1 / 57

Medicines Information

Medicines Information. for future pharmacists. March 2017. Overview of the Session. Receiving enquiries Seeing the enquiry in context (background information etc.) Searching for information Common resources: their relative strengths and weaknesses Communication skills

Download Presentation

Medicines Information

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Medicines Information for future pharmacists March 2017

  2. Overview of the Session • Receiving enquiries • Seeing the enquiry in context (background information etc.) • Searching for information • Common resources: their relative strengths and weaknesses • Communication skills • Giving/receiving queries (verbal vs. written) • Ethical dilemmas

  3. Background Information

  4. Query #1 • A GP rings and asks you: “Are steroids safe in pregnancy?” • What additional information may be required in order for you to answer the query (or for you to refer the query to MI for answering)?

  5. Query #1 • General questions – for all enquiries • Is this a general enquiry or is it about a specific patient? • What is your name? • What is your job/role/interest in this enquiry? • Establish indication if not clear. • How should I contact you? • When do you need an answer? • Prospective or retrospective?

  6. Query #1 • Retrospective: • Which steroid did she take? • What dose? Route? Indication? • At what stage of pregnancy was steroid taken? • try & get exact dates if possible • Taking anything else? • Purpose of call? • for reassurance or because something abnormal has been detected on a scan?

  7. Query #1 • Prospective: • What is being treated? • Severity of condition? • Which steroid? Dose? Frequency? Route? • What has been tried already? • Any co-morbidities? • Any other drug therapy being taken? • History of past pregnancies e.g. medication used in previous pregnancies

  8. Query #2 • A junior doctor calls you and asks: “Is fluoxetine safe to use in a breastfeeding mother who is depressed?” • What additional information may be required in order for you to answer the query (or for you to refer the query to MI for answering)?

  9. Query #2 • General questions – for all enquiries • Is this a general enquiry or is it about a specific patient? • What is your name? • What is your job/role/interest in this enquiry? • Establish indication if not clear. • How should I contact you? • When do you need an answer? • Prospective or retrospective? • At the end of the call, negotiate when you will provide an answer.

  10. Query #2 • Prospective • Has mum been treated for depression before e.g. while pregnant? If so, with what and did it work? • Proposed dose of fluoxetine to be used? • Co-morbidities for mum? • Other drug therapy for either mum or baby? • Is the GP open to suggestions of possible safer alternatives (if found)?

  11. Query #2 • Retrospective: • Establish why GP is ringing? • e.g. for reassurance? Or is the baby showing signs or symptoms thought to be due to fluoxetine? • If so, further details as appropriate... • Was baby born at term & is baby healthy & of normal weight for its age? • Dose of fluoxetine used? • Co-morbidities for mum? • Other drug therapy for either mum or baby?

  12. Query #3 • A registrar calls you and asks: “Is there an interaction between clarithromycin and citalopram?”

  13. Query #3 • General questions – for all enquiries • Is this a general enquiry or is it about a specific patient? • What is your name? • What is your job/role/interest in this enquiry? • Establish indication if not clear. • How should I contact you? • When do you need an answer? • Prospective or retrospective? • At the end of the call, negotiate when you will provide an answer.

  14. Query #3 • Prospective: • Is citalopram a ‘long-term’ therapy and clarithromycin being prescribed ‘new’? • Proposed doses, duration etc. • Why clarithromycin? What infection is being treated? • Other drug therapy being taken?

  15. Query #3 • Retrospective: • Establish why is the registrar ringing? • e.g. following a query from the patient, or because the patient is exhibiting a new symptom etc?

  16. Common Resources

  17. Common resources used • BNF/BNFc • eMC • Martindale • DrugDex • AltMedDex • Stockley’s Drug Interactions • Natural Medicines Comprehensive database • CKS • TOXBASE • UpToDate • Specialist Pharmacy Service • Fridge Database • Safety in Lactation • Dossette box stability • New Medicines Newsletters • Patent expiries • Patient.co.uk • NHS Choices • NHS Evidence • NEWT • Medline/EMBASE • Internet search engines • Pharmaceutical industry • Maudsley Prescribing Guidelines • Alerting/current awareness emails e.g. NICE, MHRA etc. • Clinical Key • Royal Pharmaceutical Society • Access to some books e.g. Pharmaceutical Excipients

  18. BNF / BNFc • Access via www.medicinescomplete.com/mc • Apps also available to download • need NHS Athens password • Same content and layout as books • Monthly updates

  19. eMC • Access via www.medicines.org.uk/emc • SPCs and PILs • Only for products registered with the ABPI (members supply ~90% of UK medicines) • Free access – no login required • Useful links, e.g. X-PIL

  20. MicroMedex • Access via NHS Wales e-library http://www.wales.nhs.uk/ehl • Basic access with NHS Athens password • DrugDex / AltMedex • Martindale • Drug Interaction Checker • Trissel IV compatibility • Reprotox / TERIS / Shepard’s (MI only access)

  21. Medicines Complete • Access via www.medicinescomplete.com/mc • Subscription required • AHFS • Stockley’s Drug Interactions • Stockley’s Herbal Medicines Interactions • Handbook of Drug Administration via enteral feeding tubes • Trissel’s Handbook on Injectable Drugs • Herbal Medicines • Dietary Supplements

  22. Common resources used • BNF/BNFc • eMC • Martindale • DrugDex • AltMedDex • Stockley’s Drug Interactions • Natural Medicines Comprehensive database • CKS • TOXBASE • UpToDate • Specialist Pharmacy Service • Fridge Database • Safety in Lactation • Dossette box stability • New Medicines Newsletters • Patent expiries • Patient.co.uk • NHS Choices • NHS Evidence • NEWT • Medline/EMBASE • Internet search engines • Pharmaceutical industry • Maudsley Prescribing Guidelines • Alerting/current awareness emails e.g. NICE, MHRA etc. • Clinical Key • Royal Pharmaceutical Society

  23. Question 1 • You need to find some information to advise a GP regarding nifedipine-induced gingival hyperplasia. • Where will you look?

  24. Adverse Drug Reactions • Is it a recognised adverse effect? • Frequency it normally occurs? • Does the patient have any risk factors for experiencing the ADR? • Is the ADR transient/reversible? • Should the drug be stopped? • Is it a class effect? • What are the alternatives?

  25. Reporting ADRs – Yellow Card • Report: • all ADRs for new drugs (marked ▼) – even if mild • serious ADRs for established drugs – even if well recognised • Serious ADRs include: • Vaccines / Unlicensed / Herbal medicines Causality does not need to be established

  26. Question 2 • You need to find some information for a GP so that he may advise a patient regarding the potential for interaction between ginkgo biloba and aspirin. • Where will you look?

  27. Complementary and Alternative Medicine • A 2001 survey found 20% of adults in England had bought OTC herbal remedies in the previous 12 months • Pharmacists • should be able to advise the consumer on the rationale and safe use of all medicines • should have an understanding of the potential interactions and adverse effects alternative medication may have with conventional medicines

  28. Complementary and Alternative Medicine • St John’s Wort (SJW) (Hypericum perforatum) • Active ingredients and mechanisms of actions unclear • Cochrane concludes that SJW is more effective than placebo in the treatment of mild to moderate depression, and is more effective and better tolerated than standard antidepressants • SJW is a potent inducer or hepatic CYP enzymes. • SJW significantly decreases plasma concentrations of digoxin, HIV medication, oral contraceptive pills, theophylline, clozapine, warfarin and many more. Also theoretical risks with anticonvulsant medication...

  29. Question 3 • You need to find some general information regarding the suggested management of Bell’s palsy. • Where will you look? Link

  30. Question 4 • You are reviewing a guideline regarding people who misuse drugs etc. and need to determine the difference between a body-packer and a body-stuffer. • Where will you look? Link

  31. Question 5 • A GP has received a query from a patient concerned that her “stomach pill” is going to give her dementia. You need to advise him so that he can reassure the patient. • Where will you look? Link

  32. Question 6 • A GP calls and asks is there evidence to support the use of enteric coated aspirin to reduce GI side effects? • Where will you look? Link

  33. Question 7 • You need to advise a community pharmacist regarding the stability of Asasantin Retard in a compliance box. • Where will you look? Link

  34. Question 8 • You need to advise a care home regarding administration of clopidogrel to a patient with swallowing difficulties. • Where will you look?

  35. Common resources used • BNF/BNFc • eMC • Martindale • DrugDex • AltMedDex • Stockley’s Drug Interactions • Natural Medicines Comprehensive database • CKS • TOXBASE • UpToDate • Specialist Pharmacy Service • Fridge Database • Safety in Lactation • Dossette box stability • New Medicines Newsletters • Patent expiries • Patient.co.uk • NHS Choices • NHS Evidence • NEWT • Medline/EMBASE • Internet search engines • Pharmaceutical industry • Maudsley Prescribing Guidelines • Alerting/current awareness emails e.g. NICE, MHRA etc. • Clinical Key • Royal Pharmaceutical Society • Access to some books e.g. Pharmaceutical Excipients

  36. Beware of the internet! • Some websites may contain information which is poorly evaluated, inaccurate and/or biased • Always consider: • Who are the authors? • Are key statements referenced? • Are the references reputable? • Is the information current? • Who owns or sponsors the site? • Is the site referred to by another authoritative site? • Always try and check an answer in another resource

  37. The internet may be good for... • Branded or foreign products • Identification of drugs and herbal products • Hospital guidelines or formulary evaluations • News regarding ‘unusual’ treatments • Street drugs and substance misuse

  38. The internet is not good for... • Drug interactions • ADRs • Formulation and compatibility queries • Pharmacoeconomics

  39. Tablet identification

  40. Communication skills

  41. Communication skills • The tablet identification role-play shows the importance of clear, concise, accurate communication • When handling an MI enquiry, do not make any assumptions and, if in any doubt, ask for further clarification on any aspect of the query • When dealing with an MI enquiry, it is important to control the conversation in order to extract all relevant background information to view the query in context

  42. Communication skills • Use a conversational tone (not a checklist!) • If necessary, consider explaining why you require the additional details you are requesting • Before ending the call, summarise the query to the enquirer (to ensure you & they agree what is being asked) • Agree a timescale for the answer (not “ASAP”)

  43. Communication skills • Consider the format in which the answer is to be given • Verbal (face to face or telephone) • Written (email v.s. letter) • If giving an answer by telephone, the quality of your enquiry answering service is likely to be judged on the 2-3 minutes when giving the answer • Spending a few minutes summarising the main points of your answer e.g. using bullet points, ensures all relevant information is provided and helps to keep the conversation ‘on track’ • Recapping (you to the enquirer, or vice versa) may be helpful to ensure the message is delivered accurately

  44. Communication skills • Verbal v.s. written answer? • Complexity of advice given? • How is the information going to be used? • Sometimes a verbal answer will require written confirmation • Email v.s. letter? • Style (formal v.s. less formal v.s. informal?) • Consider how the information is going to be used! • References? • Be aware of patient confidentiality issues • Patient identifiers & email addresses

  45. Communication skills • When writing (or speaking), consider using phrases such as: • “As you will know,...” • “As you will be aware,...” • Avoid using phrases such as: • “There are no reports of ...” • Instead, use phrases like: • “Following a detailed literature search, I have been unable to locate any reports of...”

  46. Over to you!

  47. Ethical dilemmas

  48. Ethical dilemmas – general points • You do not have to answer every question that you are asked. • Always give yourself thinking time before replying. • Consult with appropriate colleagues and/or managers before answering.

  49. Ethical dilemmas – general points • There is no one “right” answer to most ethical dilemmas, but you should be able to justify what you do. • Do not answer queries that are beyond your sphere of expertise or available resources. • Research your answers thoroughly, and document carefully everything that you do.

  50. Ethical dilemma #1 • A woman says she has found some medicines in her son’s room. She reads the labels - lamivudine, zidovudine and saquinavir. • Can you tell her what they are for? • Would your answer be different if the call was from his wife?

More Related