1
Q
What does self-care mean?
A
The independent act of preventing, diagnosing, and treating your own illness without seeking professional advice.
2
Q
Is consumer self-care increasing or decreasing?
A
Increasing
3
Q
Regarding self-care, pharmacists are an…
A
…information filter.
4
Q
What types of medications are routinely taken by self-care patients?
A
- pain
- cough/cold/flu/sore throat
- allergy/sinus
- heartburn/indigestion
- constipation/diarrhea/gas
- minor infections
- skin problems
5
Q
What 7 services can pharmacists provide in self care?
A
- assist in product selection
- assess patient risk factors for therapy
- counsel on proper use and duration of therapy
- maintain an accurate medication profile
- assess the potential of OTC meds masking serious health conditions
- prevent delays in seeking medical attention
- reinforce importance of following labels
6
Q
What 3 risk factors should a pharmacist consider in self-care?
A
- contraindications or warnings
- co-morbidities
- age (children, elderly, and females of child bearing age)
7
Q
When is self-care appropriate?
A
If the patient can self diagnose and treat without a pharmacist or other HCP–self care is used for:
- prevention
- treatment
- symptomatic relief
- cure of disease, injuries, or other conditions
(same as a prescription)
8
Q
What is inappropriate use?
A
The use of OTCs in a way that does not follow the Drug Facts label or known guidelines.
9
Q
How can inappropriate use be decreased?
A
- adequate package labeling
- more emphasis on “indication for use” versus promotion through advertising
- patient education and counseling (how to take and consequences of taking inappropriately)
10
Q
What exists to educate the public on OTC medications?
A
Public education campaigns like MedWise, FDA, and the Consumer Health Education Center.
11
Q
What is the CHEC system?
A
- C: choose a product that treats only the symptoms being experienced
- H: heed the product label directions
- E: examine the “active ingredients” and “warnings” on the label
- C: consult a health care provider if you have questions or are confused
12
Q
What are some examples of the same products being OTC and RX only?
A
- ibuprofen
- prilosec
- prevacid
- nexium
(most are in lower strength as an OTC)
13
Q
Iron + Calcium can cause…
A
…decreased iron absorption.
14
Q
Mineral oil + docusate can cause…
A
…increased mineral oil absorption.
15
Q
Aspirin + garlic can cause…
A
…increased risk of bleeding.
16
Q
Diphenhydramine + alcohol can cause…
A
…increased sedation.
17
Q
Doxylamine + glaucoma can cause…
A
…increased intraocular pressure.
18
Q
Ibuprofen + GI disease can cause…
A
…increased ulcer risk.
19
Q
How can a pharmacist build a therapeutic relationship with a patient?
A
- work with patient to achieve best possible results
- see patient as a patient (not a customer)
- assure patients that you will keep their information confidential
20
Q
What information should be collected during the patient interview?
A
- demographic (age, gender, etc.)
- chief complaint
- history of present illness
- past medical history
- family history
- social history (smoking)
- medication history
- known drug allergies
21
Q
What should be done while collecting medication history?
A
Give both brand and generic name in QuEST & SCHOLAR write ups
22
Q
What are some questions for patient specific data?
A
- Who is the patient?
- How old is the patient?
- Male or female?
- What medical conditions or allergies?
- Who is responsible for medication administration?
23
Q
Describe QuEST.
A
- always start with “How may I help you?”
- QUickly and accurately assess the patient
- Establish the patient is an appropriate self care candidate (not severe, persistent, returning, or avoiding medical care)
- Suggest appropriate self care
- Talk with the patient
24
Q
While suggesting appropriate self care (S), what should you do?
A
- have at least one recommendation with one back up plan
- can suggest life style changes
- OTC or alternative therapies and general care measures
25
While talking with the patient (T), what should you do?
* discuss medication (actions, administration, and ADRs)
* what to expect from treatment
* appropriate follow up
26
What is the SCHOLAR acronym?
* Symptoms (basic facts)
* Characteristics (describe symptoms)
* History
* Onset
* Location
* Aggravating factors
* Remitting factors
27
What should be asked during Symptoms in SCHOLAR?
* What are the main and associated symptoms?
* How has this problem effected you in the past?
(basic facts)
28
What should be asked during Characteristics in SCHOLAR?
* What is the situation like?
* Is it changing?
* How does the problem limit your daily activities?
29
What should be asked during History in SCHOLAR?
* What has been done so far?
* Has this happened in the past?
* Do other members of your family have this concern?
30
What is asked during Onset and Location in SCHOLAR?
* Onset: When did it start?
| * Location: Where is the problem?
31
What is asked during Aggravating factors and Remitting factors in SCHOLAR?
* Aggravating factors: What makes it worse? (food, meds, and physical activities)
* Remitting factors: What makes it better?
32
What is the HAMS acronym?
* Health conditions (What other health conditions do you have?)
* Allergies (What allergies do you have?)
* Medications (What medications are you taking?)
* Social history (What do you do for a living? Smoking? Drinking?)
33
What types of questions should be avoided? What types of questions should be used?
* Avoid leading questions (response is what is perceived to be the correct answer)
* Avoid closed ended questions (answer is yes or no)
* Avoid compound questions (two questions at the same time)
* Use open ended questions
34
After you have provided the medication information, what should you have the patient do?
Have the patient repeat back the instructions to make sure they have the information correct.
(What side effects will you be looking for? How will you take this medication?)
35
What if you have a small window of time to interview the patient?
* narrow focus of questions
* assess drug therapy problems by asking "What questions, concerns, or problems regarding your medications do you have today?"
36
What 3 things should you determine if the patient needs?
* referral
* self treatment
* no treatment
37
When should you give a patient a medical referral?
* symptoms are too severe to be endured by the patient without a definite diagnosis
* symptoms do NOT appear to be the result of something easily identifiable
* minor but persistent symptoms or repeatedly returned despite self treatment
* pharmacist is in doubt about the patient's medical conditions
* HIGH risk patients that need further assessment
38
What do we need to tell the patient about a medical referral?
We need to discuss with the patient the reason why we are referring them.
39
When referring a patient, what are the two options?
* PCP (primary care provider)
* emergency care facility
It is based on the urgency of treatment. Is the problem acute or chronic?
40
What patients are considered to be high risk?
* infants and children
* advanced age
* pregnant patients
* nursing mothers
* recently hospitalized
However, these patients do NOT always need to be referred.
41
What are the 2 main things a referral depends on?
* severity of condition
| * pharmacist's knowledge
42
True/False
| A pregnant patient always needs to be referred.
False
43
Premature
Gestation of less than 36 weeks
44
Neonate
First post-natal month of life
45
Infant or Baby
Age 1 to 12 months
46
Toddler
Age 1 to 3 years
47
Preschool or Early Childhood
Age 3 to 6 years
48
Middle Childhood
Age 6 to 12 years
49
Adolescence
Age 13 to 18 years
50
What are the two most common products for infants and children?
* APAP
| * cough and cold
51
When would you generally refer a child?
* If they are less than 2 years of age
| * at risk due to underdeveloped body and organ function
52
Child dosing is dependent on what?
Weight
53
When is an illness considered to be more severe in children?
Greater risk for dehydration when vomiting and diarrhea is present
54
What dosage forms are preferred for children?
* liquid
| * chewable
55
What is common with medication administration to children?
Inaccurate dosing
56
Do children and adults have the same adverse drug reactions?
Yes, it is possible the reaction in a child will be different than that of an adult.
57
What percentage of women use at least one OTC medication during pregnancy?
45%
58
What are the 3 most common OTC products used by pregnant women?
* analgesics
* vitamins and minerals (folic acid)
* GI medications
59
What is the NSAID recommendation for a pregnant woman?
May be at risk during the 1st and 3rd trimester
60
What is the APAP recommendation for a pregnant woman?
It is generally ok for all trimesters
61
What 3 things should we discuss with a pregnant woman when recommending OTC products?
1. Explain risks and benefits.
2. Use the smallest dose for the shortest amount of time possible
3. Only take medications, OTC, herbals that are essential
62
What is the recommendation for breastfeeding women that are taking medications?
Take medications immediately after feeding and drink a lot of fluids.
63
What are the 3 increased prevalence of conditions in elderly patients?
* arthritis
* insomnia
* constipation
64
Why are pharmacists being used more by the elderly population?
* patients are living longer
* low cost alternative to doctor visits and prescription medications
* pharmacist availability versus PCP
* patients like to self diagnose and treat (want to be in control and keep cost down)
Pharmacist Provided Care I
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