Certainly, Dipak!
Here's a comprehensive and structured role-play counseling script for a
patient with pulmonary tuberculosis (TB), reflecting a high level of clinical-pharmacist
communication and suitable for use in academic settings or professional practice. This
includes detailed medication counseling, lifestyle guidance, ADR monitoring, follow-up plan,
and a Morisky-8 adherence assessment.
🫁 ROLE-PLAY IN CASE OF PULMONARY TUBERCULOSIS
1.1. Objectives
To demonstrate clinical pharmacist communication and patient counseling for TB
management.
To assess adherence, recognize ADRs, and reinforce treatment literacy and infection
control.
1.2. Background (Case Description)
Parameter Details
Age 46 years
Gender Male
Persistent productive cough (4+ weeks), mild fever, appetite loss,
Chief Complaints
weight loss
Diagnosis Sputum-positive pulmonary tuberculosis
Past Medical
Type 2 Diabetes Mellitus (2 years)
History
Physical Exam Mildly reduced breath sounds in right lung
Labs Positive sputum smear for AFB; mild hyperglycemia
Current HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) + Metformin
Medications 500 mg BD
👨⚕️1.3. Pharmacist-Patient Interaction: Role-Play Script
Pharmacist: Good morning! I’m your clinical pharmacist today. Please make yourself
comfortable.
Patient: Good morning. Thank you.
Pharmacist: I'm going to ask you a few questions to understand your health better and
ensure your treatment goes smoothly. Is that alright?
Patient: Yes, of course.
🧍♂️Personal & Social History
Age & Residence:
“How old are you and where are you currently living?”
→ “I’m 46 and live in Birgunj.”
Weight Change:
“Have you noticed any recent weight change?”
→ “Yes, I’ve lost around 7–8 kg over the last few months.”
Smoking & Alcohol Use:
“Do you smoke or drink alcohol?”
→ “I used to smoke for 10 years but quit recently. I don’t drink.”
Dietary Habits:
“Tell me about your usual diet.”
→ “Rice, lentils, vegetables mostly; I avoid sugar due to diabetes.”
🤒 Symptom Exploration
Pharmacist: You mentioned persistent coughing, low-grade fever, and weight loss. Do you
also have:
Night sweats?
Chest pain or breathlessness?
Loss of appetite?
Patient: Yes, especially night sweats and poor appetite.
Pharmacist: These are typical signs of active pulmonary tuberculosis. TB is an airborne
bacterial infection caused by Mycobacterium tuberculosis, most often affecting the lungs.
💊 1.4. Medication Counseling
A. Anti-TB Regimen (HRZE)
Drug Dosage Counseling Points
Take on empty stomach; may cause peripheral neuropathy – take
Isoniazid (H) 300 mg
pyridoxine (Vitamin B6)
Can cause red-orange discoloration of urine and tears; avoid
Rifampicin (R) 600 mg
contact lenses
Pyrazinamide
1500 mg May cause joint pain, hepatotoxicity
(Z)
Report vision changes immediately; baseline visual acuity
Ethambutol (E) 1200 mg
recommended
Take all TB medicines once daily on an empty stomach, 30–60 minutes before
breakfast.
Treatment Phases:
o Intensive Phase: 2 months of HRZE
o Continuation Phase: 4 months of HR
Total: Minimum 6 months of therapy
B. Drug-Drug & Food Interactions
Avoid alcohol and hepatotoxic herbs
Space Metformin and TB drugs to minimize gastric intolerance
Maintain a diabetic-friendly high-protein diet
C. Non-adherence Consequences
Missed doses can cause treatment failure, relapse, or resistance (MDR-TB)
📋 1.5. Morisky-8 Medication Adherence Assessment
Ask the following questions and score:
1. Do you sometimes forget to take your medication? → Yes (0)
2. Over the past 2 weeks, any missed doses? → Once (0)
3. Have you ever stopped medication without informing your doctor? → No (1)
4. Do you forget meds when travelling? → Yes (0)
5. Did you take all medications yesterday? → Yes (1)
6. Do you stop when you feel better? → No (1)
7. Is taking medicine an inconvenience? → Yes (0)
8. How often do you forget to take all medications? → Sometimes (2)
→ Score: 5 (Low Adherence)
🎯 Intervention: Use reminder alarms, DOTS supervision, and involve family caregivers.
⚠️1.6. ADR Recognition & Management
Drug Potential ADRs
Isoniazid Hepatitis, peripheral neuropathy
Rifampicin Hepatitis, red-orange urine, flu-like syndrome
Pyrazinamide Hepatotoxicity, arthralgia, hyperuricemia
Ethambutol Optic neuritis (color vision loss, visual acuity reduction)
👁 Refer immediately if vision changes or jaundice appear.
🧘 1.7. Non-Pharmacological Counseling
Nutrition:
o High-protein, balanced meals (eggs, dairy, meat, legumes)
o Small, frequent meals for appetite support
o Hydration: ≥ 2 liters/day
Lifestyle:
o Light walks, rest during fatigue
o Avoid crowded places until 2–4 weeks into treatment
o Practice cough etiquette, wear a surgical mask
o Use a separate room or sleep space during intensive phase
Mental Health:
o TB can cause fatigue, emotional distress
o Encourage peer support, family discussion, meditation
📆 1.8. Follow-Up Plan
Timeline Activity
After 2 weeks Liver function tests, blood sugar monitoring
After 1 month Adherence check, symptom review
End of 2 months Sputum re-evaluation to assess conversion
Monthly till 6 months Weight, symptom tracking, lab test follow-up
Immediately if needed If ADRs or worsening symptoms appear
📚 1.9. References
1. WHO Treatment Guidelines for Drug-Susceptible TB (2023)
2. CDC TB Education Materials for Clinicians
3. National Tuberculosis Control Programme (Nepal) Guidelines
4. Morisky DE et al. (2008). Journal of Clinical Hypertension
Would you like me to convert this into a poster or patient education handout next? Or
perhaps customize it for multi-drug resistant TB (MDR-TB)?
