drug counselling

Question 1

what should you tell someone about alcohol use with warfarin

Answer 1

if u drink drink consistently dont binge

Question 2

what should you tell someone with ACEI?

Answer 2

Dry cough
Caution when diarrhoea or vomitting and consider stopping (renal impairment)
Caution if not peeing (stop)
Caution if taking over the counter NSAIDs (stop or dont take together)

Question 3

what group of patients should oral antifungals be cautiously prescribed in? Which antifungals are these ?

Answer 3

People with rheumatoid history, ANA positive particularly as there is a risk of inducing lupus.
Terbinafine-induced subacute cutaneous lupus erythematosus (SCLE) is a photosensitive skin rash that is relatively high risk. There are also instances of SLE with terbinafine.

It can also worsen psoriasis if you have it.

Liver impairment patients as it is known to cause liver toxicity presenting as jaundice, cholestasis, and hepatitis

Fluconazole does not have any of these risks. The risk is with terbenifine. Grusefolvin is at risk of worsening SLE and is known to be teratogenic so extra contraception is needed for 6 months!

Question 4

terbenifine is not good for nail infections because…

but also

Itraconazole is an issue because….

Answer 4

SLE risk, steven johnson risk, TEN risk, liver toxicity risk, ineffective risk (25% it won’t work for).

Itraconazole has multiple drug interactions, can cause hypoglycaemia in patients with diabetes, and is contraindicated in cardiac failure.

so healthpathways say Balance the risk of side-effects against potential symptomatic and cosmetic benefits of treatment.