Thyroid Disorders - OSCE book 2010

Hyperthyroidism Pharmacotherapy Thionamides

 It prevents excessive thyroid hormone production

 It must be taken regularly in order to be effective.

 Do not discontinue used without first consulting your physician

 When there is fever, sore throat, unusual bleeding, rash, abdominal pain, or yellowing of the skin patient should notify the physician

Iodides

 Dilute with water or fruit juice to improve taste



Notify physicians if ever, skin rash, metallic taste, swelling of the throat, or burning of the mouth occurs

Non pharmacologic Choices

 Surgery in patients (medical therapy is often initiated prior to surgery to make patient euthyroid if possible):

 With thyroid nodules

 With large goiter

 Occasionally in Graves disease



For management of thyroid cancer (malignancy), control ectopic production of thyroid hormone.

Copyright © 2000-2010 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is illegal to reproduce without permission. This manual is being used during review sessions conducted by PharmacyPrep

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Practice Stations

Patient Profile: Presented on desk

Patient Name: Jenny Comments: Hyperthyroidism

Age: 32 years Medication: Methimazole 10 mg BID

Address: xyz (3 weeks ago)

Dr: Tips

A patient comes to you in the pharmacy with a concern. Respond as you would in the pharmacy.

On the table:

 Tylenol Extra Strength tablets

 Advil tablets

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Asthma

Asthma Management

 Assess: asthma control, triggers, compliance, inhaler technique & co-morbidities

 Assessmentregular assessments of asthma technique, assess adherence to therapeutic regimen, assess asthma control.

 Education teach correct inhaler technique, demonstrate to confirm patient understands, and explain the basic principles of the disease highlight inflammation and muscle

constriction. Ensure patients understand the role of the medications. Using inhaled

corticosteroids on a regular basis in order to achieve good asthma control is a key message for pharmacists to focus on.

Questions to ask

 Have you used these puffers before? (Review techniques)

 Do you know what makes your asthma worse? (Avoid triggers-dust mite, mould, some food, pet allergies, pollen) Keep diary.

 Do you take any other Rx medications, such as beta-blockers, aspirin (they could exacerbate asthma)

 Have you had any changes recently-ask about non-allergic triggers cold and flu virus, weather changes, thunderstorms; ask about exercise- often asthma symptoms triggered by exercise; perfume and hairspray can irritate the airways. It is best not to use them. Some women find that their asthma worse during pregnancy, periods or menopause.

Defining asthma control

 Daytime symptoms < 4 days per week

 Night-time symptoms < 1 night per week

 Normal physical activity

 Mild, infrequent exacerbations

 No absenteeism due to asthma

 < 4 doses/week of a fast-acting β2-agonist (apart from 1 dose/day before exercise)

41-2 Treatment plan

 Very Mild: short-acting β2-agonist PRN

 Mild: ICS at low doses (if ICS is not an option, then LTRA, although less effective)

 Moderate: if not adequately controlled by ICS, add LABA (alternatives: add LTRS or

#ICS to moderate dose, but less effective)

 Severe: #ICS to high dose, if very severe add Prednisone PO.

Complementary Activity of ICS & LABA

 ICS improve the effectiveness of LABA by up-regulation of β2 receptors

 LABA improve the effectiveness of ICS, possibly by priming the glucocorticoid receptor for activation

Budesonide/Formoterol – single inhaler as maintenance & reliever

 Prolongs time to first severe exacerbation

 Reduces frequency of severe exacerbations

 Improves asthma symptoms

 PRN doses allow early intervention

 (increasing ICS dose) thus preventing exacerbation before it occurs.

Formoterol for asthma relief

 Has onset of action as fast as salbutamol, 1-3 minutes after inhalation

 In combination with budesonide has been shown to be as effective & well tolerated as salbutamol in relieving acute asthma

 Formoterol: full β2-agonist

 Salmeterol: partial β2-agonist with slower onset of action (not to be used as reliever) Counseling on Symbicort

 Maintenance of BID dosing is necessary

 As effective in short term as short acting β2-agonists (i.e. salbutamol), and beneficial in the long-term.

 Maximum dosing: 8 inhalations per day

 Symbicort SMART approach approved by Health Canada

 SMART – single maintenance and reliever therapy

Practice Station

Scenario # 1

A very concerned lady comes to you, the pharmacist, asking for your help. Respond as you would in the Pharmacy.

Patient Profile: Presented after pharmacist request Patient Name: Mrs Jane

Age: 28 years

Address: XYZ

Dr: Tips

Comments: Asthma

Medications Dr

Salbutamol Inhaler PRN Tips

Advair Diskus 1puff BID Since 3 years ago Tips

Scenario # 2

A doctor’s station, wants to talk to you!

Patient Profile: (presented on desk)

 Advair MDI 250 mcg I puff BID 250/25mcg

 Bricanyl as reliever

 Advair Diskus 250/50 I BID Allergies: None

Medical conditions: Asthma for the past 2 years

Scenario # 3

A very concerned lady comes to you, the pharmacist, asking for your help. Respond as you would in the pharmacy.

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 Fatigue, Nasal Congestion, Sore Throat No fever

On the table:

 Cepacol Lozenges,

 Strepsil Lozenges

 Salinex NS, Lozenges

Scenario # 4

A doctor’s has question for his asthma COPD patient.

Patient profile: (presented by patient after pharmacist request) Combivent (ipratropium bromide/salbutamol) ii puffs QID

Scenario # 5

Address their concerns and their need for information.

On the table:

 Cepacol Lozenges

 Strepsil Lozenges

 Ricolla Lozenges

Scenario # 6

A mother comes into the pharmacy and complains that her 15 year old son who is using a Sodium Cromoglycate bid inhaler seems to be getting more frequent asthma attacks and his asthma seems worse at night. He also takes Salbutamol, which he has not been taking that regularly. She asks whether she should increase the use of the Cromoglycate inhaler.

Counsel the patient.

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42

Cold, Cough, Congestion and

In document OSCE book 2010 (Page 125-132)