Common Medication Counselling - HTN, AC, insulin, metformin, HRT Flashcards
Rough framework for medication counselling
-introduction
Hello, I’m An a 3rd year medical student
Can I confirm your name and DOB
I’ve had a look through your notes and I understand that you’ve been diagnosed with … is that correct?
I’ve been asked by your … to discuss the treatment options for …
Would this be alright?
Is there anything else that you would like to get out of this conversation?
- Brief history
Cover key risk factors for condition
- Perceptions
What is your understanding of your condition
Is there anything that worries you about your condition
- Invitation
Would you like some more information about …
- Knowledge
Chunking information then pausing
Avoid jargon
Give an appropriate amount of info based on patient knowledge and preferences
Provide resources that patient can access later
Explains importance of managing condition
How to take medication
How we monitor
SEs to look out for
- Summary
Ask patient to summarise key points of consultation
Check if their questions have been answered
Future plan
Safety netting
ACEi/ARB
- why HTN is important
- methods of treatment
- SE
- monitoring
- reactions
Importance of BP control
Increased risk of
-heart disease
-irregular heart rhythms
-strokes, heart attacks
Methods
- medication
- smoking, alcohol, physical activity, diet,
SE and what to do
ACEi
-common - stomach upsets, rashes, nausea => go to GP
-dry persistent cough => if intolerable, go to GP
-feeling dizzy standing from lying => go to GP, adjust dose
-swelling of face and neck => go to A&E
Monitoring
- annual BP checks
- kidney function tests before treatment
- getting home monitoring BP kit
Reactions
NSAIDs - kidney damage
-not going to the bathroom as often, confusion, ankle swelling
Warfarin
- indications
- how it works
- monitoring - INR
- taking warfarin
- SE
- lifestyle impacts
Indications
- 3months DVT
- 6months PE
- life AF
MOA - helps thin blood, making it less likely for clots to form
-reduces the chance that you develop DVT/PE again/a stroke
INR - a measure of how long it takes for your blood to clot
-to reduce the chance of clots forming, we aim for an INR of 2-3
Initially
-daily until 2 consecutive readings in range
-2x weekly until 2 consecutive readings in range
-every 12 wks
Can adjust dose based on INR
Taken at same time everyday
Forget dose => take it as soon as you remember, never double dose
SE - easy bleeding esp in first few weeks
Go to A&E if
-hematuria/melena
-nosebleeds that don’t stop/persistent bleeds
-hematemesis
-headache, seizures, visual changes, tingling/weak limbs
-anaphylaxis
Lifestyle
- Eat similar amounts of VitK regularly (green leafy veg, avocado)
- Avoid cranberry, grapefruit juice => potentiates effect
- Take care when shaving
Interactions
-avoid aspirin, NSAIDs => increase bleeding
Yellow AC alert card - keep with you for emergencies
Yellow INR monitoring book - all appointments
DOAC
- indication
- MOA
- monitoring
- taking DOACs
- SE
- lifestyle impacts
Indication
- 3months DVT
- 6months PE
- life AF
MOI - helps thin blood, making it less likely for clots to form
-reduces the chance that you develop DVT/PE again/a stroke
Monitoring
Before, annually - FBC, U&E, LFT, clotting
Review 1 month afterwards
PO OD/BD with water upright at same time
-forgotten dose => take it as soon as you remember, no double dosing
SE - easy bleeding esp in first few weeks
Go to A&E if
-hematuria/melena
-nosebleeds that don’t stop/persistent bleeds
-hematemesis
-headache, seizures, visual changes, tingling/weak limbs
-anaphylaxis
Avoid NSAIDs, aspirin unless prescribed
Carry AC alert card
No interactions with alcohol or food
Statin
- indications
- MOA
- monitoring
- taking statins
- SE
- lifestyle impacts
Indication
-QRISK 10+ - lifestyle changes + statin
MOA - we have 2 types of cholesterol in our body
- we want to increase the amount of good cholesterol and decrease the amount of bad
- bad cholesterol can collect in our arteries, increases the risk of heart attacks, strokes
- statins help lower the bad cholesterol
Monitoring
Pre - lipids, LFT
3months
Yearly
OD, same time
-forgotten => soon as you remember
-no double dosing
Will not ‘feel that it’s working’ but must keep taking it
SE
Common - stomach upsets
Muscle pain/tender/weak => GP
Lifestyle impacts
- no grapefruit juice
- ABx interactions
- CV risk optimisation
Metformin
- indications
- MOA
- monitoring
- taking metformin
- SE
- lifestyle impacts
T2DM
MOA - our cells use glucose as fuel but it also needs insulin to move the glucose from the blood into our cells. In T2DM, your cells don’t respond well to insulin so the sugar levels in your blood increase, resulting in your symptoms.
-metformin helps your cells to respond to insulin so your blood sugar level stays within range and your cells get fuelled
Before - U&E (renal excretion) => 1year
HbA1C - every 3-6months until stable => every 6months
PO with meals
- missed dose => wait until next one
- no double dosing
Common SE - GI upset (nausea, diarrhoea, abdo pain) => GP if it bothers you
CV risk optmisation
- increased physical activity
- reduce intake of high sugar foods
- smoking cessation
Fe
- indications
- monitoring
- taking Fe
- SE
- lifestyle impacts
Fe is used for a variety of functions, one of which is helping our red blood cells carry O2 around to all our cells
-fatigue, SOB, pale, dizzy, cold, chest pain
Insufficient Fe in
-diet
-coeliac, IBD
-increased demand (pregnant, teens)
Fe loss
-bleeds (menstrual Hx, blood in stools, urine
Before => FBC to confirm
If within range => can stop
PO before meals
- avoid caffeine, Ca during meals
- VitC during meals increases uptake
Common SE - nausea, constipation, diarrhoea, dark stools => will go away with time, GP if bothersome
Increase Fe via diet - long term maintenance
-red meat, leafy veg, dried fruits
Increase VitC
-citrus, orange juice
Bisphosphonates
- indications and bone risk factors
- MOA
- monitoring
- taking bisphosphonates
- SE
- lifestyle impacts
Recent fracture => DEXA
- smoking, alcohol
- post menopause
- steroid use
OP is a condition where your bone become thin and weak, putting you at an increased risk of fractures. Bs work by preventing this thinning, making them stronger so you are less likely to break your bones.
Once a week sitting upright with water for 30mins before food
Takes 6 months to start working, you probably won’t feel any different but by continuing to take it, your bones will get stronger
-annual review
Common SE - stomach upset, C/D but do go away
Main SE - heartburn, pain on swallowing => GP immediately
Severe SE - MRONJ (jaw pain, ulcers that don’t heal) => GP immediately
Let your dentist know that you are on a bisphosphonate
Lifestyle
-regular weight bearing exercise
-high Ca - dairy, leafy greens, fish
-smoking cessation
HRT
- indications
- MOA
- monitoring
- taking HRT
- SE
- lifestyle impacts
During menopause, the amounts of estrogen and progesterone we have in our body decreases, resulting in the symptoms you’ve presented with
-hot flushes, night sweats
-mood swings
-vaginal dryness, reduced sex drive
With HRT, we restore the low amounts of estrogen and progesterone that occurs as a result of menopause
Pros
-reduces osteoporosis, CVD risk
Cons
-increased risk of VTE, strokes, breast and endometrial cancer
Forms
-tablet, patches, gels, implants
Combined - has uterus (progesterone protects against endometrial cancer
Estrogen only - hysterectomy (no endometrium)
SE
- PMS like (breast tenderness, headaches, nausea)
- breakthrough bleeds
CI
- current, Hx of breast cancer
- Hx of VTE, CV disease
- untreated HTN
- active liver disease
SSRI
- indications
- MOA
- monitoring
- taking SSRIs
- SE
- lifestyle impacts
Indications
-anxiety, mood, bulimia
Seretonin is a brain chemical that is involved in regulating our mood. In some people, the amount of seretonin we have is low so by taking SSRIs, we can increase this and reduce the impact of your symptoms
CI
- suicide risk
- mania
Follow up appointment in 2-4wks - see how you’re doing
PO OD
- takes up to 2months to work
- gradually stopped 6 months after feeling better => reduce risk of withdrawal
SE
- GI upset
- appetite, weight changes
- increased suicidality, anxiety
- drowsy
Atypical antipsychotics
- indications
- CI
- monitoring
- taking atypicals
- SEs
Indications
-psychosis
Dopamine is a brain chemical that has a variety of functions. However, an imbalance of the amount of dopamine results in the symptoms you’ve been experiencing. Antipsychotics work by reducing the action of dopamine in your brain
CI
- phaeochromocytoma
- hepatic impairment
Monitoring
Before - HR, BP, waist circumference, weight, HbA1c, fasting glucose, lipids, PRL, ECG
3months, 12months, yearly
Weekly weight checks 6x
PO OD/depot
- build dose up over 1wk
- dose adjusted based on response
- can be taken long term, prevents symptoms from returning
SE
Antidopaminergic
-tardive dyskinesia
-akithisia
-Parkinsonism
-acute dystonia
Weight gain, DM, sedation
High PRL - lactating, amenorrhea, gynecomastia
HIGH FEVER, MUSCLE RIGIDITY
~~~
Clozapine
- indications
- MOA
- taking clozapine
- SE
- monitoring
Indications
-2 failed atypicals => treatment resistant schizophrenia
Dopamine is a brain chemical that has a variety of functions. However, an imbalance of the amount of dopamine results in the symptoms you’ve been experiencing. Antipsychotics work by reducing the action of dopamine in your brain
PO
Dose built up over several weeks - vital that doses are not missed, otherwise have to start again
SE
-sedation, weight gain, DM, hypersalivation, constipation
AGRANULOCYTOSIS - FLULIKE => CONTACT CC
Monitoring - risk of serious side effects
-weekly FBC check => medication only dispensed if within safe limits
Baseline - ECG, BP, BMI, FBC, U&E, LFT, PRL, HbA1c, lipids
Lithium
- indications
- MOA
- CI
- taking lithium
- SE
Indications
-bipolar
MOA
- bipolar disorder is a condition where there is an imbalance of brain chemicals, resulting in the symptoms you’ve been experiencing
- lithium works by balancing the brain chemicals so your mood is not at either extreme
CI
-pregnant, breastfeeding
Tablet/liquid OD/BD
- takes 2wks to work
- long term use if effective
Monitoring
Before - FBC, U&E, TFT, Ca bHCG, ECG
6monthly
Lithium level taken
-once a week => once a month => 3 monthly until levels are stable
SE
Common - metallic taste, nausea, abdo pain, fine tremor
Urinary - increased thirst, urination
LITHIUM TOX
-ataxia, slurred speech, dizzy, confusion
-vomiting, diarrhoea
Methotrexate
-indications
-MOA
-CI
Taking methotrexatee
-monitoring
-SE
Indications
-inflammatory arthritis
To manage the symptoms you’ve been experiencing, we gave you medications to take down the inflammation.
Methotrexate is a medication that tackles the root cause of your symptoms
CI
- pregnancy, breast feeding
- liver impairment
- current infection, IC
Tablet/liquid/injection 1/7
-dose built up slowly
TAKE FOLIC ACID ON NEXT DAY
-one of the effects of methotrexate is that it lowers the amount of a vitamin called folate in our body
-folate is a vitamin that we need for many body functions, one is the make functional red blood cells.
-if we don’t have enough folate, our red blood cells become less able to carry oxygen to our cells so we feel more tired
Takes up to 3months to work
Long term medication if effective
Monitoring
Before - FBC, liver and kidney bloods
Initially - 2wkly until we’ve found we’ve found the right dose for you
After - 3months
SE
Common - GP if bothersome
-N+V+D, abdominal upset, headaches
Serious - BM failure, liver/lung toxicity => GP URGENTLY
-easy bruising/bleeding, signs of infection, SOB, fatigued
-liver toxicity - yellow skin/eyes
-lung toxicity - persistent cough, chest pain, SOB
ASK ABOUT PREGNANCY AND PLANS
Get flu jab
Avoid NSAIDs as they interact with methotrexate
Levadopa
- indications
- CI
- MOA
- taking levadopa
- SE
Indications
-PD
CI
-glaucoma
MOA
- we have a brain chemical called dopamine, it has a variety of functions, one of which is helping us move
- in PD, the amount of dopamine we have decreases, resulting in the symptoms you’ve been experiencing
3-4x a day with food + carbidopa
-for you to feel the effects of levadopa, it must reach your brain
-prevents levadopa from getting broken down along the way to your brain
Acts fast
Only lasts for 5 years
SE
Wearing off - as PD progresses, the effectiveness of levadopa decreases => bradykinesia, rigidity, tremor
N+V, dizzy, lightheaded => GP to adjust dose
Psychosis, impulsive behaviour, uncontrollable muscle spasms => ask others to look out for this
Levothyroxine
-why take it?
-how to take it
- MOA
- taking levadopa
- SE
Your thyroid is a gland at the bottom of your neck
Produces a hormone called thyroxine which regulates many aspects of our metabolism like temperature control, weight, energy levels
When your thyroid does not produce enough thyroxine, you have a condition called hypothyroidism
Levothyoxine is a synthetic form of thyroxine which helps replace the amount that you are missing
30mins before breakfast - food and drink can reduce absorption
If 1 dose missed, take it as soon as you remember but avoid 2 doses in 1 day
TFT
-4-6wks to ensure the dose is suitable
-3monthly after dose change
-annually once normal range and stable
SE - too high/low
