Counselling Week 4 (Lis/Dexamfetamine, Mirena, Implanon NXT Implant, Yaz, Micronelle 20ED, Estalis Sequi Patches, Angeliq 1/2 tablets)

Question 1

This medicine is lis/dexamfetamine and the brand we have given you is called….

Answer 1

Lisdexamfetamine: vyvanse
Dexamfetamine: dexamfetamine

Question 2

Mode of action and indication of lis/dexamfetamine

Answer 2

The active ingredient in this drug is called dexamfetamine/lisdexamfetamine. It belongs to a group of medicines called central nervous system stimulants.

Children suffering from ADHD may have trouble learning or doing school work, and may become aggressive or unmanageable at school or at home. This medication helps improve attention and shuts out distraction allowing the child to concentrate. It does this by altering certain chemicals in the brain.

Lisdex: can also be used for Binge Eating Disorder (BED)
Dexamfetamine: can also be used for people with narcolepsy

Question 3

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

Answer 3

Lisdexamfetamine:
comes in 20,30,40,50,60,70mg capsules
>ADHD
Adult, child >6 years, oral 20–30 mg once each morning; if necessary, increase the daily dose by 20 mg at intervals of at least a week. Maximum dose 70 mg daily.

>Binge eating disorder
Adult, oral 30 mg once each morning; increase the daily dose by 20 mg at intervals of at least a week to the usual dose of 50 or 70 mg daily. Maximum dose 70 mg daily. Initial treatment period 12 weeks.

Dexamfetamine:
comes in 5mg only
>ADHD
If total daily dose >5 mg, give in 2 or 3 doses (morning, lunch and afternoon).

6–12 years, oral, initially 2.5 mg in the morning for 1 week; increase daily dose by 2.5–5 mg each week, according to response and tolerability, to a usual range of 0.5–1 mg/kg (maximum 40 mg) daily.

>12 years, oral, initially 5 mg in the morning for 1 week; increase daily dose by 5 mg each week as clinically indicated to a usual range of 0.5–1 mg/kg (maximum 40 mg) daily.

Narcolepsy
Adult, oral, initially 10 mg each morning; gradually increase as clinically indicated to a maximum of 60 mg daily in divided doses.

CAL labels

5: Ask your doctor or pharmacist before using any other medicine including over the counter medicines or health products
12: This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor vehicle or operate machinery.

Question 4

AE (common, serious, allergic) of Lis/dexamfetamine (3 marks)

Answer 4

All medications can cause side effects, but not everyone will experience them. Some common side effects include nausea, diarrhoea, dry mouth, loss of appetite, weight loss, anxiety

Rarer side effects include rashes and liver dsyfunction

Please see a doctor if you experience chest pain, shortness of breath of irregular heart beat.

Question 5

Lifestyle/self-care of Lis/dexamfetamine (2 marks)

Answer 5

Avoid taking doses after early afternoon if you have trouble sleeping at night (this may make you feel drowsy next day). This medicine may also make you feel dizzy; do not drive or operate machinery if you are affected.

This medication interacts with other medications including over the counter medicines, make sure you tell your doctor or pharmacist before taking any new medications.

Your cardiovascular function will be monitored alongside height and weight.

Also, monitor to see if the psychostimulant is having an effect in the patient. This includes improved attention, focus and ability to concentrate.

Also monitor to see if the medication is having too much of an effect, this includes if the child becomes withdrawn and doesn’t want to socialise.

Question 6

This medicine is levonorgestrel and the brand we have given you is called

Answer 6

Mirena -→ it is a intrauterine device

Question 7

Mode of action and indication of Mirena (3 marks)

Answer 7

Mirena is used for a variety of different conditions, this includes contraception OR Hormone Replacement Therapy in combination with oestrogen OR Heavy Menstrual Bleeding.

>It is placed inside the womb where it slowly releases the hormone over a period of five years or until it is replaced

It is used in hormone replacement therapy to protect the effects of estrogen which can cause excessive growth of the lining from the womb. It does this by making the lining of the womb insensitive to circulating oestrogen.

By making the lining of the womb insensitive to circulating oestrogen, this stops the growth of the lining of the womb which results in a reduction in the volume and duration of menstrual bleeding.

The hormone in Mirena prevents pregnancy by making cervical mucus thicker so that the sperm cannot get through to fertilise the egg and by controlling the womb lining so that it is not thick enough to become pregnant.

Question 8

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

Answer 8

Mirena is inserted and removed by a professional experienced in the use of Intrauterine Systems

The system should be inserted within seven days from the beginning of your period.

When Mirena is used to to protect the lining of the womb during Estorgen Replacement Therapy, it can be inserted anytime if you do not have monthly bleeding or else during the last days of menstruation or withdrawal bleeding.

CAL labels

This medicine may make you feel drowsy or dizzy; if affected, do not drive or operate machinery and take the dose at bedtime where possible.

Question 9

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

Answer 9

All medications can cause side effects but not everyone will experience them, some common side effects include reduced menstrual flow, post-insertion pain or cramps

Rarer side effects include decreased libido

Please see a doctor if you experience excessive abdominal pain or vaginal bleeding.

Question 10

Lifestyle/self-care of Mirena (2 marks)

Answer 10

At first your periods may be prolonged or irregular and spotting may occur; with time, periods usually become lighter or even stop. If they become heavier this may mean the IUD has come out.

See a doctor if you have signs of an infection, such as fever, unusual vaginal discharge or pain low in your abdomen because the IUD can increase the chance of pelvic inflammatory disease. It is most likely in the 3 weeks after the IUD is fitted (but can happen at other times).

Make sure you know how to check for presence and length of IUD string each month or after a period as it may be expelled unnoticed. Contact your doctor if you cannot feel the string (especially if you have severe pain).

Question 11

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

Answer 11

Implanon NXT

Question 12

Mode of action and indication of Implanon NXT (3 marks)

Answer 12

Implanon NXT is used to prevent pregnacy, it is placed under the skin of the non-dominant upper arm.

It prevents pregnancy in two ways, it prevent the release of an egg cell from the ovaries (this is known as ovulation). It also thickens the cervical mucus thus making it difficult for sperm to enter the womb.

Replace every 3 years.

Question 13

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

Answer 13

Implanon NXT must be inserted and removed by a doctor. A small scar may remain as a result. The doctor will give you a local anaesthetic prior to inserting the Implanon.

Implanon NXT protects you against pregnacy for a period of three years, but if you are overweight, the doctor may advise you to replace the implant earlier.

No preceding hormonal contraceptive: insertion should be done on day 1-5 of normal menstrual bleeding to rule out pregnancy.

If the implant is placed after the fifth day of menses then you should use an additional contraceptive method (such as a condom for the first 7 days after insertion).

Changing from a COC: insert implant at any time; additional contraception is not required.

CAL label

This medicine may make you feel drowsy or dizzy; if affected, do not drive or operate machinery and take the dose at bedtime where possible.

Question 14

AE (common, serious, allergic) of implanon NXT (3 marks)

Answer 14

All medications can cause side effects, but not everyone will experience them. Some common side effects that may occur include irregular bleeding, breast tenderness and pain, acne and headache

Rarer side effects include loss of libido

You should see a doctor immediately if you experience severe symptoms of a severe allergic reaction such as swollen face, tongue or throat or hives and trouble breathing.

Question 15

Lifestyle/self-care of Implanon NXT implant (2 marks)

Answer 15

If you cannot feel the implant, use additional contraception and contact your doctor.

This implant wont protect against sexually transmitted infections, only condoms and safe sex practices can protect you from these diseases.

Changes in bleeding pattern usually occur and can include irregular bleeding, prolonged bleeding or periods stopping.

Effectiveness may be reduced by some medicines; check with your doctor or pharmacist before starting or stopping any medicines, including herbal (particularly St John’s wort) and over-the-counter products.

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 drospirenone and ethinylestradiol. The brand we have given you is called….

Answer 16

YAZ

Question 17

Mode of action and indication of YAZ (3 marks)

Answer 17

This medication is used to prevent pregnancy. It is also used to treat moderate acne and symptoms of premenstrual dysphoric disorder (PMDD) in women seeking oral contraception.

It contains an estrogen and progesterone component which mimics the natural hormones produced in your body. These two hormones will inhibit ovulation, and thicken the mucus in your cervix which stops sperm from reaching the egg and thus fertilisation.

Question 18

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

Answer 18

In the box of medication you will say 24 active tablets which contain the hormones I previously mentioned, and 4 inactive tablets.

Take 1 tablet once daily at about the same time each day, you can have it with or without food. Take your first tablet from the green area on the blister pack corresponding to the day of the week.

If you are starting YAZ after a natural cycle, and you have not used a hormonal contraceptive in the past month, start on the first day of your period e.g. on the first day of menstrual bleeding

> While taking inactive pills, a withdrawal bleed (similar to a period) should start. However, sometimes this may not occur. Continue taking the pills as normal but consider the possibility of pregnancy if the pill has not been taken correctly or if 2 withdrawal bleeds in a row are missed.

CAL

Question 19

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

Answer 19

All medications can cause side effects, but not everyone will experience them. Some common side effects include breast tenderness, headache, and mood changes.

Rarer side effects include high blood pressure and excessive hair growth

If any of the following symptoms occur while on the pill, stop taking it and seek urgent medical advice: severe and sudden pain in the chest, severe headache, sudden blurred vision or loss of sight, unexplained tenderness or pain and swelling in one leg.

Question 20

Lifestyle/self-care of Yaz (2 marks)

Answer 20

This medication wont protect against sexually transmitted infections, only condoms and safe sex practices can protect you from these diseases.

• If you vomit within 2 hours of taking an active pill*, take another active pill as soon as possible.
• If you are less than 24 hours late taking an active pill, take it as soon as you remember and take the next pill at the usual time; contraception will not be affected.*

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 medication is Levonorgestrel with ethinylestradiol and the brand we have given you is called

Answer 21

Micronelle 20ED

>monophasic low dose

Question 22

Mode of action and indication of Micronelle 20ED (3 marks)

Answer 22

This medication is used to prevent pregnancy.

It contains an estrogen and progesterone component which mimics the natural hormones produced in your body. These two hormones will inhibit ovulation, and thicken the mucus in your cervix which stops sperm from reaching the egg and thus fertilisation.

Question 23

Dose and directions for use (C/A labels) for Micronelle 20 ED(3 marks)

Answer 23

Swallow the tablet whole with water. It does not matter if you take it before or after food.

On the blister, each tablet is marked with the day of the week on which it is to be taken. Take one tablet daily in the order directed on the blister, at about the same time every day. This will help you remember when to take it.

There are 21 pink active tablets and and 7 inactive tablets.

Start with a pink (active) tablet from the green zone marked with that day of week. Depending on the day of the week, this may be a pink (active) tablet or a white placebo (inactive) tablet.

If you are starting this medicine after a natural cycle, start on the first day of your period (i.e. the first day of menstrual bleeding). Take a pink (active) tablet from the green zone marked with that day of the week.

You may also start on days 2-5 of your period, but you must also use an additional barrier method of contraception (e.g. condom or a cap or diaphragm with spermicide) for the first 7 days of tablet taking.

While taking inactive pills, a withdrawal bleed (similar to a period) should start. However, sometimes this may not occur. Continue taking the pills as normal but consider the possibility of pregnancy if the pill has not been taken correctly or if 2 withdrawal bleeds in a row are missed.

CAL

Question 24

AE (common, serious, allergic) of Micronelle 20-ED (3 marks)

Answer 24

All medications can cause side effects, but not everyone will experience them. Some common side effects include breast tenderness, headache, and mood changes.

Rarer side effects include high blood pressure and excessive hair growth

If any of the following symptoms occur while on the pill, stop taking it and seek urgent medical advice: severe and sudden pain in the chest, severe headache, sudden blurred vision or loss of sight, unexplained tenderness or pain and swelling in one leg.

Question 25

Lifestyle/self-care of Micronelle-20 ED (2 marks)

Answer 25

This medication wont protect against sexually transmitted infections, only condoms and safe sex practices can protect you from these diseases.

If you vomit within 2 hours of taking an active pill, take another active pill as soon as possible.

If you are less than 24 hours late taking an active pill, take it as soon as you remember and take the next pill at the usual time; contraception will not be affected.

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 estradiol and the brand we have given you is called …?

Answer 26

Estalis Sequi Patches

Question 27

Mode of action and indication of Estalis Sequi (3 marks)

Answer 27

Estalis Sequi is a type of treatment called hormone replacement therapy (HRT). It is a combination pack consisting of stick-on patches that contain hormones. Estalis Sequi Weeks 1 and 2 patches contain estradiol. Estalis Sequi Weeks 3 and 4 patches contain estradiol plus norethisterone acetate (NETA).

Estalis Sequi is used for the short-term relief of symptoms of the menopause. This medicine is used only for women who still have a uterus (womb).

Estradiol is a natural female sex hormone called an estrogen. It is the same hormone that your ovaries were producing before the menopause. NETA is a hormone called a progestogen. It has effects similar to the female hormone, progesterone, which your ovaries also produced before the menopause.

Question 28

Dose and directions for use (C/A labels) for Estalis Sequi Patches (3 marks)

Answer 28

A leaflet in the carton contains pictures and information on how to apply the patch properly

Apply estradiol patches for 2 weeks, then combined patches for 2 weeks (change patch every 3–4 days).

Most women will have a period at the end of each 4-week cycle. This is quite normal.

CAL labels

Question 29

AE (common, serious, allergic) of Estalis Sequi Patches (3 marks)

Answer 29

All medications can cause side effects, but not everyone will experience them. Some common side effects include breast tenderness, headache, and change in libido

Rarer side effects include changes in the way your body handles glucose (glucose intolerance)

Please see a doctor if you notice signs of allergy such as rash, itching or hives on the skin; swelling of the face, lips, tongue.

Also, if you notice pain or tenderness in the abdomen, which may be accompanied by fever, loss of appetite, nausea and vomiting

Question 30

Lifestyle/self-care of Estalis Sequel (2 marks)

Answer 30

Apply to clean, dry skin on your lower abdomen or buttocks. When changing the patch, remove the old patch and apply a new one to a different place. Make sure you know how to dispose of patches safely.

Limit alcohol, caffeine and spicy foods intake to reduces the occurences of hot flushes.

If you forget to use it, apply a new patch as soon as you remember, and then go back to your usual schedule.

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

This medicine is estradiol abd drospirenone and the brand we have given you is called….

Answer 31

Angleiq ½ tablets

Question 32

Mode of action and indication of Angeliq ½ (3 marks)

Answer 32

Angeliq 1/2 provides hormone replacement therapy (HRT) for the treatment of menopausal complaints in postmenopausal women.

Angeliq 1/2 tablets contain estradiol, an oestrogen hormone and drospirenone, a progestogen hormone. During menopause, the estradiol production of the ovaries declines. Although menopause is natural, it often causes distressing symptoms, which are connected with the gradual loss of the hormones produced by the ovaries

Angeliq 1/2 replaces the hormones that the body no longer makes and prevents or relieves symptoms such as hot flushes, sweats, sleep disturbances and nervousness.

Question 33

Dose and directions for use (C/A labels) for Angeliq ½ (3 marks)

Answer 33

Take one tablet daily at about the same time each day. Taking it at the same time each day will have the best effect. It will also help you remember when to take it. It does not matter if you take this medicine before or after food.

This medication does not provide contraceptive protection

CAL labels

Question 34

AE (common, serious, allergic) of Angeliq ½ (3 marks)

Answer 34

All medications can cause side effects, but not everyone will experience them. Some common side effects include breast tenderness, headache, and change in libido

Rarer side effects include changes in the way your body handles glucose (glucose intolerance)

Please see a doctor if you notice signs of allergy such as rash, itching or hives on the skin; swelling of the face, lips, tongue.

Also, if you notice pain or tenderness in the abdomen, which may be accompanied by fever, loss of appetite, nausea and vomiting

Question 35

Lifestyle/self-care of Angeliq ½ (2 marks)

Answer 35

If you miss a dose and are less than 24 hours late from your next one, take your tablet as soon as possible, and take the next one at the normal time. If you miss tablets for several days, irregular bleeding may occur.

Angeliq 1/2 has been made to provide you with hormone replacement therapy without cyclical bleeding. You may, however, get some bleeding during the first few months of treatment. It could occur at any time but it is unlikely to be heavy. Bleeding episodes should eventually get less and finally stop.

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 36

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

Answer 36

• tab, 5 mg, 28, Actonel, PBS‑R¹/RPBS‑A²
• tab, 30 mg, 28, Actonel, PBS‑R³
• tab, 35 mg, 4, Risedronate^a, PBS‑R¹/RPBS‑A²
• tab, 35 mg (enteric coated), 4, Actonel EC, PBS‑R¹/RPBS‑A²
• tab, 150 mg, 1, Actonel Once-a-Month^a, PBS‑R¹

Question 37

Mode of action and indication of Risedronate (3 marks)

Answer 37

Actonel contains the active ingredient risedronate sodium.

Actonel belongs to a group of medicines called bisphosphonates

Actonel is used to treat bone disease. Actonel works directly on your bones to make them stronger and therefore less likely to break or fracture

Actonel works by slowing down the process of old bone being removed. This allows the bone-forming cells time to rebuild normal bone. Actonel also helps to rebuild bone mass. This creates stronger bone which is less likely to fracture. Therefore Actonel can help reverse the progression of osteoporosis.

Actonel 5mg daily, and 150mg Once-a-Month tablets are used to treat:

• osteoporosis (brittle or fragile bones that may fracture easily)
• osteoporosis caused by taking steroids

Actonel 30mg tablets are used to treat:

• Paget’s disease of the bone

Question 37

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

Answer 37

Dosage – Risedronate

Paget’s disease

Adult, oral 30 mg once daily for 2 months.

Osteoporosis

Adult, oral 5 mg once daily or 35 mg once a week or 150 mg once a month.

Swallow whole; do not chew or suck on the tablet.

CAL

4A: Do not take dairy products, antacids or mineral supplements within 2 hours of each dose of this medicine

Swallow whole; do not chew or suck on the tablet.

Take in the morning with a full glass of plain water at least 30 minutes before food or drink. Remain upright during this time and until after you eat.

(Enteric coated tablets (Actonel EC®) may be taken with or without food but you must still remain upright for 30 minutes after taking them.)

Question 38

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

Answer 38

All medications can cause side effects, but not everyone will experience them. Some common side effects include nausea, vomiting, diarrhoea, headache, and muscoskeletal pain

Rarer side effects include skin rash and redness of the skin

Please see a doctor if you experience swelling of the face, lips, mouth, throat or tongue or severe skin reactions

Stop tablets and see your doctor immediately if you have pain on swallowing, or new or worsening heartburn.

Question 39

Lifestyle/self-care of Risedronate (2 marks)

Answer 39

There are rare complications with some dental procedures in people taking bisphosphonates; tell your doctor if you require any dental work and tell your dentist that you are taking this medicine (or have taken it in the past).

Ensure vitamin D status and calcium intake are adequate; if necessary supplements, can be provided for this. (to be taken at a different time of day to oral bisphosphonates).

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?