Drug Counselling

Question 1

Counsel a patient on taking EllaOne (Ullipristal)

Answer 1

• Emergency contraception
• Works up to 120 hours after UPSI
• Less effective after ovulation, as it works by delaying ovulation.
• Repeat dose if vomiting within 3 hours.

Question 2

Counsel a patient on taking levonorgestrel for emergency contraception

Answer 2

• Inhibits ovulation.
• Can be used up to 72 hours after UPSI.
• Less effective after ovulation.
• Repeat dose if vomiting within 3 hours.

Question 3

COCP: CIs

Answer 3

Migraine with aura
>35 smoking >15 a day
<6wks postpartum and breastfeeding or <3mos not breastfeeding
hx of VTE
antiphospholipid
breast Ca

Question 4

COCP: mechanism and effectiveness

Answer 4

• 99% with perfect use, closer to 90% in average use.
• affected by drug interactions, missed/late pills, vomiting/diarrhoea.
• suppresses ovulation
• effective 7 days after starting, unless started on day 1-5 of cycle.

Question 5

COCP: advantages and disadvantages

Answer 5

• non-invasive
• helps HMB, pain, acne
• regulates bleeding
• reduced risk of ovarian, endometrial cancers
• used in management of PCOS and endometriosis
• no STI protection
• user dependant
• some side effects (nausea, headaches, breast tenderness)
• inc risk of cervical and breast ca

Question 6

COCP: risks

Answer 6

• VTE
• Stroke
• Breast ca/cervical

Question 7

COCP: monitoring and safety netting

Answer 7

• regular BP and weight check
• seek medical attention if any signs of PE/DVT/stroke

Question 8

POP: mechanism and effectiveness

Answer 8

• with typical use, around 90%
• works to suppress ovulation and thicken the cervical mucus, which prevents sperm entering the uterus.

Question 9

POP: advantages and disadvantages

Answer 9

• safe during breastfeeding
• easily reversible.
• improvement in heavy or painful periods.
• user dependant
• inc risk breast ca
• no sti protection
• causes headache, nausea, mood changes, breast tenderness

Question 10

POP: starting

Answer 10

• effective immediately if started up to 5th day of cycle.
• otherwise takes 2 days.
• can start at any time postpartum

Question 11

POP: CIs

Answer 11

only UKMEC4 in current breast Ca.

Question 12

Counsel a patient on injectable contraceptives

Question 13

Counsel a patient on the contraceptive implant

Question 14

Counsel a patient on the contraceptive coils

Question 15

Counsel a patient on taking insulin

Question 16

Metformin: why and contraindications

Answer 16

• CIs: Risk of renal impairment, hepatic insufficiency, DKA, acute alcohol intoxication.
• Used first line in T2DM to help control blood sugars, without causing them to drop too low.

Question 18

Metformin: how it works and why its needed

Answer 18

• Explain what diabetes is, and explain how metformin helps - reduces the sugar produced in the liver and increasing sugar uptake by cells in the body.
• Why it’s important: over time high blood sugar damages nerves and blood vessels. This can look like loos of feeling or pain in fingers and toes, vision loss, sexual problems, heart disease and increase risk of stroke.

Question 19

Metformin: monitoring

Answer 19

• initially blood tests every 3 months, then every 6 months when stable.
• yearly review for foot check, eye screening, BP check and bloods (HbA1c, cholesterol, renal).

Question 20

Metformin: side effects

Answer 20

• GI upset, weight loss.
• Rare: B12 deficiency, lactic acidosis (stop if you get very unwell)
• Don’t drink more than 2 units of alcohol per day.

Question 21

Metformin: missed dose

Answer 21

• Take the next tablet as normal, don’t take 2.

Question 22

Counsel a patient on taking SGLT2 inhibitors

Question 23

Counsel a patient on taking gliclazide

Question 24

Counsel a patient on taking a DPP4 inhibitor

Question 25

Counsel a patient on taking an SSRI

Question 26

Counsel a patient on taking lithium

Question 27

Counsel a patient on taking clozapine

Question 28

Counsel a patient on taking a SABA

Question 29

Counsel a patient on taking inhaled ICS

Question 30

Counsel a patient on taking a CCB

Question 31

Counsel a patient on taking an ACE-I

Question 32

Statins: mechanism

Answer 32

- lower the 'bad' cholesterol to reduce the risk of atherosclerosis and related CVD events

Question 33

statins: how to take

Answer 33

- once daily, at night (matters for some, not others) - if missed dose, take as soon as possible, do not take 2 in one day - must keep taking to ensure benefit although the patient will feel no direct benefit

Question 34

Statin: monitoring

Answer 34

- pre-treatment cholesterol and LFT. - repeat bloods 3 mos after treatment starting and after 12mos to assess effectiveness.

Question 34

statins: SEs

Answer 34

- myalgia - muscle toxicity - report to GP - interstitial lung disease - nausea, constipation/diarrhoea, headache.

Question 35

Counsel a patient on taking GTN

Question 36

Counsel a patient on taking digoxin

Question 37

Counsel a patient on taking amitriptyline

Question 38

Counsel a patient on taking a DOAC

Question 39

Counsel a patient on taking levothyroxine

Question 40

Counsel a patient on taking warfarin

Question 41

Counsel a patient on taking bisphosphonates

Question 42

Counsel a patient on taking hydrocortisone

Question 43

Methotrexate: how to take

Answer 43

- prescribed once weekly, take on the same day - take folic acid once weekly, at least 24 hours before or after taking methotrexate - before or after food - usually a tablet but can have weekly injections

Question 44

Methotrexate: missed dose

Answer 44

- take as soon as you remember - if more than 2 days late, contact GP. - never take 2 doses at the same time to make up for missing one

Question 45

Methotrexate: SEs

Answer 45

- loss of appetite - nausea - indigestion - diarrhoea - headache - tiredness - hair loss BEWARE interactions - pt to alert HCP they are on methotrexate if being prescribed other meds Women of childbearing age must be on effective contraception

Question 46

Methotrexate: why and how does it work

Answer 46

- reduces inflammation - used for multiple conditions such as RA to reduce joint pain, swelling and stiffness

Question 47

Corticosteroids: other

Answer 47

- Sick day rules - Emergency card - Never stop suddenly, must be weaned slowly.

Question 48

Corticosteroids: what and why?

Answer 48

- Reduce inflammation and suppress the immune system in various conditions. - Different modes of action depending on type.

Question 49

Corticosteroids: how to take and how long

Answer 49

- Usually tablets, should be taken at the same time daily, usually morning as this is mimicking physiology. - With or soon after a meal. - Duration depends on response, aiming for the shortest length of treatment possible. - Missed dose: take when you remember, unless this means taking 2 tablets on the same day.

Question 50

Corticosteroids: monitoring

Answer 50

- pre-treatment: BP, BMI, eye test, bloods (HbA1c, cholesterol and K). - regular BP and BMI - eye exam every 6-12 mos - triglycerides and K after 1 month then every 6-12 mos - HbA1c after 1 mos then every 3 mos

Question 51

Corticosteroids: SEs

Answer 51

- More likely after repeated courses or higher doses. - Short term: sleep disturbance, weight gain, mood changes. - Long term: increased risk of diabetes, HTN, cataracts, stomach ulcers, muscle and bone weakness, mental health problems and increased risk of infections. - Seek medical attention if you develop new symptoms.

Question 52

Counsel a patient on taking iron supplements

Question 53

Counsel a patient on taking folate

Question 54

Counsel a patient on taking levodopa

Question 55

Counsel a patient on taking laxatives

Question 56

Counsel a patient on taking omeprazole

Question 57

Counsel a patient on taking PrEP

Question 58

Counsel a patient on taking beta blockers

Question 59

General approach to drug counselling

Answer 59

- Start with ICE: what do you know about the drug, do you have any specific concerns, is there anything you'd like me to discuss/focus on. - Brief Hx: to include important contraindications to taking the medication and allergies.