T2 - OSCE Prep

Question 1

When do we use MI?

Answer 1

1. Smoking
2. Physical inactivity
3. Unhealthy eating habits
4. Alcohol misuse
5. Unsafe sexual behavior
6. Poor self-care

Question 2

What is the Spirit of MI?

Answer 2

Partnership (patient is the expert)
Autonomy (acknowledge patient’s freedom)
Compassion (promote patient welfare)
Evocation (encourage patient to change)

Question 3

What are the principles of MI?

Answer 3

1. Develop discrepancy
2. Express empathy
3. Avoid argumentation
4. Roll with resistance (affirm autonomy)
5. Supports self-efficacy (build self-confidence)

Question 4

What are the strategies of MI?

Answer 4

1. Open ended questions
2. Affirmation (support)
3. Reflective listening (invitation for elaboration)
4. Summarizing

Question 5

What are the questions to ask a patient during counseling?

Answer 5

1. What did your prescriber tell you about this medication
2. How did your prescriber tell you to take this medication
3. What did the prescriber tell you to expect from this medication?

Question 6

Counceling Points for Celebrex (Celecoxib)

Answer 6

1. Used to reduces inflammation and pain associated with conditions such as osteoarthritis or rheumatoid arthritis
2. Osteoarthritis: 200 mg PO once daily or 100mg PO BID
   Rheumatoid arthritis: 100 – 200mg PO BID
   o Dose can be administered with or without food.
3. ADR: CV events, GI bleeding, Hypertension, Edema, Anaphylatic (continue to self-monitor for severe side effects)
4. If you miss a dose, take the dose as soon as possible. If you remember the missed dose at the time of the next scheduled dose, skip the missed dose and take your next scheduled dose as directed. Do NOT double the prescribed dose.
5. Contact for prescription refill
6. Store at room temp

Question 7

Counceling Points for Microzide (Hydorchlorothiazide)

Answer 7

1. Reduces BP for hypertension and reduce edemas (fluid retention) trhough diuresis
2. Hypertension: 25 – 50mg PO once daily or in divided doses
   Refractory edema: 25 – 100mg PO once daily or in divided doses
   Administer with or without food in the morning to avoid nocturia. If taking multiple doses, administer last dose no later than 6:00 PM.
3. ADR: nausea vomiting diarrhea, Whenever the patient experiences moderate to severe adverse reactions, HCTZ dosage should be reduced or discontinued, depending on the type of reaction. (Monitor for severe side effects)
4. If you miss a dose, take the dose as soon as possible. If you remember the missed dose at the time of the next scheduled dose, skip the missed dose and take your next scheduled dose as directed. Do NOT double the prescribed dose.
5. Contact for prescription refill
6. Store at room temperature between 68 – 77°F.
   o Dispense in a tight, light-resistant container using a child-resistant closure.

Question 8

Counseling point for Actonel (Risedronate)

Answer 8

1. Reduces bone resorption (breakdown) associated with osteoporosis to improve bone health
2. Treatment of post-menopausal osteoporosis: 5mg PO once daily, 35mg PO once weekly, 75mg PO once daily on 2 consecutive days each month, or 150mg PO once monthly
   o Prevention of post-menopausal osteoporosis: 5mg PO once daily or 35mg PO once weekly
   o Administer with 6 – 8 ounces of water at 30 minutes before the first food or drink of the day.
   o Do NOT lie down for 30 minutes.
3. Common: back pain, arthralgia, abdominal pain, and dyspepsia
   o Severe: hypersensitivity reactions (angioedema, generalized rash), eye inflammation
4. If you miss a dose, take the dose as soon as possible. If you remember the missed dose at the time of the next scheduled dose, skip the missed dose and take your next scheduled dose as directed. Do NOT double the prescribed dose.
5. Contact for prescription refill
6. Store at room temperature between 68 – 77°F.

Question 9

Counseling points for Zoloft (Sertraline)

Answer 9

1. Used in the treatment to relieve symptoms for a variety of mental health conditions
2. 25-200mg tablets PO QD Administer with or without food once daily in the morning or evening.
3. o Common: nausea, loss of appetite, diarrhea, indigestion, increased sweating, tremors, agitation, changes in sleep habits (i.e., increased sleepiness, insomnia), anxiety, fatigue, sexual dysfunction (i.e., decreased libido)
   o Severe: serotonin syndrome
4. If you miss a dose, take the dose as soon as possible. If you remember the missed dose at the time of the next scheduled dose, skip the missed dose and take your next scheduled dose as directed. Do NOT double the prescribed dose.
5. Contact for prescription refill
6. Store at room temperature between 68 – 77°F.

Question 10

Councelling points for Ultram (Tramadol)

Answer 10

1. Used for the treatment of moderate to moderately severe pain in adults
2. Moderate to moderately severe pain: 50 – 100mg PO every 4-6 hours as needed
   Administer with or without food.
   Tramadol is a Schedule IV controlled substance according to the DEA, meaning that it can be abused and may be subject to criminal diversion due to addiction.
3. Common: Dizziness, headaches, drowsiness, nausea, vomiting, constipation
   o Severe: serotonin syndrome, seizures
   o Monitor for GI effects and severe symptoms
4. If the patient misses a dose, skip the missed dose, and return to the regular dosing schedule.
   o Do NOT double the dose.
5. Contact for prescription refill
6. Store at room temperature between 68 – 77°F. DIspense in a tight container

Question 11

Create an SBAR voicemail

Question 12

Create an SBAR voicemail

Question 13

Create an SBAR voicemail

Question 14

Signs of limited health literacy

Answer 14

1. Reads slowly
2. Has difficulty telling a coherent story
3. Fills out forms incorrectly or incompletely
4. Does not ask clarifying questions
5. Fails to show to appointment
6. Unable to verbalize a list of meds
7. Uses excuses
8. Brings along a friend or family member for assistance
9. Nods in agreement but does not truly understand
10. Forgets to refill medications on time

Question 15

Components of medication history

Answer 15

1. Current medications
2. Past meds
3. Allergies
4. Adverse drug reactions
5. Adherence
6. Immunization status
7. Social drug use
8. Adherence challenges
9. Special needs
10. Physical limitations