POM Counselling

Introduction and purpose

- Name, role, nature of consultation (here to counsel you on your medication), consent
- Private and confidential
- Confirmation of pt details and medication
Starting point
- Have you had this medication before?
- Do you know what it is used for?
Carbimazole Levothyroxine
MOA Reduces amount of thyroid hormone Mimics thyroid hormone→acts as substitute.
produced in body.
Dose
Monitoring Regular blood tests to monitor hormone levels.
S/E Upset stomach, headache, mild rash Upset stomach, diarrhea→usually with
(treated with antihistamine) excessive dose
More prone to infections so report mouth Report to GP for dose change→diarrhea,
ulcers, sore throat, bruising bleeding, fever nervousness, rapid pulse, insomnia, tremors
Special Take 30 min before breakfast, caffeine, or
instructions other meds.
Let GP know if you are planning on becoming
pregnant.
4 hrs apart from antacids, 2 hrs apart from
iron.

Prednisolone Prednisolone long Hydrocortisone

short
MOA Reduce inflammation Mimic natural steroid in body.
Dose
Monitoring Regular reviews with consultant on weight, BP, glucose
S/E Upset stomach, Upset stomach, ab pain, mood changes.
indigestion, mood, Report depression or thoughts of suicide.
insomnia Infection risk (avoid those with chickenpox, shingles, or measles)→Report
any significant illnesses or surgery.
Discuss with doctor if need bone protection.
Muscle wasting, cataracts, increase blood sugar
Report Adrenal suppression= fever, muscle pain, joint pain, inflammation in
eye or nose, itchy skin or weight loss.
Special Take in morning Take in morning after breakfast. Larger dose in morning and smaller
instructions after breakfast. Always carry steroid card to show in evening to mimic body’s natural
Complete full healthcare professionals. release. Take with food.
course. Do not stop abruptly→mood Steroid card if long term.
changes, adrenal suppression for 1yr Do not stop abruptly→mood
or more after stopping changes, adrenal suppression for 1yr
or more after stopping
 Progesterone only (Cerazette) Combined (Microgynon)
MOA Prevent you from becoming pregnant
Dose Start on 1st day of menstruation. If starting on Start on 1st day of menstruation. If starting on
day 5 or later, use another method of day 5 or later, use another method of
contraception for 7 days. contraception for 7 days.
Take same time each day to maximize Take same time each day to maximize
contraceptive effect. contraceptive effect.
Check if 21 or 28-day pack.
Monitoring Blood pressure and weight.
S/E Upset stomach, breast tenderness, mood Upset stomach, breast tenderness, and mood
change, and headache. change.
Increased risk of breast and cervical cancer Seek medical help if you have chest pain,
but protects against ovarian cancer breathlessness, unexplained swelling or pain in
Report unexplained vaginal bleeding. calf of one leg, severe stomach pain, and
severe/prolonged headaches.
Increased risk of breast and cervical cancer but
protects against ovarian cancer.
Special If vomiting occurs within 2hrs of taking pill, If vomiting occurs within 2hrs of taking pill,
instructions take a new one asap. If replacement pill not take a new one. If persistent vomiting or severe
taken within 3 hours (12 for desogestrel) of diarrhea >24hrs, use other contraception for 7
normal time OR if vomiting/diarrhea days after recovery. If during last 7 days of
persistent→use other contraception for 2 active tabs→skip pill free/inactive interval &
days after recovery. start new pack.
Missed pill→take it as soon as you Travel→>3hrs at risk of clot. Should exercise
remember and carry on with next pill at right during journey.
time. If pill was more than 3 hours late (12 Missed pill→if you forget to take pill, take it
for desogestrel) you are not protected. ASAP and take next one at the normal time (even
Continue normal pill taking but use another if this is 2 at once). Missed pill=24 hours or more
method of contraception for next 2 days. late. If 2 or more missed (esp from first 7 in
pack)→may not be protected. Take an active pill
as soon as you remember & continue normal pill
taking + extra contraception for 7 days. If these 7
days run beyond end of pack, start new pack at
once and skip 7 day pill free/inactive period.
EHC recommended if 2 or more missed during
first 7 tabs.
 Pioglitazone Dapagliflozin Metformin Gliclazid Tolbutamid Sitagliptin Exenatide
e e
MOA Helps control Works on kidneys Helps control Lowers blood sugar by helping body to produce more insulin.
blood sugar by to  amount of blood sugar by
helping your sugar body lowering
body to respond removes in urine. amount of sugar
to insulin better. made by liver.
Dose Inject under skin, in lower ab or outer
thigh. Diff sites to avoid rxns.
Within 1hr before 2 main meals (at
least 6hrs apart). Dispose of needle.
Use pen for 30 days then dispose even
if there’s medicine in it still.
Monitoring Blood test every Blood test every 3-6 months to Blood test every 3-6 Blood test every 3-6 months.
3-6 months. monitor progress. months. Eye tests.
Liver function. Kidney test yearly. Regular BM checks 1-3x
Signs of heart Eye tests. daily→4-9mmol/L
failure. Eye tests.
Eye tests.
S/E Upset stomach, Constipation, Upset stomach, Upset stomach, diarrhea, Upset stomach. Upset stomach, decrease in appetite,
weight gain. UTI, diarrhea, ab constipation, weight gain. Report weight loss.
Report liver Hypo (in combo pain. Hypo signs=dizzy, persistent severe Report persistent severe ab pain, n/v
toxicity=n/v, ab with insulin or Report if severe drowsy, sweating, blurred ab pain (inflamed pancreas).
pain, fatigue, sulfonylurea) (lactic acidosis). vision. Have sugary snack (inflamed
dark urine. with you. pancreas).
Report blood in
urine, pain while
urinating, or
urgency to
urinate (bladder
cancer risk)
Special Take with food Take with breakfast to Missed dose→continue with next
instructions to reduce upset avoid low sugar levels. scheduled dose. Do NOT take it after a
stomach. Driving: Inform DVLA, meal.
Swallow whole check BM before driving Some other meds should be taken at
if m/r. & every 2hrs on long least 1hr before or 4hrs after
journey. exenatide→ask GP.
Women of childbearing age: use
contraception during & 12wks after
discontinuation if using m/r exenatide.
Keep unused pens in fridge.
Stay on this brand.
 Clinical Skills

Diabetes history taking

Introduction and purpose
- Name, role, nature of consultation (taking history), consent
- Washed hands
- Private and confidential
- Confirmation of patient details

Focused history
- Diabetes under control?
- Self monitor BMs?
- Last HbA1c?
- Last lipid levels?
- Last dilated eye test?
Associated problems
- Severe or numerous hypos? (dizzy, blurred vision, shaking)
- Hyper signs (polyuria, polydipsia, nocturia, weight loss)

- Neuropathy
- Kidney disease
- Hypertension
- Foot ulcers
- Frequent infection
- Stroke
- Coronary artery disease
Advice
- Initial thoughts on diagnosis→most likely HYPER, undiagnosed diabetic/hyperglycaemic stroke (family
history of diabetes will be mentioned in case), foot problem, injection site problem
- Initial referral pathway→to GP, diabetic clinic or self manage. If foot ulcer→foot clinic
- Lifestyle advice→balanced diet, exercise, stop smoking, limit alch, keep well (flu shots), foot care,
yearly eye tests, blood pressure, record BMs, etc.

Injection site examination

Introduction and purpose
- Name, role, nature of consultation (any reactions from injections), consent
- Washed hands
- Private and confidential
- Confirmation of patient details
- Name 4 possible injection sites→ab, upper arms, thighs, buttocks
General inspection→repeat for each site pt uses
Bleeding, bruising, swelling, itching, insulin leakage, pain on injection, lipohypertrophy
Palpate
Tenderness, lipohypertophy, swelling
Advice
- Rotation
- Leave needle in 5-10s to ensure full dose is administered (no leakage)
- Replace needle each injection
- Don’t use insulin directly from fridge (decrease pain on injection)
 Blood glucose levels/interpretation
Introduction and purpose
- Name, role, nature of consultation (taking blood glucose to check if it’s controlled), consent
- Private and confidential
- Confirmation of patient details

1. Check chip code matches machine then put it in.

2. Wash hands & put on gloves.
3. Wipe side pt’s finger. 30 seconds to dry.
4. Put test strip in machine and close container. Check if in date.
5. Wait for drop of blood to show up on machine to show that it’s ready to take a reading.
6. Open and arm lancet. Prick side of pt’s finger.
7. If no blood, just squeeze base of finger.
8. Wipe first bit of blood away and throw out wipe→reduce risk of contamination
9. Squeeze and get new drop.
10. Give pt cotton wool to stop bleeding.
11. Dispose of sharps and throw out test strip.
12. Record reading in diary.

Interpretation→hypo <4, hyper >11 Advice

- Explain Error code 3 is extremely high - Number of times to test BM (4x a day and
blood sugar (above 33.3mmol/L) up to 10 if unwell)
- Explain if LO spears on meter is extremely - Other testing sites→fingertips, palm (base of
low (below 0.6mmol/L) thumb), heel, forearm, upper arm
- Review pt diary and explain trends (normal, - Initial impression if problem with reading
high, low) and diary
- Possible pathway referral if req.

Foot Examination
Introduction and purpose
- Name, role, nature of consultation, consent
- Washed hands
- Private and confidential
- Confirmation of patient details
- Expose lower legs and feet
General inspection Palpate
- Joint deformities→Charcot’s disease - Temp of both limbs & compare→PVD,
- Limb colour and compare cellulitis
o Pallor→peripheral vascular disease - Posterior tibial pulses underneath ankle bone
(PVD) on inside→PVD if missing
o Erythem→infection - Capillary refill both at same time on big toe.
- Dry skin Should be 2s or less→PVD
- Ulcers - Dorsalis pedis pulses on both feet→PVD if
- Missing limbs or toes→previous foot missing
problem? Sensitivity test→tell pt to close eyes & say which
- Bottom of feet and ankles for toe you are touching. Touch 6 toes total.
calluses→abnormal gait or poor footwear - Lost in 2 or more areas→peripheral
- Hair loss→PVD neuropathy and needs referral to GP
Gait→walk 4 steps to check for stability
Footwear→uneven footwear suggest abnormal gait
 Medication History
Introduction
- Name, role, nature of consultation (medication history→asking q’s, taking notes about meds), consent
- Private and confidential
- Confirm patient details

Medications
- Name, strength, form, dose, indication→how do you take it, do you know why you’re taking it

- Prescribed medication list complete→hospital, clinic, anywhere else except GP

- Other sources of meds→OTC, herbals, supplements/vitamins, patches, creams, injections, eye drops

- Any issues with taking meds as prescribed and if so, why

- Recently started/stopped or dose change and if so, why

- Adverse reactions→what happens

- Allergies→what happens

Extra
- Monitoring