IPC final exam - communication Flashcards
Anticonvulsants
What are some MOAs
does t have a lot of a few indications and what are they?
MOAs
GABA (inhibitory neurotransmitter)
Ion channels (Na+, Cl-, Ca++)
Unknown
Many indications
Seizures
Migraine prophylaxis
Bipolar disorders
Weight loss
Neuropathic pain
what are the anticonvulsants
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
what is the cause of parkinson’s
what are the 2 meds for it
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)
what anticonvulsant is used for migraines
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?
what meds help with RA
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
What meds help with Parkinson’s Disease
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)
what meds help with Psoriasis / inflammatory skin conditions
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
what are the types of pain
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
what are non-pharm. treatments for pain
Rest
Ice
Compression
Elevation
RICE!
what adjuvants are good for neuropathic pain
Anticonvulsants
SSRI/SNRIs
TCAs
Good for neuropathic component of pain
what are NSAID MOA, ADRs & clinical pearls
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
NSAIDs – Pregnancy and Children caution
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
NSAIDs memory devices
“-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
Opioids MOA, ADRs & clinical pearls
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
which opioid is the most potent
fentanyl!
what are meds that are Opioid Analgesics
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)
Opioid Analgesic / APAP Combinations
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?)
Other pain medications
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)
Muscle relaxants
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)
what are Corticosteroids
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
TCAs – Tricyclic Antidepressants
what is t used for
what does it cause you to do
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
SSRIs – Selective Serotonin Reuptake Inhibitor
what is it used for
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
SNRIs – Serotonin Norepinephrine Reuptake Inhibitor
what is it used for
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
Depression and Smoking Cessation
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”
Second Generation (Atypical) Antipsychotics for Schizophrenia & Bipolar Disorder
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
Other Psychiatric conditions
bipolar disorder
insomnia
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
Sleep hygiene – 1st line for insomnia
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…
Benzodiazepines For Anxiety
MIA
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
Other Medications for Anxiety
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.
Alzheimer’s Disease / Dementia
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
Stimulants for ADHD
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
Other Medications For ADHD
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
Influenza and Cough
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
Abbreviations for Asthma and COPD
FEV1:
SABA:
LABA:
ICS:
SAMA:
LAMA:
LTRA:
What is Asthma?
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
Asthma – Epidemiology, Risk Factors
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
Asthma – Diagnosis
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
Asthma – Treatment
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
What is COPD?
Airflow limitation that is not fully reversible
Chronic and progressive
Umbrella term of chronic bronchitis, emphysema, or mixed
Does not affect treatment
COPD – Epidemiology
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
COPD
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
COPD – Treatment
Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Classified into Groups A, B, C, or D
Based on symptoms, airflow limitation, exacerbation history
Asthma and COPD Medications
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
Asthma and COPD Medications
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
Hormonal Products For Menopause
Estrogen
Estrace, Vagifem, Vivella dot, Alora, Climara
estradiol
Premarin
conjugated / equine estrogen
Progestin
Prometrium
progesterone
Osteoporosis med
Fosamax
alendronate
Bisphosphonate
-dronate
Combination Oral Contraceptives
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
Patient-centered medical care
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
Pharmacist’s responsibility
Patient-care responsibilities
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)
Patient-centered medical care – Five dimensions
. Practitioners must understand __________ and ________________as well as the biomedical factors that affect the patient’s illness experience
- Practitioners must understand social and __psychological as well as the biomedical factors that affect the patient’s illness experience
- “Patient as person” – providers must understand that each patient’s illness is a unique experience
- Providers and patients share power and responsibility; active dialogue and collaboration in the decision-making
- “Therapeutic alliance” – patient perceptions, mutual agreement regarding _therapeutic goals__ , a trusting relationship between patient and healthcare professionals.
- Providers must be aware that their responses to patients and their behaviors may have significant effects on patients
who ultimately makes healthcare decisions
PCP
RPh
patient
third partes
the patient
Patient-centered medical care – The pharmacist must be able to…
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
Medication use process
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
Therapeutic monitoring – patient’s role
Meeting therapeutic goals
Self-monitoring
Obtaining information from providers
Being more assertive
Joint Commission tips
Patient-Provider communication
Unanswered questions
Misunderstandings
Therapy-related problems
Self-monitoring
Decision-making
In Healthcare, Interpersonal Communication is:
The ability of the provider to elicit
and understand patient concerns,
to explain healthcare issues,
and to engage in shared decision-making if desired
Why use interpersonal communication?
Better adherence
Improve patient outcomes
Improved QOL
Patient satisfaction
Improved mental health
Trust/relationships established with healthcare team
Interpersonal communication model
The Sender
The Message
The Receiver
Feedback
Barriers
Feedback
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?
Pharmacist’s responsibility
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
The meaning of the message – words and context
The meaning of the message – Verbal and nonverbal messages
Factors influence how people assign meaning to verbal and nonverbal messages
Past experiences
Previous definitions
Languages/dialects
Incongruent messages
The meaning of the message – Preventing misunderstanding
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
Improving communication behaviors
Self-awareness
Process awareness
Changing behavior when necessary
Need to knows for interpersonal patuent centered acre lecture
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
Patient Counseling is…
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
Pharmacist’s Role in counseling
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
Patient’s Role
Adhere to medication regimen
Monitor for drug effects
_efficacy_______________
_safety_______________
Report experiences
Difficulty with adherence/cost
Medication effects
Counseling Essentials
Ideal environment
Pharmacist with knowledge and communication skills
Ideal Environment
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
Pharmacist Knowledge
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
Pharmacist Skills
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
Pharmacist Skills: Open- vs. Closed-ended Questions
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
Pharmacist Skills: Medical Jargon vs. Lay LanguagePharmacist Skills:
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
Instead of MEDICAL JARGON
renal
HTN
Lthergic
hepatic
angina
inflammaton
anaphylaxis
sublingual
myocardial infarction (MI)
gastrointestinal (G)
USE
kidney
HBP
tired, sleepy
liver
chest pain
swelling, redness
allergic rxn
under tongue
heart attack
stomach
Counseling Pts on New Prescriptions: Process
Part 1: Introduction
Part 2: Profile Verification
Part 3: Counseling
Part 4: Closing
Part 5: Communication (Style)
Part 1: Introduction
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?”
Part 2: Profile Verification
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?”
Part 3: Counseling
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
Part 3a: CounselingMedication Description/Purpose
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
Part 3b: CounselingMedication Use
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
Part 3c: CounselingOther Medication Info
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
Part 4: Closing
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
Part 5: Communication
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…”
Counseling Activities in the Classroom/Labs
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
Roadmap for communization
barriers
conflict
the angry patient
assertiveness
customer service
Barriers to Communication
Environmental
Personal
Administrative
Time
Environmental Barriers
what are the solutions?
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:
Personal Barriers
people are still people
our personality or communication style may not be for everyone
step out of comfort level
solutions
- use patient-friendly language
Patient Counseling is…
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
Pharmacist’s Role
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
Patient’s Role
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
Counseling Essentials
Ideal environment
- Conducive to learning
Private and comfortable
Safe and confidential
Free of distractions/interruptions
Pharmacist with knowledge and communication skills
Ideal Environment
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
Pharmacist Knowledge
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
Pharmacist Skills
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
Nonverbal communication consists of all messages other than words that are used in communication. Includes:
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
Nonverbal Communication
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
Nonverbal Communication
Physical elements of nonverbal communication:
Body movements and gestures - kinesics
Distance between persons trying to communicate - proxemics
Physical environment
Nonverbal Communication - kinesics
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
Nonverbal Communication - kinesics
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.
Nonverbal Communication - Proxemics
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
Nonverbal Communication - proxemics
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
Nonverbal Communication
Facial expressions –
Inadvertent facial expressions may send a message that you did not intend to transmit!
Nonverbal Communication
Environmental factors
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
Nonverbal communication - dress
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.
Nonverbal Communication
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.
Patient nonverbal language
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
Patient nonverbal language
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
Culture and nonverbal behavior
Body movements and gestures
May illustrate respect and manners
Pointing may have different meanings - different cultures have varied interpretations for hand gestures, for example.
Culture and nonverbal behavior
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)
Culture and nonverbal behavior
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
Nonverbal Communication
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
Listening
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.
Importance of Listening
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)
Active Listening
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
Avoid
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
4 Components of Non-Violent Communication
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
Non-Violent Communication: Feelings
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
Confirm the Concern
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
Should do:
Avoid
Should do:
Hear
Backchannel
Clarification
Mirror/Summarize/Paraphrase
Empathy
Avoid
Multi-tasking
Planning your response
Premature conclusion
Faking interest
Active Listening
How could a pharmacist demonstrate “hearing”:
How could a pharmacist demonstrate “back channeling”:
How could a pharmacist demonstrate “clarification”:
How to respond with empathy:
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.
Avoid:
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.
Barriers to Communication
Environmental
Personal
Administrative
Time
Personal Barriers
Pharmacist
Personality
Communication style
Comfort level
Cultural awareness
Patient
Perception of pharmacists, using medicine, etc.
Beliefs about the healthcare system
Individual
Familial
Cultural
Conflict
Inevitable
Opportunity for growth and problem solving
What are some causes of conflict in a pharmacy setting?
Causes of Conflict
Lack of awareness
Incompatible goals
Scarce resources
Dependence
Values
Anger
Stressor
Painful core feelings
Trigger statements
Anger
Acting out
Resolving Conflict / Dealing with the Angry Patient
Listening
Avoid getting trapped in the negative filter
Empathy
Respect
Self
Others
Assertiveness
Assertiveness
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.
Assertiveness
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
“I” statements allow us to…
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
Assertiveness Skills
Broken record
Fogging
Negative inquiry
Workable compromise
Sorting issues
Disarming anger
Selective ignoring
Customer Service is not The customer is always right
now it is
The customer deserves respect
Drug related problems (DRPs)
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
Effective collaboration
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
Considerations
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
Patient versus healthcare provider
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
SBAR
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!
SBAR situation
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
SBAR background
Background
Provide pertinent background information related to the situation.
May include diagnoses, allergies, current medications, etc.
SBAR assessment
Assessment
Summarize the facts and give your best assessment.
What is going on?
What might happen if this problem is not addressed?
SBAR recommendation
Recommendation
What do you want to happen next?
State your recommendation and/or the actions you are requesting of the other person
