OSCE POM Counselling PDF

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Summary

Diseased Systems: Central Nervous And Musculo-Skeletal Systems MPH322...

Description

POM COUNSELLING Introduction 1. Introduce self 2. Confirm name and age of patient 3. Explains procedure 4. Consent 5. Ensures patient privacy and dignity / wash hands 6. Confirm name, strength and dose of medication

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Hi my name is ….. and I am a third year pharmacy student at the UoS Can I confirm your name and age please Today I am just going to give you some advice about your medication. Is that okay? Anything said in this room will remain confidential Can I confirm you know the name, strength and dose of this medication

Starting Point 1. How long have you been taking this medication for? 2. Is the first time you have been prescribed this medication? 3. Why are you taking this medication ?

Medication Counselling 1. Dose : E.g 7.5mg weekly titrated up to a max of 20mg 2. MOA : How does the drug work , must explain in patient friendly language e.g. opioid blocks pain signals 3. Monitoring Requirements: e.g. what monitoring tests need to be carried out , make sure the patient is aware of these 4. Side Effects / Symptoms to report: e.g. for methotrexate they would need to report any unexplained bruising . 5. Any Additional information : e.g interactions , treatment booklets , counselling points

Conclusion 1) Clarify the patients understanding and ask if they have any questions 2) Close consultation and thank the patient

DMARDS

Methotrexate

Had before? Indication MOA Dose

Have you had this medication before? Tolerating ok? Rheumatoid Arthritis This is not a pain killer, but reduces inflammation and decreases your RA progression and symptoms Initially 7.5mg ONCE WEEKLY adjusted according to response – max. 20mg once weekly 1. Take X tablets all together at the SAME  TIME ONCE A WEEK Key Point: Methotrexate is a once weekly dose , with all the tablets take at the same time once a week

Monitoring

Side effects/symptoms to report

1. Check patient has had blood, liver and kidney tests before starting treatment? 2. Make patient aware as this is a new drug you will need regular monitoring at the beginning of the treatment, blood tests should be taken every 1-2 weeks until you are stabilised on methotrexate, then 2-3 monthly thereafter. STOP taking the medication and speak to your GP immediately if you experience any of these symptoms: 1-Any sore throat, unexplained bruising, mouth ulcers ( BLOOD DISORDERS) 2-Any nausea and vomiting, dark urine, abdominal discomfort (LIVER TOXICITY) 3-Any Shortness of breath, cough, fever (PULMONARY TOXICITY) Key Point: You must counsel the patient on symptoms of possible toxicity (pass/ fail element)

Additional Information/counselling

Ask patient

1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Has folic acid been prescribed? Take on a different day to MTX (Once Weekly dose on a different day to methotrexate) 4. Avoid  buying over-the-counter medicines such as aspirin or ibuprofen as they will increase the amount of methotrexate in your blood 5. Ask to see or give patient a purple MTX booklet: information, doses, test results 1. Was everything I said clear? 2. Do you understand what I have told you? 3. Do you have any other questions 4.SUMMARISE CONSULTATION CLOSE CONSULTATION AND THANK PATIENT

DMARDS

Azathioprine

Had before?

Have you had this medication before?

indication MOA Dose Monitoring

Side effects/ symptoms to report

Additional Information/counselling

Ask patient

Rheumatoid Arthritis This is not a pain killer, but reduces inflammation and decreases your RA progression and symptoms such as pain and swelling 1-3mg/kg daily adjusted according to response 1. Check patient has had blood, liver and kidney tests before starting treatment? 2. Make patient aware as this is a new drug you will need regular monitoring at the beginning of the treatment, blood  tests should be taken every week for first 4 weeks until you are stabilised on azathioprine, then 3  monthly STOP taking the medication and speak to your GP immediately if you experience any of these symptoms: -Any unexplained bruising or bleeding, or infection (BONE MARROW SUPPRESSION) -Dizziness, rash, or fever (HYPERSENSITIVITY REACTION) 1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Take with or just after food or a meal 4. Take ONCE a day at the same time of the day 1. Was everything I said clear? 2. Do you understand what I have told you? 3. Do you have any other questions 4.SUMMARISE CONSULTATION CLOSE CONSULTATION AND THANK PATIENT

DMARDS

Sulfalazine

Had before?

Have you had this medication before?

Indication MOA Dose

Monitoring

Side effects/ symptoms to report

Additional Information/counselling

Ask patient

Rheumatoid Arthritis This is not a pain killer, but reduces inflammation and decreases your RA progression and symptoms such as pain and swelling 1) Initially 500  mg daily, 2)increased by 500 mg at intervals of 1 week 3) Max of 2–3  g daily in divided doses 1. Check patient has had blood, liver and kidney tests before starting treatment? 2. Make patient aware as this is a new drug you will need regular monitoring at the beginning of the treatment, blood tests and liver tests should be taken every month for 3  months until you are stabilised on sulfalazine STOP taking the medication and speak to your GP immediately if you experience any of these symptoms: -Any unexplained bruising or bleeding -Any sore throat, fever, purple rash (BLOOD DYSCRASIA/DISORDERS) 1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Do not indigestion remedies 2 hours before or after you take this medicine 4. This medicine may colour your urine. This is harmless 5. Swallow this medicine whole. Do not chew or crush 6. Contact lenses may be stained 1. Was everything I said clear? 2. Do you understand what I have told you? 3. Do you have any other questions 4.SUMMARISE CONSULTATION CLOSE CONSULTATION AND THANK PATIENT

OPIOIDS

Morphine (Modified Release)

Had before?

Indication MOA Dose (MR) Starting dose:

 ST Continus, Zomorph, 12 hourly – M Filnarine, Morphgesic 24 hourly - MXL Have you had this medication before?

Point you must know if they have had the medication before If they say are taking morphine you must clarify what brand they are takin Moderate to severe pain They work by reducing pain by blocking pain signals Patient specific, adjusted according to response , however if just starting : Starting dose: *20-30mg daily for opioid-naïve patients *40-60mg daily for patient switched from weak opioid e,g codeine ,dihydrocodeine 12 hourly– Take every 12 hours at the SAME TIME each day (TWICE DAILY MST ,Zoromorph, filnarine Morphegesic

Monitoring

Side effects/ symptoms to report

Additional* Information/counselling

24 hourly – Take every 24 hours at the SAME TIME each day (ONCE DAILY) MXL 1. The patient should be closely monitored for pain relief - If your pain is uncontrolled go back to see your GP rather than self-medicate 2. Advise patient to report any signs of breathlessness (RESPIRATORY DEPRESSION) STOP taking the medication and speak to your GP immediately if you experience any of these symptoms: - Any signs of breathlessness (RESPIRATORY DEPRESSION) -. Other possible side effects include constipation, nausea and vomiting 1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Swallow this medicine whole. Do not chew or crush 4. Can take paracetamol with morphine if pain is not controlled 5. Morphine is a CD, so store this medicine out of reach of children 6. Return leftover tablets to the pharmacy for disposal 7. Avoid driving or using tools/machines if affected by drowsiness 8. Avoid alcohol while taking this medicine

OPIOIDS

MORPHINE (Immediate Release) – Sevredol, Oramorph

Had before? Indication

Have you had this medication before? Moderate to severe pain Point you must know if they have had the medication before If they say are taking morphine you must clarify what brand they are taking

MOA Dose (IR)

They work by reducing pain by blocking pain signals Patient specific, adjusted according to response , however if just starting : Starting dose: *20-30mg daily for opioid-naïve patients *40-60mg daily for patient switched from weak opioid e,g codeine ,dihydrocodeine 4 Hourly – Take every 4 Hours when required for pain

Monitoring

Side effects/ symptoms to report

Breakthrough Pain Normally 1/10 to 1/6 of the regular 24 hour dose. 1. The patient should be closely monitored for pain relief - If your pain is still uncontrolled go back to see your GP rather than self-medicate 2. Advise patient to report any signs of breathlessness (RESPIRATORY DEPRESSION) STOP taking the medication and speak to your GP immediately if you experience any of these symptoms: 1. Advise patient to report any signs of breathlessness (RESPIRATORY DEPRESSION) 2. -. Other possible side effects include constipation, nausea and vomiting

Additional Information/counselling

Ask patient

1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Morphine is a CD, so store this medicine out of reach of children 4. Return leftover tablets to the pharmacy for disposal 5. Avoid driving or using tools/machines if affected by drowsiness 6. Avoid alcohol while taking this medicine 1. Was everything I said clear? 2. Do you understand what I have told you? 3. Do you have any other questions 4.SUMMARISE CONSULTATION CLOSE CONSULTATION AND THANK PATIENT

OPIOIDS

OXYCODONE - (Modified Release) - Oxycontin, Targinact - (Immediate Release) – Oxycodone, OxyNorm

Had before?

Have you had this medication before? Point you must know if they have had the medication before must clarify what brand they are taking

Indication MOA Dose

Moderate to severe pain They work by reducing pain by blocking pain signals Patient specific, adjusted according to response (MR) – Initially 10mg every 12 hours (IR) – Initially 5mg every 4-6 hours

Monitoring

1. The patient should be closely monitored for pain relief - If your pain is still uncontrolled go back to see your GP rather than self-medicate 2. Advise patient to report any signs of breathlessness ( RESPIRATORY DEPRESSION) STOP taking the medication and speak to your GP immediately if you experience any of these symptoms:

Side effects/ symptoms to report

Additional Information/counselling

OPIOIDS

- Any  signs of breathlessness ( RESPIRATORY DEPRESSION) -. Other possible side effects include constipation, nausea and vomiting 1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Swallow this medicine whole. Do not chew or crush (Oxycontin, Targinact) 4. CD, so store this medicine out of reach of children 5. Return leftover tablets to the pharmacy for disposal 6. Avoid driving or using tools/machines if affected by drowsiness 7. Avoid alcohol while taking this medicine

FENTANYL

Had before?

Have you had this medication before? Point you must know if they have had the medication before must clarify what brand they are taking

Indication MOA Dose

Severe chronic pain, breakthrough pain They work by reducing pain by blocking pain signals Patient specific, adjusted according to response Initial dose one 12 or 25mcg/hour patch replaced after 72 hours

Monitoring

Side effects/ symptoms to report

Additional Information/counselling

How to apply patch

Ask patient

1. The patient should be closely monitored for pain relief - If your pain is still uncontrolled go back to see your GP rather than self-medicate 2. REMOVE patch and speak to your GP immediately if you experience any of these symptoms: -Any signs of marked drowsiness, confusion, dizziness, or impaired speech, fever (OPIOID OVERDOSAGE) -Any signs of breathlessness (RESPIRATORY DEPRESSION) - Other possible side effects include constipation, nausea and vomiting 1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Can take additional breakthrough doses of morphine with patches if pain is not controlled 4. CD, so store this medicine out of reach of children 5. Return leftover tablets to the pharmacy for disposal 6. Avoid driving or using tools/machines if affected by drowsiness 7. Avoid alcohol while taking this medicine 1. To the area of skin where you are going to apply patch to avoid exposure to external heat such as a bath or sauna 2. Apply patch to a non-hairy/non-irritated flat surface on the skin 3. Skin should be cleaned with water only and the skin should be completely dry before the patch is applied 4. Apply a new patch every 72 hours 5. Previous patch should be removed before applying a new one 6. The new patch should be applied to a different area of skin after removing the previous patch 1. Was everything I said clear? 2. Do you understand what I have told you? 3. Do you have any other questions 4.SUMMARISE CONSULTATION

NSAIDS

IBUPROFEN

Had before? Confirm indication/what is it for? MOA

Have you had this medication before? Mild to moderate pain

Dose

They work by reducing pain by blocking pain signals and reducing inflammation Reiterate dose – specific to indication Normally 300-400mg 3-4 times daily

Monitoring

Side effects/ symptoms to report

Max daily dose is 2.4g ELDERLY – NSAIDS should be used in caution as risk of serious side effects ASTMATICS – usually not recommended for asthmatics STOMACH PROBLEMS – NSAIDS ↑ risk of GI bleeding , report any serve stomach pain, blood in the stool 1. Renal Failure ● may be provoked by NSAIDS ● NSAIDs should be avoided in patients with renal impairment 2. Liver Failure ● may be provoked by NSAIDS ● NSAIDs should be avoided in patients with liver impairment as there is an increased risk of -Other possible side effects are stomach upset and diarrhoea

Additional Information/counselling

Ask patient

1. Are you taking any other medicines/OTC drugs? 2. Any allergies? 3. Take with or just after food or a meal 4. You don’t need to space the doses every 8 hours apart, take three times a day, so take after breakfast, lunch and tea 5. Avoid taking any other over-the-counter medicines that contain ibuprofen such cold and flu medicines 1. Was everything I said clear? 2. Do you understand what I have told you? 3. Do you have any other questions 4.SUMMARISE CONSULTATION CLOSE CONSULTATION AND THANK PATIENT

SSRI

CITALOPRAM

Had before? Confirm indication/what is it for? MOA

Have you had this medication before? Low mood (Depression)

Dose

Monitoring

Works by stabilising your mood by blocking certain chemicals being reuptaken DEPRESSION Starting dose normally 20mg once daily Increased in intervals of 20mg at 3-4 week intervals Max dose is 40mg once daily Panic disorder Starting 10mg and increase via 10mg at 3-4 week intervals (max dose the same). 1. Should  be going to see your GP every 1-2 weeks at the beginning of treatment (for at least 4-6 weeks) 2. Where necessary patients should be monitored for suicidal behaviour, self-harm and hostility particularly at the beginning of treatment or if the dose has changed 3. Carefully monitor in under 18s due to increased risk of hostility / suicidal thoughts

Side effects/ symptoms to report

STOP taking the medication and speak to your GP immediately if you experience any of these symptoms: -excess drowsiness, confusion or fits (HYPONATREMIA) – however, these are rare so it’s not really anything to worry about it’s just so that you know to go see your GP if it does happen. - rash, (HYPERSENSITIVITY REACTION)

Additional Information/counselling

-May cause nausea, vomiting, and constipation 1. Do not stop taking this medication unless your doctor tells you to do so. If your doctor does decide to stop the medication it should be a gradual reduction over 4 weeks can get headaches, nausea 2. NSAIDs increase risk of GI bleeding must inform the pharmacist or counter assistant before buying anything over the counter particularly things like ibuprofen as there is an increased risk of stomach problems with this combination of drugs 3. In the first couple of weeks it can sometimes increase your symptoms of low mood however after 2-4 weeks this should no longer be the case and symptoms will begin to improve 4. It may make you sleepy, so don’t drive or operate tools or machinery

TCA

AMITRIPTYLINE

Had before? Confirm indication/what is it for?

Have you had this medication before? 1. Low mood (Depression) 2. Pain - your patient information leaflet may tell you that this drug is used for other things however, at this dose it is used for pain. (neuropathic) 1. Works by stabilising your mood 2. They work by reducing pain by blocking pain signals. Reiterate dose – specific to indication Depression - 75mg once daily is the normal dose (Up to 150-200mg) Neuropathic pain – 10mg initially up to 75mg (higher if prescribed by specialised) Usually taken at night 1. Should be going to see your GP every 1-2 weeks at the beginning of treatment (for at least 4-6 weeks) 2. Where necessary patients should be monitored for suicidal behaviour, etc. at the beginning of treatment or if the dose has changed STOP taking the medication and speak to your GP immediately if you experience any of these symptoms:

MOA Dose

Monitoring

Side effects/ symptoms to report

-Drowsiness, confusion or any fits ( HYPONATREMIA) – however, these are rare so it’s not really anything to worry about it’s just so that you know to go see your GP if it does happen. - May cause dry mouth, blurred vision, constipation and you may find it difficult to pass urine. Due to this they should be avoided in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention or glaucoma

Additional Information/counselling

-May cause a change in weight, blood sugar levels and appetite 1. Treatment should be continued for at least four weeks (6 weeks in the elderly) before considering switching to another antidepressant due to lack of efficacy – in partial response continue for a further 2-4weeks before changing drug 2. It may take 2-4 weeks for you will see any beneficial effects with this drug so in the meantime persist with therapy, symptoms will begin to improve in a maximum of 4 weeks 3. Do no stop taking unless your doctor tells you to do so, If your doctor does decide to stop the medication it should be a gradual reduction over 4 weeks. Withdrawal effects are nausea, GI disturbance, headache 4. In the first couple of weeks it can sometimes increase your symptoms of low mood however after 2-4 weeks this should no longer be the case and symptoms will begin to improve

5. It may make you sleepy, so don’t drive or operate tools or machinery 6. Do not drink alcohol whilst on this medication

Anti-psychotic

OLANZAPINE

Had before? Confirm indication/what is it for?

Have you had this medication before? Low mood (depression) Mania Schizophrenia Works by stabilising your mood Reiterate dose – specific to indication Max dose is 20mg daily Dose range 5-20mg daily 1. Your blood pressure, pulse should be checked before starting this medicine, then taken regularly after that