Community Pharmacy · Short notes

Patient Counselling: Short Notes & Cheat Sheet

The counselling process, the three prime questions, teach-back, device technique and key counselling points for common medicines.

Short notes

Read these before you attempt the topic's MCQs.

Start by finding out what the patient already knows; then fill the gaps and check understanding.

Introduce yourself, confirm the patient's identity and find a private space.
Start with the three prime questions: What did your doctor tell you the medicine is for? How did your doctor tell you to take it? What did your doctor tell you to expect?
Fill the gaps: name and purpose, how and when to take it, how long, common side effects and what to do about them, missed doses, storage and interactions.
Check understanding with teach-back: ask the patient to explain it in their own words.
Use plain language (Urdu or the patient's own language), open-ended questions and active listening. Use pictograms for patients with low literacy.

Metered-dose inhaler: shake, breathe out, seal lips, press once while breathing in slowly, hold breath for about 10 seconds, and wait 30–60 seconds before a second puff.
A spacer helps children and anyone who cannot coordinate pressing and breathing. Rinse the mouth after inhaled steroids.
Insulin pen: prime with 2 units, rotate injection sites, and hold the needle in for about 10 seconds. Store unopened pens in the fridge; the pen in use can stay at room temperature for about 4 weeks.
Eye drops: wash hands, pull down the lower lid, instil one drop, close the eye and press the inner corner for 1–2 minutes. Wait 5 minutes between different drops.

Levothyroxine: on an empty stomach, away from iron and calcium.
Alendronate: first thing in the morning with a full glass of water, stay upright for 30 minutes before food.
Warfarin: keep vitamin K intake steady, attend INR checks, report bleeding and check before starting any new medicine.
Metronidazole: no alcohol during treatment and for 48 hours after.
Rifampicin: orange urine and tears (can stain contact lenses) and reduced effect of oral contraceptives.
Sublingual GTN: sit down, use one dose, and call emergency help if pain is not better 5 minutes later. Keep tablets in the original glass bottle.
Iron: best absorbed on an empty stomach or with vitamin C; stools turn black.

High-yield facts in one place. Cover the right-hand column and test yourself.

Medicine	Must-tell
Levothyroxine	Empty stomach; separate from iron and calcium
Alendronate	Upright 30 min, full glass of water, before food
Tetracyclines	Avoid milk, antacids, iron nearby
Metronidazole	No alcohol until 48 h after
Rifampicin	Orange secretions; contraceptive failure
Inhaled steroid	Rinse mouth after use
Warfarin	Steady vitamin K, INR checks, bleeding signs
Antibiotics	Complete the course as directed
Enteric-coated tablet	Swallow whole; do not crush

Teach-back, not 'Do you understand?': Ask the patient to repeat the instructions; a yes/no question does not check understanding.

'Do you have any questions?' does not confirm understanding; teach-back does.
Wait 30–60 seconds between inhaler puffs, not immediately.
Nasolacrimal occlusion (pressing the inner corner of the eye) reduces systemic absorption of eye drops.
GTN tablets lose potency when moved out of their glass bottle.

Attempt the Patient Counselling MCQs while the notes are fresh. Anything you get wrong is saved to your incorrect list for the next revision round.