FINAL LAB EXAM STUDY GUIDE
Counseling
INTRO Introduce self
Offer to counsel
State time factor
ID patient + identifier-is this for yourself?
Establish privacy and confidentiality: is this area private enough? Everything discussed is
confidential
Prior knowledge from Dr? Have you had this before?
SCHOLAR-MACS AGE of PT
Temp, ask what route
ESA for meds (A: how are you taking that?)-are they being taken as Rx’d?
OTC/NHPs?
Allergies: food, NHP, OTC, Rx drugs: what was the allergy and when?
S: smoking, OH, caffeine, P/L
MED INFO Drug name (generic + brand), Type of drug and purpose, how the med works
- Rationale for choice if OTC
Regimen
Supply and Duration of use
Max daily dose
If it is adapted/DTP INFORM patient
ADR Remember allergies (rash), safe to take bc NKDA
Side effects and how to MANAGE them
ADR time frame
Instructions for intolerable/persistent ADRs
INTX Explanation, meds to avoid
Consult a pharm if starting any natural, OTC, rx meds
No intx if applicable
SELF- What to expect, when to expect
MONITORING/FU What to do if no benefit (/worsening)
Offer adherence tips
Non-drug measures (4)
Ask for permission to F/U
Mention refills
Summarize main counselling points, check PT for understanding
OTC Fever
Drug <12y >=12
Acetaminophen 10-15mg/kg q4-6h MAX: 60-75mg/kg 325-650mg q4-6h MAX: 4000mg
Ibuprofen <2y 2-12 >12y
5mg q6-8h MAX 5-10mg q6-8h MAX 200mg q4h or 400mg q6-8h MAX
40mg/kg 40mg/kg 1200mg
9
- (
° F= ° C ×
5)+32
- Rectal = 0.5ºC ↑
- Axilla = 0.5-1.0ºC ↓
- If >38.0ºC (rectal) or >37.5ºC (oral), take antipyretic
- No ASA if child
- If >40.0ºC (oral) see doctor
- Non-drug measures: Dress lightly, cooling fan, sponge bath, bed rest
,Verbal DIRs
- MAC
- Concise dosing w supporting reference (search strategy)
PK dosing if appropriate, monitoring/ADR
Rationale/evidence for all recommendations (drug + non-drug)
- Include ADR and monitoring parameters for side effects
- Incompatible d/t ___
- Mechanism of intx
- Viable alts w NESA rationale
- Non-drug measures, possible unmet needs
- Renal prescribingCTC to find first line drugs go to renal prescribing to see how to adjust dose
Using Resources: ***OSCE: RxTx, RxFiles, Clinical Drug Data, Natural Medicines Comprehensive Database, Drugs in
P/L (Briggs), Health Canada Pubs, other references
CPS Green: brand/generic alphabetical index
Italics: generic
Bold and underlined: monograph
Bold: no monograph but available in canada
Pink: therapeutic guide (med condition then drug classes organization) by indication
White: drug ID
Lilac: clinical info, calcs and dosage, immunization schedules, food intx chart, etc
Yellow: contact info, manufacturer/poison control
Pr: Rx drug, C: controlled drug, N: narcotic drug, Tc: targeted substance
Updated every year
Rx Files Appendix (at the back): instructions on abbrev, how to use
Index: drug, conditions, drug classes
Trial summaries
Insulin pen delivery systems
Updated qyear
GeriRx Files Appendix in back organized by body systems
summaries of widely accepted criteria outlining potential appropriateness of drugs in older adults
updated q year
Drug Prescribing Organized by therapeutic class and then adult/pediatric
in Renal Failure Pg 16: instructions for use
Back index: pg number for drug
Dose adjustments for GFR level
- [D]: dosage ↓
- [I]: interval extension
- [A]/[B]: level of evidence
Contains level of evidence for recommendations
1 CrCl= 1 egfr
Bugs and Drugs Reference for antibiotic use
Yellow: spectra
Blue: recommendations
Orange: Px
Purple: dentistry
Red: P/L
Green: microbiology
Sanfords Spectrum of activity, common indications, special populations considerations
drugs in index
+ active, ++ recommended, +- variable, 0 n/r
Back cover table of contents then organized by disease
American dosing
Natural Meds Ref for NHPs-alphabetical
Evaluation of efficacy and safety
Can’t find extract go to index directs to general entry
P/L Briggs Preg ref-Alphabetical
3 summaries: preg, fetal risk, breastfeeding w recommendation
, Updated q 3y
Milk Ref for lactation alphabetical
Infant monitoring points, drug PK
Appendix of recommendationscontains suitable alts
updated q 2y
Peds Handbook alphabetical by drug name
appendix: useful formulas and comparison charts
Clinical info ref: pharmacology, PK, ADRs, interactions, monitoring parameters
best for determining clinical info (adverse effects and monitoring parameters)
updated q year, American-do not use for dosing
BC Childrens Back index: alphabetical drug listing
Pink: neonates
Yellow: infant/child
Dosing comments
Avg weights based on age in front
most appropriate reference to determine dose and regimen for neonatal/ped PTs (as
opposed to neonatal handbook bc American reference)
not updated often
Martindale International Ref for APIs: used to determine API in products avail outside of Canada (for products
in Canada should cross ref w CPS bc not updated reg (q3y)
- look for generic names given international brandsthen go to CPS
Alphabetical: uses and actions
- Volume B is an index: look for drugs/brands here (look for foreign name here)
general index and available preps
- Volume A: drug monographs-will tell you what drug is
Merck Ref for conditions-Alphabetical by condition
- Pathology, etiology, dx for a treatment
Back appendix
Merck Index separate indexes
- Organized by chemical formula/brand generic name
- Chemical formula for brand/generic name-in formula index
- Name index: corresponding number is assoc not w pg # but entry number
- Drug monograph w chemical info-med chem Qs
Stockley’s index in back for drugs drug of interest + potentially intx drug w corresponding page number
- 1: avoid, 2: usually avoid, 3: minimize risk, 4: no action needed, 5: no intx
best reference for determining presence and severity of drug intx
- updated q 3 years
DI Binder index in front page number
DIH Alphabetical (brand and generic name)
Appendix: formulas, drug comparison charts, therapeutic recommendations
Updated every year, American-do not use for dosing
Injectables drug name alphabetical (generic name)
i. T1: infusion solutions
ii. T2: IVs
iii. T3: syringe
iv. T4: Y sites
See last column for compatibility (C/I for compatible or incompatible)
- reconstitution instructions
- stability/storage
- Y site compatibility
- Admin routes/rates
Updated q 3 years
AHFS-DI Comprehensive drug info resource
Clinical Key In depth dx and treatment information on a clinical topic
UpToDate
Handbook of Drug-sp clinical info on special populations and drug-induced diseases
Clinical Drug Data
Parenteral Drug Institutional parenteral policies
Therapy Manual
Lexi-Comp Online POC quick searches
Micromedex
Counseling
INTRO Introduce self
Offer to counsel
State time factor
ID patient + identifier-is this for yourself?
Establish privacy and confidentiality: is this area private enough? Everything discussed is
confidential
Prior knowledge from Dr? Have you had this before?
SCHOLAR-MACS AGE of PT
Temp, ask what route
ESA for meds (A: how are you taking that?)-are they being taken as Rx’d?
OTC/NHPs?
Allergies: food, NHP, OTC, Rx drugs: what was the allergy and when?
S: smoking, OH, caffeine, P/L
MED INFO Drug name (generic + brand), Type of drug and purpose, how the med works
- Rationale for choice if OTC
Regimen
Supply and Duration of use
Max daily dose
If it is adapted/DTP INFORM patient
ADR Remember allergies (rash), safe to take bc NKDA
Side effects and how to MANAGE them
ADR time frame
Instructions for intolerable/persistent ADRs
INTX Explanation, meds to avoid
Consult a pharm if starting any natural, OTC, rx meds
No intx if applicable
SELF- What to expect, when to expect
MONITORING/FU What to do if no benefit (/worsening)
Offer adherence tips
Non-drug measures (4)
Ask for permission to F/U
Mention refills
Summarize main counselling points, check PT for understanding
OTC Fever
Drug <12y >=12
Acetaminophen 10-15mg/kg q4-6h MAX: 60-75mg/kg 325-650mg q4-6h MAX: 4000mg
Ibuprofen <2y 2-12 >12y
5mg q6-8h MAX 5-10mg q6-8h MAX 200mg q4h or 400mg q6-8h MAX
40mg/kg 40mg/kg 1200mg
9
- (
° F= ° C ×
5)+32
- Rectal = 0.5ºC ↑
- Axilla = 0.5-1.0ºC ↓
- If >38.0ºC (rectal) or >37.5ºC (oral), take antipyretic
- No ASA if child
- If >40.0ºC (oral) see doctor
- Non-drug measures: Dress lightly, cooling fan, sponge bath, bed rest
,Verbal DIRs
- MAC
- Concise dosing w supporting reference (search strategy)
PK dosing if appropriate, monitoring/ADR
Rationale/evidence for all recommendations (drug + non-drug)
- Include ADR and monitoring parameters for side effects
- Incompatible d/t ___
- Mechanism of intx
- Viable alts w NESA rationale
- Non-drug measures, possible unmet needs
- Renal prescribingCTC to find first line drugs go to renal prescribing to see how to adjust dose
Using Resources: ***OSCE: RxTx, RxFiles, Clinical Drug Data, Natural Medicines Comprehensive Database, Drugs in
P/L (Briggs), Health Canada Pubs, other references
CPS Green: brand/generic alphabetical index
Italics: generic
Bold and underlined: monograph
Bold: no monograph but available in canada
Pink: therapeutic guide (med condition then drug classes organization) by indication
White: drug ID
Lilac: clinical info, calcs and dosage, immunization schedules, food intx chart, etc
Yellow: contact info, manufacturer/poison control
Pr: Rx drug, C: controlled drug, N: narcotic drug, Tc: targeted substance
Updated every year
Rx Files Appendix (at the back): instructions on abbrev, how to use
Index: drug, conditions, drug classes
Trial summaries
Insulin pen delivery systems
Updated qyear
GeriRx Files Appendix in back organized by body systems
summaries of widely accepted criteria outlining potential appropriateness of drugs in older adults
updated q year
Drug Prescribing Organized by therapeutic class and then adult/pediatric
in Renal Failure Pg 16: instructions for use
Back index: pg number for drug
Dose adjustments for GFR level
- [D]: dosage ↓
- [I]: interval extension
- [A]/[B]: level of evidence
Contains level of evidence for recommendations
1 CrCl= 1 egfr
Bugs and Drugs Reference for antibiotic use
Yellow: spectra
Blue: recommendations
Orange: Px
Purple: dentistry
Red: P/L
Green: microbiology
Sanfords Spectrum of activity, common indications, special populations considerations
drugs in index
+ active, ++ recommended, +- variable, 0 n/r
Back cover table of contents then organized by disease
American dosing
Natural Meds Ref for NHPs-alphabetical
Evaluation of efficacy and safety
Can’t find extract go to index directs to general entry
P/L Briggs Preg ref-Alphabetical
3 summaries: preg, fetal risk, breastfeeding w recommendation
, Updated q 3y
Milk Ref for lactation alphabetical
Infant monitoring points, drug PK
Appendix of recommendationscontains suitable alts
updated q 2y
Peds Handbook alphabetical by drug name
appendix: useful formulas and comparison charts
Clinical info ref: pharmacology, PK, ADRs, interactions, monitoring parameters
best for determining clinical info (adverse effects and monitoring parameters)
updated q year, American-do not use for dosing
BC Childrens Back index: alphabetical drug listing
Pink: neonates
Yellow: infant/child
Dosing comments
Avg weights based on age in front
most appropriate reference to determine dose and regimen for neonatal/ped PTs (as
opposed to neonatal handbook bc American reference)
not updated often
Martindale International Ref for APIs: used to determine API in products avail outside of Canada (for products
in Canada should cross ref w CPS bc not updated reg (q3y)
- look for generic names given international brandsthen go to CPS
Alphabetical: uses and actions
- Volume B is an index: look for drugs/brands here (look for foreign name here)
general index and available preps
- Volume A: drug monographs-will tell you what drug is
Merck Ref for conditions-Alphabetical by condition
- Pathology, etiology, dx for a treatment
Back appendix
Merck Index separate indexes
- Organized by chemical formula/brand generic name
- Chemical formula for brand/generic name-in formula index
- Name index: corresponding number is assoc not w pg # but entry number
- Drug monograph w chemical info-med chem Qs
Stockley’s index in back for drugs drug of interest + potentially intx drug w corresponding page number
- 1: avoid, 2: usually avoid, 3: minimize risk, 4: no action needed, 5: no intx
best reference for determining presence and severity of drug intx
- updated q 3 years
DI Binder index in front page number
DIH Alphabetical (brand and generic name)
Appendix: formulas, drug comparison charts, therapeutic recommendations
Updated every year, American-do not use for dosing
Injectables drug name alphabetical (generic name)
i. T1: infusion solutions
ii. T2: IVs
iii. T3: syringe
iv. T4: Y sites
See last column for compatibility (C/I for compatible or incompatible)
- reconstitution instructions
- stability/storage
- Y site compatibility
- Admin routes/rates
Updated q 3 years
AHFS-DI Comprehensive drug info resource
Clinical Key In depth dx and treatment information on a clinical topic
UpToDate
Handbook of Drug-sp clinical info on special populations and drug-induced diseases
Clinical Drug Data
Parenteral Drug Institutional parenteral policies
Therapy Manual
Lexi-Comp Online POC quick searches
Micromedex
