Counselling Week 5 (Haloperidol, Morphine, Sildenafil, Dutasteride +/- combinations, Oxybutynin)

Question 1

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

Answer 1

Sereneace

Haldol (injection)

Question 2

Mode of action and indication of Haloperidol

Answer 2

SERENACE is used to treat mental illnesses such as: • schizophrenia, an illness with disturbances in thinking, feelings and behaviour • mania, an illness where the patient experiences episodes of overactivity, elation or irritability • severe anxiety, tension or excitement and severe agitation, hyperactivity or aggression in patients with mental or emotional illness

SERENACE belongs to a group of medicines called antipsychotics. It helps to correct chemical imbalances in the brain, which may cause mental illness. These chemicals may also affect the parts of the brain, which control nausea and vomiting.

Question 3

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

Answer 3

Comes in 500mcg tablets, 1.5mg tablets and 5mg tablets

Chronic psychoses
Oral, 1–5 mg 2 or 3 times daily; adjust according to response. Doses of 3–10 mg daily are usually adequate; higher doses are no more effective but have a greater risk of EPSE. Can be given as a single daily dose.

Acute psychoses and mania

• Oral*, 5–10 mg every 2 hours as needed.
• Short-acting IM*, 0.5–10 mg every hour as needed.

CAL labels

1: This medicine can cause drowsiness and may increase the effects of alcohol
16: This medicine may cause dizziness especially when you stand up quickly. Ask doctor or pharmacist for advice.

Question 4

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

Answer 4

All medications can cause side effects, but not everyone will experience them. Some common side effects include weight gain, dry mouth, urinary retention and blurred vision.

Rarer side effects include skin rash fast pounding heart beats

Please see a doctor if you experience swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing. convulsions, fits or seizures also → see a doc innit

Question 5

Lifestyle/self-care of Haloperidol (2 marks)

Answer 5

Tell your doctor if you start or stop smoking tobacco as your haloperidol dose may need changing.

Taking your antipsychotic medicine regularly is important:

• because stopping or taking it irregularly is associated with high risk of relapse and suicide
• in order to prevent an episode, rather than taking it after symptoms occur.

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

Answer 6

…. so many

Question 7

Mode of action and indication of morphine (3 marks)

Answer 7

Morphine is used for many different conditions. This includes:

• Severe pain
• Acute pain
• Cancer pain
• Opioid adjunct during general anaesthesia
• Refractory chronic dyspnoea (on specialist advice)

Morphine works directly on opioid receptors in the brain and spine, and reduces feelings of pain by interrupting the way nerves signal pain between the brain and body.

Question 8

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

Answer 8

Chronic non-cancer pain: adult

Controlled release, oral 5–20 mg twice daily (start with 5 mg if opioid-naive or elderly). Review every 1–2 weeks; adjust dose according to response.

Acute pain: adult, child >50 kg

Conventional oral product, initially 5–15 mg every 4 hours (start with 5 mg in patients >70 years). Titrate dose according to response and sedation score,

also comes in oral liquid and either SC/IM injection

CAL labels

1: This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not drive a motor vehicle or operate machinery.

Question 9

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

Answer 9

All medications can cause side effects, but not everyone will experience them. Some common side effects include constipation, dizziness, drowsiness, headache and sweating.

Rarer side effects include high blood pressure, confusion and mood changes

Please see a doctor if you experience severe stomach pain with nausea or vomiting and difficulty urinating. Also shortness of breath, swelling of the face, lips, tongue or other parts of the body.

Question 10

Lifestyle/self-care of Morphine (2 marks)

Answer 10

This medication may make you feel drowsy and may increase the effects of alcohol. If you are affected, do not drive or operate machinery. If you are very sleepy or have trouble staying awake, stop taking the medication and tell your doctor immediately.

Constipation may occur while taking this medication. Make sure you have adequate fluid intake (more than 2L of water a day), we can also provide a laxative which has a stimulant and stool softener, and make sure to walk around and stay mobile.

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

Answer 11

Viagra

Question 12

Mode of action and indication of Sildenafil (3 marks)

Answer 12

Viagra is used to treat erectile dysfunction. This is when a man cannot get, or keep, a hard erect penis suitable for sexual activity.

Viagra belongs to a group of medicines called phosphodiesterase type 5 inhibitors. It works by relaxing the blood vessels in your penis when you are sexually excited.

This allows blood to flow into your penis, allowing you to get an erection in the natural way. Viagra will work only if you are sexually excited. Viagra will not increase your sex drive.

Question 13

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

Answer 13

Comes in 25mg, 50mg and 100mg (20mg for PAH)

Erectile dysfunction

Take orally about 1 hour before sexual activity; no more than 1 dose daily.

Start with 50 mg; decrease dose to 25 mg or increase to a maximum of 100 mg depending on response and tolerability.

Pulmonary arterial hypertension (PAH)

Oral, adult, usually 20 mg 3 times a day; if poorly tolerated, consider reducing to 20 mg twice daily. Some people may require higher doses (specialist supervision).

CAL labels

16: medicine may cause dizziness especially when you stand up quickly.

Question 14

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

Answer 14

All medications can cause side effects but not everyone will experience them. Some common side effects include headache, dizziness, nasal congestion and rash.

Rarer side effects include temporary hearing loss

If your erection continues for four hours, or sooner if there is pain, you should seek medical attention urgently. Also see a doctor if there are any changes to your vision such as blurring.

Question 15

Lifestyle/self-care of Sildenafil (2 marks)

Answer 15

If you take sildenafil with food it may take longer to work. It is usually taken 1 hour before sexual activity.

Be careful drinking alcohol while taking Viagra. Drinking alcohol can temporarily impair the ability to get an erection. Do not drink large amounts of alcohol before sexual activity.

Tell any other doctors, dentists and pharmacists who are treating you that you are taking Viagra.

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

Answer 16

D: avodart

D and T: duobluts and duodart

Question 17

Mode of action and indication of Dutasteride (3 marks)

Answer 17

DUODART is a combination of two medicine; dutasteride and tamsulosin hydrochloride. Dutasteride belongs to a group of medicines called 5-alpha reductase enzyme inhibitors and tamsulosin hydrochloride belongs to a group of medicines called alpha-blockers. These medicines can be used either alone or in combination in men who have a condition known as benign prostatic hyperplasia (BPH).

In men with BPH, the prostate gland becomes large enough to squeeze the urine tube running through it. If the urine tube is squeezed it narrows, making it more difficult for you to pass urine normally

Prostate growth is caused by a hormone in the blood called dihydrotestosterone (DHT). The dutasteride component of DUODART lowers DHT production in the body, leading to shrinkage of the enlarged prostate in most men. The tamsulosin hydrochloride component of DUODART acts by relaxing the smooth muscle in your prostate gland, making it easier to pass urine. Just as your prostate became large over a long period of time, reducing the size of your prostate and improving your symptoms may take time.

Question 18

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

Answer 18

Dutasteride Dose: Oral, 500 micrograms once daily.

Dutasteride with Tamsulosin: 1 capsule once daily.

d: 500mcg and t: 400mcg

CAL labels

dutasteride: 13 and 21

D + T: 12,13,16, B (take 30 minutes after food)

12: may affected mental alertness and coordination, do not drive a motor vehicole or operate machinery.
16: medicine may cause dizziness especially when stand up too quickly

Question 19

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

Answer 19

All medications can cause side effects, but not everyone will experience them. Some common side effects include decrease in libido (sex drive), dizziness, difficulty with ejaculation.

Less common side effects include constipation, diarrhoea and vomiting.

Please see a doctor if you experience symptoms such as Wheezing, swelling of the lips/mouth, difficulty in breathing, hayfever, lumpy rash (hives) or fainting. These could be symptoms of an allergic reaction.

Question 20

Lifestyle/self-care of Dutasteride (2 marks)

Answer 20

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

If you are going to have eye surgery for cataracts, please tell your surgeon that you are taking or have taken DUODART.

Men taking DUODART should have their PSA measured 6 months after starting treatment and then regularly after that. Taking DUODART will reduce the amount of PSA measured in your blood. You could still be at risk for prostate cancer even though your PSA is lower. Your doctor can still use PSA to help detect prostate cancer, by comparing your test results each time you have a PSA test.

D: Swallow whole; do not open or chew the capsules as the contents may irritate your mouth and throat.

D and T: Take this medicine about 30 minutes after the same meal (eg breakfast) each day. Do not take it on an empty stomach as this may increase the risk of side effects, eg dizziness on standing.

Question 21

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

Answer 21

Ditropan (tablets)

Oxytrol (patch)

Question 22

Mode of action and indication of Oxybutynin (3 marks)

Answer 22

Ditropan is used to decrease the urgency and the frequency of urination. Ditropan works by relaxing the bladder smooth muscle and helps to decrease muscle spasm. It also helps the bladder fill up more effectively. This delays the initial desire and the urge to urinate.

Question 23

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

Answer 23

Comes in 5mg tab and 3.9mg/24 hours patch

Adult

• Oral*, usual range 2.5–5 mg 2 or 3 times daily; maximum 20 mg daily. For elderly patients, start with 2.5 mg at night; if necessary, increase dose slowly.
• Patch*, apply 1 patch twice a week (every 3–4 days).

Child

Child >5 years

Oral, initially 2.5 mg twice daily; if necessary, increase to 5 mg 2 or 3 times daily.

CAL labels

Patch: 12,21

Oral: 12

12: Medicine may affect mental alertness and or coordination. If affected do not drive a motor vehicle or operate machinery.

Question 24

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

Answer 24

All medications can cause side effects, but not everyone will experience them. Some common side effects include constipation, drowsiness, dryness of the mouth, nose and throat.

Less common side effects include fast or irregular heartbeat and skin rash.

Please see a doctor if you experience swelling of the face, lips, mouth or throat which may cause difficulty in swallowing or breathing. Also fever or heat stroke.

Question 25

Lifestyle/self-care of Oxybutynin (2 marks)

Answer 25

Patch: dry mouth may be less common than with oral oxybutynin; however, application site reactions are common (>10%) and may be intolerable

Oxybutynin may make you sweat less, causing your body temperature to rise. Take extra care to avoid becoming overheated during exercise or hot weather, since overheating may result in heat stroke.

Be careful driving or operating machinery until you know how Oxybutynin affects you → This medicine may cause drowsiness or blurred vision in some people. If you have any of these symptoms, do not drive a car, operate machinery, or do anything else that could be dangerous.

Be careful when drinking alcohol while you are taking this medicine.

>Alcohol or other sedatives may increase the drowsiness that may be caused by Oxybutynin