Drug Counselling Flashcards
Lifetyle modifacations for lowering bloods pressure
Reduce dietary salts (less than 6g)
Improve diet
Exercise
Reduce alcohol
Stop smoking
Risks of high blood pressure
Arrhythmias
Heart attacks
Stroke
Erectile dysfunction
Side effects of ramipril
Cough
Upset tummy
rashes
Nausea / vomitting
Dizziness
Swelling of face and neck (angioedema)
What are monitoring requirements for ace inhibitors?
Yearly blood pressure checks - recommend buying own blood pressure cuffs
Yearly kidney function checks (and before starting)
What drugs should be avoided whilst on ace inhibitors?
Ibuprofen - safety net about AKI - not being able to pass urine or feeling confused - get in touch with medical help
What is the function of bisphosphonates?
Help to prevent the thinning of bones and help to increase bone density
How should you take bisphosphonates
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.
What are the side effects of bisphosphonates?
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
Other advice for bisphosphonates;
When will they start to work?
Missed dose?
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
General advice for improving bone density
Exercise - weight bearing
High calcium foods - leafy green vegetables, dairy, soya beans. Dietary supplements if you are struggling to get adequate dietary calcium
Why should we anticoagulate in AF
To reduce heart attacks, strokes, clots in lungs and legs
How to take DOAC
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
Side effects of apixaban
Bruising and bleeding
Avoid contact sports
Get in touch if prolonged bleed
Severe bleeding - seek emergency help
What drugs should be avoided whilst on a DOAC
NSADIS - aspirin and ibuprofen
What follow up for apixaban?
Not routine however may make appointment in near future
What is emergency contraception
Helps reduce risk of pregnancy occuring after unprotected sex
Not abortive
Can be pill or IUD
What are the types of emergency contraception?
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.
What are the advantages of each type of emergency contraception?
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.
What are the disadvantages of each contraception?
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.
What is follow up advice for emergency contraception?
Take a pregnancy test three weeks after the unprotected sex
Offer STI screening
Offer contraception
What are the different forms of HRT?
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
Pros and cons of HRT
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.
How to take steroids?
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
What are the side effects of hydrocortisone?
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.
Interactions for hydrocortisone
Tell pharmacist if buying anything over the counter.
What are the main areas to cover when explaining type 1 diabetes?
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
How to take insulin
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
What are the side effects of insulin?
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.
What are the monitoring requirements for t1dm?
HbA1c every 3-6 months
Finger prick glucose 4 times per day - before meals/large snak and bed
Aim for 5-7
Blood pressure
What to do on sick days for insulin
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
