Part 1: Medication Knowledge and Counselling Flashcards

Question

Tramadol

Answer 1

**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.

Answer 2

**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.

Answer 3

**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.

Answer 4

**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

Answer 5

**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).

Answer 6

**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).

Answer 7

**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

Answer 8

**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.

Answer 9

**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.

Answer 10

**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.

Answer 11

**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

Answer 12

**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

Answer 13

**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

Answer 14

**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)

Answer 15

**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.

Answer 16

**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

Answer 17

**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

Answer 18

**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

Answer 19

**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??

Answer 20

**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.

Answer 21

**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.

Answer 22

**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.

Answer 23

**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.

Answer 24

**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.

Answer 25

CLASS: corticosteroid INDICATION: maintenance treatment of asthma, COPD with FEV1

Answer 26

**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.

Answer 27

**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).

Answer 28

**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.

Answer 29

**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.

Answer 30

**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.

Answer 31

**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.

Answer 32

**CLASS:** antiarrhythmic **INDICATION:** treatment and prophylaxis of serious tachyarrhythmias refractory to other treatment (including ventricular tachycardia, AF and SVT). **DOSE:** _100 - 200mg daily_ (up to 400mg). **COUNSELLING:** * Labels 5, 8, 18 * Tell your doctor if you develop shortness of breath or a dry cough, problems with your vision, weight loss, muscle weakness or worsening of your heart symptoms. * AEs: nausea and vomiting (especially when loading), taste disturbance, transient elevation of hepatic aminotransferases, thyroid dysfunction, skin pigmentation (blue/grey), photosensitivity, sleep disturbances, neurotoxicity. **MONITORING:** * Before starting check baseline and every 6 months: electrolytes, thyroid and liver function, lung function (x-ray) and ECG. * monitor for hypothyroidism (thyrotoxicosis can occur). * monitor for pulmonary toxicity (either an acute inflammatory disorder or a chronic fibrotic form associated with prolonged exposure). * monitor for worsening of arrhythmia (amiodarone has potential to worsen it). * Long half life so watch for interactions.

Answer 33

**CLASS:**'other' antibacterial **INDICATIONS:** UTIs, prostatitis, epididymo-orchitis, mild-moderate PCP. **DOSE:** 300mg daily. (150mg prophylaxis). **COUNSELLING:** * Label D * Side effects: fever, itch, rash, nausea, vomiting, hyperkalaemia. * Take at night for UTIs to maximise urinary concentration. **MONITORING:** * watch for hyperkalaemia (average onset is 4-5 days) - trimethoprim causes potassium retention. * therapeutic effect. * complete blood count and folate status during prolonged treatement. * renal function (can increase risk of hyperkalaemia).

Answer 34

**CLASS:** corticosteroid **INDICATION:** inflammatory conditions eg. autoimmune, COPD exacerbation, acute asthma, gout etc. **DOSE:** _5- 60mg once daily._ (usually morning to help reduce risk of adrenal suppression as well as to prevent insomnia). **COUNSELLING:** * With food to help prevent stomach upset (Label B). * Label 9 * side effects: increased susceptibility to infection, sodium and water retention, hypertension, hypokalaemia, hyperglycaemia, osteoporosis, increased appetite/ weight gain, dyspepsia, delayed wound healing, fat redistribution (cushingoid appearance), physchiatric effects. * Tell your doctor immediately if you have any signs of infection. * This medication may affect your mood eg. you may feel more happy or sad than usual or may cause problems with sleeping. **MONITORING:** * measure blood glucose, electrolytes, weight and BP at baseline, then each week for the first month of treatment. * Watch for signs/symptoms of infection. * For treatment \>3months, measure baseline BMD and throughout treatment. * Monitor for cataracts and glaucoma in patients on long-term corticosteroids.

Answer 35

**CLASS:** triptan **INDICATIONS:** acute relief of migrain or cluster headache. **DOSE:** _50 - 100mg_ as required. Can repeat after 2hrs if migraine recurs. _Max dose 300mg per day_. **COUNSELLING:** * Most effective when taken at the headache is beginning to develop (not earlier during an aura or later when headache more severe). * Label 12 * If there is no improvement with the first dose, do not repeat. * Dependence may occur with overuse resulting iwth rebound headaches and withdrawal syndrome. * Side effects: sensations of tingling, heat, pain, heaviness or tightness in the body. Dizziness, transient increase in BP, drowsiness. **MONITORING:** * cardiovascualar monitoring. * Therapeutic effect. * Number of migraines.

Answer 36

**CLASS:** migraine prophylactic (5HT antagonist with antihistamine and weak anticholinergtic properties). **INDICATION:** Prevention of recurrent migraine and prophylaxis. **DOSE:** 0.5 - 1.5mg nocte. Max 3-4.5mg daily in 2 or 3 doses. **COUNSELLING:** * Label 1, especially when starting. * May increase your appetite so you will need to pay more attention to your diet to avoid weight gain. * Side effects: sedation, faitue, nausea, increased appetite, weight gain, dry mouth, constipation. **MONITORING:** * weight gain * increased risk of seizures in those at risk. * prostate size - risk of prostate hypertrophy aggravation.

Answer 37

**CLASS:** Nitrate **INDICATION:** _prevention_ of angina **DOSE:** _30 - 60mg once daily_. _Max of 120mg_ daily. **COUNSELLING:** * swallow whole * Label 16 * Take at time of day when angina is most frequent. * Twice daily dosing is not recommended as there will be no nitrate free period and tolerance will be more likely to develop, * Has slow onset of action so do not use for acute episodes of angina. * Side effects: vasodilator effects such as headache, flushing, orthostatic hypotension, peripheral oedema, palpitations. **MONITORING:** * Blood pressure. * Haemoglobin (contraindicated in signficant anaemia).

Answer 38

**CLASS:** Sartan (antiotensin II antagonist, or angiotensin receptor blocker (ARB)) **INDICATIONS:** * Hypertension * Reduction of renal disease progression in patients with type 2 diabetes, hypertension & microalbuminuria or proteinuria **DOSE:** 75 - 300mg once daily. **COUNSELLING:** * Labels 11, 12\* 16\* * This medicine can take 2-4 weeks to reduce your blood pressure effectively. * Side effects: dizziness, headache, hyperkalaemia, first dose hypotension, angioedema, cough (although less likely than in ACE inhibitors). * Avoid NSAIDs - discuss with pharmacist or doctor before using. **MONITROING:** * Renal function (particularly when combined with an ACE inhibitor) * potassium levels * Angioedema if history of angioedema with ACE inhibitors.

Answer 39

**CLASS:** antiepileptic **INDICATIONS:** * Focal (partial) seizures * Adjunctive therapy in generalised seziures. * Myoclonic seizures **DOSE:** 500mg - 1.5g BD **SIDE EFFECTS:** Behavioural effects (eg agitation, depression, anxiety, hostility), Drowsiness, Weakness, Dizziness **COUNSELLING:** * Labels 1, 9 * You might feel tired or lack energy when you first start taking this medicine; these side effects will often settle down. * You may dilute this mixture **MONITORING:** * Seizure control * Renal impairment (reduce dose) * Hepatic impairment (reduce dose) * Changes in mood or behaviour.

Answer 40

**CLASS:** Lincosamide **INDICATIONS:** alternative in pts with severe allergy to pen/cephs. Some uses: acne, anaerobic infections, bacterial vaginosis, soft tissue, skin, dental and bone infections. **DOSE:** 150 - 450mg 6-8hrly. **SIDE EFFECTS:** **COUNSELLING:** * Label D * Side effects: diarrhoea (mild-severe), abdominal cramps, nausea and vomiting. * If you develop severe or prolonged diarrhoea, stop taking this medicine and tell your doctor immediately. Do not take antidiarrhoeals to treat the problem. (clostridium difficile) **MONITORING:** * For clostridium difficlie-associated disease. * complete blood count, hepatic and renal function during prolonged treatment.

Answer 41

**CLASS:** Dopamine antagonist **INDICATIONS:** nausea and vomiting. Gastric stasis. **DOSE:** 10mg PRN (max 30mg daily). Use only for 5 days max. **COUNSELLING:** * Label 12 * Side effects: drowsiness, restlessness, dizzines, insomnia and headaches. Infrequent: EPSE, hyperprolactinaemia. * May take 30 - 60mins for onset of effects. * Use for longer than 5 days can increase the risk of Parkinsonian like symptoms. **MONITORING:** * Signs of EPSEs (particularly in anyone under 20). * Renal function (reduce dose).

Answer 42

**CLASS:** 5HT₃ antagonist **INDICATION:** Nausea and vomiting associated with: cancer chemotherpay, postoperative, radiotherapy-induced. **DOSE:** 8mg every 8-12hrs. **COUSNELLING:** * Label 5 * Side effects: constipation (++), headache, dry mouth and sensation of warmth or flushing. Rare: EPSEs * If you vomit within 1hr of taking the tablet, take the same dose again. * For wafer or ODT, place on _top_ of tounge and allow to dissolve, then swallow. **MONITORING:** * Therapeutic effect * Signs of EPSEs * QT prolongation

Answer 43

**CLASS:** bipolar drug. Mode of action not entirely known. **INDICATION:** * Prevention of manic or depressive episodes in bipolar disorder. * treatment of acute mainia. * treatment resistant depression. **DOSE:** 250mg - 2.5g in 1-3 doses. **COUSNELLING:** * Labels 5, 13, A\*, B * Take with food. * Can initially cause nausea, diarrhoea, muscle weakness and dizziness. Transient. * Other side effects: _weight gain_, metallic taste, loss of appetite, constipation, headaches. * If the level of lithium in your blood becomes too high you may experience lithium toxicity. See doctor _immediately_ if you start needing to urinate frequently, or develop extreme thrist, severe diarrhoea, vomiting, blurred vision, weakness or drowsiness. * Avoid low-salt diets and heavy excercise that causes excessive sweating as these may lead to increased lithium levels. * Avoid sodium bicarbonate (found in products such as indigestion medicines and Ural etc) as these can make lithium less effective. **MONITORING:** * renal impairment (reduce dose). * serum lithium levels (narrow therapeutic range). * thyroid function * cardiac function. * calcium levels

Answer 44

**CLASS:** opioid antidiarrhoeal **INDICATIONS:** diarrhoea (usually short term), intestinal stoma (to reduce frequency and fluidity of motions). **DOSE:** 2 - 16mg daily. (Usually 4mg then 2mg after each bowel motion). **COUNSELLING:** * Should only be used for as long as necessary (eg. while at work or travelling). * Side effects: constipation, nausea, abdominal pain, bloating and flatulance. * To prevent dehydration during a bout of diarrhoea drink plenty of fluids. **MONITORING:** * bowel motions

Answer 45

**CLASS:** P2Y₁₂ antagonist (antiplatelet drug). **INDICATIONS:** History of symptomatic atherosclerosis, ACS with aspirin, post stent insertion (1-12 months). **DOSE:** 75mg once daily. **COUNSELLING:** * Labels 9, 10a, 18. * Grapefruit may decrease the efficacy of clopidogrel. * Tell your doctor asap if you develop signs of bleeding (eg. nosebleeds, unexplained bruising, dark or blood-stained bowel motions, dark urine, coffee-coloured vomit). * Tell your doctor, pharmacist, dentist and other health professionals you are taking this medicine. * It is safe to take paracetamol while taking this medicine. * Avoid using NSAIDs as they can increase the risk of bleeding. **MONITORING:** * Signs of bleeding. * Hepatic function (reduce dose). * Drug interactions.

Answer 46

**CLASS:** thyroid hormone **INDICATIONS:** hypothyroidism **DOSE:** 50 - 200 mcg once daily. **COUNSELLING:** * Labels: 3b, 4a, 6 * Take at the same time each day (preferably before breakfast). * Take on an empty stomach. * Tell doctor if you notice symptoms of hyperthyroidism: palpitaitons, excitability, insomnia, flushing, sweating or weight loss. * Tablets should be kept in the fridge. Can take a single blister strip out of the fridge for 14 days. **MONITORING:** * thyroid function * signs of hyperthyroidism * INR in patients taking warfarin when thyroxine dose is changed (can cause an increase in anticoagulant effects).

Answer 47

**CLASS:** Antithyroid drug (blocks thyroid hormone synthesis). **INIDCATIONS:** Grave's disease, thyroid storm, preparation for thyroid surgery. **DOSE:** 10 - 80mg in divided doses. Use for 3-4 weeks. **COUNSELLING:** * Side effects: itch and mild rashes (respond to antihistamines), mild leucopenia, nausea, vomiting, gastric discomfort. * Tell your doctor immediately if you develop fever, mouth ulcers, sore throat, rash, severe fatigue, nausea, abdominal pain or jaundice. **MONITIORING:** * thyroid function * hepatotoxicity * agranulocytosis (most likely in first 3 months of treatment and is of rapid onset).

Answer 48

**CLASS:** infertility medication (competitively antagonises oestrogen receptors in hypothalamus, interfereing with negative feedback, therefore increasing release of pituitary gonadotrphins eg. LH stimulating ovulation). **INDICATIONS:** anovulatory infertility **DOSE:** _25- 100mg once daily for 5 days_. Start on day 2-5 of menstrual cycle. (max dose 150mg). **COUNSELLING:** * Label 12 * Stop this medicine and tell your doctor if your vision alters; avoid driving or using machinary if you are affected. * **Side effects:** hot flushes, abdominal discomfort, visual distrubances, breast tenderness, nausea, vomiting and insomnia. **MONITORING:** * Liver function before starting treatment. * pregnancy tests after each cycle.

Answer 49

**CLASS:** dyslipidaemia drug. **INDICATIONS:** hypercholesterolaemia, homozygous sitosterolaemia. **DOSE:** 10mg once daily. **COUNSELLING:** * Side effects: abdominal pain, diarrhoea, fatigue. * If you develop new or unusual muscle pain, tenderness or weakness, tell your doctor. **MONITORING:** * may cause depression. Monitor for changes in mood or behaviour, particularly in initial weeks of therapy. * Myopathy (particularly when used with statins). * Cholesterol and lipid levels. * Hepatic impairment (contraindicated).

Answer 50

**CLASS:** Nitroimidazole anti-infective. **INDICATIONS:** * anaerobic infections * protozoal infections eg. giardiasis * clostridium difficile infections * aspiration pneumonia * intra-abdomnial infections **DOSE:** 200 - 400mg 8-12hrly. **COUNSELLING:** * Labels: 2, 5, B, D * Take with food to reduce stomach upset. * May make you feel dizzy or confused, avoid driving if you are affected like this. * Avoid alcohol and for 24hrs after finishing the course. * Stop taking and check with your doctor immediately if you have any numbness, tingling, pain or weakness in hands or feet. * **Side effects:** nausea, vomiting, diarrhoea, loss of appetite, abdomnial pain, metallic taste and headaches. **MONITORING:** * prolonged treatment (\>10 days): total and differential leucocyte count.

Answer 51

**CLASS:** antianginal drug **INDICATIONS:** angina refractory to other drugs or surgical procedures. **DOSE:** 50mg once weekly to 400mg daily depending on metaboliser status. **COUNSELLING:** * Labels 5, 12\* * You will need regular blood tests while taking this medicine. * Tell your doctor promptly if you have weakness, weight loss or feel pins and needles or numbness of fingers or toes. * This medicine may initially cause nausea nd dizziness which should dissapear with use. * **Other side effects:** hypoglycemia, peripheral neuropathy, hepatotoxicity, weight loss (can be significant), EPSEs, seizures. **MONITORING:** * Liver function at baseline and regualr intervals. * Weight * blood glucose * peripheral neuropathy signs. * Metaboliser type (take blood sample within 3-5 days of starting to determine perhexiline concentration). Then samples each month until stable, then every 3 months.

Answer 52

**CLASS:** Other antianginal **INDICATIONS:** * Stable angina, with normal sinus rhythm and heart rate \>70 bpm * Stable chronic heart failure in sinus rhythm and heart rate \>77 bpm as adjunct to optimal treatment (including beta blocker) **DOSE:** _2.5 – 7.5mg twice daily_ **COUNSELLING:** * Labels 5, 12, 13, 18, 21, A, B * This medicine is absorbed best when taken with food. * Many CYP interactions – tell other health professionals before taking other meds. * Your vision may be blurred and you may see bright areas, especially when there are sudden changes in light intensity. These effects are most likely in the first 2 months and generally do not persist throughout treatment. Do not drive if affected. * Tell your doctor if your pulse rate is slow (may feel short of breath, tired or dizzy) – your dose may need adjusting. * Side effects: Luminous effects, Bradycardia, AF, Dizziness, hypotension. **MONITORING:** * Heart rate (contraindicated if HR \<70bpm before treatment, and if \<50 during treatment). * Blood pressure (contraindicated when BP \<90/50) * For AF (especially if angina worsens, palpitations or irregular pulse occurs). * Hepatic impairment (reduce dose)

Answer 53

**CLASS:** other antianginal **INDICATIONS:** Prevention & treatment of stable angina **DOSE:** _10 - 20mg twice daily_ **COUNSELLING:** * Labels 9, 12, 13 * Tell your doctor if you get any ulcers, wounds or skin problems that are slow to heal. * **Side effects:** Headache (especially on starting), Dizziness, nausea, palpitations, flushing, myalgia, hypotension, ulcers & fistulae. **MONITORING:** * Hepatic impairment (reduce dose). * Blood pressure. * Ulcer & fistulas (eye tests, skin tests, blood in stools/vomit) * Chest pain.

Answer 54

**CLASS:** Nitrate **INDICATIONS:** * Prevention and treatment of angina * Heart failure **DOSE:** _20-40mg QID_ **(HF)** _5-10mg PRN_ **(acute angina)** _10-40mg TDS_ **(prevention of angina)** **COUNSELLING:** * Labels: 16 * Use during episodes of angina or before activity expected to bring on angina. * Sit or lie down before using as this will prevent dizziness. * Place tablet under your tongue (do not swallow). After pain is relieved spit out what is left to avoid adverse effects. * Call ambulance is symptoms are severe, get worse quickly or do not go away within 10 minutes. * **Side effects (due to vasodilatory effects)** headache, flushing ,nausea, orthostatic hypotension, fainting, dizziness. **MONITORING:** * Tolerance to nitrates (develops in no nitrate-free interval is given for 10-12hrs). * Blood pressure.

Answer 55

**CLASS:** Thiazide diuretic **INDICATIONS:** * hypertension (with another antihypertensive) * Oedema associated with HF or cirrhosis. **DOSE:** _12.5 – 100mg daily_ (sometime taken in 2 doses) **COUNSELLING:** * Label 16 * Usually taken in the morning. If you are taking it twice a day take the first dose in the morning and the second dose before 6pm. * Can take up to 4 weeks to reduce your blood pressure effectively. * Tell your doctor if you have any thirst, or increased fluid loss due to diarrhoea vomiting or excessive sweating. * **Side effects:** dizziness, muscle cramps, orthostatic hypotension, polyuria, electrolyte disturbances, hyperglycaemia, blurred vision, dehydration. Rarely: blood dyscrasias. **MONITORING:** * BSLs – may increase blood glucose concentrations (not clinically important at low doses though). * May aggravate gout. * Potassium concentration. * BP * Electrolyte concentrations. * Renal impairment (loses its diuretic effect – change to loop diuretic) * Hepatic function

Answer 56

**CLASS:** Thiazide diuretic **INDICATION:** hypertension **DOSE:** _1.25 – 2.5mg once daily_ **COUNSELLING:** * Label 16 * Swallow whole for CR product * Can take up to 4 weeks to reduce your blood pressure effectively. * Take in the morning. * Tell your doctor if you have any thirst, or increased fluid loss due to diarrhoea vomiting or excessive sweating. **MONITORING:** * May aggravate gout. * Potassium concentration. * BP * Renal impairment (loses diuretic effect - need to change to loop diuretic). * Hepatic function (electrolyte imbalances can be dangerous in impairment.

Answer 57

**CLASS:** non-dihydropyridine calcium channel blocker **INDICATIONS:** * HTN * Angina * AF/atrial flutter * SVT * Cluster headache prophylaxis **DOSE:** _80 – 160mg BD to TDS_. CR product: _120 – 240mg daily to BD_ (max 480mg d) **COUNSELLING:** * Labels, 5, 9, 12\*, 13, 18 * May increase the effects of alcohol so you are more easily affected and the effects last longer. * This medicine can initially cause dizziness, headache and flushing. These may decrease or disappear with continued use. * If you develop swollen ankles tell your doctor. * **Side effects:** constipation, vasodilatory effects (headache, dizziness, hypotension, flushing), bradycardia, tachycardia, chest pain. **MONITORING:** * Heart rate * HF * ECG * Onset of chest pain * CYP interactions

Answer 58

**CLASS:** non-dihydropyridine calcium channel blocker **INDICATIONS:** * HTN * Angina * AF or Atrial Flutter (ventricular rate control) **DOSE:** IR: _120mg – 360mg in 3 or 4 doses_. CR: _180 – 360mg once daily_. **COUNSELLING:** * Labels 5, 9, 12\* * This medicine can initially cause dizziness, headache and flushing. These may decrease or disappear with continued use. * If you develop swollen ankles tell your doctor. * Can up to 2 weeks to reduce your blood pressure effectively. * Label A for CR products. * **Side effects:** bradycardia, atroventricular block, vasodilatory effects (headache, dizziness, flushing, hypotension), nausea. **MONITORING:** * HR (contraindicated in severe bradycardia). * BP (contraindicated when systolic \<90mmHg) * Hepatic impairment (reduce dose) * ECG * Onset of chest pain * CYP interactions

Answer 59

**CLASS:** dihydropyridine calcium channel blocker **INDICATIONS:** * HTN * Angina * Suppression of preterm labour **DOSE:** _10-40mg bd_ CR product: _20 - 120mg once daily_. **COUNSELLING:** * Labels 9, 12\*, 13, 18 * Label A for CR product * This medicine can initially cause dizziness, headache and flushing. These may decrease or disappear with continued use. * **Side Effects:** nausea, vasodilatory effects (flushing, headache, dizziness), peripheral oedema, gingival hyperplasia, gynacomastia. **MONITORING:** * BP * Peripheral oedema * Hepatic impairment (reduce dose)

Answer 60

**CLASS:** centrally acting antihypertensive **INDICATION:** hypertension **DOSE:** _0.2 – 0.3mg daily to BD_ **COUNSELLING:** * Labels 1, 9, 12, 16 * **Side effects:** dry mouth, weakness, dizziness, headahce, nausea, somnolence, sleep disturbance, vasodilation, rash. **MONITORING:** * BP * Renal impairment (reduce dose)

Answer 61

**CLASS:** Alpha 2 andrenoceptor agonist **INDICATION:** * HTN * Treatment of menopausal flushing * ADHD * Management of opioid withdrawal symptoms * Adjunct analgesic * Diagnosis of phaeochromocytoma **DOSE:** _25 – 100mcg BD to TDS_ (_max 600mcg daily_). **COUNSELLING:** * Labels 1, 9, 16 * This medicine can initially cause tiredness, difficulty sleeping, headaches, nausea, constipation, and dry mouth and eyes. These may decrease or disappear with continued use. * Do not stop taking suddenly – may precipitate withdrawal syndrome (headache, flushing, sweating, insomnia, tremor, agitation) * **Side effects:** dizziness, drowsiness, sedation, fatigue, sleep disturbance, headache, depression, Nausea & vomiting, constipation, dry mouth, salivary gland pain, orthostatic hypotension, erectile dysfunction, bradycardia, nightmares, disturbed mental state. **MONITORING:** * BP * BSLs (can cause an increase in glucose concentrations). * May exacerbate depression. * Heart rate

Answer 62

**CLASS:** Beta blocker **INDICATION:** treatment and prevention of arrhythmias. **DOSE:** _40 – 160mg BD (Max 640mg daily)_ **COUNSELLING:** * Label 3b, 4a, 9, 12\*, 16 * Withdraw gradually * May cause dizziness, drowsiness or visual disturbance. If you are affected do not drive or operate heavy machinery. * **Side effects:** shortness of breath, fatigue, dizziness, headache, prolonged QT interval, hypotension, bradycardia, arrhythmias (new or worsened), cold extremities, vivid dreams, reduced libido. **MONITORING:** * ECG & QT interval * BP * HR * Electrolyte disturbances (increased risk of arrhythmias) * BSLs (may mask signs of hypoglycaemia in diabetes eg. tachycardia, tremor).

Answer 63

**CLASS:** Selective alpha blocker **INDICATIONS:** hypertension **DOSE:** _3 – 20mg daily in 2 or 3 doses._ **COUNSELLING:** * Label 12, 16 * Take the first dose at bedtime, but be careful if you get up during the night as you may feel dizzy. * Dizziness on standing may occur especially when starting or dose is increased. * Tell your ophthalmologist you are taking, or have taken, this medicine if you are going to have cataract surgery. (associated with a risk of intra-operative floppy iris syndrome). * **side effects:** first dose hypotension, dizziness **MONITORING:** * Renal impairment (can increase risk of profound first dose effect). * BP

Answer 64

**CLASS:** Fibrate **INDICATIONS:** * Hypercholesterolemia (second line) * Mixed hyperlipidaemia associated with diabetes (second line). * Reducing progression of pre-existing diabetic retinopathy **DOSE:** _145mg once daily_ **COUNESLLING:** * Label 8 * Tell your doctor promptly if your urine is dark (brown) or if you have any muscle pain, tenderness or weakness. **MONITORING:** * LFTs * complete blood count * CK * Lipid levels * Renal impairment (reduce dose)

Answer 65

**CLASS:** cardioselective beta blocker **INDICATIONS:** * HTN * Angina * Tachyarrhythmias * MI * Prevention of migraine **DOSE:** _25 – 200mg daily._ **COUNSELLING:** * Label 9, 12 * May cause dizziness or tiredness especially at the start of treatment or when the dose is increased. If affected do not drive. * If you feel dizzy, get up gradually from sitting or lying to minimise the effect. * Do not suddenly stop taking (need to wean dose to prevent exacerbation of angina, or rebound MI, hypertension or arrhythmias). * **Side effects:** dizziness, lethargy, orthostatic hypotension, bradycardia, dysponea, abnormal vision, cold extremities. **MONITORING:** * Blood pressure * HR * BSLs in diabetics (Beta-blockers may mask important signs of acute hypoglycaemia eg. tremor or tachycardia). * Respiratory function as can precipitate bronchospasm (monitor patients with asthma or COPD). * Hepatic impairment (reduce dose).

Answer 66

**CLASS:** ACE inhibitor **INDICATIONS:** * HTN * Post MI * Prevention of progressive renal failure in patients with persistent proteinuria. **DOSE:** _2.5 – 10mg (in 1 or 2 doses)_ **COUNSELLING:** * Label 11 * Label 16 * Label 12 * If you notice a dry persistent cough go and see your doctor. * Angioedema, rash, difficulties breathing (speak to your doctor immediately). * **Side effects:** hypotension, cough, angioedema, hyperkalaemia, dizziness, headache, renal impairment (with other meds) **MONITORING:** * Electrolytes * Potassium (can cause hyperkalaemia) * Renal function * BP * Cough * Angioedema

Answer 67

**CLASS:** Statin **INDICATION:** * Hypercholesterolemia * Post MI * Unstable angina **DOSE:** _20 – 80mg daily_ **COUNSELLING:** * Label 18 * Take at night. * Seek medical advice promptly if your urine is dark (brown) or if you have any muscle pain, tenderness or weakness. * **Side effects:** * Myalgia * Mild transient GI symptoms * Headache * Sleep disturbances (insomnia/ nightmares) * Dizziness * Myopathy/ rhabdomylosis * Elevated aminotransferase concentrations **MONITORING:** * Lipid levels * Aminotransferase * Creatine kinase (CK) * Myopathy * Renal impairment (increases risk of myopathy) * Hepatic function (can cause increase in liver enzymes)

Answer 68

**CLASS:** ACE inhibitor **INDICATIONS:** * HTN * HF * Post MI **DOSE:** Arginine: _2.5 – 10mg daily_ *\*Note: 2.5mg arginine = 2mg erbumine.* **COUNSELLING:** * Label 11 * Label 16 * Label 12 * If you notice a dry persistent cough go and see your doctor. * Angioedema, rash, difficulties breathing (speak to your doctor immediately). * **Side effects:** hypotension, cough, angioedema, hyperkalaemia, dizziness, headache, renal impairment (with other meds) **MONITORING:** * Electrolytes * Potassium (can cause hyperkalaemia) * Renal function * BP * Cough * Angioedema

Answer 69

**CLASS:** dihydropyridine calcium channel blocker **INDICATION:** hypertension **DOSE:** _5 – 20mg daily_ **COUNSELLING:** * Label 9 * Label 12\* * *Label 18* * *Label A for CR product* * This medicine can initially cause dizziness, headache and flushing. These may decrease or disappear with continued use. * If you develop swollen ankles tell your doctor. * **Side effects:** vasodilatory effects (flushing, headache, dizziness, hypotension), Peripheral odema which does not respond to diuretics. **MONITORING:** * BP * Peripheral oedema * Hepatic impairment (reduce dose)

Answer 70

**CLASS:** loop diuretic **INDICATIONS:** * severe hypercalcemia Oedema associated with: * Heart failure * Hepatic cirrhosis * Renal impairment * Nephrotic syndrome **DOSE:** _20 -40mg daily or BD. Max 1g daily_ **COUNSELLING:** * Label 16 * Usually taken once daily in the morning. If you are taking twice a day take the second dose at lunchtime. * **Side effects:** electrolyte imbalances, increased frequency of urination, dehydration, metabolic alkalosis, dizziness, orthostatic hypotension, gout (hyperuricaemia). **MONITORING:** * Electrolytes * Weight * Renal function * Hepatic function (increased risk of hepatic encephalopathy due to diuretic-induced electrolyte imbalance.)

Answer 71

**CLASS:** Thiazolinediones **INDICATION:** T2DM **DOSE:** _15-30mg daily (max 45mg daily)_ **COUNSELLING:** * Label 10a * Tell your doctor immediately if you have swollen feet or ankles, breathlessness, nausea, vomiting, abdominal pain, fatigue, loss of appetite or dark urine. * **Side effects:** peripheral oedema, weight gain, headache, dizzienss, arthralgia, decrease in haemoglobin, elevated liver enzymes, heart failure (rare). May increase risk of bladder cancer if used \>1yr. **MONITORING:** * Liver enzymes * Signs of fluid retention, if found to have heart failure cease medication. * Weight gain & diet. * BSLs * HB1Ac * Haemoglobin levels * bladder cancer

Answer 72

**CLASS:** anti-epileptic **INDICATIONS:** * Epilepsy (including partial and generalised tonic clonic seizures). * Bipolar disorder * Trigeminal neuralgias. **DOSE:** _400mg – 2g daily in 2 or more doses_. **COUNSELLING:** * Labels 5, 9, 12, 13, 18, B * Label A for controlled release * Take with food to prevent stomach upset. * Carbamazepine may increase the effects of alcohol. * Tell your doctor immediately if rash, sore throat, fever, mouth ulcers, bruising or bleeding occur. * Do not stop taking this medicine suddenly (may precipitate seizures). * May reduce the efficacy of the Combined oral contraceptive. * **Side effects:** * Drowsiness and nausea on starting. * Ataxia * Headache * Blurred vision * Severe skin reactions (eg. Stevens-Johnson syndrome). More common in Asian ancestry. * Multi-organ hypersensiticity syndrome (DRESS). **MONITORING:** * BMD monitoring in patients on long term treatment or those at higher risk eg. elderly patients. * Changes in mood or behaviour. * Plasma concentration when applicable eg. for compliance.

Answer 73

**CLASS:** anti-epileptic **INDICATON:** * Epilespy (including partial seizures & generalised seizures). * Status epilepticus **DOSE:** _200 – 500mg daily (Max 600mg daily.)_ **COUNSELLING:** * Labels 5, 9, 12, 13 * This medication interacts with many drugs. * Visit your dentist regularly; good dental care can help; prevent phenytoin causing enlarged gums. * Tell your doctor immediately if you develop a sore throat, fever, rash, mouth ulcers, bruising or bleeding. * May reduce the efficacy of the Combined oral contraceptive. * **Side effects:** * ****Nausea + vomiting * Insomnia * Agitation * Sedation * Blurred vision * Vertigo * Behavioural disturbances * Impaired learning (dose related) * Gingival hypertrophy * Skin eruption * Coarse facies * Hirsutism (long term use) **MONITORING:** * Changes in mood or behaviour. * Regular TDM due to low therapeutic index. * BMD/ vit D and calcium monitoring with long term use.

Answer 74

**CLASS:** ACE inhibitor **INDICATIONS:** * HTN * HF * Post MI **DOSE:** _5 – 40mg daily_ **COUNSELLING:** (same as other ACE inhibitors) * Label 11 * Label 16 * Label 12 * If you notice a dry persistent cough go and see your doctor. * Angioedema, rash, difficulties breathing (speak to your doctor immediately). * **Side effects:** hypotension, cough, angioedema, hyperkalaemia, dizziness, headache, renal impairment (with other meds) **MONITORING:** (same as other ACE inhibitors) * Electrolytes * Potassium (can cause hyperkalaemia) * Renal function * BP * Cough * Angioedema

Answer 75

**CLASS:** 5-aminosalicylate intestinal anti-inflammatory **INIDCATIONS:** * Ulcerative Colitis * Chron's disease **DOSE:** Oral: 250-500mg tds **COUNSELLING:** * Label 3b, 13, A * If you develop a fever, severe sore throat, unusual bleeding or bruising, severe or bloody diarrhoea, muscle or join pains, a persistanent cough, difficulty breathing or weakness, seek immediate medical attention. * Swallow tablets or granules whole without chewing or crushing them * *Mesasal*: Take tablets at least half an hour before food * *Mezavant*: Take tablets with food * *Salofalk*: Take tablets at least one hour before food; it doesn’t matter when granules are taken in relation to food * *Pentasa*: It doesn’t matter when the tablets or granules are taken in relation to food. The tablets may be dispersed in 50mL cold water, stirred and taken immediately. * Different brands of mesalazine are not interchangeable due to differences in formulation and release characteristics. **SIDE EFFECTS:** More common with higher doses * Nausea * Rash * Headache * Diarrhoea * Infrequent * Interstitial nephritis * Rare * Blood dyscrasias * Pancreatitis (reverible) * Hepatitis **MONITORING:** * Renal and hepatic function (baseline + every 3 months in the first year, then every 6 months)

Answer 76

**CLASS:** SGL-2 inhibitor (increases glucose excretion in urine) **INDICATION:** T2DM **DOSE:** _10mg daily_ **COUNSELLING:** * Your urine will test positive to glucose. * Make sure you drink enough water to control your thirst in order to avoid dehydration. * **Side effects:** * _**Increased sugar in urine:**_ UTIs, genital infections etc. * Polyuria/ dysuria * Dyslipidaemia * **Thirst** * Renal impairment * constipation **MONITORING:** * UTI/genital infections * BSLs * HB1Ac * Euglycaemic ketoacidosis * Renal impairment

Answer 77

**CLASS:** _GLP-1 analogue_ (causes an increase in glucose-dependent insulin secretion. Also delays gastric emptying to slow glucose absorption). **INDICATION:** T2DM **DOSE:** * **Byetta®:** 5mcg subcut BD * **Bydureon®:** 2mg subcut once weekly. **COUNSELLING:** * Byetta®: inject in the _60mins before_ breakfast and dinner (or before your 2 main meals, which should be 6hrs apart). Do NOT use after a meal. * This medicine slows stomach emptying, which occasionally affects absorption of some medicines (antibiotics should be taken 1hr before or 4hrs after injecting). * Bydureon®: inject once a week _on the same day_ each week, _with or without food_. * Tell your doctor immediately if you develop unexplained severe abdominal pain. * This medication may cause nausea, vomiting or diarrhoea. If affected, drink plenty of fluids to avoid dehydration. * **Side effects:** * Nausea & vomiting (up to 50%) * Diarrhoea * Constipation * Dyspepsia * GORD * Pancreatitis (rare) **MONITORING:** * BSLs * HB1Ac * Nausea and vomiting * Pancreatitis

Answer 78

**CLASS:** _DPP-4 inhibitor_ (increases glucose dependent insulin secretion). **INDICATION:** T2DM **DOSE:** _100mg once daily_ **COUNSELLING:** * Label 10a * Can be taken with or without food. * CR product: swallow whole. * Side effects: * Hypoglycaemia (mainly with a sulfonylurea or insulin) * Headache * Musculoskeletal pain * constipation * nausea **MONITORING:** * BSLs * HB1Ac * Signs of hypoglycaemia * Renal function (reduce dose)

Answer 79

**CLASS:** gout medication/ rheumatological drug **INDICATIONS:** * Relief of pain in acute gout * Prophylaxis of gout flares * Familial Mediterranean fever * Acute pericarditis **DOSE:** ***Acute:*** _1mg followed by 500mcg 1 hr later_. Max 1.5mg per course. Do not repeat course within 3 days. Wait at least 12 hrs before resuming prophylaxis dose. ***Prophylaxis:*** _500mcg once or twice daily_ **COUNSELLING:** * Labels 5, 18, A * Label 5 – CYP interactions * Stop taking this medicine and tell your doctor if you develop severe diarrhoea or vomiting, muscle pain, tenderness or weakness, numbness or tingling in your fingers or toes, unusual bleeding or bruising, or an infection. * Acute gout: don’t take more than 3 tablets (1.5mg) in a course to treat acute gout or repeat the course within 3 days. * This medicine is not a pain killer so should not be used to treat other types of pain. * In an acute attack, start asap (within 24hrs). * **Side effects:** * _Diarrhoea_ * Nausea + vomiting * Abdominal discomfort * Pharyngolaryneal pain * GI haemorrhage * Rash * Rare but important: myopathy, blood dyscrasias, thrombocytopenia, peripheral neuropathy **MONITORING:** * Colchicine toxicity (when dose is too high, renal impairment, continued when GI effects occur, or when used with a drug that inhibits its metabolism). * Complete blood count before and during treatment. * Creatine kinase before starting (repeat is symptoms of myopathy occur). * Renal function (impairment risk of toxicity) * Hepatic function (impairment risk of toxicity)

Answer 80

**CLASS:** urate lowering medication (uricosuric) **INDICATIONS:** * Gout * Adjunct to beta-lactam antibacterial treatment (penicillins & some cephalosporins) **DOSE:** _0.5 – 2g daily in 2-4 doses._ **COUNSELLING:** * Label 10a * Label B – take with food to reduce stomach upset. * Make sure you drink lots of fluids during treatment to prevent kidney stones. * You will probably get more gout attacks in the first few months of taking this medicine. This doesn’t mean the treatment isn’t working. This medicine reduces urate in your body and when it is low enough gradually flares will improve and eventually stop. * Continue during gout flare. * Do not start during acute gout flare. * **Side effects:** nausea + vomiting, rash, headache, dizziness, flushing, sore gums, alopecia, uric acid kidney stones. **MONITORING:** * Full blood count * Renal function * Serum urate concentration.

Answer 81

**CLASS:** antiepileptic **INDICATON:** * Primary generalised epilepsy (including tonic-clonic, absence, atonic & myoclonic) * Focal (partial) seizures * Bipolar disorder * Prevention of migraine **DOSE:** _600mg – 2.5g daily_ (in 1 or 2 doses) **COUNSELLING:** * Labels 9, 10a, 12, 13, A\*, B * Take with food to reduce stomach upset. * Valproate may make you feel drowsy, if affected do not drive. Can increase effects of alcohol. * Your appetite may increase so you may need to pay more attention to your diet. * Tell your doctor immediately if symptoms such as fever, rash, abdominal pain, vomiting, jaundice, bruising or bleeding develop. * Women of child-bearing age should consider a contraceptive as valproate causes congenital malformations. * **Side effects:** sedation, appetite stimulation/weight gain, hair loss, tremor, gastric irritation, hyperandrogenism in females, menstrual irregularities, thrombocytopenia **MONITORING:** * Changes in mood or behaviour. * Signs of hepatotoxicity or pancreatitis (malaise, jaundice, dark urine, pale stools, abdominal pain). * Use TDM when necessary to confirm toxicity or compliance. * For signs of thrombocytopenia (bruising or bleeding). * Check complete blood count before starting treatment. * BMD monitoring during long term treatment & ensure vit D and calcium adequate.

Answer 82

**CLASS:** Non-selective NSAID **INDICATION:** * rheumatoid arthritis * osteoarthritis * pain, especially due to inflammation * actinic keratoses * local pain and inflammation in tissues (1% gel) * heavy menstrual bleeding **DOSE:** _75 - 150mg daily in 2 - 3 doses_. (max 200mg/day) **COUNSELLING:** * Labels 10a, 12, 19b, A\*, B * Swallow tablets whole * If you develop swollen ankles, difficulty in breathing, chest pain, black stools or dark coffee-coloured vomit, stop taking and tell your doctor immediately. * Do not take if you are dehydrated, for example due to vomiting or diarrhoea, as it might increase the likelihood of side effects. * **Side effects:** * ****This medicine can increase the risk of a heart attack or stroke. * If you develop new or unusual abdominal pain, indigestion or heartburn, tell your doctor. * Headache, dizziness, diarrhoea, dyspepsia, salt + fluid retention. * Rare: blood dyscrasias. **MONITORING:** * signs of bleeding * signs of gastric irritation/ulcers * aminotransferase concentrations * BP * renal function (risk of renal toxicity). * Liver function (risk of exacerbation)

Answer 83

**CLASS:** Nitroimidazole antibiotic **INDICATION:** * Protozoal infections * Amoebiasis * Bacterial vaginosis * Prophylaxis in GI and gynaecological surgery. **DOSE:** 2g as a single dose **COUNSELLING:** * Label D * Label B * Label 2 – avoid alcohol during treatment and for 24hrs after finish to prevent nausea, vomiting, flushing, headache & palpitations. * **Side effects:** metallic taste, furry black tongue, urine discolouration (brown), nausea + vomiting, CNS effects (dizziness, headache) **MONITORING:** * Neurotoxic so can aggravate existing neurological disease (eg. Seizures). * Blood count (when using \> 10 days). * Renal impairment – monitor with long course (renally excreted).

Answer 84

**CLASS:** Nitroimidazole antibiotic **INDICATION:** * Anaerobic bacterial infections * Protozoal infections * Clostridium difficile-associated disease * Dental infections * Intra-abdominal infections * Aspiration pneumonia * Lung abscess * Bacterial vaginosis * PID * H. pylori **DOSE:** _200 – 400mg every 8-12hrs (max 4g per day)_ **COUNSELLING:** * Label D * Label 2 – avoid alcohol during treatment and for 24hrs after finish to prevent nausea, vomiting, flushing, headache & palpitations. * Label 5 * Label B – with food to reduce stomach upset. * This medicine may make you feel dizzy or confused. Avoid driving if you are affected. * Stop taking and check with your doctor immediately if you have any numbness, tingling, pain or weakness in hands or feet. * **Side effects:** metallic taste, furry black tongue, urine discolouration (brown), nausea + vomiting, CNS effects (dizziness, headache) **MONITORING:** * Neurotoxic & can aggravate existing neurological disease (eg. Seizures). * Blood count (when using \> 10 days). * Renal & hepatic impairment (increased risk of metabolite accumulation)

Answer 85

**CLASS:** Macrolide antibiotic **INDICATIONS:** * URTI & LRTIs * CAP * Skin infections **DOSE:** _150mg BD OR 300mg daily_ **COUNSELLING:** * Label D * Label 3b - Best absorbed if taken 15mins before a meal. If it makes you feel sick then you can take with food. * **Side effects:** nausea + vomiting, diarrhoea, abdominal pain, candia infection, QT prolongation. **MONITORING:** * Infection resolution * QT prolongation

Answer 86

**CLASS:** Direct thrombin inhibitor **INDICAITON:** * treatment and prevention of VTE * non-valvular AF and high risk of stroke or systemic embolism. **DOSE:** 150mg BD or 220mg daily depending on indication. **COUNSELLING:** * Labels 10b, 13, A * This medicine can cause dispepsia, abdominal pain, diarrhoea, nausea and headache. * If you develop signs of bleeding or if you suddenly feel weak, dizzy, short of breath seek immediate medical attention. * Tell you dentist, doctor or pharmacist you are taking this medicine. * There is no antidote to dabigatran, so anticoagulation cannot be rapidly reverese if bleeding occurs. * Take about the same time each day, mark off with a calender after taking a dose. * consider use of a medical alert bracelet. **MONITORING** * signs of bleeding * renal function regularly.

Answer 87

**CLASS:** Sartan (angiotensin II receptor blocker) **INDICAITON:** * HTN * Prevention of cardiovascular morbidity/mortality in patients with coronary artery disease, PAD, diabetes, previous stroke or TIA. **DOSE:** 40 - 80mg daily **COUNSELLING:** * Label 11 * Label 12 * Label 16 * First dose hypotension * **Side effects:** dizziness, headache, hyperkalaemia, first dose hypotension, muscle cramps, renal impairment, diarrhoea **MONITORING:** * Renal function * Electrolytes * Potassium levels (can cause hyperkalaemia). * Signs of angioedema in patients who experienced it using an ACE inhibitor. * Monitor use with NSAIDs - risk of renal impairment

Answer 88

**CLASS:**'other' antifungal **INDICATION:** Dermatophyte infection of skin (tinea corporis), scalp and hair (tinea capatis), nails (tinea unguium), feet (tinea pedis) and groin (tinea cruris) where topical treatment has failed or is innapropriate. **DOSE:** 500 - 1000mg daily (usually at least 4 weeks treatment) **COUNSELLING:** * Labels 2, 8, 12, B, D * Label B - take with food or milk to increase absorption. * Label 2 - avoid alcohol (very occasionally effects such as increased heart rate and skin flushing may occur if you take alcohol during your courrse). * The contraceptive pill iwll not be as effective while taking. Use additional contracpetiion during treatment and for 4 weeks after. * May affect sperm, do not fater children during treatment or for 6 months after. * **Side effects:** nausea + vomiting, headahces (can be severe on starting), diarrhoea, rashes, photosensitivity, blurred vision, dizziness, taste disturbance. **MONITORING:** * infection improvement With prolonged therapy: * complete blood count * renal and heaptic function

Answer 89

**CLASS:** SSRI **INDICATION:** * Major Depression * OCD * Panic disorder * Social phobia * Premenstrual dysphoric disorder **DOSE:** _50 – 200mg once daily_ **COUNSELLING:** * Usually taken in the morning * Label 12 * Label 9 – withdrawal effects * Label 5 – (CYP interactions) * Usually take in the morning to minimise insomnia * It may take 1-2 weeks to start feeling some benefit from this medication, with full effect not occurring until 2-4 weeks. * Your mood may initially feel worse before it starts to improve. If you feel you start to get worse and need support seek help. * Look for signs of serotonin toxicity (excessive sweating, palpitations, nausea etc.) * **Side effects:** nausea, diarrhoea, insomnia, agitation, dry mouth, dizziness, sweating, anxiety, sexual dysfunction, tremor, drowsiness, hyponatremia **MONITORING:** * Serotonin toxicity * Risk of bleeding * QT prolongation (mainly citalopram, escitalopram, fluoxetine) * Sodium concentration (especially if at risk of hyponatraemia). * Suicidal thoughts on treatment initiation. * Reduces seizure threshold

Answer 90

**CLASS:** anti-smoking agent **INDICATION:** nicotine dependence (smoking cessation) **DOSE:** 0.5mg for 3 days, then 0.5mg BD for 4 days, then _1mg BD for 11 weeks_. **COUNSELLING:** * Labels 12, A, B * Start taking this medicine for at least a week before you stop smoking because it takes this long for it to become effective. * Swallow tablets whole * You may feel nauseous when taking this medicine. Contact your doctor if this is severe, because it may improve with dose reduction. * After finishing this treatment, some people have found a temporary increase in cigarette craving, irritability and insomnia. It may be useful to have a fast-acting nicotine product at hand in case you have an overwhelming urge to smoke. * Use a fast-acting nicotine replacement product (eg. lozenge, spray) to help when strong cravings occur. * If you develop any unusual or serious change in mood, thinking or behaviour, stop taking this medicine and tell your doctor immediately. * **Side effects:** nausea (affects 30%), vomiting, dyspepsia, constipation, flatulence, increased appetite/ weight gain, headache, taste disturbance, insomnia, abnormal dreams, neuropsychiatric symptoms **MONITORING:** * Cravings * Compliance * Exacerbation of psychiatric illness * Renal function (reduce dose in impairment)

Answer 91

**CLASS:** selective dopamine and NA re-uptake inhibitor **INDICATION:** nicotine dependence (smoking cessation) **DOSE:** 150mg daily for 3 days, then _150mg BD (at least 8hrs apart) for 7 – 9 weeks_. **COUNSELLING:** * Labels 5, 12\*, 16\*, A * Swallow tablets whole * Start taking for a week before you stop smoking because it takes this long for it to become effective. * It is best to start taking in the morning so it minimises sleep disturbance. * Drink only small quantities of alcohol when you are taking this medicine, as it can increase the risk of fits and other unpleasant effects. * This medicine may have side effects (like dizziness or difficulty concentrating) which could affect your ability to drive and operate machinery. Avoid these until you know how it affects you. * If you develop any unusual or serious change in mood, thinking or behaviour, stop taking this medicine and tell your doctor immediately. * **Side effects:** insomnia, nightmares, dizziness, concentration difficulties, agitaiton, anxiety, tremor, headache, nausea, dry mouth, constipation, neuropsychiatric symptoms, seizures. **MONITORING:** * Cravings * Compliance * Neuropsychiatric symptoms * Blood pressure * seizures

Answer 92

**CLASS:** opioid antagonist **INDICATION:** * Adjunct treatment of alcohol dependence. * Adjunct in maintenance of abstinence from opioids after opioid detoxification. **DOSE:** _50mg once daily._ **COUNSELLING:** * Label 12 * Most side effects are usually transient and subside after 1-2 weeks of treatment. * If you notice yellowing of the whites of your eyes, dark urine or pale bowel motions, stop taking naltrexone and tell your doctor at once. * Tell your dentist, pharmacist, new doctor or hospital dr that you are taking naltrexone. If you need a new medicine they will make sure it is compatible with your treatment. * Carry a Revia® or Medic Alert bracelet. * Does not influence intoxication or the withdrawal effects of alchol, however reduces craving. * Do not try to overcome the blockade effects of naltrexone by using higher doses of opioids. * After taking this you will be more sensitive to the effects of opioids and will be at great risk of fatal overdose if you stop taking naltrexone and use opioids again. It can block the effects of opioids for some time after you stop taking it. * **Side effects:** nausea, headache, dizziness, anxiety, fatigue, insomnia, sleepiness, hepatoxicity. **MONITORING:** * Liver function frequently * Compliance * Cravings (alcohol) * Abstinence from opioids

Answer 93

**CLASS:** Non-benzo hypnotic **INDICATION:** Short-term treatment of insomnia **DOSE:** _3.75 – 7.5mg_ before bedtime. **COUNSELLING:** * Label 1a, 2 * 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 the next day until you know how you react. * Label 2 – avoid alcohol and other medications that may cause drowsiness while taking this drug. * Dependence & tolerance can develop with long term use (only used for 2-4 weeks). * 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:** taste disturbance (bitter), dry mouth, drowsiness, nightmares, sleepwalking and related behaviour, amnesia, dyspepsia, angioedema. **MONITORING:** * Sleep quality * Tolerances & dependence (check intervals between dispensing of prescriptions). * Dangerous behaviour (eg. sleep walking/driving)

Answer 94

**CLASS:** Phosphodiesterase 5 inhibitor **INDICATION:** * Erectile dysfunction * Pulmonary arterial hypertension **DOSE:** _25- 100mg PRN_ **COUNSELLING:** * Label 5, 16 * Take about 1hr before sexual activity. Take NO MORE than 1 dose per day. * Start with 50mg, then decrease to 25mg or increase to 100mg depending on response and tolerability. * If you take with food it may take longer to work. * Do not take this medicine if you already take nitrates as the combination may cause a serious drop in your blood pressure. This can happen even if you take them on different days. Tell your health professional (even in medical emergency) that you take this medicine before taking any new medicines. * Can cause visual disturbances and dizziness. If you are affected do not drive or operate machinery. * Tell your doctor immediately if you have any sudden loss of hearing or vision. * Taking this medication may worsen any dizziness or faintness if you are already taking medications to lower your blood pressure. If also taking prazosin or terazosin, separate doses by at least 4hrs (6hrs if taking vardenafil). * This medicine is ineffective in the absence of sexual stimulation. * If erection persists for more than 4hrs seek immediate medical attention. **MONITORING:** * BP * eyesight * therapeutic effect * caridovascular function

Answer 95

**CLASS:** cholinesterase inhibitor **INDICATION:** mild - moderate alzheimer's disease **DOSE:** _8 – 24mg once daily_ **COUNSELLING:** * Label 5, 12 * Label B * **Side effects:** nausea, vomiting, diarrhoea, loss of appetite, dizziness, drowsiness, headaches, insomnia, vivid dreams, urinary incontinence, hypertension. **MONITORING:** * Cognitive function * Exacerbation of asthma/COPD * trial period of 6 months * weight loss

Answer 96

**CLASS:** NMDA antagonist **INDICATIONS:** alzheimer's disease **DOSE:** _5 – 20mg once daily_ **COUNSELLING:** * Label 12 * Trialled for 6 months. * Usually taken in the morning. * **Side effects:** confusion, dizziness, drowsiness, insomnia, headache, vomiting, CNS effects (hallucinations, agitation), VTE **MONITORING:** * Cognitive function * Increased risk of seizures * compliance (need to reduce dose if missed several days)

Answer 97

**CLASS:** anticholinesterase **INDICATION:** alzheimer's disease **DOSE:** * _1.5 – 6mg BD_ * ***Patch:*** 4.6mg/24hrs – 9.5mg/24hrs _once daily_. **COUNSELLING:** * Label 12 * Label B * Capsules: take with morning and evening meals. * Patch: apply to clean dry, hairless skin on the back, upper arm or chest. * Avoid reapplying patch to same spot for 2 weeks. * **Side effects:** nausea + vomiting, diarrhoeam, loss of appetite/weight loss, dizziness, headache, increased sweating, irritaiton at patch site. **MONITORING:** * Cognitive function * Exacerbation of asthma/COPD * Weight loss - strong possibility * nausea + vomiting - strong possibility.

Answer 98

**CLASS:** macrolide antibiotic **INDICATION:** * URTI & LRTIs * Legionnaires’ disease * Campylobacter enteritis * Chlamydial infections * Acne * Rosacea **DOSE:** _250mg 6hrly_ OR _500mg 12hrly_ **COUNSELLING:** * Label 5 – CYP interactions * Label 18 * Label C – best absorbed when taken on an empty stomach, but if it upsets your stomach take with food. * Label D * **Side effects:** nausea + vomiting, diarrhoea, Abdominal pain + cramps, Candida infections, QT prolongation **MONITORING:** * QT prolongation!! * Renal impairment (reduce dose) * Hepatic impairment

Answer 99

**CLASS:**'other' antibacterial **INDICATION:** * Acute lower UTIs * Prophylaxis in recurrent UTIs **DOSE:** _50 – 100mg QID_ (Prophylaxis once nocte) **COUNSELLING:** * Label 12 * Label D * Label B – take with food or milk to reduce nausea and to improve absorption. * Tell your doctor immediately if you have difficulty breathing, develop a cough or get any numbness or tingling. * May make your urine a brownish colour and can stain your contacts. Disposable lenses can be worn. * Do not take antacids or urinary alkalinisers at the same time as this medicine as they can reduce its effectiveness. * **Side effects:** Nausea, Abdominal pain, Diarrhoea, Headache, Dizziness, Peripheral polyneuropathy, Hepatic & pulmonary toxicity, Blood dyscrasias **MONITORING:** * Pulmonary function * Liver function (for onset of hepatotoxicity) * Renal function (peripheral polyneuropathy can occur) * Development of paraesthesia (stopping early can prevent severe neuropathy)

Answer 100

**CLASS:** osteoporosis therapy (Increases bone density & reduces bone resorption.) **INDICATION:** * Reduction of fracture risk in severe postmenopausal osteoporosis when other agents are unsuitable * Treatment of severe osteoporosis in men when other agents are unsuitable **DOSE:** _2mg daily at bedtime_ **COUNSELLING:** * This medication is best taken at bedtime, at least 2 hours after eating, because food and drink (esp calcium-containing products such as milk) can reduce its absorption (Label 4). * Mix the granules in 30mL of water and drink immediately. * If you develop swelling, redness or pain in one leg, shortness of breath, a rash or fever, seek immediate medical attention. * **Side effects:** nausea, diarrhoea, headache, dermatitis, CNS effects (memory loss, seizures, confusion), VTE, MI, Increased creatinine kinase concentration. **MONITORING:** * cardiovascular risk factors (including BP) every 6 months. * BMD * renal function * VTE signs. * Vit D and calcium levels.

Answer 101

**CLASS:** tetracyline antibiotic **INDICATION:** * Acne * Rosacea * CAP * Chronic bronchitis * Sinusitis * Chlamydial and non-gonococcal genital tract infections * PID * Rickettsial infections * Melioidosis * Sexually acquired epididymo-orchitis * Chronic prostatitis * Malaria prophylaxis **DOSE:** 200mg stat, then 100mg daily thereafter. Max 100mg BD. For rosacea/acne = 50mg daily _(50 - 100mg daily - BD)_ **COUNSELLING:** * Label B -Take with food to reduce stomach upset. * Take with a large glass of water and remain upright for an _hour_ after taking * Label 4a (delete dairy) - Do not take antacids, iron, calcium or zinc within 2 hours of this tablet * Label 8 -Avoid excessive sun exposure * Label D * If for malaria prophylaxis, start taking doxycycline 2 days before entering and continue until 4 weeks after leaving endemic area. * **Side effects:** nausea + vomiting, diarrhoea, epigastric burning, tooth discolouration, photosensitivity. **MONITORING:** * Side effects

Answer 102

**CLASS:** inhaled corticosteroid. **INDICATION:** Maintenance treatment of asthma **DOSE:** _100 – 400mcg BD_ (max dose 2000mcg daily) **COUNSELLING:** * Label 14 - rinse mouth after use * Do not use this medicine for immediate relief of symptoms. * Use this medicine every day even if you are feeling better. Do not reduce dosage or stop unless your doctor tells you to. * Inhaler technique. * **Side effects:****** * Oropharyngeal candidiasis * Facial skin irritation following nebulisation * Bruising. * Typical systemic corticosteroid effects **MONITORING:** * Lung function * Inhaler technique * Oral candidasis

Answer 103

**CLASS:** inhaled corticosteroid. **INDICATION:** Maintenance treatment of asthma **DOSE:** _80 – 320mcg once daily_ **COUNSELLING:** * Label 14 - rinse mouth after use * Do not use this medicine for immediate relief of symptoms. * Use this medicine every day even if you are feeling better. Do not reduce dosage or stop unless your doctor tells you to. * Inhaler technique. * Regularly clean mouthpiece to prevent nozzle blocking. * **Side effects:** * ****Oropharyngeal candidiasis * Bruising. * Typical systemic corticosteroid effects **MONITORING:** * Lung function * Inhaler technique * Oral candidasis

Answer 104

**CLASS:** dopamine antagonist **INDICATIONS:** nausea + vomiting **DOSE:** Initially 20mg, then 10mg 2 hours later. If still needed, 5-10mg tds. **COUNSELLING:** * Label 1, 16 * Should use short term only (risk of tardive dyskinesia) * **Side effects:** constipation, dry mouth, drowsiness, blurred vision, parkinsonism, EPSE (especially children), hypotension, hyperprolactinaemia, prolonged QT interval. **MONITORING:** * CNS depression (contraindicated) * Parkinson’s disease (domperidone preferred)

Answer 105

**CLASS:** non-selective NSAID **INDICATION:** * RA * OA * Gout * Ankylosing spondylitis * Pain due to inflammation * Closure of patent ductus arteriosus **DOSE:** _25-50mg 2-4 times daily_. (Indocid 25mg) **COUNSELLING:** * Label 10a, 19b * Label B - Take with or shortly after food * Label 12 -This medication may affect your alertness and coordination. Avoid tasks which require a lot of concentration. * Do not take this medicine if you are dehydrated because it can increase the likelihood of side effects * If you develop swollen ankles, difficult breathing, chest pain, black stools or dark coffee coloured vomit, stop taking the medicine and tell your doctor. * Do not take aspirin for pain relief as it will increase the risk of bleeds. * **Side effects:** * ****GI ulceration * Bleeding * Diarrhoea * Headache * Salt and fluid retention * HTN * Renal impairment **MONITORING:** * GI bleeds * Renal function * BP

Answer 106

**CLASS:** sympathomimetic (oral decongestant) **INDICATION:** relief of nasal congestion associated with acute and chronic rhinitis. **DOSE:** _60mg every 4-6hrs. Max 240mg daily._ CR product: 120mg every 12hrs. **COUNSELLING:** * needs to be recorded in 'project stop'. * **side effects:** insomnia, headache, nervousness, palpitations, sweating and flushing. * In a very small portion of the population it causes drowsiness instead of stimulation. **MONITORING:** * BP - can increase in hypertension. * diabetes - may affect blood glucose control.

Answer 107

**CLASS:** tricyclic antidepressant **INDICATION:** major depression **DOSE:** 25 - 300mg daily. **COUNSELLING:** * You may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but should lessen or disappear after about a week. * Try taking at night to reduce daytime drowsiness. * Label 1 * Label 5 * Label 16 * Label 13 * Label 9 – withdrawal symptoms * May take 2 – 4 weeks to take full effect. * May feel worse before getting better, speak to someone if you are having trouble coping. * **Side effects:** sedation, dry mouth, blurred vision, decreased lacrimation, constipation, weight gain, urinary retention, orthostatic hypotension, impotence, dizziness, sweating, agitation, insomnia, gynaecomastia, galactorrhea, hyperglycaemia, prolonged QT interval. **MONITORING:** * Overdose – high risk of fatality. * BP * Mood or behavioural changes on starting * Prolonged QT interval

Answer 108

**CLASS:** topical antibacterial **INDICATION:** * infected small skin lesions (cream) * mild impetigo (ointment) **DOSE:** 2% cream/ointment: apply TDS for up to 10 days **COUNSELLING:** * avoid contact with eyes and mouth. * children with impetigo should be kept home until approprate treatment has started. sores on exposed surfaces must be covered with watertight dressing when returning to school. * **Side effects:** Localised skin reactions including itch, burning, erythema, stinging, dryness and pain **MONITORING:** * allergic reactions * wound healing

Answer 109

**CLASS:** SSRI **INDICATION:** * Major depression * OCD * Premenstrual dysphoric disorder **DOSE:** _10 – 80mg once daily_. (generally ~20mg daily) **COUNSELLING:** * Label 12 * Label 9 – withdrawal effects * Label 5 – (CYP interactions) * Usually take in the morning to minimise insomnia * It may take 1-2 weeks to start feeling some benefit from this medication, with full effect not occurring until 2-4 weeks. * Your mood may initially feel worse before it starts to improve. If you feel you start to get worse and need support seek help. * Look for signs of serotonin toxicity (excessive sweating, palpitations, nausea etc.) * Usually taken in the morning. * **Side effects:** nausea, diarrhoea, agitation, insomnia, drowsiness, tremor, dry mouth, dizziness, sweating, anxiety, weight gain or loss, sexual dysfunction, rhinitis, myalgia, hyponatremia, QT prolongation. **MONITORING:** * Serotonin toxicity * Risk of bleeding * QT prolongation (mainly citalopram, escitalopram, fluoxetine) * Sodium concentration (especially if at risk of hyponatraemia). * Suicidal thoughts on treatment initiation. * Reduces seizure threshold * Long half-life so more prone to interactions. * Hepatic impairment (increases long half-life – use alternative SSRI)

Answer 110

**CLASS:** opioid analgesic **INDICATION:** moderate - severe chronic pain **DOSE:** 50mg - 250mg BD (max 500mg/day.) **COUNSELLING:** * Label 1 * Label 5 * Label 16 (also inhibits NA reuptake) * Label A * Prolonged use can reslut in tolerance and dependence, necessitating gradual dose reduction to minimise withdrawal symptoms. * **Side effects:** nausea, vomiting, dizziness, dry mouth, seating, rash, itching, headache, anxiety, flushing, constipation. **MONITORING:** * Sedation * Pain control * BP * constipation

Answer 111

**CLASS:** stimulant laxative **INDICATION:** * Constipation * Bowel preparation **DOSE:** * Oral:* _5-15mg nocte_ * Rectal:* 10mg daily **COUNSELLING:** * Swallow tablets whole * *Enema for a child \<3 years*: Insert the nozzle of the tube halfway only * Onset of action is 6-12 hours (oral), 15-60 minutes (suppository), 5-15 minutes (enema) * **Side effects:** * *Infrequent* * ****Diarrhoea * Fluid and electrolyte imbalance (prolonged/excessive use) * Abdo discomfort * Cramps * Nausea **MONITORING:** * Fluids * Electrolytes

Answer 112

**CLASS:** leukotriene receptor antagonist **INDICATION:** * Maintenance treatment of asthma * Allergic rhinitis * Prevention of exercise-induced bronchoconstriction **DOSE:** 10mg once daily **COUNSELLING:** * Take this in the evening. * Do not use to relieve symptoms in asthma attack. * Effect should be seen within days. * **Side effects:** * Headache * Abdominal pain * Diarrhoea * Chrug-strauss syndrome **MONITORING:** * lung function

Answer 113

**CLASS:** dopamine _antagonist_ **INDICATION:** * Nausea and vomiting * Gastroparesis **DOSE:** 10mg TDS **COUNSELLING:** * Label 18 * Label C * **Side effects:** dry mouth, headache, hyperprolactinaemia (leading to galactorrhoea & gynaecomastia), insomnia, EPSE, prolonged QT interval. **MONITORING:** * EPSE - although does not readily cross BBB so EPSEs are rare (makes it preferred anti emetic agent in Parkinson's). * therapeutic effect * QT prolongation

Answer 114

**CLASS:** Selective COX 2 inhibitor (NSAID) **INDICATION:** * OA * RA **DOSE:** 7.5-15mg daily **COUNSELLING:** **MONITORING:**

Part 1: Medication Knowledge and Counselling Flashcards

(138 cards)