role preparation for nurse advisors handling medicines calls day 2 your name medicines information...

Role Preparation for Nurse AdvisorsHandling Medicines Calls

Day 2

Your name

Medicines Information Pharmacist

Your Medicines Information Service

Role Preparation for Nurse Advisors - Day 2

Medicines Training for NursesTraining Duration Trainer

Week 4 Using Toxbase® to support poisons calls ½ day NHSD

Week 5/6 Handling Calls about medicines and the Medicines Algorithm

Trainer evaluation

Further medicines case scenarios

1 ½ days

½ day

UKMI

UKMI + NHSD

Self directed

Week 10 Handling calls about Hormonal Contraception and Emergency Contraception

EC algorithm – further scenarios

½ day UKMI

Self directed

3-6 months Medicines calculations for NAs

e-Toxbase®

One-to-one medicines training on request

Self directed

Self directed

UKMI

6 months Handling calls about medicines during pregnancy and breastfeeding

½ day UKMI


Timetable - Day 2 Morning

Welcome & re-cap

Handling calls about Adverse Effects & Drug Interactions

Workshop 4: Case scenarios on Adverse Effects and

Drug Interactions

Break

Handling calls about analgesia

Workshop 5: Case scenarios on analgesia

Lunch


Timetable - Day 2 Afternoon

Medicines Algorithm

Workshop 6: Case scenarios using the medicines algorithm

Break

Where are the risks when handling medicines calls?

Examples of common mistakes

Review and close



Welcome & re-cap



Drug Interactions

Break



Lunch


Adverse Drug Reactions

• Account for 2-6% of hospital admissions

• Type A predicted by mode of actionType B idiosyncratic or unpredictable

• Estimated that 10-20% of patients suffer an ADR during hospital stay

• Length of stay may be increased in up to 50% of in-patients

Unwanted effect that drug has on a person


Incidence of Adverse Effects

Very common >10%

Common >1% Risk of dying from cancer if smoke 20 a day for 30 years

Uncommon >0.1% Risk of being injured on the stairs in next 12 months

Rare >0.01% Risk of dying in an accident at home in next 12 months

Very rare up to 0.01%

Risk of being killed by lightening


Yellow Card Reporting Scheme

NEWER DRUGS & VACCINES ()

All ADRs even if

• Not certain that drug has caused it

• Reaction well known

• Other drugs at same time

ESTABLISHED DRUGS& VACCINES

All serious ADRs

• Fatal, life threatening or disabling

• Prolonged hospital stay

• Even if well known


Patient reporting to Yellow Card Scheme

• Patients can report suspected adverse effects • www.yellowcard.gov.uk• Patient report forms from 4000 GPs in pilot or

MHRA

• Help MHRA understand the patient experience and perspective of suspected adverse effects

• Patients can view anonymous data on website


MHRA Website

www.mhra.gov.uk

Medicines & Healthcare Products Regulatory Authority


Recent Drug Alerts / Scares

Rofecoxib Withdrawn, risk MI/stroke

HRTAvoid long-term, risk breast cancer

Kava-Kava Withdrawn, hepatoxicity

Cerivastatin Withdrawn, rhabdomyolysis

Co-proxamol

Risk of death in overdose

Paroxetine Not if <18 yrs, risk suicide


Drug Interactions

One drug modifies the effect(s) of a second drug.More likely if taking several medicines.

Toxicity

• Warfarin + amiodarone = greater risk of bleeding

Efficacy

• Thyroxine + Rifampicin = more thyroxine needed


One way medicines work

The more neurotransmitter the more the receptor is stimulated

Noradrenaline released from nerve endings stimulates bronchioles in the lung to dilate

Nerve ending

Neurotransmitter

Receptor on cell


One way medicines interact:At the receptor

Nerve ending

Atenolol closes the bronchioles

Salbutamol opens the bronchioles

Receptor stimulated Receptor blocked

Nerve ending


How medicines are handled by the body

ABSORPTION DISTRIBUTION

METABOLISM

ELIMINATION

Kidney

Liver

BloodGut wall


One way medicines interact:Absorption of the drug

• Antacids can absorb other drugs e.g. Ciprofloxacin

• Cholestyramine (Questran) binds to many drugs so give 1 hour before or 4-6 hours after cholestyramine


More ways medicines interact:Metabolism of the drug

DRUG LEVEL

Metabolic Enhancers

SmokingAlcohol

CarbamazepinePhenytoinRifampicin


More ways medicines interact:Metabolism of the drug

Metabolic Inhibitors

CimetidineCiprofloxacinErythromycinMetronidazole

DRUG LEVEL


Narrow TherapeuticRange Drugs

CARBAMAZEPINE

CICLOSPORIN

DIGOXIN

LITHIUM

PHENYTOIN

THEOPHYLLINE

WARFARIN


Where to look for Information on Drug Interactions and ADRS

•eBNF

•eMC

•Stockley (via MedicinesComplete)

Recommended to confirm in more than one source

If nothing found do not assume no interaction or ADR

Often no info on OTC or herbal medicines



Welcome & re-cap



Drug Interactions

Break



Lunch


Workshop 4 – Case Scenarios



Welcome & re-cap



Drug Interactions

Break



Lunch


What is a medicine?

Simple analgesics (pain killers)

Paracetamol

Ibuprofen

Aspirin

Co-codamol


What is a medicine?

Ibuprofen

• Reduces pain, fever and inflammation

• Used for mild to moderate pain eg toothache, headache, muscle pain

• Side effects include: Heartburn/indigestion, stomach ulcers, stomach bleeds, allergy – rash, wheezing, breathlessness, worsening of asthma

• Should not be taken if: Allergic to aspirin, have asthma, stomach ulcer or previous stomach bleed, high blood pressure or on medication to thin the blood (e.g. warfarin)


What is a medicine?

Paracetamol

• Reduces pain and fever

• Used for mild to moderate pain eg toothache,

headache

• Side effects not usually a problem

• Must not exceed recommended dose – dangerous

in overdose

• Must not take with other products containing

paracetamol


What is a medicine?

Aspirin

• When used as a pain killer has similar effects and precautions as ibuprofen.• Must not be given to children under 16 years.• Also used at low doses to prevent heart attacks and strokes.


What is a medicine?Co-analgesics

Many painkillers contain several drugs

Often paracetamol + other(s)Examples: Co-codamol contains paracetamol and codeine

Co-dydramol contains paracetamol and dihydrocodeine

Co-proxamol contains paracetamol and dextropropoxyphene

Co-codaprin contains aspirin and codeine


What is a medicine?

Cough and cold products

Many cough and cold products contain analgesics

Beechams Powders® Aspirin 600mg + caffeine 50mg

Lemsip Max® Paracetamol 500mg + caffeine 25mg

Nurofen Cold and Flu® Ibuprofen 200mg + Pseudoephedrine 30mg



9.30 Welcome & re-cap

9.45 Handling calls about Adverse Effects & Drug Interactions


Drug Interactions

11.15 Break

11.30 Handling calls about analgesia


1.00 Lunch



1.30 Medicines Algorithm


3.15 Break

3.45 Where are the risks when handling medicines calls?


4.15 Review and close


Demonstration of Meds Algo led by CAS trainer

Medicines Algorithm





3.15 Break





Where are the risks when handling a Medicines Call?

Clarify the question

Plan search strategy& research problem

Evaluate the information

Tailor the answer/advice

Refer to MI

Recordall

stages


Where are the risks when handling

• Misunderstanding what the caller said• Missed symptoms• Incomplete background information• Omitting relevant information sources• Working outside level of competency• Caller doesn’t understand the answer• Incomplete or inaccurate documentation





3.15 Break



4.15 Review of learning outcomes and close



• Thinking ‘interaction’ not total daily dose• Hearing what you want to hear• Asking important questions as fillers• Using jargon• Incorrect interpretation from information

sources• Not understanding what you read• Using Self Knowledge





3.15 Break




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