Medicines Knowledge Week 4 (Levodopa +/- Carbidopa or Benserazide, Pramipexole, Diazepam, Escitalopram, Lithium)

Question 1

Levodopa with benserazide or carbidopa drug class

Answer 1

“other drugs for parkinsons disease”

Question 2

Levodopa +/- Carbidopa or Benserazide indication

Answer 2

Parkinsons disease

Question 3

Levodopa +/- Carbidopa or Benserazide dosage range and timing

Answer 3

Oral, initially 50–100 mg 2 or 3 times daily; adjust gradually according to response and tolerance. Doses of up to 2 g (given in 3 or more doses) daily may be needed.

Question 4

Levodopa +/- Carbidopa or Benserazide Counselling (3 marks)

Answer 4

Take this medicine at the same time each day and in the same way (eg always before food).

Mdication may cause drowsiness; if affected do not drive or operate machinery.

Be careful when you stand up as this medicine might make you feel dizzy if you stand up too quickly.

Question 5

Levodopa +/- Carbidopa or Benserazide monitoring

Answer 5

Monitor for adverse effects such as allergic reactions including angioedema

Monitor for overuse of levodopa which includes psychiatric effects such as psychosis and impulse control disorders

Question 6

Pramiprexole drug class

Answer 6

Dopamine agonist

Question 7

Pramiprexole indication

Answer 7

Parkinsons disease

Restless leg syndrome

Question 8

Pramipexole dosage range and timing

Answer 8

Parkinsons disease: Initially, 125 micrograms 3 times daily for a week, then 250 micrograms 3 times daily for a week, then 500 micrograms 3 times daily. Maximum of 1.5mg 3 times daily.

Restless leg syndrome: Initially 125 micrograms at night 2-3 hours before bedtime. Maximum of 750 micrograms once daily.

Question 9

Pramipexole counselling

Answer 9

Take tablets with food to lessen the chance of nausea or stomach upset.

Tell your doctor if you notice any change in your behaviour, eg overspending, gambling or excessive sexual activity.

This medicine may cause dizziness or drowsiness; if affected, do not drive or operate machinery.

Question 10

Pramipexole monitoring

Answer 10

Monitor for psychiatric adverse effects such as hallucinations and confusion

Warn patients and carers of the possibility of impulse control disorders which include gambling,overspending and binge eating.

Question 11

Diazepam drug class

Answer 11

Benzodiazepine

Question 12

Diazepam indications

Answer 12

Short term managment of anxiety and management

Acute alcohol withdrawal

Benzodiazepine withdrawal

Status epilepticus

Premedication

Question 13

Diazepam dosage range and timing

Answer 13

Anxiety/agitation: Oral, 2–5 mg as a single dose. Dose may be repeated, if necessary, up to a maximum of 10 mg daily.

Pre-medication: IV –> 0.1-0.2 mg/kg

Question 14

Diazepam counselling

Answer 14

You may feel drowsy while taking this medication, drowsiness may persist the following day

Avoid alcohol and other medications that may cause drowsiness while taking this drug

If you stop the medicine suddenly, you may have unpleasant effects (eg feeling anxious, difficulty sleeping)

Question 15

Diazepam monitoring

Answer 15

Monitor for adverse effects such as allergic reactions and rash

Monitor renal function

Question 16

Escitalopram drug class

Answer 16

Selective serotonin reuptake inhibitor (SSRI)

Question 17

Escitalopram indications

Answer 17

Major depression

Generalised anxiety disorder

Social phobia

Obsessive-compulsive disorder

Question 18

Escitalopram dosage range and timing

Answer 18

Adult, oral 10 mg once daily, increased if needed after 2–4 weeks to a maximum of 20 mg once daily.

• Maintenance doses >10 mg are not usually necessary.

Question 19

Escitalopram counselling (3 marks)

Answer 19

This medicine is usually taken in the morning.

Do not stop taking this medicine suddenly unless your doctor tells you to.

Do not drive or operate machinery until you know how this medicine affects you.

Question 20

Escitalopram monitoring

Answer 20

Monitor patients for increases suicidal thoughts and behaviour, as this can occur after starting antidepressants

Monitor for adverse effects such as taste disturbances and parasthesia

Question 21

Lithium drug class

Answer 21

Drugs for bipolar disorder (mood stabiliser)

Question 22

Lithium indications

Answer 22

Treatment of acute mania

Prevention of manic or depressive episodes in bipolar disorder

Augmentation for treatment-resistant depression

Question 23

Lithium dosage range and timing

Answer 23

Acute mania: 750-1000mg daily in divided doses, increase dose by 250-500mg daily if necessary

Prophylaxis: 250-1000mg daily in divided doses for 2 weeks

> adjust according to serum concentration

Question 24

Lithium counselling

Answer 24

Take with food

Maintain a normal diet with regular salt and fluid intake.

Regular blood tests are important during treatment

Question 25

Lithium monitoring

Answer 25

Monitor for signs and symptoms of lithium toxicity such as extreme thirst, frequent urination, nausea and vomiting. If these occur, stop taking the tablets and seek medication attention immediatelty.

Monitor weight, renal and thyroid function at baseline then every 3-6 months.