Drug counselling

Question 1

Mnemonic for drug counselling

Answer 1

ATHLETICS - Action; Timeline; How to take; Length of treatment; Effects before time; Tests; Important side effects; Complications/Contraindicatios; Supplementary advice

Question 2

Action of Lithium

Answer 2

Mood stabiliser; Exact mechanism unknown; Thought to enter the cells and interfere with neurotransmitter release and second messenger systems

Question 3

Timeline of Lithium

Answer 3

Once or twice daily depending on brand

Question 4

How to take lithium

Answer 4

Tablet, capsule or syrup

Question 5

Length of lithium treatment

Answer 5

Usually lifelong if it works; Regular reviews by psychiatrist

Question 6

Time for effects of lithium

Answer 6

1-2 weeks

Question 7

Pre-tests for lithium

Answer 7

FBC, U&Es, TFTs, betaHCG, ECG

Question 8

How often to review lithium

Answer 8

Check after 5 days then every week until stable for 4 weeks, then every 3 months

Question 9

What extra tests to review lithium

Answer 9

TFTs, U&Es, Ca2+ every 6 months

Question 10

Important side effects of lithium

Answer 10

GI (abdo pain and nausea), Metallic taste, Fine tremor, Water symptoms (thirst, polyuria, impaired urinary concentration, weight gain, and oedema)

Question 11

Signs of lithium toxicity

Answer 11

GI (anorexia, diarrhoea, vomiting); Neuromuscular (dysarthria, dizziness, ataxia, in-coordination, muscle, twitching, tremor); Others (drowsiness, apathy, restlessness)

Question 12

Complications of lithium

Answer 12

Renal toxicity; nephrogenic diabetes insipidus; Hypothyroidism

Question 13

Contraindications for lithium

Answer 13

1st trimester pregnancy; breastfeeding; Cardiac disease; significant renal impairment; Addison’s disease; low sodium diets; untreated hypothyroidism

Question 14

Supplementary advice for lithium

Answer 14

www.bipolaruk.org.uk

Question 15

Action of methotrexate

Answer 15

A disease modifying agent which both reduces inflammation and suppresses the immune system
Early use improves outcome and symptoms

Question 16

Frequency of methotrexate

Answer 16

Once weekly with folic acid at another time

Build up dose slowly

Question 17

How to take methotrexate

Answer 17

Tablet usually, injection also available

Question 18

Length of methotrexate treatment

Answer 18

Long term

Question 19

Time for methotrexate to have an effect

Answer 19

4-6 months

Question 20

Pretests for methotrexate

Answer 20

FBC, LFTs, U&Es

Question 21

Review tests for methotrexate

Answer 21

FBC, LFTs, U&Es

Every 2 weeks until therapy is stabilised then every 2-3 months

Question 22

Important side effects of methotrexate

Answer 22

Allopecia, Headaches, GI disturbances

Myelosupression: Infection (go to A&E if fever or other infection signs); unexpected bleeding/bruising/purpura; anaemia

Question 23

Complications of methotrexate

Answer 23

Myelosupression; liver toxicity (careful of alcohol); pulmonary toxicity (tell us if you get breathlessness/SOB)

Question 24

Contraindications of methotrexate

Answer 24

Pregnancy (including male if trying); hepatic impairment; breastfeeding; active infection; immunodeficiency

Question 25

Supplementary advice for methotrexate

Answer 25

No NSAIDs/aspirin; annual flu jab; arthritisresearch.org.uk

Question 26

Action of atypical antipsychotics

Answer 26

Schizophrenia is caused by an over activity of neurotransmitters Olanzapine works by blocking relevant receptors in the brain

Question 27

Timeline of atypical antipsychotics

Answer 27

Tablet daily or depot injection every 2-4 weeks

Question 28

How to take antipsychotics

Answer 28

Table or depot injection Start at a small dose and build up over a week or two Dose adjusted depending on persons response

Question 29

Length of atypical antipsychotic treatment

Answer 29

``` Long term (keeps symptoms from returning) Tell doctor if wanting to get pregnant ```

Question 30

How long for antipsychotics to have an effect

Answer 30

Several days or weeks

Question 31

Tests required for antipsychotics

Answer 31

Occasional LFTs as it may impair liver function

Question 32

Important side effects of antipsychotics

Answer 32

Anti-dopaminergic: Tardive dyskinesia; tremor; movement disorders Anti-cholinergic: Constipation; dry mouth Anti-histaminergic: Weight gain; dizziness; drowsiness Anti-adrenergic: hypotension

Question 33

Complications of antipsychotics

Answer 33

Neuroleptic malignant syndrome (high fever and muscle rigidity) Agranulocytosis (swelling of mouth or throat or rash) Withdrawal

Question 34

Contraindications of antipsychotics

Answer 34

Liver failure; Phaeochromocytoma

Question 35

Cautions for antipsychotics

Answer 35

Epilepsy; DM; glaucoma; parkinsons; heart, prostate, kidney problems; pregnancy

Question 36

Supplementary info for antispychotics

Answer 36

www.rethink.org