Counselling Points Flashcards
How would you counsel a patient using mometasone furoate spray ?
Counsel patient how to use the spray appropriately (use of PIL)
Common side effects: Headache / sneezing / sore nose
Non-drug advice in relation to managing patient’s symptoms
How would you counsel a patient on Clarithromycin 125mg/5ml oral suspension
Make sure to complete the course and take the medication at regular intervals. There will be some liquid left over, to be discarded
Counsel on how to measure the medication, especially if oral syringe is used
Non-drug advice (hygiene measures)
Possible side effects – diarrhoea, GI discomfort etc
Shake the bottle well before use
How would you counsel a patient on Paracetamol soluble 500mg Tablets
To be taken as required
Do not take more than 2 at any one time, no more than 8 in 24 hours
Don’t take anything else containing paracetamol whilst taking this medicine
To be dissolved in a full glass of water before taking
How would you counsel a patient on Diprobase cream
Emollients should be applied immediately after washing or bathing to maximise the effect of skin hydration. Emollients should be applied in the direction of hair growth to reduce the risk of folliculitis.
Risk of paraffin containing emollients due to them being flammable. (MHRA safety advice in BNF). Advise patients not to smoke or go near naked flames once they have put the medicine on
How would you counsel a patient on Hydrocortisone cream 1%
Hydrocortisone: Advice on application, spread thinly on affected skin only. Check location of eczema to discuss quantity to use. Wash hands before use. Do not cover the area after application
Patients and their carers should be reassured that side effects such as skin thinning, and systemic effects rarely occur when topical corticosteroids are used appropriately.
How would you counsel a patient on 12 x Glycerol suppositories 1g
Directions for administration: remove protective film before use moisten with water before insertion
To be used when required
How would you counsel a patient on Calpol Six Plus sugar free suspension
Maximum of 4 doses within 24 hours to ensure patient does not overdose
Do not give any other paracetamol containing products at the same time do ovoid accidentally taking too much paracetamol
Instructions on how to use the syringe (if calpol used) or measure the correct amount with spoon to ensure correct dose is given
Shake the bottle before use to ensure suspension is mixed and correct dose is administered
How would you counsel a patient on Chlorhexidine gluconate 0.2% mouthwash
Chlorhexidine gluconate may be incompatible with some ingredients in toothpaste; rinse the mouth thoroughly with water between using toothpaste and chlorhexidine-containing product. (BNF)
Spit out after use / do not swallow (SmPC)
For the treatment of gingivitis a course of about one month is advisable (PIL)
It can cause temporary staining of teeth and tongue, change in taste and dry mouth
How would you counsel a patient on Aspirin tablets 300mg
Take with or after food as NSAIDs can irritate empty stomach
If disp aspirin: dissolve in water as cannot be swallowed whole
Aspirin: do not take any other products containing aspirin because this could result in patient accidentally taking too much aspirin.
How would you counsel a patient on Metronidazole 200mg/5ml oral suspension
Instructions on how to measure the appropriate quantity with the oral syringe supplied so correct dose is given
Make sure to complete the course (seven days) and take the medication at regular intervals as this will improve efficacy of antibiotic
There will be suspension remaining after 21 doses completed so please return remaining liquid to pharmacy where it can be disposed of safely.
Shake the bottle before use
avoid alcohol
How would you counsel a patient on Fusidic acid 1% m/r eye drops
Use for 48 hours after eye returns to normal
Discard 28 days after opening
Wash hands before use
White powder may appear round the eye after use. This is normal and can be wiped away (PIL)
How would you counsel a patient on Nitrofurantoin
Could turn urine red. This is harmless
Swallow whole, do not chew
Space doses evenly
Take after food
How would you counsel a patient on Otrivine nasal drops 0.1%
Otrivine: do not use for more than 7 days as can cause rebound congestion
How would you counsel a patient on Fluoxetine 20mg capsules
Fluoxetine: Beware it may not be safe to drive after taking this medicine as it may impair performance of skilled tasks (e.g. driving, operating machinery).
How would you counsel a patient on Daktarin 2% oromucosal gel for children?
- 1.25ml measured in oral syringe, smeared around inside of mouth after feeds
- Portion the 1.25ml dose - full dose is a choking hazard
How would you counsel a patient on Amoxicillin SF 250mg/5ml 500mg
allergic to penicillin?
• Symptoms of anaphylaxis as never used penicillins before (SOB, wheeze, facial swelling, rash)
• Shake well before use to resuspend
• Store in the fridge
How would you counsel a patient on Prednisolone 5mg Tablets
- Take steroid with or after food (monograph BNF online caution label 21)
- Because it protects stomach from risk of ulceration.
- Take steroid in morning
- As repeat evening doses may necessitate gradual withdrawal (monograph BNF online)
- Due to pituitary-adrenal suppression
- Counsel to seek medical advice if psychiatric symptoms (especially depression and suicidal thoughts) occur
- Because steroids can trigger psychiatric symptoms in some patients
How would you counsel a patient on Braltus inhalation Caps 13mcg
- Counsel on Inhaler technique (NICE guidelines)
- Because he has COPD and poor inhaler technique contributes poor symptom control
- Remind Patient of risk of choking if Braltus capsule is inhaled (as per MHRS/CHM warning in BNF)
- Advise to always check mouthpiece before inhaling dose
- And store capsules in screw-top bottle provided
How would you counsel a patient on Fluticasone and Salmeterol
- Inhaler technique
- As thrush can be a sign of poor technique with steroid inhalers
- Advise to rinse mouth out with water after using Seretide
How would you counsel a patient on Montelukast 10mg Tabs
- Montelukast chewable tablets to be taken on an empty stomach - this means 1 hour before food or 2 hours after
- To ensure it is properly absorbed from gi tract
- Montelukast should be taken at night
- As asthma symptoms are often worse at night
- Both montelukast and clenil modulite should be taken regularly
- Even if asthma is feeling better
- Because they both act as preventers of asthma
- Counsel parent to be aware of neuropsychiatric reactions
- Because montelukast can cause mood changes, speech impairment and obsessive-compulsive symptoms
- See GP immediately if they occur
How would you counsel a patient on Azathioprine
- Counsel to report immediately any signs or symptoms of inexplicable bruising, bleeding or infection such as sore throat or fever
- As this is a sign of bone marrow suppression
- Take with or just after food, or a meal
- To help reduce nausea
- Nausea is common early in the course of treatment
- But usually resolves after a few weeks without an alteration in dose.
How would you counsel a patient on Lansoprazole 30mg Capsules
- Lansoprazole should be taken 30 to 60 minutes before food
- To maximise absorption into blood(SPC)
- Do not take indigestion remedies 2 hours before or after you take the lansoprazole
- As they damage the enteric coating of the capsule
- Swallow this medicine whole(Lansoprazole). Do not chew or crush
- So the enteric coating isn’t destroyed.
How would you counsel a patient on Amoxicillin 500mg Capsules
- Confirm the patient has no allergy to penicillin
- Because amoxicillin is a penicillin
- Space the doses of both antibiotics evenly throughout the day
- In order to get optimum levels in the blood
How would you counsel a patient on Cimetidine 200mg tablets
- avoid eating large meals, especially late at night
- as this will ensure the stomach is not full at bedtime
- raise the head of the bed 10-20cm
- as lying flat can exacerbate reflux at night
- avoid spicy and fatty foods, alcohol, and caffeine later in the day
- as these are all known triggers for reflux symptoms
How would you counsel a patient on Asacol MR 400mg tablets
- Advise to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment.
- Because the salicylates can cause blood dyscrasias
- Do not take indigestion remedies 2 hours before or after you take the asacol
- As it will affect the absorption of the drug.
- Swallow this medicine whole. Do not chew or crush
- So the drug’s coating is not damaged
- Advise to avoid alcohol during a flare up of UC
- As it can worsen diarrhoea (NHS CHOICES)
- Counsel around guidelines for recommended alcohol intake
- In order to minimise risk to health from excessive alcohol intake.
How would you counsel a patient on Alendronic Acid
- Patient should be counselled as per BNF advice on alendronic acid:Tablets should be swallowed whole with plenty of water while sitting or standing, on an empty stomach at least 30 minutes before breakfast (or another oral medicine); patient should stand or sit upright for at least 30 minutes after administration.
- This is to reduce the risk of oesophageal irritation
- You may have noticed another interaction: Calcium salts reduce the absorption of alendronic acid.
- The advice is to take these medicines 30 minutes apart, hopefully you have already advised the patient to take calcium at lunch time.
- Patients should report any thigh, groin or hip pain (risk of atypical femoral fractures – MHRA advice)
- This is because alendronic acid can increase osteonecrosis leading to fracture of the femur
- Jaw and ear problems should be reported. Good dental hygiene should be maintained.
- This is due to increased risk of osteonecrosis of the jaw and the external auditory canal
- Advise to stop treatment and seek medical attention if oesophageal irritation occurs.
- This is because alendronic acid should be discontinued in cases of inflammation or ulceration of the oesophagus.
How would you counsel a patient on levothyroxine?
- Levothyroxine should be taken 30-60 minutes before breakfast, caffeine containing drinks or other medication.
- This is because the efficacy of levothyroxine can be reduced by these.
How would you counsel a patient on Warfarin ?
- Advise patient to consult doctor if they develop a painful skin rash
- This is based on MHRA advice in the BNF around a rare chance of calciphylaxis whilst taking warfarin
- Anticoagulant treatment booklets should be issued to all patients or their carers; these booklets include advice for patients on anticoagulant treatment.
- Pharmacist should check that monitoring and dosage information is up to date to ensure therapy is appropriate.
How would you counsel a patient on Insulin ?
- Check if patient will need other blood glucose monitoring equipment e.g. lancets, testing strips and sharps bin.
- These are needed to adequately deliver medication and test blood for dose adjustment
- Check patient / representative knows how to use products / adjust dose and have access to some kind of diabetes education
- because it has been shown that this improves control and reduces HbA1c
- Guidance in the BNF tells us to physically show the insulin box to the patient in order to confirm the expected product has been dispensed.
- Because this helps to avoid supplying the incorrect insulin
- Patients should be advised on the importance of avoiding hypoglycaemia. This involves adjustment of insulin type, dose, frequency and timing around meals and snacks. They should also be aware of symptoms of hypoglycaemia.
- The patient / parents should be aware of signs of hypo in order to administer prompt treatment
- The BNF suggests all patients are offered an insulin passport.
- These are available via insulin manufacturers (However, in practice, these are never seen!)
- Use a clean needle for every injection.
- Needles become dirty and damaged after even one use and can cause damage to infection site and increase risk of infection.
- Use different injection site at each administration.
- Using the same site repeatedly can cause injection site hypertrophy leading to scarring, pain and changes in insulin delivery
- Store in fridge when unopened
- Insulin will only last 28 days at ambient temperature
How would you counsel a patient on Metformin M/R?
- Metformin dose should be taken with evening meal but If still not tolerated (e.g. side effects) can talk to GP to switch to bd dosing
- Because some patients still experience side effects despite switching from IR to MR
How would you counsel a patient on Sildenafil?
- Advise patient to avoid large or fatty meals close to taking sildenafil
- because sildenafil onset of action can be delayed
- Advise patient that side effects of facing flushing and headache can occur with initial dose(s) of sildenafil
- Because these effects can be worrying but normally improve at future doses.
How would you counsel a patient on Rivaroxaban 20mg tablets
- Take rivaroxaban WITH FOOD (largest meal)
- Taking treatment dose (15mg or 20mg) on an empty stomach decreases oral bioavailability by 30% (SPC), therefore increased risk of stroke
- Counselled on signs and symptoms of bleeding with rivaroxaban and to seek medical attention after injury esp. head injuries,
- as could lead to internal bleeding/fatal bleeds.
How would you counsel a patient on Bisoprolol 5mg tablets
- B-blocker – dizziness/lightheadedness, fatigue, cold extremities, shortness of breath
- Provide rationale for counselling point(s) selected
How would you counsel a patient on Clopidogrel 75mg tablets
- Increased risk of bleeding with aspirin and clopidogrel in combination
- Report prolonged/unexplained bleeding or bruising; excessive tiredness, fatigue, breathlessness, palpitations (occult bleed)
• Clopidogrel prescription for max 12 months post ACS (after 12 months risk of bleeding outweighs benefit)
How would you counsel a patient on Simvastatin 20mg tablets
- Simvastatin should be taken at night (after 6pm)
- Short duration of action (half life), most cholesterol produced at night
- Take first few doses of ACEi at night
- ACEi cause postural drop
- Report persistent dry cough
- Side effect of ACEi, may require switch to therapy (ARA)
- Report abdo pain/muscle pain
- Side effect of statins
How would you counsel a patient on
How would you counsel a patient on
