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AIP > Drug counselling > Flashcards

Drug counselling Flashcards

1
Q

What are the contraindications to methortrexate?

A 
Pregnancy including male partner
Breast feeding
active infection
immunodeficiency
hepatic impairment
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2
Q

How does methotrexate work?

A

It is a disease modifying agent that reduces inflammation and immune response
Early use improves survival and outcomes

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3
Q

What is the treatment course of methotrexate?

A

It is taken once a week on the same day
Folic acid should also be taken once a week on a different day
Gradually build up the dose
Takes 3-12 weeks to work

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4
Q

What are the monitoring requirements for methotrexate?

A

They need FBC, u and e and Lfts checked before starting

Then these should be done every 2 weeks then 3 monthly

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5
Q

What are the side effects of methotrexate?

A 
Alopecia
Headaches
GI upset (don't take with NSAIDs)
Infections - if feeling unwell or notice bruising then need to present to medical professional
Liver and lung toxicity
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6
Q

What are the contraindications to lithium?

A

1st trimester pregnancy
Breastfeeding
Cardiac arrhythmia
Significant renal impairment

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7
Q

How does lithium work?

A

Alters neurotransmitters in the brain to cause mood stabilisation

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8
Q

What is the treatment course of lithium?

A

Take it once or twice a day
Same time each day
Takes 2-3 weeks to work

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9
Q

What are the monitoring requirements for lithium?

A

Before starting treatment FBC, U and E, LFT, TFTs, Bhcg and ECG
They need to have lithium level checked weekly then gradually less frequently
Check TFTs, U and E and calcium every 6 months

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10
Q

What are the side effects of lithium?

A 
GI (abdo pain and nausea)
Fine tremor
Water symptoms (thirst, polyuria, weight gain, oedema)
Renal toxicity
Hypothyroidism
Lithium toxicity:
-Gi (d and v)
-Neuromuscular (dysarthria, dizziness, impaired coordination)
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11
Q

What are the contraindications to atypical antipsychotics?

A

Hepatic impairment

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12
Q

How do atypical antipsychotics work?

A

They cause blockage of many neurotransmitter receptors causing reduction in psychosis

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13
Q

What is the treatment course of atypical antipsychotics?

A

They are taken daily or an injection every 2-4 weeks
Takes several weeks to start working
Change doses over time
Continued long term to stop symptoms from returning

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14
Q

What are the monitoring requirements for atypical antipsychotics?

A

Before starting, at 3 months, then annualy weight, waist circumference, pulse, BP, Hba1c, fasting glucose, lipid profile
Weight checks weekly for 6 weeks

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15
Q

What are the side effects of atypical antipsychotics?

A

Dopaminergic - parkinsonism, movements disorders, tremor, tardive dyskinesias
Histaminergic - weight gain, dizziness, drowsiness
Cholinergic - dry mouth, constipation, urinary retention
adrenergic - postural hypotension
Neuroleptic malignant syndrome - high fever and muscle rigidity
Prolonged QT
Hyperprolactinaemia - sexual dysfunction

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16
Q

What are the contraindications to levodopa?

A

Glaucoma

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17
Q

How does levodopa work?

A

It increases the amount of dopamine in the brain as this is reudced in parkinsons
Helps reduce rigidity and slow movements
Given with carbidopa to inhibit peripheral degeneration

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18
Q

What is the treatment course for levodopa?

A

3-4 times a day tablet
Taken for as long as it works effectively - typically after 5 years start to get ‘on-off’ effect i.e. the effects wear off before the next dose

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19
Q

What monitoring requirements are there for levodopa?

A

none

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20
Q

What are the side effects of levodopa?

A 
psychosis
nausea and vomiting
diskinesias
postural hypotension
on-off effect
impulsive behaviours
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21
Q

What are the monitoring requirements for insulin?

A

cap glucose before each meal and before bed

Should be checked if getting any side effects

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22
Q

What are the side effects of insulin?

A

Weight gain
Hypoglycaemia
Sharp injuries
Lipodystrophy

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23
Q

What are the contraindications to bisphosphonates?

A

Pregnancy
dysphagia
Recent peptic ulcer
Significant renal impairment

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24
Q

How do bisphosphonates work?

A

They increase osteoblast activity to increase bone mineral density
Lifestyle factors that can help are exercise, balanced diet and stopping smoking

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25
Q

What is the treatment course of bisphosphonates?

A

They are taken once daily or once weekly in the morning 30 mins before food
Remain sitting up for 30 mins after taking it

26
Q

What is the monitoring for bisphosphonates?

A

Regular check ups for osteonecrosis of jaw

27
Q

What are the side effects of bisphosphonates?

A 
Headaches
Indigestion and bloating
Gi (diarrhoea/constipation,abdo pain)
Seek medical attention if:
-Painful jaw
-dysphagia
-Upper Gi bleed/black stools
28
Q

What are the contraindications to warfarin?

A

Pregnancy
Active bleeding
Significant risk of major bleeding

29
Q

How does warfarin work?

A

It is a vitamin K antagonist that stops your blood clotting through the extrinsic coagnulation pathway
Inhibits 10, 9, 7 and 3

30
Q

What is the treatment course for warfarin?

A

Tablets taken once a day (usually evening)
Adjusted to INR
Dose changes take 2-3 days to have an affect
Usually on it 3 months DVT, 6 months PE and lifelong for AF

31
Q

What are the monitoring requirements for warfarin?

A

Starting dose 5mg each evening
Have INR done on days 3,4,5
Adjust dose according to dosing chart
Regular INR checks determined by INR stability - given dosing book

32
Q

What are the side effects of warfarin?

A

Warn about bleeding risk and neeed to seek medical advice if get severe head injury, bleeding from anywhere, unusual headache, unexplained bruising
Dirrhoea, nausea
Avoid things that interact cytochrome p450 - cranberry juice, NSAIDs/aspirin

33
Q

What are contraindications to DOACs?

A

Significant renal impairment
Significant risk of major bleeding
Active bleeding

34
Q

How do doacs work?

A

They inhibit factor 10a to cause anticoagulation and prevent blood clots

35
Q

What is the treatment course for doacs?

A

They are taken once or twice a day
Full glass of water sitting upright
3 months for DVT, 6 months PE and lifelong for AF

36
Q

What are the monitoring requirements for DOACs?

A

Before starting need renal function and check annually

No regular monitoring required

37
Q

What are the side effects of doacs?

A

Bleeding - go to doctor if any significant head injury, unusual headache, bleeding from vomit,urine, stool, unexplained bruising
GI disturbance
No reversal except dabigitran

38
Q

What are the contraindications to levothyroxine?

A

None

39
Q

How does levothyroxine work?

A

Replaces the thyroid hormone to give you more energy

40
Q

What is the treatment course of levothyroxine?

A

It is taken once daily and adjusted depending on the effects

Takes 4-6 weeks to take effect

41
Q

What are the monitoring requirements for levothyroxine?

A

TSH test every 2-3 months until stable

Once stable then check annually

42
Q

What are the side effects of levothyroxine?

A

Hyperthroidism effects - diarrhoea, weight loss, headache, palpatations, heat intolerance
Dose too low - constipation and cold intolerance

43
Q

What are the contraindications for statins?

A

Pregnancy

44
Q

How do statins work?

A

Stop your liver producing cholesterol
High cholesterol causes heart attacks, strokes and kidney disease
Also need to reduce dietary LDLs

45
Q

What is the treatment course of statins?

A

Taken once a day in the evening

Taken long term and it will reduce the risk over many years

46
Q

What are the monitoring requirements for statins?

A

Before starting need LFTs, at 3 months and at 12 months

Review lipid levels at 4 weeks then every 6-12 months

47
Q

What are the side effects of statins?

A 
Gi upset
Headache
Muscle pains
Rhabdomyolysis
Interact with grapefruit juice
48
Q

What are the contraindications to metformin?

A

Significant renal impairment
Ketoacidosis
Low BMI

49
Q

How does metformin work?

A

Increases insulin sensitivity and reduces glucose production in liver

50
Q

What is the treatment course of metformin?

A

taken once, twice or three times daily with meals

51
Q

What are the monitoring requirements for metformin?

A

Require U and es before tating then anually

Hba1c every 3-6 months until stable, 6 monthly at diabetic check ups

52
Q

What are the side effects of metformin?

A

Risk of lactic acidosis
Nausea, diarrhoea, weight loss
Do not take 2 days before operation

53
Q

What are the contraindications to iron tablets?

A

none

54
Q

How do iron tablets work?

A

They replace the iron levels in the body

Used to make red blooc cells

55
Q

What is the treatment course of iron tablets?

A

1-3 times a day
Works best if taken without food but can irritate stomach
Once levels normal then another 3 months to replenish stores

56
Q

What are the monitoring requirements for iron?

A

Hb in 3-4 weeks to assess response

57
Q

What are the side effects of iron?

A

It causes Gi side effects - constipation/diarrhoea
Black/green stools
metallic taste

58
Q

What are the contraindications to SSRIs?

A

Suicidal or manic

59
Q

How do SSRIs work?

A

They cause an increase in the chemicals in brain to cause less depressions

60
Q

What is the treatment course for SSRIs?

A

Take once a day
Takes 4-8 weeks to work
can be gradually stopped after feeling better

61
Q

What are teh monitroing requirements for SSRIs?

A

None

62
Q

What are the side effects of ssris?

A 
Worse symptoms first 2 weeks then improve
Appetite and weight change
Headache
Drowsiness
Withdrawl

AIP (19 decks)

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