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1. Patient counselling by pharmacist
Ravish Yadav

2. Patient counseling refers to the process of
providing information, advice & assistance to help
patients use their medications appropriately.

3. Effective patient counseling aims to produce the following
results:
1) Better patient understanding of their illness & the role
of medication in its treatment.
2) Improve medical adherence.
3) More effective drug treatment.
4) Reduce incidence of adverse effects & unnecessary
healthcare costs.
5) Improved quality of life for the patient.
6) Better coping strategies to deal with the
medication related adverse effects.
7) Improved professional rapport between the patient &
the pharmacist.

4. Communication skills for effective
counseling:
1) Language.
2) Tone
3) Volume
4) Speed
5) Proximity
6) Eye contact
7) Facial expression

5. Steps during patient counseling:
1) Preparing for the session.
2) Opening the session.
3) Counseling content.
4) Closing the session
5) Getting started.
Qualities of a good counselor:
1) Be a good listener.
2) Be flexible
3) Be empathetic
4) Be non-judgmental
5) Be tolerant
6) Communicate confidently.

6. Drug interactions
Definition:
A drug interaction is a situation in which the effects of
one drug are altered by prior or concurrent
administration of another drug.

7. Reasons for Drug interactions
1. Food
2. Certain dietary items
3. Alcohol
4. Diagnostic laboratory test
5. Environmental chemicals
6. Cigarette smoking
7. Multiple drug therapy.

8. 1) Interacting drugs can usually be used together:
2) Beneficial interactions: probenecid + penicillin.
Antiparkinson drug+ antipsychotic drug.

9. Reasons for increasing number of drug interactions:
1) Drug potency: several anticholinergic drugs are
used but they produce similar side effects.
2) Patient consult several physicians:
Ophthalmologist prescribe pilocarpine eye drops (a
cholinergic agent) for a patient who is also taking an
anticholinergic preparation (propantheline) prescribed
by another physician for a GIT condition. It result in
change in intraocular pressure for some extent.
Pharmacist can help to avoid this condition.

10. 3) Concurrent use of prescription & non-prescription
drugs:
Patient may take OTC drugs like
aspirin,antacids,decongestant.
4) Patient Non-Compliance:
Not administered according to direction. It may be due to
lack of instructions or confusion or excess dose of drugs,
lead to increase possibility of drug interactions.
5) Drug abuse & Misuse:
Psychiatric patient continue to use drugs like
barbiturates,narcotics,amphetamine.
Patient take excessive anti-anxiety drugs before surgery.

11. 1) Complex situation of a patient physician use more
drugs lead to drug interaction.
2) Therapeutic setting of drug is unable to quantify lead to
drug interactions.
3) Patient variables like age,sex,weight & disease state
also affect the activity of drugs.

12. Factors causing drug interactions:
1) Dosage.
2) Route of administration
3) Time of administration
4) Sequence of administration
5) Duration of therapy.
6) Age: More drug interaction in pediatric &
geriatric patient.
7) Sex & genetics: body weight, administration
time,tolerance,body temperature &
pathological conditions are also responsible.

13. 8) Disease states: impaired renal & hepatic functions,
decrease concentration of proteins lead to
hypoalbuminemia change the availability of drugs.
9) Impaired renal function:
10)Impaired hepatic function:
barbiturate stimulate the activity of liver microsomal
enzymes (induction) lead to short action of another
drug.

14. TYPES OF DRUG INTERACTIONS:
1) Drug-Drug interactions: modify the action of one
drug by another drug.
i) Prescription drugs: diphenyl hydantoin +
phenobarbital.
Probenecid + penicillin.
Ferrous sulphate or aspirin enteric coated tablet for
intestinal use--------------but antacid is taken in this
situation can lead to degradation of enteric coated
tablet in the stomach.--------results in nausea &
vomiting.

15. ii) Over the counter Products (OTC):
Like aspirin,laxatives,antacids,vitamins.
Administration of aspirin should be avoided
in patients of anti-coagulant therapy. It is
70% protein bound drug displace another
drug.
Vitamins: absorption of fat soluble vitamin is
decreased by 20ml of mineral oils.
Excretion of ascorbic acid is increased by
salicylates,atropine,barbiturates &
sulphonamindes,

16. Tetracycline decrease the activity of vit-k
Laxatives decrease the effect of drugs by shortening
the gastric emptying time like tetracycline & digitalis.
Anti-histaminics show sedative effect with CNS
depressants like narcotics,sedatives,hypnotics &
alcohol.

17. 2) Drug food interaction:
Riboflavin absorption is enhanced in presence of
food.
Potentiation of amine toxicity occurs when used with
yeast,beef,chicken,pickels,tomatos,bananas,cheese
etc.
Low level of salt in digitalis therapy decrease the
effect of digitalis.
Tetracycline & penicillin's are given before meal or 2-3
hours after the meal for proper absorption from GIT.

18. Fatty meal increase the absorption of griseofulvin.
Milk decrease the absorption of tetracyclines.
Pyrodoxin in multi-vitamin preparation antagonize the
action of levodopa.
Amphetamine excretion is less in alkaline urine as
compared to acidic urine some protein containing
amino acids may change urinary PH.

19. 3) DRUG ALCOHOL INTERACTIONS:
Heavy drinking increase metabolism of
warfarin, phenytoin & tolbutamide by enzyme
induction. Less use of alcohol inhibit the
enzyme activity.
Alcohol + sedative hypnotics---------synergism
effect.
Psychological tolerance of alcohol is more.

20. 4) Drug-smoke interaction:
Smoke increase the enzyme activity of liver results
in decrease activity of chlordiazepoxide & diazepam
(CNS depression).
Decrease activity of propoxyphene (used in pain)
was observed in smokers.
Phenacetin & theophylline activity is also less in
smokers.

21. 5) Drug-laboratory test interaction:
During colorimetric analysis, spectrum
analysis. Drugs also act as a reducing agent
6) Drug environmental contaminants:
When patient contaminate with solvent
vapors, industrial fumes, pesticides like DDT
increase the formation of hepatic enzymes &
also increase the metabolism of cortisol in
human body