Transcript Before the tutorial

You start your afternoon shift at the
pharmacy when Mr Elric (66 years old)
who is one of your regular customers,
enters your pharmacy to have his
prescriptions filled. You notice that he
is having a bit of difficulty walking and
is wearing a scarf on this reasonably
warm day. Upon asking how his day is,
he tells you that the medicine he
purchased off you earlier that day
caused him to get a rash that covers his
neck and part of his body. He also
comments that although the doctor
only calls it a ‘mild allergic reaction’ he
doesn’t think it’s very mild.
Image adapted from: http://www.corbisimages.com/images/572/7A1D2540-C3D4-40D8-B42D-8DBDAE6D365D/42-16374371.jpg
Tutorial Scenario – Part 1
• He explains to you that the doctor prescribed
him a new pain relief medication as the old
one he was taking was causing problems with
his stomach. His work colleague had told him
the 2 medications are very similar and he is a
bit confused how one would be better for his
stomach and one would cause him to get a
rash while the other doesn’t.
Tutorial Scenario – Part 1
• He then hands you a prescription for the rash and a new
medication to replace the one he had dispensed earlier
that day and a referral for an HMR (see blackboard).
• The new prescription contains:
• Phenergan 25mg nocte prn
• Hydrocortisone cream 1% to be applied to the rash bd prn
• Colgout 1mg stat followed by 0.5mg q6h mdu
Lectures to support this case
• NSAIDs - Thomas Grewal
• Pain and inflammation: Gout and
hyperuricaemia – Peter Carroll
References to support this case
•
•
•
•
•
Rheumatology guidelines
Emergency guidelines
Dermatology guidelines
AMH
References provided on Blackboard
Information Gathering Prior to Tutorial 1
WHAT ARE THE PATIENT SPECIFIC FACTS THAT
NEED TO BE IDENTIFIED AND PRIORITIZED TO
ACHIEVE THE DESIRED THERAPEUTIC
OUTCOME?
Before the tutorial: Have a list of questions you
would like to ask Mr Elric in an HMR interview.
See blackboard for referral.
Information Gathering Prior to Tutorial 1
WHAT ARE SOME ISSUES THAT YOU CAN
IDENTIFY WITH THE MEDICINES THE MR ELRIC
HAS BEEN PRESCRIBED?
Before the tutorial: look at all the medicines that
have been prescribed, check each drug for
appropriateness (does, indication etc).
Information Gathering Prior to Tutorial 1
• WHAT ARE THE DIFFERENT GRADES AND
ASSOCIATED SYMPTOMS OF AN ALLERGY?
• WHAT IS THE DIFFERENCE BETWEEN
IMMEDIATE HYPERSENSITIVITY REACTIONS
AND DELAYED HYPERSENSITIVITY REACTIONS?
• WHICH IS MORE COMMON?
Information Gathering Prior to Tutorial 1
• SHOULD MR ELRIC AVOID ANY OTHER
MEDICATIONS IN THE FUTURE?
• WHAT IS THE MOST APPROPRIATE
TREATMENT FOR MR ELRIC’S ALLERGY?
Information Gathering Prior to Tutorial 1
• WHAT IS THE FUNCTION OF CYCLOOXYGENASE
(COX) 1 AND 2?
• WHAT ARE THE CLINICAL AND MOLECULAR
DIFFERENCES BETWEEN A NON-SELECTIVE
AND SELECTIVE COX-2 INHIBITOR?
• Before your tutorial refer to your lecture notes
and chemistry texts to answer this
Information Gathering Prior to Tutorial 1
• WHAT ARE THE RISK FACTORS FOR GOUT?
• WHAT MEDICATIONS ARE RECOMMENDED
FOR AN ACUTE GOUT ATTACK?
• WHICH MEDICATIONS CAN BE USED IN RENAL
IMPAIRMENT?
Information Gathering Prior to Tutorial 1
• WHAT MEDICATIONS SHOULD BE AVOIDED
DURING AN ACUTE GOUT ATTACK?
• WHAT MEDICATIONS ARE RECOMMENDED
FOR MAINTENANCE OF GOUT?
Information Gathering Prior to Tutorial 1
• WHAT WILL YOU TELL MR ELRIC ABOUT
COLGOUT?
• Before your tutorial review the CMI on WebCT.
Be prepared to counsel Mr Elric on this
medication.
Information Gathering Prior to Tutorial 1
• Before your tutorial you should read the
following articles as well as do further
research to answer these questions
• http://www.nps.org.au/health_professionals/publications/np
s_radar/2010/may_2010/brief_item_colchicine
• http://www.australianprescriber.com/magazine/27/1/10/3/
• http://www.australianprescriber.com/magazine/31/1/8/10/
Tutorial Scenario – Part 2
• A year after your review, Mr Elric returns to your pharmacy. You
notice he seems to be having difficulty walking and you ask him if
his gout is acting up again. He tells you his gout has not caused him
problems since your review. He explains to you that he accidently
stubbed his toe on his way to your shop and that his vision is not as
good as it used to be. He tells you that he saw his ophthalmologist
who says he has conjunctivitis and that his glaucoma is getting
worse. He asks if the medications will help improve his vision.
• He hands over the prescription which contains the following:
• G.Tenopt 0.5% 1 drop OD BD
• G.Chlorsig 1 drop q4h OS for 2 days then 1 drop qid for 5 days
Information Gathering Prior to Tutorial 2
• WHAT DOES OD, OS AND OU STAND FOR?
• WHAT SHOULD BE USED IN PHARMACY
INSTEAD OF OD, OS AND OU?
Information Gathering Prior to Tutorial 2
• WHAT OTHER MEDICATIONS BESIDE TENOPT
COULD BE ADDED TO LOWER MR ELRIC’S IOP?
• HOW DO THESE MEDICATIONS LOWER IOP?
• IS TENOPT THE MOST APPROPRIATE
GLAUCOMA MEDICATION TO GIVE MR ELRIC?
Information Gathering Prior to Tutorial 2
• CAN CARBONIC ANHYDRASE INHIBITORS BE
DISPENSED TO A PATIENT WITH AN ALLERGY
TO A SULFONAMIDE MEDICATION?
• WHAT DOES THE PRODUCT INFORMATION
FOR AZOPT SAY REGARDING SULFONAMIDE
ALLERGIES?
Information Gathering Prior to Tutorial 2
• WHAT ARE COMMON SIDE-EFFECTS WITH
BRIMONIDINE?
• HOW DO YOU MINIMISE SIDE-EFFECTS FROM
EYE DROPS?
Information Gathering Prior to Tutorial 2
• WHAT ARE POSSIBLE CAUSES FOR MR ELRIC’S
CONJUNCTIVITIS?
• HOW CAN YOU MINIMISE MICROBIAL
CONTAMINATION WHEN USING EYE DROPS?
Information Gathering Prior to Tutorial 2
• WHAT WILL YOU TELL MR ELRIC ABOUT HIS
NEW EYE DROPS?
Be prepared to counsel Mr Elric on this new
medications.
References to support this case
• Antibiotics guidelines
• AMH
• NHMRC Guidelines for Screening, Prognosis,
Diagnosis, Management and Prevention of
Glaucoma
Information Gathering Prior to Tutorial 2
• Before your tutorial you should read the
following articles as well as do further
research to answer these questions
• http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Conte
nt/D0DABD9912D44A14CA257516000FDABB/$File/18202.pdf
• http://www.psa.org.au/site.php?id=5676
• Goldberg I, Adena M. Co-prescribing of topical and systemic beta-blockers
in patients with glaucoma: a quality use of medicine issue in Australian
practice." Clinical and Experimental Ophthalmology; 2007: 35, 700-705