Counselling Week 5 (Amitriptyline, Venlafaxine, Aripiprazole, Clozapine, Donepezil)

Question 1

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

Answer 1

10,25,50mg = endep or entrip

Question 2

Mode of action and indication of amitriptylline (3 marks)

Answer 2

This medicine is used for major depression or bed wetting provided there is no physical cause (eg problems with the bladder). It is also used as a adjuvant in pain management.

Amitriptyline belongs to a group of medicines called tricyclic antidepressants (TCAs). TCAs work by correcting the imbalance of certain chemicals in the brain. These chemicals, called amines, are involved in controlling mood. By correcting this imbalance, TCAs can help relieve the symptoms of depression.

Question 3

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

Answer 3

Depression: oral 25–75 mg daily, increasing by 25–50 mg every 2–3 days to 75–150 mg daily. Maximum 300 mg daily.

• Daily dose may be divided or given as a single dose at night; maintenance dose is usually given at night.

Adjuvant in pain management and migraine prophylaxis: 10–25 mg at night initially; titrate up to a maximum night time dose of 75 mg in migraine and 150 mg in pain management.

CAL labels: 1,5,9,13,16

1: This medicine may cause drowsiness and may increase the affects of alcohol. If affected do not drive.
5: Ask your doctor or pharmacist before using any other medicine including otc medicines or health products
9: Do not stop taking this medicine abruptly unless advised by your doctor
13: Do not remove from original packaging until dose required
16: This medicine may cause dizziness especially when you stand up quickly,

Question 4

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

Answer 4

All medications can cause side effects, but not everyone will experience them. Initially dry mouth, dizziness, increased sweating and nausea can occur.

Rarer side effects include seizures

Please see a doctor if you have chest pain

Question 5

Lifestyle/self-care of Amitriptyline (2 marks)

Answer 5

Try taking this medicine at night to reduce daytime drowsiness

These drugs may increase the effects of alcohol.

You may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days.

Get up gradually from sitting or lying to minimise the effect of dizziness; sit or lie down if you become dizzy.

Question 6

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

Answer 6

Efexor XR or Elaxine SR or Enlafax = 37.5mg, 75mg, 150mg

Question 7

Mode of action and indication of venlafaxine (3 marks)

Answer 7

Venlafaxine is used to treat major depression, and to prevent it coming back. It is also used to treat panic attacks and anxiety.

Venlafaxine belongs to a group of medicines called serotonin-noradrenaline reuptake inhibitors (SNRIs).

Venlafaxine increases the level of serotonin and noradrenaline in the brain, helping to restore your feeling of wellness.

Question 8

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

Answer 8

Adult, oral 75 mg once daily; if required, increase to 150 mg once daily.

CAL lables: 5,9,12,A,B

5: Ask your doctor or pharmacist before using any other medicine incldyuing over the counter medicines or health products
9: Do not stop taking this medicine abruptly unless otherwise advised by your doctor
12: This medicine may affect mental alertness and coordination. If affected, do not drive a motor vehicle or operate machinery.

Question 9

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

Answer 9

All medications can cause side effects, but not everyone will experience them. Initially dry mouth, dizziness and increased blood pressure can occur.

Rarer side effects include seizures

Please see a doctor if you have bloody diarrhoea or swelling of the face and lips.

Question 10

Lifestyle/self-care of venlafaxine (2 marks)

Answer 10

Take with food to minimise stomach upsets.

Be careful driving or operating machinery until you know how this medicine affects you.

increased suicidal thoughts and behaviour can occur soon after starting antidepressants, if you are experiencing these thoughts, please see a doctor

Question 11

This medicine is aripiprazole and the brand we have given you is …

Answer 11

5,10,15,20,30mg = abilify, tevaripiprazole, abyraz

Question 12

Mode of action and indication of aripiprazole (3 marks)

Answer 12

ABILIFY is used to treat symptoms of schizophrenia.

ABILIFY may be given to treat acute episodes of sustained upward mood swings (mania) in adult patients with Bipolar 1 Disorder

It works by altering chemicals in the brain and this includes stabilising dopamine activity in the brain.

Question 13

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

Answer 13

Schizophrenia: adult, oral 10–15 mg once daily. Do not increase dose for at least 2 weeks after starting –> achieve steady state

Bipolar disorder: adult, oral 15-30mg once daily.

CAL labels: 1,16

1: This medication may cause drowsiness and may increase the effects of alcohol, if affected, do not drive a motor vehicle
16: This medication may cause dizziness, especially when you stand up quickly.

Question 14

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

Answer 14

All medications can cause side effects, but not everyone will experience them. Intially headache, light-headedness and insomnia may occur.

Rarer side effects include allergic reactions and severe skin conditions

Please see a doctor if you have thoughts about suicide, or an increase in aggressive behaviour.

Question 15

Lifestyle/self-care of Aripiprazole (2 marks)

Answer 15

Consider whether a regular injection may suit you better than taking tablets.

Taking your antipsychotic medicine regularly is important:

• because stopping or taking it irregularly is associated with high risk of relapse and suicide

Question 16

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

Answer 16

25,50,100,200mg = clopine or clozaril

Question 17

Mode of action and indication of clozapine (3 marks)

Answer 17

Clozaril belongs to a group of medicines called antipsychotics. It helps to correct chemical imbalances in the brain which may cause mental illness.

Clozaril is used to treat schizophrenia when other antipyschotic medicines have either not worked or caused severe side effects. Also used in bipolar.

Question 18

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

Answer 18

Adult, oral 12.5 mg on the first day, increased to 25–50 mg on second day. If well tolerated, increase in 25–50 mg increments to 300 mg daily within 2–3 weeks. Then increase in 50–100 mg increments at 4–7‑day intervals if required. Usual range is 200–600 mg daily (maximum of 900 mg daily).

> Doses upto 300mg are usually given as a single dose in the evening

CAL labels: 1,9,12,13,16

1: This medication may cause drowsiness and increase the effects of alcohol, do not drive if affected
9: Do not stop taking this medicine abruptly unless otherwise advised by your doctor
12: This medicine may affect mental alertness and coordination.
13: Do not remove from original packaging until dose required
16: This medicine may cause dizziness especially if you stand up quickly

Question 19

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

Answer 19

All medications can cause side effects, but not everyone will experience them. Drowsiness, headache and constipation may occur

Rarer side effects include high blood pressure

Please see a doctor if there are signs of high blood glucose (diabetes) such as excessive thirst and passing large amounts of urine.

Question 20

Lifestyle/self-care of Clozapine (2 marks)

Answer 20

You will need to have regular blood tests and other checks while taking clozapine to help your doctor look out for serious side effects.

Your clozapine dose may need changing if you vary your caffeine intake (eg tea, coffee, cola drinks) or if you start or stop smoking tobacco; tell your doctor if any of these habits change.

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

Answer 21

5,10mg = aricept, arazil or aridon

Question 22

Mode of action and indication of donepezil (3 marks)

Answer 22

It is used to treat mild, moderate and severe Alzheimer’s disease, also called dementia of the Alzheimer’s type.

This medicine will not cure this disease, but it should help your memory and improve your ability to think more clearly.

They are thought to work by increasing the level of a chemical called acetylcholine in the brain.

Question 23

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

Answer 23

Oral, initially 5 mg once daily for a minimum of 4 weeks. Increase to 10 mg once daily according to clinical response

CAL labels: 12,16

This medicine may affect mental alertness and coordination. If affected, do not drive a motor vehicle or operate machinery (12)

This medicine may cause dizziness especially when you stand up quickly (16)

Question 24

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

Answer 24

All medications can cause side effects, but not everyone will experience them. Initially vivid dreams, insomnia and nausea may occur.

Rarer side effects include hallucinations and confusion

Please see a doctor if you have black sticky stools or dark brown urine.

Question 25

Lifestyle/self-care of Donepezil

Answer 25

Tell all doctors, dentists and pharmacists who are treating you that you are using this medicine.

This medicine helps to control your condition, but does not cure it. It is important to keep taking your medicine even if you feel well.

It may take several weeks for this medicine to take effect, so do not be discouraged if you do not see an improvement straight away.