Summary
Summary Clinical check interactions for OSCE station - 3rd year
- Module
- PHA333
- Institution
- University Of Sunderland (UoS)
All the interactions for OSCE
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Clinical Check Station(Use clinical language – NOT patient friendly)
When contacting the prescriber:
Explain problem e.g. Interaction
What are the implications and problem for patient?
Explanation and propose a solution
Additional considerations/problems/issues/follow up?
Prescriber may ask questions
Clinical Check Scenario - Alzheimer’s:
- Problem – Patient is bradycardic – may be due to donepezil and donepezil can cause
bradycardia and worsened by bisoprolol (can reduce HR) – due to interaction
- Implication to patient – potential for falls/fainting/dizziness – Bradycardia can be
asymptomatic but can lead to syncope/fainting/cardiac collapse. Remember patient
admitted with a fall – may be related to this.
- What do you suggest/solution (RED FLAG) – likely patient had previous MI history due
to meds (Acei, Statin, aspirin) – most likely to withhold donepezil and monitor HR and
then consider alternative dementia treatment e.g. memantine
- Additional considerations/problems/issues/follow up – monitor the HR
, Dementia Interactions
Galantamine + Chlorphenamine
1. Problem – Chlorphenamine has high anticholinergic burden which can increase
the risk of cognitive decline
2. Implication for patient – increases risk of cognitive decline and increased
mortality. Also, drugs with anticholinergic actions cause SE e.g. constipation,
drowsiness, urinary retention, falls, confusion
3. Solution – Confirm indication with prescriber – offer alternative antihistamine
with lower anticholinergic burden e.g. Fexofenadine
Donepezil – Non-compliance to medication
1. Problem – Identified non-compliance to Donepezil
2. Implication for patient – Patient not receiving benefits from the medication
which would help maintain his current skills and abilities therefore improving
QoL
3. Solution – Explore reasons of non-adherence e.g. swallowing difficulties – switch
to oro-dispersible tablets. Consider other support e.g. reminder charts or family
support
Donepezil + Bisoprolol (BB) + Lowered Pulse/BP
1. Problem – Patient has bradycardia (if pulse below 60bpm). Due to interaction of
Donepezil and exacerbated by combination with BB which can both reduce HR
2. Implication for patient – Risk of bradycardia is reduced blood pumped from
heart to meet body needs. Symptoms such as fatigue, dizziness, or more serious
e.g. cardiovascular collapse = life threatening
3. Solution – Withhold Donepezil and review patient/monitor HR. May need to try
alternative e.g. Memantine
Depression Interactions
Citalopram 40mg + Elderly (>65)
1. Problem – Dose is too high for elderly patient >65
2. Implication for patient – Increased risk of QT prolongation, SE e.g. light-
headedness, weakness, blurred vision, heart palpitations
3. Solution – Reduce dose to 20mg. ECG should be done before initiation especially
if patient has CV complication and U&E due to potential hyponatraemia with
antidepressants especially SSRIs
Citalopram 40mg + Elderly + Low Sodium Levels (Hyponatraemia)
1. Problem – Dose is too high, maximum dose for >65 is 20mg
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