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Explaining medications and procedures to patients (Pharmacology station) By Ronan Fitzgerald & Risma RemsudeenLearning aims • Format of how to approach explaining a medication to a patient • Common medications that require explaining • How to do a medication review • Explaining procedures to patients • Explaining a disease to a patient Explaining medications to a patient • Brief initial history(what brings them in today-seewhether they know what medicationthey’re starting) • What is the patientsunderstandingof the medication:ICE (if a patient is concerned aboutany elementstate that you will answer any concerns reassure them on certain bits)the medicationand hopefully you can • Explain the medication • Check for Contraindications • How the treatmentworks • Treatmentcourse/Howis the treatmenttaken • **Good pointto do chunk and check • Monitoringrequired • Side effects (common+ serious) • **Any questionsso far • Offer a patient leaflet on the medicationand also contactdetails if any issues/concernsarise. • **If unsure abouta certain elementfor ISCE say you don’tknow, have a guess and then statethat you will check to make sure. Methotrexate How it works Contraindications Treatment course/how its taken Supresses the immune -Pregnancy (including -once weekly tablet system reducing male with partner) -same day each week inflammation -Hepatic impairment -Taken long term -Active infection Monitoring Side effects -FBC,LFTs,U&Es before starting -Common: GI disturbances -Then every 2 weeks until stable -Serious: Blood dyscrasias (leucopenia, -Then every 2-3 months agranulocytosis, anaemia & thrombocytopenia) Sertraline How it works Contraindications Treatment course/how its taken Rebalances the chemicals N/A -tablet once daily in your brain -Once improvement seen continued for minimum 6 months Monitoring Side effects N/A -Common: GI upset + headaches -Serious: increased suicide risk when startingLithium How it works Contraindications Treatment course/how its Mood stabiliser: -Pregnancy taken Rebalances the chemicals -Heart failure -Tablet once daily in the brain -Renal impairment -Taken long term Monitoring Side effects - Before starting: -Common: GI upset, FBC,U&E,TFT,Beta Metallic taste in mouth, HCG,ECG Fine tremor - Lithium level after 5 -Serious: Symptoms of days, then every week toxicity; neurological, until stable for 4 weeks, cardiac & renal symptoms then every 3 monthsWarfarin Treatment course/how its How it works Contraindications Thins the blood to prevent -Pregnancy taken clotting -Risk of major bleeds -Once daily tablet -Length of time depends on indication: Monitoring Side effects (AF=lifelong, -INRs on day 3,4 & 5 Serious: seek medical DVT/PE=3-6months) -Then regular INR checks advice if any major bleed at a anticoagulation clinic or injury e.g. head injury, blood urine or stool e.t.c.Statin How it works Contraindications Treatment course/how its Stops liver making Pregnancy taken cholesterol -Once daily tablet in the evening -Taken long term Monitoring Side effects -Serious: muscle pain -> LFTs before starting, at 3 months and at 12 months RhabdomyolysisMetformin How it works Contraindications Treatment course/how its Improves body’s response -Severe renal impairment taken to insulin (risk of lactic acidosis) -Tablet once daily with meals -Taken long term Monitoring Side effects -U&Es before starting then -Common: Abdo annually discomfort (can switch to -HbA1C every 3-6 months modified release tablet)Atypical antipsychotics (Olanzapine, Clozapine & Risperidone) How it works Contraindications Treatment course/how its Schizophrenia caused by -Hepatic impairment taken problems with dopamine -Phaeochromocytoma -Daily tablet or depot receptors in the brain. injection every 2-4 weeks Blocks dopamine -Taken long term receptors Monitoring Side effects -Before treatment, at 3 -Antidopaminergic (tardive dyskinesia and movement disorders) months, 12 months and -Anti-cholinergic (dry mouth, dry eyes, constipation, urinary then annually: Pulse, BP, retention) weight, ECG, HbA1C, -Antihistaminergic (weight gain, dizzy, drowsy) glucose, lipid, prolactin -Prolonged QT interval -Clozapine → agranulocytosisBisphosphonates How it works Contraindications Treatment course/how its taken Prevents bone being -Pregnancy -once daily tablet broken down -Peptic ulcer disease -Swallow tablet with full glass of water -Dysphagia -At least 30 mins before food and must be 30 mins upright after swallowing -Taken long term Monitoring Side effects -Regular dental check ups -GI upset **Serious: -osteonecrosis of the jaw -Dysphagia/odynophagia -Upper GI bleedOther medications to be aware of • PPIs • Carbimazole • Anti-arrhythmics • Levodopa My advice • DOACs • NSAIDs • -Don’t rope learn every single drug: Learn the most common/likely ones • Iron tablets • Opioids • Steroids • Antiemetics • -Look at each drug and have a rough idea about how to explain each one • Beta Blockers • Contraceptives • -The key with this station is more can you • Inhalers • HRT give a rough explanation of what the medication does and address the patients' • Antibiotics • Antihypertensives ideas and concerns on starting the drug. • Insulin • Other antidiabetics • LevothyroxineT op tips • At the end of an explanation of a medication, check patient's understanding • Explaining side effects: “With any medication there is a risk of side effects. With most side effects though they usually resolve in a week or 2. If they don’t then you can come back to see us. With the more serious side effects these are very rare and we tell you before things get to that stage. Does that make sense?”e then we can treat you early • If you know what blood tests for monitoring, translate this into patient friendly material. i.e. Statins- LFTs=blood test to check your liver. • With multiple test medications try and simplify the material e.g. Antipsychotics: Pulse, BP, weight, ECG, HbA1C, glucose, lipid, prolactin =We check your pulse, blood pressure blood tests. All these tests are done to make sure that everything is going fine while being on the medication. • How to remember treatment course: most of the common drugs are once daily tablets EXCEPT: atypical AP, levodopa and insulin. • Introduction • Establish what medications patient is taking: includes tablets, liquids, suppositories, inhalers, over the counter medications and supplements • For each drug A. What condition its for B. When they started it C. Dose/route/frequency Medication review D. How they take it E. If they take it-compliance F. Side effects G. If it helps • Also very important to ask if any new medications have been started or any recent hospital admissions (can often tell you if someone has an exacerbating cause for a new symptom)Explaining procedure to a patient • Brief initial history (what brings them in today and do they know about the procedure they need) • What is the patients understanding of the procedure: ICE & reassure that concerns will be addressed • Explain what the procedure is • Explain the reason for the procedure • What will happen before the procedure: Oral intake, any preop measures • What happens during procedure: general anaesthetic?, sedatives?, other procedures to facilitate • What happens after the procedure: can they go home afterwards, eating/drinking?, driving, follow up • Chunk and check • Risks of procedure: if not sure default: risk of bleeding, damage to local structures and risk of infection- reassure by stating what is done to mitigate risks e.g.infection risk-everything is done under a sterile environment so no bug is introduced to site. • Any questions and offer patient leaflet with contact details • Brief initial history (what brings them in today and do they know about the diagnosis they have been given) • What is the patients understanding of the disease: ICE & reassure that concerns will be addressed • Normal anatomy and physiology: make things simple Explaining a (nerves=wires and conduction) (blood vessels=tubes) disease to a • What the disease is and how it affects normal physiology patient • Check understanding + if need to or if will help use diagrams to aid explanation • Symptoms and complications of the disease (is it progressive in nature) • Management • Understanding and questions • Offer leaflet and contact detailsThank you for listening. Any questions?