All Flashcards
Steroids - what are they and what do they do?
Tablet taken once a day long-term to reduce inflammation in the body
Steroids - minor risks
Weight gain
Acne
Mood change
Proximal myopathy
Skin thinning
Steroids - major side effects and ways to reduce these
Gastritis/peptic ulcers: take tablets with or soon after a meal, PPI, avoid NSAIDs
Osteoporosis: Vitamin D and calcium supplementation, keep active
Hypertension: regular BP check-up, diet/exercise/smoking cessation/alcohol etc
Diabetes: attend your check ups, diabetic symptoms to be aware of (polydipsia, polyuria), mindful of diet etc
Immunosuppression: be aware of infection risk, wash hands etc
Addisonian crisis: most important last - don’t stop suddenly!
Lifestyle modifications
Weight loss
Physical activity
Diet - reduce salt/fats
Smoking cessation
Reduce alcohol intake
Stress reduction
Adhere to treatments/targets
Warfarin - contraindications
Pregnancy
Significant risk of bleeding
Active bleeding
Warfarin - mechanism of action
Thins blood to treat/prevent blood clots
Blocks Vitamin K which is used by the body to make proteins that cause blood to clot
Warfarin - treatment course
Once daily tablet, usually taken in the evening
Different durations - 3-6 months, lifelong
Dose change takes 2-3 days to take effect
Warfarin - monitoring
Start at 5mg
INR on days 3/4/5
Refer to warfarin dosing charts
Then regular INR checks
Warfarin - side effects
Bleeding - when to seek advice: head injury, prolonged epistaxis, unusual headache, blood in urine/vomit/stool, unexplained/severe bruising
Diarrhoea
Rash
Hair loss
Nausea
Interactions: avoid liver, spinach, cranberry juice, alcohol binges, NSAIDs/aspirin
DOAC - contraindications
Significant renal impairment
Risk of or active bleeding
Not licensed for metallic heart valves
DOAC - mechanism of action
Thins blood to treat/prevent blood clots
Blocks a protein required for blood clotting
DOAC - treatment course
Once/twice daily tablet/capsule
Take with full glass of water sitting up
Duration: 3-6 months or lifelong
DOAC - monitoring
None regular
Annual U&Es (and before)
DOAC - side effects
Bleeding
GI disturbance
Irreversible
Levothyroxine - contraindications
None
Levothyroxine - mechanism of action
Synthetic version of thyroxine
Given cause thyroid not producing enough so to bring thyroid activity back to normal
Levothyroxine - treatment course
Once daily tablet before breakfast, taken long-term
Dose takes 4-6 weeks to take effect
Levothyroxine - monitoring
TSH every 2-3 months until stable, then annually
Levothyroxine - side effects
Rare
Hyperthyroidism if over-prescribed
Hypothyroidism if under-prescribed
Statin - contraindication
Pregnancy
Statin - mechanism of action
Stop liver making cholesterol (why this is important)
Statin - treatment course
Once daily tablet usually in the evening, taken long-term (decreases risk over many years)
Statin - monitoring
Review lipids in 4 weeks then every 6-12 months
LFTs before, at 3 months and 12 months (monitor ALT)
Statin - side effects
Muscle pains
Headache
Itching
Nausea, vomiting
Diarrhoea
Abdominal pain
Rhabdomyolysis (unexplained muscle pain - tell doctor)
Some interact with grapefruit juice
Metformin - contraindications
Significant renal impairment
Ketoacidosis
Low BMI
Metformin - mechanism of action
Increases response to insulin (cells take up more glucose)
Also reduces amount of glucose produced by the liver
Metformin - treatment course
Once/twice/three times daily tablet within meals, taken long-term
Metformin - monitoring
U&Es before and annually
HbA1c every 3-6 months until stable, then 6-monthly at diabetic check ups
Metformin - side effects
Nausea
Diarrhoea
Abdominal pain
Weight loss
Lactic acidosis (don’t take on day or 2 days following GA/contrast)
Iron tablets - contraindications
None
Iron tablets - mechanism of action
Replace body’s iron supply, mineral needed to make RBCs
Iron tablets - treatment course
Tablet or syrup taken 1-3 times daily (as much as able)
Works best taken without food however can irritate stomach
Takes 3-4 weeks for Hb to normalise then further 3 months to improve stores
Iron tablets - monitoring
Hb at 3-4 weeks
Iron tablets - side effects
GI irritation
Black stools
Metallic taste
SSRI - contraindications
Suicidal risk
Mania
SSRI - mechanism of action
Alter balance of chemicals in brain called neurotransmitters. Imbalance thought to lead to depression.
SSRI - treatment course
Once daily tablet, 4-8 weeks to take effect
May slowly reduce tablet after 6 months of feeling better
SSRI - monitoring
None
SSRI - side effects
GI irritation
Appetite and weight change (up or down)
Headache
Drowsiness (take at night)
Anxiety for 2 weeks
Withdrawal
Increases suicide risk in younger patients
Methotrexate - contraindications
Pregnancy
Breastfeeding
Hepatic impairment
Active infection
Immunodeficiency
Methotrexate - mechanism of action
Reduces inflammation and suppresses immune system
Early use improves outcome and symptoms
Methotrexate - treatment course
Once weekly tablet, long-term - same day. Dose builds up slowly, takes 3-12 weeks to work.
Folic acid on alternate day
Methotrexate - monitoring
FBC, U&Es, LFTs
- Before
- Then every 2 weeks until stable
- Then every 2-3 months
Methotrexate - side effects
Alopecia
Headaches
GI disturbance - no NSAIDs/aspirin
Myelosuppression - doctor if unexplained bleeding/bruising, infective symptoms and get annual flu jab
Liver and lung toxicity
