DRUGS Flashcards
Selective serotonin reuptake inhibitors (depression and GAD)
(SSRIs):
Examples: sertraline, citalopram, fluoxetine, first line drugs for depression.
Action: selectively inhibits the reuptake of serotonin
Timeline: must take once daily starting 50mg then increased at intervals of at least 1 week PRN max 200mg to take effect and remain effective, please do not cease taking medication
How to take: oral tablets
Length of treatment: indefinitely until your mood stabilizes, then we can consider weaning you off over several weeks if you are taking combination therapy (CBT etc.) with a 4 week review to see how you’re getting on
Effects: 2-4 weeks to start to feel the effects - you may feel WORSE for the first week
Tests: review in 4 weeks to assess compliance, potentially monitor plasma levels if needed.
Important side effects: may impair performance in skilled tasks, abnormal appetite, arrhythmias, arthralgia, asthenia, impaired concentration, confusion, constipation, diarrhoea, dizziness, drowsiness, dry mouth, headache, memory loss, menstrual cycle disturbances, nausea and vomiting, weight changes
Complications: toxicity - N+V, agitation, nystagmus, drowsiness, tachycardia, convulsions, neuropsychiatric effects (serotonin syndrome)
Supplementary advice: offer CBT, counseling and therapy referrals. Encourage good family and friends support networks. Safeguard for harm to self and others and safety net to call back or to call 99 if an emergency to life. Avoid during pregnancy and breastfeeding, unless benefit outweighs risk.
Serotonin noradrenaline reuptake inhibitors (depression and GAD)
(SNRIs):
Examples: venlafaxine, duloxetine
Action: serotonin and noradrenaline reuptake inhibitor
Timeline: take once daily, increase dose with at least 2 week intervals PRN
How to take: oral tablet
Length of treatment: indefinitely until your mood is more stable with regular reviews to see how you’re getting on and the potential to wean off the drug after mood stabilizes if you have adjunct therapies.
Effects: takes 2-4 weeks to start to see the effects - you may feel WORSE for the first week
Tests: regular reviews to assess progress
Important side effects: may affect performance of skilled tasks, Anxiety, appetite decrease, arrhythmias, asthenia, confusion, constipation, depersonalisation, irregularities, movement disorders, sexual dysfunction, skin reactions, altered taste or sweat, urinary disorders, vision disorders, weight changes, vomiting
Complications: high risk of withdrawal effects, increased risk of bleeding (effect platelet function)
Supplementary advice: offer CBT, counseling and therapy referrals. Encourage good family and friends support networks. Safeguard for harm to self and others and safety net to call back or to call 99 if an emergency to life.
tricyclic antidepressants (depression dose)
Examples: amitriptyline
Action: blocks reuptake of serotonin and noradrenaline
Timeline: take once daily it is very important to continue taking your medication every day for it to have consistent effects
How to take: oral tablet in the evening.
Length of treatment: indefinitely with regular review (4 weeks) to assess dependence, compliance, how your doing etc. with view to wean off dose - withdrawal effects occur within 5 days of stopping drugs.
Effects: between 4-6 weeks before effects can be noticed fully.
Tests: baseline ECG, resting BP, pulse rate. Monitor plasma levels to assess compliance and avoid toxicity.
Important side effects: anticholinergic syndrome, drowsiness (may affect driving), prolonged QT interval
Complications: potential to induce fatal overdose - dry mouth, hypotension, hypothermia, hyperreflexia, convulsions, respiratory failure, cardiac conduction defects, dilated pupils and urinary retention
Supplementary advice: offer CBT, counseling and therapy referrals. Encourage good family and friends support networks. Safeguard for harm to self and others and safety net to call back or to call 99 if an emergency to life. Only take in pregnancy if benefit outweighs risk.
Angiotensin converting enzyme inhibitors ACEI - HTN
Screening: have you got any known allergies, any previous history of having taken ACEi before? Any sensitivity or anaphylaxis? Any pre-existing kidney conditions? Could you be pregnant or breastfeeding? Do you currently take any other medications? (NSAIDs, diuretics or lithium). MUST NOT BE USED WITH ARBS
ICE: have you heard of ACEi before? Do you know what they do? Is there anything that concerns you about taking them? Any concerns about your health atm? Do you understand the benefits of taking these tablets? What are you hoping they will achieve?
Action: ACEi acts to block the production of a chemical called aldosterone II in the blood, this helps to relax blood vessels and helps to prevent water retention in the kidney by lessening the production of a hormone called aldosterone, decreasing blood pressure. It is also protective to kidney function due to vasodilation and promoting water excretion.
Timeline: once daily increased PRN from 1.25-2.5mg to 10mg once daily at intervals of 2-4 weeks
How to take it: oral tablet
Length of treatment: indefinitely, to be review in 4 weeks for side effects, effectiveness and compliance
Effects (how long will it take to work?): 3-4 weeks
Tests: blood test (U+Es) before starting, 2 weeks after starting and 2 weeks after each dose change
Important side effects: low blood pressure (dizziness), persistent dry cough, lips, eyes swelling
Complications: hypotension, kidney function decline, anaphylaxis to medication
Supplementary advice: avoid taking NSAIDs, diuretics and lithium unless you speak to a doctor first as these can interact with this medication. Lifestyle and diet advice, smoking cessation, alcohol reduction and leaflets for information
angiotensin receptor blockers (ARBs) - HTN
Screening: any known kidney disease? Possibility you could be pregnant? Are you breastfeeding? Are you currently taking any other medications? (AVOID NSAIDs, diuretics and lithium). MUST NOT BE USED WITH ACEI
ICE: Have you heard of ARBs before? Do you know what they do? Is there anything that concerns you about taking them? Any concerns about your health atm? Do you understand the benefits of taking these tablets? What are you hoping they will achieve?
Action: increases water and salt excretion from the kidneys, also relaxes blood vessels by blocking the action of angiotensin chemical made naturally found in the blood.
Timeline: once daily in the morning, 8mg increased up to 32mg PRN at intervals of 4 weeks
How to take it: oral tablet
Length of treatment: indefinitely with review to see how you’re getting on in 4 weeks
Effects (how long will it take to work?): 3-4 weeks
Tests: blood test (U+Es) taken before starting and 2 weeks after as well as 2 weeks after any change of dose
Important side effects: usually well tolerated, can cause dizziness (hypotensive)
Complications:
Supplementary advice: lifestyle and diet advice, smoking cessation clinics, alcohol reduction and leaflets for information
Calcium channel blockers CCBs - HTN
Screening: any current medications? (beta blockers) have you been diagnosed with heart failure? (AVOID ALL ASIDE FROM AMLODIPINE IN HF)
ICE: Have you heard of CCBs before? Do you know what they do? Is there anything that concerns you about taking them? Any concerns about your health atm? Do you understand the benefits of taking these tablets? What are you hoping they will achieve?
Action: act on calcium channels on the heart to prevent as much calcium getting into the muscle cells of the heart and blood vessels, resulting in the heart not beating as hard or fast and blood vessels relaxing, helping lower blood pressure. Some are also safe to take with beta blockers and heart failure, however verapamil must never be taken with either of these.
Timeline: take once daily or in daily divided doses depending on medications
How to take it: orally
Length of treatment: indefinitely with a review in 4 weeks to assess how you’re getting on
Effects (how long will it take to work?): 3-4 weeks for full effects
Tests: measure blood pressure 4 weeks after each dose change
Important side effects: dizziness, facial flushing (vasodilation), nausea, constipation, mild ankle swelling.
Complications: heart block
Supplementary advice: lifestyle and diet advice, smoking cessation clinics, alcohol reduction, leaflets
Thiazides - HTN
ICE: Have you heard of thiazides before? Do you know what they do? Is there anything that concerns you about taking them? Any concerns about your health atm? Do you understand the benefits of taking these tablets? What are you hoping they will achieve?
Action: they act to increase the amount of salt and water that you excrete in urine, helping to reduce blood pressure by reducing the amount of circulating fluid in the blood.
Timeline: once a day in the morning preferably
How to take it: oral tablet
Length of treatment: indefinitely with a 4 week review to assess how you’re getting on
Effects (how long will it take to work?): 3-4 weeks
Tests: regularly monitor blood pressure (advice to buy a home monitoring machine), annual review of blood pressure and
medications
Important side effects: can cause gout attacks in a small number of people or make gout worse if you already have gout.
Can also cause impotence, diarrhoea, constipation, electrolyte imbalances.
Complications: electrolyte imbalances (HYPOKALAEMIA), decreases K+
Supplementary advice: lifestyle and dietary advice, smoking cessation clinics, reduce alcohol intake. Leaflets
beta blockers - HTN
Screening: do you have any medical conditions of the heart, lungs (asthma, COPD), any current medications? (Anti-arrhythmics, antihypertensives, antipsychotics, clonidine, mefloquine). Could you be pregnant? Are you breastfeeding?
ICE: Have you heard of beta blockers before? Do you know what they do? Is there anything that concerns you about taking them? Any concerns about your health atm? Do you understand the benefits of taking these tablets? What are you hoping they will achieve?
Action: acts to inhibit receptors on muscle of the heart, slowing the heartbeat and reducing strength of contractions helping lower blood pressure
Timeline: 80mg taken twice daily increased at weekly intervals as needed (maintenance 160-320mg daily)
How to take it: oral tablet in the morning
Length of treatment: indefinitely with 4 week review to assess how you’re getting on
Effects (how long will it take to work?): up to 1 week.
Tests: monitor blood pressure (Buy home machine if possible), monitor lung function in patients with history of obstructive airway disease. If diabetic, monitor blood sugars closely as can obstruct symptoms of hypoglycemia
Important side effects: bradycardia, depression, dry eyes, fatigue, peripheral coldness, sleep disorders
Complications: worsening of asthma, COPD or other heart conditions
Supplementary advice: lifestyle and dietary advice, smoking cessation clinics, alcohol reduction advice. Leaflets
Statins - cholesterol
Examples: atorvastatin, simvastatin, fluvastatin
CI in pregnancy, breastfeeding, liver disease
AVOID grapefruits or grapefruit juice when taking simvastatin, atorvastatin and lovastatin
Action: inhibits a coenzyme (HMG CoA) involved in the synthesis of cholesterol, especially in the liver
Timeline: once daily 10-80mg, increase at intervals of at least 4 weeks
How to take: take once daily in the morning. Oral tablet
Length of treatment: indefinitely with a review of medication in 4-6 weeks
Effect: 1-3 months
Tests: blood test to measure cholesterol and LFTs before starting then again within 1-3 months and at 12 months for LFTs/assess cholesterol
Important side effects: MAN PAD - myalgia, abdominal pain, Nausea, Pins and needles, alopecia, diarrhoea.
Complications: muscle inflammation - let your doctor know if you have any UNEXPLAINED muscle pain/tenderness, cramps or weakness.
Supplementary advice: lifestyle advice, dietary advice, smoking cessation clinics and alcohol reduction, leaflets
diabetes type I lifestyle advice
Avoid alcohol as this interferes with blood sugars and can increase the risk of DKA
Monitor blood glucose regularly for life to avoid hypoglycemia (if on insulin) or hyperglycemia
If unwell, starting new exercise or diet, phone the doctor in case you need increased insulin doses while your body is under stress
Advise the DVLA of your condition and treatment regimen
type I diabetes insulin medication
Action: natural hormone produced in the body to facilitate the uptake of glucose (sugar) from the blood into cells to enable the cells to use this sugar for energy.
Timeline: several types - short acting (rapid, novorapid etc.), intermediate and long acting (tresiba, levemir etc.) are injected before every meal. Biphasic - contains short and long acting (novomix, humalog etc.) injected twice daily. Each insulin can be injected at different times depending on needs and brand.
How to take: inject into a fatty area (stomach, upper arms, thigh, buttocks), given as vials, cartridges and pre-filled pens depending on brand, it is important to regularly change your injection site to prevent skin problems and difficulties injecting. Store in a fridge until ready to use - do not freeze. Once opened, keep at room temp for a few weeks (<25 degrees) away from heat and sunlight, always check instructions.
Length of treatment: lifelong with regular reviews (6 monthly eye, foot, bloods, urine tests)
Effects: 1-2 weeks to take effect
Tests: pregnancy, U+Es, LFTs, medication review, allergies
Important side effects: skin reaction, bruising at site of injection, scarring of tissue if repeatedly injected into the same site
Complications: hypoglycemia.
Supplementary advice: regularly monitor blood glucose to prevent DKA and hypoglycemia, if you become unwell then it is important to phone your doctor as you may need to alter your insulin dose. Do not drink alcohol, you must advise the DVLA of your insulin treatment. Smoking cessation, regular exercise is important to general health but ask your doctor before starting anything new to check if your insulin dose is correct or does not need more monitoring for this.
diabetes type II lifestyle advice
Regularly eye tests and diabetic foot checks (6 monthly)
Regular urine and bloods tests (6 monthly)
Avoid alcohol
Smoking cessation
NHS 10 minutes daily exercise regimen
diabetes type II metformin
Action: increases sensitivity to the hormone insulin, used to remove excess sugars from the blood.
Timeline: take once daily, starting 500mg increased in weekly increments up to 1g
How to take: take one tablet in the morning, best taken with food to reduce side effects. Store metformin in a cool, dry place away from direct light and heat. Modified release tablets must be taken whole
Length of treatment: usually lifelong with 4 week review for side effects and compliance
Effects: 2-4 weeks to take effect
Tests: before starting - U+Es, LFTs, review medications, are they pregnant/breastfeeding? Have they had an XR in the past 2 days with dye injected, have they been severely unwell recently, do they have any allergies? Re-test LFTs and U+Es 2 weeks after starting.
Important side effects: nausea, vomiting, diarrhoea, unusual taste, lack of appetite, weight loss, abdominal pains - these should ease after 2 weeks of taking the medication and taking with food in the morning should also help reduce symptoms.
Complications: lactic acidosis, if you experience muscle cramps, muscle pains that are unexplained then please phone a doctor for medication review and tests.
Supplementary advice: smoking cessation, good exercise and diet, reduce alcohol consumption
diabetes type II gliclazide
Action: increased production of insulin from the pancreas.
Timeline: once daily
How to take: one tablet a day with breakfast in the morning (modified release tablets must be taken whole). If you forget to take one, take one as soon as you remember but do NOT take two doses at once.
Length of treatment: lifelong with 4 week review for symptoms, side effects and effects of drug
Effects: within 2-4 weeks
Tests: U+Es, LFTs, pregnancy, G6PD condition, medication review, allergies. Re-check bloods after 2 weeks and 2 weeks after any dose change. Regular blood glucose home testing to ensure no hypoglycemia
Important side effects: nausea, vomiting, diarrhoea, constipation, increased weight
Complications: hypoglycemia - eat a sugary snack to help combat shakiness, dizziness, looking pale, sweating, heart pounding then phone a doctor to check medication.
Supplementary advice: smoking cessation, good exercise and diet, reduce alcohol consumption, ensure you regularly check your blood glucose to avoid hypoglycemia.
Hyperthyroidism carbimazole
Action: inhibits thyroid hormones
Timeline: starting dose 10-20mg taken once daily. Two regimens - block and replace using levothyroxine as well or dose titration where only antithyroid drugs are taken. Aim for T4 and T3 within normal range on lowest effective dose.
How to take: tablets taken before or after meals once a day, try to take at the same time each day, if a dose is forgotten, take it as soon as you remember, you can take two doses at once. Block and replace method given levothyroxine 4-8 weeks after carbimazole. Titration method taken in 2-3 doses per day and reduced after 4-8 weeks to maintenance dose taken once daily. Store in a cool dry place.
Length of treatment: remission is usually between 18-24 months at which time attempts to stop carbimazole medications can be made.
Effects: 2-3 weeks to see apparent effects, Graves’ disease usually euthyroid by 4-8 weeks of titrating
Tests: TFTs and FBC before, repeated every 6 weeks for dose adjustments, TSH is unreliable - look at T4. pregnancy, breastfeeding, bone marrow disorders, LFTs or liver disease, acute pancreatitis, medication review, allergies
Important side effects: nausea, bitter taste after taking medication, headache, muscle pains, skin rashes, itching, hair loss, joint pains.
Complications: bone marrow suppression - come to doctors for FBC if they have a sore throat, mouth ulcers, fever, unusual bruising or bleeding, unexplained tiredness or infection. Less than 0.6% of patients develop this.
Supplementary advice:
radio-iodine hyperthyroidism
Action: iodine is taken up by the thyroid normally in the body during production of thyroid hormones T4 and T3. radio-iodine is taken up by the thyroid and selectively destroys thyroid gland cells, reducing activity.
Timeline: one off treatment and is a definitive method of treatment
How to take: given as a drink, stop antithyroid drugs 5-7 days before treatment to increase cure rate
Length of treatment: once taken by drink.
Effects: 3-4 months to take full effect
Tests: TFTs, medication review, pregnancy and breastfeeding CI
Important side effects: may worsen Graves’ thyrotoxicosis eye disease (more common in smokers)
Complications: can be passed on to others as is excreted via urine, avoid children and pregnant women for 3 weeks. Hypothyroidism is a possible complication too
Supplementary advice: advise women not to get pregnant for at least 6 months.
hypothyroidism levothyroxine
Action: synthetic T4 thyroxine hormone acting on peripheral tissues to stimulate response that thyroxine would.
Timeline: take once daily. Initial dose for elderly or other comorbidities is 25mg adjusted in 25 mg increments every 4 weeks according to response. Titrate dose to aim for TSH of 0.4-4.0 mlU/L
How to take: one tablet each day preferably before breakfast, some brands can be added to water and dissolved before swallowing if needed. If you forget to take a dose you can take it if it’s within a few hours of missing but never take two doses at once. Store in a dry cool place away from heat and light.
Length of treatment: usually lifelong, 4 weeks review for compliance, effects, TFTs tests.
Effects: 2-4 weeks to take effect.
Tests: TFTs and TSH before starting, 4 weeks after starting, in 1st, 2nd and 3rd trimester if pregnant, dose may need to be increased by >50% during pregnancy. Any heart failure or angiina? HTN? Adrenal gland conditions? Diabetes, diabetes insipidus, epilepsy, medication review, allergies.
Important side effects: nausea and vomiting, diarrhoea, headaches, palpitations
Complications: hyperthyroidism - let your doctor know if you are feeling restless, flushed, hot, sweaty, difficulty sleeping, weight loss, muscle cramps, hair loss, itchy rash, menstrual changes
Supplementary advice: calcium and iron can reduce levothyroxine, do not take at the same time as indigestion medications containing calcium or iron. If you have diabetes you may need to check your blood glucose more regularly than normal as levothyroxine affects blood sugar levels.
pregabalin (anti-epileptic, neuropathic pain and GAD)
Action: anti-epileptic group of medications but can treat GAD, epilepsy and neuropathic pain. Works by reducing abnormal amounts of electrical activity in the brain (epilepsy) and often helps reduce anxiety and neuropathic pain as well via reduced neuronal activity.
Caution in <18 YOs, pregnancy, kidney issues, heart conditions, drug or alcohol dependence, other medications, allergies.
Timeline: start on a low dose and titrate as needed guided by symptoms. Usually up to two or three doses daily once on maintenance dose.
How to take: take once daily, tablet to be taken before or after food. Swallow capsule with water. Can come in oral liquid form also. Try to take at the same time each day, do not take two days worth of doses at once. Store in a cool, dry place.
Length of treatment: indefinitely based on symptoms with regular reviews for anxiety, epilepsy for life usually.
Effects: 2-3 weeks.
Tests: U+Es, LFTs, medication review, pregnancy test, drug or alcohol dependence history, allergies, heart conditions
Important side effects: dizziness, blurred vision, headaches, back pains, dry mouth, nausea, bloating, flatulence, constipation, diarrhoea, increased appetite and weight, ENT infections, sleeping difficulty, paraesthesia, erectile dysfunction, speech problems, muscle cramps, peripheral oedema.
Complications: epilepsy may show change in frequency or type of seizures. Possible mood changes or suicidal thoughts - let your doctor know immediately for medication review. Can interact with contraceptive medications - ensure you discuss the appropriate option with your doctor before starting. Has been associated with allergic reactions - look out for mouth, throat, facial swelling
Supplementary advice: with epilepsy, must advise to stop driving until around 1 year since the last seizure. Do not suddenly stop medication, must be reduced slowly to avoid withdrawals.
Topical Retinoids Differin and Epiduo (acne)
Action: differin - just retinoid cream containing adapalene. Works by helping to unblock pores and reduce mild inflammation of spots. Epiduo - adapalene and benzoyl peroxide (antiseptic) cream. Suitable for use on the face, back and chest.
Timeline: remission dose for 6-8 weeks, maintenance dose indefinitely to prevent or lessen flares.
How to take: wash and dry the skin gently before applying adapalene to the affected areas only. Apply once daily in the evening. Wash hands after applying. Avoid sunlight after applying as it increases sun sensitivity. Try to avoid sensitive areas of the face such as in or around the nostrils, eyes or mouth and only apply a thin layer.
Length of treatment: remission dose for 6-8 weeks, maintenance dose indefinitely to prevent or lessen flares.
Effects: 1-4 weeks to take effect, review in 6-8 weeks and consider stopping if no effects can be seen.
Tests: CI in pregnancy and breastfeeding. Other skin issues such as eczema, medication review and allergies.
Important side effects: skin redness, irritation, burning, dry or peeling skin. If this occurs, stop using the cream for a day or so then see if it settles, speak to a doctor if it is severe or troublesome. Epiduo can cause bleaching, avoid contact with hair or fabrics.
Complications: skin irritation.
Supplementary advice: do not use makeup or moisturisers at the same time as adapalene use, try to avoid skin products that exfoliate or dry the skin.
Topical clindamycin + benzoyl peroxide (DUAC) - acne
Action: antibiotic that stops bacteria that can contribute to acne from multiplying. Duac also contains benzoyl peroxide (antiseptic) that helps unblock pores.
Timeline: during flares for up to 3 months
How to take: topical preparation used for acne. Also used vaginal cream for BV and oral capsules for infection. Wash and dry the skin gently before applying a thin layer to the area where spots occur. Some are once daily, some twice daily. Wash hands well after use.
Length of treatment: for up to 3 months during acne flares, review to see if it helps
Effects: 1-4 weeks to see effects.
Tests: CI in pregnancy and breastfeeding, bowel problems causing diarrhoea or allergies.
Important side effects: skin irritation, itching, dry or oiliness, diarrhoea. For skin issues stop using cream for a few days and see if it settles, discuss with the doctor if it becomes a problem. Contact doctor for diarrhoea symptoms.
Complications: diarrhoea, speak to a doctor.
Supplementary advice: Cleansing wash daily, use lukewarm water as hot or cold water can worsen acne. You cannot clean off blackheads. Moisturise any dry skin regularly, avoiding oily substances on the skin.
Fringes create more grease on the face, keep fringe clean
