OSCE

Drug Inquiry

The process of gathering information about a drug-related inquiry, including patient details, medical history, drug identification, dosing, administration, and therapy goals.

Pregnancy and Lactation

Considerations related to the use of medications during pregnancy and breastfeeding, including assessing the patient's status, drug safety, and potential effects on the fetus or infant.

Availability and Identification

Checking the availability of a specific drug, identifying the drug by brand or name, and understanding the reason for the inquiry (e.g., poisoning, ordering, allergy).

Dosing and Choice of Therapy

Determining the appropriate dosage, frequency, and route of administration for a medication based on the patient's condition and treatment goals.

Parenteral Administration

Understanding the administration of drugs through injection, including the drug's name, strength, route, and urgency of treatment.

Adverse Drug Reactions (ADR)

Identifying and managing adverse reactions to medications, including stopping the drug, managing symptoms, and assessing the timing and severity of the reaction.

Drug-Drug Interactions (DDI)

Evaluating potential interactions between medications, assessing indications, monitoring for adverse effects, and considering alternative therapies if interactions occur.

Communications

Engaging in effective patient education and counseling, including building rapport, communicating information about medications, and encouraging behavior change.

Unsafe Medications for Pregnancy

Identifying medications contraindicated during pregnancy and suggesting safer alternatives.

Acute Bacterial Conjunctivitis

Understanding the condition, its causes, symptoms, and treatment with antibiotics like fluoroquinolones.

Polymyxin

Typically gentamicin, used in eye drops for infections.

Fusidic acid

Known as Fucithalmic, used in eye drops for infections.

Viral conjunctivitis

Inflammation caused by certain viruses, presenting with red eye, itching, and watery discharge.

Allergic conjunctivitis

Hypersensitivity to allergens, leading to red eyes, intense itching, and watery discharge.

Dry eye disease

Multifactorial condition resulting in dry eyes and redness, caused by various factors like Sjogren syndrome or environmental factors.

Blepharoconjunctivitis

Inflammation treated with antibiotic ointment and eye drops containing gentamicin or levofloxacin hydrate.

Blepharitis

Eyelid inflammation due to clogged glands, associated with dry eye symptoms and treated with heat and cleaning.

Hordeolum (stye)

Bacterial infection causing a painful, swollen eyelid, managed with warm compresses and good hand hygiene.

Chalazion

Blockage of eyelid glands leading to a painless bump, treated with warm compresses or medical procedures.

Primary open-angle glaucoma

Condition with increased eye pressure and gradual vision loss, managed with eye drops like Latanoprost or surgery.

Eye drop administration

Steps include hand washing, tilting head back, forming a sac, applying drops, and waiting between medications.

Eye ointment use

Instructions involve hand washing, tilting head back, applying ointment, and waiting before applying drops or contacts.

Ulcer Treatment Goal

Eradicate bacteria, relieve ulcer disease, heal ulcer, prevent recurrence, reduce complications.

PPI Triple Therapy

PPI OD/BD, amoxicillin 1g BD/metronidazole 500mg BD, Clarithromycin 500mg PO BD.

Bismuth Quadruple Therapy

PPI or H2RA OD/BD, metronidazole 250-500mg QDS, Bismuth Salicylate, Tetracycline 500mg QDS.

Non-Bismuth Quadruple Therapy

PPI BD/OD 10-14 days, Amoxicillin, Clarithromycin, Metronidazole days 1-10.

NSAID Ulcer Treatment Goal

Heal ulcers, STOP NSAIDs, Omeprazole 20mg daily.

Medication Administration

Bismuth, tetracycline, omeprazole on empty stomach, amoxicillin, clarithromycin after food.

Side Effects Management

N/V, diarrhea - amoxicillin, tetracycline; Metallic taste - clarithromycin, metronidazole.

Stress Reduction

Emphasize full course medication intake, stress reduction, smoking cessation, dietary changes.

GERD Symptoms

Heartburn, acidic taste, regurgitation; Complications:esophagitis, strictures, chronic cough.

GERD Treatment

PPI for frequent heartburn, antacids, H2RAs for episodic heartburn.

Dyspepsia Symptoms

Gastroduodenal area discomfort, epigastric pain, burning.

Dyspepsia Treatment

Alginates, antacids, H2RAs, PPIs for symptom relief.

Constipation Symptoms

Infrequent bowel movements, straining; Causes:poor diet, medications.

Constipation Treatment

Bulk forming agents, lactulose, glycerin for symptom relief.

Diarrhea Symptoms

Increased stool frequency, pasty stools; Causes:IBD, malabsorption, drugs.

Diarrhea Treatment

Loperamide, diphenoxylate, adsorbants for symptom relief.

Ulcerative Colitis

Autoimmune intestinal inflammation, risk factors, symptoms, complications, treatment goals.

Hypertension Definition

Increased blood pressure in blood vessels; Risk factors:sedentary lifestyle, diabetes, stress.

Hypertension Treatment

ACEi, ARB, CCB, Diuretics; Lifestyle modifications, monitoring guidelines.

Heart Failure Definition

Heart's inability to pump sufficient blood; Risk factors:hypertension, AF.

Heart Failure Treatment

ARNi, BB, MRA, SGLT2i; Target HR, medication choices, treatment goals.

Diuretics

Medications like Frusemide and Bumetanide that help in treating fluid retention and reducing blood pressure by increasing urine output.

ACEi

Medications that may cause a dry cough as a side effect, requiring medical attention if experienced.

ARNi

Medications that may lead to dizziness, cough, and lightheadedness, necessitating blood pressure monitoring.

BB

Medications that reduce heart rate and heart contraction, with side effects like tiredness and shortness of breath.

CCB

Medications that may cause edema/swelling initially, which should subside after two weeks.

MRA

Medications that can result in gynaecomastia as a side effect.

SGLT2i

Medications that require daily weight checks, fluid restriction, and monitoring of sodium intake, among other precautions.

Hyperlipidemia

High cholesterol levels in the blood, often managed with statins to control cholesterol levels and prevent cardiovascular events.

Atrial Fibrillation

Abnormal heart rhythms treated with rate control (BB, CCB, Digoxin, Ivabradine) or rhythm control (amiodarone).

Angina Pectoris

Chest pain due to reduced blood supply to the heart muscles, managed with medications like BB, CCB, nitrates, and lifestyle changes.

Blood Pressure Machine

Instructions on setting up and using a blood pressure monitor correctly for accurate readings.

Asthma

Condition characterized by inflamed airways, managed with controller and reliever medications to control symptoms and reduce risks.

Cerumen Impaction

Accumulation of earwax in the ear, treated with ear drops like Docusate sodium and Hydrogen peroxide.

Water-Clogged Ears

Accumulation of water in the ear canals, treated with ear drops containing Isopropyl alcohol and glycerin.

Common Cold

Viral infection causing symptoms like cough, sore throat, and nasal congestion, often transmitted through hand contact.

Transmission of Virus

Infection occurs through large particle droplets from close contact with an infected person or small particle droplets that can remain airborne for up to 5 hours.

Pathophysiology

The virus attaches to receptors in the airway, causing damage to cilia and triggering inflammation in the airways.

Risk Factors

Crowded spaces, weakened immunity (stress, lack of sleep, underlying medical conditions), and smoking increase susceptibility to infection.

Symptoms

Include sore throat, runny nose, cough, and can last 7-14 days, with rare fever and muscle aches.

Complications

May lead to acute rhinosinusitis, otitis media, lower respiratory tract infections, and exacerbation of asthma or COPD.

Symptomatic Relief for Runny Nose

H1 antihistamines like chlorpheniramine or second-generation H1 antihistamines like Fexofenadine or Loratadine.

Symptomatic Relief for Congestion

Topical decongestants like Oxymetazoline nasal spray or nasal saline.

Oral Combination for Relief

Zyrtec-D (cetirizine HCl 5mg, Pseudoephedrine HCl 120mg) for congestion relief.

Preventive Measures

Drink water, get adequate rest, maintain a nutritious diet, practice good respiratory and hand hygiene to reduce symptoms and boost immunity.

Asthma Diagnosis

Asthma is characterized by sensitive airways leading to symptoms like shortness of breath, coughing, or wheezing, managed with inhalers and good technique.

Inhaler Use

Inhalers like ICS-formoterol/SABA or montelukast tablets are prescribed to control asthma symptoms, with specific dosing instructions and potential side effects.

Inhaler Priming

Before first use or after several days of non-use, spray 2 puffs into the air to prime the inhaler.

Spacer Attachment

Hold the inhaler correctly and attach it to the end of the spacer for proper use.

Spacer Preparation

If using the spacer for the first time, press the inhaler 10 times to prepare it.

Puff Administration

Breathe out completely, place the mouthpiece between teeth, inhale slowly while pressing the canister for 1 puff.

Holding Breath

After inhaling, hold your breath for about 10 seconds or as long as possible before exhaling slowly.

Spacer Cleaning

Clean the spacer by soaking it in lukewarm water with detergent for about 15 minutes, then air dry.

DPI Preparation

Remove the cap, check the dose counter, prime the inhaler, load a dose, and avoid shaking or inverting the inhaler.

DPI Administration

Breathe out completely, inhale quickly and forcefully, hold breath for about 10 seconds, then exhale slowly.

Smoking Cessation Patch Application

Wash hands, apply patch to clean skin, avoid oily lotions, press firmly, change daily, and dispose properly.

Smoking Cessation Gum Usage

Chew gum slowly, rest between cheek and gums, repeat for 30 minutes, avoid eating or drinking 15 minutes before or during use.

Erythropoietin Dosing

The dosing regimen for hemodialysis (HD) patients is 40 units/kg administered intravenously (IV) or subcutaneously (SC) three times a week.

Erythropoietin Administration

To inject Erythropoietin, pinch about 5cm of skin in the stomach/thigh and inject the prescribed dose using the appropriate syringe.

Erythropoietin Duration and Quantity

Recormon is typically prescribed for 1, 2, or 3 months with a specified number of syringes for the entire treatment duration.

Erythropoietin Non-Adherence

It is crucial to adhere to the medication regimen consistently to support the ongoing production of red blood cells.

Erythropoietin Missed Dose

If a dose is missed, inject it as soon as possible. However, if close to the next scheduled dose, skip the missed one and do not double the dose.

Erythropoietin Storage

Store Erythropoietin in the refrigerator at 2-8°C, ensuring it is not frozen and is protected from light exposure.

Erythropoietin Side Effects

Common side effects include increased blood pressure, stomach upset, vomiting, diarrhea, fatigue, shortness of breath, and headaches.

Erythropoietin Serious Side Effects

Rare but severe side effects like leg swelling, slurred speech, vision changes, or chest pain require immediate medical attention.

Erythropoietin Interactions

Erythropoietin may interact with poorly controlled hypertension, necessitating caution and monitoring.

Erythropoietin Monitoring

Regularly monitor hemoglobin levels, especially following initiation or dosage adjustments, to ensure the therapy's effectiveness.

Acne Vulgaris

A chronic skin condition characterized by the presence of papules, pustules, and scarring, often treated with medications like EPIDUO.

Doxycycline

An antibiotic used in the treatment of acne vulgaris, recommended at a dose of 100mg PO BD to reduce papules and pustules.

EPIDUO

A topical gel applied once daily to affected areas for the treatment of acne vulgaris, with potential side effects like photosensitivity.

GERD

Gastroesophageal reflux disease, managed with medications like TUMS and lifestyle modifications to control symptoms.

Hypertensive Emergency

A severe increase in blood pressure requiring immediate intervention to prevent organ damage, often due to non-compliance with antihypertensive medications.

Nifedipine LA

A medication used to treat hypertension, with potential side effects like lower limb swelling and the need for adherence to prevent hypertensive emergencies.

Ramipril

An ACE inhibitor used in the management of hypertension, essential for preventing complications like severe headaches and dizziness in hypertensive emergencies.