Common Drugs Requiring Counselling

Question 1

SSRI

Answer 1

Action- alter the balance of some of the chemicals in the brain. Mainly affects serotonin. Altered balance of this chemical is thought to cause depression

Timeline-once daily

How to take- tablet
Length of treatment-stop 3-6 months after feeling better
Effects- after 4-6 weeks
Tests- nil
Important side effects- GI- diarrhoea, nausea, vomiting, appetite and weight change. Headaches, drowsiness, anxiety for 2 W
Complications and contraindications-suicide risk, past psychiatric illness
Supplementary advice- www.mind.org.uk

Question 2

Methotrexate

Answer 2

Action-DMARD reduces inflammation and suppresses immune system. Early use improves outcome.
Timeline- once weekly with folic acid at another time. Build up dose slowly

How to take- tablet, injection also available
Length of treatment- long term
Effects- 4-6 months
Tests- FBC, LFT, U&E
Important side effects-alopecia, headaches, GI disturbance, myelosuppression
Contraindications- pregnancy
Supplementary advice- no NSAIDs/aspirin. Get annual flu jab. Arthritis research.org.uk

Question 3

Bisphosphonates

Answer 3

Action- prevents bone from being broken down and helps to rebuild new bone
Timeline- once weekly or smaller dose daily
How to take- swallow tablet with full glass of water 30 mins before a meal and remain upright for 30 mins

Length- long term
Tests- dental checkups before starting and regularly after due to risk of osteonecrosis of the jaw
Important side effects- headache, heartburn, bloating, indigestion, GI sx
Complications and contraindications- osteonecrosis of the jaw, contraindications- pregnancy, dysphagia, stomach ulcers, renal impairment

Question 4

Warfarin

Answer 4

Action- thins the blood by blocking vitamin K which is a vitamin used to make proteins which make the blood clot

Timeline- once daily
How to take- tablet
Length of treatment- 3months for DVT, 6 months for PE, lifelong for AF

Effects- 2-3 days
Tests- start 5mg for 4 days then test INR on day 5 and 8. Then regular INR checks by anticoagulation clinic

Important side effects- bleeding, diarrhoea, rash, hairloss, nausea
Many drug interactions- cyp450

Contraindications- pregnancy, haemorrhagic stroke, significant bleeding, high falls risk

Supplementary advice- avoid liver, spinach, cranberry juice, alcohol binges, no NSAIDs, aspirin. Give anticoagulant book.

Question 5

Levothyroxine

Answer 5

Action- synthetic version of the normal hormone produced by the thyroid gland called thyroxine

Timeline- once daily before breakfast
How to take- tablet
Legnth of treatment- lifelong
Effects- few weeks
Tests- start test dose then review in 2-3 weeks. TSH test every 2-3 months until stable. When stable check annually.

Side effects- rare when thyroxine levels stable
May have hyperthyroid symptoms if level is too high or hypothyroid symptoms if level is too low

supplementary advice- free prescriptions for everything if taking levothyroxine

Question 6

Statin

Answer 6

Action- stops the liver making cholesterol. This is one of the things which predisposes to artery problems causing heart disease, stroke and kidney disease.

Timeline-once daily in the evening
How to take- tablet
Length of treatment- lifelong
Effects- decreases risk over many years
Tests- review in 4 w then every 6 months. LFTs before starting, at 3 months and at 12 months.
Side effects- muscle pains, hair loss, itching, nausea, sickness, diarrhoea, abdo pain.

Complications- rhabdomyolysis
Contraindications- pregnancy
Supplementary advice- avoid grapefruit

Question 7

Metformin

Answer 7

Action-Increases the sensitivity of cells to insulin, thereby allowing the body to make better use of lower insulin levels.
Timeline- once daily with breakfast
How to take- take tablet with or after a meal at the same time each day
Length of treatment- lifelong if it works
Tests- U&Es before starting then annually
Side effects- nausea, diarrhoea, abdo pain, weight loss
Complications- lactic acidosis
Contraindications- renal impairment, ketoacidosis, low BMI
Supplementary advice- if you miss a dose take ASAP unless it’s close to next dose time.

Question 8

Iron tablets

Answer 8

ActionReplace your body’s store of iron, a mineral required to make red blood cells
Timeline- 1-3 times daily
How to take- take on an empty stomach but can irritate stomach so may need to take with food
Length- 4 months
Effects- 3-4 weeks
Tests- Hb in 3-4 weeks
Important side effects- Gi irritation, coloured stools, taste bad