Explaining Medication Flashcards
(58 cards)
What does the pneumonic ATHLETICS stand for?
A => Action T => Time to take it H => How to take it? L => Length of treatment E => Effect time line T => Tests I => Important side effects C => Complications and contraindications S => Supplementary advice
Using ATHLETICS, explain Warfarin treatment to a patient.
A => Thins the blood by blocking vitamin K action which the body uses to make proteins that cause the blood to clot
T => Once daily
H => Tablet(s) in the morning
L => 3 months for DST, 6 months for PE, Lifelong for AF or Mechanical HV
E => 2-3 days. Start with LMWH if immediate action required.
T => Start on 5mg for 4 days, take INR on day 5 and 8. Adjust accordingly. Regular INR checks by warfarin clinic. Will be given a yellow book to keep this info in.
I => Bleeding (1-2%). Diarrhoea, rash, alopecia. Many drug interactions.
C => Cx in pregancy, haemorrhagic stroke and active bleeding. Caution in pts at high risk of falls. Interactions with P450 inducers and inhibitors as well as steroids. Antidote is Vitamin K and Beriplex prothrombin complex.
S => Avoid; liver, spinach, cranberry juice, alcohol binges. Avoid activities with high risk of injury. NO NSAIDs or aspirin.
Using ATHLETICS, explain DOAC treatment to a patient.
A => Acts to thin the blood by blocking the action of proteins called clotting factors
T => Once daily
H => Tablet/capsule. Take with a FULL GLASS OF WATER and sitting upright.
L => 3 months for DVT, 6 months for a PE, Lifelong for AF.
E => Instant
T => None regularly. Check renal function before initiating and Annually.
I => Bleeding. GI Disturbance.
C => Irreversible action except for Dabigatran. Cx in severe hepatic or renal impairment, risk of major or active bleeding.
S => Do not exceed safe level of bleeding.
What is included in a clotting screen?
- FBC, specifically platelet count
- PTT expressed as INR
- APTT
- Thrombin time
What does PTT show?
- PTT assesses the EXTRINSIC clotting pathway.
- It is prolonged in Liver failure, Vit K Deficiency, DIC, and WARFARIN Rx.
- Expressed as INR which is normally 0.8-1.2
What does APTT show?
- Assesses the Intrinsic clotting pathway
- Prolonged in liver failure, DIC, haemophilia, heparin treatment
- Normal range is 29-42 seconds
Explain Aspirin treatment to a patient when being used for prevention of Cardiovascular Disease.
A => Aspirin is an anti-platelet agent meaning it acts to block the action of platelets by inhibiting COX-1 enzyme
T => With food
H => 75mg Once daily tablet with food and a PPI
L => Life long
E => Measurable within 60 minutes.
T => Yearly chronic disease blood tests at GP
I => rash, gastrointestinal ulcerations, abdominal pain, upset stomach
C => Cx in Children <16, haemophilia, Peptic ulceration, NSAID sensitive asthma, severe renal failure
S => Take with food.
What are some of the main antiplatelet drugs?
- Aspirin
- ADP receptor antagonists e.g. Clopidogrel, prasugrel
- Ticagrelor
Describe the secondary prevention of cardiovascular disease.
- Beta blocker (Propanolol 80mg)
- Ace inhibitor (5mg Ramipril)
- Aspirin (75mg OD)
- Clopidogrel for 12 months (prasugrel and ticagrelor can also be used)
- Statin (high intensity atorvostatin 80mg)
Using ATHLETICS, explain to a patient Levothyroxine treatment.
A => A synthetic version of the thyroid hormone, Thyroxine.
T => Once daily before breakfast
H => tablet
L => Longterm-lifelong
E => 4-6 weeks
T => Start test dose and review in 2-3 weeks. TSH every 2-3 months and then annually once stable.
I => depending on if dose it too high or too low, hyper/hypothyroidism.
C => No Cx.
S => Free prescriptions for everything.
Using ATHLETICS, explain to a patient Statin treatment.
A => Stop the liver from making cholesterol. High levels of LDL and non-HDL cholesterol increases risk of plaques forming in the arteries, increasing risk of CVAs.
T => Once daily in the evening
H => Tablet
L => Longterm-lifelong
E => 4-6 weeks
T => Risk decreases over many years.
I => Muscle pains, hairloss, itching. Nausea, sickness, diarrhoea and abdo pain
C => Cx in pregnancy. Complications: Rhabdomyolysis. Tell doctor if get muscle pain.
S => Must address other cardiovascular risk factor.
What is primary prevention of CV disease and why might it be used for a patient?
if a patient scores more than 10% on QRISK2 they might benefit from medical primary prevention. This involves:
- Daily 75mg of aspirin
- Daily Statin (20 mg Atorvostatin)
- Blood pressure medication to keep SBP below 140
Using ATHLETICS, explain to a patient Iron Tablets treatment.
A => Replaces your bodies store of iron, a mineral required to make red blood cells
T => 1-3 times daily
H => Tablet or syrup. Works best if taken WITHOUR food but can irritate the stomach so may eat with.
L => about 4 months minimum
E => 3-4 weeks for Hb to normalise and a further 3 months for iron stores to replenish
T => FBC and haematinics in 3-4 weeks
I => GI irritation, black/green stools, metallic taste
C => None
S => Food advice
Using ATHLETICS, explain to a patient Metformin treatment.
A => Increases your bodies response to insulin. Also reduces gluconeogenesis in the liver.
T => 1-3 times daily
H => Tablet WITH food
L => long term if successful
E => 4-5 days to have an effect and lower blood sugar
T => U&Es before starting, then annually. HbA1c every 3-6 months until stable and then twice yearly.
I => Nausea, vomiting, diarrhoea, abdo pain
C => Cx in significant renail impairment and low BMI. Complications; ketoacidosis
S => take with meals. May help with weight loss.
Using ATHLETICS, explain to a patient Insulin treatment.
A => Allows the cells of your body to take up glucose from the blood and replaces endogenous insulin in Diabetes.
T => Depends on dosing regimen.
H => Using pen to inject into subcutaneous tissue at different sites.
L => Lifelong
E => Depends on preparation but acts over less than 15 mins - 12 hours
T => Capillary blood glucose testing before each meal and before bed. Diabetic monitoring as per plan for managing complications on NICE.
I => Weight gain, hypoglycaemia, sharps injuries, lipodystrophy at injection sites
C => Complications; hypoglycaemia
S => Advice about symptoms of hyper and hypoglycaemia. Sick day rules.
What are the SICK day rules for Diabetics (not medication rules)
- Stay hydrated
- Do not fast: maintain carbohydrate intake
- If you are unable to eat or drink or are vomiting, replace meals with sugary fluids or ice cream
- Never stop insulin: you may have to adjust the dose and notice/treat hypos
What medications should diabetics omit on Sick days?
- Metformin – dehydration can make it more likely that you will develop a serious side effect
called lactic acidosis
- Sulfonylureas – if you are unable to eat or drink, it will be more likely that you develop low blood glucose (hypos). Examples: names ending with ‘ide’ such as gliclazide, glibencamide, glipizide If you are eating and drinking normally and blood sugars are high continue to take Sulfonylureas
- GLP-1 analogues –dehydration can make it more likely that you will develop a serious side
effect. Examples: names ending with ‘tide’ such as exenatide, dulaglutide, liraglutide, ixisenatide and semaglutide - SGLT2 inhibitors – dehydration can make it more likely that you will develop a serious side
effect called ketoacidosis.. Examples: names ending with ‘flozin’ - ARBs, ACEis, NSAIDs, Diuretics.
What are the symptoms of a hypoglycaemic episode?
- sweating.
- feeling tired.
- dizziness.
- feeling hungry.
- tingling lips.
- feeling shaky or trembling.
- a fast or pounding heartbeat (palpitations)
becoming easily irritated, tearful, anxious or moody
Explain Methotrexate to a patient.
A => Disease modifying agent which reduces inflammation and surpasses the immune system.
T => Once weekly with folic acid tablet on another day. Sam day each week.
H => Tablet
L => taken long term if effective
E => dose built up slowly, takes 2-3 weeks to work
T => FBCs, LFTs, and U&Es before starting, every two weeks until therapy stabilised then every 2-3 months. Given monitoring book.
I => Alopecia, Headaches, GI Disturbance
C => Cx: Pregnancy including male partner, breast feeding, hepatic impairment, active infection, immunodeficiency. Complications: Myelosupression
S => Annual flu jab
Explain Bisphosphonates to a patient
A => prevents bone being broken down and helps to rebuild new bone
T => Once daily or weekly
H => Tablet. Swallow with a full glass of water and sit upright for 30 mins.
L => Taken long term
E => gradual benefit
T => regular dental check ups due to osteonecrosis of jaw
I => headache, heartburn, bloating, indigestion, GI disturbance
C => Cx: Pregnancy, dysphagia/odynophagia, recent peptic ulcer, significant renal impairment.
Complications: Osteonecrosis of jaw, Upper GI bleed, Dysphagia
S =>
What are the actions of the COCP?
- suppression of the HPO axis to inhibit development of follicles and ovulation
- thickening of cervical mucus
- reducing endometrial receptivity to implantation
What is the failure rate of the COCP?
0.1 - 3%
What are the side effects of COCP?
- breast tenderness - headache
- mood changes
- weight gain
- breakthrough bleeding
- nausea
What are the advantages of the COCP?
- Non-invasive
- Menses become lighter and more regular
- Improvement in acne
- Decreased PMS symptoms
- Decreased risk of ovarian, endometrial and colorectal cancer
