Medication counselling

Question 1

Warfarin Contraindications?

Answer 1

pregnancy
active bleeding
significant risk of bleeding

Question 2

How does Warfarin work?

Answer 2

Thins the blood to prevent blood clots by blocking vitamin K (as this vitamin is responsible for making proteins which cause blood clotting)

Question 3

How do you take Warfarin + time course?

Answer 3

Once daily, usually in the evening. 3 months for DVT, 6 months for PE, lifelong for AF.

Question 4

Monitoring for Warfarin?

Answer 4

Start at 5mg. INR at day 3,4 and 5 - adjust dose accordingly. Then regular checks.

Question 5

Interactions for Warfarin (what to warn patients about?)

Answer 5

Avoid liver, spinach, cranberry juice, alcohol binges, NSAIDs/aspirin

Question 6

Significant side effects of warfarin?

Answer 6

• Seek help if significant bleeding / head injury.
• diarrhoea, hair loss, rash and nausea.

Question 7

Contraindications for DOAC’s?

Answer 7

• significant renal impairment
• significant risk of bleeding
• active bleeding

Question 8

How do DOAC’s work?

Answer 8

Thins the blood to prevent blood clots.

Question 9

DOAC’S - treatment course and how is it taken?

Answer 9

• once/twice daily tablet
• 3 months for DVT, 6 months for PE, lifelong for AF.

Question 10

DOAC’s - monitoring?

Answer 10

• none regularly
• check renal function before and annually.

Question 11

How does levothyroxine work?

Answer 11

• synthetic version of thyroxine - brings back thyroid function back to normal.

Question 12

Levothyroxine - treatment course and how to take it?

Answer 12

• Once daily tablet before breakfast
• taken long term
• changes every 4-6 weeks until effective

Question 13

Levothyroxine - monitoring?

Answer 13

TSH every 2-3 months until stable. Once stable - annually.

Question 14

Levothyroxine - side effects?

Answer 14

rare
hypo/hyperthyroidism

Question 15

Statin - contraindications?

Answer 15

pregnancy

Question 16

how do statins work?

Answer 16

stop the liver making cholesterol

Question 17

Statins - treatment course and how to take?

Answer 17

once daily tablet in the evening, taken long term

Question 18

Statins - monitoring?

Answer 18

• review in 4 weeks, then every 6-12 months - dose change based on results
• LFT’s before starting, at 3 months and at 12 months.

Question 19

Statins - side effects?

Answer 19

• muscle pain
• headache
• itching
• GI upset
• rhabdomyolysis

Question 20

COCP - contraindications?

Answer 20

• smoking ( + age >35y)
• Hx/FHx of thromboembolism, breast/cervical cancer, migraine with aura.
• BMI >35

Question 21

How does COCP work?

Answer 21

• stops ovulation
• increases cervical mucus
• thins endometrium

Question 22

Missed COCP advice?

Answer 22

1 missed - take immediately, continue as normal
2 missed - take 1 + condoms for 7 days

Question 23

HRT - contraindications?

Answer 23

Undiagnosed PV bleeding
Pregnancy/breastfeeding
Oestrogen-dependent cancer
Acute liver disease
Uncontrolled hypertension

History of breast cancer
History of venous thromboembolism
Recent stroke/MI/angina

Question 24

Risks of HRT?

Answer 24

• Venous thromboembolism (no risk with transdermal therapy)
• Stroke
• Breast cancer (small increase in risk, higher with combined HRT)
• Ovarian cancer (small increase if used >5 years)
• Endometrial cancer (only if women with uterus take oestrogen-only HRT – this is why oestrogen-only HRT is only used in women with no uterus)
• Coronary heart disease (if started >10 years after menopause)