Reflection: Patient Interaction - Essay Example

Reflection: Patient Interaction During my placement, I had the opportunity to observed pharmacist interactions with several patients, three of whichwill be described in this exercise. The first patient, Mr. J, came to the pharmacy complaining of runny nose and a cough which occurred at most times of the day, and sometimes at night. He needed a medication which he could take before he went in to work but would not affect his ability to do his work. I observed that the pharmacist interviewed and asked him how long he had these symptoms and if he already took any prescription or over-the-counter medications for his symptoms. He replied that the symptoms manifested the day before, and that he has not had any medications as yet. He appeared to be a very healthy man in his forties. The pharmacist later revealed to me that the patient was a regular at the pharmacy. The patient’s blood pressure and cholesterol levels were within normal range and he did not suffer any medical conditions. After the interview, I observed that the pharmacist advised him to take Dimetapp which is an over-the-counter, no-drowse, cough and cold remedy. The pharmacist also advised him to increase his water intake in order to facilitate his recovery from his colds. A review of various articles and researches on the effectiveness of non-antibiotic remedies for cough and colds revealed that the most promising remedies for cough and colds include “dextromethorphan, bisolvon, and guiaphenesin for cough, antihistamine- decongestant combinations for a wide range of symptoms, nasal decongestants (at least for the first dose) and possibly zinc lozenges” (Arroll, p. 1478). Dimetapp is an antihistamine-decongestant, hence highly recommended for colds and cough. Another patient came in to buy a sedative nasal decongestant. I observed the pharmacist interview where the pharmacist asked him if he was taking any other medication, and he said he was taking Exxefor. I reviewed my knowledge of Exxefor and was able to establish that Exxefor is an antidepressant classified as an SSRI (Selective Serotonin Reuptake Inhibitor). It is a prescription drug for major depressive and anxiety disorders. This drug is also contraindicated for patients who are hypersensitive to Venlafaxine. I was further able to establish that the most common side-effects for Exxefor are the following: headache, nausea, insomnia, dry mouth, dizziness, and sweating. When taken with any sedative drug, the chances for the occurrence of these side-effects would increase. I then understood why the pharmacist recommended instead a nasal spray decongestant to the patient, and not a sedative nasal decongestant. A study reviewing whether hypertonic saline nasal spray relieves nasal symptoms and shortens illness duration was conducted on two control groups, or about 143 adult participants. Results of the research revealed that “hypertonic saline does not improve symptoms or illness duration in patients with common colds of rhinosinusitis” (Adam, et.al., p. 1). Another study evaluating the safety and efficacy of ipratropium bromium nasal spray in children 2-5 years of age who were ill with rhinorrhea from common colds or allergies revealed that “The 0.06% ipratropium bromide nasal spray, 42 or 84 μg per nostril 3 times daily, is easy to administer, safe, and effective for the control of rhinorrhea in children aged 2 to 5 years with a common cold or allergies” (Kim, p. 73). This makes the nasal decongestant a good remedy to treat the patient’s condition. The third patient, Miss J, came to the pharmacy feeling a little unwell. She said she knew her body well, and she felt that she may be having an allergic reaction to something. She also felt that she had a bit of hay fever. She asked to be given Phenergan as an antihistamine. I observed that the pharmacist asked her if she was going to drive soon after taking the medication, and if she was taking any other medications at that time. She said she was not going to drive, but was just not feeling well. After the interview, the pharmacist recommended that the patient take Claratyne instead of Phenergan because Claratyne had a non-sedating property and is used to relieve allergies. I reviewed my knowledge of the drug and was able to explain further to the patient that Claratyne is more appropriate for her because it does not enter the central nervous system, therefore does not make the patient drowsy and is non-sedating. A clinical trial of loratadine tablet involving 10,700 patients, ages 12 years and above in double blind randomized controlled studies revealed that 10mg once a day of loratadine is superior to placebo in favorably affecting nasal and non-nasal symptoms of allergic rhinitis. Another study was undertaken to compare the efficacy and tolerability of once-daily astemizole-D with beclomethasone nasal spray. The study was able to reveal that astemizole-C “appears to be at least as effective and well tolerated as intranasal beclomethasone in the treatment of seasonal allergic rhinitis, providing at least comparable relief from all nasal symptoms including congestion…” (Negrini). These studies reveal how effective loratadine is in treating allergies and how nasal sprays can help ease symptoms of allergies. Claratyne: S2 Claratyne is used to relieve symptoms which are associated with allergic rhinitis such as sneezing, runny or itchy nose, and burning or itchy eyes. It can also be used to relieve symptoms associated with the skin condition known as urticaria. It is in a class of drugs known as antihistamines and it reduces allergic symptoms by blocking the effects of histamine produced by the body in response to a foreign substance which the body is allergic to. It comes in the form of tablets, syrups, and effervescents. Claratyne contains loratadine as an active ingredient; it also contains maize starch, magnesium stearate, lactose, and does not contain gluten or sucrose. Loratadine is an H1 antihistamine second generation drug widely used because it does not penetrate the central nervous system and does not have antimascarine properties. It is for this reason why it is the drug of choice for the treatment of allergic reactions. Loratadine is a long acting tricyclic antihistamine with selective H1 receptor antagonist activity. It is also rapidly absorbed after oral administration; in a healthy person, it takes about 1.4 to 2.5 hours to metabolize. A clinical trial of loratadine tablet involving 10,700 patients, ages 12 years and above in double blind randomized controlled studies revealed that 10mg once a day of loratadine is superior to placebo in favorably affecting nasal and non-nasal symptoms of allergic rhinitis. Loratadine is contraindicated to patients who are hypersensitive to this medication or any of its ingredients. It is cautioned in patients with liver impairment or renal insufficiency. Summary for the trails: In the first trial, the over-the-counter cough and cold medication is marketed widely for the relief of cough and colds, however, studies failed to indicate the benefits of these medications to young children. Over-the-counter medications can be associated with significant levels of morbidity and sometimes even mortality. There have been three cases over a 13-month period (including one death) resulting from OTC cough and cold medication. This makes it important to caution patients and pharmacists about the proper methods of dispensing OTC medications. The second evidence shows that there is a relationship between brand familiarity confidence in brand evaluation, attitude, and purchase intention. The greater the familiarity with the brand, the greater the patient’s confidence in such brand, and in the end, the patient’s purchase intention is also greater on said brand. The patient specified his intention to buy a sedative nasal decongestant because he was familiar with it, therefore more confident in its effectiveness. Another study was able to show that antibiotic treatment for the common cold is probably not effective. Dextromethorphan, bisolvon and guiaphensin for cough, antihistamine, decongestant combinations for a wide range of symptoms, nasal decongestant and possible zinc lozenges are recommended for the relief of cough and colds. During my placement in the pharmacy, I noticed that I felt more confident after each interview. The more interactions I was able to observe and handle, I gained confidence in my interview and interaction methods. I enjoyed every interaction with the patient and as the interviews progressed, I was able to gain more confidence in speaking freely and straight to the point. Every time I am in the pharmacy, I continually hope that more patients come my way in order to give me more experience in dealing with patients. There are various over the counter branded medications. This is fortunate because the patients can choose what medication will best suit them. When patients can choose their own medications, the chances of compliance are increased. Most of the customers knew the staff members and vice versa. They called each other by name. This shows that the pharmacy staff is doing a very good job in taking care of the customers, and they have a very good relationship with their customers. I noticed that they were able to talk to each other about everything like politics, favorite sports teams, and the economy. There is a feeling of being treated with respect in the pharmacy and this makes the customers, even myself, easily approach the pharmacy and the staff about our problems or questions. I noticed that if the pharmacy staff knows about the ingredients of an over the counter medicine, they will help the customer choose which medicine is best suited for them. There are many outstanding medications available to customers. And some patients prefer these medications because they can get better quickly. Unfortunately, I noticed that when a patient wanted a very strong medication for his illness, the pharmacist gave him a medication which he claimed will make him better within the next two days. This is not actually accurate because, it usually takes time for the drug to have a therapeutic effect on the patient. Hence, two days is not enough the patient to feel better. Works Cited Adam, P., et.al. (1998) A Clinical Trial of Hypertonic Saline Nasal Spray in Subjects With the Common Cold or Rhinosinusitis. American Medical Association. 05 April 2009 from http://archfami.ama-assn.org/cgi/reprint/7/1/39.pdf Arroll, B. (15 May 2005) Non-antibiotic treatments for upper-respiratory tract infections (common cold). Baylor College of Medicine. 05 April 2009 http://www.bcm.edu/medpeds/articles/TreatmentofURI.pdf Claritin. April 1993. Allergyny. 05 April 2009 http://www.allergyny.com/treatments/medications/Nose/Claritin.htm Dimetapp Cold Cough & Flu Day & Night Liquid Caps. 08 September 2005. National Prescribing Service. 05 April 2009 https://www.nps.org.au/__data/assets/pdf_file/0007/60982/wtcdimdn.pdf Kim, K., et.al. (2005) Use of 0.06% ipratropium bromide nasal spray in children aged 2 to 5 years with rhinorrhea due to a common cold or allergies. Annals of Allergy, Asthma, and Immunology, vol. 94, pp. 73-79 Negrini, A., et.al. (25 July 1994) Oral antihistamine/decongestant treatment compared with intranasal corticosteroids in seasonal allergic rhinitis. Wiley Interscience Journal. 05 April 2009 http://www3.interscience.wiley.com/journal/119253129/abstract Shin, J., et.al., 2008. Evidence-based Otolaryngology. New York: Springer. Schroeder, K. (2002) Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults. British Medical Journal. 05 April 2009 http://archfami.ama-assn.org/cgi/reprint/7/1/39.pdf Read More