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P1 Fall 2023 > IPC final exam - communication > Flashcards

IPC final exam - communication Flashcards

1
Q

Anticonvulsants

What are some MOAs

does t have a lot of a few indications and what are they?

A

MOAs
GABA (inhibitory neurotransmitter)
Ion channels (Na+, Cl-, Ca++)
Unknown

Many indications
Seizures
Migraine prophylaxis
Bipolar disorders
Weight loss
Neuropathic pain

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2
Q

what are the anticonvulsants

A

carbamazepine
Seizures are curbed
We are amazed that seizures are controlled

oxcarbazepine
Similar to carbamazepine (structural analog)
Drug interactions, MOA

Tegretol is first alphabetically, then Trileptal
Newer agent has clinical benefits

Trileptal  epilepsy

Keppra
levetriacetam
Elevate seizure threshold?
No – but prevents seizures

Dilantin
phenytoin
Dilantin rhymes with “shakin’?

Lamictal
lamotrigine
Limo  have shocks to prevent excessive shaking
-trigine  trigger  causes rash (SJS)
-motrigine  no trigger  does not trigger seizures (prevents)

Topamax
topiramate

Depakote
valproic acid, divalproex sodium
val  vul  convulsions
proex: professional at extracting seizures
kote  coat  protection from seizures

Neurontin and Lyrica
gabapentin and pregabalin
GABA

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3
Q

what is the cause of parkinson’s

what are the 2 meds for it

A

Neurodegenerative
Lack of dopamine
Movement issues
Chronic, progressive

Cogentin
benztropine
Anticholinergic
atropine  cholinergic
Cog  cog-wheel rigidity

Requip, Requip XL
ropinirole
Dopamine agonist
Rope & roll 
reign in your movement
Pin & roll 
pill rolling (tremor)

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4
Q

what anticonvulsant is used for migraines

A

Imitrex
sumatriptan
Serotonin Receptor Agonist
-triptans
Summa cum laude
Get rid of the migraine and you’ll be able to study and focus
Im  available in other formulations for severe migraine
But NOT IM!
SC and nasal (and PO)
Imitates serotonin?
Trips up migraines?

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5
Q

what meds help with RA

A

Plaquenil
hydroxychloroquine
RA and lupus
Antimalarial
Anti-Covid?
Chronic inflammation with RA  plaques in arteries

Trexall
methotrexate
RA and cancers
T-Rex + all + ate 
T-Rex ate it all!
Pain & inflammation
All formulations
PO
IM, SC, IV
Intrathecal

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6
Q

What meds help with Parkinson’s Disease

A

Neurodegenerative
Lack of dopamine
Movement issues
Chronic, progressive

Cogentin
benztropine
Anticholinergic
atropine  cholinergic
Cog  cog-wheel rigidity

Requip, Requip XL
ropinirole
Dopamine agonist
Rope & roll 
reign in your movement
Pin & roll 
pill rolling (tremor)

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7
Q

what meds help with Psoriasis / inflammatory skin conditions

A

Kenalog
triamcinolone
Tri  3 indications
Psoriasis
Inflammatory skin conditions
Pruritus
-olone  alone
Commercials about psoriasis show people wanting to be alone

Temovate
clobetasol
vate  alleviate itching
Vacate itching
clob  clobber itching

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8
Q

what are the types of pain

A

somatic pain
- musculoskeletal
- dull/achy/surgical
- local

visceral pain
- internal organs
- pressure/squeezing
- diffuse

neuropathic pain
- nerve pain
- burning, shooting, stabbing, stinging
- waves of frequency and intensity
- diffuse

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9
Q

what are non-pharm. treatments for pain

A

Rest
Ice
Compression
Elevation

RICE!

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10
Q

what adjuvants are good for neuropathic pain

A

Anticonvulsants
SSRI/SNRIs
TCAs

Good for neuropathic component of pain

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11
Q

what are NSAID MOA, ADRs & clinical pearls

A

MOA: mode of activity
Inhibit Cyclooxygenase (COX) mediated prostaglandin synthesis
Decrease immune response
Decrease inflammation, fever, pain

ADRs
GI upset/ulcers
Bleeding
Edema
Hypertension

Clinical Pearls
Take with food
Can cause kidney issues
Increased risk of MI/stroke

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12
Q

NSAIDs – Pregnancy and Children caution

A

Chronic use in women of childbearing age: linked to reversible infertility

DO NOT give during 3rd trimester
Premature closure of the ductus arteriosus and other effects
Consult with OBGYN before taking in 1st or 2nd trimester

DO NOT give to children <6 months

Other classes:
APAP: Safe in pregnancy and children of any age (Rx)
Opioids: Able to be used in pregnancy and children at any age but not preferred due to risk of addiction and neonatal withdrawal

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13
Q

NSAIDs memory devices

A

“-profen” & “-proxen”

Advil, Motrin
ibuprofen

Aleve, Naprosyn, Naprelan
naproxen
Alleviate pain

Mobic
meloxicam

Voltaren, Zipsor, Flector
diclofenac
Voltage  decrease conduction of pain
Flec on your skin (patch)

Celebrex
Celecoxib
Celebrate pain relief!
Cox  COX-2 selective

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14
Q

Opioids MOA, ADRs & clinical pearls

A

MOA
Mu (μ) receptor agonist
Analgesic, antitussive, antidiarrheal
Not anti-inflammatory

Clinical Pearls
Opioid epidemic
Scheduled/controlled
Take with bowel regimen

ADRs
Common:
Pruritus (up to 80% for morphine)
Constipation, N/V
Dizziness, HA, Lightheadedness, drowsiness/somnolence
Miosis
Urinary retention

Serious:
Respiratory depression
CNS depression
Dependence

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15
Q

which opioid is the most potent

A

fentanyl!

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16
Q

what are meds that are Opioid Analgesics

A

Duragesic (CII)
fentanyl
“fent can kill”  super potent, current killer
Used for sedation and general anesthesia (“vent”  ventilator)

MS Contin, Kadian, Duramorph (CII)
morphine sulfate (MS)
cont  continuous (lasts 8-12 hours)
Kadian  circadian rhythm  24 hour pain relief

Roxicodone, OxyContin, Oxaydo (CII)
oxycodone
contin  continuous (lasts 8-12 hours)
-codone  related to codeine

Ultram (CIV)
tramadol
tram wreck (not as strong as a train wreck)

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17
Q

Opioid Analgesic / APAP Combinations

A

Tylenol with codeine (CIII)
APAP with codeine
#3: 300 mg APAP, 30 mg codeine
#4: 300 mg APAP, 60 mg codeine

Percocet, Roxicet, Endocet (CII)
oxycodone with APAP
-cet  acetaminophen
oxy  oxygen group (breathe easier with pain relief?)

Vicodin, Norco (CII)
hydrocodone with APAP
-codin  -codone  related to codeine
hydro  hydrogen group (relax, like floating in water?)

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18
Q

Other pain medications

A

Methadose, Dolophine (CII)
methadone
For pain or opioid use disorder (opioid analgesic)
done  done using opioids or done with cancer pain
This is the method to stop using opioids

Suboxone (CIII)
buprenorphine and naloxone
For opioid use disorder (opioid partial agonist and antagonist)
Sub-  sublingual, or substitute for opioids

Lidoderm Patch
lidocaine
For pain (Topical analgesic/anesthetic)
-derm  topical / applied to skin
-caine  anesthetic (benzocaine, cocaine)

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19
Q

Muscle relaxants

A

Flexeril
cyclobenzaprine
Improve flexibility, you can cycle and bend!

Robaxin
methocarbamol
Relaxin with Robaxin

Soma
carisoprodol

Zanaflex
tizanidine
Improve flexibility

Gablofen, Lioresal
baclofen
Similar sounds
“-fen” might imply NSAID (be careful)

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20
Q

what are Corticosteroids

A

Used for inflammatory conditions (asthma, urticaria, severe allergic reactions, gout, IBD, etc.)

“-sone” or “-solone”

Orapred, Millipred, Pediapred
prednisolone
In liquid form for pediatric patients

Deltasone
prednisone

Medrol
methylprednisolone
Dose pack: 6-5-4-3-2-1

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21
Q

TCAs – Tricyclic Antidepressants

what is t used for

what does it cause you to do

A

Used for:
Depression
Neuropathic pain
Migraine prophylaxis/prevention

Elavil
amitriptyline
Pamelor
nortriptyline

“-triptyline”

“tri”  Tricyclic antidepressant

Sedating  could make you dizzy, careful not to trip

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22
Q

SSRIs – Selective Serotonin Reuptake Inhibitor

what is it used for

A

Used for depression and anxiety

Celexa
citalopram
Sounds like “relax”

Lexapro
escitalopram
Celexa, but like a professional

Zoloft
sertraline
Loft  lift up, lift your mood

Paxil
paroxetine
Packs ill feelings

Prozac
fluoxetine
Pro + Zac  hard sounds, strong antidepressant

Careful with “-oxetine”
Atomoxetine and duloxetine are not SSRIs

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23
Q

SNRIs – Serotonin Norepinephrine Reuptake Inhibitor
what is it used for

A

Used for depression
Some also used for fibromyalgia, anxiety disorders, narcolepsy, etc.

Cymbalta
duloxetine
du-  Dual action w/ serotonin and norepinephrine
Playing the cymbals makes you happy

Effexor XR
venlafaxine

Pristiq
desvenlafaxine
Newer agent, must be prestigious, pristine

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24
Q

Depression and Smoking Cessation

A

Desyrel
trazodone
Serotonin Reuptake inhibitor
Used for depression and sleep
-azodone  alone  only works on serotonin

Remeron
mirtazapine
Remember, only one
no real pharmacologic category, it’s just an antidepressant

Wellbutrin, Zyban
bupropion
Be well, no butts
I ban smoking

Wellbutrin  TID
Wellbutrin SR  BID
And Zyban
Wellbutrin XL  once daily

Chantix
varenicline
My chant is “I’m very inclined to quit”

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25
Q

Second Generation (Atypical) Antipsychotics for Schizophrenia & Bipolar Disorder

A

Abilify
aripiprazole
“-prazole” but not a PPI
Improved the ability to function

Risperdal
risperidone
Risper  sounds like whisper
Whispers are done

Seroquel, Seroquel XR
quetipine
Quiet the voices

Zyprexa
olanzapine
Lan  land on your feet
Zap  zap the voices away

Be careful with ”-pine”
also suffix for CCBs

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26
Q

Other Psychiatric conditions
bipolar disorder
insomnia

A

Lithobid
lithium
BID dosing
Also bipolar  swings 2 ways
Mania
Depression
Lithium battery  recharge
back to baseline

Ambien, Intermezzo
zolpidem
Z drugs for zzzz  sleep
Non-benzodiazepine hypnotic
Ambient light
Set up light for sleep

Restoril
temazepam
Benzodiazepine used only for sleep
Rest = sleep

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27
Q

Sleep hygiene – 1st line for insomnia

A

Use bed for sleeping or intimacy only
Establish a regular sleep pattern
Make the bedroom comfortable
Relax before bed
Exercise regularly*
Avoid eating meals shortly before bedtime
Avoid napping
Avoid alcohol, caffeine, nicotine for at least 4-6 hours before bedtime
Do not watch the clock at night
If unable to fall asleep…

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28
Q

Benzodiazepines For Anxiety
MIA

A

MOA:
Increase GABA (inhibitory)

“-azepam” or “azolam”

Klonopin
clonazepam
Clonus  stiffening and relaxing of muscles (brain)

Xanax
alprazolam
Sound like “z”
makes you relax, feel sleepy

Ativan
lorazepam
Nap at a van?
“Van down by the river?”

Valium
diazepam
Dial it back  relax

V  available PO and IV
Both used for seizures

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29
Q

Other Medications for Anxiety

A

BuSpar
buspirone
Take the bus to the park  relaxing

Vistaril
hydroxyzine pamoate
1st generation antihistamine
Also used for pruritus (brand Atarax)

Great options if we cannot use controlled medications (All BZDs are CIV)
Patients with history of substance use disorder, alcoholism, etc.

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30
Q

Alzheimer’s Disease / Dementia

A

Aricept, Adlarity
donepezil
Acetylcholinesterase Inhibitor
keeps ACh around  helps w/ learning, memory, cognition
Air  cognition is suffering  “airy”
-cept  improve perception

Namenda, Namenda XR
memantine
NMDA Receptor Antagonist
Sounds like “Rememba”
mem  memory

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31
Q

Stimulants for ADHD

A

Adderall, Adderall XR
sextroamphetamine & amphetamine

Concerta, Daytrana, Metadate, Methylin, Ritalin
methylphenidate
CDMMR
Concentrate Daily, Must Must Repeat!

Focalin, Focalin XR
dexmethylphenidate
Helps you focus

Vyvanse
lisdexamfetamine
Odd man out
“f”
Vyv

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32
Q

Other Medications For ADHD

A

Strattera
atomoxetine
Not the same as SSRIs (fluoxetine, paroxetine)
Norepinephrine Reuptake Inhibitor
Strat  Straightens patients’ attention
If you’ve got moxie – you’ve got determination and character (just need focus)

Intuniv
guanfacine
Intun  in tune  spot on  focused
-facine  facing forward  paying attention

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33
Q

Influenza and Cough

A

Fluzone High Dose Quadrivalent, Fluarix Quadrivalent
influenza virus vaccine
Helps to prevent (or decrease severity) of the flu
IM given annually

Tamiflu
oseltamivir
Neuraminidase Inhibitor
Osel  oscillation  flu moves back and forth every year
-tamivir sounds like Tamiflu

Tessalon Perles
benzonatate
Tess  tuss  anti-tussive

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34
Q

Abbreviations for Asthma and COPD

A

FEV1:

SABA:

LABA:

ICS:

SAMA:

LAMA:

LTRA:

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35
Q

What is Asthma?

A

Chronic inflammatory disease

Reversible

Allergen triggered inflammatory reaction
Both acute and chronic inflammation

Leads to airway remodeling and bronchial hyper-reactivity

Tightened muscles constrict airway, thickened airway wall, mucus

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36
Q

Asthma – Epidemiology, Risk Factors

A

10% of children by 5-17 years

Pediatric Disease
Diagnosis by 5 years
Most have symptom resolution by adulthood
30-40% persistent adult asthma

Environmental Risk Factors
Family Size
Tobacco Smoke in utero or infancy
Allergen exposure
Urbanization
Respiratory viral infection
Decreased exposure to childhood infectious agents

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37
Q

Asthma – Diagnosis

A

1) Assess symptoms
Wheezing
History of any of the following:
Cough, worse at night
Recurrent wheeze
Recurrent difficulty breathing
Recurrent chest tightness
Symptoms occur or worsen at night, waking the patient
Symptoms worsen with triggers

2) Confirm with spirometry testing
FEV1 (forced expiratory volume in 1 second) before and after SABA

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38
Q

Asthma – Treatment

A

intermittent
symptoms: <2 days/week
step 1 - rescue (PRN)

Mild
symptoms: 2-6 days/week
step 2 - rescue (PRN) + maintenance

moderate
symptoms: daily
step 3 - rescue (PRN) + maintenance

severe
symptoms: throughout the day
step 4-5 - rescue (PRN) + maintenance

Symptoms occur: >2 times per week
Uncontrolled
STEP UP Therapy
Symptoms occur: 0-2 times per week
Controlled
If >3 months, STEP DOWN therapy
Caution with close monitoring

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39
Q

What is COPD?

A

Airflow limitation that is not fully reversible

Chronic and progressive

Umbrella term of chronic bronchitis, emphysema, or mixed
Does not affect treatment

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40
Q

COPD – Epidemiology

A

12.1 million people in US
9 million have chronic bronchitis
3.1 million have emphysema or combination

4 leading cause of death
Only leading cause of death to increase (projected to become 3rd)
By 2020 5th highest cost burden on US Healthcare

2nd leading cause of disability

Cigarette smoke is leading cause
Currently 25% of population

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41
Q

COPD

A

Exposure
Environmental tobacco smoke
Occupational dusts and chemicals
Air pollution

Patient factors
Genetic predisposition (AAT deficiency)
Airway hyper-responsiveness
Impaired lung growth

Chronic sputum production, dyspnea, chronic cough

History of exposure

FH of COPD

> 40 years old

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42
Q

COPD – Treatment

A

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

Classified into Groups A, B, C, or D
Based on symptoms, airflow limitation, exacerbation history

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43
Q

Asthma and COPD Medications

A

ICS
Pulmicort
budesonide
Pulm  pulmonary

Flovent
fluticasone
“-sone”
Vent  ventilate, breathe

ICS + LABA Combination
Breo
fluticasone & vilanterol

Advair
fluticasone & salmeterol

Symbicort
budesonide & formoterol
“-terol”  LABA
Work symbiotically to help asthma/COPD

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44
Q

Asthma and COPD Medications

A

ProAir, Ventolin, Proventil
albuterol
SABA

Combivent
ipratroprium & albuterol
Atropine is anticholinergic (antimuscarinic)
Combination of SAMA and SABA

Spiriva
tiotropium
LAMA
Spirometry revitalized

Singulair
montelukast
LTRA
Single ingredient to help breathe air
luk  leukotriene

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45
Q

Hormonal Products For Menopause

A

Estrogen
Estrace, Vagifem, Vivella dot, Alora, Climara
estradiol

Premarin
conjugated / equine estrogen

Progestin
Prometrium
progesterone

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46
Q

Osteoporosis med

A

Fosamax
alendronate
Bisphosphonate
-dronate

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47
Q

Combination Oral Contraceptives

A

All contain ethinyl estradiol & a progestin

Nuvaring
etongestrel
Vaginal ring

Aviane, Seasonique, Twirla
levonorgestrel
Transdermal, weekly

Necon, Junel, Loestrin
norethindrone

Yaz, Yasmin
drospirenone
Won’t drop the potassium

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48
Q

Patient-centered medical care

A

Transitioning away from medication-centered care
Or “task-centered care”

RPhs accepting more responsibility

Depends on RPhs ability to:

Develop trusting relationships​​
Engage in an open exchange of information​
Involve patients in decision-making regarding treatment​
Help patients reach their therapeutic goals​

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49
Q

Pharmacist’s responsibility

Patient-care responsibilities

A

Medication-related morbidity and mortality

Omnibus Budget Reconciliation Act of 1990
OBRA 90

Mission statements

Patient-care responsibilities:
Communication between patient and healthcare professionals serves 2 functions:

To establish an ongoing relationship

To exchange information so that you can effective utilize the Pharmacist Patient Care Process (PPCP)

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50
Q

Patient-centered medical care – Five dimensions

. Practitioners must understand __________ and ________________as well as the biomedical factors that affect the patient’s illness experience

A
  1. Practitioners must understand social and __psychological as well as the biomedical factors that affect the patient’s illness experience
  2. “Patient as person” – providers must understand that each patient’s illness is a unique experience
  3. Providers and patients share power and responsibility; active dialogue and collaboration in the decision-making
  4. “Therapeutic alliance” – patient perceptions, mutual agreement regarding _therapeutic goals__ , a trusting relationship between patient and healthcare professionals.
  5. Providers must be aware that their responses to patients and their behaviors may have significant effects on patients
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51
Q

who ultimately makes healthcare decisions

PCP

RPh

patient

third partes

A

the patient

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52
Q

Patient-centered medical care – The pharmacist must be able to…

A

Understand the patient’s illness experience

Acknowledge that each patient’s experience is unique

Foster a mutually respectful relationship with patients

Establish a “therapeutic alliance” with patients to meet mutually understood goals of therapy

Develop self-awareness of personal effects on patients

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53
Q

Medication use process

A

Process begins with perception and interpretation of the problem
Identifying symptoms
Previous experiences
Cultural differences
Knowledge of the problem
Misinformation?
Health beliefs

Patient may take action
Self-care therapy
Medical/medication therapy
Complimentary medicine

Power transfers to the provider?

Patient has final say

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54
Q

Therapeutic monitoring – patient’s role

A

Meeting therapeutic goals

Self-monitoring

Obtaining information from providers
Being more assertive

Joint Commission tips

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55
Q

Patient-Provider communication

A

Unanswered questions

Misunderstandings

Therapy-related problems

Self-monitoring

Decision-making

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56
Q

In Healthcare, Interpersonal Communication is:

A

The ability of the provider to elicit
and understand patient concerns,
to explain healthcare issues,
and to engage in shared decision-making if desired

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57
Q

Why use interpersonal communication?

A

Better adherence
Improve patient outcomes
Improved QOL
Patient satisfaction
Improved mental health
Trust/relationships established with healthcare team

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58
Q

Interpersonal communication model

A

The Sender

The Message

The Receiver

Feedback

Barriers

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59
Q

Feedback

A

Simple or complex

Two-way process

Focus is typically on the message (may miss the opportunity to provide appropriate feedback)

How can we ensure understanding and proper interpretation of the message?

60
Q

Pharmacist’s responsibility

A

As the sender, you must ensure that the message is transmitted effectively
In clearest form
In terminology understood
In an environment conducive to clear transmission

Be fully aware of barriers

Improve communication skills to ensure appropriate message transmission

61
Q

The meaning of the message – words and context

The meaning of the message – Verbal and nonverbal messages

A

Factors influence how people assign meaning to verbal and nonverbal messages

Past experiences

Previous definitions

Languages/dialects

Incongruent messages

62
Q

The meaning of the message – Preventing misunderstanding

A

Anticipate how others may translate your message
We interpret messages based on the individual as well as what we believe the message is
What is said may not actually be what the receiver (patient) actually hears

Know the person to whom you are delivering the message

Use feedback to check for or ensure understanding

63
Q

Improving communication behaviors

A

Self-awareness

Process awareness

Changing behavior when necessary

64
Q

Need to knows for interpersonal patuent centered acre lecture

A

The five dimensions of patient-centered care. Why it is important? How has it changed from medication-centered or provider-centered care?

The importance of active participation by patients in medication use and therapeutic monitoring.

The interpersonal communication model
The different parties involved
The message – how and why it can be misinterpreted
The importance of feedback

65
Q

Patient Counseling is…

A

Pharmacists talking with patients about their meds in order to educate them about medication-related issues and to help them get the most benefit from their medications.
Today’s focus: Counseling pts on NEW Rx’s

66
Q

Pharmacist’s Role in counseling

A

Educate patients to follow medication regimens and monitoring
Assess patient understanding, knowledge and skill
Motivate patients to learn/know about meds
Empower patients to be active partners in their own care

67
Q

Patient’s Role

A

Adhere to medication regimen
Monitor for drug effects
_efficacy_______________
_safety_______________
Report experiences
Difficulty with adherence/cost
Medication effects

68
Q

Counseling Essentials

A

Ideal environment
Pharmacist with knowledge and communication skills

69
Q

Ideal Environment

A

Conducive to learning
Private and comfortable
Safe and confidential
Free of distractions/interruptions

Equipped with learning aids
Written materials/pamphlets
Medication administration devices/memory aids
Audiovisual resources

70
Q

Pharmacist Knowledge

A

Pharmacotherapeutics Knowledge

Cultural awareness/competence
Understand patient’s health beliefs, attitudes, and practices
Understand patient’s feelings about the healthcare system
Understand patient’s views of their role in managing their care

71
Q

Pharmacist Skills

A

Ask effective questions
Be active listener
Interpret patient’s nonverbal cues

Be adaptable
Health literacy level
Language
Cognitive ability
Learning style
Physical and sensory abilities

72
Q

Pharmacist Skills: Open- vs. Closed-ended Questions

A

Open-ended
Patient answers in their own words
Shows RPh’s willingness to listen
Patient - centered approach
Engages patient as an ACTIVE participant in a dialogue
Helps determine level of understanding
Begin w/ the 5W’s and 1 H:
Who, What, When, Where, Why and How

Closed-ended
Patient can answer with “Yes” or “No”
Very impersonal

Pharmacist - centered approach
Patient is a PASSIVE participant in a monologue/lecture

73
Q

Pharmacist Skills: Medical Jargon vs. Lay LanguagePharmacist Skills:

A

Medical Jargon
__technical______________________ terms that are understood mostly by medical professionals/scientists
Intimidates most patients

Lay Language
_______________________ terms that can be understood by the general public
Avoid words w/ > 3 syllables if possible
Need to be able to speak to pts at a 4th or 5th grade level

74
Q

Instead of MEDICAL JARGON
renal
HTN
Lthergic
hepatic
angina
inflammaton
anaphylaxis
sublingual
myocardial infarction (MI)
gastrointestinal (G)

USE

A

kidney
HBP
tired, sleepy
liver
chest pain
swelling, redness
allergic rxn
under tongue
heart attack
stomach

75
Q

Counseling Pts on New Prescriptions: Process

A

Part 1: Introduction
Part 2: Profile Verification
Part 3: Counseling
Part 4: Closing
Part 5: Communication (Style)

76
Q

Part 1: Introduction

A

Identifies SELF
Purpose: establishes who you are and your role, helps establish trust and caring relationship
“Hi, my name is _________. I am the Pharmacist who filled your prescription today.”
Identifies PATIENT
Purpose: verifies who the medication is for.
If it’s not the patient picking up, may be legal limits of what you can say.
Use OPEN-ENDED questions to identify patient name + DOB +/- Address, ideally all 3
“What is your name and date of birth? What is your address?”

Explains PURPOSE OF INTERACTION
Purpose: to get patient buy-in to the importance of the interaction
“I would like to discuss some important information about your medication to ensure you are getting the most benefit from it”

Request PATIENT’S TIME
Purpose: establishes respectful and caring relationship
“Do you have ____ minutes to talk about this information?”

77
Q

Part 2: Profile Verification

A

Purpose: to confirm that patient profile is accurate and complete
Used in advanced assessments of drug regimen: DDI’s, dosing appropriateness, etc.
Use OPEN-ENDED questions to verify all info in this section
DRUG ALLERGIES
“What drug allergies do you have?”

OTHER MEDS (OTC, Rx, herbals)
“What prescription medications do you currently take?”
“What medications, including herbals, supplements, or vitamins, do you purchase without a prescription?”
HEALTH CONDITIONS/DISEASE STATES
“What other health conditions (diseases) do you have?”

78
Q

Part 3: Counseling

A

3 Main components
Medication Description/Purpose
Medication Use
Other Medication Information
Purpose:
Find out and reinforce what patient knows
Fill in any gaps or inaccuracies
Each component should start with its corresponding Prime Question

79
Q

Part 3a: CounselingMedication Description/Purpose

A

PRIME QUESTION 1: (OPEN-ENDED)
Purpose: Assess patient understanding of which med they are expecting and what it’s for
“What medication did your doctor (provider) prescribe for you and what is for?”

NAME
Give name of drug as dispensed
If Rx is written for brand name and generic is substituted, give both generic and brand names.
Lexicomp  Brand Names: US
Must pronounce name(s) correctly to receive credit during lab/application sessions

STRENGTH (with units)
mg/mcg/etc

DOSAGE FORM
Tablet, capsule, liquid, suspension, patch, inhaler, etc
Lexicomp  Preparations: US

INDICATION (Purpose/use) for THAT patient
Lexicomp  Uses; Dosages

80
Q

Part 3b: CounselingMedication Use

A

PRIME QUESTION 2: (OPEN-ENDED)
Purpose: to assess patient understanding of how to take/use the medication
“How did your doctor (provider) tell you to take (use) this medication?”
DOSE
How many units to take/use at a time (tablet/capsule/tsp/etc)

ROUTE OF ADMINISTRATION
How/where the medication is to be taken/used/applied
Use the appropriate VERB!
FREQUENCY
How often the medication should be taken/used
Helpful to relate to regular daily activities such as mealtimes, waking or bedtime

DURATION
How long patient should expect to use this medication
As outlined on Rx - often noted if acute (short-term)
If not on Rx, give patient idea of short-term/long-term need for medication
Indication/purpose is the best way to judge this
Short-term: antibiotics/antifungals/antivirals/pain (days or weeks)
Long-term: HTN/diabetes/thyroid/ADHD
Qty/ DS/ refills may also be helpful
Remember some Rx’s are limited in these areas by law

ADMINISTRATION/ TECHNIQUE/ STORAGE
Explain what the patient needs to know to optimally use the medication
Relation to meals and need to avoid/limit alcohol, other drinks, or foods
Relation to other medications
How to use devices (inhalers, injections, etc.)
How to apply (patches, topicals, etc.)
Storage/Disposal
Lexicomp  Administration and Storage Issues

QUANTITY / DAYS SUPPLY / REFILLS
QTY: Number of units dispensed
DS: How long quantity dispensed should last
REFILLS:
If refillable explain:
How many refills and when they expire
How/when to get a refill
If NOT refillable explain:
What patient should do if they need more medication

81
Q

Part 3c: CounselingOther Medication Info

A

PRIME QUESTION 3: (OPEN-ENDED)
Purpose: to assess patient’s understanding of expectations (both efficacy and safety)
“What did your doctor (provider) tell you to expect from this medication?”

SIDE EFFECTS
Explain common/expected SE’s of the medication
What to watch for/do if they occur
Ways to minimize/avoid SE’s
Explain possible serious/rare SE’s (and Black Box Warnings)
What to watch for/do if they occur
Explain carefully – do not scare them into not taking the medication!
Allergic Response
What to watch for and do if allergic reaction occurs
Lexicomp  Adverse Reactions; Warnings/Precautions

MISSED DOSES (for all meds except PRN)
Purpose: Explain what to do if patient misses a dose of their medication
Be as clear and specific as possible
Lexicomp  Dosages; Administration and Storage Issues
Specific instructions may be provided by manufacturer (package insert/monograph) for some medications
If specific instructions not provided:
Do not just say “Do not take it if it’s too close to the next dose”?
My general rule of thumb: ½ the frequency
Example: Q12 hrs - do not take if <6 hours to next dose

82
Q

Part 4: Closing

A

Asks patient to REPEAT KEY POINTS
Purpose: to assure patient understands information provided above
“Just to make sure that I did not leave anything out, would you repeat back to me the information we talked about today?”

CLOSES APPROPRIATELY
Purpose: to let the patient know the encounter is over
Ask if patient has questions using an OPEN-ENDED question
“What questions/concerns do you have for me about your medications?”
Provide contact information for future questions/concerns
Thank them for coming in and talking with you

83
Q

Part 5: Communication

A

USES OPEN-ENDED QUESTIONS for all areas outlined above
ID Pt, Profile Verification section (3), Prime Questions (3), Closes appropriately
Miss or use closed-ended questions for any of these = deduction
APPROPRIATE NON-VERBAL COMMUNICATION
Eye contact, facial expressions, attitude
APPROPRIATE PACE
Don’t speak too fast or too slow
APPROPRIATE FLOW
Logical order/flow is important for patient understanding

PATIENT FRIENDLY LANGUAGE
PATIENT SPECIFIC INFO
Male vs female:
Do NOT educate males or females >/= 55 y/o about pregnancy/lactation
Patient vs agent
If Rx is for child, counsel parent or care giver (aka agent) appropriately:
“Give Johnny 5 milliliters by mouth…” instead of “Take 5 milliliters by mouth…”

84
Q

Counseling Activities in the Classroom/Labs

A

When playing the part of the pharmacist:
Focus on the process provided in the rubric
Content and order are most important
Learn how to pronounce drug names correctly!
Lexicomp Online for generic names of drugs
Manufacturer’s website/commercials for brand names of drugs

When playing the part of the Patient:
Be the patient on the Rx regardless of gender, age, etc.
EXCEPTION: If Rx is for a child, be the parent/caregiver
Use the info on the Rx for patient name, DOB, address, etc.
Pretend you are a patient with no knowledge of the medication
Don’t make the counseling difficult for the pharmacist or take up too much time
Don’t be too helpful either – don’t “lead” the pharmacist
Responses should be short and simple

85
Q

Roadmap for communization

A

barriers
conflict
the angry patient
assertiveness
customer service

86
Q

Barriers to Communication

A

Environmental

Personal

Administrative

Time

87
Q

Environmental Barriers

what are the solutions?

A

Pharmacist visibility (can see how busy you are or cannot even see you)

Privacy (are you publicizing their issues or can you provide privacy)

Noise level

solutions:

88
Q

Personal Barriers

A

people are still people

our personality or communication style may not be for everyone

step out of comfort level

solutions
- use patient-friendly language

89
Q

Patient Counseling is…

A

Pharmacists talking with patients about their meds in order to educate them about medication-related issues and to help them get the most
benefit from their medications.

Today’s focus: Counseling pts on NEW Rx’s

90
Q

Pharmacist’s Role

A

Educate patients to follow medication regimens and monitoring

Assess patient understanding, knowledge and skill

Motivate patients to learn/know about meds

Empower patients to be active partners in their own care

91
Q

Patient’s Role

A

Adhere to medication regimen

Monitor for drug effects
- efficacy - does it work? Like for lisinopril: is it lowering the blood pressure
- safety
Report experiences
Difficulty with adherence/cost
Medication effects

92
Q

Counseling Essentials

A

Ideal environment
- Conducive to learning
Private and comfortable
Safe and confidential
Free of distractions/interruptions

Pharmacist with knowledge and communication skills

93
Q

Ideal Environment

A

Conducive to learning
Private and comfortable
Safe and confidential
Free of distractions/interruptions

Equipped with learning aids
Written materials/pamphlets
Medication administration devices/memory aids
Audiovisual resources

94
Q

Pharmacist Knowledge

A

Pharmacotherapeutics Knowledge

Cultural awareness/competence
Understand patient’s health beliefs, attitudes, and practices
Understand patient’s feelings about the healthcare system
Understand patient’s views of their role in managing their care

95
Q

Pharmacist Skills

A

Ask effective questions
Be active listener
Interpret patient’s nonverbal cues

Be adaptable
Health literacy level
Language
Cognitive ability
Learning style
Physical and sensory abilities

96
Q

Nonverbal communication consists of all messages other than words that are used in communication. Includes:

A

Tone of voice
Vocally produced noises
Body posture
Body gestures
Facial expressions

Body behavior provides a nonverbal message as well - general appearance, attire, odor, personal care, and touch

Physical environment

97
Q

Nonverbal Communication

A

Unique for three reasons:
Mirrors innermost feelings and thoughts
Difficult to “fake” during interpersonal interaction
If not consistent with verbal communication, people will be suspicious of intended meaning of your message

98
Q

Nonverbal Communication

A

Physical elements of nonverbal communication:

Body movements and gestures - kinesics
Distance between persons trying to communicate - proxemics
Physical environment

99
Q

Nonverbal Communication - kinesics

A

Lack of eye contact is the most distracting form of nonverbal communication
Many pharmacists do this unconsciously
This may limit your ability to assess if a patient understands the information you are giving -
This does not mean you must continually stare at the patient! It might make them feel uncomfortable

100
Q

Nonverbal Communication - kinesics

A

Patients may judge your willingness to talk to them based on your body position

Closed posture:
A person guarding their space with arms folded, putting up a closed barrier with crossed legs and turning away from another person. Eyes - averted or a strong and challenging stare.

Open posture:
A person seems more open and caring. Hands are apart, arms resting in the lap or on the arms of the chair. There is an interest in the other person, a willingness to listen.

101
Q

Nonverbal Communication - Proxemics

A

Proxemics is the distance between people when they communicate – “personal space”
Distance is a powerful nonverbal tool
We are more comfortable when interactions occur at a distance of 18-48 inches between people

102
Q

Nonverbal Communication - proxemics

A

Sometimes personal space may have to be invaded when counseling patients on certain medications

Can you think of some
medications that may require
having a conversation within
the personal zone?

Ideally pharmacies should have
private areas

103
Q

Nonverbal Communication
Facial expressions –

A

Inadvertent facial expressions may send a message that you did not intend to transmit!

104
Q

Nonverbal Communication
Environmental factors

A

Environment plays an important role in communicating nonverbal messages
Color, lighting, temperature, music, scent, architecture, and décor have also been documented as important nonverbal factors.
Pharmacy counters and general appearance

105
Q

Nonverbal communication - dress

A

What you wear, along with how you communicate with others both verbally and nonverbally, can impact the image others form about you.
Your choice of clothing:
Makes a first impression!
Communicates that you take your job seriously
Represents your company/position
Gives you confidence

Presenting a positive representation of yourself is a key component of experiencing professional success.

106
Q

Nonverbal Communication

A

Tone
People may interpret a message in not only what is being said but how it is being said

A sarcastic or angry tone will produce a much different effect than if spoken with an empathic tone

Pausing while speaking, silence while waiting for someone’s response, and the rhythm of communication are all nonverbal cues that also convey meaning.

107
Q

Patient nonverbal language

A

Patients with ADHD may be fidgeting or appear to not listen when spoken to
Patients who are clinically depressed may avoid questions and appear uninterested in interaction
Patients with PTSD may avoid eye contact and appear hyper-vigilant, anxious, irritable, distracted or nervous
Patients with Parkinson’s Disease may have a flat affect and appear uninterested

108
Q

Patient nonverbal language

A

Studies have shown that patients are more satisfied with healthcare providers who are skilled at translating nonverbal language to emotional states
As the pharmacist- observation of a patient’s nonverbal communication may help you to address a special need
Patient with hearing difficulties may come closer or tilt head one way
Patients reluctant to ask a question or with a language barrier may hold back from counter or limit eye contact
Autistic/Asperger’s patients may avoid eye contact but that does not mean they are not listening/interested

109
Q

Culture and nonverbal behavior

A

Body movements and gestures
May illustrate respect and manners
Pointing may have different meanings - different cultures have varied interpretations for hand gestures, for example.

110
Q

Culture and nonverbal behavior

A

Eye contact
Valued in Western society but may be considered an insult in some Asian cultures
Latin American, Caribbean and African cultures may avoid eye contact as a sign of respect
Touch
Kissing, hugging, and shaking hands are used more or less in different cultures
Cultures with more restraint are less likely to touch (English, Germans) while others encourage signs of emotions and touch (Latin America, Middle Eastern, south European)

111
Q

Culture and nonverbal behavior

A

Paralanguage
A loud voice communicates strength and sincerity for Middle Eastern cultures, authority for Germans, impoliteness or lack of control for other cultures
Proxemics
Cultures that stress individualism demand more personal space
African, Middle Eastern and Mexican cultures tend to stand much closer when speaking than Western or European cultures

112
Q

Nonverbal Communication

A

Nonverbal communication can be more powerful than verbal
If spoken word contradicts nonverbal behaviors, the nonverbal messages are often what are believed
Some nonverbal behaviors are universal but many are culturally specific
Environment, appearance, colors, and images are also forms of non-verbal communication
Know your patients and populations to the best of your ability in order to tailor all forms of communication to their needs

113
Q

Listening

A

Humans have two ears, but only one mouth. Some people say that’s because we should spend twice as much time listening as talking. Others claim it’s because listening is twice as hard as talking.

114
Q

Importance of Listening

A

Helpful
- when patients feel they are being heard

trust
- patients report increase trust in health care providers that listent

collect
- patients are more willing to share info to someone willing to listem

comfort
-patients will be at ease at listening removes the feelinng of intitmdiaton (anxiety of health care environemtns; whte coat synndrome)

115
Q

Active Listening

A

hear
- Focus all attention on the patient’s question/concern

backchannel
- syaing things like ah huh, nodding, mmm I see

clarification
- ask follow-up questions (to gain fiirthur understanding, or demonstrate interest)

mirror.summarize.paraphrase
- repeat back what you heard
- confirm udnerstanding to assure lsietjing

emoathy
- identify the feeling
- empathetic facila expression/body language and repsonse

116
Q

Avoid

A

Multitasking
- Focusing attention on other things at the same time

plannign your response while soemone is talking

premature conclsuon
- determineing a recommendstaion before listening fully to what the speaker said

faking interest
- pretending to listen

117
Q

4 Components of Non-Violent Communication

A

Observation: Identify the baseline facts of the situation while avoiding assumptions or generalizations

Feelings: Identify the feeling the other person is experiencing

Needs: Identify the other person’s needs

Request: Propose a request of the other person with an achievable goal

118
Q

Non-Violent Communication: Feelings

A

Identify the feeling the otherperson is expressing(empathy)
NOTthe feeling you have orwould have (sympathy)
NOTtelling them how to feel
Use reflective speech toconfirm the feeling

119
Q

Confirm the Concern

A

Summarizing and Paraphrasing
Review the patient’s main points with them
This bridges the gap between listening and empathetic responding
Use this step to identify feelings
Answer any further questions they have as a result of yousummarizing their concern

120
Q

Should do:

Avoid

A

Should do:
Hear
Backchannel
Clarification
Mirror/Summarize/Paraphrase
Empathy

Avoid
Multi-tasking
Planning your response
Premature conclusion
Faking interest

121
Q

Active Listening

A

How could a pharmacist demonstrate “hearing”:

How could a pharmacist demonstrate “back channeling”:

How could a pharmacist demonstrate “clarification”:

122
Q

How to respond with empathy:

A

Reflective speech
*“Ihear….” “Iunderstandthat….”

Open up
* “I’m so glad you told me that…” “Thank you for sharing this…”’
Be judgment free
* Don’t judge the person for being in this circumstance. Give the benefit of the doubt.

Offer help
* When within your ability, in a patient-centered way. Just listening is also helping.

Physical comfort (when appropriate)
* Most people are ok with touches of the hand or arm. ASK if anything more than that. * Know culture norms.
* Read body language.

123
Q

Avoid:

A

Blame
*Avoid blaming others or the speaker for their problem

Silver lining
*Avoid telling the speaker all the ways it could be worse

Promises
*Don’t promise things that are out of your control

Rude/aggressive behavior
*Even if the patient is communicating in a rude or aggressive way. *Continually try to de-escalate the situation.

124
Q

Barriers to Communication

A

Environmental

Personal

Administrative

Time

125
Q

Personal Barriers

A

Pharmacist
Personality

Communication style

Comfort level

Cultural awareness

Patient
Perception of pharmacists, using medicine, etc.

Beliefs about the healthcare system
Individual
Familial
Cultural

126
Q

Conflict

A

Inevitable

Opportunity for growth and problem solving

What are some causes of conflict in a pharmacy setting?

127
Q

Causes of Conflict

A

Lack of awareness

Incompatible goals

Scarce resources

Dependence

Values

128
Q

Anger

A

Stressor

Painful core feelings

Trigger statements

Anger

Acting out

129
Q

Resolving Conflict / Dealing with the Angry Patient

A

Listening

Avoid getting trapped in the negative filter

Empathy

Respect
Self
Others

Assertiveness

130
Q

Assertiveness

A

Assertion:
the action of stating something or exercising authority confidently and forcefully.

Standing up for personal rights and expressing thoughts, feelings and beliefs in direct, honest and appropriate ways that do not violate another person’s rights.

131
Q

Assertiveness

A

Assertion does not equal Deference

Each patient has the right to be treated fairly and with respect

We are not responsible for how others feel or for their actions

Being assertive:
Take responsibility for your own thoughts, actions and feelings
Setting boundaries

132
Q

“I” statements allow us to…

A

Respond in a way to de-escalate conflict

Avoid using “you” statements that will escalate conflict

Identify feelings

Identify behaviors that are causing conflict

Help individuals resolve the present conflict and prevent future conflicts

133
Q

Assertiveness Skills

A

Broken record

Fogging

Negative inquiry

Workable compromise

Sorting issues

Disarming anger

Selective ignoring

134
Q

Customer Service is not The customer is always right
now it is

A

The customer deserves respect

135
Q

Drug related problems (DRPs)

A

Unnecessary drug therapy

Drug selection not optimal

Clinical significant drug interaction

Medication dosing regimen not optimal

Adverse drug reaction

Needs additional drug therapy

Failure to receive drug therapy appropriately

Needs additional follow-up

135
Q
A
136
Q

Effective collaboration

A

Sharing:
Responsibilities
Values
Interventions
Commitment to patient-centered care

Partnering:
Collegial and productive relationship
Honest communication
Mutual trust and respect
Common goals!

Interdependency:
Not autonomous
Work together to meet common goals

Power:
Shared among partners
All participants are empowered
Based on knowledge and experience
Not only titles and functions

137
Q

Considerations

A

Introduce yourself

Don’t blame the provider, explain the situation, focus on the problem

Tone of voice and body language is important

Know the role of the person with whom you are speaking (but be cautious…)

Don’t presume that you’re recommendation will be accepted

Be confident

138
Q

Patient versus healthcare provider

A

Must use lay terms - these are basic termswhile jargon are technical terms

Don’t scare your patient

Remember that preconceived ideas and experiences may shape medication use

139
Q

SBAR

A

Standardized approach to communication in healthcare

This will be used:
In future courses (including PPP lab)
On rotations (IPPE and APPE)
Whenever communicating with a healthcare professional!

140
Q

SBAR situation

A

Situation
Identify yourself, the patient, and the prescriber.

Briefly state what the problem is, when it occurred, and how severe it is or appears to be.

In general, a concise statement of the problem

141
Q

SBAR background

A

Background
Provide pertinent background information related to the situation.

May include diagnoses, allergies, current medications, etc.

142
Q

SBAR assessment

A

Assessment
Summarize the facts and give your best assessment.

What is going on?

What might happen if this problem is not addressed?

143
Q

SBAR recommendation

A

Recommendation
What do you want to happen next?

State your recommendation and/or the actions you are requesting of the other person

144
Q
A

P1 Fall 2023 (66 decks)

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