Councelling Flashcards
ACEi
If the patient develops dry cough within the first months of starting ACEi they should report this to their GP and the drug should be switched to an ARB.
If the patient is at risk of 1st dose hypotension suggest that dose is taken at night.
Do not take non-steroidal anti-inflammatory medications (e.g. ibuprofen) when taking this drug. ACEi are normally stopped on the day of surgery (unless told otherwise).
If the patient becomes pregnant, the ACEi must be stopped immediately (preferably within 2 working days of notification of pregnancy) and alternatives offered (NICE 2010, CG107).
If swelling of the face, eyes, lips or tongue develops or if breathing difficulties occur, stop drug and call an ambulance.
ARBs
No dry cough: explain that drug does not cause dry cough but may cause dizziness and hyperkalaemia.
NSAIDs: NSAIDs should not be used with this drug.
Pregnancy: if the patient becomes pregnant, the ARB must be stopped immediately (preferably within 2 working days of notification of pregnancy) and alternatives offered (NICE 2010, CG107).
Warfarin
Mode of action and side-effects: explain that warfarin thins the blood and may cause bleeding and bruising. If bleeding is excessive, e.g. if the patient suffers from nosebleeds that do not stop, if there is blood in the urine or in the stool or the patient notices severe bruising, they should attend A&E immediately. * * Yellow Book and heparin: when a patient is started on warfarin, they will have to take heparin for a couple of days and they will receive a Yellow Book to bring to appointments to record their INR results and warfarin prescriptions. * * How to take warfarin and missed doses: warfarin should be taken once a day, at the same time every day. It is important not to miss warfarin doses. If a dose is missed, it is advisable that the patient contacts their GP or anticoagulation clinic for advice. * * Food and drug interactions: a balanced diet should be maintained when taking warfarin. Avoid excessive amounts of leafy green vegetables and alcohol. Over-the-counter NSAIDs and aspirin should not be taken when taking this drug, and warfarin interacts with many medications and herbal remedies, so check with a doctor or pharmacist before starting a drug. * * Pregnancy: if patient becomes pregnant they must stop taking warfarin immediately. * * Inform health professionals about warfarin: if the patient is having a medical or dental procedure, they should inform their clinician that they are on warfarin. * * Emergencies: attend A&E urgently in cases of head injury. * * Contact sports: contact sports and other high-risk activities should be avoided whilst on warfarin due to the increased risk of bleeding in the event of minor injury or trauma.
DOACs
N o INR monitoring O nly interacts with a few foods and meds A void in severe renal impairment C an’t be readily reversed*
GTN advice
‘The first and second dose can be taken at 5-minute intervals and if the pain does not ease after the second dose call an ambulance’
Lithium
Different preparations of lithium have different bioavailability. Therefore changing the preparation of lithium may require dose changes. It is advisable not to interchange brands (e.g., Camcolit, Priadel).
Long-term use of lithium has been associated with thyroid dysfunction. TFTs should be monitored every 6 months.
There is a risk of teratogenicity (cardiac abnormalities) if taken during pregnancy.
Routine serum lithium monitoring should be performed weekly during initiation and during dose changes until concentrations are stable, then every 3 months for the first year and every 6 months thereafter.
