Drug counselling Flashcards by charlie haslam

What are the contraindications to methortrexate?

Pregnancy including male partner
Breast feeding
active infection
immunodeficiency
hepatic impairment

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How does methotrexate work?

It is a disease modifying agent that reduces inflammation and immune response
Early use improves survival and outcomes

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What is the treatment course of methotrexate?

It is taken once a week on the same day
Folic acid should also be taken once a week on a different day
Gradually build up the dose
Takes 3-12 weeks to work

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What are the monitoring requirements for methotrexate?

They need FBC, u and e and Lfts checked before starting

Then these should be done every 2 weeks then 3 monthly

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What are the side effects of methotrexate?

Alopecia
Headaches
GI upset (don't take with NSAIDs)
Infections - if feeling unwell or notice bruising then need to present to medical professional
Liver and lung toxicity

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What are the contraindications to lithium?

1st trimester pregnancy
Breastfeeding
Cardiac arrhythmia
Significant renal impairment

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How does lithium work?

Alters neurotransmitters in the brain to cause mood stabilisation

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What is the treatment course of lithium?

Take it once or twice a day
Same time each day
Takes 2-3 weeks to work

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What are the monitoring requirements for lithium?

Before starting treatment FBC, U and E, LFT, TFTs, Bhcg and ECG
They need to have lithium level checked weekly then gradually less frequently
Check TFTs, U and E and calcium every 6 months

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What are the side effects of lithium?

GI (abdo pain and nausea)
Fine tremor
Water symptoms (thirst, polyuria, weight gain, oedema)
Renal toxicity
Hypothyroidism
Lithium toxicity:
-Gi (d and v)
-Neuromuscular (dysarthria, dizziness, impaired coordination)

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What are the contraindications to atypical antipsychotics?

Hepatic impairment

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How do atypical antipsychotics work?

They cause blockage of many neurotransmitter receptors causing reduction in psychosis

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What is the treatment course of atypical antipsychotics?

They are taken daily or an injection every 2-4 weeks
Takes several weeks to start working
Change doses over time
Continued long term to stop symptoms from returning

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What are the monitoring requirements for atypical antipsychotics?

Before starting, at 3 months, then annualy weight, waist circumference, pulse, BP, Hba1c, fasting glucose, lipid profile
Weight checks weekly for 6 weeks

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What are the side effects of atypical antipsychotics?

Dopaminergic - parkinsonism, movements disorders, tremor, tardive dyskinesias
Histaminergic - weight gain, dizziness, drowsiness
Cholinergic - dry mouth, constipation, urinary retention
adrenergic - postural hypotension
Neuroleptic malignant syndrome - high fever and muscle rigidity
Prolonged QT
Hyperprolactinaemia - sexual dysfunction

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What are the contraindications to levodopa?

Glaucoma

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How does levodopa work?

It increases the amount of dopamine in the brain as this is reudced in parkinsons
Helps reduce rigidity and slow movements
Given with carbidopa to inhibit peripheral degeneration

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What is the treatment course for levodopa?

3-4 times a day tablet
Taken for as long as it works effectively - typically after 5 years start to get ‘on-off’ effect i.e. the effects wear off before the next dose

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What monitoring requirements are there for levodopa?

none

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What are the side effects of levodopa?

psychosis
nausea and vomiting
diskinesias
postural hypotension
on-off effect
impulsive behaviours

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What are the monitoring requirements for insulin?

cap glucose before each meal and before bed

Should be checked if getting any side effects

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What are the side effects of insulin?

Weight gain
Hypoglycaemia
Sharp injuries
Lipodystrophy

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What are the contraindications to bisphosphonates?

Pregnancy
dysphagia
Recent peptic ulcer
Significant renal impairment

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How do bisphosphonates work?

They increase osteoblast activity to increase bone mineral density
Lifestyle factors that can help are exercise, balanced diet and stopping smoking

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What is the treatment course of bisphosphonates?

They are taken once daily or once weekly in the morning 30 mins before food Remain sitting up for 30 mins after taking it

What is the monitoring for bisphosphonates?

Regular check ups for osteonecrosis of jaw

What are the side effects of bisphosphonates?

``` Headaches Indigestion and bloating Gi (diarrhoea/constipation,abdo pain) Seek medical attention if: -Painful jaw -dysphagia -Upper Gi bleed/black stools ```

What are the contraindications to warfarin?

Pregnancy Active bleeding Significant risk of major bleeding

How does warfarin work?

It is a vitamin K antagonist that stops your blood clotting through the extrinsic coagnulation pathway Inhibits 10, 9, 7 and 3

What is the treatment course for warfarin?

Tablets taken once a day (usually evening) Adjusted to INR Dose changes take 2-3 days to have an affect Usually on it 3 months DVT, 6 months PE and lifelong for AF

What are the monitoring requirements for warfarin?

Starting dose 5mg each evening Have INR done on days 3,4,5 Adjust dose according to dosing chart Regular INR checks determined by INR stability - given dosing book

What are the side effects of warfarin?

Warn about bleeding risk and neeed to seek medical advice if get severe head injury, bleeding from anywhere, unusual headache, unexplained bruising Dirrhoea, nausea Avoid things that interact cytochrome p450 - cranberry juice, NSAIDs/aspirin

What are contraindications to DOACs?

Significant renal impairment Significant risk of major bleeding Active bleeding

How do doacs work?

They inhibit factor 10a to cause anticoagulation and prevent blood clots

What is the treatment course for doacs?

They are taken once or twice a day Full glass of water sitting upright 3 months for DVT, 6 months PE and lifelong for AF

What are the monitoring requirements for DOACs?

Before starting need renal function and check annually | No regular monitoring required

What are the side effects of doacs?

Bleeding - go to doctor if any significant head injury, unusual headache, bleeding from vomit,urine, stool, unexplained bruising GI disturbance No reversal except dabigitran

What are the contraindications to levothyroxine?

None

How does levothyroxine work?

Replaces the thyroid hormone to give you more energy

What is the treatment course of levothyroxine?

It is taken once daily and adjusted depending on the effects | Takes 4-6 weeks to take effect

What are the monitoring requirements for levothyroxine?

TSH test every 2-3 months until stable | Once stable then check annually

What are the side effects of levothyroxine?

Hyperthroidism effects - diarrhoea, weight loss, headache, palpatations, heat intolerance Dose too low - constipation and cold intolerance

What are the contraindications for statins?

Pregnancy

How do statins work?

Stop your liver producing cholesterol High cholesterol causes heart attacks, strokes and kidney disease Also need to reduce dietary LDLs

What is the treatment course of statins?

Taken once a day in the evening | Taken long term and it will reduce the risk over many years

What are the monitoring requirements for statins?

Before starting need LFTs, at 3 months and at 12 months | Review lipid levels at 4 weeks then every 6-12 months

What are the side effects of statins?

``` Gi upset Headache Muscle pains Rhabdomyolysis Interact with grapefruit juice ```

What are the contraindications to metformin?

Significant renal impairment Ketoacidosis Low BMI

How does metformin work?

Increases insulin sensitivity and reduces glucose production in liver

What is the treatment course of metformin?

taken once, twice or three times daily with meals

What are the monitoring requirements for metformin?

Require U and es before tating then anually | Hba1c every 3-6 months until stable, 6 monthly at diabetic check ups

What are the side effects of metformin?

Risk of lactic acidosis Nausea, diarrhoea, weight loss Do not take 2 days before operation

What are the contraindications to iron tablets?

none

How do iron tablets work?

They replace the iron levels in the body | Used to make red blooc cells

What is the treatment course of iron tablets?

1-3 times a day Works best if taken without food but can irritate stomach Once levels normal then another 3 months to replenish stores

What are the monitoring requirements for iron?

Hb in 3-4 weeks to assess response

What are the side effects of iron?

It causes Gi side effects - constipation/diarrhoea Black/green stools metallic taste

What are the contraindications to SSRIs?

Suicidal or manic

How do SSRIs work?

They cause an increase in the chemicals in brain to cause less depressions

What is the treatment course for SSRIs?

Take once a day Takes 4-8 weeks to work can be gradually stopped after feeling better

What are teh monitroing requirements for SSRIs?

None

What are the side effects of ssris?

``` Worse symptoms first 2 weeks then improve Appetite and weight change Headache Drowsiness Withdrawl ```

Drug counselling Flashcards

(62 cards)