Counselling Points Flashcards

Question

How would you counsel a patient on Asacol MR 400mg tablets

Answer 1

* 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.

Answer 2

* 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.

Answer 3

* 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.

Answer 4

* 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.

Answer 5

* 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

Answer 6

* 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

Answer 7

* 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.

Answer 8

* 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.

Answer 9

* B-blocker – dizziness/lightheadedness, fatigue, cold extremities, shortness of breath * Provide rationale for counselling point(s) selected

Answer 10

* 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)

Answer 11

* 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