Part 1: Medication Knowledge and Counselling Flashcards
Norfloxacin
CLASS: quinolone antibiotic
INDICATIONS:
- resistant UTIs and prostatitis
- travellers diarrhoea
DOSE: dependent on indication. Usually 400-800mg. Reduce dose if CrCl is less than 30ml/min.
COUNSELLING:
- take on an empty stomach for best absorption (label 3b)
- avoid sunlight (label 8).
- May experience dizziness/fainting (label 12).
- Label 4
- Label D
MONITORING:
- watch for tendon damage.
- Can lower seizure threshold
Esomeparazole
CLASS: Proton Pump Inhibitor
INDICATIONS: reduce stomach acid, GORD, treatment of stomach ulcers, prevention of peptic ulcer bleeding.
DOSE: 20-40mg once daily (twice daily for some indications).
COUNSELLING:
- swallow whole
- Can disperse in water then drink after 30 mins.
- S/E: flatulence, Nausea and Vomiting, diarrhoea/constipation
MONITORING: Long term use associated with:
- enteric infections (eg C diff)
- decreased B12
- risk of fractures/osteoporosis (monitor vit D and Ca)
- increased risk of pneumonia.
Metformin
CLASS: Biguanide
INDICATIONS: T2DM, polycystic ovary syndrome.
DOSE: 500 - 2000mg daily - tds (max 3 g daily). CR product once daily only. Reduce in renal impairment. COUNSELLING:
- Take with food to reduce stomach upset.
- Tell your doctor immediately if you have loss of appetite, n and v, abdo pain, cramps, fatigue, diarrhoea or weight loss.
- Label 10a
- Alcohol can increase risk of side effects. Avoid binge drinking and have something to eat while drinking.
- AEs: N and V, malabsorption of vit B12. diarrhoea.
- Can take 2 weeks for BSLs to stabilise.
MONITORING:
- signs of lactic acidosis
- renal function
- HbA1c
Beta Blockers
INDICATIONS: Hypertension, Angina, Tachyarrhythmias, MI, Heart Failure, Prevention of Migraine.
COUNSELLING:
- May cause dizziness or tiredness, especially at start of treatment.
- Do not stop taking this medicine suddenly unless doctor tells you to (abrupt withdrawal can exacerbate angina, precipitate rebound hypertension, MI or arrhythmias)
MONITORING:
- blood pressure
- heart rate
- Kidney function (may need to reduce dose in poor renal function).
Beta Blocker doses
Atenolol: 25 - 50mg once daily. Max 100mg daily.
Bisoprolol: 1.25 - 10mg daily
Carvedilol: 3.125- 50mg BD
Metoprolol:
- HTN: 50 - 100mg BD
- Angina: 25 -100mg BD - TDS
- HF: 23.75mg CR to 190mg daily.
Propanolol: 10mg TDS - 320mg daily
Nebivolol: 1.25 - 10mg daily depending on indication.
Labetalol: 100-400mg BD (max 2.4g in a day)
Pindolol: increase to maintenance of 10-30mg daily in 2 or 3 doses.
Oxprenolol: 20 - 320mg daily
Moxifloxacin
CLASS: Quinolone Antibiotic
INDICATIONS: Community Acquired Pneumonia, multi drug resistant TB, exacerbations of chronic bronchitis, other infections.
DOSE: 400mg once daily.
COUNSELLING:
- Side effects: dizziness, taste disturbances, GI effects
- Label 4a - Avoid cation agents within two hours (eg. antacids, iron, zinc supplements etc). But NOT dairy products.
- Labels 12, D
MONITORING:
- Prolonged QT interval
- Tendon damage
Ciprofloxacin
CLASS: Quinolone antibiotic
INDICATIONS: Complicated UTIs/ pyelonephritis / prostatitis, Enteral infections, bone/joint infections, other infections.
DOSE: 250- 500mg BD. Maximum of 1.5g daily.
COUNSELLING:
- Label 8 (photosensitivity).
- Take on empty stomach (label 3b)
- Avoid dairy products, iron, zinc, calcium etc. within 2 hours (label 4).
- Can increase the effects of caffeine in some people.
- Labels 12, D
MONITORING:
- reduced seizure threshold
- QT prolongation (rare). more common with moxifloxacin.
Simvastatin
CLASS: Statin (HMA-CoA reductase inhibitor)
INDICATIONS: Hypercholesterolaemia, high risk of coronary heart disease.
DOSE: 10-40mg once daily. Can use a max of 80mg however significantly increases risk of myopathy.
COUNSELLING:
- Label 18
- Take at night
- Tell your doctor if the whites of your eyes become yellow, faeces pale, have dark urine or pain in muscles that aren’t exercise related.
- Side effects: transient GI symptoms, sleep disturbances, headache, gynaecomastia, myalgia, myopathy, rhabdomylosis
MONITORING:
- renal function
- drug interactions (CYP) -
- rhabdomylosis.
- Aminotransferase concentrations
Alendronate
CLASS: Bisphosphonate
INDACTIONS: Prevention and treatment of osteoporosis. Paget’s disease of bone.
DOSE: 5 - 10mg daily (however 5mg tabs not available) OR 70mg weekly.
COUNSELLING:
- Take in the morning with a full glass of plain water at least 30 mins before food and drink. Remain upright during this time and until after you eat. (Label C)
- Swallow whole (do not chew or suck the table)
- Do not take antacids, calicum, iron or metal supplements within 30 minutes of alendronate as they may interfere with its absorption. (Label 4).
- Stop tablets and see your doctor immediately if you have pain on swallowing, or new or worsening heartburn.
- There are rare complications with some dental procedures in people taking bisphosphonates (osteonecrosis of jaw). Tell your doctor if you require any dental work and tell your dentist that you are taking this medicine.
- Tell your doctor if you have severe pain in your bones, joints or muscles while taking this medicine.
MONITORING:
- Calcium and vit D levels
- Incidence of fracture
- Oesophageal state
- Full dental assessment
- ?efficacy after 5 years in post-menopausal women
Gliclazide
CLASS: Sulfonylurea
INDICATIONS: Type 2 diabets
DOSE: usually 40-320mg daily in 1 or 2 doses (up to 160mg as a single dose).
CR product 30mg to max of 120mg daily.
Note: 30mg of CR = 80mg IR tablet.
COUNSELLING:
- swallow whole CR product.
- Take with food to minimise risk of low blood glucose (hypoglycaemia). (Label B).
- intermediate risk. (Risk increases with advanced age, renal or hepatic impairement + drug interactions.)
- Drinking alcohol decreases your blood glucose and can mask symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when drinking.
- Side effects: hypoglycaemia, weight gain, nausea, metallic taste (infrequent).
MONITORING:
- blood glucose levels
- urine ketones
Celecoxib
CLASS: COX-2 selective inhibitor (NSAID).
INDICATIONS: osteoarthritis, rheumatoid arthritis, pain.
DOSE: note risk of cardiovascular adverse effects is dose-related –> do not use > 200mg daily long term.
Use dose 200mg once or twice daily. Max 5 days treatment for pain.
COUNSELLING:
- do not use if dehydrated (eg vomiting or diarrhoea) as it can increase he likelihood of side effects.
- do not take with aspirin for pain relief as it will increase the risk of side effects.
- Can have serious GI effects
- If taking low dose aspirin for another condition, do not stop taking the aspirin.
- Labels 10a, 12, 19b
MONITORING:
- renal function
- therapeutic effect - eg. pain levels
- liver function.
- signs of bleeding with the use of blood thinners.
- GI discomfort
- Cardiovascular function.
Allopurinol
CLASS: Xanthine oxidase inhibitor (reduces production of uric acid).
INDICATIONS:
- Chronic symptomatic hyperuricaemia (eg. gout)
- Hyperuricaemia secondary to disease (eg. tumour lysis syndrome from chemotherapy).
DOSE: 300-600mg daily (max 900mg).
COUNSELLING:
- Take with food to reduce stomach upset.
- Label 12 (when starting or increasing dose).
- You may notice an increase in flares in the first few months of treatment however these flares will gradually improve and eventually stop as the body reduces the amount of urate in your body.
- Look for signs of hypersensitivity reaction in the first few months (rash, swollen mouth, persistent fever or sore throat).
- AEs: flare of acute gout, raised liver enzymes, oedema, rash.
MONITORING:
- renal and liver function at baseline and repeated regularly throughout treatment.
- Measure serum urate every 6 months for maintenance.
Citalopram
CLASS: SSRI
INDICATIONS: major depression, anxiety.
DOSE: 20mg once daily gradually increasing over 2-4 weeks if necessary to max of 40mg daily.
COUNSELLING:
- take in the morning (can cause insomnia).
- It can take 2-4 weeks for the medicine to take effect, you may feel worse during this time before you start to feel better while your body is adjusting.
- Do not stop taking this medicine suddenly as it can precipitate withdrawal effects. (label 9)
- Label 12 - may affect mental alertness.
- SEs: sexual dysfunction, insomnia, sweating, rhinitis, tremor.
MONITORING:
- therapeutic effect - eg. mood.
- signs of serotonin toxicity.
- prolonged QT interval
Venlafaxine
CLASS: SNRI INDICATIONS: Major depression, generalised anxiety disorder, panic disorder, social phobia. DOSE: 75mg once daily, increase to 150mg once daily if required. Max 225mg daily. Reduce dose if Crcl
Mirtazapine
CLASS: Antidepressant which has post-synaptic blockade of serotonin receptors and pre-synaptic blockade of alpha2 inhibitory autoreceptors. Blocks H1 receptors (sedative effects).
INDICATIONS: Major depression.
DOSE: 15mg nocte, increases gradually to 30-45mg as needed. Max 60mg.
COUNSELLING:
- sedation (label 1)
- increased appetite/ weight gain.
- peripheral oedema
- do not stop taking this medicine suddenly as it can precipitate withdrawal effects. (Label 9)
- Increased suicidal thoughts and behaviour can occur soon after starting the medication (can take a few weeks to be effective and stabilise).
MONITORING:
- changes in mood when starting (suicidal tendencies).
- seizures –> can reduce seizure threshold in those affected. Dose dependent risk.
- Therapeutic effect.
Spironolactone
CLASS: Aldosterone antagonist (inhibits Na+ absorption in the distal tubule and increases Na+ and water exretion while reducing K+ excretion).
INDICATIONS:
- primary hyperaldosteronism
- refractory oedema associated with secondary hyperaldosteronism.
- hirtuism in females (anti-androgenic effects)
- heart failure.
DOSE:
- Oedema: Maintenance 25-200mg daily (Max of 400mg daily in ascites).
- Heart failure: 25mg - 50mg once daily.
COUNSELLING:
- Labels 12, 16, 11.
- Take with food.
- SEs: Hypochloraemia, Headache, Nausea, Mastalgia, GI cramps, Impotence, Menstrual irregularities, Gynaecomastia, Alopecia.
MONITORING:
- Potassium levels (hyperkalaemia)
- Renal function
- BP
- hepatic function
- serum electrolytes
Digoxin
CLASS: Antiarrythmic
INDICATIONS: AF and Atrial Flutter, heart failure.
DOSE: Tailor according to renal function, clinical response and concentration monitoring. Loading dose can be used to achieve a more rapid control, usually 250-500 microg every 4-6hrs according to response (max 1.5mg).
Maintenance - 125-250microg once daily (max 500microg).
COUNSELLING:
- Tell your doctor or pharmacist you are taking this medicine before taking any other medicines (including OTC). (Label 5).
- Side effects: dizziness, visual disturbances (eg. blurred vision), drowsiness, arrhythmia, Nausea and vomiting, diarrhoea.
MONITORING:
- TDM levels to guide dose adjustment and to confirm toxicity.
- Renal and electrolyte function
- heart rate and rhythm (ECG)
- Digoxin toxicity (GI symptoms, then cardiac symptoms eg arrhythmias)
Latanoprost eye drops
CLASS: Prostaglandin analogue (reduce intraocular pressure by increasing uveoscleral outlfow of aqueous humour).
INDICATIONS: glaucoma, ocular hypertension.
DOSE: 1 drop once daily, preferably at night. COUNSELLING:
- SEs: bitter taste, periorbital rash, eye irritation, blurred vision.
- Instil in the evening for optimal effect.
- can slowly change (over months to years) the colour of your eye making the iris appear darker. The change is permanent and may be more noticeable if used in only one eye.
- Can cause gradual darkening, lengthening and thickening of eyelashes –> reversible when treatment stopped.
MONITORING:
- ocular pressure (paradoxical increase can occur if using 2 ocular prostaglandin analogues).
Amitriptyline
CLASS: Tricyclic Antidepressent (TCA)
INDICATIONS: Major depression, adjuvant in pain management, migraine prophylaxis, urinary urge incontinence.
DOSE: Depression- 25 -300mg daily (usually nocte)
COUNSELLING:
- Take at night to reduce day time drowsiness. (label 1)
- May cause dizziness. (label 16)
- Label 12
- Do not suddenly stop taking this medication as it can cause withdrawal effects. (Label 9)
- SEs: blurred vision, dry mouth, drowsiness, constipation, orthostatic hypotension. May lessen or disappear after 7 days.
- May cause anticholinergic delirium in the elderly.
MONITORING:
- prolonged QT interval
- Monitor BP for orthostatic hypotension.
- Monitor for increased suicidal thoughts in initial use.
Aspirin
CLASS: Anti-platelet/ NSAID
INDICATIONS: Acute coronary syndrome, symptomatic atherosclerosis, relief of pain/inflammation/fever.
DOSE:
- Antiplatelet effect - 75-150mg once daily.
- Pain effect - 300-900mg every 4-6 hours prn.
COUNSELLING:
- Labels 9, 13, 19b (high doses), A*, B
- Take with food to reduce stomach upset & prevent ulcers.
- Look for signs of bleeding: swollen ankles, difficulty breathing, black stools or vomit that looks like coffee grounds.
- Remove tablets from packaging just before use as it can break down rapidly if it isn’t protected by packaging.
- Tell your doctor and dentist you are on this medication.
- Speak to your pharmacist or doctor before using any antiflammatories for pain relief.
MONITORING:
- monitor for GI bleeding, renal failure or hepatic dysfunction.
- Watch for bronchospasm in those with asthma and worsening of rhinitis in those affected.
Cephalexin
CLASS: cephalosporin (moderate spectrum)
INDICATIONS: Staphylococcal and streptococcal infections in people with mild penicillin allergy , UTIs, Epididymo-orchitis.
DOSE: 250-500mg QID (max 4g daily). UTI prophylaxis - 250mg daily
COUNSELLING:
- Complete the entire course even if you are feeling better. (Label D)
- If you develop swelling of the face, lips or tongue, itching of the skin or difficulty breathing, seek medical attention immediately .
- SEs: Diarrhoea, Nausea, Vomiting, Rash, Headache, Dizziness, C.diff/superinfection (long duration), Neurotoxicity (seizures, confusion, encephalopathy), - rarely: cholestatic hepatitis
MONITORING:
- signs of allergic reaction.
- therapeutic effect - ie improvement in symptoms.
- Superinfection eg. thrush
Tamsulosin
CLASS: Selective alpha blocker (block alpha1 receptors relaxing smooth muscle in the bladder neck and prostate decreasing resistance to urinary flow).
INDICATIONS: Benign Prostate Hyperplasia (BPH), (also can be given in combination with dutasteride for BPH).
DOSE: 400microg once daily.
COUNSELLING:
- do not crush or chew.
- May cause dizziness or drowsiness. - SEs: abnormal ejactulation, first dose hypotension, orthostatic hypotension (BP effects less frequent with tamsulosin than other alpha blockers).
- Tell your opthalmologist you are taking or have taken this medicine if you are going to have cataract surgery.
MONITORING:
- symptomatic effect.
- prostate size.
- Blood pressure
Isotretinoin
CLASS: Retinoid
INDICATIONS: cystic acne/ severe acne
DOSE: Initially up to 0.5mg/kg each day as a single dose or in 2 doses. Can be increased to 1mg/kg after 4 weeks according to response. Continue treatment for 4-6months until total cumulative dose is 120-150mg/kg to prevent condition relapse.
COUNSELLING:
- do not donate blood during treatment and for 8 weeks after stopping.
- Females need to use adequate contraception before during and for 1 month after treatment as birth defects can occur.
- Acne flare may occur during the first few weeks of treatment.
MONITORING:
- Monitor liver function tests and lipids at baseline then after first month of treatment.
- monitor for psychological symptoms as there is evidence between isotretinoin and psychiatric disorders.
Lercandipine
CLASS: di-hydropyridine (Calcium Channel Blocker)
INDICATIONS: hypertension (sometimes in fixed dose combinations with enalapril).
DOSE: 10 - 20mg daily.
COUNSELLING:
- Best absorbed if taken 15 MINUTES before a meal.
- look for signs of peripheral oedema (common in dihydropyridines).
- SEs: dizziness, headache, nausea, hypotension.
- Labels 12 (during initiation and dose increase), 9, 18, C
MONITORING: blood pressure
Tramadol
CLASS: opioid analgesic (also a serotonin and noradrenaline reuptake inhibitor).
INDICATIONS: moderate pain
DOSE: 50-100mg every 4-6 hrs up to max daily dose of 400mg (300mg for those >75 years). There is also a 12hr and 24hr controlled release product.
COUNSELLING:
- Label 1, 5
- May make you feel dizzy.
- For chronic use, look after teeth and mouth as opioids may make your mouth dry increasing the risk of dental caries.
- Swallow whole controlled release products.
- With regular use may cause some constipation.
MONITORING:
- therapeutic effect.
- serotonin syndrome with other reputake inhibitors.
- atypical withdrawal symptoms (panic attacks, hallucinations, paraesthesia).
- Bowel function.
Betamethasone
CLASS: Corticosteroid
INDICATIONS: Comes in IM, intra-articular, intradermal, soft tissue injection. - adjunctive treatment for inflammatory arthritis, acute gout, tendonitis. - inflammatory skin conditions (moderate-potent corticosteroid)
DOSE: topical: apply enough to cover affected areas 1-2 times daily.
COUNSELLING:
- allow sufficient time for absorption between application of a topical corticosteroid and moisturiser.
MONITORING:
- monitor for systemic absorption of topical products.
- monitor for immune suppression with other forms.
Buprenorphine
CLASS: Partial opioid agonist
INDICATIONS: moderate-severe pain, opioid dependence.
DOSE: for patch (chronic pain) start with 5microg/hr in opioid-naive people then titrate dose to effect. Do not increase dose at intervals 2 patches concurrently. MAX dose = 2 x 20microg/hr patches. Change patch every 7 days.
COUNSELLING:
- write date and time of application on patch with permanent marker.
- apply patch to dry, non-irritated, hairless skin on upper torso.
- rotate site of application (avoid re-using same area for at least 3 weeks).
- when wearing, do not allow it to come in contact with direct sources of heat eg. electric blankets, heat pads, heat lamps, saunas or hot baths.
- do not cut or divide patches as may effect drug release.
MONITOR:
- therapeutic effect
- it is a partial agonist so may precipitate withdrawal symptoms in people dependent on other opioids.
Olanzapine
CLASS: Atypical antipsychotic
INDICATION: Schizophrenia and related psychoses, bipolar disorder with lithium or valproate.
DOSE: range of 5-20mg once daily depending on indication. Max 20mg.
COUNSELLING:
- tell your doctor if you start or stop smoking tobaccao as the dose may need to be changed.
- response may not be noticed until 1-2 weeks –> allow 2-3 months for full trial.
- SEs: weight gain, EPSE effects, orthostatic hypotension. - may cause drowsiness and increase the effects of alcohol.
MONITORING:
- check glucose tolerance if patient gains weight.
- monitor clinical effect
Amoxycillin
CLASS: Penicillin antibiotic
INDICATION: infections including URTIs, UTIs, H pylori.
DOSE: generally 250-500mg every 8 hours or 1g BD. Can use 1g 8hrly for severe infections. NOTE: dose is different when given with clavulanic acid.
COUNSELLING:
- look for signs of allergic reaction (if have not had before) eg. rash, swelling severe diarrhoea.
- SEs: nausea and diarrhoea.
- Label D
MONITORING:
- improvement of symptoms
- signs of rash (either immediate or delayed).
Ibruprofen
CLASS: NSAID
INDICATION: Pain, especially due to inflammation (eg. period pain, headache), rheumatoid arthritis, osteoarthritis.
DOSE: 200-400mg 3 or 4 times a day (Max 2.4g daily).
COUNSELLING:
- take dose with glass of water.
- can be taken without food but if it upsets your stomach take with food.
- use short term only.
- Labels 10a, 12, 19b, B
MONITORING:
- signs of GI adverse effects
- watch for signs of broncospasm in asthmatic.
- watch for reduced renal function.
- signs of bleeding with other antiplatelet meds eg. aspirin (non-selective NSAIDs such as ibruprofen may increase risk of bleeding through its antiplatelet effect).
Famciclovir
CLASS: Guanine analogue anti-viral.
INDICATION: treatment and prevention of herpes simplex infections and shingles (varicellar zoster).
DOSE: depending on indication and renal function.
- cold sores - 1500mg as a single dose (OTC)
- Shingles - 250mg tds for 7 days (prescription)
COUNSELLING:
- start treatment within 72 hours of symptom onset.
- good idea to carry a course of tablets for recurrent herpes simplex infections so they can be started as soon as symptoms are noticed.
- SEs: headache, vomiting, diarhhoea
MONITORING:
- renal function in those applicable
Temazepam
CLASS: Benzodiazepine
INDICATION: Short term treatment of insomnia
DOSE: 5-20mg at night. (elderly 5 - 10mg)
COUNSELLING:
- you may feel drowsy while taking this medication which may persist the following day. Avoid driving/heavy machinary until you know how you react.
- Avoid alcohol and meds that may increase drowsiness.
- If you take it for more than 2-4 weeks, your body may become used to it and you will need a higher dose to feel its effects.
- suddenly stopping may cause unpleasant effects eg. feeling anxious, difficulty sleeping. Discuss with doctor how to stop.
- Labels 1, 9
MONITORING:
- therapeutic effect
- risk of falls
- drowsiness with other medications.
Oxycodone
CLASS: Opioid analgesic
INDICATION: moderate- severe pain
DOSE:
- acute pain: 5-15mg 4hrly prn.
- chronic pain: 5-10mg controlled release product, BD, adjust as needed.
- fixed dose combination with naloxone.
COUNSELLING:
- Labels 1, 18
- may cause constipation.
- do not crush or chew CR products.
MONITORING:
- pain response
- side effect response ie sedation, respiratory depression
- constipation, may need to prescribe preventative laxative.
Fluconazole
CLASS: Azole anti-fungal
INDICATIONS: Candidasis infection and other fungal infections.
DOSE:
- vaginal thrush - 150mg single dose.
- Systemic candidasis - 400mg once daily.
COUNSELLING:
- Tell your doctor if you feel unusually tired nauseous or are not eating or if you notice dark urine, pale faeces or yellowing of the whites of eyes or skin.
- Labels 5, D
- Can interact with many medications, tell your doctor or pharmacist.
MONITORING:
- if using for longer than a stat dose, monitor liver function and serum potassium concentration at baseline then at regular intervals.
- check culture to see if infection susceptible to fluconazole.
Quetiapine
CLASS: Atypical antipshycotic
INDICATIONS: schizophrenia, bipolar disorder, adjunct in major depression, generalised anxiety disorder.
DOSE: dependent on indication. Generally 300-800mg total daily for maintenance (generally given BD due to short half life).
COUNSELLING:
- swallow whole slow release product.
- SEs: metabolic effects (weight gain, hyperglycemia), tachycardia, hypothyroidism.
- May cause sedation
- Can cause orthostatic hypotension
- extraparamidal side effects (less likely)
MONITORING:
- monitor thyroid function
- Blood pressure
- therapeutic effect
Zolpidem
(Stilnox)
CLASS: Potentiation of inhibitory effects of GABA (insomnia drug).
INDICATIONS: Short term treatment of insomnia
DOSE: 5 - 10mg immediately before bed.
Controlled release 6.25 - 12.5mg immediately before bed.
COUNSELLING:
- Label 1a, 2, A*
- This medicine should start to work within 30mins.
- Usually only taken for short periods (2-4 weeks).
- This medication is intended to make you feel sleepy, but you may be less alert or even drowsy the following day. Avoid driving or operating machinery for at least 8 hrs after taking your tablet (possibly longer).
- Label 2 – do not take alcohol or other medications that may cause drowsiness while taking zolpidem as this may increase the risk of walking or driving while you’re asleep.
- Swallow whole CR products.
- This medicine can cause potentially dangerous sleep-related behaviours, including sleepwalking and driving while asleep. If you experience any of these tell your doctor.
- Side effects: sedation, dizziness, headaches, diarrhoea, nausea, nightmares, amnesia, sleep walking & related behaviour, hallucinations.
MONITORING:
- Sleep quality
- Tolerances & dependence (check intervals between dispensing of prescriptions).
- dangerous behaviour eg. sleep walking
Atorvastatin
CLASS: Statin (HMA-CoA reductase inhibitor)
INDICATIONS: Hypercholesterolaemia, high risk of coronary heart disease, mixed hyperlipidaemia.
DOSE: 10 - 80mg daily
COUNSELLING:
- Label 18
- Tell your doctor if the whites of your eyes become yellow, faeces pale, have dark urine or pain in muscles that aren’t exercise related.
- S/Es: transient GI symptoms, sleep disturbances, headache, gynaecomastia, myalgia, myopathy, rhabdomylosis
MONITORING:
- renal function
- rhabdomylosis.
- LFTs
- CK
Rosuvastatin
CLASS: Statin (HMA-CoA reductase inhibitor)
INDICATIONS: Hypercholesterolaemia, high risk of coronary heart disease.
DOSE: 5-40mg daily (anytime during day)
COUNSELLING:
- Label 18
- Tell your doctor if the whites of your eyes become yellow, faeces pale, have dark urine or pain in muscles that aren’t exercise related.
- S/Es: transient GI symptoms, sleep disturbances, headache, gynaecomastia, myalgia, myopathy, rhabdomylosis
MONITORING:
- renal function
- rhabdomylosis.
- LFTs
- CK
- Asian ancestry (20mg max)
Pregabalin
CLASS: Anti-epileptic
INDICATIONS: Focal (partial) seizures, neuropathic pain.
DOSE: 75 -300mg BD
COUNSELLING:
- Labels 1, 9, 12
- S/Es: dizziness, drowsiness, visual disturbances, insomnia, oedema, constipation, weight gain.
- avoid stopping abruptly (may cause anxiety, headache, insomnia, sweating, nausea and diarrhoea).
MONITORING:
- therapeutic effect
- seizure frequency.
Amlodipine
CLASS: Calcium Channel Blocker (dihydropyridine)
INDICATIONS: HTN, angina
DOSE: 2.5 - 10mg
COUNSELLING:
- Label 9, 12, 18
- dizziness (get up slowly)
- signs of oedema
- Let your doctor and dentist know if you have any changes to your gums and teeth.
- Side effects: hypotension, nausea, dizziness, headache, flushing, OEDEMA (dihydropyridines), gingival hyperplasia, gynecomastia, tachycardia.
MONITORING:
- BP
- peripheral oedema
- ECG
- Chest pain
Gliclazide
CLASS: sulfonylurea
INDICATION: Type 2 diabetes
DOSE: 40-320mg in 1-2 doses (IR) 30-120mg daily (CR)
COUNSELLING:
- Take with food to minimise risk of low blood glucose (hypoglycaemia)
- Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol
- Make sure that you and your friends and family know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you are unsure
- SEs: Hypoglycaemia, Weight gain, Nausea, Diarrhoea, Metallic tastes, Headache, Rash, Blood disorders (thrombocytopenia, agranulocytosis, aplastic anaemia, haemolytic anaemia), SJS, Exfoliative dermatitis, Photosensitivity, Hepatotoxicity.
MONITORING:
- Hepatic function
- BSLs
- HbA1c
- Weight
Ezetimibe
CLASS: drug for dyslipidaemia
INDICATION: Hypercholesterolemia
DOSE: 10mg daily.
COUNSELLING:
- Tell your doctor if you develop any muscle pain, tenderness or weakness.
- SEs: GI (N+V+D), Myalgia, Raised LFTs, Headache, Pancreatitis, Myopathy.
MONITORING:
- Lipids
- CK
- LFTs
Ipratropium (inhaled)
CLASS: Short acting anticholinergic (promotes bronchodilation by inhibiting cholinergic bronchomotor tone)
INDICATION: COPD, asthma
DOSE: MDI 2-4 inhalations up to 4 times daily. Nebs: 250- 500microg up to 4 times daily.
COUNSELLING:
- dilute solution for nebulisation to 2-3mL with sodium chloride 0.9%.
- do not allow the mist to come into contact with your eyes. If using a nebuliser close your eyes or wear eye protection during use.
- tell doctor if you notice any eye pain/discomfort, blurred vision or visual halos, or difficulty urinating.
- label 12 (do not drive or operate machinary until you know how it affects you –> can cause dizziness or affect your vision).
- SEs: dry mouth, throat irritation, blurred vision, dizziness (particularly ipratropium), urinary retention.
MONITORING:
- breathlessness - FEV1??
Donepezil
CLASS: Anticholinesterase (decreases breakdown of ACh reducing apparent deficienc of cholinergic neurotransmitter activity in Alzheimer’s disease).
INDICATION: Alzheimer’s disease
DOSE: 5 - 10mg daily.
COUNSELLING:
- Label 12 –> may cause dizziness or drowsiness.
- SEs: urinary incontinance, vivid dreams, insomnia, dyspepsia, dizziness, nausea and vomiting.
- Take at night, however if vivid dreams or insomnia are causing problems can take in the morning.
MONITORING:
- assess for improvement over 3 months. If side effects intolerable or no improvement seen, cease.
- congnitive function.
Phenytoin
CLASS: antiepileptic
INDICATION: Epilepsy (focal (partial) seizures, generalised tonic-clonic seizures).
DOSE: 200-500mg daily.
COUNSELLING:
- women of child-bearing age should consider using contraception.
- label 12
- interacts with many drugs.
- visit dentist regularly to prevent enlarged gums.
- tell doctor immediately if you notice fever, sore throat, rash, mouth ulcers, bruising or bleeding.
- Do not stop taking this medicine suddenly unless advised by your doctor.
- SEs: nausea, vomiting, insmonia, agitation, sedation, blurred vision, behavioural disturbances, gingerval hyperplasia, hirsutism (long term use).
MONITORING:
- therapeutic level
- free phenytoin 1-2mg/L.
- therapeutic effect ie seizure control.
- vitamin D and bone denisity monitoring in long term use to prevent osteoporosis.
Levodopa
CLASS: Dopamine precursor.
INDICATION: Parkinson’s disease
DOSE: 50 - 100mg 2-3 times daily (up to 2g per dose).
COUNSELLING:
- Take at the same time each day and in the same way (eg. always before food).
- Can cause drowsiness.
- Can make you dizzy.
- Do not stop taking this medicine suddenly unless your doctor tells you to.
- SEs: nausea, orthostatic hypotension, dyskinesia, episodes of sudden loss of mobility (‘off’ effect), insomnia, drowssiness, hallucination, confusion in elderly, dark discolouration of urine and sweat.
MONITORING:
- clinical response
- may need to adjust dose over time, or increase freqency as disease progresses.
- signs of dyskinesias.
- end of dose fluctuations.
Cabergoline
CLASS: dopamine agonist
INDICATION: Parkinson’s disease
DOSE: 0.5 -3mg daily.
COUNSELLING:
- take with food, and start at night.
- can cause dizziness or drowsiness, do not drive if affected.
- Label 16
- AEs: strong nausea and vomiting, impulse control disorders (eg. pathological gambling), cardiac fibrosis, dizziness, drowsiness.
MONITORING:
- therapeutic effect
- regular cardiovascular evaluation to assess for presence of asymptomatic valvular disease.
Oestriol (eg. Ovestin brand)
CLASS: Oestrogen replacement.
INDICATIONS: menopausal symptoms, vulvovaginal symptoms due to oestrogen deficiency.
DOSE: oral - 1-4mg daily Combined HRT - continuous oestrogen with either cyclical progestogen or continuous progestogen. vaginally: 0.5mg (1 applicator full) once or twice a week.
COUNSELLING:
- Tell your doctor immediately if you develop: symptoms of a blood clot, changes in your breasts, changes in vaginal bleeding.
- AEs: breast enlargement/tenderness, headache, depression, change in libido, breakthrough bleeding/spotting, endometrial hyperplasia, leg cramps, drye eye syndrome.
- Only use oestrogen only systemically in women who have had a hysterectomy.
MONITORING:
- signs of oestrogen related cancers (mammograms, pap smears)
- adverse effects –> may need to change route, dose.
- Wait 3 months before making any changes to regimen.
Fluticasone (inhaled)
CLASS: corticosteroid INDICATION: maintenance treatment of asthma, COPD with FEV1
Gabapentin
CLASS: anti epileptic
INDICATION: focal (partial) seizures which are not controlled satisfactorily by other antiepileptic drugs. Neuropathic pain.
DOSE: maintenance of 0.9 - 3.6g daily in 3 divided doses.
COUNSELLING:
- label 1
- do not stop taking this medicine suddenly unless your doctor tells you to.
- AEs: sedation, dizziness, tremor, diplopia, peripheral oedema, weight gain, dry mouth.
MONITORING:
- renal function (need to adjust dose).
- for neuropathic pain, assess risks vs benefit after 12 weeks.
- use of other drugs that may lower seizure threshold.
Lamotrigine
CLASS: anti-epileptic
INDICATIONS: focal (partial) and generalised seizures, Bipolar disorder.
DOSE: 100 - 200mg daily. Adjust with concurrent use of valproate or enzyme inducers.
COUNSELLING:
- label 1 , 9
- Tell your doctor immediately if you develop a rash, fever or swollen glands. (severe skin reactions - eg. steven-johnson syndrome - concurrent use with valproate can increase risk).
- AEs: diplopia (double vision), blurred vision, dizziness, headache, hyperkinesia, nausea, vomiting, maculopapular rash.
MONITORING:
- signs of severe skin reaction
- clinical effect (seizure free period).
Cyproterone with ethinyloestradiol (Brenda-35, Estelle-35 etc)
CLASS: Combined oral contraceptive
INDICATION: androgenisation (eg. mild - moderate hirsutism) and contraception in these women.
DOSE: 1 tablet daily (cyproterone 2mg, ethinyloestradiol 35 microg, 21 active followed by 7 inactive).
COUNSELLING:
- AEs: breakthrough bleeding, breast enlargement/tenderness, nausea and vomiting, increased BP, mood changes, thrush.
- Watch for signs of VTE (higher risk with cyproterone): severe and sudden pain in chest, severe headache, unexplained tenderless or pain and swelling in one leg, sudden blurred vision.
- Start taking in the indicated section according to instructions.
- Things that can make the pill less effective: other medicines (including herbal products), vomiting or diarrhoea, forgetting a dose.
- If you forget a dose check the instructions (if less than 24hrs late take as soon as you remember then take the usual dose at the usual time).
MONITORING:
- Blood pressure
- pap smears for cervical cancer
- stop treatment 3-4 cycles after the androgen-related condition has resolved.
Oxybutynin
CLASS: Anticholinergic
INDICATIONS: urinary urge incontinence
DOSE:
- 2.5 – 5mg BD to TDS (max 20mg/day)
- Patch: 3.9mg/24hrs applied twice weekly (every 3-4 days)
COUNSELLING:
- Label 12 - May cause drowsiness, dizziness or blurred vision. If affected do not drive or operate machinery.
- Patch: apply to dry intact skin on abdomen, hip or buttock. Avoid applying another patch within 7 days to same site. After use fold the patch in half so the adhesive sides stick together and dispose of it safely.
- Side effects: facial flushing, application site reactions, dry mouth, constipation, urinary retention, nausea and vomiting, blurred vision, dry eyes, confusion, dizziness.
MONITORING:
- clinical effect.
- Urinary retention
- Anticholinergic effects.
Nevirapine
CLASS: Non-nucleoside reverse transcriptase inhibitor.
INDICATION: HIV infection with other antiretrovirals, also prevention of transmission of HIV during late pregnancy.
DOSE: 200mg twice daily.
COUNSELLING:
- Tell your doctor immediately if rash develops or if you feel unusually tired, nauseated, are not eating, notice dark urine, pale faeces or yellowing of your skin or the whites of your eyes.
- This medicine interacts with many drugs.
- Label 5
- AEs: severe rash (can be life threatening), malaise, nausea and vomiting, elevated liver enzymes, headache, fever, weakness.
MONITORING:
liver function every 2 weeks during first 2 months then every 3 months thereafter.
Azathioprine
CLASS: Immunosupressant (cytotoxic)
INDICATION: immune and inflammatory diseases (eg. RA, IBD, lupus etc), prevention of organ transplant rejection.
DOSE: 1 - 3mg/kg daily.
COUNSELLING:
- swallow tablets whole
- Take with food to reduce stomach upset.
- Tell your doctor immediately if you have bleeding, increased bruising or infection.
- Label 8
- Handle with cytotoxic precautions.
- AEs: dose-related myelosuppresion (eg. thrombocytopenia), infection, alopecia, diarrhoea, anorexia, mouth ulceration, oesophagitis, nausea and vomiting.
MONITORING:
- complete blood count each week for 2 months initially then every month. Reduce or stop treatment if white cell count drops.
- liver function
- monitor dose closely with concurrent use of allopurinol or febuxostat.
