W23 Counselling

Question 1

What should happen during patient counselling?

Answer 1

-An assessment of the patient’s
understanding and comprehension of the appropriate use of their medication.
- An assessment of the patient’s awareness of
how to use the information given by the pharmacist in order to ensure more positive outcomes of the prescribed medication.

Question 2

What is the definition of Patient education?

Answer 2

“A planned learning experience using a combination of methods such as teaching, counselling, and behaviour modification techniques that influence patient’s knowledge and behaviour”.
So, Counselling is a part of patient education.

Question 3

What is the role of the pharmacist in counselling?

Answer 3

• Community pharmacists have great potential to be the first contact for patients seeking treatment for minor ailments.
• They have an increasing role in public health promotion of healthy lifestyles
• Pharmacist-patient interactions may address diet, device use, exercise, referrals, or other non -medication issues

Question 4

What are some methods of effective counselling?

Answer 4

Establishing caring relationships
Assessing the patient’s knowledge, attitude, physical and mental capability
Providing visual aids in addition to oral information
Verifying patients’ understanding

Question 5

What is Effective medication counselling?

Answer 5

Hand gestures, facial expression

• An interactive approach between the patient and the pharmacist, which takes into account the patient’s special needs, beliefs and perceptions about medication use.
• Effective medication counselling has a significant effect on patients’ adherence with the treatment plan.
• Without sufficient knowledge, patients cannot efficiently manage their own care.
• Failing to adhere to treatment instructions commonly leads to serious negative outcomes such as disease progression, lowered quality of life and death, in addition to increased health care costs.
• Medication counselling before patient discharge from the hospital significantly reduces the adverse drug reactions after discharge.

Question 6

Counselling; What are the things to consider about a patient? (8)

Answer 6

Age
Gender
Co-morbidities
Formulation
Indication- why are they taking it?
Ethnicity
Class of medicine
Nature of medicine (high risk?)

Question 7

What are the types of oral formulations? (5)

Answer 7

Tablets (and caplets)
Capsules
Powders and Granules
Solutions
Suspensions

Immediate release and Enteric-coated are oral formulations with different release profiles.

Question 8

What are the different types of topical formulations?

Answer 8

Emulsions
Patch
Creams
Ointment

Question 9

Exercise: You have 5 min per formulation to find the most important points and the most challenging aspects in each counselling consultation

Answer 9

Counsel a patient asking to purchase an OTC product:
Oral paracetamol
1)for a 6 year old;
2)for a 60 year old with Parkinsons’ disease and swallowing
difficulty

Please find the links to the patient information leaflet (PIL) under each
picture
2
*Before starting any counselling, think of your patient’s characteristics
and special needs which may relate to their age, gender, ethnicity,
social history, physical/mental health history, past traumas, etc.
3
*Consult the SPC/PIL and find the nature/class of drug (if any special
precautions need to be taken), then look at important info such as
dose/frequency etc, then go to the ‘how to use’ section
4
*Finish the counselling by putting safety nets in place and confirming
the patient’s understanding/ answering any questions they might have

Question 10

What are the type of GI formulations?
What are the different auricular formulations?

Answer 10

Tablets, Capsules, Powders
Ear drops
Ear spray

Question 11

What are the different enteral and CNS/pain formulations?

Answer 11

Enteral= Sprays/Lozenges
CNS/Pain=Tablets, Effervescent tablets e.g. Nurofen and Co-Codamol

Question 12

What are different ophthalmic formulations?

Answer 12

Eye drops
Viscous eye drops
Eye ointments
Gel drops

Question 13

How do you counsel a patient on using a beclametasone nasal spray?

Question 14

Stye counselling

Answer 14

• Wash face and remove eye makeup before bed
• Replace your eye makeup every 6 months
• Wear glasses and not contacts
• Apply a warm compress to eye for 5-10 minutes

Question 15

Blepharitis

Answer 15

Crustiness, dryness, swollen eyes
Wash eyelids every day

Question 16

Jaundice

Answer 16

Refer to urgent medical help
Skin may turn hello
Can be a sign of something serious such as liver disease

Question 17

Impetigo

Answer 17

A skin infection that is very contagious
Starts with red sores or blisters
Topical antibiotic: Fusidic acid

Wash affected areas with soap and warm water

Fusidic acid:
- apply to skin, do not swallow

Question 18

Hives

Answer 18

Aka urticaria

Cetirizine, Loratadine, chloramphenamine

Watch out for triggers

Question 19

Scarlett fever

Answer 19

Refer to GP

Strawberry tongue

Question 20

Hand foot and mouth disease

Answer 20

Usually gets better on its own 7-10 days
Sore throat, high temp, not eating

Mouth ulcers,

Question 21

What is the treatment for a foot verruca:
How should it be applied?

Answer 21

Bazuka gel (Salicylic 12%)

• Apply once a day, at night.
• Before applying, debride the surface of the wart or verruca with an emery board and/or
  soften the area by soaking it in warm water for 5–10 minutes -excess abrasion may enhance spread of the virus to surrounding skin.
• For subsequent applications, peel off any film remaining from the previous application and
  debride and soak as above.
• AVOID applying the treatment to the SURROUNDING skin by applying carefully to wart and protecting the surrounding skin with SOFT PARAFFIN or plaster.
• Do not apply to the face or areas that are extensively affected because of an increased risk
  of skin irritation and scarring.

Question 22

What is the treatment for fungal toe nail

Answer 22

Amorolfine 5% w/v nail lacquer

• Will take 9-12 months to fully heal
• Apply once weekly
• Can only treat if:
• Mild infection beneath tips and sides of nails
• Max 2 nails infected
• Not diabetic

Question 23

Fungal toe nail symptoms:

Answer 23

• Also known as onychomycosis
• Sometimes start at the edge of the nail.
• Often spreads to the middle of the nail, making the nail discoloured and
  sometimes thicker in parts.
• The nail becomes brittle and pieces can break off. Sometimes the whole nail
  lifts off. This can cause pain and swelling in the skin around the nail.
• Usually affects toe nails, but can affect fingernails too

Question 24

What is the difference between Warts and Verrucae?

Answer 24

• Also known as onychomycosis
• Sometimes start at the edge of the nail.
• Often spreads to the middle of the nail, making the nail discoloured and
  sometimes thicker in parts.
• The nail becomes brittle and pieces can break off. Sometimes the whole nail
  lifts off. This can cause pain and swelling in the skin around the nail.
• Usually affects toe nails, but can affect fingernails too

Question 25

What are the hygiene measures for warts and verrucae?

Answer 25

Wash your hands after touching
Change your socks daily if you have a verruca
Cover with a plaster when swimming
Take care not to cut a wart when shaving

Dont share towels, flannels, socks or shoes
Dont not bite or suck fingers with warts
Do not walk barefoot with verruca
Do not scratch or pick a wart

Question 26

Fungal toe nails do’s and dont’s

Question 27

How to apply Amorolfine medicated lacquer:

Question 28

What are the similarities and differences between corns and calluses?

Answer 28

• Both - hard or thick areas of skin that can be painful
• Both - you mostly get them on your feet, toes and hands.
• Both - can also be tender or painful.
• Both - caused by pressure or rubbing of the skin on the hands or feet.
• Corns are small lumps of hard skin.
• Calluses are larger patches of rough, thick skin.

Question 29

OTC Management for Corns and Calluses

Answer 29

• Heel pads and insoles to cushion feet and stop them rubbing
• Hydrocolloid plasters
  -Cushion corn to relieve pain
  -Protects from further rubbing
  -Moisturises surrounding area to help remove it
• Plasters containing salicylic acid
  -Dissolves the keratin structure that makes up the dead skin
  -Dead skin will then turn white- file away
• Calluses: soften skin by bathing, then file with pumice stone or foot file

Question 30

A patient comes to you with a diabetic foot ulcer:
What is a foot ulcer?
What causes them?
What treatment do you recommend?

Answer 30

• An ulcer is a medical term for an open sore.
• Foot ulcers are serious and can take weeks or months to heal.
• Occasionally they can deteriorate and lead to severe infection, gangrene or amputation.

What causes foot ulcers?
* Ill-fitting footwear
* Injury
* Walking barefoot
* Poor foot hygiene
* Dry skin.
Foot deformity, poor blood supply or nerve damage to the feet can increase the risk of foot ulcers.

Refer to GP or A&E
Red flag signs for urgent appointment with GP:
* Breaks in skin on foot
* Discharge seeping from foot wound
* Skin over all or part of foot changes colour and becomes more red/blue/pale/dark
* Extra swelling where there was a blister or injury
* Refer to A&E if signs of systemic infection alongside the ulcer, e.g. fever, rigors,
lethargy

Question 31

Hygiene measures for corns and calluses:

Answer 31

Wear thick, cushioned socks
Wear wide, comfortable shoes with a low heel and soft sole that do not rub
Use soft insoles or heel pads in your shoes
Soak corns and calluses in warm water to soften them
Regularly use a pumice stone or foot file to remove hard skin
Moisturise to keep skin soft

Do not try to cut off corns or calluses yourself
Do not walk long distances or stand for long periods
Do not wear high heels or tight pointy shoes
Do not go barefoot

Question 32

Diabetic foot ulcer do’s and dont’s