OSCE Toolbox | Medication Counselling 9 - Scenario

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Scenarios

Medication Counselling 9

By Jitesh Arora • March 21, 2024 • Last reviewed: 24/09/24 •

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Summary Beginner

In this scenario, the student is tasked with counselling a patient who has been started on amlodipine. The focus is on explaining hypertension, its management, amlodipine use, and addressing the patient’s questions and concerns.

Please ensure that this scenario and mark scheme align with the most up-to-date guidelines from the UK NICE and the BNF when using it for your OSCE assessment.

You will need a student pharmacist and an actor for this OSCE station.

Revision Topics

Be aware, this may reveal any answers!

Hypertension

Student Instructions

You are a pharmacist. You have been asked to counsel an Afro-Caribbean patient who has recently been diagnosed with stage 1 hypertension and newly prescribed amlodipine. The patient is curious about the condition and medication. Please address the patient’s questions and concerns and offer clear instructions.

To do:

You are expected to provide counselling information to this patient and to answer any questions appropriately. You must provide relevant advice.

You have 8 minutes.
You have access to the BNF.

You can use the following resources for this station:
EMC, 2023.Amlodipine Tablets - Patient Information Leaflet. [Online]. Available at:https://www.medicines.org.uk/emc/files/pil.3478.pdf

Actor Instructions

This may reveal scenario objectives!

You are Jordan Davis (Jor-dun, Day-vis).

Opening Statement: “I have just been told I have high blood pressure, and I was prescribed amlodipine. Can you explain what this means and why I must take this medication?”

Patient Information:
Provide this information if prompted.

Name: Jordan Davis

Age: 30
Ethnicity: Afro-Carribean

Medical Conditions:

- “I am newly diagnosed with high blood pressure.”

Medication History:

- “None.”

Allergies:

- “Penicillin, causing a rash.”

Symptoms:

- “None.”

Prescription:

- “Amlodipine 5mg tablet ONCE a day.”

Social History:

- “I am a social smoker, and I drink alcohol once per week. I have around 4 beers a week.”

Questions (use to prompt the student if they miss these areas):

“What exactly is high blood pressure and why is it so bad?”

“I have been told that I have ‘stage 1 hypertension’, but I am not sure what that means?”

“Why do I have to take amlodipine when my childhood friend takes something called ramipril for the same thing?”
- If asked: "My childhood friend is British, white and the same age as me."
“I recently bought a blood pressure monitor - what sort of readings should I be aiming for when I check it at home?”

Mark Scheme

Introduction

0 / 2

Introduce yourself and greet the patient professionally.

Confirm the patient's name and age.

Medical History

0 / 4

Confirms Medical history

Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies

Confirms Allergies

Confirms the amlodipine regimen is correct i.e. correct dose, frequency, form prescribed and understood by the patient

Management and Advice

0 / 9

Explain what hypertension is and its role in raising blood pressure and potential risks to health:

Describe hypertension as a condition where the force of blood against the artery walls is consistently too high, contributing to heart disease, stroke, kidney problems, and other health issues

Discuss how uncontrolled high blood pressure can damage blood vessels, and organs, and lead to serious complications

You cannot always feel hypertension and it can get worse over time which can lead to a higher risk of serious medical emergencies, so it is important to regularly check blood pressure and record results to notice any changes.

Explain what stage 1 hypertension means:

Explain that the patient's diagnosis of stage 1 hypertension signifies slightly elevated blood pressure

State that there are 3 stages overall.

Explanation for medication choice (Amlodipine over ramipril):

Explains that ACE inhibitors (e.g. ramipril) may work less effectively in Black patients due to the unique way our bodies process certain medications.

It’s like different keys for different locks. ACE inhibitors work by blocking a specific pathway in the body to lower blood pressure. In some cases, especially for people of African or Caribbean descent, this pathway might not be as responsive to ACE inhibitors. It’s like trying to unlock a door with a key that doesn’t fit perfectly.

Emphasises choosing this medicine is backed up by prior scientific data and what the patient is most likely to benefit from.

"Amlodipine ensures that you have the best chance of effectively managing your blood pressure and reducing risks associated with high blood pressure. It’s all about finding the right treatment that’s the best fit for you."

Discuss the potential side effects of amlodipine:

States common side effects e.g., dizziness, drowsiness, ankle swelling, headaches, flushing

States serious side effects e.g., irregular heartbeat, chest pain

Blood Pressure Monitoring

0 / 2

If they do blood pressure monitoring at home, ensure they take another reading a few minutes after the first reading to make sure it is accurate

Set target BP levels: < 140/90 mmHg in patients under 80 years old (including in diabetics)

The blood pressure target is < 130/80 mmHg in patients under 80 with CKD and an ACR above 70 mg/mmol

Safety Netting

0 / 1

Provide safety netting advice, including when to seek medical attention

e.g., severe side effects, persistent high blood pressure, or unusual symptoms.

Communication

0 / 5

Maintains professionalism throughout the interaction

Use clear and understandable language.

Ensure the patient comprehends the information provided.

Conclude the conversation professionally, offering reassurance, and encouraging further questions or concerns

The student did not say anything that could harm the patient

This includes but is not limited to, providing incorrect information or medication, misdiagnosing conditions, neglecting to inquire about allergies, making incorrect referrals, or failing to act on red-flag symptoms.

Any criteria in bold must be written down accurately to pass this OSCE station.

Referral Criteria

Referral Criteria for Hypertension

A&E

Extremely high blood pressure (hypertensive crisis): Blood pressure readings of 180/120 mmHg or higher with symptoms such as severe headache, chest pain, shortness of breath, or vision changes could indicate a hypertensive crisis, requiring immediate medical attention.
Severe chest painthat may suggest a heart attack: If a patient experiences chest pain or discomfort that feels like pressure, squeezing, or fullness, it could indicate a heart attack requiring emergency care.
Symptoms of organ damage associated with high blood pressure, such as acute kidney failure (e.g., reduced urine output, confusion, or swelling), require immediate medical intervention.

Urgent GP Appointment

Elevated blood pressure readings with additional risk factors: Patients with high-normal blood pressure and additional cardiovascular risk factors (e.g., diabetes, smoking, family history of heart disease) require an urgent evaluation.
Symptoms of hypertension-related complications, such as persistent severe headaches, visual changes, or nosebleeds, may indicate poorly controlled blood pressure needing urgent review.
A sudden drop in blood pressure (hypotension)with symptoms like dizziness, fainting, or confusion: Could indicate a serious condition like shock, requiring urgent evaluation.

References

British National Formulary (BNF), 2024.Hypertension - Treatment Summary. [online] Available at: https://bnf.nice.org.uk/treatment-summaries/hypertension/ [Accessed 23 August 2024].
British National Formulary (BNF), 2024.Hypertension - Treatment Summary. [online] Available at: https://bnf.nice.org.uk/treatment-summaries/hypertension/ [Accessed 23 August 2024].
National Health Service (NHS), 2024.Blood Pressure Test. [online] Available at: https://www.nhs.uk/conditions/blood-pressure-test/ [Accessed 23 August 2024].
National Health Service (NHS), 2024.Blood Pressure Test. [online] Available at: https://www.nhs.uk/conditions/blood-pressure-test/ [Accessed 23 August 2024].

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Referral Criteria for Hypertension

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