Counselling Week 1 (Dapagliflozin, Metformin +/- combinations, Clopidogrel +/- combinations, Enoxaparin, Nitrates: Oral and Sub-lingual)

Question 1

This medicine is dapagliflozin and the brand we have given you is called …?

Answer 1

Forxiga

Question 2

Mode of action and indication of dapagliflozin (3 marks)

Answer 2

It is used for type 2 diabetes, it also used in heart failure and in kidney disease

It lowers the level of your blood sugar by removing the excess sugar from the body in the urine.

This medication itself is unlikely to cause low blood sugar (hypoglycaemia) because it does not interfere with the insulin hormone that regulates blood sugar

Question 3

Dose and directions for use (C/A labels) for dapagliflozin (3 marks)

Answer 3

Adult, take one 10mg tablet once daily.

CAL:

10a: Do not take more than one aspirin or anti-inflammatory medicine each day while being treated with this medicine

Do not take a double dose to make up for the dose that you missed.

Question 4

AE (common, serious, allergic) of dapagliflozin (3 marks)

Answer 4

All medications can cause side effects, but not everyone will experience them. Some common side effects include back pain, headache and and urinary tract infections

Some rarer side effects include dizziness, be careful driving until you know how it affects you.

See a doctor if you have symptoms, such as burning or pain when you pass urine, more frequent or urgent need to urinate, fever, chills, or blood in the urine, contact your doctor as soon as possible. –> because forxiga can cause UTI

Question 5

Lifestyle/self-care of Dapagliflozin (2 marks)

Answer 5

Make sure you drink enough water to control your thirst, in order to avoid dehydration.

This medicine can be taken with or without food.

Both men and women may be more likely to get a genital infection (eg thrush) while taking this medication; maintaining good hygiene is important to reduce the chance of this happening.

Enjoy healthy eating by: - eating plenty of vegetables and fruit; - reducing your saturated fat intake (eat less fatty meats and full fat dairy products)

Progress, over time, to at least 30 minutes of moderate intensity physical activity on 5 or more days each week

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?

Question 6

This medication is metformin and the brand we have given you is called …?

Answer 6

formet, diabex, diaformin, diabex XR, metex XR, diaformin XR

500mg, 850mg, 1g

Question 7

Mode of action and indication of metformin (3 marks)

Answer 7

It belongs to a group of medicines called biguanides. It lowers high blood glucose (hyperglycaemia) by helping your body make better use of the insulin produced by your pancreas.

People with type 2 diabetes are unable to make enough insulin or their body does not respond properly to the insulin it does make. This causes a build up of glucose in the blood, which can lead to serious medical problems.

It is used for type 2 diabetes. Also used in PCOS for infertility.

Question 8

Dose and directions for use (C/A labels) for metformin (3 marks)

Answer 8

Adult

Conventional tablet, initially 500 mg 1–3 times daily; may be increased up to 850 mg 2 or 3 times daily according to response. Maximum daily dose 3 g.

Controlled release tablet, initially 500 mg once daily; may be increased up to 2 g once daily. When changing from conventional tablets, start with the patient’s usual daily dose. (If >2 g daily is required, use conventional tablets.)

• Do not take a double dose to make up for the dose you missed.

CAL labels

10a: Do not take more than one aspirin tablet or capsule each day while being treated with this medicine.

Question 9

AE (common, serious, allergic) of metformin (3 marks)

Answer 9

All medications can cause side effects, but not everyone will experience them. Some common side effects include include nausea, vomiting, and malabsorption of vitamin B12.

Rarer side effects include rash.

Please see a doctor if you have signs of lactic acidosis (build up of lactic acid in the blood). This includes slow heart beat, trouble breathing and feeling extremely cold.

Question 10

Lifestyle/self-care of metformin (2 marks)

Answer 10

Take with or after food to reduce stomach upset.

Drinking alcohol can affect control of your diabetes. It can also increase the risk of serious side effects. Limit your alcohol intake, avoid binge drinking and have something to eat when you drink alcohol.

Enjoy healthy eating by: - eating plenty of vegetables and fruit; - reducing your saturated fat intake (eat less fatty meats and full fat dairy products)

Progress, over time, to at least 30 minutes of moderate intensity physical activity on 5 or more days each week

Stay hydrated and avoid dehydration.

metformin with glibenclamide: risk of hypoglycaemia

metformin with SGLT2 inhibitors (dapagliflozin, empagliflozin, ertugliflozin):

Swallow tablets whole, with or after food; do not crush or chew. –> increased risk of thrush

metformin with DPP4 inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin, valagliptin)

With or after food

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?

Question 11

This medicine is clopidogrel and the brand we have given you is called …?

Answer 11

clovix, piax, plidogrel, plavicor = 75mg

Plavix = 300mg

Question 12

Mode of action and indication of clopidogrel (3 marks)

Answer 12

This medication is used to prevent blood clots forming in blood vessels, which can lead to events such as stroke, heart attack or death.

Platelets are very small blood cells which clump together during blood clotting. By preventing this clumping, anti-platelet medicines reduce the chances of blood clots.

Used because:

• You have previously suffered a heart attack, stroke or have a condition known as peripheral arterial disease (leg pain on walking or at rest).

>transient ischaemic attack → mini stroke

• Also used to prevent another heart attack or stroke from occurring
• You have suffered Acute Coronary Syndrome (either a severe type of chest pain called unstable angina, or a heart attack). In this case you may also be prescribed aspirin.

Question 13

Dose and directions for use (C/A labels) for clopidogrel (3 marks)

Answer 13

Prevention of vascular ischaemic events

Oral, 75 mg once daily (1 tablet once daily)

ACS (heart attack or angina)

Oral, loading dose 300 mg, then 75 mg once daily with aspirin; continue for 1–12 months or longer; seek specialist advice.

Aspirin and copidogrel: 1 tablet once daily (75mg clopidogrel, 100mg aspirin)

CAL

9: Do not stop taking this medicine abruptly unless otherwise advised by your doctor
10a: Do not take more than one aspirin tablet or capsule each day whole being treated with this medicine

clopidogrel with aspirin

10b: do not take aspirin or anti-inflammatory medicines while being treated with this medicine unless advised by your doctor
18: Avoid eating grapefruit or drinking grapefruit juice while being treated with this medicine.

Question 14

AE (common, serious, allergic) of clopidogrel (3 marks)

Answer 14

All medications can cause side effects, but not everyone will experience them. Some of these side effects may include diarrhoea and itching.

More severe side effects include a fast pounding heart beat and pain or stiffness in the joints.

Please see a doctor if you have bloody or black dark bowel motions. Also tell your doctor if you notice any bleeding (nose bleeds) or bruising more easily than normal.

Question 15

Lifestyle/self-care of Clopidogrel (2 marks)

Answer 15

Avoid grapefruit juice as it may decrease the efficacy of clopidogrel.

Some medicines and clopidogrel may interfere with each other. These include NSAIDs, medicines use to treat reflux. Tell us or your doctor before you start taking these medications.

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?

Question 16

This medicine is enoxaparin and the brand we have given you is called …?

Answer 16

clexane

Question 17

Mode of action and indication of enoxaparin (3 marks)

Answer 17

Clexane is one of a group of medicines called low molecular weight heparins (LMWH). These medicines work by reducing blood clotting activity.

Clexane is used in a number of medical conditions. It is used to:

• treat blood clots
• reat certain types of heart disease (eg. angina and heart attacks), when used with aspirin
• prevent blood clots forming after an operation, during hospitalisation or extended bed rest or haemodialysis

Question 18

Dose and directions for use (C/A labels) for enoxaparin (3 marks)

Answer 18

Prevention of VTE

> surgical patients: SC 20 mg once daily for 7–10 days or until mobilised, starting 2 hours before surgery –> moderate risk

Treatment of VTE

> SC, 1 mg/kg twice daily, or 1.5 mg/kg once daily until adequate oral anticoagulation is established

Unstable angina, non-STEMI

> Give for 2–8 days, with aspirin.

> Adult, SC 1 mg/kg twice daily.

Do not inject IM because of risk of haematoma.

CALS

10b: Do not take aspirin or anti-inflammatory medicines while being treated with this medicine unless advised by your doctor

Question 19

AE (common, serious, allergic) of enoxaparin (3 marks)

Answer 19

All medications can cause side effects, but not everyone will experience them. Some of these may include bleeding, bruising and pain at the injection site.

Rarer side effects include osteoporosis, but this is associated with long term use

Tell your doctor immediately if you have any signs of bleeding (eg nosebleeds, black or tarry bowel motions, or unexplained bruising) during and after treatment.

Question 20

Lifestyle/self-care of Enoxaparin (2 marks)

Answer 20

Your doctor will tell you how long you will be using enoxaparin

If you plan to have surgery, tell your doctor or dentist that you are using this medication

Ask your doctor whether there are any activities you should avoid while using this medication., for example certain sports. Sometimes after an injury bleeding may occur inside your body without you knowing about it.

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?

Question 21

This medicine is isosorbide dinitrate and the brand we have given you is called …?

Answer 21

isordil 5mg (sublingual)

Question 22

Mode of action and indication of isosorbide dinitrate (3 marks)

Answer 22

This medication is used for the prevention and treatment of attacks of angina. It will not reduce the pain of an angina attack, but when taken regularly may prevent an attack from occurring.

Angina is a pain or uncomfortable feeling in the chest, often spreading to the arms, neck and sometimes to the shoulders and back. The pain may be caused by too little blood and oxygen getting to the heart.

This medciation belongs to a group of medicines called nitrates. Isordil works by opening up blood vessels which allows more blood and oxygen to reach the heart.

This medication may also be helpful in the treatment of some types of heart failure.

Question 23

Dose and directions for use (C/A labels) for isosorbide dinitrate (3 marks)

Answer 23

Acute angina:

At the first signs of an anginal attack, place one or two tablets under your tongue. If your angina is not relieved after taking these tablets you should call your doctor or nearest hospital immediately.

Prevention of acute angina before a activity that may precipitate angina such as exercising:

Sublingual, place one or two tablets under your tongue 10 minutes before activity.

Do not try to make up for the dose that you missed by taking more than one dose at a time.

CAL labels

16: This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or pharmacist or advice.

Question 24

AE (common, serious, allergic) of isosorbide dinitrate (3 marks)

Answer 24

All medications can cause side effects, but not everyone will experience them. Some common side effects include headache, dizziness, light headadness and flushing where your face may become red.

Rarer side effects include swollen hands and feet

Please see a doctor if you notice a increase in your heart rate or severe drops in blood pressure.

Question 25

Lifestyle/self-care of Isosorbide dinitrate (2 marks)

Answer 25

After angina has been relieved, you may spit out what is left of the tablet to avoid adverse effects such as headache.

This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.

Call an ambulance if your angina lasts for 10 minutes.

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?

Question 26

This medicine is isosorbide mononitrate and the brand we have given you is called …?

Answer 26

60mg, 120mg (duride, imdur, isobide MR, monodur)

Question 27

Mode of action and indication of isosorbide mononitrate (3 marks)

Answer 27

This medication is used for the prevention of angina

Angina is a pain or uncomfortable feeling in the chest, often spreading to the arms, neck and sometimes to the shoulders and back. The pain may be caused by too little blood and oxygen getting to the heart.

This medciation belongs to a group of medicines called nitrates. This medication works by opening up blood vessels which allows more blood and oxygen to reach the heart.

This medication may also be helpful in the treatment of some types of heart failure.

Question 28

Dose and directions for use (C/A labels) for isosorbide mononitrate (3 marks)

Answer 28

Adult, oral, initially 30–60 mg (half a tablet to 1 tablet) once daily, increased if necessary up to 120 mg (1 tablet) once daily.

Do not take a double dose to makeup for the dose you missed. If you miss a dose of of this medication, you may get attacks of angina.

CAL labels

16: This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or pharmacist for advice.

Question 29

AE (common, serious, allergic) of isosorbide mononitrate (3 marks)

Answer 29

All medications can cause side effects, but not everyone will experience them. Some common side effects include headache, dizziness, light headadness and flushing where your face may become red.

Rarer side effects include swollen hands and feet

Please see a doctor if you notice a increase in your heart rate or severe drops in blood pressure.

Question 30

Lifestyle/self-care of Isosorbide mononitrate (2 marks)

Answer 30

take at the time of day when angina is most frequent, eg at night for nocturnal angina or in the morning for daytime angina

isosorbide mononitrate is not recommended for treatment of acute episodes of angina because of its slow onset of action, it is used only for prevention

This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.

Swallow whole, do not crush or chew tablet

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?

Question 31

Mode of action and indication of glyceryl trinitrate (3 marks)

Answer 31

This medication is used for angina. Angina is a pain or discomfort in the chest, often spreading to the arms or neck and sometimes to the shoulders and back. This is usually caused by too little blood and oxygen getting to the heart muscle.

This medication belongs to a group of medicines called nitrates. It lets more blood and oxygen reach the heart muscle.

Question 32

Dose and directions for use (C/A labels) for glyceryl trninitrate (3 marks)

Answer 32

• At the first sign of an attack, sit down and place 1(one) Anginine tablet under your tongue or in your cheek, and allow it to dissolve.

> If the Angina is not relieved within 5 minutes, take another dose. You may use up to 2 tablets to relieve the angina pain or discomfort.

• Can use it before you exercise also. 1-2 tablets 5-10 minutes before the activity.

Place your Anginine tablet under your tongue, or in your cheek and allow to dissolve.

> While the tablet is dissolving, avoid any eating, drinking or smoking until the tablet has completely dissolved.

Spray

Acute angina: (1 or 2 sprays); repeat after 5 minutes if necessary to a maximum of 3 sprays.

CALs

sublingual tablet: 7b, 13, 16

7b: discard days after opening
13: Do not remove from the original packaging until dose required
16: This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or pharmacist for advice.

GTN spray: 16

Question 33

AE (common, serious, allergic) of glyceryl trinitrate (3 marks)

Answer 33

All medications can cause side effects, but not everyone will experience them. Some of the common side effects include headache, low blood pressure, flushing of the face.

Rarer side effects include blurred vision and dry mouth

See a doctor if you notice swelling of yor face or or worsening if your angina

Question 34

Lifestyle/self-care of Glyceryl Trinitrate (2 marks)

Answer 34

This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.

tablets

Place under your tongue; do not swallow. After the pain has been relieved, you may spit out or swallow what is left of the dose to avoid adverse effects such as headache.

It is important to store these tablets properly or they may not work as well. Keep them in the original glass bottle away from moisture, heat and light; close lid tightly. Do not carry them close to your body.

spray

Prime the spray before using it for the first time by pressing the nozzle 5 times, spraying it into the air. Prime it with 1 spray if it hasn’t been used for 7 days. Prime it with 5 sprays if it hasn’t been used for more than 4 months.

When ready to use, aim the spray under the tongue and press the nozzle once; do not inhale the spray.

Do not take Viagra (sildenafil), Cialis (Tadalafil) or Levitra (Vardenafil) whilst taking this medicine because it could cause your blood pressure to drop to a dangerously low level.

Questions + CMI (1 mark)

I have printed information for you about this medication, is there anything you would like me to explain more? Do you have any questions?