Patient counselling

Assess and counsel patients on potential adverse drug events and drug interactions. 

Stimmel GL. How to counsel patients about depression and its treatment. Pharmacotherapy 1995 15(6 pt 2) 100S-104S. 

Counsel patients on appropriate expectations of pharmacotherapy in SAD, including the gradual onset of effect and the need for extended treatment of at least 1 year. 

A number of factors can alter LT4 dose requirements (Table 41—4). The most common cause of increased dose requirement is the co-administration of LT4 with calcium or iron supplements. Counsel patients that they should take the LT4 dose at least 2 hours before or 6 hours after the calcium or iron dose. 

Counsel women taking metronidazole regarding potential for nausea, vomiting, and abdominal pain. Counsel patients to avoid alcohol or alcohol-containing substances during therapy with metronidazole owing to the risk of disulfuram-like reactions. 

Clindamycin vaginal cream is the preferred therapy for bacterial vaginosis during lactation because metronidazole is listed as a drug of concern by the American Academy of Pediatrics (AAP)14 (Tables 44—4 and 44—5). Counsel patients that clindamycin cream weakens latex condoms and diaphragms, potentially rendering them ineffective. 

Recommend appropriate pharmacologic therapy and educate on proper use. If a counterirritant is recommended, counsel patients on the irritant effect of the product and recommend washing hands immediately after use and to avoid heating pads. For patients using a capsaicin product, emphasize that adherence to regular application is required for effectiveness. 

Counsel patients about glaucoma, drug therapy options, ophthalmic administration techniques, and the importance of adherence to the prescribed regimen. 

Complementary and alternative medicine therapies, such as acupuncture, biofeedback, chiropractic manipulation, dietary supplements, herbal therapy, and homeopathic preparations, are used by individuals with allergic rhinitis.29,30 Use of bromelain, gingko, ginseng, licorice, quercetin, and Urtica dioica has been reported, but large-scale studies documenting efficacy are lacking.31,32 Caregivers should inquire routinely about patients use of alternative therapies and counsel patients about the lack of validated data to support such practices.12... 

Valacyclovir 500 mg orally once daily has been implicated to prevent the sexual transmission of HSV to an uninfected partner. In addition to pharmacologic therapy, counsel patients regarding safe sex practices. 

Ultraviolet light and increased skin exposure may increase the risk of skin malignancies, especially in individuals who are fair-skinned. Practitioners can counsel patients to minimize skin exposure to the sun and to use to strong sun screens on exposed areas. 

Counsel patients to be compliant with all treatment regimens and appointments. 

Counsel patients receiving cytotoxic chemotherapy to report fever promptly. Provide patients with a diet to use during the neutropenic period. Counsel patients to avoid close contact with sick friends and relatives, and remind the patient and caregivers of the importance of hand washing. 

In summary, food will delay stomach emptying and, as a result, may decrease the rate of availability of a drug from its oral dosage form. The extent of availability of that drug, however, may be increased, decreased, or unaffected by meals. Thus, it is important for the pharmacist to counsel patients on the importance of timing the taking of their medications relative to their mealtimes. 

Because orlistat reduces the absorption of some fat-soluble vitamins and beta-carotene, counsel patients to take a multivitamin containing fat-soluble vitamins to ensure adequate nutrition. Instruct the patient to take the supplement once a day, at least 2 hours before or after the administration of orlistat, such as at bedtime. Doses greater than 120 mg 3 times a day have not been shown to provide additional benefit. 

Transmission-The recommended dosage of valacyclovir for reduction of transmission of genital herpes in patients with a history of 9 or fewer recurrences per year is 500 mg once daily for the source partner. Counsel patients to use safer sex practices P.1041... 

Basaria S, Dobs AS. Safety and adverse effects of androgens how to counsel patients. Mayo Chn Proc 2004 79 (4 Suppl) S25-S32. 

When GHB use is suspected or discovered, physicians and other hospital staff may counsel patients about the dangers of GHB use. They may make a referral to a rehabilitation program. As with any other drug, the physician should inquire about the possibility of the abuse of multiple drugs. 

Attempt to change patients medication orders when barriers to compliance exist Counsel patients on new and refill medications as necessary Promote patient wellness... 

A STATE PRACTICE ACT/BOARD OF PHARMACY PROVISION Trudy Hamilton, Pharm.D., is a licensed pharmacist and is currently the manager of a hospital pharmacy department. In the state where Dr. Hamilton is licensed, nonpharmacist personnel are prohibited by both statute (the state pharmacy practice act) and state board of pharmacy regulation from engaging in activities defined as the practice of pharmacy. The specific activities that fall within the definition of the practice of pharmacy are limited to being personally performed by licensed pharmacists only. Such activities include counseling patients about their medications and responding to drug information requests from other health care professionals (e.g., physicians and nurses). 

To sell the opportunity effectively, the entrepreneur must be able to quickly communicate the value proposition associated with the product, service, or business. In entrepreneurship circles, this is referred to as the elevator pitch. The elevator pitch refers to the ability to pitch the concept to a potential investor in the amount of time it takes to get on an elevator and then get off. The idea behind this is for the entrepreneur to be ready to pitch the concept clearly and concisely at any time. This skill actually fits in well for pharmacists because it is similar to how pharmacists often must counsel patients and make drug therapy recommendations to prescribers. One method of getting additional training in doing this effectively is the book, How to Get Your Point Across in 30 Seconds or Less (Frank, 1986). Three key questions that may be helpful to address are... 

ED and vascular disease commonly coexist. They share the same risk factors and endothelial dysfunction is the common denominator. ED may develop in an otherwise asymptomatic male and be an important predictor of subsequent acute or chronic cardiac events. ED may therefore offer an opportunity for risk assessment and therapeutic intervention to reduce the chance of a subsequent cardiac presentation. Cardiac patients with ED need a careful assessment to judge the safety of sexual activity and suitability for ED treatment. Properly assessed and counselled patients can safely enjoy sexual activity. ED therapy with phosphodiesterase type five inhibitors is safe and effective providing the patient and partner are advised on their use and the importance of avoiding drug interactions, especially with nitrates. 

In the same way that data on the short-term risk of stroke following TIA are essential for informing the early management of patients, data on the medium-term (one to five years) and long-term (five years and beyond) prognosis are required to counsel patients and direct secondary prevention. 

Consider the presence of noncompliance and counsel patient and parents... 

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