POM MPH327 - Summaries and Peparation notes for OSCE station - POM Counselling PDF

Preview

Summary

Summaries and Peparation notes for OSCE station - POM Counselling ...

Description

Steroid Hydrocortisone *** MOA

Prednisolone (Long term)** ***

Prednisolone (Short term)

To help control inflammatory and allergic conditions such as asthma, COPD, rheumatoid arthritis, colitis and Crohn’s disease

Monitoring Regular review to see how well the medicine is working **Body weight, BP, glucose level S/E

Additional

Short & long term: Insomnia, mood disturbances (early treatment), GI disturbances Long term: Increase infection risk, severe back pain (osteoporosis), weight gain (fluid retention), skin changes eg. easy bruising Muscle wasting for hydrocortisone 1. Should be taken in the morning with food / after breakfast 2. Do not stop taking it unless your GP tell you to do so. Long term: 1. You will be given a 'steroid treatment card' which says that you are on steroids and contains some important advice for you. It is important that you read this card and carry it with you at all times 2. Do not stop it suddenly as it will cause your symptoms more serious, you may need to reduce the dose gradually. 3. If you buy any medicines, check with your pharmacist that they are suitable for you to take with prednisolone 4. It can suppress your immune system, so it is important if you become ill that you make an appointment to see your doctor straight away. Also, if you come into contact with anyone who has measles / chickenpox, you must see your doctor as soon as possible. 5. If you are having an operation or dental treatment or any treatment for an injury, tell the person carrying out the treatment that you are taking prednisolone and show them your treatment card. This is because your dose may need adjusting 6. Calcium intake

Thyroid disorder Carbimazole (Hyperthyroidism)

Levothyroxine (Hypothyroidism)

MOA

It works by reducing the amount of thyroid hormones made in your thyroid gland

Used to replace the thyroxine that your thyroid gland cannot produce and prevent the symptoms of hypothyroidism

Monitorin g

Regular blood tests to see how well the medicine is working TFT at 4-6 months and once stable then annually

S/E

Stomach upset, nausea, taste disturbance, headache Itch & rash - can be treated with antihistamines without stopping it

GI disturbances, weight loss, muscle cramps / weakness, headache, flushing Report immediately: Very high temperature, fast heart rate, irregular heartbeat, low blood pressure, heart failure, confusion (Severe reaction to high levels of thyroid hormone)

Additional

1. 2.

Can be taken before / after meal Report immediately if sore throat, mouth ulcers, bruising, fever, sign of infections occurs (bone marrow suppression)

1.

Should be taken 30 minutes before breakfast, caffeine containing liquids or other drugs 2. Antacids (Gaviscon) -relieve heartburn/digestion / Ironcontaining medication (Ferrous Sulphate): at least 4 hours apart

Metformin (biguanides) MOA

Monitorin g

Lowers blood sugar level by improving the way your body handles insulin (reduces amount of sugar your liver releases into your body & makes your body respond better to insulin) For type 2 diabetes, especially in overweight patients • Renal function test before treatment and at least annually (TWICE a year in patient with additional risk factors for renal impairment, or if deterioration suspected) • Regular blood test

S/E

Nausea and vomiting, GI disturbances like diarrhoea, abdominal pain. (goes away in two weeks)

Additional

1. MR: Take with or just after food, or meal & Swallow this medicine whole. Do not chew or crush 2. IR: Take with or just after food, or meal. 3. May cause lactic acidosis (imbalance pH level in body) symptoms: severe nausea and vomiting, rapid breathing, feeling cold. Stop taking and go to hospital immediately. 4. For sachets, dissolve or mix with water and taken immediately Exenatide (Glucagon- like peptide- 1 receptor agonists)

MOA

Lower blood glucose level

Monitoring Monitor patient HbA1c level with 6 months. S/E

Nausea and vomiting, GI disturbances like diarrhoea or constipation, weight loss. Report: Signs and symptoms of pancreatitis such as abdominal pain, nausea and vomiting.

Additional

1. 2. 3. 4.

Inject before one hour of mealtime. For other oral medication, take at least 1hour before or 4hours after exenatide injection. (separation of administration) If a dose is missed, continue the next dose without injecting after the meal. MAKE SURE PATIENTS KNOW HOW TO USE THE INJECTIONS.

Gliclazide (Sulfonylureas) and Tolbutamide (Sulfonylureas) MOA

Lowers blood sugar level by increasing the amount of insulin your body produces.

Monitorin g

S/E

Additional

Pioglitazone (Thiazolidinediones)

Patient with high cardiovascular risk should be closely monitored. Treatment should be stopped when it shows signs of heart failure. LFT annually Risk of bladder cancer. Nausea and vomiting, GI disturbances like diarrhoea or constipation, Weight gain

Common: Weight gain, oedema, GI and visual disturbances, headache and dizziness

Low risk of hypoglycaemia, symptoms: headache, hunger, confusion, dizziness and drowsiness

Liver dysfunction symptoms: dark urine, fatigue and vomiting, abdominal pain. Seek medical attention.

1. MR: Swallow this medicine whole. Do not chew or crush. 2. Be careful when driving or doing skilled tasks due to the side effects and avoid hypoglycaemia. 3. Carry some sweets or fruit juice if hypoglycaemia happens. Sitagliptin (Dipeptidylepeptidase -4 inhibitor)

MOA

Lower blood glucose level

Monitorin g

Liver and renal function test are required. Blood glucose test

S/E

GI disturbances like diarrhoea or constipation, headache, Peripheral oedema (swelling usually lower limbs) Report: Severe and persistent abdominal pain

Dapagliflozin (Sodium glucose co-transporter 2 inhibitor)

GI disturbances like constipation, headache, risk of urinary infection, pain/ difficult urination Report: DKA symptoms (rapid weight loss, nausea/vomiting, abdominal pain, fast and deep breathing, sweet sweet/metallic taste in mouth)

Contraceptive COC Monitoring: BP S/E: headache/migraine, nausea, breast tenderness, mood changes (if these do not stop within a few months, change the type of COC) Report immediately: swelling of one leg, pain or tenderness in the leg which may be felt only when standing or walking (DVT) 1. 2. 3. 4. 5. 6. 7.

First course start on FIRST day of menstruation, any later than day FOUR use further contraception for seven day. Future packets will all be started on the same day of the week as the first packet, following a strict 28-day cycle. Take at the same time each day. If you want to change from a different type of contraceptive, start new pill without a break. If you vomits within two hours of taking a pill should ideally take another one as soon as possible. If you experience vomiting or diarrhoea for more than 24 hours is to follow the same advice as if they had missed pills. If the illness occurs while taking last 7 tablets, omit any pill-free period and start the next cycle immediately If more than seven pills are missed, the woman should start again as if starting for the first time.

Missed Pill Rule: More than 24 hours / less than 48 hours (One pill missed) • The last pill missed should be taken now, even if it means taking two pills in one day. • The rest of the pack should be taken as usual. • No additional contraception is needed. • The seven-day break is taken as normal. • Emergency contraception is not needed if just one pill has been missed. However, it should be considered if other pills have been missed recently, either earlier in the current packet, or at the end of the previous packet More than 48 hours / two or more pill missed • The last pill missed should be taken now, even if it means taking two pills in one day. • Any earlier missed pills should be left. • The rest of the pack should be taken as usual and additional precautions (eg, condoms or abstinence) should be taken for the next seven days. • The next step then depends on where in the packet the pills are missed: • If the pills are missed in the first week of a pack (pills 1-7): emergency contraception should be considered if the patient had unprotected sex in the pill-free interval or the first week of the pill packet. She should finish the packet and have the usual pill-free interval. • If the pills are missed in the second week of a pack (pills 8-14): there is no need for emergency contraception as long as the pills in the preceding seven days have been taken correctly. The packet should be finished and the usual pill-free interval taken.

• If the pills are missed in the third week of a pack (pills 15-21): the next pack of pills should be started without a break - ie the pill-free interval is omitted. If taking a packet with dummy/placebo pills, these should be discarded, and the new packet started. Emergency contraception is not required. Qlaira® 1. Should start on Day 1, additional precautions should be used for nine days. Missed Pill Rule: • If the missed pill is less than 12 hours late, the pill should be taken immediately. Further pills should be taken as usual. Emergency contraception is not needed. • If the missed pill is more than 12 hours late, advice depends on where in the cycle it was missed: REFER TO PIL • Day 1-17: take the missed pill immediately and the next pill as usual. (Even if this means taking two pills on the same day. Do not take MORE than two pills on the same day.) Continue the packet. Use additional contraceptive measures (eg, condoms) or abstain from sexual intercourse for nine days. • Day 18-24: discard the rest of the current packet. Start the next packet immediately. Use ;n contraceptive measures (eg, condoms) or abstinence for nine days. • Day 25-26: take the missed pill immediately and the next pill at the usual time. (Even if this means taking two pills on the same day. Do not take MORE than two pills on the same day.) Additional contraceptive precautions are not necessary. • Day 27-28: discard the forgotten pill, and continue taking pills in the usual way. Additional contraceptive precautions are not necessary. • If pills have been missed and no withdrawal bleed occurs at the end of the packet, pregnancy should be excluded. • Pregnancy and emergency contraception should be considered if more than one pill is missed. Zoely® Missed Pill Rule: • If the missed pill is less than 12 hours late, the pill should be taken immediately. Further pills should be taken as usual. Emergency contraception is not needed. • If the missed pill is more than 12 hours late, the advice depends on where in the cycle it was missed: REFER TO PIL • Days 1-7: take the missed pill immediately and the next pill as usual (even if this means taking two pills on the same day). Continue with the rest of the packet in the normal way. Use additional contraceptive measures (eg, condoms) or abstain from sexual intercourse for seven days. • Days 8-17: take the missed pill immediately and the next pill as usual (even if this means taking two pills on the same day). Continue with the rest of the packet in the normal way. No extra contraceptive precautions are required as long as the seven preceding pills have been taken correctly. • Days 18-24: take the missed pill immediately and the next pill at the usual time (even if it means taking two tablets on the same day). Continue with the active pills in the normal way (pills are active from day 1-24 and inactive from day 25-28). Omit the inactive pills and start the next packet of pills. A withdrawal bleed is likely to be absent. OR, an alternative option is to discard the remainder of the active pills in the

current pack and take the remaining four inactive pills in the normal way, then start the next packet of pills. If no withdrawal bleed occurs, the possibility of pregnancy should be considered. • Days 25-28: discard the missed pill and continue to the end of the packet in the normal way. Additional contraception is not necessary. • Advise the woman that if pills have been missed and no withdrawal bleed occurs at the end of the packet, she should consider a pregnancy test. POP S/E: menstrual irregularities (Common), nausea, breast tenderness, mood changes 1. First course start on FIRST day of menstruation, any later than day FOUR use further contraception for first 48 hours. Future packets will all be started on the same day of the week as the first packet, following a strict 28-day cycle. 2. Do not stop taking it when you have a period. When you finish one pack, start another the next day 3. If you vomits within two hours of taking a pill should ideally take another one as soon as possible. 4. If you experience vomiting or diarrhoea for more than 24 hours is to follow the same advice as if they had missed pills Missed Pill Rule: • She should take the missed pill as soon as she remembers and resume her usual pill-taking schedule - even if this means taking two pills on the same day. • In addition, if the pill is more than three hours late (12 hours for desogestrel pills such as Cerazette®) other contraceptive precautions are required (eg, condoms) for the next 48 hours. • Consider emergency contraception if there was unprotected sexual intercourse 2-3 days prior to the missed pills, or there has z intercourse since the missed pill(s)....