Drug counselling Flashcards
Methotrexate
A - Disease modifying agent which reduces inflammation + suppresses immune system. It can be used to treat RA, psoriasis, crohn’s maintenance.
T - Once weekly with folic acid at another time not at same time. It is important you take it on the same day each week - usually there’s a reminder on pill packet + pt card. Doses will vary in AI + you’ll receive a pt card where you can record the details of doses + day you take it, keep this with you and show it to anyone involved in your care. Miss pill = take as soon as you remember h/e if more than 2d late contact GP/clinic.
H - Tablet, liquid/drink, injection. Wash hands, drink water after taking med.
L - Long term
E - 4-6m up to 12m before you notice any benefits but it is important to keep taking it., as med is working even if you do not feel any diff for a few months.
T - Check blood, liver, kidneys (FBC, LFT, UE) before starting, every 2w, 2-3m. It’s important to record results + dose in the given booklet.
I - SE: alopecia, headaches, GI disturbance - speak to dr it bother you or do not go away. Seek urgent help if liver syx (jaundice), inflam lung syx (cough/CP/sob), blood disorder syx (bruising, mouth ulcers, sore throat)
C - myelosupression, liver toxicity, pulmonary toxicity. CI: pregnancy inc male, breastfeeding, hepatic impairment, infection, immunodeficiency.
S - no NSAIDs/aspirin. Not to get ‘live’ vaccines. Flu vaccine in adult is ok as it is inactivated.
Statin
A - Too much of the ‘wrong sort’ of cholesterol can increase risk of CV events e.g. heart disease or stroke. Statins reduce cholesterol production within the liver and thus reducing total amount of bad cholesterol circulating in the body. In doing so reduces likelihood of future heart disease and strokes.
THL - PO OD in evening. Lifelong.
E - Decreases risk over many years.
T - LFTs before starting, 3m, 12m as statin causes altered LFTs. Review pt in 4w, then 6m.
I - Usually safe + well tolerated. SE: headache, N+V, diarrhoea, abdo pain + also muscle aches, hair loss, itching.
C - Complications: rhabdomyolysis. CI: pregnancy, breastfeeding.
S
- Safety netting: SUMA if jaundice, abdo pain, muscle weakness
- Abx can interfere with the effectiveness, refer to leaflet for guidance and discuss any new meds with GP or pharmacist.
- Avoid grapefruit
- Supp info: BHF.co.uk
Warfarin
When gathering info check: Hx of haemophilia, peptic ulcers, severe HTN, IE, kidney or liver disease, DH abs, NSAIDs (ibuprofen) and medications for epilepsy. FH of clotting or bleeding disorders.
A - Drug that thins the blood by blocking vit K (responsible for making proteins that cause blood clot). Warfarin makes it less likely for blood to clot. It is prescribed to treat or prevent clots in blood.
THL - OD in evening. Take it for 3m (DVT), 6m (PE), life-long (AF).
E - Takes 3-5d for it work effectively, so you may be given an heparin injection in order to thin the blood faster or alternatively given a higher dose of warfarin at the start (aka loading dose).
T - INR measures how long it takes for your blood to clot. Normal INR = 1, your target INR = 2-3. This means it’ll take you 2-3x as long for your blood to clot compared to someone who is not taking warfarin. You’re at hi risk for clots so we want your blood thinner than normal so we would expect your blood to take longer to clot. We will monitor your INR through blood tests, this will initially be OD for first week, then weekly, then over a longer period. Your warfarin dose will be adjusted based on your INR to keep it within your target range. WE will give you a booklet so you can keep a record of your results and warfarin doses.
Missed pills = if you forgot to take a pill take it as soon as you remember h/e if you don’t remember till the next day skip this dose + inform dr in next appt. Never take more than one dose a day. If you do forget to take 2-3d then inform ur dr and they can advise you of what to do.
I - SE: bleed + bruise easily, rash, hair loss.
SUMA if haematuria, haematemesis, melaena, severe headache, jaundice, skin necrosis.
C - CI: pregnancy - ensure on contraceptive, severe HTN, IE, liver/kidney disease.
S - When undergoing procedure/prescribed new med let dr/pharmacist/dentists know about warfarin.
- Lifestyle: diet = avoid green leafy, cranberry juice, alcohol = limit intake, avoid binge drinking. Take care w/ brushing teeth, shaving. Avoid any sport where there is a significant risk of injury or bleeding.
- Yellow booklet (monitor dose + to take every appt) and alert card (tells HCP ur on warfarin, good for in emergency).
COCP
A - Contains oestrogen + progesterone. These hormones are similar to natural hormones produced by your ovaries. Pill prevents you from getting pregnant by stopping your ovaries from producing an egg every month (inhibit ovulation), it also thickens mucus around your cervix which stop sperm from entering your womb, it can also make womb lining thinner, which makes harder for fertilised egg to implant.
THL - take for 21d followed by 7d break (withdrawl bleed). Same time every day. Starting pill: use condom for 7d.
Miss pill: take pill ASAP + continue as normal.
Miss two pills: take most recent and use condom for 7d.
If >7pills in pack: finish pack + have 7d break as usual
If <7pills in pack: finish pack, start new back to back.
Sick within 2hrs: take another.
Diarrohea >24hrs: take pill as missed one, additional contraceptive used.
E - 99% effective if taken correctly.
T
I - SE: headache, nausea, mood change, breast tenderness, breakthrough bleeding, no STI protection. Pros: non-invasive method, effective, light + more regular + less painful period, control timing of period, improves acne, reduces cancer risk.
Risks: VTE, breast/cervical ca.
SUMA if severe migraine, swollen leg, severe CP.
C - CI: pregnant, breastfeeding, smoke + >35y, BMI > 35, migrane with aura, FH cervical/breast ca, blood clots
S - Starting new med let dr/pharmacists know. If needing surgery you will need to stop 4-6w beforehand.
Metformin
A - Increases sensitivity of cells to insulin, thus increasing glucose uptake.
THL - PO OD with/after breakfast at same time each day. This will be increased gradually so you’re taking it 3/day with each meal. Lifelong.
E - Immediately
T - U&E before starting and then annually. Assess BG control by measuring HbA1c to ensure it is in target range of 48mmol/mol.
I - SE: N+D, abdo pain, wt loss.
SUMA if experiencing sudden breathlessness, CP, fever.
C
- Complications: lactic acidosis so withhold metformin before + after 48hrs use of contrast.
- CI: Renal impairment, ketoacidosis, low BMI
S
- safety netting: if dose missed take as soon as you remember unless close to next dose.
- Important to continue to maintain a healthy, balanced diet with regular exercise. Promote wt loss, smoking/alcohol cessation if applicable
Iron Tables
A - Iron tablets are taken to replace your body’s store of iron which is required to make red blood cells. It tops up your iron stores and improves syx of anaemia.
THL - PO 1-3/day, work best on empty stomach h/e some prefer to take it with food as can irritate your stomach lining. Taking for 3months.
E - It may take few months before the full benefit is felt.
T - Check Hb in 3-4w
I - SE: dark/black sticky stools, n+v, diarrhoea, abdo pain.
C -
S -
Extra info: iron treatment should be stopped before any colonoscopy procedure.
SSRI
A - SSRIs work by increasing serotonin in the brain, by reducing it’s neuronal reuptake. It is a NT that is thought to have a good influence on mood, emotion, sleep.
THL - OD in the morning to avoid sleep disruption. Length of tx can be stopped after 3-6m after feeling better where it will be tapered off.
E - 4-6w for full effect
T
I - SE: N+V, diarrhoea, reduced appetite, wt loss, headache, drowsiness (take at night). May feel agitated, shaky, anxious. Inc sucidial and self harm thoughts. SE improve with time.
SUMA: Hyponatremia in elderly, Serotonin Syndrome - confusion, muscle twitching, high temp, fits, shivering. Blood in vomit, stools, movement problems, hallucinations, unable to pee SUMA.
C CI: suicide risk, bipolar disorder, poorly controlled epilepsy, PUD, past psychiatric illness.
S - DVLA: if experiencing drowsiness you should not drive
- Inform dr/pharamcists you’re on it as can interact with med + OTC.
- FU: 1-2w after tx start.
