level 3 osce revision notes complete PDF

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Summary

POM CounsellingCriteria How to do consultation Introduce yourself Hello my name is... today I am going to be giving you advice on your medication. Is that ok? Confirms identity of the patient Can I confirm that you are.. how old are you? Check if they have had the medication before So, here I have a...

Description

POM Counselling

Criteria

How to do consultation

1. Introduce yourself

Hello my name is… today I am going to be giving you advice on your medication. Is that ok? Can I confirm that you are…and how old are you? So, here I have a medication for you…..have you had it before and how long for.

2. Confirms identity of the patient 3. Check if they have had the medication before 4. Indication/mechanism of action 5. Dosage instructions

Do you know why you are taking this medicine? Read label. This drug is to be taken…

6. Checks if on any other prescribed meds/OTC products

Are you on any other medication? OTC/herbal etc?

7. States special warnings/precautions if applicable

Labels from the BNF and blue box

8. Monitoring requirements if applicable

10. Summarise consultation

Blood tests need to be done to minimise side effects OR monitor for pain There are side effects with this medicine that you need to be aware of they are…but don’t worry So to conclude….

11. Allows for questions

Do you have any questions?

9. States main side effects

DOMLS Dosage

OTC

Monitor

Label

Side effect

AZATHIOPRINE Indication  

Rheumatoid arthritis M/A it is a DMARD it reduces inflammation and slows down the progression of the disease

Dosage Confirm the dose on the bottle and tell patient how to use the medicine. E.g. how many times a day, when in the day



Label 21. Take with or just after food, or a meal. Small amount of food is enough. This is to reduce gastric irritation or absorb better

 

Special warning 

Causes bone marrow suppression. Any signs of unexpected bruising, bleeding or infection should be reported.

Monitoring   

Monitor for toxicity throughout treatment Initially, monitor weekly for 4 weeks. Once stable monitor every 3 months

Side effects (common and few)  

Bruising, bleeding, infection Tired, dizziness, nausea, vomiting, diarrhoea and fever

Storage 

Store in a cool dry place away from children

METHOTREXATE Indication

 

Rheumatoid arthritis M/A it is a DMARD it reduces inflammation and slows down the progression of the disease

Dosage   

Weekly dose. Take on the same day Folic acid? 3 days after methotrexate. This is to reduce S/E Confirm the dose on the bottle and tell patient how to use the medicine. E.g. how many times a day, when in the day. DOSE AND FREQUENCY

Label 

N/A

Special warning     

Blood count - causes bone marrow suppression. Reduced white blood cell or platelets. REPORT: Blood disorders: sore throat, bruising and mouth ulcers. REPORT: Liver toxicity: nausea, vomiting, abdominal discomfort, dark urine REPORT: Respiratory effects: shortness of breath, cough and fever. Discontinue if pneumonitis is suspected Aspirin and other NSAIDs shouldn’t be bought OTC. If prescribed them monitor carefully.

Monitoring   

Blood tests before starting treatment and repeated 1-2 weeks until stable Then monitor 2-3 months Report all symptoms and signs suggesting infection especially sore throat.

Side effects (common and few)   

Sore throat, bruising and mouth ulcers Nausea, vomiting, abdominal discomfort, dark urine Shortness of breath, cough

Storage 

Store in a cool dry place away from children

IBUPROFEN Indication 

Rheumatoid arthritis and pain



Anti-inflammatory

Dosage Confirm the dose on the bottle and tell patient how to use the medicine. E.g. how many times a day, when in the day



Label 21. Take with or just after food, or a meal. Small amount of food is enough. This is to reduce gastric irritation or absorb better

 

Special warning  

Gastro-intestinal events: associated with gastro-intestinal toxicity, the risk is higher in elderly Don’t buy other NSAIDs OTC. Seek advice

Monitoring 

N/A

Side effects (common and few)  

Nausea, diarrhoea, tummy aches headache, dizziness, drowsiness

Storage 

Store in a cool dry place away from children

MORPHINE/ OXYCODONE/ FENTANYL PATCH Indication 

Pain management

Dosage       

Confirm the dose on the bottle and tell patient how to use the medicine. MST-12 hourly so space out dose e.g. 9am and 9pm MXL-24 hourly so space out dose Immediate release 4 hourly Need form Breakthrough pain dose, one tenth – one sixth of the regular 24 hour dose Oxycodone generic. Oxynorm=immediate. Oxycontin=M/R

For fentanyl  

Apply to a dry area, remove after 72 hours and don’t use same area all the time C - Patients and carers should be informed about safe use, including correct administration and disposal, strict adherence to dosage instructions, and the symptoms and signs of opioid overdosage. Patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech, and patients and carers should seek prompt medical attention.

Label Morphine salts MST MXL

Label 2 2

Immediate Fentanyl Oxycodone Oxynorm Oxycontin

2 2 2 2 2

 

25 C – Swallow whole or open capsule and sprinkle contents on soft food C

25

2. Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol 25. Swallow this medicine whole. Do not chew or crush

Special warning   



Makes you sleepy Do not drink alcohol Fentanyl: fever or external heat: Monitor patients using patches for increased sideeffects if fever present (increased absorption possible); avoid exposing application site to external heat, for example a hot bath or sauna (may also increase absorption) Fentanyl: respiratory depression: Risk of fatal respiratory depression, particularly in patients not previously treated with a strong opioid analgesic; manufacturer recommends use only in opioid tolerant patients

Monitoring 

Monitor for pain relief and for respiratory depression in morphine

Side effects (common and few)  

Drowsiness/sleepy, nausea, vomiting, constipation and rarely dry mouth Shortness of breath

Storage 

Store in a cool dry place away from children

OLANZAPINE Indication  

Mental health disorder. It is an antipsychotic Say it according to the RX

Dosage 

Confirm the dose on the bottle and tell patient how to use the medicine. E.g. how many times a day, when in the day

Label 

2. Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

Special warning 

N/A

Monitoring  

    

Full blood count, urea and electrolytes, and liver function test monitoring is required at the start of therapy then annually thereafter. Blood lipids and weight should be measured at baseline, at 3 months (weight should be measured at frequent intervals during the first 3 months), and then yearly. Patient’s olanzapine require more frequent monitoring of these parameters: every 3 months for the first year, then yearly. Fasting blood glucose tested at baseline, after one months’ treatment, then every 4–6 months. ECG may be needed before initiating therapy BP monitoring before initiating therapy and frequently during dose titration of antipsychotic drugs. Monitor prolactin concentration at the start of therapy, at 6 months, and then yearly. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year.

Side effects (common and few) 

Constipation, dry mouth, drowsy, increase in appetite

Storage 

Store in a cool dry place away from children

LITHIUM (narrow therapeutic window) Indication  

Mental health disorder. E.g. mania, bipolar Say it according to the RX

Dosage   

Confirm the dose on the bottle and tell patient how to use the medicine. E.g. how many times a day, when in the day Do not overdose Stay on the same brand.

Label  

10. Warning: Read the additional information given with this medicine 25. Swallow this medicine whole. Do not chew or crush (for Camcolit 400 tabs)

Special warning 



  

Lithium treatment pack contains: information booklet, lithium card and record book. Lithium card – alter card (purple) carry it around always and present to healthcare professional treating you. Counselling – report signs and symptoms of lithium toxicity: tremor, muscle twitches, slurred speech and uncontrollable eye movement. If these potentially hazardous signs occur, treatment should be stopped, serum-lithium concentrations redetermined, and steps taken to reverse lithium toxicity. In mild cases withdraw lithium and ensure adequate hydration and correction of electrolyte imbalance. Maintain adequate fluid intake and avoid dietary changes which reduce or increase sodium intake May impair performance of skilled tasks like driving. Avoid NSAIDs or any drug that affects renal excretion

Monitoring 

Routine serum-lithium monitoring should be performed weekly after initiation and after each dose change until concentrations are stable, then every 3 months thereafter.

Side effects (common and few)

 

Report any signs of toxicity like: tremor. Muscle twitches, slurred speech and uncontrollable eye movement. GI disturbance (nausea, vomiting and diarrhoea)

Storage 

Store in a cool dry place away from children

CITALOPRAM Indication   

Mental health disorder. E.g. depression, panic disorder Say it according to the RX For elderly 20mg daily e.g. 65 years and over

Dosage Confirm the dose on the bottle and tell patient how to use the medicine. E.g. how many times a day, when in the day



Label 

N/A

Special warning  

SSRIs may also impair performance of skilled tasks (e.g. driving, operating machinery). Prolongs QT interval (MHRA}

Monitoring 

N/A

Side effects (common and few)  

GI disturbance (nausea, vomiting, abdominal pain, diarrhoea, constipation) Drowsiness, headache

Storage 

Store in a cool dry place away from children

AMITRIPTYLINE (COULD ALSO HAVE A PAIN INDICATION) Indication    

Depression or neuropathic pain Say it according to the RX 10mg at night for neuropathic pain 25-100mg initially for depression

Dosage  

Confirm the dose on the bottle and tell patient how to use the medicine. E.g. how many times a day, when in the day Dangerous in overdose

Label 

2. Warning: This medicine may make you sleepy. If this happens, do not drive or use tools or machines. Do not drink alcohol

Special warning 

Drowsiness may affect the performance of skilled tasks (e.g. driving); effects of alcohol enhanced.

Monitoring 

N/A

Side effects (common and few)    

Drowsiness, anxiety, dizziness, agitation, confusion, sleep disturbances, irritability Dry mouth, constipation Nausea, vomiting, taste disturbance Another side-effect to which the elderly are particularly susceptible is hyponatraemia (reduced salt, so, postural hypotension?) check pharmacy prac sess 4

Storage 

Store in a cool dry place away from children

Medication history There will be a list of drugs that need to be confirmed by the patient. There may be a missing sheet so confirm that with the patient and find out what it is. Go through the drugs in order. Ask/confirm how they take it and point out any special warnings. Do they know why they are taking it? Do Any reviews or monitoring? Ask if they have went if not why not? And explain the importance. Criteria

How to do consultation

1. Introduces self 2. Confirms identity of the patient

Hello my name is… Can I confirm that you are…and how old are you? Today I am going to be taking a history of your medications. Is that ok? Do you have any allergies at all? What happens and when was the last time it happened? Have you had any side effects from the medicines? If so what? Is this list your most up to date set of medication? Is there anything missing? Have you left any at home? Have there been in any changes to your medicines recently? Added/stopped/changed Do you know how to use your medication, and why you are using it? Do you get your blood tested/monitor/clinics? Last time/ next time? Do you buy any medicines OTC? Do you take any herbal medicines/ supplements/recreational drugs?

3. States purpose of consultation 4. Ascertains allergy status

5. Checks for ADR’s 6. Confirms whether source provided is the most recent/up to date 7. Identifies with the patient any missing info from the source provided 8. Checks for any recent changes; newly added/stopped/changed meds 9. Check’s for patient’s use of meds 10. Checks for any monitoring/clinics

11. Identifies if any OTC meds 12. Checks for herbal remedies/supplements/recreational drug use 13. Checks for any devices 14. Identifies any special requirements

Do you have any help with taking your meds like a medibox or reminder chart or any aids? Do you have a carer any special needs to help take your meds? E.g. large labels

Clinical check Be clear and clarify what the RED FLAG is and what the suggestions are. Think outside the box with suggestions for instance when talking about referral who to? Methotrexate and S/E of cough and SOB refer to respiratory specialist and test lung function. Maybe do a chest xray. If the patient has an ulcer as S/E who would treat it? Be clear and concise Criteria

How to do consultation

1. Introduces self 2. Purpose of the station

Hello my name is… Today I am going to discuss with you a problem that has come to my attention regarding … Can I just confirm the name and age of the patient please? There is a clinically significant problem… explain the problem The implication for the patient is…explain what would happen to the patient Explain how €the clinical significance comes about Is the prescriber aware of the clinical significance? Say what needs to be done make suggestions What do you think? Come to a conclusion

3. Confirm the patient 4. Explanation of the problem to the prescriber 5. Explanation of the implication of the problem for the patient 6. Awareness and communication of the ‘red flag’ problem 7. Proposal of possible solutions

8. Agreement with the prescriber of action to be taken

Musculoskeletal examination Criteria Basic communication skills 1. Greets patient and introduces self 2. Asks patient name and age 3. States washed hands 4. States the purpose of the history taking and gains consent

Exploration of the presenting complaint 1. Establishes presenting complaint 2. Onset-when did injury occur? 3. Mechanism of injury-how did injury occur? 4. Effect of daily activities 5. Able to weight bear immediately? 6. Pain on movement 7. Exacerbating and relieving factors 8. Any swelling present? How quickly did it occur? 9. Any clicking, locking or giving way of joint

How to do consultation

Hello my name is… What is your name and age? I have washed my hands Today I am going to be taking a history and performing an examination to find out what is wrong then give you some advice. Is that ok? Shall we begin? So what seems to be the problem? When did it happen? How did it happen? Which joint? Right/left Does it affect your daily activities? Were you able to put weight through it immediately? Could you pick things up? Is there any pain when you move it? Type/Severity Does anything make it better or worse? Have you tried anything? Is there any swelling? When did it occur and how quickly? If there any clicking, locking or giving way of joint? Have you injured the joint before? Do you have any concerns or ideas?

10. Previous injuries to the joint 11. Concerns/ideas of the patient Examination of the affected joint. Is it ok to begin the examination? 1. Asks patient to expose joint Can I please see the joint? Take of clothing or

shoe/socks 2. Observes joint for swelling, inflammation, deformities 3. Compares with unaffected side 4. Feels joint for tenderness, swellings, temp 5. Asks patient to move joint through full range 6. Assess function of affected joint Management advice 1. PRICE-Protect, Rest, Ice, Compress, Elevate 2. Avoid HARM- Heat, Alcohol, Running, Massage (for 72 hours)

3. Analgesia 4. Mobilisation 6. Recovery period/return if problems Impression...