Maxamox

Ok, time for some studying. My Pharmacy Practice 2B oral assessment is on Friday, and I have been given the following scenario:

Joe (35 years old) is a regular customer of your pharmacy. He comes in today and presents a new prescription for the following medication:

Maxamox 1000mg,
One tablet to be taken twice a day

Patient history: Joe is not taking any other presciption or over-the-counter medications. He has had antibiotics in the past.

So....what might I need to know for Friday? Maxamox is the antibiotic amoxycillin trihydrate, which is a penicillin. According to Mims Online, it is meant to be used for "acute exacerbation of chronic bronchitis", with chronic bronchitis being excessive mucous production and airway inflammation, probably caused by smoking. So I should probably ask Joe if he smokes.

But the CMI says that "Maxamox is used for the treatment of chest infections". So I wonder if that means Joe doesn't necessarily have to have chronic bronchitis to get a chest infection? After all, his patient history says he isn't taking any other medications. Still, probably should ask in case he's been going to another pharmacy or something.

Also, need to ask if he's taken penicillins or cephalosporins before, he could get an allergic reaction. If he says yes, need to ask what sort of reaction he had to them, if any. An allergic reaction may include wheezing; shortness of breath; swelling in the face, lips or tongue; skin rash, itching or hives. If he's had any of these symptoms before when taking penicillin, I cannot give him Maxamox. If it was only nausea or diarrhoea, then it's ok for him to take it. If he had a delayed (after 3 days of starting treatment) or mild rash, he needs to use it with caution. So if he starts having any syptoms of an allergic reaction, he should go to a doctor immediately.

How to take it: he has to take one tablet twice a day, so that's 12 hours apart, perhaps at 7am and 7pm. He should take it at the same time everyday for it work the best, and he should take it with a glass of water. It can be taken with or without food. He also has to make sure he finishes the whole course, even if he feels better after a few days, to make sure the infection is totally cleared.

Missed doses: If you remember within two hours of the time you were meant to take it, then it's ok to take it. If it is more than two hours, just skip that tablet and take a tablet at the time you're meant to for the next dose. NEVER take a double dose to make up for the missed one.

Possible side effects:
Mild: oral thrush (white, furry, sore tongue); mild diarrhoea; nausea; headache
Severe: allergic reaction (see above); severe abdominal cramps, watery and severe diarrhoea - symptoms of rare side effects, either pseudomembranous or haemorrhagic colitis, infections in the bowel.

Storage: Below 25 C and away from moisture.

Hmmm...I think that's a lot more than five pieces of information (you're only meant to give five pieces or information to a patient verbally). Plus I've only got five minutes...and still haven't mentioned precautions. Might just highlight storage in the CMI.

Precautions: renal or hepatic impairment (i.e. kidney or liver problems), asthma, lymphatic leukaemia (more suscpetible to skin rash) - I guess I only have to ask about these, doesn't really count as a piece of info to give him.

Now, what else do I have to remember? Need to introduce myself, ask who he is, ask if the medication is for him, if he has any other medical conditions or taking any medications...hmmm, i mentioned that already. Also need to remember that Joe is possibly blind, deaf, intellectually impaired, non-English speaking, angry, anxious, depressed, distracted, or in a hurry. Oh yeah, need to state the purpose of the counselling, summarise the points at the end and/or ask him to repeat it back to me.

Wow....I actually got some work done today! Yay! Hmmm, maybe blogging is useful after all perhaps I'll do this for all my other exams too...although anyone who is not a pharmacy student who reads this is going to fall asleep. And if you are a pharmacy student...well, I guess if you're doing the same stuff as me, you'll find this blog very useful :)

Who would have thought? Using a blog to motivate me to write study notes???