Drug counselling Flashcards
Formula for drug counselling
Action
How to take
How long for
Positives
Negatives
Tests (monitoring)
Complications + Contraindications
Supplementary advice
Drug counselling SSRI
● Action: Antidepressants alter the balance of some of the chemicals in the brain (neurotransmitters). SSRI antidepressants mainly affect a neurotransmitter called
serotonin. An altered balance of serotonin and other neurotransmitters is thought to
play a part in causing depression and other conditions
● Timeline: once daily
● How to take: tablet
● Length of treatment: continue for 3-6 months after you feel better
● Effects (time before): 4-6 weeks
● Tests: NA
● Important side effects: GI upset (diarrhoea, nausea, vomiting) appetite +/- weight
change. Headaches, drowsiness (can take at night if problematic), anxiety,
withdrawal.
● Contraindications: high suicide risk
● Supplementary advice: www.mind.org.uk
Drug counselling methotrexate
Action: It is a ‘disease-modifying agent’ which has both reduced inflammation and
suppresses the immune system. Early use improves outcome and symptoms
● Timeline: once weekly with once weekly folic acid on a different day (methotrexate mondays and folic acid fridays)
● How to take: tablet usually but injection also available
● Length of treatment: long term
● Effects (time before): 4-6 months
● Tests: FBC, LFTs, U&Es -Before starting -Then, every 2 weeks until therapy
stabilised -Then, every 2-3 months
● Important side effects: Alopecia, headaches, GI disturbance.
Myelosuppression:
1. Infection (go to A&E if you have fever/other infection signs)
2. Unexpected bleeding/ bruising/purpura
3. Anaemia
● Complications/Contraindications: Myelosuppression Liver toxicity (careful of alcohol)
Pulmonary toxicity (tell us if you get breathlessness/ SOB).
Contraindicated in: pregnancy, males and females trying to conceive, breast feeding,
hepatic impairment, active infection or immunodeficiency.
● Supplementary advice: Get an annual flu jab, avoid NSAIDs/aspirin.
www.arthritisresearch.org.uk
Drug counselling lihtium
Action: Mood stabiliser. Exact mechanism unknown. Thought to enter the cells and
interfere with neurotransmitter release and second messenger systems.
● Timeline: once or twice daily depending on brand
● How to take: tablet, capsule or syrup
● Length of treatment: typically lifelong if good response, regular psychiatric reviews
● Effects (time before): 1-2 weeks
● Tests:Before starting - FBC, U&Es, TFTs, βHCG, ECG
Check lithium level after 5 days, then every week until stable for 4 weeks, then every
3 months.
Check TFTs, U&Es, Ca2+ every 6 months
● Important side effects: GI (abdo pain, nausea) Metallic taste, Fine tremor, Water
symptoms (thirst, polyuria, impaired urinary concentration; weight gain and oedema.
Lithium toxicity: GI (anorexia, diarrhoea, vomiting) Neuromuscular (dysarthria,
dizziness, ataxia, in coordination; muscle twitching, tremor) Others (drowsiness,
apathy, restlessness
● Complications/Contraindications: Renal toxicity, Nephrogenic diabetes insipidus,
Hypothyroidism
Contraindicated in:1st trimester pregnancy, Breast feeding, Cardiac disease,
Significant renal impairment, Addison’s disease, Low sodium diets, Untreated
hypothyroidism
● Supplementary advice: www.bipolar.org.uk
Drug counselling atypical antipsychotics
● Action: Schizophrenia is caused by an over-activity of chemicals in transmission of
messages in the brain. Olanzapine works by blocking the receptors in the brain that
are involved in transmitting these messages between the nerve cells.
● Timeline: daily if tablet, or injection every 2-4 weeks
● How to take: start at a low dose and build up over a period of weeks, adjust dose
based on response.
● Length of treatment: Long term (keeps symptoms from returning) Tell doctor if
wanting to get pregnant
● Effects (time before): several days to weeks
● Tests: May impair liver function, occasional LFTs may be needed
● Important side effects: Anti-dopaminergic (tardive dyskinesia, tremor, movement
disorders) Anticholinergic (constipation, dry mouth) Antihistaminergic (weight
gain, dizziness/ drowsiness) Anti-adrenergic (hypotension)
● Complications/Contraindications: Neuroleptic malignant syndrome (high fever and
muscle rigidity) Agranulocytosis (swelling of mouth or throat or rash) Withdrawal
Contraindicated in:Liver failure Pheochromocytoma
● Supplementary advice: www.rethink.org
Drug counselling levodopa
Action: levodopa works to replace some of the dopamine your brain is no longer able
to make. This will help to reduce your symptoms, in particular your rigidity and your
slow movements. Given with carbidopa (inhibits peripheral levodopa degeneration)
● Timeline: 3-4 times daily with food
● How to take: tablet.
● Length of treatment: For as long as it works, some people suffer end dose
deterioration after around 5 years
● Effects (time before): fast acting
● Tests: NA
● Important side effects: Psychosis, Nausea & vomiting, Dyskinesias, Postural
hypotension (drugs such as domperidone can help with these)
● Complications/Contraindications: End dose deterioration, on-off effects
Contraindicated in: Glaucoma
● Supplementary advice: www.parkinsons.org.uk
Drug counselling bisphosphonates
Action: Prevents the bone from being broken down and by helping to rebuild new
bone. Remember lifestyle factors can also help with this, such as exercise, no
smoking (we can help) and eating a well-balanced diet.
● Timeline: once weekly (pr a smaller daily dose)
● How to take: Swallow tablet with full glass of water Take at least 30 minutes before
food or anything other than water Be upright for 30 minutes after swallowing.
● Length of treatment: Long term
● Effects NA
● Tests: Dental checkups, before starting and regularly (risk of osteonecrosis of jaw)
● Important side effects: Headache Heartburn, bloating, indigestion GI (diarrhoea/
constipation, black stools, abdo pain)
● Complications/Contraindications: osteonecrosis of jaw
Contraindicated in: Pregnancy, dysphagia, stomach ulcers, severe renal impairment
● Supplementary advice: www.versusarthritis.org
Drug counselling warfarin
● Action: Thins the blood. It does this by blocking vitamin K – the vitamin used by the
body to make proteins that cause the blood to clot
● Timeline: once daily usually in the evening
● How to take: Tablet(s)
● Length of treatment: 3 months for DVT, 6 months for PE, Lifelong for AF
● Effects 2-3 days
● Tests: Start 5mg for 4 days then test INR on day 5 and 8, adjusting dose accordingly.
Started concomitantly with LMWH if immediate effect is required. Then, regular INR
checks by anticoagulation clinic – regularity determined by INR stability
● Important side effects: Bleeding (1-2%) – tell doctor if any unusual bleeding e.g.
bruises, dark stools, cuts take longer to heal. Also diarrhoea, rash, hair loss, nausea.
Many interactions: enzyme inducers - decrease warfarin action, decrease INR,
increase clot risk (St John’s Wort, carbamazepine, rifampicin, alcohol, phenytoin).
Enzyme inhibitors, increase warfarin action, increase INR, Increase bleeding risk
(metronidazole, erythromycin, NSAIDs, Tetracyclines, azole antifungals)
● Complications/Contraindications: NA
Contraindicated in: Pregnancy Haemorrhagic stroke Significant bleeding Cautions
Patients at high falls risk
● Supplementary advice: Avoid foods high in vitamin K as reduce effect: e.g. liver,
spinach, cranberry juice, alcohol binges. No NSAIDs/aspirin. Should be given an
anticoagulant book.
Drug counselling levothyroxine
Action: A synthetic version of the normal hormone produced by the thyroid gland
called thyroxine. It is given to bring your thyroxine levels back up to normal.
● Timeline: once daily before breakfast
● How to take: Tablet
● Length of treatment: lifelong
● Effects few weeks
● Tests: Start test dose then review in 2-3 weeks. TSH test every 2-3 months until
stable. When TSH level is stable, check annually.
● Important side effects: SE rare as replacing a normal hormone. If the level is too high
you may have hyperthyroid Sx such as diarrhoea, headache, palpitations, heat
intolerance.
● Complications/Contraindications: NA
Contraindicated Na
● Supplementary advice: You are eligible for free prescriptions for all medicines not just
levothyroxine but will need a medical exemption certificate.
Drug counselling statins
● Action: Statins stop the liver making cholesterol. Cholesterol is one of the things
which predisposes to artery problems causing heart disease, stroke and kidney
disease. It is important to also address other risk factors…
● Timeline: once daily in the evenings
● How to take: Tablet
● Length of treatment: lifelong
● Effects decreases risk over many years
● Tests: Review in 4w, then every 6 months. LFTs before starting, at 3 months & at 12
months. (statins cause altered LFTs
● Important side effects: Muscle pains, hair loss, itching, nausea, sickness, diarrhoea,
abdominal pain
● Complications/Contraindications: Rhabdomyolysis
Contraindicated Pregnancy
● Supplementary advice:Avoid grapefruit. www.bhf.org.uk
Drug counselling metformin
● Action: Increases the sensitivity of cells to insulin, thereby allowing the body to make
better use of the lower insulin levels.
● Timeline: once daily with breakfast, may be increased to twice daily
● How to take: Tablet with or immediately after a meal
● Length of treatment: lifelong if it works
● Effects NA
● Tests: U&E before starting then annually
● Important side effects: Nausea, diarrhoea, abdo pain, weight loss
● Complications/Contraindications: lactic acidosis
Contraindicated Renal impairment, ketoacidosis, low BMI, on day of or two days after
general anaesthetic or contrast media as this increases lactic acidosis risk
● Supplementary advice:If you miss a dose, take as soon as remember unless it’s
close to next dose time www.diabetes.org.uk.
Drug counselling iron tablets
● Action: Replace your body’s store of iron, a mineral required to make red blood cells
(which is deficient)
● Timeline: 1-3 times daily depending on brand
● How to take: Tablet - work best on empty stomach but can irritate stomach so most
prefer to take with food
● Length of treatment: Usually 4 months (3-4 weeks for Hb to normalise, then take for
3 months after that to replenish stores)
● Effects 3-4 weeks
● Tests: Hb in 3-4 weeks
● Important side effects: GI irritation (nausea, sickness, diarrhoea, abdo pain) Coloured
stools Taste bad
● Complications/Contraindications: NA
● Contraindicated NA
● Supplementary advice:NA
Drug counselling EllaOne
- Action: emergency contraception. ellaOne contains ulipristal acetate, which stops progesterone working normally. This also works by stopping or delaying the release of an egg.
- Timeline: Needs to be taken within 5 days of UPSI
- How to take: tablet
- Length of treatment: once
- Tests: pregnancy test should be performed if the next menstrual period is delayed by more than 7 days
- Important SE: Headaches, Tummy pain, Changes to your next period
Feeling or being sick – get medical attention if you’re sick within 3 hours of taking ellaOne, as you’ll need to take another dose or have an IUD fitted
Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period - Supplementary: would you be interested in starting regualr contraception…
Drug counselling levongestrel
Action: emergency contraception. Levonelle contains levonorgestrel, a synthetic version of progesterone produced by the ovaries. Taking it’s thought to stop or delay the release of an egg (ovulation).
Timing: Needs to be taken within 3 days of UPSI- double dose if BMI over 26
How to take: tablet, take as soon as you get it…
Length: once
Tests: pregnancy test should be performed if the next menstrual period is delayed by more than 7 days
Important SE: Headaches, Tummy pain, Changes to your next period
Feeling or being sick – get medical attention if you’re sick within 2 hours of taking Levonelle as you’ll need to take another dose or have an IUD fitted
Supplementary: would you be interested in starting regualr contraception…
Counselling copper coil emergency contraception
Action: It releases copper to stop the egg implanting in your womb or being fertilised. emegrency or normal contraception
Timing: The IUD can be fitted up to 5 days after unprotected sex, or up to 5 days after the earliest time you could have ovulated
How to take:
Length: Can last up to 10 years, but cna have removed whenever
Important SE: Pain, infection, heavier more painful periods
Contraindications: Untreated STIs, irregular shaped uterus, unexplained bleeding between periods or after sex
