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Communication skills and Effective counseling 念歷歷歷念臨念 91~96 年念 95 年 (50) 96 年 (60 Drug Information Counseling() 說 Consultation 都 : E-mail Internet 路 : ( 索流讀索 : 了 / 了類略料錄略略良度略了略了略識索略了度略六說來練 3 Communication skills and Effective counseling 倫理 2 1

(Actual & potential drug related problems) (Actual & potential drug related needs) Health Promotion 療 (Medical Diagnosis) 理 (Nursing Diagnosis) 療 (Pharmaceutical Diagnosis) 量療六 GDP 六讀讀數 6 Aspirin? 1. 2. 量 / 異 Aspirin? Low dose aspirin (CVA) Scr or >50 y/o. high BP Baktar? R Dz. ( Herbal drug ) 1. 2. 不 3. 理 1. ( 惡 /) 2. 3. 4. 5. 不老年 / 不良量理 Q.I.D? Regimen : Baktar 28 days ( ) 療 ) 理狀 / ( 惡 NG tube) 2

Pharmaceutical diagnosis TID TID 力 1. 量 2. 3. 療度不 1. 2. 不良 3. 濫 1. 2. 3. 4. 不良 Pharmaceutical diagnosis 1. 量 or 不 2. 3. 4. 5. 療 1. 2. 類 3. 4. 療不 5. 療 1. 2. 3. 數 4. 量不療 (2-6 y/o, 13-21 kg) 45/6.4 mg/day 5 y/o, 19 kg Dosage 5 ml BID - 療類不良例 Scanol + Panadol Gliben + Amaryl Theophylline + Phyllocontin Amoxicillin + Augmentin? Is there any rationale for using two CCBs together Combinations has been studies in hypertension and refractory angina The combination of a dihydropyridine with a nonhydropyridine is more effective than each agent alone, especially when high-dose monotherapy is needed to control BP Dual CCB therapy is considered a last-line therapy, but may needed in certain patients (those with CKD or diabetes ) to achieve aggressive BP goal or severe angina Regimen: DHP+ (Diltiazem or verapamil) Is there any rationale for using two CCBs together? Aspirin 不降 ph 不飯 3

類 : 料 ( 柳 ) : 料 ( 柳 ) : 酪 : 茶樂 : 量 K 綠蘆猪茶 : 離降 : : Bokey : Theophylline, Lansoprazole Nexium: 粒, 不. 不, Mesalazine:, PH>7,, 不 - - 療不良 diphenhydramine β-blockers reserpine, clonidine, methyldopa ACEIs spironolactone 臨 4

Beers : 老 (1) (, 率, 量 ) 刺 :, 類便 : dose < 325mg/day, 量, 易便 Estrogen:, 年女 : 量女 (2) 異率 1~2% 2% 精卵 14~55: 12 ACEI: Antithyroid drugs: 狀 Benzodiazepines: Floppy infant syndrome ( 異異 ) -blockers: Barbiturates: NSAID: Tetracyclines: Warfarin: Phenytoin Carbamazepine Valproic acid Lithium Warfarin Retinoids Danazol ACEIs, ARBs Estrogen Thalidomide - Analgesics: acetaminophen, ibuprofen, naproxen, ketoprofen Antacids Antisecretory agents: cimetidine, famotidine, ranitidine, and nizatidine Antidiarrheals: kaolin-pectin and attapulgite Antihistamines: brompheniramine, chlor-pheniramine, diphenhydramine, and triprolidine Cough preparations: dextromethorphan Decongestants: phenylephrine Bulk-forming, senna, MgO, glycerin, docusate, Vitamins 不良, 錄 Penicillin Cephalosporin Augmentin (Amoxicillin+Clavulanate) Baktar (Sulphamethoxazole+Trimethoprim) 5

polypharmacy 75 y/o, male 度 On NG, on foley CVA, HTN Bladder Ca, metastatic 量量 1 Esomeprazole 40 mg 1# QDAC 2 Tamsulosin 0.2 mg 1# HS 3 Terazosin 2 mg 1# HS 4 Etodolac 400 mg 1# Q5PM 5 Aluminum hydroxide 324 mg 1# QID Polypharmacy 量量 1 Esomeprazole 40 mg 1# QDA C 2 Tamsulosin 0.2 mg 1# HS 3 Terazosin 2 mg 1# HS 4 Etodolac 400 mg 1# Q5PM 5 Aluminum hydroxide 324 mg 1# QID Peptic ulcer, On NG, on foley, CVA, HTN, Metastatic Bladder Ca, Constipation On NG tube feeding 不 1 Esomeprazole 粒 ( 類 ) 2 Tamsulosin () 3 Etodolac 2 -blockers 理 Hytrin (terazosin) HTN, BPH Harnalidge (tamsulosin) BPH bladder Ca, on foley? Constipation Aluminum containing product 不不臨 1.simvastatin (Zocor) 降臨 2.Adalat OROS 不讀 1. 療不 2. 讀來不來量不不索療療念 () 3. 4. 5. 不狀 1 量不不狀 2~ 率. 不狀 3 不量狀 1 療論便參狀 1 料論 6

療 Pharmaceutical diagnosis 參力 1. 量 2. 3. 療度不 1. 2. 不良 3. 濫 1. 2. 3. 4. 不良 Pharmaceutical diagnosis 1. 量 or 不 2. 3. 4. 5. 療 1. 2. 類 3. 4. 療不 5. 療 1. 2. 3. 數 4. 1. 療 2. 識 3. 不路 4. 療療療念識理參 (participation) 識識立參 Revised from Japan Health Promotion & Fitness Foundation, 2000 THE PROCESS OF HEALTH PROMOTION FOCUS STRATEGIES IMPACT OUTCOMES Drug related needs warfarin, INR 38%, CYP2C19 Individuals Groups Population Education counseling Economic change Legislative change Policy or organization change Behavioral educational change Social, economic and environment change Better Health Quality of life 7

Community pharmacists are also looking for new way to interact with patients and improve the outcomes of drug therapy 療理理都都不了療療不療不療療療療療立療療 \ 契 ( 若歷料 ) 1. 療»» 錄狀參» 類不» 2.() 度 3. 療來 4. 不 5. 令 Health promotion is the process of enabling people to increase control over and improve their health. WHO1984Ottawa 8

Key Priorities (from Healthy Mid Sussex ) 行領 1986 Cancer Coronary Heart Diabetes Mental health Improving life chances for children Older people Reducing substance misuse 立行行 Ethical Issues in Patient Counseling Ethical Issues in Patient Counseling 良錄 ;; 率不漏料 ( 歷 ) 立切 : 禮兩益 9

什??? 什? 不? 不? 了不? 10

, 行度異聆力說離力連裂不聆 : 聆, 了 : 了度異聆狀力量狀來 (care) 了精神錄利識, 來 11

略參更 1. 不不茶 2. 立數泥 1 狀論度立見良六略略良度略了略了略識略了度略六說來參略良度來度錄神令律不 Arrhythmia 亂糖尿 Diabetic 糖 Epilepsy NSAID: Aspirin: 路離不不度勵說說裡論令論列 : 濫不識便便不 : 度列不 (Ostomy supplies) 12

見 Non-Verbal Communication 1. 立 ( ) 2. 不 3. 4. 5. 度 6. 說 7. Ex: ( 了 ) 8. High educational patient Psychiatric patient 3Oncology patient 9. 療 Viagra, sulpiride 10. 11.: 12. Drug Information counter Sexual dysfunction 3Pharmacological abortion 4 不論 Accounts for 65% - 93% of the total meaning of communication 2010/4/22 www.health nurses doctors.blogspot.com 領識念老年 or 理 ~ :,, 不泥 :,, 2010/4/22 領識精神離 1.5~4 13

念錄利利見略了 X 來老 70 老來 cataflam 1 T.I.D.(Diclofenac) 3 年 1. 2. 3. 理度 4. 了識 ( 度度不見 ) 例了什理什? 什? 不? 力見度 (Adherence) 了不了讀狀 14

例 1. 不力不料來,, 飯飯 ( 什 ), 不, 2. 年老 3. 不了了不來立便不來了識 ~() 不 ( 勞 ) () (IE, hypnotics)!!! 了了更料了類 XX 領來療類類? 類? 類 ()vs.() 量見年類療類立 ~ 索不見了立 15

識 16

料路念例異 17

Bing 略了不量來略識略了度識識識不療療識療識流療不不說料來理讀都不說 18

略六說略六 ~ 說說療說更說利識.. 料識理臨料行理臨狀 19

不不 / 不不 / 不 Ex: Clonazepam(Rivotril) : 說,, 練說來 :, 索 : 勵,, 不識度不不不讀讀識料參不若不來不 (1) 2 : 拉狀不 1-3 0.5 3-5 2 離 5-10 : 拉拉 : 塞 3-5 20

: 若 303-5 30 度 45 度 15 : 冷 : 塞兩 5-10 : 塞兩 5 說老年残力不易 (Hard -to Reach) 不不度老年老年力不度流行說 21

不良 Ex :Fenoterol,Procaterol 糖糖冷残聯不力不不不力. 練理讀理狀度力不度利離. 理說神來 point and spell boards( ) 不力說不不來識說 Insulin pens 不易年更不利不不來了療不率惡說 22

不 (PRN) 降 NSAID 若理不說度說不說不來論來療度度離拉論不易若了力降療索識更練累獵識類療理行略 () 錄練復不不索索類略料錄說了 / 了 /// 料來 SCREEN 見狀留錄索索類略料錄復不不說了 / 了 / 1. 復什 2. 復不? 識 1. 路 2.MIMS(Ceftibuten- 3 G cepha) (Most frequent reactions were gastrointestinal and nauseas) 1.2. 見不見若若不狀療若留錄聆流里車念 kenstar5148@yahoo.com.tw 23