CHAPTER 6 Patient Education
I. Provide health care information regarding the prevention and treatment of diseases and medical conditions, including emergency patient care.
B. Steps in counseling patients regarding medication use
4. Ask what over-the-counter (OTC), herbals/supplements, and other prescriptions the patient is taking (patients may not fill all prescriptions at the same pharmacy). Additional medical conditions may also be considered as needed (i.e., a patient with asthma receiving a beta blocker with beta-2 action).
5. Ask the patient what they know about their medications and why they are being prescribed (i.e., the medication’s use, expected benefits, and action).
6. Discuss with the patient what their doctors told them regarding their medications, how to use them, and what to expect.
7. Open the medication container and show the patient what the medication looks like or demonstrate use; the patient may not be expecting a generic substitution, and they can also verify correct product.
10. Discuss what to do if a dose is missed (take missed dose immediately or skip the missed dose and wait until new administration time).
C. Important patient considerations for counseling
1. New patients or those receiving a medication for the first time (including transfer prescriptions)
11. Patients receiving medication with special storage requirements, complicated directions, significant side effects, or narrow therapeutic ranges [e.g., digoxin and anti-epileptic drugs (AED)].
13. Patients receiving oral contraception regarding the risk of cardiovascular disease (CVD) if they smoke or are older than 35 years
14. Patients receiving oral contraception and select antibiotic medications (contraception failure may occur)
D. Other Concepts to discuss with patients and health care professionals
1. Adverse reaction concerns:
a. An adverse drug event (ADE) is any undesirable experience associated with the use of a medical product in a patient. Most potential adverse drug events can be prevented; however, an unpreventable adverse drug event is considered an adverse drug reaction.
b. Most adverse drug reactions (ADR) are common, relatively mild, and disappear when the drug is discontinued or the dose is changed. Common mild drug reactions include loss of appetite, bloating, nausea, and constipation. Serious drug reactions are those that cause death, disability or congenital anomaly or that require hospitalization. Serious ADR may require medical intervention to prevent further damage or impairment.
c. The following examples illustrate various adverse drug events:
(a) Sulfonamide antibiotics versus other sulfa-containing products (i.e., cross-sensitivity reactions rather than sulfa-allergy)
d. Adverse events that are common that require minimal intervention (e.g., postural hypotension when starting beta blockers; constipation for opioid analgesics), and that require immediate attention (e.g., Stevens-Johnson syndrome for sulfonamide antibiotics; tendinitis/tendon rupture for quinolones).
e. True allergy (e.g., anaphylaxis) versus ADR (nausea with opioid analgesics or oral penicillins); including what reactions allow a rechallenge or desensitization of the drug
2. Examples of appropriate drug use
a. Spacing antacids and calcium containing products from certain medications (e.g., select antibiotics, such as tetracyclines, quinolones)
c. Spacing of medication administration times for peak effects or to avoid toxic effects (e.g., aspirin shortly before or long after a nonsteroidal anti-inflammatory drug)
d. Dietary restrictions for monoamine oxidase inhibitor (MAOI), warfarin, or quinolones (no tyramine-containing products [cheese, wine, red meats], do not alter the intake of the amounts of vitamin K containing products, and separate dairy intake from the time of administration, respectively)
e. Understanding “Two tabs twice daily” = 4 tablets a day total not 2 tablets each day; and similar multiplying concepts
f. Importance of finishing an antibiotic course of treatment to ensure therapeutic response and avoid recurrence of infection
h. How to use inhalers, nebulizers, injectable medications, insulin pens, blood glucose monitors, and other devices
j. Understand cautions needed with the use of medications in special populations (e.g., pediatric, geriatric, patients with organ failure, patients with immunosuppression, pregnant or lactating women)
E. Emergency/non–self-care considerations
Table 6-1 Examples of Consumer Terms to be used in Patient Education
| Medical Term | Consumer Term |
|---|---|
| Analgesic | pain reliever |
| Arrhythmia | irregular heartbeat |
| Buccal | between the cheek and the gum |
| Diuretic | water pill |
| Hepatic | liver |
| Hypercholesterolemia | high cholesterol |
| Hyperglycemia | high blood sugar |
| Hypertension | high blood pressure |
| Hypoglycemia | low blood sugar |
| Inflammation | swelling |
| Metabolism | (drug) breakdown |
| Ophthalmic | for the eye |
| Otic | for the ear |
| Postural hypotension | fainting |
| Prophylaxis | preventative |
| Pruritus | itching |
| Renal | kidney |
| Saline | salt solution |
| Sublingual | under the tongue |
| Subcutaneous | under the skin |
| Topical | applied to the skin |
| Transdermal | absorbed through the skin |
II. Provide health care information regarding nutrition, lifestyle, and other nondrug measures that are effective in promoting health or preventing or minimizing the progression of a disease or medical condition
A. Patient monitoring based on drug or disease state
1. Hypertension
5. Antiretroviral therapy for HIV/AIDS
6. Mental disorders
8. Osteoporosis
III. Provide information regarding the documented uses, adverse effects, and toxicities of dietary supplements.
A. Explaining basic differences between modern medicine (allopathic) and complementary (homeopathic, Chinese medicine, etc.)
2. The term complementary and alternative medicine (CAM) is generally regarded as encompassing a broad group of healing philosophies, diagnostic approaches, and therapeutic interventions that do not belong to the dominant (conventional) Western health system.
B. Selecting dietary supplements
1. Not all products have the stated doses or purity that the label may suggest. The manufacturers of herbals/supplements (products that have “Supplement Facts” on the back) decide if they are willing to be inspected by the FDA to reach Good Manufacturing Practice (GMP) standards. Not all companies are willing to do this, but those who pass inspections are granted USP status. Alternatively, all medications labeled as drugs (prescription and OTC medications containing “Drug Facts” on the back) must pass GMP standards. Products are assessed for purity, potency, and the stated strength.
C. Deciding if therapy is appropriate
1. Patients should be evaluated by their physician to decide if supplemental therapy is necessary. Most patients with an adequate diet do not need supplements added to their diet. Patients should be aware of multisourcing their vitamins (dietary intake and supplements) to avoid exceeding the recommended dietary intakes (RDI).
IV. Provide information regarding the selection, use, and care of medical/surgical appliances and devices, self-care products, and durable medical equipment, as well as products and techniques for self-monitoring of health status and medical conditions.
A. Drug administration considerations
1. Description of inhaler use (which is brand specific), with and without a spacer
b. Prime suspensions/aerosol solutions before first use, and if they have not been used for a period of time (actual length of time where product requires re-priming is product/manufacturer specific)
c. Hold the inhalation for an appropriate amount of time and the appropriate spacing between multiple inhalations
2. Description of eye drop or ointment administration
e. After administration, with a tissue gently wiping away excess moisture or ointment from around the eye(s)
3. Description of ear drop administration
b. Warming drops by rolling between the hands, not a heating device; shake suspensions well before each use.
4. Description of nasal spray administration
5. Insulin administration
d. Pinch up a fold of skin and insert the needle at 90° to the skin fold. Inject at 45° in areas that have less fat
e. Rotate injection sites to maximize rate absorption and prevent lipohypertrophy (enlargement of subcutaneous fat)
9. Product specific considerations. Examples:
a. Nuva-Ring®: product-switching considerations (i.e., if a back-up method is necessary, how soon should the new product be initiated)
b. Nitroglycerin ointment: apply measured dose only to a 2″ × 3″ area using the provided ruler; application only to chest or back
c. Sublingual nitroglycerin (Note: patients may not experience a tingling sensation with newer products; if no relief after first dose, get emergency help and continue acute relief instructions.)
Ball A.M., Smith K.M. Optimizing transdermal drug therapy. Am J Health Syst Pharm. 2008;65:1337.
PEIPB PEIPB. Guidelines on counseling. http://www.napra.org/pdfs/provinces/pe/Guidelines-on-Counseling.pdf. Accessed September 22, 2008
Lexi-Comp Online. Nitroglycerin [patient education leaflets – adult]. http://online.lexi.com. xxx. Accessed September 23, 2008
AHFS MedMaster. How to use metered dose-inhalers. http://www.safemedication.com/Administer/DoseInhalers.pdf. Accessed July 2009
REVIEW QUESTIONS
(Answers and Rationales on page 333.)
2. When a patient is being counseling on the use of Nexium®, which of the following is most appropriate for the pharmacist to state?
3. An asymptomatic patient who started taking atenolol goes to the pharmacy with a blood pressure of 132/78 and pulse of 54 beats per minute? Which of the following is the most appropriate action?
5. Which of the following counseling points should be made regarding the administration of Metamucil®?
6. What are the possible side effects of Ritampin about which the pharmacist should counsel the patient?
7. A 57-year-old patient with long-standing COPD takes a new prescription for an ipratropium (Atrovent®) inhaler to the pharmacy. The pharmacist’s medication record shows that the patient is also using an albuterol inhaler as needed. Which of the following indicates that the patient understands how to incorporate the Atrovent® into her regimen?
8. A 48-year-old patient with stable COPD has a refill prescription for Combivent® and a new prescription for Spiriva®. Which of the following actions indicates that the patient understands the COPD regimen?
9. During medication counseling for Diovan® tablets, which of the following statements would verify that the patient has a good understanding of the possible side effects of the drug?
12. When counseling a patient, it is important to include “take on an empty stomach” for which of the following medications?
13. A mother comes to the pharmacy with questions about diaper rash. What counseling points would a pharmacist provide?
14. Which of the following questions should a pharmacist ask a patient when dispensing a new prescription?
15. What should you advise a patient with diabetes to do if he/she feels symptoms of low blood sugar?
16. A patient goes to the pharmacy with a prescription for Prandin®. What should the pharmacist tell the patient when dispensing the filled prescription?
18. Which of following describes proper technique for administering eye drops?
20. A 40-year-old man is going to a wedding this weekend. He is afraid he may experience heartburn and wants to try Gaviscon®. Which of the following should a pharmacist tell him?
21. A patient is thinking about trying the EZ Detect® fecal occult blood test. What should the pharmacist tell him about using the test?
22. A 58-year-old man recently started using Niaspan®. He complains that he is experiencing flushing. What should a pharmacist recommend for this patient?
23. A 50-year-old woman asks a pharmacist about what she can to do prevent osteoporosis. What should the pharmacist recommend?
24. A 62-year-old woman goes to the pharmacy with a prescription for Fosamax®. What should the pharmacist tell her about its use?
25. A patient goes to the pharmacy with a new prescription for Miacalcin® nasal spray. What should the pharmacist tell the patient when dispensing the medication?
27. When counseling a patient about emergency contraception, which of the following is an accurate statement to make?
28. A patient has been counseled on the appropriate use of his new prescription for risedronate. Which of the following statements would verify that the patient has a good understanding of the consultation information that the pharmacist has provided?
29. A patient is counseled on the appropriate use of his new prescription for Betaseron®. Which of the following statements would verify that the patient has a good understanding of the information that the pharmacist provided?
30. Which of the following statements demonstrates that a female patient understands the risks associated with cytarabine therapy?
31. A pharmacist has counseled a patient on a new prescription for the Levemir® FlexPen. Which of the following demonstrates that the patient understands the storage requirements?
32. Which of the following factors would not be considered potential barriers to providing a thorough oral consultation to a patient?
33. Peak flow meters are often classified into three zones. Which of the following describes this system?
35. Which of the following counseling points should be mentioned to a person wanting to take Xenical®?
36. Which of the following counseling points should be made to the patient taking felodipine (Plendil®)?
37. A patient has a prescription for tranylcypromine (a MAO inhibitor). Which of the following foods should the pharmacist advise the patient to avoid?
39. A patient has a prescription for Tri-Levlen®. Which of the following counseling points should be made to the patient?
41. A 52-year-old woman complains about menopausal hot flashes. She wants to avoid using any medication. She asks the pharmacist if there are any nonpharmaceutical therapies she can try. What could the pharmacist suggest?
42. A patient is planning on using a bismuth subsalicylate preparation. What should the pharmacist tell the patient?
43. A patient has a prescription for cimetidine for GERD. Which of the following counseling points should the pharmacist make to this patient?
44. A pharmacist is counseling a new patient in the anticoagulant clinic who is beginning warfarin therapy. Which of the following should he avoid?
46. A patient asks a pharmacist for advice on how to quit smoking and what products to use. Which of the following statements regarding nicotine replacement therapy are true?
47. A patient asks a pharmacist about the DASH diet. Which of the following statements about the diet are true?
48. Which of the following are symptoms of high blood sugar that should be mentioned when a pharmacist is counseling a patient with diabetes?
49. With which of the following medications should a pharmacist counsel the patient to avoid alcohol consumption?
