drug of day Flashcards
sodium valporate use
AND SE
epielpsy
men and only women who can not have children - these below are all for men and women cant have childrne!
generalsied tonic clonic
myoclonic seizures
atonic sizures
2nd line focal seizures
2nd line abscence seizures
SE
teratogenic
liver damage and hepatitis
hair loss
tremor
use and se and mechanism of carbamazapine
first line for trigeminal neuralgia
second line for focal seizures
nerve pain - diabetic perioheral neuropathy
can trat tonic clonic, partial seziures,
can be used for bipolar if others dont work
se= agranulocystosis
aplastic anaemia
induce p450- drug interactions
action= inhibit na channles
what else need prescibe if going on methotrexate
folic acid
rivaroxaban use and main se
factor xa inhibitor = DOAC (ban the x factor)
prophylaxis VTE
treatment and prophylaxis of :
DVT
PE
prophylaxis of atherothrombotic events in patients with coronary artery disease or symptomatic peripheral artery disease at high risk of ischaemic events (in combination with aspirin)
for rivaroxaban
CI=
bleeding anyhing - before surgery etc.
SE=
haemorrhages, onstipation, diarrhoea, dizzy, dry mouth, scars (severe cutaneous adverse reactions)
dont use breast feeding and pregnanyc or hepatic impairemnt if have coagulaopahty
Lithium uses and SE and lithium toxicity
bipolar
se:
tremor
weight gain
toxicity:
renal dysnfucntoin–> polyuria, polydipsia
benign intracranial ht= headaches, visual
hypothyroidism
can casue ebsteins anomoaly in babys if woman takes lithoium when preg- cardiac abnormalities
Warfarin
CI= pregancy, active bleeding, signifiant risk of major bleed
what purpose- reduce clot formation
how- thins the blood, less likelt clot form. Vovitamin K antagonist = affects clotting cascade
can reverse if needed
how take it= oral tablet
once a day- same time each day
if miss a dose take when remeber, unless if following day then skipp the missed dose so not to double dose
how long: lifelong AF , 3 months DVT often, 6 months PE often
monitoring required- INR aim 2-3 (metallic heart valve 2.5-3.5)= marker on how long takes for blood to clot
go to anticoagulation cliic
carry a yellow booklet for monitoring
SE
more easily bleed. eg. periods heavier and longer, brusing easily, nose bleeds
serious bleeds are a risk which need urgent attention, nose vleed more 10 mins, red wee, black poo, blood in vomit, blood coughing up, severe headahces, changes in vision suggest bleed in brain
other:
mild rash
hair loss
if jaundice, painful swoelln areas of skin seek help
interactions: avoid liver, spinach (vit k), cranberry juice, alcholol binges, nsaids/aspirin
TERATOGEN- do not have it if wanting child/ pregnant- need be on effective contraception for it
diet- avoid foods contaitning vitamin K as lessen effect of warfarin
try avoid alcohol binges too.
metformin
all about it- what say to counsel pt
intro, name DOB, PMH, allergies, quick hx, CI, ICE
CI= dont prescirbe if at risk of lactic acidosis
renal impairment - risk AKI(hypovolaemia, shock)
eGFR<30
ketoacidosis- DKA
any casue tissue hypoxia- shock, recent MI, resp/cardiac failire
liver issues
drugs may interact:
corticosteroids, HRT, diuretics, beta blockers
are they on other antidiabetic meds
what is it and when used: used in first line T2DM, used to lower blood gluocse
advantage is it doesnt casue blood sugar levels to drop too low
how does it work= increases insulin sesntivity and decreases liver produiction of gluvose = loweing blood gluocse (doesnt sitmulate insulin secretion so not risk hypo)
how to take it: usually tablet-oral
with food will help reduce GI upset
same time each day
dose may be slowly increased to reduce chance of SE
can have standard release- start on. if gi upset can have modified/slow release= both work same
missed d0se- if miss take next day and dont double dose
monitoring: check kidney function first before stating - dont start if eGFR below 30
check kindey function annulaly- bloods test
HbA1c checled 3 - 6 months until stbale then 6 monthly diabetic checks
SE- common= diarrhoea, vomiting, nasuea, abdo pain, taste distuburbance. some pt experience some weight loss
rare but serious:
B12 deficinecy- tired, sob, faint, pins and needles seek help
lactic acidosis- occur more commonly if serious illness and with alcholol use. seek help if: n and v, abdo pain, sob, chest pain. fever, tired = unwell
warnings:
limit alchol use to 2 units max per day as high in calsoires and can increase risk lactic acidosis
before any medical scans inform staff on metformin as may need to stop it : stop before and 48hrs after if IV contrast as can damage kidneys and impair function so metformin buildup and lactic acidosis
lifesytle- this drug helps reduce blood usgar levels but you can control you blood sugar levels too by a balanced diet and keeping active
high fibre, reduce foods high in sugar
150 mins exercise a week
attend annual health checks- feet, eyes, bp, blood tests for monitoring
SSRI counselling
name, DOB, quick hx, PMH, drugs on, allergies
CI= suicide risk
mania
pregnancy- not in first trimester especially- loss of baby, heart defects. ok to breastfeed
ICE
what it is: antidepressant
how it works: alters the chemicals in the brains. this one effects a chemical called serotonin. an imbalance of this and other chemicals is thought to play a part in causing depression
when to take: tablet. once daily
how long: may be gradually stopped 6 momths after feeling better
time course- take 4-8 weeks to feel effect
monitoring- non - may have appt to see how doing in frist few weeks
SE: can feel more anxious/ suciidal i nforst few weeks
diarrhoea, n and v
appetie and weight changes
drowsiness- can take it at night
headaches
withdrawal
fluvoxamine can enhance the effect of caffieone- palpitations, reseltessness, insominia. so enocurgae not have caffein while on
bsisphosphonates counselling
name DOB
quick hx
pmh
drugs
allergies
CI= pregancy, recent peptic ulcer, dysphagia, signofiant renal impairemnt, unable sit upright
ICE
what it is and how it works: prevents bone being broken down and helps rebuild new bone. helps bone gain strenght over time and recuces risk of future fractures
how to take it: most oral once a week- same day each week (some iv and some od)
take at least 30 mintues before food or other medications. sit upright when taking it with a big glass of water. stay upright and dont eat for another 30 mins after swallowing
if miss dose take it when remeber but dont double dose
how long= lifelong but renew check up once a year. take 6mohths to come into effect and wont feel the efefects of it so important keep taking it.
montiroting: yearly. attend anual dental checks. and inform dentisit on them
SE:
headache
heartburn, bloating, indigestion = irritate the gullet
abdo pain, nausea, constipation, diarrhoea but settle in few months
major: seek advice if hard to or hurt to swallow, black poo or vomit blood. tell GP if heart burn
osteonecrosis of jaw. this is where can get ulcers, pain and facial swelling. if have this go to GP. this is why good to attend dental checks.
warnings:
speak to GP before taking NSAIDS- ibruprogen as affets stomach too
lifestyle:
diet- high in calcium eg. milk and leafy greens.
Vit D supplements (can have ca supplements but only if low ca)
stop smoking as this is a risk factor for thinning bones.
exercise- weight bearing ones such as walking, jogging maonly as helps strenthen bone
DOACs counselling
name, DOB, hx, pMH, meds on, allergies
CI= signifiant renal impairemnt, signifiant bleeding risk, active bleed, pregnant
What it is and how it works= anticoagulant. thins the blood to treat or prevent clots. many proteins involved in formation of blood clots and this medication works by blocking one of these protiens from working (Xa)
how to take it, how often, how long:
orally- tablet or caspule, once or twice a day
DVT= 3 months usually.
PE- 3 months if know casue and its reversible, 6 months if unknonw cause or not reverisble. maybe more if cancer casue
AF- lifelong
missed dose= if forget then take when remebr but dont double dose
monitoring- non. may need check renal fucntion before
SE: gi disturbance- diarrhia, constipation, discomfort, nasuea.
Bleeding - heavier periods, bruise easily, bleed easier
seroud bleeds- not common but have to tell about all risks: if have ehadinjury, prolonged nose bleed, unusual headache, blood in urine, stool or vomit or black stool then seek attention
warnings: doacs are irreversible if a serous bleed occurs (unlike warfarin) dabigatran is reversible though
dont take aspirin, ibruprofen as increases the risk of a bleed
dont take st john wort as can increase risk of ahving side effects
statins counselling
name
dob
hx
pmh
meds
allergies
CI= pregancy, breast feeding. stop statin 3 months before attempting to conceive
ICE
what it is and does: cholesterol is essential and its used in many processes in the body. Howeve, too much of the wrong sort (LDL) can casues prblems with your arteries and this then increases your risk of having heart disease such as heart attack and angina and also stroke and kidney disease. this is becasue the cholesterol clogs the arterites
this works by stopping the liver making as miuch cholesterol and clears the bad cholesterol from the blood.
how to take it, how often and how long for:
once daily tablet- same time each day in the evening (atrovastatin can be taken any time, others need be eve)
. life long.
decreases the risk of these events over many years of use
if miss a dose then take when remeber but dnt double dose
monitoring=
blood test before starting them- too look at cholesterol levels now before treatment and also check liver function
have a blood test 3 and then 12 months after starting to see how the cholesterol levels are and to check on liver function. cehck CK if muscle pains
SE= common, nasuea, diarrhea, constipation, flatulence, headache.
Can experience unexplained muscle pains, cramps, tenderness. if this happens usually not concerning however see Dr as a rare side effect is muslce toxicity.
warninga:
grapefurit interacts with some statins
lifestyle adivce:
physcial activity- 150 mins in a week= 30 mins a day aim for ish.
stop smoking
reduce alcohol intake
these can imporve caridiovascular health too.
summarise:
help lower cholesterol and decrease risk of cv event
happy with everything discussed? any questions?
LDL is the bad cholesterol
statins inhibit = HMG coA reductase
smoking cessation
ice
how do you feel about smoking and feel about quitting? why do you want to
anything worrying you - smoking and giving up
hoping to get out of today ?
smoking hx= how long smoked for
how often smoke
when do you smoke- certain triggers
smoking make the pt feel
affecting life/ relationships
do you ever find yourself struggling to affort the cigarettes
tried quiting before - if so why realpse- what tried before
pmh of smokijg related thigs= lung conditions?
CVD?
meds- on any nicotine now or before?
allergies
fam hx of maligancy
social hx= alcholo
recreational drugs
stressors in life ? make smoke?
occupation ? impact on smoking? impact on quitting?
SMARTER
specific- how much want to quit - reduce
measureable-
action orientated =
pharmacological= nicotine replacement - 1st line- pathces, sprays
cuation in CVD/ ACS
buprpion= start 1-2 weeks before starting quitting and 12 week course
CI= hyeprsentitivity, sizures, eating disorders
varenidine= nicotine partial r agonist
start 1 week before quitting and 12 week course
CI = hypersentitivty rxn
non pharmacologucal= short f2f behavioural theapy
indv counselling
group counselling
phone cousnelling
realsitc- barriers? how important is it to quit? how confident feel to quit? any one who can help?
time? = date of start and finish
evaluation- how know succeeding- dairy/ tally
review- speak to friends about how getting on.
follow up in 1-2 weeks see how getting on and then in future
levothyroxine counselling
name
DOB
quick hx
pmh
meds
allergies
CI= non
ICE- idea hypothyrodisim, what levothyroxine is, why on it
concerns
like to get out of today
what hypothyroidism is= thyroid sits at base of neck and produces hormone thyroxine. this regualtes aspects of metabolism - heat control, weight and energy .
hypo thyroid not producing enough thyroxine
what it is and how it works= synthetic thryoxine. given to restore normal levels and prevent symptoms
how to take it , how often and how long =
30 mins before breakfast
tablet oral
once daily - same time each day
dont suddenly stop taking it
long term
takes 4-6 weeks for take effect
missed dose- if miss take when rember expect dont double dose
monitoring= blood test. 2-3 weeks after starting to cehck thyroid levels as can be hard to know the right dose as everyone is slightly different. then every 2-3 months until levels are stable
then yearly once stable
se= dont really ahve any. its more have se of if have too much or too little of the emdication which is why important to check the elvels so often at the start
hypo= constipation- cold intolerance, weight gain, dry skin = dose too low
hyper= heat inotlerence, sweating, palpitations, dizzy, weight loss, headache, vomiting, diarrhoea= dose too high
iron counselling
name, dob, hx, pmh, meds, allergies
CI- non
ICE
role of iron= needed in body to help make rbc which trasnport oxygen around body.
if iron deficnecy left untreated then= sob, palpiations, dizzy, tired, headaches
explain the casue of thier iron deficnecy - blood loss, malnutrtion, malabsorbtion, increase demand
what it is= getting iron levels back to normal
how often take it, when, how long for=
1-3 times a day, table or syrup
take an hour before meal to help it be absrobed but if find this casues tummy upset can take it just after a meal but less be absrobed
typically take it 3-6months then reasses= this allows time to get hb levels back to normal and then replenish the stores
takes 3-4 weeks for hb to go to normal
takes 3 months more to replenish iron stores in body
monitoring= may do Hb in 3-4 weeks to asess repsonse or may wait and asses after 3 motnhs
SE= nausea, diarrhoa/constipation, abdo pain
dark coloured stool- blakc/green
metallic tast
these se dec over time but if struggling to cope get in touch
diet:
foods high in iron- red meat, leafy green veg- brocoolli, spinach, nuts, dried fruit- apricots
vit c helps absorb iron- citrus fruit / oragne juice
try avoid tea, coffee hour before and after a meal becasue contains tannins in that redueces the absorbtion of iron
steroids counselling
name
gob
hx
pmh
meds
allergies
CI= infection, heart problems, liver problems, kidney problems stomach ulcers, high bp, diabetes, epilepsy
pregant/breast feeding- varies pt-pt - affect fetal growth
meds = avoud NSAIDS- if need thenadd ppi
if on an immunosupressive dose avoid live vaccines at least 3 months after stoppped taking them- can casue life threatening infection if do
interact= anti coag, anti conulsants, daibetic meds, HIV meds
meds that inc chance hypokalaemia- digoxin, bronchodilators, insulin, laxatives, diuretics
what is it and how worls= medication used to reduce inflammation or dampen down immune system
treat lots of conditions
do this by changing the way some cells bahve and so reduces sweling, redness and pain from inflammation
how to take, how often, how long =
tablet, liquid, powder, injection. most commonly tablet
same time each day. usually morning as can cause diff sleeping. with or soon after meal as can irritate stomach. take all at once- may have more than one tablet
duration varies. aim is to be shortest time and lowest dose possible
missed dose- take when remebr but dont double dose
monitoring- baseline tests of bp, weight and eye examiantion before starting
blood test to check blood sugar and electroylte levels before
regu;ar bp, weight checks, blood sugar and eye examinations
SE= if on dose for more than 3 weks/ high dose/ repeated short courses:
short term- usualy resolve once stopped meds=
increase appeite leading to weight gain.
mood changes
insomnia
long term - prolonged use:
muscle and bone weakness
stomach ulcers
metnal health problems
increase risk of infection
increase risk of developing diabetes, catarcts and high bp
any concerns or new symtpoms seek advice. reg review to monitor for SE
warnings:
dont stop taking steroids suddenly. if been taking long time and abruptly stop can cause a life threatening condition called adrenal crisis. this happens beacuse our boyd stops making the steroids when on the medication.
crisis: tummy pain., nasuea, dizzy, headahce, weight loss, extremely tired or weak - seek urgent help esp if come on suddnely or severely
to stop this happening when stop the steroids then the dr will reduce the steroids gradually helpij gbody get used to makijg its own again
steroid card- carry a card around so people know relying on steroids = if on prednisolone 5mg more than 4 weeks or equivalent
on inhaled beclametasone more 1000mcg per day or 500mcg fluticasone per fay
sick day rules- if become suddenly ill then contact dr as may need to increase dose of steroids. this is becasue normally when bosy is ill it would increase steroids its making and becasue not doing this we need to. this is to avoud the adrenal crisis.
