Drug counselling Flashcards
Mnemonic for drug counselling
ATHLETICS - Action; Timeline; How to take; Length of treatment; Effects before time; Tests; Important side effects; Complications/Contraindicatios; Supplementary advice
Action of Lithium
Mood stabiliser; Exact mechanism unknown; Thought to enter the cells and interfere with neurotransmitter release and second messenger systems
Timeline of Lithium
Once or twice daily depending on brand
How to take lithium
Tablet, capsule or syrup
Length of lithium treatment
Usually lifelong if it works; Regular reviews by psychiatrist
Time for effects of lithium
1-2 weeks
Pre-tests for lithium
FBC, U&Es, TFTs, betaHCG, ECG
How often to review lithium
Check after 5 days then every week until stable for 4 weeks, then every 3 months
What extra tests to review lithium
TFTs, U&Es, Ca2+ every 6 months
Important side effects of lithium
GI (abdo pain and nausea), Metallic taste, Fine tremor, Water symptoms (thirst, polyuria, impaired urinary concentration, weight gain, and oedema)
Signs of lithium toxicity
GI (anorexia, diarrhoea, vomiting); Neuromuscular (dysarthria, dizziness, ataxia, in-coordination, muscle, twitching, tremor); Others (drowsiness, apathy, restlessness)
Complications of lithium
Renal toxicity; nephrogenic diabetes insipidus; Hypothyroidism
Contraindications for lithium
1st trimester pregnancy; breastfeeding; Cardiac disease; significant renal impairment; Addison’s disease; low sodium diets; untreated hypothyroidism
Supplementary advice for lithium
www.bipolaruk.org.uk
Action of methotrexate
A disease modifying agent which both reduces inflammation and suppresses the immune system
Early use improves outcome and symptoms
Frequency of methotrexate
Once weekly with folic acid at another time
Build up dose slowly
How to take methotrexate
Tablet usually, injection also available
Length of methotrexate treatment
Long term
Time for methotrexate to have an effect
4-6 months
Pretests for methotrexate
FBC, LFTs, U&Es
Review tests for methotrexate
FBC, LFTs, U&Es
Every 2 weeks until therapy is stabilised then every 2-3 months
Important side effects of methotrexate
Allopecia, Headaches, GI disturbances
Myelosupression: Infection (go to A&E if fever or other infection signs); unexpected bleeding/bruising/purpura; anaemia
Complications of methotrexate
Myelosupression; liver toxicity (careful of alcohol); pulmonary toxicity (tell us if you get breathlessness/SOB)
Contraindications of methotrexate
Pregnancy (including male if trying); hepatic impairment; breastfeeding; active infection; immunodeficiency
Supplementary advice for methotrexate
No NSAIDs/aspirin; annual flu jab; arthritisresearch.org.uk
Action of atypical antipsychotics
Schizophrenia is caused by an over activity of neurotransmitters
Olanzapine works by blocking relevant receptors in the brain
Timeline of atypical antipsychotics
Tablet daily or depot injection every 2-4 weeks
How to take antipsychotics
Table or depot injection
Start at a small dose and build up over a week or two
Dose adjusted depending on persons response
Length of atypical antipsychotic treatment
Long term (keeps symptoms from returning) Tell doctor if wanting to get pregnant
How long for antipsychotics to have an effect
Several days or weeks
Tests required for antipsychotics
Occasional LFTs as it may impair liver function
Important side effects of antipsychotics
Anti-dopaminergic: Tardive dyskinesia; tremor; movement disorders
Anti-cholinergic: Constipation; dry mouth
Anti-histaminergic: Weight gain; dizziness; drowsiness
Anti-adrenergic: hypotension
Complications of antipsychotics
Neuroleptic malignant syndrome (high fever and muscle rigidity)
Agranulocytosis (swelling of mouth or throat or rash)
Withdrawal
Contraindications of antipsychotics
Liver failure; Phaeochromocytoma
Cautions for antipsychotics
Epilepsy; DM; glaucoma; parkinsons; heart, prostate, kidney problems; pregnancy
Supplementary info for antispychotics
www.rethink.org
