OSCE drug counselling Flashcards
What is the approach to a drug counselling station ?
- Establish the patients understanding of why they are there, what they are there to talk about and if they’re ready to hear everything.
- Take a general history -> including PMH, medications and allergies.
- What do they understand about the drug
- Explain how they drug works
- Explain how to take it and how often
- Explain how long they will be on it
- Explain what to do if they miss a dose
- Pre testing / monitoring
- Benefits of treatment
- SE of treatment
- Safety net
- Can they make any beneficial lifestyle changes
- Check understanding
What specific questions should be asked to rule out cautions / CI before starting a pt on steroids ?
- Pre exisiting conditions (DM, HTN, CKD, liver problems).
- Stomach ulcers
- Previous mental health issues
- Breastfeeding / any chance you could be pregnant?
- Any regular meds (inc NSAIDs)
What are corticosteroids ?
Medications that act to reduce inflammation and suppress the immune system in various conditions.
How should patients take steroids
- Usually orally
- Once daily
- Take with food to prevent stomach irritation
- In the morning ! To prevent interruption of sleep !
- Usually long term
what should a patient taking steroids do if they miss a dose ?
Take it as soon as they remember, don’t take two in one day !
What monitoring is done when on long term steroids
- Baseline BP, weight, HbA1c.
- Monitor BP, blood sugar and weight.
Side effects of long term steroid use ?
- Short term : sleep disturbance, weight gain, change in mood, GI upset
- Long term : skin thinning, easy burisinh, thinnin bonesn
- DO NOT SUDDENLY STOP TAKING - talk to doctot before stopping as body’s natural production will be reduced.
What should patients taking steroids always carry
Steroid emergency card - very important so healthvcare professionals are aware they take regular steroids and therefor don’t miss a dose.
What should patients do when ill if taking regular steroids?
Contact a heatlhcare professional so they can guide the patient in terms of doubling their dose !.
Important history to check when starting a patient on metformin
- Symptoms
- Any previous management : impact, compliance, SE.
CI / Cautions to check before metformin
- PMH : liver / kidney problems
- Drug Hx
- Allergies
How does metformin work
- Works to lower the blood sugar by reducing how much glucose your liver releases and helping cells to absorb it !
- Does so without sending your blood sugar too low !
Why is it important to control blood sugar levels
If they get too high they can cause long term damage to our bodies. Increase our risk of srtoke, damage the nerves in our body and effect our vision.
How is metformin taken
Usually tablet
Same time everday with a meal
Dose will be increased gradually
Duration of treatement
“Treatment of diabetes is life-long. After being prescribed metformin, you will likely be taking this long-term. We may need to change your metformin dose depending on your blood sugar levels”.
SE of metformin
Most common with standard release = GI upset. If this happens ! Get in touch and we can switch the type of metformin you are on which will act to try and reduce these symptoms
More serious SE
- B12 deficiency - any numbness or tingling ! get in touch
- Any more serious symptoms (fever, SOB, chest pain ! Get in touch as this could be signs of a more serious adverse reaction.
- Any scans in the furture, make sure to let people know you are on metformin ! as it may need to be stopped
- GIVE A LEAFLEt
what to do if miss a dose
Take the next dose as normal, DO NOT TAKE TWO .
Any monitoring for metformin
- HbA1c every 3 mnths until stable
- Annual diabetic review : foot check, retinopathy, BP, cholesterol and renal function.
What conversation needs to be had regarding life style if starting pt on any diabetic medications ?
- Ask about smoking and alcohol
- Explain that stopping smoking, reduxing alochol, increasing exercise and weight loss will have bigger impact on blood sugar control (high fibre, low carbohydrate).
How should you end a consultation if starting pt on diabetic medications
Very important that you attend follow ups to lower the risk of complications !!!
how does methotrexate work ?
Methotrexate is a medication used to decreased inflammation in the body and prevent disease progression - will help with your symptoms of X,Y,Z
How is methotrexate taken
Tablet, liquid or injection form taken once weekly. ! Folic acid will be co-prescribed. Also to be taken once weekly on a different day to the methotrexate. Acts to reduce the SE !!
Common SE of methotrexate
- Headache, nausea, loss of appetite, fatigue
- Any symptoms of more serious SE : yellowing of skin , persistent cough, fever, chillis, bleeding CONTACT
What advice should you give to people about taking other medications whilst on methotrexate
Always check with pharmacist / dr due to potential for interaction.
What monitoring will a person taking methotrexate have ?
- Certain bloods (FBC, kidney and liver) will be checked every1-2 wks until stabilised. This will then change to every 2-3 mnths.
What should be checked in regards to history before starting clozapine ?
- Quick schizophrenia history : other medications, hospital admission, complianace and adverse SE. Current symptoms
what is clozapine and when is it used
- Type of antipsychotic medication
- Used when other medications have failed to control s§chizophrenia symptoms
How is clozapine taken ?
- Tablet, liquor or orodispersible form
- Will be titrated up over several weeks !
Advantages of clozapine ?
6/10 people with treatment resistant schizophrenia will benfit from clozapine !!
Common clozapine SE
- Tired, constipation, weight gain
Serious SE
Can drop our WBC levels making us more susceptible to infections. Any symptoms such as a sore throat or other flu like synptoms, seek urgent medical assessment immediately. !
Warfarin
- Explain
minor and more extensive bleeding - Extensive bleeding : hospital to reverse
- Always tell medical professionals they are on warfarin
Clozapine
- Miss 2 doses have to retitrate !
