# PSA communicating information: counselling points Source: PassthePSA, PSA revision notes URL: https://passthepsa.com/psa-revision/communicating-information/ Updated: 2026-10-01 Topic: UK Prescribing Safety Assessment (PSA) revision Short answer: The PSA communicating information items ask you to choose the single most important thing a patient needs to know about a medicine. Use a method: indication, how to take it, key risk, and what to do if something goes wrong. Rank by harm prevented, and prefer advice specific to that drug over generic advice. ## What does the communicating information skill test? The item tests prioritisation: several options may be true, but one prevents the most serious harm. - Rank by harm, not by how often a side effect occurs. - Specific beats general: a drug-specific warning usually beats advice that applies to any medicine. - Fit the patient: pregnancy, driving, occupation and other medicines change which point matters most. ## What method picks the right counselling point? 1. Indication: say what the medicine is for, so the patient knows why to take it. 2. How to take it: dose timing, route, relation to food, and technique. 3. Key risk: the worst realistic harm, and the sign that should prompt action. 4. If something goes wrong: what to do for missed doses, vomiting, illness or symptoms, and who to contact. The BNF monograph sections on important safety information and patient and carer advice list the points the exam favours. ## What are the key counselling points for cardiovascular and anticoagulant drugs? Medicine | Most important point | Why --- | --- | --- Warfarin | Keep INR checks; report bleeding; tell staff before any new medicine, including antibiotics and OTC drugs | Many interactions alter INR DOACs | Take regularly without missed doses; carry the alert card; report bleeding; do not stop without advice | Short half-life gives little protection if doses are missed GTN | Sit down to use it; if chest pain is not relieved within the time given in the patient advice (about 5 minutes), call 999; never with sildenafil-type (PDE5 inhibitor) drugs | Hypotension; profound hypotension with PDE5 inhibitors Statins | Report unexplained muscle pain or weakness | Myopathy and rhabdomyolysis ## What are the key counselling points for inhalers, steroids and diabetes drugs? Medicine | Most important point | Why --- | --- | --- Inhalers and spacers | Preventer is taken daily even when well, unless on a combined maintenance-and-reliever regimen where the prescriber explains the single inhaler; reliever is for symptoms; use a spacer with a metered-dose inhaler, one puff at a time; rinse the mouth after an inhaled steroid | Poor technique and reliever overuse mark poor control Oral steroids | Carry a steroid card; do not stop suddenly after a long course; seek advice when ill (sick-day rules) | Adrenal suppression can cause crisis Metformin | Temporarily stop during dehydrating illness and restart once eating and drinking normally, seeking advice if unsure; for iodinated contrast follow local policy (usually withheld only if eGFR is low or there is acute kidney injury) | Risk of lactic acidosis with acute kidney injury Insulin | Recognise and treat hypoglycaemia and carry fast-acting carbohydrate; do not stop insulin when ill, and check glucose (and ketones in type 1) more often; follow DVLA driving advice | Hypoglycaemia is the main harm of treatment; omitting insulin when ill risks diabetic ketoacidosis Bisphosphonates (oral) | Swallow whole with a full glass of plain water on an empty stomach; stay upright and wait before food, drink or other medicines (at least 30 minutes, longer for ibandronate) | Oesophageal irritation ## What are the key counselling points for opioids, antidepressants, methotrexate and antibiotics? Medicine | Most important point | Why --- | --- | --- Opioids | Expect constipation and take a regular laxative; drowsiness, driving and alcohol; do not stop abruptly after regular use, and discuss dependence and dose reduction with the prescriber | Constipation is very common and does not wear off; sedation and respiratory depression are the key risks Methotrexate | ONCE WEEKLY, never daily; report sore throat, fever, mouth ulcers, bruising or breathlessness | Daily dosing errors can be fatal; bone marrow toxicity Antidepressants | Effect takes weeks; do not stop suddenly; report worsening mood or agitation early on | Discontinuation symptoms; early risk review Antibiotics | Take as prescribed; report severe or persistent diarrhoea; drug-specific warnings (alcohol with metronidazole, upright with doxycycline) | Prevents harm and failure of treatment Rifampicin | Orange body fluids; reduces the effect of pills, patch, ring and implant (not injectable, IUS or copper IUD), so alternative contraception advice is needed | Enzyme induction ## How are contraception and teratogens counselled? Contraception counselling at PSA level covers missed pills, interacting drugs and when to seek help; check FSRH guidance for the exact rules. - Missed combined pills: one missed pill (taken 24 hours or more late) should be taken as soon as remembered, with no extra precautions; two or more missed pills reduce protection, so take the most recent missed pill, use condoms or abstain for 7 days, and consider emergency contraception depending on where in the pack the pills were missed and whether sex has occurred. Check FSRH guidance. - Enzyme inducers, such as rifampicin, carbamazepine and St John's wort, reduce hormonal contraceptive effect. - Valproate: enrolled in a Pregnancy Prevention Programme because of major malformations and neurodevelopmental harm; not for women and girls who can become pregnant unless conditions are met. - Isotretinoin: strictly contraindicated in pregnancy, with a Pregnancy Prevention Programme and effective contraception. - Topiramate, acitretin and mycophenolate also carry pregnancy-prevention requirements; check the BNF and MHRA advice. - ACE inhibitors and ARBs: avoid in pregnancy unless essential, because of fetal and neonatal renal harm (mainly second and third trimesters); advise review when planning a pregnancy. Note: Confirm in the BNF: counselling points here are principles, not doses. Check the BNF patient advice, important safety information and FSRH guidance before relying on them. ## Check yourself - What is the single most important counselling point for methotrexate? - What advice should a patient on long-term oral steroids receive? - How should oral bisphosphonates be taken? - What is the key counselling point for GTN, and which drug class must not be combined with it? - Why should insulin never be stopped during illness? - What constipation advice goes with opioids? - Which medicines need a Pregnancy Prevention Programme? - What four-step method organises counselling? ## Questions people ask Q: What does the communicating information section ask? A: It asks you to choose the single most important thing a patient should be told about a medicine. Several options may be true, so you rank them by the harm they prevent. Q: What should patients on oral steroids be told? A: Carry a steroid card, do not stop suddenly after prolonged or repeated courses, and seek advice when unwell because extra doses may be needed. Check the BNF for specifics. Q: What is the key warning with methotrexate? A: It is taken once a week, never daily, and patients should report sore throat, fever, mouth ulcers, bruising or breathlessness promptly. Q: Which medicines carry pregnancy prevention programmes? A: Valproate, topiramate and oral retinoids such as isotretinoin and acitretin have Pregnancy Prevention Programmes because of serious fetal harm, and mycophenolate has similar mandatory measures. ACE inhibitors and ARBs have no such programme but are avoided in pregnancy. ## Related notes - Adverse drug reactions for the PSA: https://passthepsa.com/psa-revision/adverse-drug-reactions/ - High-risk medicines for the PSA: https://passthepsa.com/psa-revision/high-risk-medicines/ - Drug interactions for the PSA: https://passthepsa.com/psa-revision/drug-interactions/ - Antibiotic prescribing for the PSA: https://passthepsa.com/psa-revision/antibiotics/ Sources: BNF; MHRA Drug Safety Update; FSRH guidance on contraception; NICE guidance. Exam-revision notes, not patient-specific advice; the BNF is the authority. More: https://passthepsa.com/psa-revision/ (all notes), https://passthepsa.com/psa/ (exam guide), https://passthepsa.com/ (practice questions).