this may reveal any answers!

Student Instructions

Actor Instructions

This may reveal scenario objectives!

You are Rupinder Sandhu (ROO-pin-der, SAN-doo).

Opening statement: ‘Hello. The nurse said my blood pressure was fine last week, so hopefully this won’t take long.’

Patient information:

To be given if the student asks.

Name: Rupinder Sandhu
Date of Birth: 07/10/1978
Age: 48
Address: 27 Marwood Crescent, Leicester, LE4 6GX
Past medical history:
- ‘Just my blood pressure. I’ve been on tablets for it for about three and a half years.’
Medication history:
- ‘Amlodipine every morning for my blood pressure. I never miss it.’
  - How you are getting on with your amlodipine: ‘Fine. No swollen ankles or anything.’
  - Checking your blood pressure at home: ‘I don’t, I just come in to the nurse.’
- ‘Hay fever tablets when I need them in the summer.’
Allergies:
- ‘None that I know of.’
Symptoms:
- ‘Actually, while I’m here, can I ask you about something else? I’m having awful hot flushes. Everyone keeps saying I should use HRT, but the idea of it scares me.’
  - (Say this once the pharmacist has asked how you are getting on, or after about 30 seconds.)
- Hot flushes: ‘Several times a day, for about six months. I go bright red and have to leave the room.'
  - ‘I had to walk out of a meeting last week because I had a hot flush. I just want to feel like myself again.’
  - What you have tried: ‘I bought some black cohosh from the health food shop. It didn’t help, so I stopped it a month ago.’
  - Whether you have seen anyone about the flushes: ‘No, this is the first time I’ve mentioned it.’
- Night sweats: ‘I wake up soaked most nights.’
- Sleep and tiredness: ‘I’m shattered. I can’t remember the last time I slept through.’
- Mood: ‘I snap at everyone at home. That’s not me.’
- Memory and concentration: ‘I keep losing my words at work.’
- No other symptoms
Lifestyle factors:
- Smoking: ‘I don’t smoke and never have.’
- Alcohol: ‘A couple of glasses of wine at the weekend.’
- Exercise: ‘I swim twice a week.’
- Occupation: ‘I work in a school office.’
If the pharmacist asks further questions:
- Your periods: ‘They’ve been all over the place for about a year. My last one was about 3 months ago.’
- Heavy bleeding, bleeding between periods or after sex: ‘No. If anything they’re lighter.’
- Family history of breast cancer: ‘Not in my family. My husband’s sister had breast cancer a couple of years ago, and she’d been on HRT.’
- Family history of clots: ‘Not that I know of.’
- Contraception/chance of pregnancy: ‘My partner is transgender, so I can't get pregnant.'

Responses to the pharmacist:

What you would prefer:
- ‘I don’t mind really. I swim twice a week, though. Would a patch come off in the pool?’
- If the pharmacist explains the options: ‘A gel might suit me better, then.’ Accept whichever option you and the pharmacist agree.
If the pharmacist suggests the hormonal coil:
- ‘I’ve heard of that. If it does two jobs, I’d think about it.’
If the pharmacist says you cannot have HRT because of your blood pressure:
- ‘Oh. So I just have to put up with this?’
If the pharmacist mentions an interaction or problem with your tablets:
- ‘Oh, right.’ Then accept what they say.

Questions to ask the pharmacist: Ask only if the student has not already covered them.

‘But doesn’t HRT give you breast cancer? My husband’s sister got it.’
‘My friend at work had a clot in her leg on HRT. Could that happen to me?’

Acting notes:

Use everyday language.
If the student uses a term you would not understand: ‘Sorry, what does that mean?’
You are worried. Relax once your worries have been answered clearly.

Mark Scheme

Introduction

0 / 1

Introduces themselves by name and role, and confirms the patient’s identity using her full name and date of birth.

+1

Reviewing Her Medicines

0 / 1

Checks how she is getting on with her amlodipine: whether she takes it regularly and whether she has any side effects (for example ankle swelling).

+1

This is the booked task. Accept either question on side effects alongside one on adherence.

Clinical Reasoning

0 / 2

Explains that her symptoms, together with the change in her periods at her age, fit with the perimenopause.

+1

Recommends HRT as the most effective treatment for her hot flushes, while leaving the decision to her.

+1

BNF Menopause: “Oestrogen therapy is the most effective treatment for symptoms caused by low oestrogen and hormone fluctuations, particularly vasomotor symptoms.” and “Females aged 40 years and over with vasomotor symptoms should be offered systemic HRT.” Mentioning lifestyle measures or menopause specific CBT is acceptabale.

Agreeing the Treatment

0 / 4

Recommends oestrogen through the skin (patch, gel or spray) rather than tablets, and gives her BMI over 30 or her blood pressure as the reason.

+1

BNF Menopause: “The transdermal route is preferred in females aged over 60 years, and in individuals at increased risk of venous thromboembolism (VTE) such as those with a body mass index above 30 kg/m2.” and “Transdermal administration should also be considered for females who have poor symptom control with oral treatment, risk factors for cardiovascular disease”. Recommending the transdermal route without a reason linked to her does not earn the mark. Th

Explains that she also needs a progestogen because she still has her womb, to protect the womb lining.

+1

BNF Menopause: “In females with an intact uterus, a progestogen must be included in the HRT regimen to prevent endometrial hyperplasia and cancer.” Accept “a second hormone to protect the womb”.

Recommends a sequential regimen (progestogen for part of each month, giving a monthly bleed) because her last period was less than 12 months ago, or explains that a hormonal coil can provide the progestogen instead.

+1

BNF Menopause: “if the last menstrual period was less than 12 months ago (or less than 2 years in females with POI or early menopause), sequential HRT is used as continuous progestogen at this stage can lead to irregular bleeding and spotting.” and “Intrauterine levonorgestrel provides adequate endometrial protection for up to 5 years within HRT regimens”.

Describes at least two ways of taking the oestrogen (patch, gel or spray) or the progestogen, and asks which she would prefer, rather than choosing a product for her.

+1

BNF Menopause: “The choice of therapy is based on patient preference after a discussion of risks and benefits.”

Risks of HRT

0 / 2

Explains her breast cancer risk

+1

There is a small increase with combined HRT; it rises the longer HRT is taken and falls after stopping; it is lower with the sequential type she would start on; her sister-in-law is not a blood relative, so this is not a family history; her weight and alcohol also affect her risk.

Explains that the raised clot risk is with HRT tablets, and that oestrogen through the skin does not increase it.

+1

Plan and Safety Netting

0 / 1

Agrees a clear plan: she books with a GP to start HRT and sort out contraception, and the pharmacist passes on or records what they discussed.

+1

Communication

0 / 2

Acknowledges her specific worries or the effect on her life

+1

For example her fear after her sister-in-law’s cancer, or having to walk out of a meeting) before or while giving information.

Checks her understanding regularly

+1

Patient Safety

0 / 1

Gives safe advice throughout.

+1

Forfeited if the student: says HRT is suitable without screening for contraindications; recommends oestrogen without a progestogen; tells her HRT works as contraception or that she no longer needs contraception; recommends the combined pill; tells her she cannot have HRT because of her blood pressure and offers no plan; or recommends St John’s wort or another herbal product for her symptoms.

Referral Criteria

References

Joint Formulary Committee (2026a) British National Formulary: Amlodipine (interactions). London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/interactions/amlodipine/ (Accessed: 27 October 2026).
Joint Formulary Committee (2026b) British National Formulary: Cetirizine (interactions). London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/interactions/cetirizine/ (Accessed: 27 October 2026).
Joint Formulary Committee (2026c) British National Formulary: Estradiol. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/drugs/estradiol/ (Accessed: 27 October 2026).
Joint Formulary Committee (2026d) British National Formulary: Ethinylestradiol with levonorgestrel. London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/drugs/ethinylestradiol-with-levonorgestrel/ (Accessed: 27 October 2026).
Joint Formulary Committee (2026e) British National Formulary: Menopause (treatment summary). London: BMJ Group and Pharmaceutical Press. Available at: https://bnf.nice.org.uk/treatment-summaries/menopause/ (Accessed: 27 October 2026).
National Institute for Health and Care Excellence (2026) Menopause: identification and management (NICE guideline NG23). Available at: https://www.nice.org.uk/guidance/ng23 (Accessed: 27 October 2026).
NHS (2023) Side effects of sequential combined hormone replacement therapy (HRT). Available at: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/sequential-combined-hormone-replacement-therapy-hrt-tablets-and-patches/side-effects-of-sequential-combined-hormone-replacement-therapy-hrt/ (Accessed: 27 October 2026).
NHS (2026) Symptoms of menopause and perimenopause. Available at: https://www.nhs.uk/conditions/menopause/symptoms/ (Accessed: 27 October 2026).

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