Giving Appropriate Medicine Information to Patients
Session 12: Giving Appropriate Medicine Information to Patients
Total Session Time: 120 minutes
Prerequisites
Learning Tasks
By the end of this session students are expected to be able to:
and Storage of Dispensed Medicines
Medicine(s)
Resources Needed:
medicine
effects and storage of medicines
of dispensed medicines
SESSION OVERVIEW
|Step |Time |Activity/ |Content |
| | |Method | |
|1 |05 minutes |Presentation |Introduction, Learning Tasks |
|2 |10 minutes |Presentation |Definitions of Drug Interaction, |
| | | |Side effects, Contraindication and |
| | | |Precautions of Medicines |
|3 |30 minutes |Presentation |Appropriate Instructions on the Use |
| | |Role play |of Prescribed Medicine(s) |
|4 |30 minutes |Presentation |Appropriate Information on |
| | |Role play |Precautions, Interactions, Side |
| | | |effects and Storage of Dispensed |
| | | |Medicines |
|5 |30 minutes |Presentation |Patient Understanding on the Use and|
| | |Role play |Precautions of Dispensed Medicine(s)|
|6 |10 minutes |Presentation |Key Points |
|7 |05 minutes |Presentation |Evaluation |
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes
READ or ASK students to read the learning tasks and clarify
ASK students if they have any questions before continuing.
STEP 2: Definitions of Drug Interaction, Side effects, Contraindication and
Precautions of Medicines (10 minutes)
drug) affects the activity of a drug when both are administered
o However, the effect of medicine may be modified by food, smoking, alcohol
or environmental pollutants
o A drug interaction may occur when one drug potentiates or diminishes the
action of another drug
o These actions may be desirable or undesirable
o Drugs may also interact with various foods, alcohol, tobacco, and other
substances
desired
insomnia, rash, confusion, dizziness, or an unwanted drug-drug
interaction
usefulness of the drug
treated with a specific drug or not continue with a specific treatment
because circumstances make that treatment unsuitable
harm, or possible failure
STEP 3: Give Appropriate Instructions on the Use of Prescribed Medicine(s)
(30 minutes)
Activity: Role Play Demonstration on giving appropriate information on the
use medicine (20 minutes)
EXPLAIN that this will be a role play demonstration between a patient and a
health care provider. You (the tutor) will play the Dispenser and lead the
conversation of the instructions on the use of medicines prescribed to the
patient, who will be a student volunteer.
ASK a student to volunteer to play the patient role.
[pic]Refer student volunteer to Worksheet 12.2: Role Play Demonstration so
that he/she can read the description of the patient.
[pic] Refer students to Worksheet 12.1: Sample Prescription Serial No.
001190
TELL the rest of students to observe carefully
EXPLAIN that the patient will listen carefully and provide answers to
dispenser as will be asked to do so.
EMPHASIZE that the Dispenser should concentrate on presenting the
instructions on how to use the prescribed medicines.
START the role play.
LEAD a discussion after the role play.
DE-ROLE yourself and the student, once the role play is over.
ASK students if they have any questions about the role play.
instruct and counsel the patient on the following information:
he/she will be tempted to take medication
work efficiently if taken before or after food, for examples:
or two hours after food
be advised not to take alcohol when under medication and it
should not be taken with medicines such as metronidazole,
phenobarbitone and antihistamines.
o Storage of medicines: Patient should be advised to keep medicines away
from the reach of children as some drug colors might attract
children's attention
o The Direct observed treatment (DOT) Strategy
most effective standardized, short-course regimen, and of fixed-
dose drug combinations (FDCs) under observation to facilitate
adherence to treatment and to reduce the risk of the development of
drug resistance
tablets
doses and at the right time intervals.
tuberculosis medicines.
STEP 4: Give Appropriate Precautions, Interactions, Side effects and
Storage of Dispensed Medicines (30 minutes)
Activity: Role Play Demonstration (30 minutes)
EXPLAIN that this will be a role play demonstration between a patient and a
health care provider. One volunteer student will play the Dispenser and
lead the conversation of the instructions on the use of medicines
prescribed to the patient, who will be another student volunteer.
ASK the students to volunteer to play the dispenser role and the patient
role.
[pic]Refer student volunteer to Worksheet 12.3: Role Play Demonstration so
that he/she can read the description of the patient.
[pic] Refer students to Worksheet 12.1: Sample Prescription Serial No.
001191.
TELL the rest of students to observe carefully
EXPLAIN that the patient will listen carefully and repeat the information
provided when asked.
EMPHASIZE that the Dispenser should concentrate on presenting the
instructions on how to use the prescribed medicines as well as telling
about precautions to a patient, common side effect of medicines dispensed
and the storage condition of medicine
START the role play.
LEAD a discussion after the role play.
DE-ROLE all the students, once the role play is over.
ASK students if they have any questions about the role play.
The dispenser must give the following information to a patient:
important is it to take the drug; what happens if it is not taken;
food, before or after food, with more water or at night only
medication administration; – drug-drug interactions and drug-food
interactions
interferes with the action of another drug. For example taking
anti-acid with oral Tetracycline causes a decrease in the
effectiveness of tetracycline.
impair or enhance its absorption
bloodstream at a faster rate than when drug is taken with food in
the stomach
Captopril to achieve optimal effect
long will they remain; how serious they are; what to do if they occur
Warnings: What not to do (driving, machinery); maximum dose (toxic
drugs); need to continue treatment (antibiotics)
[pic][pic] Refer students to Handout 12.1: Warnings/Cautions to Patients
for further reading
STEP 5: Check Patient Understanding on the Use and Precautions of
Dispensed Medicine(s) (30 minutes)
Activity: Role Play Demonstration (30 minutes)
EXPLAIN that this will be a role play demonstration between a patient and a
health care provider. One volunteer student will play the Dispenser and
lead the conversation of the instructions on the use of medicines
prescribed to the patient, who will be another student volunteer.
ASK the students to volunteer to play the dispenser role and the patient
role.
[pic]Refer student volunteer to Worksheet 12.4: Role Play Demonstration so
that he/she can read the description of the patient.
[pic] Refer students to Worksheet 12.1: Sample Prescription Serial No.
001192
TELL the rest of students to observe carefully
EXPLAIN that the patient will listen carefully and repeat the information
provided when asked. The dispenser should present the instructions on how
to use the prescribed medicines as well as telling about precautions to a
patient, common side effect of medicines dispensed and the storage
condition of medicine
EMPHASIZE that the Dispenser should concentrate on checking the patient
understanding on the use of medicines and the precautions given.
START the role play.
LEAD a discussion after the role play.
DE-ROLE all the students, once the role play is over.
ASK students if they have any questions about the role play.
else repeat the information; let the patient ask any more questions.
nausea, mild diarrhoea, urine changing colour
medicine
STEP 6: Key Points (10 minutes)
how to take; how to store; how long to continue the treatment, what to do
in case of problems and wheather the medicine therapy needs Direct
Observed Therapy (DOT)
instructions given
understanding on how to take medication
effect caused by medicine
STEP 7: Evaluation (5 minutes)
medicines?
understood the medication taking instructions?
prescriber?
References
Rice, J. (2011). Principles of pharmacology for medical assisting (5th
ed.). Boston, United States of America: Cengage Learning.
Roach, S. S., & Ford, S. M. (2008). Introductory clinical pharmacology (8th
ed.). Philadelphia, United States of America: Lippincott Williams &
Wilkins.
Taber, C. W., & Thomas, C. L. Taber's cyclopedic medical dictionary (pp.
v.). Philadelphia, United States of America: F.A. Davis Co.
Walker, R., & Whittlesea, C. (2012). Clinical pharmacy and therapeutics
(5th ed.). Edinburgh, United Kingdom: Churchill Livingston
|[pic] |Handout 12.1: Warnings/Cautions to Patients |
WARNINGS/CAUTIONS TO PATIENTS
1. Warning. May cause drowsiness
To be used on preparations for children containing antihistamines, or other
preparations given to children where the warnings of label 2 on driving or
alcohol would not be appropriate.
2. Warning. May cause drowsiness. If affected do not drive or operate
machinery. Avoid alcoholic drink
To be used on preparations for adults that can cause drowsiness, thereby
affecting the ability to drive and operate hazardous machinery; label 1 is
more appropriate for children. It is an offence to drive while under the
influence of drink or drugs.
Side-effects unrelated to drowsiness that may affect a patient's ability to
drive or operate machinery safely include blurred vision, dizziness, or
nausea. In general, no label has been recommended to cover these cases, but
the patient should be suitably counselled.
3. Warning. May cause drowsiness. If affected do not drive or operate
machinery
To be used on preparations containing monoamine-oxidase inhibitors; the
warning to avoid alcohol and dealcoholized (low alcohol) drink is covered
by the patient information leaflet.
Also to be used as for label 2 but where alcohol is not an issue.
4. Warning. Avoid alcoholic drink
To be used on preparations where a reaction such as flushing may occur if
alcohol is taken (e.g. metronidazole and chlorpropamide). Alcohol may also
enhance the hypoglycaemia produced by some oral antidiabetic drugs but
routine application of a warning label is not considered necessary.
5. Do not take indigestion remedies at the same time of day as this
medicine
To be used with label 25 on preparations coated to resist gastric acid
premature dissolution of the coating in the presence of an alkaline pH.
Label 5 also applies to drugs such as ketoconazole where the absorption is
significantly affected by antacids; the usual period of avoidance
recommended is 2 to 4 hours.
6. Do not take indigestion remedies or medicines containing iron or zinc at
the same time of day as this medicine
To be used on preparations containing Ofloxacin and some other quinolones,
doxycycline, minocycline, and penicillamine. These drugs chelate calcium,
iron and zinc and are less well absorbed when taken with calcium-containing
antacids or preparations containing iron or zinc. These incompatible
preparations should be taken 2-3 hours apart.
7. Do not take milk, indigestion remedies, or medicines containing iron or
zinc at the same time of day as this medicine
To be used on preparations containing ciprofloxacin, norfloxacin or
tetracyclines that chelate calcium, iron, magnesium, and zinc and are thus
less available for absorption; these incompatible preparations should be
taken 2-3 hours apart. Doxycycline and minocycline are less liable to form
chelates and therefore only require label 6 (see above).
8. Do not stop taking this medicine except on your doctor's advice
To be used on preparations that contain a drug which is required to be
taken over long periods without the patient necessarily perceiving any
benefit (e.g. antituberculosis drugs).
Also to be used on preparations that contain a drug whose withdrawal is
likely to be a particular hazard (e.g. clonidine for hypertension). Label
10 (see below) is more appropriate for corticosteroids.
9. Take at regular intervals. Complete the prescribed course unless
otherwise directed
To be used on preparations where a course of treatment should be completed
to reduce the incidence of relapse or failure of treatment.
The preparations are antimicrobial drugs given by mouth. Very occasionally,
clindamycin) and in such cases the patient may need to be advised of
reasons for stopping treatment quickly and returning to the doctor.
10. Warning. Follow the printed instructions you have been given with this
medicine
To be used particularly on preparations containing anticoagulants, lithium
and oral corticosteroids. The appropriate treatment card should be given to
the patient and any necessary explanations given.
This label may also be used on other preparations to remind the patient of
the instructions that have been given.
11. Avoid exposure of skin to direct sunlight or sun lamps
To be used on preparations that may cause phototoxic or photoallergic
reactions if the patient is exposed to ultraviolet radiation. Many drugs
like phenothiazines and sulphonamides) may, on rare occasions, cause
reactions in susceptible patients. Exposure to high intensity ultraviolet
radiation from sunray lamps and sunbeds is particularly likely to cause
reactions.
12. Do not take anything containing aspirin while taking this medicine
To be used on preparations containing probenecid and sulfinpyrazone whose
activity is reduced by aspirin.
Label 12 should not be used for anticoagulants since label 10 is more
appropriate.
13. Dissolve or mix with water before taking
To be used on preparations that are intended to be dissolved in water (e.g.
soluble tablets) or mixed with water (e.g. powders, granules) before use.
In a few cases other liquids such as fruit juice or milk may be used.
14. This medicine may colour the urine
To be used on preparations that may cause the patient's urine to turn an
unusual colour. These include phenolphthalein (alkaline urine pink),
triamterene (blue under some lights), levodopa (dark reddish), and
rifampicin (red).
15. Caution flammable: keep away from fire or flames
To be used on preparations containing sufficient flammable solvent to
render them flammable if exposed to a naked flame.
16. Allow to dissolve under the tongue. Do not transfer from this
container. Keep tightly closed. Discard eight weeks after opening
To be used on glyceryl trinitrate tablets to remind the patient not to
transfer the tablets to plastic or less suitable containers.
17. Do not take more than . . . in 24 hours
To be used on preparations for the treatment of acute migraine except those
containing ergotamine, for which label 18 is used. The dose form should be
specified, e.g. tablets or capsules.
It may also be used on preparations for which no dose has been specified by
the prescriber.
18. Do not take more than … in 24 hours or … in any one week
To be used on preparations containing ergotamine. The dose form should be
specified, e.g. tablets or suppositories.
19. Warning. Causes drowsiness which may continue the next day. If affected
do not drive or operate machinery. Avoid alcoholic drink
To be used on preparations containing hypnotics (or some other drugs with
sedative effects) prescribed to be taken at night. On the rare occasions
(e.g. nitrazepam in epilepsy) when hypnotics are prescribed for daytime
administration this label would clearly not be appropriate. Also to be used
as an alternative to the label 2 wording (the choice being at the
discretion of the pharmacist) for anxiolytics prescribed to be taken at
night.
It is hoped that this wording will convey adequately the problem of
residual morning sedation after taking 'sleeping tablets'.
20. …with or after food
To be used on preparations that are liable to cause gastric irritation, or
those that are better absorbed with food.
Patients should be advised that a small amount of food is sufficient.
21. …half to one hour before food
To be used on some preparations whose absorption is thereby improved. Most
oral antibacterials require label 23 instead (see below).
22. …an hour before food or on an empty stomach
To be used on oral preparations whose absorption may be reduced by the
presence of food and acid in the stomach.
23. …sucked or chewed
To be used on preparations that should be sucked or chewed.
The pharmacist should use discretion as to which of these words is
appropriate.
24. …swallowed whole, not chewed
To be used on preparations that are enteric-coated or designed for modified-
release.
Also to be used on preparations that taste very unpleasant or may damage
the mouth if not swallowed whole.
25. …dissolved under the tongue
To be used on preparations designed for sublingual use. Patients should be
advised to hold under the tongue and avoid swallowing until dissolved. The
buccal mucosa between the gum and cheek is occasionally specified by the
prescriber.
26. …with plenty of water
To be used on preparations that should be well diluted (e.g. chloral
hydrate), where a high fluid intake is required (e.g. sulphonamides), or
where water is required to aid the action (e.g. methylcellulose). The
tumblerful). In most cases fruit juice, tea, or coffee may be used.
27. To be spread thinly . . .
To be used on external preparations that should be applied sparingly (e.g.
corticosteroids, dithranol).
28. Do not take more than 2 at any one time. Do not take more than 8 in 24
hours
To be used on containers of dispensed solid dose preparations containing
paracetamol for adults when the instruction on the label indicates that the
dose can be taken on an 'as required' basis. The dose form should be
specified, e.g. tablets or capsules.
This label has been introduced because of the serious consequences of over
dosage with paracetamol.
29. Do not take with any other paracetamol products
To be used on all containers of dispensed preparations containing
paracetamol.
30. Contains aspirin and paracetamol. Do not take with any other
paracetamol products
To be used on all containers of dispensed preparations containing aspirin
and paracetamol.
31. Contains aspirin
To be used on containers of dispensed preparations containing aspirin when
the name on the label does not include the word 'aspirin'.
32. Contains an aspirin-like medicine
To be used on containers of dispensed preparations containing aspirin
derivatives.
|[pic] |Worksheet 12.1: Sample Prescriptions |
|Serial Na. 001 |
|KIDIA HEALTH CENTER |
|P.O. Box 58 |
|IRINGA |
|Name: |Amina Salehe |
|Gender: |Fe |
|Age: |17 Yrs |
|Weight: | |
|Rx |Cotrimoxazole tabs 480mg|
| |bd 5/7 |
| |Paracetamol Tabs 1g 5/7 |
|Prescriber’s |Hamis Juma Mgenja |
|name |C/O |
|qualification | |
|Signature |[pic] 12/6/2015 |
|Serial Na. 002 |
|KIGOMA HOSPITAL |
|P.O. Box 5 |
|KIGOMA |
|Name: |Peter John |
|Gender: |Me |
|Age: |25 Yrs |
|Weight: | |
|Rx |Erythromycin tabs 500mg |
| |qid 5/7 |
| |Paracetamol Tabs 1g tds|
| |5/7 |
|Prescriber’s |Kisa Mwanjela |
|name |MO |
|qualification | |
|Signature |[pic] 12/6/2015 |
|Serial Na. 003 |
|HASSANALI HOSPITAL |
|P.O. Box 5118 |
|MTWARA |
|Name: |Miriam Kilimilimi |
|Gender: |Fe |
|Age: |43 Yrs |
|Weight: | |
|Rx |Erythromycin tabs 500mg |
| |qid 7/7 |
| |Paracetamol Tabs 1g 5/7 |
| |Diazepam Tabs 5mg o.d |
| |nocte 3/7 |
|Prescriber’s |Kilimani Kajengeni |
|name |AMO |
|qualification | |
|Signature |[pic] 12/6/2015 |
|[pic] |Worksheet 12.2: Role Play Demonstration: Giving Appropriate |
| |Instructions on the Use of Prescribed Medicine |
|Script: |
|[pic] REFER Worksheet 7.1: Role Play Demonstration on Good Dispensing |
|Practice |
| |
|You act as a Dispenser to give instructions to a patient on how to use |
|medicines as prescribed. |
|Cotrimoxazole Tablets is taken 2 tablets after every 12 hours for 5 |
|days |
|Paracetamol Tablets is taken 2 tablets after every 8 hours for 5 days. |
|Make sure you emphasize the 12hourly and 8 hourly well to a patient |
|After receiving prescription and properly prepare the medicine, when |
|dispensing follow the following tips; |
|Communicate to the patient the correct way to take medication. Give |
|verbal instructions. Use symbolic instructions in case of illiteracy. |
|Use auxiliary labels if required. |
|In case of illiterate patients or patients familiar with only the |
|regional language, devise a system of pasting specific colored |
|labels/stickers on strips/ bottles to take it easier to identify the |
|product. |
|Repeat orally the labeled instructions, if possible, in laymen's terms.|
|Do not disturb any other pharmacy staff person, dispensing or preparing|
|a bill. |
|Make the patient repeat the advice to ensure that he/she has understood|
|them. Emphasize the need for adherence. Inculcate awareness in patients|
|about the importance of therapy. |
|Patient information leaflets can be provided along with a particular |
|medicine or for a particular illness. Provide warnings and cautions. |
|Give special attention to certain cases- |
|Those with visual impairment |
|Illiterates. |
|Those taking multiple medications. |
|Special group of patients (pregnant, children and elderly patients, |
|patients with liver and kidney problem) |
|OTC medicines are requested, the pharmacy professionals can evaluate if|
|the product requested, is appropriate for the patient's condition, and |
|advise accordingly. |
|[pic] |Worksheet 12.3: Role Play Demonstration: Giving appropriate |
| |precautions, interactions, side effects and storage of |
| |medicines |
|Script: |
|[pic] REFER Worksheet 7.1: Role Play Demonstration on Good Dispensing |
|Practice |
| |
|You act as a Dispenser to give instructions to a patient on how to use |
|medicines as prescribed. |
|Erythromycin Tablets is taken 2 tablets after every 6 hours for 5 days |
|Paracetamol Tablets is taken 2 tablets after every 8 hours for 5 days. |
|Make sure you emphasize the 6 hourly and 8 hourly well to a patient |
|You must tell the patient about common side effect of Erythromycin |
|Tablets which is stomach discomfort. It is also enteric coated to avoid|
|stomach discomfort but it should be stored at a cool and dry place out |
|of children reach. Keeping medicines out of children reach should apply|
|for Paracetamol also. |
|Remember to ask a patient to repeat instructions as given |
|[pic] |Worksheet 12.4: Role Play Demonstration: Checking patient |
| |understanding on the use and precautions of dispensed |
| |medicines |
|Script: |
|[pic] REFER Worksheet 7.1: Role Play Demonstration on Good Dispensing |
|Practice |
| |
|You act as a Dispenser to give instructions to a patient on how to use |
|medicines as prescribed. |
|Erythromycin Tablets is taken 2 tablets after every 6 hours for 7 days |
|Paracetamol Tablets is taken 2 tablets after every 8 hours for 5 days. |
|Diazepam Tablets is taken 1 tablet once a day at night before sleeping |
|for 3 days |
|Make sure you emphasize the 6 hourly and 8 hourly and at night before |
|sleeping well to a patient |
|You must tell the patient about common side effect of Erythromycin |
|tablets which is stomach discomfort. |
|It is also enteric coated to avoid stomach discomfort but it should be |
|stored at a cool and dry place out of children reach. |
|Keeping medicines out of children reach should apply for Paracetamol |
|and Diazepam also |
|Emphasize on Erythromycin is causing stomach discomfort; |
|Diazepam is causing drowsiness on the next day. |
|Precaution to a patient not to drive in case of drowsiness |
|Remember to ask a patient to repeat instructions as given |
|Put more emphasis to patient understanding on the instructions given |
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