The document provides guidelines for pharmacists on counseling patients. It discusses that pharmacists should be able to provide information to patients about their prescribed medications, including how to take medications, what they are for, and any precautions. It also emphasizes the importance of ensuring patients understand treatment regimens and the need for compliance. Case studies demonstrate pharmacists answering patients' questions about medications, treatments, and addressing concerns in order to optimize health outcomes.

2. PATIENT INFORMATION
•Patientslookuptopharmacistsforinformationabouthealthandmedicines
•Knowledgeablepharmacistscanplayavitalroleinprovidingthisinformation
•Incompleteandinadequateinformationleadstoinappropriateuseofmedicines,leadingtoserioushealthandeconomicconsequencesforbothindividualsandthecommunityatlarge

3. OBJECTIVES
By the end of this study, the pharmacists will be able to understand :
•Various areas in which the pharmacist can provide information
•What information the pharmacist can provide to the patient
•Various methods and tecniques to provide this information
•The pharmacist’s role in patient compliance
•The pharmacist’s role in effective counselling

4. INFORMATION/COUNSELLING TO BE PROVIDED TO THE PATIENT
A.OnPrescribedTreatment
Listofthingstobetoldtoapatient:
Whateachmedicineisfor
Howtotakemedicine(whattime,howmany/much,beforeorafterfood)
Howtousecertaindevices

5. Theinstructionstobegivenforeachmedicine
Thespecificprecautionstobetakenwithcertainmedicines
Whatsideeffectstoexpect
Whatconditionshouldthemedicinesbestoredunder

6. ForExample:
Medicationtobetakeonanemptystomach:
Levofloxacin:Tobetakenonanemptystomachonehourbefore,ortwohoursaftermeals,withafullglassofwater.
Presenceoffoodmayslightlydecreaseordelayabsorption.

7. Medicationtobetakenataparticulartimeofthedayforbettereffect
Indapamida:preferablytobetakeninthemorningtominimizetheeffectofincreasedfrequencyofurinationduringsleep
Atorvastatin:tobetakenatnightafterdinnerbecauseitismosteffectivewhensynthesisofcholesterolismaximumatduringthenight

8. Medicationtobetakenonafullstomach:
Alfacalcidol:tobetakenafterfoodforbetterabsorption
Fluconazole:tobetakenafterfoodbecauseitisabsorbedbetteronafullstomach
Doxycycline:tobetakenafterfood.Fooddoesnotaffectabsorption.Iftakenonanemptystomach,howevwe,itcancauseGIupset

9. Instructions to be given with certain medicines
Example : Use of Antibiotics
Themedicineshasbeenprescribedforyouforaparticularinfection;
Completetheentirecourseoftherapyanddonotmissadose;
Donotstoptreatmenifyoufeelthesymptomsaregoneintwoorthreedays, causingtheinfectiontorecur;
Donotgivethismedicinetootherstotake;

10. Donotusethismedicineinfuture,evenforasimilerillness,unlessspecificallyrecommendedorprescibedbythephysician;
Incaseofanyadverseeffect,reporttothephysicianimmediately.

11. Case Study 1
Could you tell me how I
should take my cholesterol tablets and the other two tablets?
The pharmacist finds out the following from the patient’s prescription -
Atorvastatin 10mg 1OD..continue Metoprolol 50mg 1b.d…. continue Pantoprazole 40mg 1ODC10days

12. 1. You have been prescribed Atorvastatin for lowering your cholesterol levels. The physician has written O.D. i.e. Once daily. This should be taken preferably in the night after dinner, everyday.
2. Metoprolol has been prescribed for high B.P. It has to be taken after breakfast in the morning and once after dinner (as per the prescription). Continue taking these two medicines till your physician advises you to stop.
3. Pantoprazole has been prescribed for increased acid
secretion in your stomach. It has to be taken one hour before breakfast with two glasses of water. The physician has recommended that you take these only for ten days.
Thank you

13. For your treatment to work well, make sure you don’t miss your daily dose of Atorvastatin and continue to take Metoprolol till you see your physician next. Stopping the medicines without the physician’s advice will not be good for your health, so please stick to the schedule. If you forget to take a dose, take it as soon as you remember, but please do not double the dose to compensate for the missed dose...

14. Just to make sure that you have understood, can you repeat how you are going to take your tablets?
Yes ---------- ----------

15. That’s perfect! Hope you begin to feel better soon. If you have any other query, please don’t hesitate to call on us anytime.
Thank you so much.

16. GUIDELINES
Pharmacistsshouldbeeducatedtoprovideinformationaboutprescribedmedicines;
Pharmacistsshouldbeknowledgeableaboutthetimeofadministrationofmedicinesandabouttherationalebehindeachinstruction;
Apharmacistsshouldbeaccessibletoclientsatalltimestoprovideinformationandadviceappropriatetotheirneeds.

17. Practically speaking :
oDuetorushloadsandpaucityoftime,itmaynotbepossibletogivesuchdetailedinformationtoeverypatient;
oAnattemptmust,however,bemadetoinstructasmanypatientsaspossibleabouthowtotaketheprescribedmedication.

18. PLEASE REMEMBER :
•ItistheRIGHTofeverypatienttoknowandbegivenvariousinstructions/informationabouttheprescribedmedication.

19. Case Study 2
•Patients approach pharmacists not only for instructions on how and when to take their medicines, but also for queries regarding the therapy prescribed by the physician;
•Make sure that they are aware of that to expect of the treatment, or to provide additional important information.

20. Ihavebeensufferingfromdiarrheaforthelast4days.ThedoctorhasadvisedmetotakeORS. Howwillithelp?Idon’tthinkmydiarrheawillstopwithit
ORSmeansOralRehydrationSalt,commonlycalledaselectrolyte.Itsroleistoreplacethesaltsandfluidlostduetodiarrhea

21. Shouldn’t I take tablets to stop my diarrhea? Why hasn’t he prescribed me any?
Thedoctorhasdiagnosedyourdiarrheatobeviral.Viraldiarrheapassesoffonitsown.Allthatisneededistokeepyourselfhydrated.Drinklotofwaterandavoidspicy,heavymeals

22. GUIDELINES
Thepharmacistshouldbereasonableandapproachableenoughtofacilitateaclient- pharmacistdialogueinaconvenientandresponsivemanner;
Thepharmacistshouldensurethatclientsareprovidedwithsufficientinformationtofacilitatethesafeandeffectiveuseofmedicines;

23. GUIDELINES
Thepharmacistshouldensurethathedoesnotleavethepatientwithdoubtsabouttheappropriatenessofthetreatmentprescribedbythephysicianoraboutthephysician’sviewofthepatient’scondition;
Acommonmanbelievesinapillforeveryillandsoexpectsthephysiciantoprescribeapillforeverycondition.Intheabovecasestudy, thepharmacistexplainswhyapillisnotrequared.

24. Informationregardingprescribedmedicinescanproveveryimportantinthesuccessofthetreatmentprescribedforthepatient.Pharmacistsmustinformpatientsthatfollowingthedosinginstructionsisthekeytoensurethatthetreatmentworkasthephysicianintendeditto.

25. B. Awareness About the Role of Therapy
Thepharmacisthastotakeuptheresponsibilityto:
Informthepatientaboutthetherapyprescribed;
Makehim/herawareoftheseriousnessofmedicines;
Makehim/herawareoftheneedtoadheretothetherapy.

26. Case Study 3
•Thedurationoftherapyisaveryimportantfactorasfarrecoveryisconcerned.
•Thecasestudygivenbelowenumeratesanacuteconditioninwhichapatienthastotoldthatcompliancetothetreatmentismandatory.
•Thattreatmentshouldnotbediscontinuedunlessadvisedbythephysician,orunlesssideeffectsareexperienced.

27. I just want to make you aware
that you have been prescribed an antibiotic. Please complete the course of 15 capsules i.e. 3 capsules X 5 days.
What if I feel better in 3 days?

28. Evenifyoufeelbetterafter3days, completethecoursefor5daystomakesureallthebacteriaareeradicated.Ifyourconditiondoesnotimproveorrecurs,donottakemoreofthisantibiotic.Insuchcases,thebestthingtodoistoconsultthephysician.
OH! I’ll make sure I remember this

29. GUIDELINES
•Thepharmacistmusthaveaccestoavarietyofresourcematerials,textsandreferencessothathecangivetherequiredinformationtopatient;
•Thepharmacistshouldmakethepatientawareoftheroleoftherapyandencouragethepatienttoadheretothetherapy;
•Thepharmacistshouldprovideback-upinformationintheformofhand-writteninstructionsorprintedleaflets.

30. Always bear in mind
•Thepatientmaynotknowwhathisillnessis, orwhatexactlyiswrongwithhim/her;
•Thepatientmayveryapprehensiveorscaredunnecessarilyoveraconditionthatcanbetreatedorcontrolledwiththerapy;
•Theatmosphere,layout,attitudeinthepharmacyshouldbesuchthatpatientsfeelcomfortableaskingquestionsabouttheirmedication/condition.

31. Case Study 4
•Pharmacistwhiledispensingaprescriptionforantihypertensive

32. Your BP seems to have gone high. You have been prescribed medicines to lower your BP
I know! The physician said to take the tablets continuously for
15 days and then see him again

33. Yes, that’s right! Don’t miss your dose till you see the physician. Even if you happen to meet him after more than 15 days please see that you do not stop therapy (unless, of course if you get some intolerable, severe adverse effects or you feel bad). You may have to continue taking the medication to keep your blood pressure under control.
Thank you. I didn’t know that

34. GUIDELINES
•Patientcomplianceisthekeytosuccesoftreatmentandpharmacistshaveavitalroletoplayinthis;
•Pharmacistcanfacilitatecompliancebymakingthepatientawareoftheseriousnessoftheprescribedmedicinesandtheneedforcompliance.

35. Patient Counseling Area (PCA)
•Apotekharusmenawarkanlayananprofesionalkepadapasien
•AlihkanperhatianpasienkePCAdenganmembuattanda-tandayangcocok

36. Need a Separate Counselling Area
•Pasienterkadangmalumengklarifikasittgmasalahnyadidepanumum(banyakpelangganlaindisampingmeja)
•MenasehatipasiendiPCAlebihmudahdaripadadimeja
•DemonstrasialatinstrumenlebihbaikdilakukandiPCA
•DudukdiPCAbersamaPharmacistmembuatpasienyakindidengartanpagangguan

37. Patient Counselling Area
Sebuahareatertentutempatkegiatanyangberkaitandgnpelayananpasien/jasaprofesionaldilakukan
JasaProfesional(Apoteker):
•Pengukuranklinis(TD,GD,TBB,BMI)
•Demonstrasipemberiansediaanobat(TH, TT,TM,SInsulin)
•Tempatmendiskusikanmasalahkesehatan/medisdantempatmendistribusikanhandout

38. Activity
•Tempatkanmejadan2-3kursididaerahterpencil
•Tawarkanprivasidanpastikankenyamananpasienberkonsultasi
•BerikanlabelPCA
•Siapkanselebaran,pamflet(menarik)
•Tawarkanpengukuranklinis
•Secarabertahapmulaidgnlayanansepertidiatas,sesuaikenyamanandantingkatkeyakinanmu

40. Written information
Instruksitertulissangatbergunabagipasien(stiker,pamflet,selebaran)
A.Stickers(instruksitertulis)
Tempatkanpdbagianluarkemasanobat
Tempatpadabagianygtdkmenghilangkandetaillabel

41. Do not stop taking this medicine without the doctor’s adviceAvoid exposure to sunlight after taking this medicine
Avoid alcoholic drinks
While taking this medicineThis medicine may cause drowsiness. Avoid driving or operating machinery after taking this medicine

42. B.Medicineinformationcards
Berisiinformasitentangobat(dosis,efeksamping,dll)
Melengkapiinstruksilisan(DokteratauApoteker),meningkatkankepatuhanpasien

43. C.PatientInformationLeaflets(Pils)
Sumberinformasilainbagipasien
MelengkapiinformasidariPharmacistygmungkinhilang
Mencakupinformasiterkaitobat-obatan, penyakit,perawatandanmasalahkesehatanlainnya

44. D.Charts
TampilkandiwilayahKonseling,ruangtunggu
Menerangkanttgaspekpenyakitumum
Berisitindakanpencegahanygharusdiambilsehubungandgnobat-obattertentu

45. Uncontrolled dibetes effects the : Kidneys HeartEyes FeetGood diabetes control will reduce the risk or delay the onset of diabetic complications........... SO, CONTROL YOUR DIABETES!!!

46. E.Booklets
•Bukutentangtopikkesehatan
•Dapatdisimpandiapotekuntukdibacaatauuntukdijual

47. NON-PHARMACOLOGICAL MEASURES
Tindakannon-farmakologissecarasederhana, selainobat-obatan,dapatmembantupengobatanbekerjadenganbaik,atauyangmemilikiefekmenguntungkanpadakesehatanpasien:
Membatasiasupankaloridapatmembantudalammengurangikemungkinandiabetes/ obesitas
Meminimalkanasupangaramdapatmembuktikanpenurunanresikotekanandarahtinggi

48. Case Study 5
•Dalamkasus-kasustertentu,obat-obatanmungkintidakdiperlukansamasekali,atauobat-obatanmungkintidakbekerjadenganbaiktanpatindakandietyangditentukan
•Jikapasienyangmembutuhkannasihatmemintapendapatpharmacist,iamungkinharusmeyakinkanmerekabahwaobattidakdiperlukanuntukkondisi/tahaptertentupenyakit

49. Ihavebeensufferingfromjointpainandjointswellingespeciallymybigtoe.ThedoctorrecentlytoldmethatIhavehighuricacidlevelsinmybloodandhasgivenmedicine.Canyouhelpmelessenmysuffering?
Don’tworry!Takeyourtabletsasperyourdoctor’sadvice.Besidesthatremember,avoidallalcoholicdrinksastheyincreaseuricacidproduction. Purinerichfoodslikecrabs,redandorganmeat,shellfish,cauliflower, spinachhastobeavoided.

50. Thankyou!Ihavebeenconsumingalcoholeverynightlately...nowondermypaingotonlyworsewiththetablets!
Anotherthingthatisveryimportantisyouhavetolearntorelax.Stressoftentriggersanattackofpaininthosewithhighuricacidlevels.Also, remembernottofastbecausethatisanothertriggerfactor.Drink1.5-2Lofwaterthroughthedayandcheckonyourweight-thelesserthebetter!

51. SomeChangeInYourLifestyleAndDietaryHabitscanhelpyoufeelbetter.Don’tforgettocheckyoururicacidlevelsaftercertainintervals(monthlyoraftermonths) Thankyou!Ihopethesemeasuresreallyworkandreducemysufferingtoacertainlevel.

52. Tindakan-tindakannon-farmakologisdapatdisarankanolehpharmacistbersamadenganOTCatauresepobat-obatan,untukmembuatmerekabekerjalebihbaikatausebagaialternatifuntukobatbebas.
Keuntungandaritindakan-tindakannonfarmakologis:
Umumnyahematbiaya.
Bermanfaatbagipasienyangtidakinginmenyukaiobat-obatan.
Mencegahobatyangtidakperlu.
Kebanyakanpasienlebihsesuaiuntukpengobatanrumahdaripadaobat-obatan.

53. GUIDELINES
•Pharmacistharusmenyarankantindakan- tindakannon-farmakologisyangterbuktiataudapatdiandalkan.
“Kadang-kadang,obatterbaikadalahTIDAKOBATsamasekali!!“
•Pharmacistharusmemperbaruidiridengantindakan-tindakannon-farmakologissederhanadanmerekomendasikanlangkah- langkahtersebutuntukberbagaipenyakit/ kondisi.

54. GUIDELINES
•Tipsnon-farmakologisharussamasekalitidakmengganggupengobatandokter.
•PharmacistharusmenasihatiuntukmelakukandanLaranganuntukmembantupemulihan.

55. Perintah dan Larangan untuk pasien hipertensi :
Do’s
Don’ts
Regular visit to your physician
Ignore medication
Use less salt
Smoking
Control weight
Be inactive
Regularly exercise
Drink alcohol
Eat fruits and vegetablesrich in potassium. E.g. carrot, cabbage, peas, green turnip, tomato, orange, grapes, pineapples etc.
Eat fatty foods

56. Tindakan-tindakannon-farmakologisdapatmembantumembukajalanuntukpemulihanlebihcepat.Pharmacistdapatmemainkanperanutamadalammembantupasienmengontrolkesehatanmerekadenganmenasihatimerekatentanglangkah-langkahdietatauperubahangayahidup

57. THE PHARMACIST AND OTC MEDICINES
•ObatOTC/obatnonresep,dibeli/dijualtanparesepdokter
•OTCdapatdibeliolehkliensendiri
•OTCdapatdirekomendasikanolehApoteker
•Seringdianggapobat“tidakbegituserius”
•SebenarnyaOTCadalahobatygserius
•hati-hatisaatmenggunakanOTC

58. KebutuhanpasienuntukmemintaOTC, disebabkanoleh:
Pengaruhiklanataumedia
Rekomendasiteman/kerabat
Penggunaansebelumnyauntukkondisisama
Ketidakmampuankedokter(faktorbiaya, waktu,tdkadadokter)
AdanyapendapatbahwakondisikliensederhanashgdgnOTCsudahcukup

59. WhatthePharmacistcando:
•Tanyakanapakahpasientahupenggunaanobatygbenar
•TanyakangejalapasienshgklienmenginginkanOTCtertentu
•Tanyakanapakahklienmengkonsumsiobatlain
•Tanyakanapakahpasienmenderitapenyakitlainnya
•MembantuklienmemilihOTCygcocok
•Rekomendasikanmetodepengobatanlain

60. Informthepatient:
•Howtotake
•Howmuchtotake(Maximumpermissibledailydose)
•Whentotake
•Forhowlongtotake
•Anyadversedrugreactionsobserved
•Anysideeffectslikelytooccur
•Anyprecationstobetaken
•Toseeaphysicianiftheconditiondoesnotimproveinafewdaysorifworsens

61. Case Study 6
CanyougivemeDisprin(Aspirin)formybodyache?
Sure.ButIwouldliketoaskafewquestionstomakesurethatAspirinistherightchoiceforyou.Areyouasthmatic, ordoyouhaveanybreathingproblems?Doyouhaveanygastrointestinal(GI)problems,GIbleeding,oranactiveulcer?Haveyouhadanulcerbefore?Areyoutakinganyothermedication?Aspirinisnotsuitableforasthmatics.Itcantriggeranasthmaticattackinsusceptiblepersons.Itcanalsoprecipitateoraggravateanunderlyingulcer.

62. GUIDELINES
•PharmacistharusdilengkapidgnpengetahuandanketerampilanshgkompetenuntukmemberikannasehatketikaklienmemintaobatOTC
•PharmacistdapatmembantupasienmemilihobatOTCygbenar,tapikeputusanadapadapasien
•Klienmemilikihakuntukmenolakpengobatanatausaran,atauuntukmencaripendapatalternatif

64. BAHAN DISKUSI
•SELFCARE
•SWAMEDIKASIPADADEMAM
•SWAMEDIKASIPILEKDANALERGI
•SWAMEDIKASIPADAASMA
•SWAMEDIKASIPADASEMBELIT
•SWAMEDIKASIPADADIARE
•SWAMEDIKASIPADADIABETES