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module menu icon 2. Starting the consultation

Starting the consultation

A good starting point is to actually explain the role of a pharmacist to the patient. This not only helps them understand why you are talking to them – possibly at more length than usual – but also gives them an insight into how and why the pharmacy is a place they can come to for ongoing support without the need for an appointment.

A patient presenting a prescription for gout medication may have been diagnosed with the condition recently or some time ago. It is sensible to explore their understanding of the condition and medication: their knowledge may be extensive or extremely limited and possibly not entirely accurate either. 

A gout attack can be extremely painful, so patients are usually motivated to try and get their symptoms under control or reduce the risk of a further exacerbation. Someone with a decent understanding of their condition is much more likely to comply with measures that have been recommended. It is also useful to establish what information they have already received.

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Learning scenario 1

Tell him it is OK to take the colchicine for up to seven days if his symptoms persevere.

INCORRECT. He should not take more than 6mg colchicine per course, and taking 500mcg even twice a day for seven days would exceed this.

Recommend starting at the highest dose and then titrate down as needed.

INCORRECT. Colchicine has a narrow therapeutic index, so care needs to be taken with dosing. 

Highlight diarrhoea and vomiting as common side-effects, but tell him to push on through in the interests of getting on top of his gout attack.

INCORRECT. These side-effects should not be ignored.

Stress he needs to avoid his usual glass of grapefruit juice in the morning.

CORRECT. An interaction exists between colchicine and grapefruit juice.

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