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

Question 1

This medicine is levodopa +/- Carbidopa or Benserazide and the brand we have given you is called

Answer 1

Levodopa with benserazide: madopar

Levodopa with carbidopa: sinadopa, sinemet

Question 2

Mode of action and indication of levodopa +/- carbidopa or benserazide (3 marks)

Answer 2

Levodopa and benserazide: belongs to a group of medicnes called antiparkinsonian agents and is used for the treatment of Parkinson’s disease. Antiparkinsonian agents work on the central nervous system. The symptoms of Parkinson’s disease are caused by a deficiency of a natural substance in the brain called dopamine. Madopar helps to replace this substance.

Levodopa and carbidopa: Levodopa is a chemical closely related to dopamine which allows the body to make its own dopamine. Carbidopa makes sure that enough levodopa gets to the brain where it is needed. In many patients, levodopa/carbidopa reduces some of the symptoms of Parkinson’s disease. Improves slow movements and muscle stiffness.

Question 3

Dose and directions for use (C/A labels) for Levodopa +/- Carbidopa or Benserazide (3 marks)

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.

CAL: 4a, 9, 16

• Do not take dairy products, antacids or mineral supplements within 2 hours of each dose of this medicine
• Do not stop taken this medicine abruptly unless otherwise advise by your doctor
• This medicine may cause dizziness especially when you stand up quickly.

Question 4

AE (common, serious, allergic) of Levodopa +/- Carbidopa or Benserazide (3 marks)

Answer 4

All medications can cause side effects, but not everyone will experience them. Slow movements, discolouration of urine, nausea and vomiting can occur.

Rarer side effects include blood in the urine, skin rach or itchiness.

Please see a doctor if you have chest pain or mental changes such as feeling very fearful or paranoid.

Question 5

Lifestyle/self-care of Levodopa +/- Carbidopa or Benserazide (2 marks)

Answer 5

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

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

Tell your doctor if you experience times where this medicine does not appear to be working as well as it did previously –> after taking this medicine for long periods of time, such as a year or more, some people suddenly lose the ability to move (will last for a few minutes to several hours, may need stronger dose or change medication)

Question 6

This medication is pramipexole and the brand we have given you is called …?

Answer 6

sifrol, simipex, simpra

Question 7

Mode of action and indication of pramipexole (3 marks)

Answer 7

It is used in the treatment of Parkinsons disease. Symptoms of parkinsons disease are caused by a lack of dopamine, dopamine relays messages in the part of the brain that controls movement.

Pramiprexole works by having a smilar effect as dopamine in the brain and is known as a dopamine agonist.

Question 8

Dose and directions for use (C/A labels) for pramiprexole (3 marks)

Answer 8

Initially, 125 micrograms 3 times daily for a week, then 250 micrograms 3 times daily for a week, then 500 micrograms 3 times daily.

• If necessary, increase dose each week by 250 micrograms 3 times daily, up to a maximum of 1.5 mg 3 times daily.

CAL labels 1,9,12,16

Medicine may cause drowsiness and may increase effects of alcohol if affected, do not drive (1)

Do not stop taking this medicine abruptly unless otherwise advised by your doctor (9)

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor vehicle (12)

This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or pharmacist for advice (16)

Question 9

AE (common, serious, allergic) of pramipexole (3 marks)

Answer 9

All medications can cause side effects, but not everyone will experience them. Initially confusion, constipation, dizziness and swelling of hands or feet may occur.

Rarer side effects include fainting and alopecia

Please see a doctor if you or your family see an increase in compulsive behaviour (gambling, binge eating, hypersexuality)

Question 10

Lifestyle/self-care of Pramipexole (2 marks)

Answer 10

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

You should monitor your skin and see your doctor in case of any concerns.

Question 11

This medicine is diazepam and the brand we have given you is called …?

Answer 11

Diazepam, antenext, valpam, valium

tablets: 2mg or 5mg

Question 12

Mode of action and indication of diazepam (3 marks)

Answer 12

Valium is used for anxiety. Anxiety or tension associated with the normal stress of everyday life usually does not require treatment with medicines.

Valium is used to relax muscles.

Valium can also be used to treat trembling, confusional states or anxiety associated with alcohol withdrawal. It is also used to treat panic attacks.

Valium belongs to a group of medicines called benzodiazepines. They are thought to work by their action on brain chemicals.

Question 13

Dose and directions for use (C/A labels) for diazepam (3 marks)

Answer 13

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

CAL labels: 1 and 9

1: This medicine may cause drowssiness and amy increase the effects of alcohol, do not drive a motor vehicle or operate machinery
9: Do not stop taking this medicine abruptly unless advised by your doctor

Question 14

AE (common, serious, allergic) of diazepam (3 marks)

Answer 14

All medications can cause side effects, but not everyone will experience them. Initally drowsiness, excessive saliva and blurred vision may occur.

Rarer side effects include allergic reactions and rash

Please see a doctor if you experience hallucinations or delusions

Question 15

Lifestyle/self-care of diazepam

Answer 15

If you take this medicine regularly for more than 2–4 weeks your body may become used to it and in time, you may need a higher dose for it to continue to work

If you stop the medicine suddenly, you may have unpleasant effects (eg feeling anxious, difficulty sleeping). Discuss how to stop the medicine with your doctor first.

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?

Question 16

This medication is escitalopram and the brand we have given you is called …?

Answer 16

Lexam, lexapro, loxalate, esitalo

Tablet: 10mg, 20mg

Question 17

Mode of action and indication of escitalopram (3 marks)

Answer 17

Escitalopram is used to treat depression and obsessive compulsive disorder

It belongs to a group of medicines called Selective Serotonin Reuptake Inhibitors (SSRIs). Escitalopram and other SSRIs are thought to help by increasing the amount of serotonin in your brain.

> Depression is thought to be caused by a chemical imbalance in parts of the brain, escitalopram corrects this chemical imbalance and may help relieve the symyptoms of depression

Question 18

Dose and directions for use (C/A labels) for escitalopram (3 marks)

Answer 18

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

CAL labels : 5,9,12

> Ask your doctor or pharmacist before using any other medicine including over the counter medicines or health products (5)

> Do not stop taking this medicine abruptly unless otherwise advised by your doctor (9)

> This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor vehicle or operate machinery (12)

Question 19

AE (common, serious, allergic) of escitalopram (3 marks)

Answer 19

All medications can cause side effects, but not everyone will experience them so dont be alarmed by these side effects. Initially nausea, dry mouth, diarrhoea and insomnia may occur.

Rarer side effects include taste disturbances and liver failure

Please see a doctor if you experience swelling of the face, lips, tongue or throat and rash or itching or hives on the skin. Or thoughts of suicide or attempting suicide or self-harm.

Question 20

Lifestyle/self-care of Escitalopram (2 marks)

Answer 20

This medicine can be taken in the morning

Increased suicidal thoughts can occur soon after starting antidepressants, you or anyone close to you should watch for these thoughts and tell your doctor immediately or go to the nearest hospital.

Question 21

This medicine is lithium and the brand we have given you is called …?

Answer 21

Lithicarb: 250mg

Quilonum: 450mg

Question 22

Mode of action and indication of lithium (3 marks)

Answer 22

Lithium is used to treat and prevent manic or depressive episodes in bipolar disorder, it is also used in the treatment of schizo-affective illness and chronic schizophrenia.

Lithium is a powerful mood stabiliser, the exact way that lithium works to stabilise a person is not known. It helps you to have more control over your emotions and helps you cope better.

Question 23

Dose and directions for use (C/A labels) for lithium (3 marks)

Answer 23

CAL labels: 5,13,21,A,B

Ask your doctor or pharmacist before using any other medicines including over the counter medicines or health products (5)

Do not remove from the original packaging until dose required (13)

Special handling and disposal required (21)

A: swallow whole, do not crush or chew

B: Take with or soon after food

Question 24

AE (common, serious, allergic) of lithium (3 marks)

Answer 24

All medications can cause side effects, but not everyone will experience them. Initially metalic taste, acne, nausea and diarrhoea may occur.

Rarer side effects include hyperthyroidism

Please see a doctor if you are passing large amounts of urine or have increased muscle twitches or weakness

Question 25

Lifestyle/self-care of Lithium

Answer 25

Maintain a normal diet with adequate salt and fluid

Avoid heavy exercise which may lead to excessive sweating and water loss

Regular blood tests are important during treatment.

Take with food

Be alert for signs and symptoms of lithium toxicity (eg extreme thirst and frequent urination, nausea and vomiting)

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?