MEDICATION COUNSELLING Flashcards
GENERAL STRUCTURE
what is the general structure for a medication counselling station?
OPENING CONSULTATION
- introduce self
- confirm name and DoB
- explain the reason for the consultation
ICE
WHAT IS THE MEDICATION?
HOW IS IT TAKEN?
HOW DOES IT WORK?
SIDE EFFECTS
LIFESTYLE ADVICE
WARFARIN
how would you explore ICE?
IDEAS
- have you heard of warfarin
- what do you already know?
- do you know why people take it?
CONCERNS
- is there anything that worries you about taking warfarin?
EXPECTATIONS
- what were you hoping we would discuss today?
WARFARIN
how would you explain how warfarin works?
- type of medication known as anticoagulant
- helps to thin blood, making it less likely that a dangerous blood clot can form
- can be used to treat people who have a previous blood clot in leg or lungs
- can prevent future blood clots in people at high risk e.g. irregular heart beat or artificial valve
- can be rapidly reversed with an antidote
WARFARIN
how would you explain INR?
- measure of how long blood takes to clot
- normal = 1
- since you are at higher risk of clots = 2-3
- will need to monitor INR every so often through a blood test
- will be frequent to start with (every 3-4 days) then every 1-2 weeks and then every 12 weeks
- dose of warfarin is adjusted according to your INR to keep it in the 2-3 range
WARFARIN
how would you explain how to take warfarin?
- same time each day
- tablets have different colours according to strength
- if missed dose, take as soon as you remember unless it is next day. If next day, skip missed dose
- inform doctor/nurse of missed doses at next appointment
- if unwell + not able to take meds, contact doctor as you may need more frequent testing or alternative
- tell doctor and pharmacist before taking any new medications, prescription or OTC
- continue taking medication unless told to stop by doctor
- not safe during pregnancy so should have effective contraception in place
- if planning to get pregnant, talk to doctor so alternatives can be discussed
WARFARIN
how would you explain what to do in less serious bleeding?
- normal to bleed more easily
examples: - periods heavier
- bleeding a little longer if you cut yourself
- occasional nosebleeds
- bleeding from gums with brushing teeth
- bruising more easily
- not dangerous + should stop by itself
- keep taking warfarin but tell doctor if it bothers you
WARFARIN
how would you explain serious bleeding?
- can be dangerous + needs urgent medical attention
- stop warfarin + call doctor or go to A&E
Examples - red pee or black poo
- large nosebleeds lasting >10 mins
- large bruises
- blood in vomit
- coughing up blood
- severe headaches, seizures, changes to eyesight or tingling in arms or legs
- bleeding from cut which will not stop
WARFARIN
how would you explain other side effects of warfarin other than bleeding?
COMMON
- mild rash
- hair loss
- are typically mild, contact doctor/pharmacist if they are bothersome
SERIOUS
- jaundice
- skin necrosis
- seek urgent medical attention if skin is yellowing or painful swollen areas of skin
WARFARIN
what is the lifestyle advice?
DIET
- avoid cranberry juice
- avoid drastic changes in food high in vit K e.g. broccoli, kale or spinach
ALCOHOL
- limit intake
- never binge drink
- major changes to alcohol can affect INR
OTHER
- take extra care when shaving or brushing teeth
- inform dentist that they take warfarin
WARFARIN
what should you advise about yellow booklets and alert card?
- all patients should be provided 2 yellow booklets, INR monitoring booklet and a patient info leaflet
- always carry anticoagulant alert card
- take INR monitoring book to each appointment with doctor/nurse
HRT
how would you explore ICE?
IDEAS
- have you heard of HRT?
- what do you already know about HRT?
- do you know why people take HRT?
CONCERNS
- is there anything that worries you?
EXPECTATIONS
- what were you hoping we would discuss today?
- what were you hoping HRT might be able to do for you?
HRT
how would you explain what HRT is?
- an effective treatment for menopause related symptoms
- have positive influence on other long term conditions
- reducing risk of osteoporosis, cardiovascular disease and strok
- aim is to restore low hormone levels that occur as a result of menopause
HRT
how would you explain how it is taken?
- many ways to take HRT
- most common = oral tablets
- other forms = skin patches, gels and implants such as mirena coil
- can try different forms to find ones that work for you
HRT
how would you explain how it works?
- menopause = when ovaries stop producing eggs
- therefore there are less hormones such as oestrogen and progesterone in the body
- results in hot flushes, weakened bones + vaginal dryness
- HRT replaces hormones with the hope of reducing symptoms + health problems
HRT
who is eligible for HRT?
- treatment of menopausal symptoms where risk/benefit ratio is favourable
- early menopause until age of natural menopause
- women under 60 who are at risk of osteoporosis + non-oestrogen treatments are not suitable
HRT
how would you describe the different types?
- cyclical = period in last 12 months
- continuous = LMP over 12 months ago
- oestrogen + progesterone = have uterus
- oestrogen only = no uterus
HRT
how would you explain the pros?
- reduction of frequency of hot flushes (up to 87%)
- improve mood
- improve vaginal dryness + overall sexual function
- can improve urinary symptoms such as increased frequency passing urine
- reduces risk of osteoporosis
- reduce risk of cardiovascular disease such as HTN + heart attacks
HRT
how would you explain the cons?
- oestrogen = breast tenderness, bloating, headaches + leg cramps
- progesterone = backache, pelvic pain, depression
- breakthrough bleeding in first 3-6 months in continuous combined HRT
HRT
what are the risks?
VTE
- increased risk of blood clots
- oral HRT increases risk by 2-3 times, but overall risk is low. Skin absorption reduces risk
ISCHAEMIC STROKE
- blood clot blocks blood supply to brain
- still very unlikely
- skin preparations do not carry this risk
BREAST CANCER
- small increased risk
- risk decreases when stop taking HRT
ENDOMETRIAL CANCER
- oestrogen only HRT increases risk of developing cancer of the lining of the womb
- no increased risk if taking combined HRT
HRT
what are the contraindications?
- current, past or suspected breast cancer
- oestrogen-sensitive cancer
- undiagnosed vaginal bleeding
- untreated endometrial hyperplasia
- previous idiopathic or current VTE
- active/recent angina or MI
- untreated HTN
- active liver disease
- pregnancy
BISPHOSPHONATES
how would you explore ICE?
IDEAS
- do you know anything about bisphosphonates?
- do you know what they are used for?
CONCERNS
- is there anything in particular worrying you?
- what is your number one concern?
EXPECTATIONS
- what were you hoping we would discuss today?
BISPHOSPHONATES
what would you explore in patient history?
- any fractures
- ever had DEXA scan which identified osteoporosis
- medications
- any heartburn or reflux
osteoporosis risk factors
- smoking
- alcohol
- steroid use
- menopause
BISPHOSPHONATES
how would you explain how they work?
- osteoporosis = thinning of bones which increases risk of fractures
- bisphosphonates prevent thinning + allow bones to gain strength over time to reduce risk of fractures
BISPHOSPHONATES
how would you explain how to take them?
- take once per week
- take on same day each week in the morning
- take tablet with large glass of water + sit upright for 30 minutes after taking it
- take at least 30 minutes before food or other medications
- if you miss a tablet, take in the morning after remembering. Never take two tablets on the same day
BISPHOSPHONATES
how would you explain how long it takes for treatment to work?
- takes 6 months to start strengthening bones
- will most likely not feel any different
- important to keep taking medication for long term benefits
- GP will review annually
BISPHOSPHONATES
what are the side effects?
OESOPHAGEAL IRRITATION
- oesophageal irritation + heartburn = sit upright after taking. Do not take NSAIDs as they can increase irritation
ABDOMINAL UPSET
- abdo pain, nausea + joint/muscle pain in first month
OSTEONECROSIS OF JAW
- osteonecrosis of the jaw = pain + ulcers in mouth + jaw
- seek urgent medical review
BISPHOSPHONATES
what lifestyle advice can be given?
- importance of diet + exercise
- weight bearing exercise e.g. walking, hikingm jogging or resistance training
- eat high calcium food e.g. dairy, leafy green veg, soya beans, nuts or boney fish
- stop smoking
STATINS
how would you explore patient history?
- previous heart attack
- previous stroke
- smoking
- alcohol
- HTN
- sedentary lifestyle
STATINS
how would you explain Q RISK?
10% = 1 in 10 risk of developing cardiovascular disease e.g. MI or stroke in next 10 yrs
cannot predict what will happen but can give indication that we might want to look at reducing risk
STATINS
how would you explain what statins are + how they work?
- cholesterol is essential for life + used by body in many processes
- too much of the wrong sort can increase risk of CVD and stroke
- statins work by limiting production of new cholesterol in the body whilst clearing bad cholesterol
- aims to reduce total amount of bad cholesterol + reduce risk of heart attacks and strokes
STATINS
how should they be taken?
- taken once daily at night
- if you miss a tablet, take one as soon as you remember. Do not take two tablets in the same day
STATINS
how are they monitored?
- blood test before treatment to check cholesterol + liver function
- blood test after 3 months + after 12 months
- will not feel beneficial effects but it is important to keep taking the medication consistently
STATINS
what are the side effects?
- muscle tenderness = common + not serious
- can cause muscle toxicity so any increase in muscle aches need to be reported
- can cause interstitial lung disease
- seek advice if develop cough, SOB or weight loss
common side effects = nausea, constipation, diarrhoea, headache + flatulence
are generally well tolerated + have proven long term safety record
STATINS
what are the key interactions?
- avoid grapefruit
- should discuss any new medications or supplements with doctor or pharmacist as some can interact and reduce effect
