Pce sample case 2017 2018 (english)

Patient Counselling Event Sample Case 2017-2018

IPSF Chairperson of Professional Development pd@ipsf.org IPSF PCE Coordinator patientcounselling@ipsf.org

Copyright Š 2017 International Pharmaceutical Students' Federation. All Rights Reserved.

Preface Please read the following information before going through the sample cases.

In the PCE portfolio for 2017-2018, there will be three kinds of PCE levels: PCE 101, Beginners and Advanced. These are expected to be applied at World Congress (WC) and/or Regional Symposia.

Here is a brief description of the format of the competition for each PCE level: PCE 101: this level is aimed at pharmacy students who are still in the first year of their studies. The announcement of the topic and the actual case will be supplied further in advance to give the participants more time for practice and preparation.

PCE Beginners: the announcement of the therapeutic topic will be given in advance (i.e. injury pain or respiratory infection) but participants do not receive the actual case until 24 hours prior to the event.

PCE Advanced: there will be no pre-announcement of either the topic or case. During the day of the competition, there will be several rooms for the contestant to progress through. The first room is the references room. In this room, the contestants will be given a certain amount of time to read the case and prepare their response. In the references room, we will provide some references (either book or clinical drug information applications such as Lexicomp). After the given time is finished, the contestant will move to the counselling room to counsel the patient in front of the judges.

The aim of the following PCE sample cases is to show IPSF members how the PCE competition will run this year. At the time we release the sample cases, we will also release the PCE survey. The PCE survey will determine the clinical topics for the upcoming cases in the PCE portfolio.

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Preface

PCE 101

Case A pharmacy student comes to your pharmacy to ask for an OTC medicine for his itchy eyes, runny nose, and cough. He complains that the symptoms are interfering with his school activities. He is a busy student and he does not have time to go and see a doctor right now but he has already made an appointment with a doctor for the end of the week. Currently, he is pet sitting his sister’s cat for 2 weeks. He has been having difficulty taking care of his sister’s cat because the cat’s furs have spread throughout the house.

The only OTC antihistamine drug you have available in your pharmacy is: Cetirizine (Brand: Zyrtec) 10 mg

Patient Information Personal Information

Name Jack Marrow

Age 19 years old

Date of Birth 23 March 1998

Gender Male

Weight 65 kg (143.3 lbs or 10 st 3.3 lbs)

Height 1.78 m (70.1 inches or 5’10’’)

Medical Information

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Current medication(s) None

Allergies/Drug Intolerance None

Past Medication(s) None

Current Medical Conditions None

PCE 101 Case

Actor Guidelines You are Mr. Jack Marrow, a busy pharmacy student who has the symptoms of an allergic reaction to cats.

You should only give out the following information when the contestant asks: ㆍ ㆍ ㆍ ㆍ ㆍ

You are pet sitting your sister’s cat for 2 weeks while they are renovating their house.

The symptoms started occurring 3 days after you had the cat.

You have never had any allergies before.

You are generally healthy, but for several days you didn’t get enough sleep.

You don’t drink or smoke.

The questions you might ask if the contestant does not make a clear point at the 8-minute mark of the counselling session: ㆍ Clarify when you should start therapy and when to stop it. ㆍ Clarify if the medicine interferes with your daily activities. ㆍ Clarify whether you need to undergo an allergy test.

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PCE 101 Actor Guidelines

Adjudication Form Introduction Greet Patient Private/Confidential Overall Impression Comments

□ □ 1–2–3–4–5

Information Gathering Identify agent picking up Inquire if drug is new Inquire about reason of visiting doctor/symptoms experienced Inquire about information given by health professional Confirm current drug therapy/medical condition Over-the-counter/herbal Confirm allergies/intolerance Lifestyle

Overall Impression Comments

Medication Counselling Name of medication Dose Type Refills (if applicable in your country)

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PCE 101 Adjudication Form

Identify Self State time factor

□ □

Notes for patient actor □ Mr. Jack Marrow □ No previous experience with antihistamine □ Itchy eyes, runny nose, and cough for 3 days and the symptoms are interfering with patient’s school activities □ The patient doesn’t have time to go to the doctor because of his hectic school activities □ None □ None □ The symptoms started occurring 3 days after the patient had the cat □ Asks if the patient was consuming alcohol or smoking cigarette and if the patient had enough sleep and food.

Patient doesn’t smoke or consume alcohol.

1–2–3–4–5

□ □ □ □

Brand (Zyrtec) and generic name (Cetirizine) 10 mg per day Oral tablet OTC

Mechanism of action

□ In patient friendly terms Antihistamine/anti-allergy medication Cetirizine is an antihistamine used to relieve allergy symptoms. It works by blocking a certain natural substance (histamine) that your body produces during an allergic reaction Overall impression of information given 1 – 2 – 3 – 4 – 5

Instruction

□ In patient friendly terms Advises patient to take 1 tablet with or without food and a glass of water Overall impression of information given 1 – 2 – 3 – 4 – 5

Monitoring of therapy

□ What to expect – when to expect - management If treatment is successful, we are expecting either a reduction in the allergic symptoms to the cat or no symptoms at all Overall impression of information given 1 – 2 – 3 – 4 – 5

Monitoring of side effects

□

● ● ● ● ●

Somnolence Headache Fatigue Dry mouth Dizziness

Points given for each relevant monitoring point Overall impression of information given 1 – 2 – 3 – 4 – 5

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Give information as to monitoring (should look for what warrants a doctor’s visit)

□ In patient friendly terms Advises patient to visit the doctor if the symptoms are getting worse or if there is a new symptom such as shortness of breath or wheezing Overall impression of information given 1 – 2 – 3 – 4 – 5

Overall Impression Comments

1–2–3–4–5

PCE 101 Adjudication Form

Storage/Interaction/Patient Self Care □ N/A Interaction with current medication/OTC □ N/A Interaction counsel □ Avoid storing the medication within reach of children Storage Store away from light □ ● Reduce exposure to cats by maintaining physical Address self-care distance and restricting the cat to certain areas of the house (e.g. not allowing the cat in the patient’s bedroom) □ ● If possible, move the cat from the patient’s house and check if there is relief from the allergic symptoms □ ● Clean the cat’s fur or dander that spreads in the house □ ● Recommend an allergy test to the patient Overall Impression 1–2–3–4–5 Comments

Conclusion Ask for understanding/summary Address for question

□ □ Patient’s questions: When should I start my therapy and when to stop it?

Does my medicine interfere my daily activity?

Should I need to undergo an allergy test?

If applicable

Offer to answer any further question/call patient to check-up Thank patient Overall Impression Comments

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PCE 101 Adjudication Form

□

□ 1–2–3–4–5

Verbal and Non Verbal Communication □ Overall impression 1 – 2 – 3 – 4 – 5 Verbal Communication Patient friendly language/no jargons Flow of counsel Appropriate tone/volume □ Overall impression 1 – 2 – 3 – 4 – 5 Non-Verbal Communication Posture Eye Contact Manners Facial Expression Overall Impression 1–2–3–4–5 Comments

References

Drugs.com, 2017. Cetirizine. https://www.drugs.com/cetirizine-hcl.html Was accessed on 6th November 2017.

WebMD, 2016. Cat Allergies. https://www.webmd.com/allergies/cat-allergies#1 Was accessed on 6th November 2017.

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PCE 101 Adjudication Form

PCE Beginners

Case Mrs. Sarah, a young mother, comes into your pharmacy with her 12 month-old daughter. Mrs. Sarah’s daughter has recently received her MMR (measles, mumps and rubella), Varicella and Hepatitis A vaccinations from a healthcare center. Her daughter was prescribed an antipyretic drug and Mrs. Sarah was instructed to give the medicine only when her daughter has a fever. The doctor said that two of the vaccines are live attenuated vaccines that may cause fever after 24 hours. Please counsel Mrs. Sarah regarding her daughter’s therapy to ensure the safe and effective use of the medicine and answer any questions that Mrs. Sarah may have.

Lalaland Clinic Michelle Johnson

5th November 2017

Prescribe: Acetaminophen (paracetamol) 160 mg/5 ml (Tylenol or applicable brand name) Give 3.75 mL 4 times per day as needed Dr. Alice

Patient Information Personal Information

Name Michelle Johnson

Age 12 months-old

Date of Birth 11 November 2016

Gender Female

Weight 8.2 kg (18 lbs)

Height 77 cm (30.5 inches)

Medical Information

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Current medication(s) None

Allergies/Drug Intolerance None

Past Medication(s) None

Current Medical Conditions None

PCE Beginners Case

Routes to Measure Temperature Where Temperature Was Measured

Normal Temperature Range

Fever If Temperature Above

Rectal

36.6℃ to 38℃ (97.9℉ to 100.4℉)

38℃ (100.4℉)

Mouth

35.5℃ to 37.8℃ (95.9℉ to 100℉)

37.8℃ (100℉)

Armpit

34.7℃ to 37.2℃ (94.5℉ to 99.1℉)

37.2℃ (99℉)

Ear

35.8℃ to 38℃ (96.4℉ to 100.4℉)

37.5℃ (99.5℉)

Reference A Guide to Fevers, http://quintepediatrics.com/2015/01/a-guide-to-fevers/

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PCE Beginners Case

Actor Guidelines You are Mrs. Sarah Johnson whose daughter, Michelle, has been given the MMR, Varicella and Hepatitis A vaccinations.

You should only give out the following information when the contestant asks: ㆍ Currently, your daughter is fine. ㆍ The physician said to give the medicine when your daughter has a fever. ㆍ The doctor said that the fever may occur 24 hours after the immunization and it may last for one to two days. ㆍ Your daughter has never had paracetamol before. ㆍ Your daughter is generally healthy (enough sleep and food). ㆍ Your daughter is still breastfed. ㆍ You do not know how to measure body temperature properly. ㆍ You have a thermometer that measures temperature via the mouth in your house.

The questions you might ask if the contestant does not make a clear point at the 8-minute mark of the counselling session: ㆍ Clarify how to recognize the symptoms of a fever in a child. ㆍ Clarify when your daughter should start therapy, and when to stop it. ㆍ Clarify what length of time you should leave between taking the medicine and feeding Michelle.

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PCE Beginners Actor Guidelines

Adjudication Form Introduction Greet Patient Private/Confidential Overall Impression Comments

□ □ 1–2–3–4–5

Information Gathering Identify agent picking up Inquire if drug is new Inquire about reason of visiting doctor/symptoms experienced Inquire about information given by health professional Confirm current drug therapy/medical condition Over-the-counter/herbal Confirm allergies/intolerance Lifestyle Overall Impression Comments Medication Counselling Name of medication Strength Type Refills (if applicable in your country) Mechanism of action

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Identify Self State time factor

□ □

Notes for patient actor □ Mrs. Sarah (Michelle’s mother) □ No previous experience with antipyretic medication □ The patient came to the healthcare center for the scheduled immunization (MMR, Varicella, Hepatitis A) □ Two of the vaccines are live vaccines that may cause fever after 24 hours □ None □ None □ None □ Asks if the patient has had enough sleep and food Asks if the patient is still breastfed 1–2–3–4–5

□ Brand (Tylenol or applicable brand name) and generic name (Acetaminophen/Paracetamol) □ 160 mg/5 ml □ Oral Suspension □ OTC □ In patient friendly terms An anti-pyretic medication can help soothe the child’s fever and relieve pain Overall impression of information given 1 – 2 – 3 – 4 – 5

PCE Beginners Adjudication Form

Instruction

□ In patient friendly terms, explains the following: 1. Shake the suspension well before measuring the dose 2. Uncap the suspension 3. Use a dose-measuring cup or spoon to measure the dose 4. Give 3.75mL of paracetamol suspension 4 times a day 5. Give the suspension when daughter has a fever 6. Cap the suspension and clean the measuring device 7. Store the suspension in a medicine box or any safe places Overall impression of information given

1–2–3–4–5

Monitoring of therapy

□ What to expect – when to expect - management If treatment is successful, the fever should be relieved and body temperature should return to normal Overall impression of information given 1 – 2 – 3 – 4 – 5

Monitoring of side effects

□

● ● ● ● ●

Nausea Stomach pain Loss of appetite Skin rash Redness or swelling

Points given for each relevant monitoring point Overall impression of information given 1 – 2 – 3 – 4 – 5 Give information as to monitoring (should look for what warrants a doctor’s visit)

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□ In patient friendly terms: Advises mother to visit the doctor if the patient still has a fever after 3 days of use, if the symptoms get worse, new symptoms develop, or if her daughter experiences any adverse events including a skin rash, any redness or swelling.

PCE Beginners Adjudication Form

Storage/Interaction/Patient Self Care □ N/A Interaction with current medication/OTC □ N/A Interaction counsel □ Avoid storing the medication within reach of children Storage Store away from light □ ● Asks Mrs. Sarah if she knows how to measure body Address self-care temperature □ ● Asks Mrs. Sarah if she has a thermometer in her house □ ● Educates Mrs. Sarah on how to use a mouth route thermometer properly Overall Impression 1–2–3–4–5 Comments

Conclusion Ask for understanding/summary Address for question

Offer to answer any further question/call patient to check-up Thank patient Overall Impression Comments

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□ □ Patient’s questions: How can I recognize the symptoms of a fever in my daughter?

When should my daughter start therapy and when should she stop?

Should I leave a gap between giving the medicine to my daughter and feeding my daughter? □

□ 1–2–3–4–5

PCE Beginners Adjudication Form

Verbal and Non Verbal Communication □ Overall impression 1 – 2 – 3 – 4 – 5 Verbal Communication Patient friendly language/no jargons Flow of counsel Appropriate tone/volume □ Overall impression 1 – 2 – 3 – 4 – 5 Non-Verbal Communication Posture Eye Contact Manners Facial Expression Overall Impression 1–2–3–4–5 Comments

References

CDC, 2017. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger. https://www.cdc.gov/vaccines/hcp/acip-recs/index.html Was accessed on 5th November 2017.

Immunize.org, 2011. After the Shots: What To Do If Your Child Has Discomfort. https://www.immunize.org/catg.d/p4015.pdf Was accessed on 5th November 2017.

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PCE Beginners Adjudication Form

PCE Advanced

Case Mrs. Lauren Kyle is a 55 year old female who often comes by your pharmacy to get her anti-diabetic medication. After an appointment with her regular GP, she arrives to present the following prescription. Please counsel Mrs. Lauren regarding her new medication and answer any questions that Mrs. Lauren may have.

One Health Clinic Lauren Kyle

7th November 2017

Prescribe: Ethinyl estradiol 2.5 mcg/ Norethindrone acetate 0.5 mg (FemHRT 28 oval tablets, a continuous HRT) Take one tablet one time per day Dr. Smith Prescriber Number: 112233

Patient Information Personal Information

Name Lauren Kyle

Age 55 years old

Date of Birth 2 July 1962

Gender Female

Weight 70 kg (154 lbs)

Height 160 cm (62.9 inches)

Medical Information

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Current medication(s) ㆍMetformin 500 mg – 2 times per day ㆍDiclofenac 50 mg 2 – 3 times per day

Allergies/Drug Intolerance None

Past Medication(s) None

Current Medical Conditions Type 2 Diabetes (T2D) and back pain

PCE Advanced Case

Actor Guidelines You are Mrs. Lauren Kyle and have been prescribed a hormone replacement therapy (HRT) drug by your regular GP. You should only give out the following information when the contestant asks: ㆍ The GP told you that the medicine is for the treatment of your menopausal symptoms. ㆍ The GP advised you to monitor your blood glucose while taking the hormonal medicine. ㆍ Your last menstrual period was a month ago. ㆍ You have been experiencing a sudden warmth in your body, night sweats, and vaginal dryness. ㆍ You have not had a hysterectomy, you rejected this medical treatment. ㆍ You have been taking the anti-diabetic drug (metformin) for 2 years and diclofenac for 3 days.

The diclofenac is taken only when you feel back pain. ㆍ Your blood glucose is controlled and you have had nutritional adjustment suitable for a diabetic patient. ㆍ You don’t smoke or drink. ㆍ You will have a follow-up appointment with your GP next week.

The questions you might ask if the contestant does not make a clear point at the 8-minute mark of the counselling session: ㆍ Clarify the function of your new medication and what happens if you miss a dose. ㆍ Clarify whether the medicine interferes with your current medications. ㆍ Clarify whether your back pain is related to your hormonal condition.

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PCE Advanced Actor Guidelines

Adjudication Form Introduction Greet Patient Private/Confidential Overall Impression Comments

□ □ 1–2–3–4–5

Information Gathering Identify agent picking up Inquire if drug is new Inquire about reason of visiting doctor/symptoms experienced Inquire about information given by health professional Confirm current drug therapy/medical condition Over-the-counter/herbal Confirm allergies/intolerance Lifestyle Other Overall Impression Comments

Medication Counselling Name of medication Strength Type Refills (if applicable in your country)

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Identify Self State time factor

□ □

Notes for patient actor □ Mrs. Lauren Kyle □ No previous experience with hormone replacement therapy drugs □ A sudden feeling of warmth in the body, night sweats and vaginal dryness □ The medicine is indicated for the treatment of the patient’s menopausal symptoms. She is advised to monitor her blood glucose while taking the hormonal medicine □ The patient has been taking an anti-diabetic drug (metformin) for 2 years □ The patient has been taking diclofenac for the past 3 days □ None □ The patient doesn’t smoke and drink □ The patient hasn’t had a hysterectomy 1–2–3–4–5

□ □ □ □

PCE Advanced Adjudication Form

Ethinyl estradiol/ Norethindrone acetate Ethinyl estradiol 2.5 mcg/ Norethindrone acetate 0.5 mg Continuous HRT, oral tablet Prescription drug

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Mechanism of action

□ In patient friendly terms Hormone replacement therapy is used by women to help reduce the symptoms of menopause that are caused by the body making less estrogen. The progestin in this medication helps to reduce the risk of cancer which can be caused by using estrogen.

Overall impression of information given 1 – 2 – 3 – 4 – 5

Instruction

□ In patient friendly terms This medication is to be taken by mouth with or without food, once daily. It may be taken with food or right after a meal to prevent stomach upset.

If a dose is missed, it is best to take the missed dose as soon as you remember. If it almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. It is not advised to take two doses at the same time.

Overall impression of information given 1 – 2 – 3 – 4 – 5

Monitoring of therapy

□ What to expect – when to expect- management If treatment is successful, the patient should expect relief from her menopausal symptoms Overall impression of information given 1 – 2 – 3 – 4 – 5

Monitoring of side effects

□

Give information as to monitoring (should look for what warrants a doctor’s visit)

□ In patient friendly terms Report any unusual vaginal bleeding right away as this medicine may increase the risk of uterine cancer.

Overall impression of information given 1 – 2 – 3 – 4 – 5

Overall Impression Comments

1–2–3–4–5

PCE Advanced Adjudication Form

● Breast or uterus cancer ● Edema ● Weakness ● Change in menstrual flow ● Stomach Upset Points given for each relevant monitoring point Overall impression of information given 1 – 2 – 3 – 4 – 5

Storage/Interaction/Patient Self Care □ Moderate level of interaction: Ethinyl estradiol may Interaction with current medication/OTC interfere with blood glucose control and reduce the effectiveness of metformin □ Monitor blood sugar levels and the symptoms of hyperInteraction counsel and hypoglycemia □ Avoid storing the medication within reach of children Storage Store away from light □ ● Reassess the need for treatment. Every 3-6 months, Address self-care there should be a discussion with the doctor regarding whether or not you still need the medicine to control the menopausal symptoms □ ● Maintain a healthy diet and exercise regularly □ ● Relieve vaginal dryness with vaginal moisturizers and lubricants (if applicable) Overall Impression 1–2–3–4–5 Comments

Conclusion Ask for understanding/summary Address for question Offer to answer any further question/call patient to check-up Thank patient Overall Impression Comments

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□ □ Patient’s question: Is my back pain related to my hormonal condition? □

□ 1–2–3–4–5

PCE Advanced Adjudication Form

Verbal and Non Verbal Communication □ Overall impression 1 – 2 – 3 – 4 – 5 Verbal Communication Patient friendly language/no jargons Flow of counsel Appropriate tone/volume □ Overall impression 1 – 2 – 3 – 4 – 5 Non-Verbal Communication Posture Eye Contact Manners Facial Expression Overall Impression 1–2–3–4–5 Comments

References

Wells, B.G., et al., 2015. Pharmacotherapy Handbook. Ed. 9th. McGraw-Hill Education.

United States. P. 276.

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PCE Advanced Adjudication Form

Patient Counselling Event Sample Case 2017-2018