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So I think we're still waiting for a few people. Um But I'm just gonna sort of progress the slides. Um We've got a mentee meter today so I'll just start the session and then let people join on to that and then we can get going. Ok. Um So just a quick introduction. Um I'm Megan. I'm one of the fy ones um that, that graduated from Cardiff. So I'm working at Basildon Hospital at the moment in Essex, which is where I'm from. Um Obviously, uh I'm a Cardiff graduate and I know Devon um because they intercalated um and I graduated before them. So we're quite close friends and this is how I got into the um Iski Boost business. So, so just to start with um log on to the ment timeter, the code is 61857441. And then I just want you to have a think, what's your biggest concern or question about the Pharmacology Station? And then just give me responses and we'll, we'll have a look. Cool. So I've got one response coming. Keep it coming guys. Ok. Yeah, so making sure I've covered all the drugs that should come up. Yeah, there's a lot of them. Um, it is difficult to cover everything just as with everything in medicine I'm afraid. Um, but I've given a little list at the end of the slides of all the drugs that I think you should try and know about. Ok, so you can just take those off with your revision, how much depth of knowledge is needed for drug interactions and side effects. Yeah, definitely. Um, so as I said, there's a lot of drugs to cover, um, but I'll sort of give you an idea of, of what you should be, um, revising with each of those drugs. Um, and sort of the, the things that the examiners can test you on, um, explaining the complications of the drug without knowing the exact function. Ok. Yeah, that's, that's, I suppose that's tricky because obviously the best way to sort of be able to explain, um, the way that things work to a patient or to the examiner is having a good idea of like the physiology and pharmacology of it yourself. Um, you, you're not going to know all of the like exact pharmacology with each drug. Um, but I'd certainly recommend going on to, I don't know if any of you have heard of, um, Amando has and, um, there's other sort of youtube videos that cover pharmacology, especially for drugs, like the atypical antipsychotics that have got a lot of side effects you might want to go and have a sort of more in depth, look at those so that you have a better understanding and of the side effects when you're counseling a patient. Ok. I'm just gonna go back to the slides. Ok. So this is the Pharmacology Station, obviously, we're making our way through um, lots of different sessions. Now, I believe next week is the P session. Um, and we've had three sessions so far and I believe people had raised, um, that they wanted to sort of have their CBD S looked at. So obviously CBD S are quite difficult to know if you've picked the right topic. I mean, you can have a very interesting case. Um, but sometimes it's difficult to know whether that will match up well with the questions that the examiners are going to ask you. Um, and so what Devon has suggested is, um, you can email through your CBD, um, to this email on the slide. Um, and they'll happily review your topic, um, and give you some tips on whether it's a good topic for the station and things that you could potentially improve because it is a tricky one. I don't think there's really much guidance for it. So, ok, so just an overview of today's session. So today we'll look at what the station is and how you're going to tackle it, which medications to learn and how to learn them and looking at some examples of the kinds of cases that can come up in this station, uh any questions put them in the chat. Um I think I've also enabled some sort of function or mentor meter for you to ask questions as well. And I'll, I'll try and keep an eye on that as we go along. Ok. Sorry, what can you expect from this station? So just like with all the other stations you get this a history at the beginning. Um, so you'll get like a little, um, sort of overview at the beginning. So, I don't know, Missus Jones is a 53 year old woman that's, um, come in for a medication review, come and take a history from her and then it will give you another prompt afterwards that will say, oh, then summarize your findings and then you'll be asked to interpret some data and, or answer some questions that are going to test your clinical reasoning, um, and your communication skills skills in that station. So, what sort of things do you think you need to ask the patient in this history? So I'm just gonna go back to a centimeter. Now. We'll just send through the ment code in case people have missed it. Ok, good. Yeah. What medication they're taking? I see. That's very important to know what they're on drug allergies. Yes. There you go. You absolutely need to ask about drug allergies in any ki station. Just ask because it's a, um, it's kind of a safety alert if you don't ask about allergies. So, just every station, including the medication one especially ask about allergies past medical history. Yeah. Really good. How long have they been taking it? And why is it helping their symptoms? Yeah. Absolutely. Compliance is a really good one. obviously a patient could be on medication but if they're not taking it then it's not going to be doing anything for them. So, it's important to know if they remember the timings and dosages. Yeah, I'll come to that one as well. That's a really passionate point. Um What are they taking their medications for? Good side effects? Good. Yeah. Any more responses, guys? Give me a few more. No. Ok. Fine. Yeah, let's move on then. Sorry. It's been a long time since I've done a powerpoint presentation. So you just have to bear with me. So obviously with any history, you want to start with an open ended question. Um So this will really help you guide sort of how you're going to approach the history because the thing is with the Pharmacology Station is that despite it being a Pharmacology station, there are potentially going to be other aspects of the history that you're going to want to explore. They might come in with a particular like presenting complaint that you're going to want to delve further into. So obviously, if they've got an issue, um, then Socrates it. So even if it's not pain, just try and keep to that structure. Um, delve a little bit deeper there and also asking about a systems review and any red flags. So I'll give you an example. My, um, pharmacology station was a medications review, but the patient was on bisphosphonates. Um, and she was presenting with symptoms of esophagitis. Um, so what I wanted to do was because she was a little bit older was just explore any red flags, um, that potentially could be, you know, hiding something sinister that wasn't to do with the medication. Um, so that just really shows to the examiner that you're, you're thinking of the worst case scenario. You're thinking, what can I not miss with this patient? Which is really important. Ok. Past medical history and drug history, I feel like they kind of go together. So someone said about, um, asking the patient, you know, what you're taking the drugs for, I think it's really important to sort of gauge the patient's understanding, um, of the medications that they're on. Like, do they actually know what they take them for or do they just have a list of medications that they just take because their GP told them to, you know, so, and obviously it gives you an idea if you're not sure as well, you might think, oh, why are they on this drug? But actually the patient might have the answer for you. So, the medication history, yeah, it probably is going to be the bulk of the history in this station, but do try not to forget about your family history as well. Um And your social history because especially with like alcohol, smoking and recreational drugs, they're all things that could potentially interact with the drug that a patient is on. Um So those are important aspects to explore as well. And of course, just exploring their ideas, concerns, expectations is just a good thing to do in a station that shows the examiner that you've got good communication skills that you're taking a patient centered approach to the history. So, always try and squeeze that in if you can. Ok. So what questions do you need to ask on drug history? Ok. So we'll just go back cementing. Yeah, you're taking, how long have you been taking it? How are they taking the drug yet? Very good. Any side effects? Yeah. What they're taking the medication for? Check understanding compliance. Yeah, possible adverse effects because of drug interactions. Yeah. And over the counter medications and herbal as well down here. I said that that is very important. Ok. Any more responses? Ok. No worries. Sorry. I completely forgot how to like present from the current slide. Ok, good. So, um, what you want to ask in the drug history? Yes. So list of medications, what are they taking it for? Um, are they actually taking it? Compliance is really important in these patients? Um, because they could just be on these medications but not actually be taking them or not taking them properly. So, do they actually take them as instructed? So, big culprits here are things like bisphosphonates. So, bisphosphates, you have to take that up, right? With nothing but water. Um, and you can't have food, um, until 30 minutes after you've taken the, um, drug. Um, obviously the NSAID NSAID you have to take with food as well. So a lot of patients won't be doing that and they'll suffer the side effects because of that. Ok. Um, allergies, allergies, allergies really important, uh, any side effects at all. So, yeah, someone said, you know, do they have any side effects? But also do they feel it's working? Um, I think that's important to gauge because, you know, a patient might be doing all the right things with their medication, but maybe they are not on quite the right dose and therefore it's not having the desired therapeutic effect. So, definitely ask if they think it's actually working, um, and any drug interactions. So, things I would watch out for in this bit of the history. So, have they been started on any new regular meds? And are they getting any side effects because of that? So, I feel like if you get someone who's got like a new presenting complaint and they've just been started on a medication, um, like within the past few days or a week ago or, you know, um, then you want to be thinking, oh, could this be an interaction? Um, and does that need to be reviewed? And especially if they've been given more acute things as well. So, the patient might not think, oh, if they've been given a course of antibiotics and they're on other regular medications they might just assume that it's still safe to take with all their other regular meds. Um, but actually some antibiotics can interact with some quite common medications. I think one of those is, um, you can't have macrolides with statins, for example, um, and steroids as well. Uh, they could potentially interact with some other drugs um, over the counter medications and herbal remedies. Obviously, it's, it's crucial not to miss out on this because um, patients might give you a list of their regular medications. But then don't think about all the things that they're buying over the counter and any herbal remedies as well. So we all know ST John's wort is a big culprit for interacting with certain things. Um, so think about your list of cyp 450 inducers inhibitors. Um, and just to watch out for those in this station. Ok. So we're gonna move on to some interpretation now. So what data might you be asked to interpret? Um So there's, there's a few things really here that I feel like they can go down. So bloods, for example, that's like a nice easy one to give you. Um, but there's lots of different parameters that you can monitor with drugs. So, for example, liver function tests um and particularly like with statins and LT derangements, um having a look at someone's renal function. So has someone been started on a like a nephrotoxic drug? Um and maybe they've sort of had another insult to their kidneys. They've been particularly dehydrated, they might present to you um the findings of an AKI on their bloods thinking about uh different electrolyte abnormalities as well. So, obviously, lots of different drugs can cause um lots of derangements in like uh levels of sodium and potassium. Um So potentially there could be some derangements there and that could be causing some confusion perhaps. Um So, yeah, definitely keep an eye out for those electrolyte derangements, full blood count. Um So this is particularly relevant with cloZAPine. Um So, cloZAPine is one of those horrible drugs where you have to monitor it uh weekly for 18 weeks. Um And you're particularly looking at the full blood count because of the risk um of neutropenia or any kind of infections. So you have full blood count and cloZAPine and dances as well. So your disease um modifying drugs, um they might throw some blood sugars at you. So obviously, there's always a potential for insulin to come up. I feel like insulin scares a lot of people. Um But I feel like really the only thing that they can do here is sort of having a look at your patient's blood sugar control. Um, so just, just know sort of when to adjust the levels of insulin, I'd say. Um, so you having a look at your short acting insulins, understanding when you'd be using those as compared to your long acting insulins and when you might make adjustments there as regards to your, um, blood sugars. Ok. I don't wait for gentamicin levels in there, but it is something to be aware of. Um just because of the, like the narrow therapeutic index with gentamicin. Obviously, there's, there's quite a risk for um like autotoxicity and nephrotoxicity if it's not within the correct range. Um So just know what levels are appropriate for the patient. Ok. Uh ECG S as well. Um Again, specifically, I'd sort of say maybe know what the signs are for digoxin toxicity with your ECG. Um Otherwise I can't think of any, any specifics, but um especially with all like your drugs that might cause like postural hypotension, which might be like mimicking some arrhythmias. Um just to be comfortable with your ecg interpretation, they might just throw in a simple new score at you um or they might even ask you to calculate um a particular score. So in my mo Ski, uh my Pharmacology station was um starting someone on a DOAC. So I had to sort of counsel the patient on starting the direct. But before I had to do that, um they gave me sort of a list of her parameters and characteristics and asked me to calculate the chads Vas score and determined to determine whether she actually needed to be on the anticoagulant. Um So just try and get familiar with the chads Vas score. Um and I'm not sure what Cardiff advises you to do with has blood or orbit nowadays. Um but yeah, just try and know your husband and all that as well off the top of your head just in case and that comes up. Ok? So we'll just move on to counseling now. Ok. So counseling patient, it's tricky and I feel like it takes practice. Um But you've all done communication skills. I'm pretty sure you've all done this as a session in Cardiff before. Um So it's just about the structure um and keeping it simple. So beforehand, make sure that you check their understanding. So before you just start like rattling off information, actually gauge with them. Oh What, what do you understand about this drug or about the disease that they have and sort of go from there um during the explanation, don't use any jargon. Keep it really simple. Um because they will pick you up on that like you'll say a bit of jargon in the station and they'll be like, what's that? And then you have to like go and explain that and I think it just then puts you off. So just try and keep it really simple, speak slowly. Um give little bit of information at the time. Um They've used the language chunk in and check in before I'm sure, and communication skills. So, um essentially just giving them a bit of information and then asking, uh do you, do you understand um everything that I've said so far? Ok. Um Use clinical context to explain why you want to start the drug. So again, rather than just sort of explaining all the risks and benefits of the drug, like go back to the disease, um and explain the sort of physiology behind the disease and then use that to um to explain why the drug you want to start is indicated. Ok? And then go through the risks and benefits of the treatment you like, you'll have to do this loads as a doctor anyway, um being able to sort of give all the information so that the patient can make, um you know, can make an informed decision on whether they want to start the drug or not. Um It's very important. So, yeah, rather than just saying all the benefits, make sure that they're aware of the risks as well and make sure that you give. Um, so give any like safety net and advice. I have said that in the after section. But with the risks, like there are specific risks with some drugs, like for example, like the risk of bleeding. So if a patient hits their head, um then you must, must, must tell them that they need to go and seek medical advice if they hit their head and they're on a blood thinner because of the risk of having a, a brain bleed. Ok. So after ask if they have any questions and definitely try and provide them with uh any supporting information. So even if you don't like actually have a leaflet, you could just pretend to hand over a leaflet and say, I I'm giving you this Um, so that you have information on this drug or yeah, just say I'll give you a, a link for a website so that they have more information. Um I think it just shows that you're proactive. Um, and you're really thinking about the patient in this scenario. Um, so yeah, that those are sort of like really nice things that you can Sprinkle into this station. Ok? And as I said, for safety net, safety net, um, just make sure that they're aware of any sort of risks and dangers of being on the drug and make sure that they know to seek medical advice if they do become more unwell on the drug. Ok. So we'll move on to some example cases. So case one, Missus is a 65 year old woman presenting to her GP for a medication review. You are the fy two who reviews her, please take a history from the patient and review their medications. So this is what you gained from the history. So, Missus Khan tells you that she is feeling mostly well. She's come to the GP, as she's been told her medications keep reviewing. However, she's been getting a few episodes of dizziness recently and she has a bit of pain in her back. So, what else do you want to ask, Missus Khan? Um, if you go on to the mentee meter, what else would you like to ask her on the basis of that history? Ok. Yeah. So I guess Socrates, when did she get the dizziness? Is it on standing after sitting or lying down? Yeah. Good. When did the dizziness start? Did it coincide with a new medication? Yeah. Or really good points anyone ask or any questions I wanna ask. Any recent medication started. Red flags in caps. I like it where the back pain is. Yeah. Past medical history. Recent trauma. Yeah. Good. Nice. Yeah. Associated symptoms. So someone's speaking about their differentials there. That's really good. 94 was lovely. Yeah. Good anymore. Cool. Ok, let's move on. No. Ok. So she feels a bit funny when she gets out of bed in the morning or when she gets up out of her chair, uh, she's never fallen or lost consciousness with regards to the back pain. Um, it's longstanding, um, she's had it for a while and she thinks it's just due to her getting a bit older. Um, no sort of worrying symptoms there. No weight loss, et cetera, et cetera. Past medical history. She's got hypertension and she's got type two diabetes. Um, she's got a drug history of amLODIPine and Lisinopril. She has no allergies. She does her BP at home and the readings average about 100 and 30. Over 80. She's eating and drinking well, and she doesn't recall having any recent illnesses. Ok. So, what are your differentials and what data might they ask you to interpret? That's ment. So, using a bit of your sort of knowledge here with sort of differentials of dizziness or lightheadedness? Yeah. Good. Drug induced hypertension B BPV. Yeah. Good. So lots of people saying postural hypotension many years. Yeah. Could be. And what about the data guys? What, what sort of data do you think they're gonna ask you to interpret? What do you think the examiner is gonna hand you that might sort of confirm um your differential? No. Yeah. L DBP. Yes. All done. Anything else causing dizziness that's not postural or sort of in inner ear related thinking about your systems anemia? Yeah. Pretty good. Okie Dokie. Let's, let's move on. It's got some really good responses there. OK. So please interpret the E CG and the LY on standing BP. Ok. So the lying BP is 100 and 35/76 and the standing BP is 100 and 8/70. Have a look at that. Have a think, what do you think your differential is? Your main differential is? Now, I'll just give you a minute or two to have a, have a scan for the ECG. Yeah. Yeah. Ok. So let's move on. So, what would you now recommend to Missus car? Having looked at that line and standing BP and the ECG, what would your management be? Yeah. Increased fluid intake. Cool. Yeah. Drink some water education advice such as standing up slowly drinking plenty of fluids. So, yeah, definitely. The standing up slowly trial of reduced dosage of antihypertensive medication. Yeah, I think that's quite sensible conservative hydrate. Go up slowly legs crossing before standing. Good medication review. Yeah. Ok. Good. A bit more salt. Yeah, you could increase your salt intake. But maybe if the BP regions at home are 100 and 30/80 maybe we've got her on a few, too many antihypertensives. So potentially a medication review is indicated here, but definitely all the other advice is solid as well. Ok. Sorry, let's move on. Ok. So case number two, 83 year old Miss Pond presents to the GP to ask questions about their recently prescribed Warfarin. You are the healthcare professional that sees them. Please take a history from the patient and answer any questions that they may have. So this is the station. So this is a 70 year old female. She's given Warfarin by her cardiologist two weeks ago and she was diagnosed with atrial fibrillation. So she's concerned about starting it. She has friends who have regular monitoring with it. She's got no other past medical history, no other drug history. Um and she's got a penicillin allergy. She has anaphylaxis, so she has pen and so we don't want to give her that. Ok. Um So she's got a few questions for you. Why is she being prescribed? Warfarin? What are the risks of taking it? How often will she need tests? And what if she misses a dose? Ok. So she sounds quite concerned about starting this warfarin. So how will you counsel Miss Pond? Ok. Back to the mentee. How do you think you're gonna counsel her? How you'll explain and how, what sort of things will you say to her as well? How would you answer her questions? Pride, pride. Good. Ask her what she knows about all before you start? Good. Yeah. So any counseling just make sure that you check the patient's understanding beforehand. So yeah. Really good question. Yeah. So someone's explained in simple language there explained that Warfarin is a medication that makes the blood thinner. So it's less likely to clot good risks and benefits. Yeah. So what, what are the risks and benefits? What sort of things would you say? Risks of bleeding? Yeah, side effects. Yeah. Ask about her concerns and address them directly. OK. What sort of things might you say about um about the monitoring and about missing the dose? I know I'm monitoring regularly. Yeah. So generally with the warfarin um initiation you'd do either daily or alternate inr. Um And then you'd wait until the Inr becomes more stable. Um And then you'd start reducing the frequency down to about twice weekly. And then once you've got a couple of Inr s which are within your range, then you can look at the, the sort of local protocols on how often you then need to um do monitoring afterwards. OK. Explain af and therefore the need for an good. Yeah. So we've explained why she's why we wanted to start her on Warfarin. Um because she's got af that she's at an increased risk of clots. But we've also explained that there is a lot of monitoring involved and we've explained the risks of her being on this medication. So it's not completely safe. There is an increased risk of bleeding and we said that we'll safety net her as well. Um Good. Someone said about so take this dose as soon as you remember this next day, then leave it. Yeah, that's, that's absolutely perfect. Yeah. And some to give her a leaflet. Yes. Well done. Good. OK, cool. So we'll move on from that one. So we've counseled her and what data do you think they might throw into this station? Um Sorry, I spit back and forth you guys, but back to the mentee, what sort of things do you think they're gonna ask you to interpret? I know. It's a cool. I know. Yeah. Good. Yeah, everyone's saying, I know head ct bleeds. Yeah. So uh she says to you, you know, she's had a fall and she's on Warfarin. Um Then she's definitely gonna need um some imaging of the head to rule out bleed. Good. Yeah, let's move on. So, yeah, please interpret the following blood tests. You've all predicted it. I have a little look on how are you gonna manage this patient? I'll give you a minute just to have a little look at those results. Ok. Back to lamenting. So you've seen the IR wash your management out of those options. So you can either stop it, continue it or clarify the target. I know I'm going to enable comments on this thing. Can anyone tell me why you want to clarify the target inr? Why wouldn't you just continue it? What, what information are you missing here maybe for in the middle chat and we'll come back to it. Uh But you, you've all got the right answer. Um Essentially you want to clarify at the time. Oh, someone's answered. Come on, give me two seconds. She has a prosthetic valve, et cetera. Yeah, changes the inr. Absolutely. Um So the ideal, the ideal Inr target is usually around 2 to 3. Um But depending on her type of af so if this is valvular af if she has a um prosthetic valve, then her inr target is going to be much higher. Um So usually around 3 to 4. So you're already good guys. Ok. So this, this is the last case. So 50 year old Mr Noble presents to his GP with muscle pain. You are a medical student on placement, please take a history from the patient and review their medications. So you'll gain this history from the patient. So he's a 50 year old male. He's got increased muscle pain and it feels like he's run a marathon, he's fit and he does go to the gym regularly, but he doesn't feel like he's done anything extreme recently and he feels generally stiff. He's got this reduced movement in his left hand due to having a stroke two weeks ago. Um but he's got no numbness or altered sensation. Um in terms of other past medical history, he's got peripheral vascular disease. Um But nothing else of note. He's on atorvastatin and he's on Aspirin. He's got no known drug allergies. Um and this is affecting his recovery. So he said that because of this pain. Um and this stiffness, he's struggling to engage with physio. So what are the differentials for this case? Atorvastatin side effects? Yeah. Mhm Myalgia. Yeah. So lots of people saying myalgia, rhabdomyolysis. Ok. Yeah, good. So obviously, statins um a very common side effect is myalgia. Um But always having the back of your head with these stations. Is there something serious that I absolutely must not miss. And another differential. Yeah, soft tissue injury. I mean, he's saying that he's feeling well, but potentially he could have just gone a bit too hard in the gym and maybe he's feeling a bit um I got feeling a bit myalgic because of that good. OK. So let's move on. Oops, sorry. So what data might they ask you to interpret? Given that history and given your differentials? E Yeah. Cool. Yeah. So creatinine kinase levels good. OK. So they do give you some bloods to look at and this is what I show you. OK? So have a little look at that for me and then tell me what your differentials are still and then what would your management plan be for that patient? OK. So start putting in your responses. Yeah. So main differential here. Definitely. Rhabdo. Does anyone know how you're gonna deal with that? Yeah. Fluids. Quite aggressive fluids. You're basically treating it for an AK and stop the statin. Yeah, stop in big capsules. Absolutely. You want to discontinue that statin? Yeah, good. So a lot of the um lots of fluids to clear the Yeah, lots and lots and lots of fluids get you, you're mainly managing the complications um with rhabdomyolysis. So you're, you're treating it as you would an AK so yeah, aggressive IV fluid treatment, um strict fluid input output um charting and someone said just then as well, if electrolytes are deranged, then correct them. Yeah. Absolutely. So if, if it's really severe um the rhabdomyolysis, then you may even have to consider them for dialysis. Um, so obviously that won't be your decision as a junior. Um, but it's something that may need to be escalated to itu for example, sorry, I was just laughing at the bananas for potassium. It's ok. So that's the last case. So I'll just show you a couple of cheat sheets and we will be uploading these slides and the recording. So, um, you don't feel the need to take a picture or anything at all or be on me. Um, so medications you've all asked, what do you actually need to revise with the medications? What kind of depth do you need to go into? So, as I said, there's lots of medications that, um, can come up in these stations. I think I'd just try to sort of get a basic overview of all of them, don't sort of, but delve too deep into the pharmacology. Um, I think maybe the ones that are worth focusing on with the, um, pharmacology aspect would be sort of looking at the atypical antipsychotics or maybe something like lithium, um, because they can have like a whole host of side effects and I think it just helps you to remember those and to be able to explain them to the patient if you know why they happen. Um, so yeah, there's some really good youtube videos pharmacology wise. Um, so have a look at that, but in terms of what you actually need to know for the medications. So, um, make sure you know, the indications. So why, um, patients are started on these drugs, how often they have to take them and how to take them. Um, so some meds are once weekly. Um, so for example, methotrexate and bisphosphonates, um, a common sort of, um, example that can come up maybe in the Iski but also in the PSA which you'll see it next year, um, is having someone who's on methotrexate and they're meant to be on a weekly dose, but actually they're taking it daily and then they um yeah, they overdose on it essentially um and how to take them. So some drugs will need to be taken with food. So like your nsaids or before food and with water, like your bisphosphonate. So um just try and know sort of the um directions of use on those medications in terms of the monitoring requirements. So just try and be aware of what blood tests are needed both before starting the medication and then when they're needed. Um once you've initiated that treatment. Um So for example, like many drugs will need sort of um monitoring of the renal function or every few months or monitoring of the TS, um some drugs will need an ECG or need some sort of imaging beforehand. So I believe with um things like biologics particularly you, like you want to do a, a chest X ray uh beforehand to make sure there's sort of like no um, dormant TBI doubt that would come up. But it's just an example. So just be aware, is, is there any sort of special things that you need to do before starting the medication, um, side effects? So obviously, you're not going to know every side effect um for each drug. But again, having an understanding of how the drugs work will kind of help you sort of understand what side effects you get. Um as a result of the um the pharmacology of the drug, um try and be aware of any like specific interactions. Um So again, your py cyp 450 inhibitors and inducers. Um There are Pneumonics online that you can search up for those um and just try and look up sort of specific interactions as well for certain drugs. So, like I said beforehand, an example, like statins and macrolides, um you don't mix them and um like SSRI S and nsaids because of the increased risk of bleeding, there are certain things and I'm sure that there's a list online that you can find for specific interactions. Gki medics, I think has a page which is quite good on that. Um and then safety netting. So just making sure that the patient is aware of any red flags that they need to look out for. So, like with cloZAPine, you always need to tell the patient just be aware um of any infections that may arise and seek medical help earlier on, um, for that because it could be a sign of neutropenia. Um, yeah. So just go and have a look. There's a page on osk stop. I don't know if you guys all have the book but it's online as well. And there's a page called medications that require counseling and I found that really useful before the oy. Um, because it does sort of set, set the drugs out in this format and it tells you like what they're needed for when you take them any monitoring requirements and any sort of specific side effects or red flags that you need to tell the patient about. Um, that's really useful. Ok? And on the next slide, I've just put a little cheat sheet of medications that I think you should go and revise, um and go and look up um, the things that we just covered in the previous slide. And I think that will give you like a really good basis for the Pharmacology Station. Then honestly, I can't, I can't see them throwing them throwing anything, you know, particularly out there um at you and anything um on this list should hopefully cover what could come up in the Pharmacology Station. Ok. So as I said, the slides will be uploaded, so you can go through um that list and when you please, and if anyone's got any questions, we'll go back to the middle page now. Um And if anyone's got any questions please feel free to put them in the chat and we'll try and go through them. No worries guys. I hope it was helpful. Um Sorry about some of the technical difficulties. I'll try and um iron those out for the next one. But yeah, thank you for coming in and please, if you do have any questions, I'll give you a couple of minutes otherwise have a lovely, lovely evening. Oh, ok. No worries. Thank you guys for participating as well. It's always helpful when you've got a few people giving you some responses. Ok, so if you do have any questions, um, feel free to email me. Um, I'll put my, I'll put my email on the chat. Um, just so that you can message me any questions that you want. It doesn't have to be about the Pharmacology Station. If you just wanna know sort of about, um, anything else about the ki or fifth year or F I one, just give me a bell. Um, I'm happy to answer anything. So, yeah, don't be shy. Ok, have a lovely evening guys. We're in the session there now and please don't forget to fill out the feedback form. It's in the chat and it will get sent to you, please. It's really helpful just so that we can improve the sessions for, um, the future. Uh, what was the website for medications that require counseling? Um, OSK stop. So it's, um, there's a book version of it. And I'm pretty sure the list is in there. Um, but yeah, if you Google it as well, it'll come up i on the Husky Stop and that you also do like a page of, um, thank you, Devon one step ahead of me. They've also got, um, pages on common medications prescribed in the hospital and in the community as well, which is, uh, a good one to go and look at. Ok. If there are no other questions, I'll end the session there. Thank you very much guys and hopefully we'll see you in the next sessions. Ok? Bye.