Describe the counselling you would provide Ebrahim regarding his lifestyle, make it specific to his needs. Discuss which organisations and pharmacy services you would recommend or refer him to and why.

Ebrahim is a 54-year-old taxi driver who lives at home with his wife, and three teenage sons. He knows that he does not lead a very healthy lifestyle- he is morbidly obese with a BMI of 41 and enjoys what he calls “real food” rather than fruits and vegetables, or food that is low in saturated fats. He does not undertake any form of aerobic exercise and has smoked ten cigarettes a day since the age of 19.

Over the course of a month, Ebrahim starts to feel generally unwell. He notices that he becomes breathless when climbing the stairs, and that his chest feels tight.
One day, he leaves for work and after driving for ten minutes his left arm begins to ache intensely. Within 20 minutes he has a crushing pain in the centre of his chest, is sweating profusely, and feeling dizzy and lightheaded. He recognises these as symptoms of a heart-attack and pulls over to the side of the road to call 999.

An ambulance is with him in eight minutes and confirms via ECG that Ebrahim is having a heart attack. They transport him to the local hospital with a larger coronary care unit and the ability to perform PCI, after administering 300mg aspirin and 2.5mg IV morphine.

PART 1 (5%)
Explain how the ambulance team were able to ascertain that Ebrahim was having a myocardial infarction (MI) from the ECG. (5%)
Standards:
ID and employ the appropriate diagnostic or physiological testing techniques to inform clinical decision-making

Ebrahim arrives at hospital where his diagnosis of an MI is confirmed by the medical team. Whilst waiting for further test results, you overhear him talking on the phone to his wife, and he says “I’m not going to tell them I’m a taxi driver, cause they won’t let me work for a while after a heart attack, and they’ll tell the DVLA”. He notices that you have overheard the conversation and asks to speak with you.

He begs you not to tell the medical team that he is a taxi-driver, as his family rely solely on his income, and he can’t afford not to work when he gets out of hospital.

PART 2 (15%)

Citing the GPhC standards for pharmacy professionals, explain what the best course of action would be. (15%)
Standards:

Recognise ethical dilemmas and respond in accordance with relevant codes of conduct
Support the patient in choosing an option by listening and responding to their concerns and respecting their decisions

Apply the principles of clinical governance in practice

Ebrahim has now returned from theatre after having a PCI procedure, where the medical team found one occluded artery, in which they placed a drug eluting stent.

PART 3 (15%)

Compare and contrast a drug-eluting and conventional stent. In your answer you should briefly define what they are how they differ in formulation and what are their advantages and disadvantages. In your discussion of drug-eluting stents you should name at least two examples of drugs used and also make mention at least three mechanisms of drug release with an explanation. (15%)

Standards:

Demonstrate how the science of pharmacy is applied in the design and development of medicines and devices

A new consultant in the hospital has been assigned to Ebrahim’s care, and you notice that she has prescribed a drug that you are unfamiliar with.

She has prescribed: Omacor, 1g daily

You explain to the consultant that this drug is not normally given post-MI at your hospital trust, but the she is adamant she wants to prescribe it, as she has used it in the past where she used to work.

PART 4 (15%)

Critically evaluate the evidence for the use of Omega-3 fatty acids post MI in secondary prevention. Give a recommendation to the consultant based on the evidence you have analysed on whether this drug should be used for the patient. (15%)

Standards:
Access and critically evaluate evidence to support safe, rational and cost-effective use of medicines.
Use the evidence base to review current practice

After a total of 5 days in hospital after his MI, Ebrahim is now ready for discharge, and has been referred to you for lifestyle counselling.

PART 5 (15%)
Lifestyle counselling
Describe the counselling you would provide Ebrahim regarding his lifestyle, make it specific to his needs. Discuss which organisations and pharmacy services you would recommend or refer him to and why. (10%)

Research into one specific local service that is provided outside the pharmacy or healthcare setting. Explain how this service will be of value to Ebrahim, discuss how this will improve his health and quality of life.

Provide a website link to the service. (this may include activity or social prescribing etc) (5%)

Standards:

Promote healthy lifestyles by facilitating access to and understanding of health promotion information

Play an active role with public and professional groups to promote improved health outcomes

Contribute to research and development activities to improve health outcomes

It has now been 18 months since Ebrahim had his MI, and he receives an appointment to see the pharmacist at his GP surgery for a medication review.
His current medication list is:

Aspirin dispersible tablets 75mg OM
Ticagrelor 90mg BD
Ramipiril 1.25mg ON
Atorvastatin 80mg ON
Bisoprolol 1.25mg OM

Blood pressure: 168/98mmHg
Pulse: 90bpm
NKDA

PART 6 (15%)
Clinically evaluate the appropriateness of each of the medicines that Ebrahim has been prescribed for long term secondary prevention of MI. Give recommendations for any changes you would make, and how you would work with the GP practice team to ensure these changes are made. (15%)

Standards:

Apply knowledge of current pharmacy-related policy to improve health outcomes

Clinically evaluate the appropriateness of prescribed medicines

Optimise treatment for individual patient needs in collaboration with the prescriber

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