Candidate card · Community pharmacy
You are a pharmacist in a community pharmacy. The patient, aged 74, is collecting their first prescription of apixaban 5 mg twice daily for newly diagnosed atrial fibrillation.
Task
- Check what the patient knows about why they are taking apixaban.
- Explain how and when to take it, and what to do if a dose is missed.
- Explain the signs of bleeding and when to seek help.
- Advise about over-the-counter painkillers and supplements.
- Give them an anticoagulant alert card and check understanding.
Preparation: 3 minutes · Role-play: about 5 minutes
What to expect from the patient
- The patient takes ibuprofen regularly for arthritis and fish oil supplements.
- They are worried about “bleeding to death” after reading the leaflet.
Sample phrases for each stage
Opening
“Before we start, could you tell me what the doctor said about why you need this medicine?”
Instructing
“Take one tablet in the morning and one in the evening, about twelve hours apart, with or without food.”
Reassuring
“Serious bleeding is uncommon, and this medicine greatly reduces your risk of a stroke. Knowing the warning signs means you can act quickly if needed.”
Advising
“Ibuprofen increases the risk of bleeding when taken with apixaban, so it’s best to avoid it. Paracetamol is a safer choice for your arthritis pain — and I’d also let your doctor know so they can review it.”
Checking
“Could you tell me what you would do if you noticed blood in your urine or black stools?”
Common mistakes on this card
- Delivering a monologue of leaflet information without asking about current medicines.
- Missing the ibuprofen and supplement use, which is the key safety issue.
Say it out loud — with an AI patient
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