Common Drug Explanations Flashcards
1
Q
How should you organize your explanation of drugs to patients?
A
ATHLETICS
- Action
- Timeline
- How to take
- Length of treatment
- Effects (time before)
- Tests
- Important side effects
- Complications and contraindications
- Supplementary advice
2
Q
What is the action of SSRIs?
A
Antidepressants alter the balance of some of the chemicals in the brain.
SSRI antidepressants mainly affect a chemical called serotonin.
An altered balance of serotonin and other chemicals is thought to play a part in causing depression and other conditions.
3
Q
What is the timeline of SSRI treatment?
A
once daily
4
Q
How do you take SSRIs?
A
Tablet form
5
Q
What is the length of SSRI treatment?
A
Stop 3-6mo after feeling better (taper off)
6
Q
How long before there’s an effect of the SSRI treatment?
A
4-6 weeks
7
Q
What tests need to be done to monitor SSRIs?
A
None
8
Q
What are some important side effects to note of SSRIs?
A
- GI upset (diarrhea, nausea, vomiting)
- Appetite + weight change
- Headaches
- Drowsiness (can take at night)
- Anxiety for 2w
- Withdrawal
9
Q
What are some complications of SSRIs?
A
None
10
Q
What are some contraindications for SSRIs?
A
- Suicide risk (refer)
- Past psychiatric illness
11
Q
What supplemental advice can you give someone for SSRIs?
A
www.mind.org.uk
NHS website
12
Q
What is the action of methotrexate?
A
It is a disease-modifying drug which reduces inflammation and suppresses the immune system.
Early use improves outcome and symptoms.
13
Q
What is the timeline of treatment with methotrexate?
A
- Once weekly with folic acid at another time.
- Take at same time each week
- Build up dose slowly.
- Taken long-term if effective.
- Takes 3-12wks to work.
14
Q
How do you take methotrexate?
A
Tablet usually
Injection also available
15
Q
How long is treatment with methotrexate?
A
Long term
16
Q
How long before there are effects of the methotrexate treatment?
A
3-12wks
17
Q
What tests are done to monitor methotrexate levels?
A
FBC, LFTs, U&Es
- Before starting
- Every 2wks until therapy stabilized
- Every 2-3mo afterwards
18
Q
What are important side effects of methotrexate?
A
- Alopecia
- Headache
- GI disturbance
- Myelosuppresion
1. Infection (go to A&E if you have fever/other infection signs)
- Unexpected bleeding/bruising/purpura
- Anemia
19
Q
What are complications of methotrexate use?
A
- Myelosupression
- Liver toxicity (careful of alcohol)
- Pulmonary toxicity (tell us if you get SOB)
20
Q
What are contraindications for methotrexate use?
A
- Pregnancy (including male!)
- Hepatic impairment
- Breast-feeding
- Active infection
- Immunodeficiency
21
Q
What is some supplemental advice for methotrexate use?
A
- No NSIADs/aspirin
- Get annual flu jab
arthritisresearch. org.uk
22
Q
What is the action of lithium?
A
Mood stabiliser.
Exact mechanism unknown.
Thought to enter the cells and interfere with chemical release + second messenger systems.
23
Q
What is the timeline of lithium treatment?
A
1-2x daily depending on the brand
24
Q
How do you take lithium treatment?
A
Tablet, capsule, or syrup
25
What is the length of lithium treatment?
Lifelong usually (if works)
Regular reviews by psychiatrist
26
How long before lithium treatment works?
1-2 weeks
27
What tests need to be done for lithium treatment?
Before starting: FBC, U&Es, TFTs, bHCG, ECG
- Check lithium level after 5d, then every week until stable for 4wks, then every 3mo
- Check TFTs, U&Es, Ca2+ every 6mo
28
What are the important side effects of lithium?
- GI (abdo pain, nausea)
- Metallic taste
- Fine tremor
- Water symptoms (thirst, polyuria, impaired urinary concentration, weight gain, oedema)
Lithium toxicity symptoms
1. GI (anorexia, vomiting, diarrhea)
2. Neuromuscular (dysarthria, dizziness, ataxia, in coordination, muscle twitching, tremor)
3. Others (drowsiness, apathy, restlessness)
29
What are complications of lithium treatment?
1. Renal toxicity
2. Nephrogenic diabetes insipidus
3. Hypothyroidism
30
What are the contraindications to lithium treatment?
- 1st trimester pregnancy
- Breast feeding
- Cardiac disease
- Significant renal impairment
- Addison's disease
- Low sodium diets
- Untreated hypothyroidism
31
What supplementary advice can you give someone on lithium treatment?
www.bipolaruk.org.uk
32
What is the action of atypical anti-psychotics?
Schizophrenia is caused by an over-activity of chemicals in transmission of messages in the brain.
Olanzapine works by blocking the receptors in the brain that are involved in tramsitting these messages between nerve cells.
33
What is the timeline of olanzapine treatment?
Tablet daily or depot injection every 2-4wks
34
How do you take olanzapine?
Tablet or depot injection
Start at a small dose and build up over 1-2 weeks.
Dose adjusted depending on person's response.
35
How long is olanzapine treatment for?
Long term (keeps symptoms from returning)
Tell doctor if wanting to get pregnant
36
How long before olanzapine starts working/see effects?
Several days or weeks
37
What tests need to be done with olanzapine treatment?
Occasional LFTs (may impair liver function)
38
What are important side effects of olanzapine?
1. Anti-dopaminergic
- Tardive dyskinesia
- Tremor
- Movement disorders
2. Anticholinergic
- Constipation
- Dry mouth
3. Antihistaminergic
- Weight gain
- Drowsiness/dizziness
4. Anti-adrenergic
- Hypotension
39
What are complications with olanzapine treatment?
1. Neuroleptic malignant syndrome (high fever + muscle rigidity)
2. Agranulocytosis (swelling of mouth/throat or rash)
3. Withdrawal
40
What are the contraindications for olanzapine treatment?
- Liver failure
- Phaeochromocytoma
Cautions:
- Epilepsy
- DM
- Glaucoma
- Heart, prostate, kidney problems
- Pregnancy
41
What supplementary advice can you give someone on olanzapine?
www.rethink.org
42
What is the action of levodopa?
Levodopa works to replace some of the dopamine your brain is no longer able to make.
This will help to reduce your symptoms, particularly your rigidity and slow movements.
Given with carbidopa (inhibits peripheral levodopa degeneration)
43
What is the timeline of levodopa treatment?
3-4x daily with food (reduces nausea)
44
How is levodopa taken?
Tablet
45
What is the length of levodopa treatment?
As long as it works effectively
After 5 years most suffer end dose deterioration (works for shorter time) and on-off effect (fluctuate between severe parkinsonism + repetitive involuntary movements)
46
How long before there's an effect with levodopa?
Fast acting
47
What tests must be done when on levodopa?
None
48
What are some side effects of levodopa?
- Psychosis
- Nausea/vomiting
- Dyskinesia
- Postural hypotension
*Other drugs help with these: domperidone (peripheral dopamine antagonist) + selegiline (inhibits dopamine degeneration in CNS so lower levodopa dose can be used)
49
What are the complications of levodopa treatment?
1. End-dose deterioration
| 2. On-off effects
50
What are the contraindications for levodopa treatment?
Glaucoma
51
Where can one find supplemental info on levodopa?
parkinsons.org.uk
52
What is the action of bisphosphonates?
Prevents bone from being broken down and by helping to rebuild new bone.
Remember lifestyle factors can also help with this: exercise, no smoking, eating a well-balanced diet
53
What is the timeline of taking bisphosphonates?
Once weekly or smaller dose daily
54
How are bisphosphonates taken?
Swallow tablet with full glass of water.
Take at least 30min before food or anything other than water.
Be upright for 30min after swallowing (big tablet)
55
How long do you need to stay on bisphosphonates?
Long term
56
How long before you feel the effects of bisphosphonates?
N/A
57
What tests must be done for bisphosphonates?
Dental checkups - before starting then regularly
B/c risk of osteonecrosis of jaw
58
What are side effects of bisphosphonates?
- Headache
- Heartburn, bloating, indigestion
- GI (diarrhea, constipation, black stools, abdominal pain)
59
What are complications of taking bisphosphonates?
Osteonecrosis of the jaw
60
What are contraindications to bisphosphonates?
1. Pregnancy
2. Dysphagia
3. Stomach ulcers
4. Severe renal impairment
61
Where can one find more info about bisphosphonates
www.Nos.org.uk
62
What is the action of warfarin?
Thins the blood.
It does this by blocking vitamin K - the vitamin used by the body to make proteins that cause the blood to clot.
63
What is the timeline of taking warfarin?
Once daily (usually in the evening)
64
How do you take warfarin?
Tablet
65
How long is warfarin treatment?
```
3mo = DVT
6mo = PE
Lifelong = AF
```
66
How long before you feel the effects of warfarin?
2-3 days
67
What tests must be done when on warfarin?
- Start 5mg for 4 days then test INR on day 5 + 8 adjusting dose accordingly
- Started concomitantly with LMWH if immediate effect is required
- Then regularly check INR by anti-coagulation clinic (regularity determined by INR stability)
68
What are important side effects of warfarin?
1. Bleeding (bruises, dark stool, cuts take longer to heal)
2. Diarrhea
3. Rash
4. Hair loss
5. Nausea
* Many drug interactions
- Mainly with cytochrome P450 inhibitors/inducers, steroids
69
What are complications of warfarin?
N/A
70
What are contraindications for warfarin?
- Pregnancy
- Hemorrhagic stroke
- Significant bleeding
*Caution in patients at high risk of falls
71
What is some supplementary advice for those on warfarin?
Avoid liver, spinach, cranberry juice, alcohol binges
No NSAIDs/aspirin
Give anticoagulant book
72
What is the action of levothyroxine?
A synthetic version of the normal hormone produced by the thyroid gland called thyroxine.
It is given to bring your thyroxine levels back up to normal
73
What is the timeline of levothyroxine?
Once daily before breakfast
74
How do you take levothyroxine?
Tablet
75
How long do you take levothyroxine for?
Lifelong
76
What tests must be done when on levothyroxine?
- Start test does then review in 2-3 weeks
- TSH test every 2-3mo until stable
- When TSH level stable, check annually
77
What are the side effects of levothyroxine?
Rare when thyroxine level stable as it's replacing a normal hormone.
May be hyperthyroid symptoms if level is too high
- Vomiting
- Diarrhea
- Headache
- Palpitations
- Heat intolerance
Or hypothyroid symptoms if level is too low
78
What are complications and contraindications to levothyroxine treatment?
N/A
79
What is supplementary advice for levothyroxine?
Free prescriptions for everything if taking levothyroxine
80
What is the action of a statin?
Statins stop the liver making cholesterol
Cholesterol is one of the things which predisposes to artery problems causing heart disease, stroke, and kidney disease
(Its important to also address other risk factors when talking to the patient)
81
What is the timeline of statin treatment?
Once daily in the evening
82
How do you take a statin?
Tablet
83
What is the length of statin treatment?
Lifelong
84
When do you feel the effects of statins?
Decreases risk over many years
85
What are the tests when taking a statin?
Review in 4w then every 6mo
LFTs before starting, at 3mo and at 12mo (statins cause altered LFTs)
86
What are important side effects of statins?
1. Muscle pains
2. Hair loss
3. Itching
Also nausea, sickness, diarrhea, abdominal pain
87
What are complications of statin treatment?
Rhabdomyolysis
88
When is a statin contraindicated?
Pregnancy
89
What is supplementary advice when taking a statin?
Avoid grapefruit juice
www.bhf.org.uk
90
What is the action of metformin?
Increases the sensitivity of cells to insulin, thereby allowing the body to make better use of the lower insulin levels.
91
What is the timeline of metformin treatment?
Once daily with breakfast (may be increased to 2x daily)
92
How is metformin taken?
Take tablet with or immediately after a meal at the same time each day
93
How long is metformin taken for?
Lifelong if it works
94
When are the effects of metformin felt?
N/A
95
What tests need to be done when on metformin?
U&Es before starting, then annually
96
What are side effects of metformin?
- Nausea
- Diarrhea
- Abdo pain
- Weight loss
97
What are complications of metformin?
Lactic acidosis
98
What are contraindications for metformin treatment?
1. Renal impairment
2. Ketoacidosis
3. Low BMI
NB: metformin must not be taken on the day of, and for 2 days after having general anaesthetic or X-ray contrast media (increase lactic acidosis risk)
99
What is supplementary advice for metformin?
If miss a dose, take as soon as remember unless its close to next dose time
www.diabetes.org.uk
100
What is the action of iron tablets (ferrous sulphate)?
Replace your body's store of iron, a mineral required to make red blood cells (which is deficient)
101
What is the timeline of taking iron tablets?
1-3 times daily (depending on brand)
102
How do you take iron tablets?
Work best if taken on empty stomach but most can be taken with food b/c iron can irritate the stomach
Tablet
103
How long are iron tablets taken for?
Usually 4mo
3-4weeks for Hb to normalise, then take for 3mo after that to replenish stores
104
How long before seeing an effect on iron tablets?
3-4weeks
105
What tests must be done when on iron tablets?
Hb after 3-4 weeks
106
What are side effects of iron tablets?
1. GI irritation
- Nausea/vomiting
- Diarrhea
- abdo pain
2. Black-coloured stools
3. Bad taste
107
What are complications/contraindications of iron tablets?
N/A
108
What is supplementary advice for iron tablets?
N/A
109
What is the action of a salbutamol inhaler?
- Relieves symptoms of asthma/COPD attack
| - Inhaler contains a set dose of medication that should end up in your lungs
110
How is an inhaler used?
1. Check expiration date of inhaler
2. Shake vigorously
3. Remove lid and check mouthpiece is clean
4. Stand/sit up straight
5. Hold inhaler upright with index finger on top and thumb on bottom
6. Breath out completely
7. Seal mouth well around mouthpiece
8. Simultaneously press down on canister while taking slow deep breath in (aim for back of throat, not tongue)
9. Hold breath for 10s (or as long as possible)
10. Breath out slowly
11. Replace cap
12. Repeat after 1min if required
111
What are the side effects of salbutamol inhalers?
1. Tachycardia
2. Tremor
3. Anxiety
4. Paradoxical bronchospasm
5. HypoK+
112
What supplementary advice would you offer for someone taking a salbutamol inhaler?
- Go to A&E if symptoms not relieved or are severe
- See GP/specialist nurse if using inhaler >3x/week
- Can use spacer if patients finding complicated to use inhaler
113
What is the action of a steroid inhaler?
- Prevent an asthma/COPD attack from happening
- Use in the morning and evening
- Rinse mouth out after use
**If on high dose steroids (≥250mcg) carry a steroid card!!**
114
What are the side effects of a steroid inhaler?
1. Dry mouth
2. Hoarse voice
3. Oral thrush
Oral:
1. Adrenal crisis
2. Infection
3. Osteoporosis
4. GI upset
115
What is the action of GTN spray?
- Relaxes blood vessels increasing blood flow throughout your body and to the heart
- Take it when you have chest tightness (anginal pain) or pre-emptively when you're expecting to experience pain (i.e. will be going up a hill)
116
How do you take GTN spray?
1. Sit down
2. Spray 1-2 sprays under the tongue
3. Close mouth
4. Pain should go away within 5min, if not use again
5. If pain still remains after 15min call an ambulance
117
What are the side effects of GTN spray?
1. Headache
2. Flushing
3. Light-headedness (hypotension)
118
What are the contraindications for GTN spray?
1. Hypotensive conditions
2. Arrhythmias
3. Raised ICP
4. Marked anemia
