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OSCE > Drug Counselling > Flashcards

Drug Counselling Flashcards

1
Q

Lifetyle modifacations for lowering bloods pressure

A

Reduce dietary salts (less than 6g)

Improve diet

Exercise

Reduce alcohol

Stop smoking

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2
Q

Risks of high blood pressure

A

Arrhythmias

Heart attacks

Stroke

Erectile dysfunction

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3
Q

Side effects of ramipril

A

Cough

Upset tummy

rashes

Nausea / vomitting

Dizziness

Swelling of face and neck (angioedema)

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4
Q

What are monitoring requirements for ace inhibitors?

A

Yearly blood pressure checks - recommend buying own blood pressure cuffs

Yearly kidney function checks (and before starting)

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5
Q

What drugs should be avoided whilst on ace inhibitors?

A

Ibuprofen - safety net about AKI - not being able to pass urine or feeling confused - get in touch with medical help

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6
Q

What is the function of bisphosphonates?

A

Help to prevent the thinning of bones and help to increase bone density

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7
Q

How should you take bisphosphonates

A

Oral tablet once weekly

Take on same day every week

Take first thing in the morning on empty stomach with a large glass of water

Do not eat or drink anything other than water for two hours after

Stay upright for 30 minutes after taking the tablet.

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8
Q

What are the side effects of bisphosphonates?

A

Heartburn - if you experience heartburn after taking bisphosphonates then you should contact GP

Osteonecrosis of jaw - ulcers inside mouth that do not heal, pain in mouth and haw. Swelling of face - urgent medical help if present. Yearly dental check ups are important.

Less serious side effects (settle within the first month normally)

Abdominal pain

Nausea

Muscle pain

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9
Q

Other advice for bisphosphonates;

When will they start to work?

Missed dose?

A

6 - months to take effect

Long - term medication

Reviewed regularly

Missed dose - take tablet as soon as you remember - do not take two tablets on the same day

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10
Q

General advice for improving bone density

A

Exercise - weight bearing

High calcium foods - leafy green vegetables, dairy, soya beans. Dietary supplements if you are struggling to get adequate dietary calcium

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11
Q

Why should we anticoagulate in AF

A

To reduce heart attacks, strokes, clots in lungs and legs

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12
Q

How to take DOAC

A

Apixaban is 5mg taken twice a day

Take lifelong because AF will likely be lifelong

Explain that missed doses out you at risk of having a stroke etc..

Get in touch with medical help if you take an extra dose

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13
Q

Side effects of apixaban

A

Bruising and bleeding

Avoid contact sports

Get in touch if prolonged bleed

Severe bleeding - seek emergency help

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14
Q

What drugs should be avoided whilst on a DOAC

A

NSADIS - aspirin and ibuprofen

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15
Q

What follow up for apixaban?

A

Not routine however may make appointment in near future

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16
Q

What is emergency contraception

A

Helps reduce risk of pregnancy occuring after unprotected sex

Not abortive

Can be pill or IUD

17
Q

What are the types of emergency contraception?

A

Levonelle - progesterone mimic - can be taken up to 3 days of having uprotected sex

EllaOne (ulipristal acetate) Single tablet - taken within 5 days of having unprotected sex

Copper IUD - small plastic and copper device fitted into the womb up to 5 days after unprotected sex or 5 days before expected ovulation date - can be left in for up to 10 years for ongoing contraception - 99% effective. EllaOne is slightly more effective than Levonelle.

18
Q

What are the advantages of each type of emergency contraception?

A

Levonelle - safe, can start ongoing contraception today

Ellaone - safe, more effective than levonelle

Copper IUD - Most effective - can remain as regualr contraception for up to 10 years. No hormonal contect, does not interact with other tablets. Can be used alongside tablet contraception as an extra precaution.

19
Q

What are the disadvantages of each contraception?

A

Levonelle: N&V. Next period can be late or early. Least effective. Not effective if you have already ovulated.

EllaOne - N&V. Next period can be late or early. Least effective. Not effective if you have already ovulated. Cannot be taken around the same time as other hormones.

Copper IUD - Procedure required, can be uncomfortable. Infection, expulsion and perforation risk. Can cause bleeding for a few days after insertion. Some people may suffer heavier and more painful periods.

20
Q

What is follow up advice for emergency contraception?

A

Take a pregnancy test three weeks after the unprotected sex

Offer STI screening

Offer contraception

21
Q

What are the different forms of HRT?

A

Tablets, patches, gels and implants such as the mirena coil - important to tell the patient that they can try several and find out what works best for them.

Continuous combined = O and P every day

Monthly = O every day and then P every 10-14 days

3 monthly HRT = O is taken every day and then P is taken for two weeks every 3 months

Oestrogen only HRT = for women without a wombq

22
Q

Pros and cons of HRT

A

Advantages:

  • Improvement of flushing
  • Improvement of vaginal dryness
  • Improvement of urinary frequency
  • Improvement in mood
  • Protective against osteoporosis

S/Es:

  • Breast tenderness, leg cramps, bloating, nausea, headaches. If HRT contains progesterone then you may experience breast tenderness, backache, low mood and pelvic pain. Breakthrough bleeding is common in the first 3-6 months with CC HRT.

Risks of HRT:

  • Blood clots in the lefs and lungs (possibility of co-prescribing a blood thinner)
  • Stroke - not present in skin patches
  • Slight increase in risk of breast cancer in women over 51 - 1 extra case of breast cancer per 1000 women each year.

Increased risk of endometrial cancer if you don’t take progesterone.

23
Q

How to take steroids?

A

Take so that highest doses are taken in the morning to mimic the bodies natural cortisol

Do not suddenly come off the medication

Carry a steroid emergency card

Avoid grapefruit juice

24
Q

What are the side effects of hydrocortisone?

A

Dizziness

Headaches

Swollen ankles

Feeling weak or tired

Increased appetite - increased weight

Growing hair over body

Rounding of face

Wasting of muscles

Thinning of bones

Depression

Mania

Insomina

Psychosis

Reflux

Stomache ulcers - warn of potential symptoms

Immuno compromise - avoid people with infectious disease, contact medical help if in contact with chickenpox, shingles or measles.

25
Q

Interactions for hydrocortisone

A

Tell pharmacist if buying anything over the counter.

26
Q

What are the main areas to cover when explaining type 1 diabetes?

A

Body attacks pancreas cells responsible for producing insulin

Insulin responsible for storing glucose / sugar in the body

Blood sugar levels are now poorly controlled

Can be too high - explain risks

Can be too low - explain risks and symptoms

27
Q

How to take insulin

A

Explain insulin is an injection

Most common regime = basal bolus of long acting insulin, then short acting insulin when having meals - to mimic the bodys normal response - helps prevent spikes of blood sugar

Injections are into the fatty part of the tummy, injecting into the fat makes absorption slower, - important to rotate sites to aid absorption and to prevent skin becomming hard

28
Q

What are the side effects of insulin?

A

Insulin can change fatty tissue - impeding absorption - switch injection sites

Lumpy areas may form where you frequently inject yourself - try to avoid injecting in to these areas

Hypos - not enough food / too much exercise

Symptoms include sweating, anxiety, hunger, blurred vision, trembling, lethargy, brain fog

Can correct a hypo by using jelly babies - might take time to work out how many brings sugard back to normal

Education programmes available to help count carbohydrates and correct a hypo.

29
Q

What are the monitoring requirements for t1dm?

A

HbA1c every 3-6 months

Finger prick glucose 4 times per day - before meals/large snak and bed

Aim for 5-7

Blood pressure

30
Q

What to do on sick days for insulin

A

Increase blood sugar monitoring to every 4 hourly at minimum

Check urine for ketones

Keep eating and taking insulin - if unable to keep down food make sure to drink sugary fluids

Make sure to have a mobile phone near by

Drink plenty of water

Sick day box with snacks and water for when you’re sick

If blood sugars very high may need to take corrective doses if insulin

OSCE (37 decks)

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