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
Azelaic acid (acne and rosacea)
Action: used to treat acne and rosacea. Works mainly by unblocking pores for both conditions to prevent spots.
Timeline: continue treatment for at least a month for acne (2 for rosacea) with a review to see if it is beneficial or not, if no improvement speak to a doctor to stop treatment or continue as prescribed.
How to apply: use twice daily in the morning and evening, wash and dry the skin gently before applying. Rub cream or gel gently. If skin is particularly sensitive, apply once daily. Avoid sensitive areas around or in nostrils, mouth or eyes and do not apply to already irritated or sore areas.
Length of treatment: 1-2 months with review then indefinitely/as needed with flares.
Effects: 1-2 months.
Tests: medication review, allergies
Important side effects: itching, burning, irritation, redness of skin, dry skin, tingling, numbness or rash (reduce number of times using the cream or stop for a few days).
Complications: skin irritation
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
Lymecycline (acne)
Action: used for bacterial infections or acne. Works by preventing or treating bacterial infection which can lead to increased pore clogging and spot formation.
Timeline: infection - 1-2 weeks. Acne - at least 8 weeks up to 3 months.
How to take: 1-2 capsules daily for infection and 1 capsule daily for acne. Take at around the same time each day, swallow with a large drink of water, do NOT open or chew capsules. Avoid taking before bed or lying down. Can be taken with or without food. Do NOT take two days doses at once
Length of treatment: up to 3 months
Effects: 1-3 months
Tests: CI in pregnancy and breastfeeding or <12 YOs. liver or kidney problems, SLE, myasthenia gravis, medication review, allergies. Bloods - U+Es and LFTs, SLE or myasthenia gravis antibodies PRN before starting.
Important side effects: oral or genital thrush. Sensitivity to sunlight. Nausea, abdominal pain, diarrhoea, headache.
Complications: antibiotics resistance
Supplementary advice: over the counter medications can interact with lymellecyline, always check with the pharmacist if it is okay to take with this antibiotic. Avoid strong sunlight or sunbeds (safe sun exposure). Can stop the oral typhoid vaccine working so make healthcare workers aware if you need to have this vaccine.
Combined oral contraceptives (contraception and acne)
Action: suppresses FSH and mid cycle LH surge to prevent ovulation, prevents sperm penetration by thickening mucus and thickens endometrial lining to prevent implantation. Efficacy when taken correctly is 99%. Works for acne by stabilising androgen hormone production and leading to decreased sebum production overall.
Timeline: indefinitely until wanting pregnancy.
How to take: starting on day 1 of the period needs no other contraception, starting on any other day needs 7 days of barrier contraception. Can be started after emergency contraception. Take once daily at the same time everyday. Pills come in packs of 21, take these then have a 7 day pill free break allowing withdrawal bleed. Missed pills should be taken as soon as remembered. If missed by 24 hours or more, then must use barrier contraception for 7 days and if unprotected sex was had during this time, consider advice for emergency contraception.
Length of treatment: indefinitely until wanting pregnancy. Review after 3 months of starting then every 6 months for weight and BP.
Effects: within 7 days or immediately if taking from day one of the menstrual cycle.
Tests: BP and BMI/weight. CI in >50, >35 BMI, smokers >35YO, migraine with aura, postnatal <6 weeks and breastfeeding, CVD risk factors (HTN etc), vascular disease, history/family history of VTE, stroke, MI, breast cancer, liver disease, SLE, medication review for liver enzyme-inducing medications (antibiotics, St John’s wort and some anticonvulsants)
Important side effects: breakthrough bleeding, weight gain, mood changes, breast tenderness, tend to settle over the first 3 months.
Complications: risk of VTE, MI, stroke, breast and cervical cancer increased.
Supplementary advice: anything causing excessive vomiting or diarrhoea within 2 hours of taking the pill may render the pill ineffective, take another as soon as possible. If fluid loss for >24 hours follow missed pill protocol. Antibacterial, antidepressants, anticonvulsants, antiretrovirals and ellaOne can interact with the pill affecting efficacy.
Asthma SABA inhaler
salbutamol
Action: bronchodilator medication acts on the airways to relax smooth muscle and widen the airway allowing more air to travel in. They relieve breathlessness only, they do not prevent it.
Timeline: you will need to perform a reversibility test for 2 weeks using a SABA blue inhaler. You will then receive a written asthma plan from the nurse/doctor instructing you how many puffs to use when needed.
How to take: inhalers are taken by checking it is in date, shaking the inhaler before use, remove the cap, breathe out as much as you can and then put the mouthpiece in your mouth and breathe in deeply while pressing the inhaler button down ONCE. keep breathing in slowly for as long as you can. Remove the inhaler from your mouth and hold your breath for the count of 10. Breathe out slowly through your mouth. Put the cap back on the inhaler firmly. Spacers - put the spacer between your teeth and close your lips tightly around it. Keep chin up, start breathing slowly through the mouth. Spray one puff into the spacer and continue breathing slowly and deeply. Remove the spacer from the mouth and hold your breath for the count of 10 then breathe out slowly through your mouth. If you need a second puff then wait about 1 minute before reusing. For both methods rinse your mouth out with water after use to prevent side effects.
Length of treatment: lifelong, take as needed.
Effects: within a few minutes and should last between 3-5 hours.
Tests: peak flow and spirometry tests. condition review - pregnancy, breastfeeding, hyperthyroidism, heart conditions, HTN, diabetes, other medications, allergies. Test beforehand is a reversibility test, given the inhaler to use every day and a peak flow machine to measure peak flow before and after inhaler use to determine if you do have asthma/need an inhaler.
Important side effects: feeling shaky, headaches, nervous tension, muscle cramps, palpitations
Complications: toxicity (very rare)
Supplementary advice: your asthma plan will outline what you need to do during an asthma attack.
SMOKING CESSATION
LABA inhaler asthma
salmeterol, brands include sevevent, soltel.
Action: long acting beta 2 agonist bronchodilator. Works by widening the airways allowing air to travel more freely helping relieve breathlessness symptoms.
Timeline: can be prescribed alongside preventer inhaler or in a combined LABA and ICS inhaler, taken twice daily every day.
How to take: inhalers are taken by checking it is in date, shaking the inhaler before use, remove the cap, breathe out as much as you can and then put the mouthpiece in your mouth and breathe in deeply while pressing the inhaler button down ONCE. keep breathing in slowly for as long as you can. Remove the inhaler from your mouth and hold your breath for the count of 10. Breathe out slowly through your mouth. Put the cap back on the inhaler firmly. Spacers - put the spacer between your teeth and close your lips tightly around it. Keep chin up, start breathing slowly through the mouth. Spray one puff into the spacer and continue breathing slowly and deeply. Remove the spacer from the mouth and hold your breath for the count of 10 then breathe out slowly through your mouth. If you need a second puff then wait about 1 minute before reusing. For both methods rinse your mouth out with water after use to prevent side effects.
Length of treatment: indefinitely with view to step down treatment if possible, twice daily everyday.
Effects: within 20 minutes lasting around 12 hours.
Tests: peak flow and spirometry tests. Condition review - hyperthyroidism, heart conditions, HTN, diabetes, hypokalaemia, pregnancy and breastfeeding, medication review and allergies.
Important side effects: muscle cramps, feeling shaky, palpitations, headaches
Complications: toxicity (rare)
Supplementary advice: written asthma plan will tell you what to do in an attack
ICS inhaler asthma
fluticasone
Action: preventative inhaler that works by reducing inflammation in the airway, preventing asthma symptoms. Can also be used in combination with LABA in combined inhalers.
Timeline: use twice daily
How to take: inhalers are taken by checking if it is in date, shaking the inhaler before use, removing the cap, breathing out as much as you can and then putting the mouthpiece in your mouth and breathing in deeply while pressing the inhaler button down ONCE. keep breathing in slowly for as long as you can. Remove the inhaler from your mouth and hold your breath for the count of 10. Breathe out slowly through your mouth. Put the cap back on the inhaler firmly.
Spacers - put the spacer between your teeth and close your lips tightly around it. Keep chin up, start breathing slowly through the mouth. Spray one puff into the spacer and continue breathing slowly and deeply. Remove the spacer from the mouth and hold your breath for the count of 10 then breathe out slowly through your mouth. If you need a second puff then wait about 1 minute before reusing. For both methods rinse your mouth out with water and brush your teeth after use to prevent side effects.
Length of treatment: lifelong usually.
Effects: a few days to take effect
Tests: review of conditions - pregnancy and breastfeeding, eye, mouth or chest infection, pulmonary TB, medication review, allergies.
Important side effects: oral thrush, sore throat, hoarse voice, chest infections, skin bruising
Complications: aggravating mental health issues, osteoporosis, eye problems, skin thinning and hair loss.
Supplementary advice: if your asthma worsens after using this inhaler for the first time, let a doctor know immediately.
LTRA inhaler asthma
montelukast 10 mg OD
Action: leukotrienes are released during inflammation in asthma. Leukotriene receptor antagonists block the effects of leukotrienes therefore lessening asthma symptoms.
Timeline: take once daily in the evening.
How to take: tablet to be taken with water or either before or after food. Also available as cherry flavoured chewable tablets for children, preferably taken on an empty stomach or sachets to be taken from the packet or mixed with yogurts.
Length of treatment: indefinitely
Effects: a few days/weeks
Tests: review for pregnancy, breastfeeding, other medications, allergies
Important side effects: abdominal pain, nausea, diarrhoea, headaches, throat and chest infections, fever and skin rashes. Less commonly can affect sleeping, cause nightmares, depression, anxiety or mood changes
Complications: Churg-Strauss syndrome - flu like malaise, paraesthesia or numbness in the arms or legs, difficulty breathing and skin rashes
Supplementary advice: as lifestyle advice
oral steroids for asthma/short courses
Action: glucocorticoids that reduce systemic inflammation usually used during an acute asthma attack. Block the production of histamine which is released during an allergic reaction. Also used for IBD, SLE, MS, polymyalgia, allergies, COPD and croup
Timeline: for asthma exacerbation - tablet OD in the morning with food for 5-7 days. Needing short courses of 1-2 weeks you can simply stop taking the tablets after this. Longer courses require tapering off of doses to wean you off of the drug due to risk of addisonian crises.
How to take: given tablets to take OD with food in the morning.
Length of treatment: 5 days - 2 weeks
Effects: within a few days
Tests: Caution in Liver disease, history of mental health, osteoporosis, heart conditions, diabetes, epilepsy, pregnancy and breastfeeding
Important side effects: short courses do not tend to cause many side effects.
Complications: Taking for 2-3 months may cause cushing’s, osteoporosis, skin thinning, weight gain, TB relapse, HTN, hyperglycemia, difficulty with wounds healing, lowered immunity, increased risk of cataracts, stomach ulcers, muscle weakness and mood and behavioural changes. Addisonian crises.
Supplementary advice: do not take NSAIDs as increased bleeding risk, carry your steroid card with you in case of emergency, may need steroid dose increase when unwell or during asthma exacerbations. Warfarin, NSAIDs, live vaccines, antiepileptics, digoxin, diuretics and HIV treatments can interact with steroids. Must monitor blood glucose if on extended steroid doses.
PPIs
Action: reduce the amount of acid made by the stomach via inhibiting proton pumps (ATPase enzymes)in the stomach lining which prevents H+ ions from being transported into the duodenum lining and increasing acidity. Commonly used to protect the stomach from ulcers. You can buy omeprazole, lansoprazole and pantoprazole OTC, but if needing for >4 weeks consult a doctor.
Timeline: take one-two tablets twice daily for usually one month then try to step down treatment to antacids PRN. it is very possible symptoms may return and you may need to go back on the medication again.
How to take: often take one tablet on an empty stomach twice daily. Try to avoid taking with other medications as this can affect absorption.
Length of treatment: usually one month then try to step down treatment to antacids PRN.
Effects: depending on the purpose - provides relief from GORD symptoms within a few minutes/hours however takes a week/few weeks to help heal ulcers etc.
Tests: CI in liver disease, pregnancy and breastfeeding (aside from omeprazole). let your doctor know if you take warfarin, phenytoin, digoxin, methotrexate or cilostazol as these all interact with PPIs
Important side effects: constipation, diarrhoea, wind, headaches, nausea, abdominal pain, vomiting
Complications: potential increased risk of gastric cancer with long term use, therefore H2RAs are preferred for long term treatments.
Supplementary advice: Weight loss to healthy BMI
Smoking cessation
Decreased alcohol intake
Raise the head of the bed at night
Small, regular meals
Avoid hot drinks and eating <3 hours before bed
Avoid known triggers (NSAIDs, hot, spicy foods etc.)
Take gaviscon or rennie OTC PRN (antacids)
H2RAs
Action: reduce the amount of acid made by the stomach. Histamine from ECL cells stimulates acid making parietal cells in the stomach, blocking this histamine release leads to lesser acid production. They are not as effective as PPIs which is why they are second line. Some H2RAs can be bought OTC
Timeline: can be prescribed PRN or everyday.
How to take: oral tablets to be taken as prescribed. Avoid taking antacids at the same time as H2RAs
Length of treatment: PRN indefinitely or for one full month with a view to step down when possible.
Effects: within a few hours - weeks depending on cause
Tests: CI in kidney problems, pregnancy and breastfeeding
Important side effects: diarrhoea, headaches, dizziness, rashes, fatigue
Complications: consult a doctor if you experience haematemesis, meleana, weight loss (unintentional), dysphagia or abdominal pains.
Supplementary advice: Weight loss to healthy BMI
Smoking cessation
Decreased alcohol intake
Raise the head of the bed at night
Small, regular meals
Avoid hot drinks and eating <3 hours before bed
Avoid known triggers (NSAIDs, hot, spicy foods etc.)
Take gaviscon or rennie OTC PRN (antacids)
Bulk forming laxatives
Action: contain soluble fibres, act by retaining fluid within the stool and increasing faecal mass, helping stimulate peristalsis but also softens stool. Ispaghula sachets can be bought OTC or on prescription.
Timeline: usual dose is twice daily until regular bowel motions are achieved with view to stepping down treatment once lifestyle changes can be addressed.
How to take: pour granules into a glass of water around 150ml, stir well and drink ASAP. best taken just after a meal, never taken at bedtime. Don’t worry if you miss a dose, just take the next one as prescribed, do NOT take two doses at once. Ensure you drink at least 8-10 cups of water per day to avoid dehydration.
Length of treatment: as long as needed.
Effects: up to 7 days
Tests: review for anyone pregnant, breastfeeding, children, dysphagia, faecal impaction, medication review and allergies.
Important side effects: mild allergies - nose/eye irritation, SOB, itchy skin (stop taking and consult Dr). excessive wind, bloating, abdominal pain which should settle within a few days/weeks.
Complications: mild allergy
Supplementary advice: Increased dietary fibres (fruits, whole wheats, bran, vegetables)
Increased dietary sorbitol to draw water into faeces (fruits, peaches, plums, prunes, raspberries, strawberries, grapes, apricots, apples etc.)
Increased exercise regimen
osmotic laxatives
lactulose
Action: draws fluid into the bowels making stool soften and easier to pass and changes the acidity of stools to discourgage growth of germs. Can be bought OTC or on prescription. Also used for people with liver encephalopathy due to antibacterial properties..
Timeline: take daily for as long as needed.
How to take: usual dose is 15ml twice daily but can be adjusted to suit needs. If you forget a dose, don’t worry, just take the next one as prescribed. Do NOT take two doses together. Drink plenty of water to replace lost fluids (8-10 glasses a day). Try taking with meals or mixing dose with a drink in order to help reduce side effects.
Length of treatment: as long as needed.
Effects: up to 48 hours
Tests: review for fecal impaction, lactose intolerance, galactosaemia, pregnancy and breastfeeding, children, other medications, allergies.
Important side effects: excessive flatulence, abdominal pain, cramps, nausea and vomiting.
Complications: none?
Supplementary advice:
Increased dietary fibres (fruits, whole wheats, bran, vegetables)
Increased dietary sorbitol to draw water into faeces (fruits, peaches, plums, prunes, raspberries, strawberries, grapes, apricots, apples etc.)
Increased exercise regimen
stimulant laxatives
Senna and sodium picosulfate
Action: causes peristalsis by stimulating colonic nerves (senna) or colonic and rectal nerves (bisacodyl, sodium picosulfate). Can but OTC. sodium picosulfate is often given before medical procedures or examination like colonoscopy.
Timeline: SENNA: usual dose is 2-4 tablets or 10-20ml daily only to be used for a few days as it can cause dependence of the bowels. SODIUM PICOSULFATE: usual dose 5-10ml liquid, best taken at bedtime, for a day/two days before an operation or procedure.
How to take: take senna in the evening, it is important to drink lots of water to replace lost fluids
Length of treatment: a few days at a time only
Effects: within 8-12 hours (senna) and 6-12 hours (sodium picosulfate)
Tests: review for pregnancy, breastfeeding, children, fecal impaction, other medications, allergies, recent bowel surgery.
Important side effects: stomach pain or cramps, stop taking if this occurs. Diarrhoea, dizziness, nausea.
Complications: dependence of bowels for stimulation.
Supplementary advice: Increased dietary fibres (fruits, whole wheats, bran, vegetables)
Increased dietary sorbitol to draw water into faeces (fruits, peaches, plums, prunes, raspberries, strawberries, grapes, apricots, apples etc.)
Increased exercise regimen
Trimethoprim (UTI)
Action: antibiotic that kills bacteria causing infection
Timeline: alternate antibiotics every 1-2 months to avoid resistance
How to take: prophylaxis - 100 mg at night. Infection - 200 mg twice daily morning and evening.
Length of treatment: 3-7 days or 1-2 months.
Effects: within 48 hours, if no improvement or worsening then let a doctor know.
Tests: review for pregnancy, breastfeeding, low folic acid, kidney function, liver function, porphyria, other medications, allergies
Important side effects: nausea and vomiting, diarrhoea, headache, itchy skin rash
Complications: aseptic meningitis, erythema multiforme, fever, thrombocytopenia, hyponatremia, leukopenia - let your doctor know if you have any sore throats, ulcers, fever, bleeding or bruising that isn’t explainable.
Supplementary advice: contraceptive pill efficacy can be reduced by vomiting and diarrhoea, can stop the oral typhoid vaccine from working.
Drink at least 2L of fluids a day (recommended fluid intake)
Try cystitis sachets OTC (for cystitis only)
Try cystopurin OTC
Nitrofurantoin (UTI)
Action: antibiotics that kills off bacteria causing urinary tract infection
Timeline: take for 3 days (women) or 7 days (men and pregnant women)
How to take: take one tablet twice daily for 3-7 days one in the morning one in the evening.
Length of treatment: 3-7 days. May prescribe long 6 month course for frequent urinary tract infections.
Effects: within 48 hours you should start to improve, if you get worse or do not improve by the end of the antibiotic course then phone back and let the doctor know.
Tests: review for pregnancy, breastfeeding, liver and kidney problems, diabetes, anaemia, breathing problems, peripheral neuropathy, G6PD deficiency, other medications or allergies
Important side effects: can colour your urine red/brown, nausea, vomiting, loss of appetite, diarrhoea, dizziness or drowsiness, itchy rash, allergies, swollen glands.
Complications: pulmonary fibrosis (if on long term course)
Supplementary advice: antacids can interfere with function, can reduce effectiveness of the pill due to vomiting/diarrhoea >24 hours. Let your dentist or doctor know if you are currently taking nitrofurantoin as this affects diagnostic tests. Can stop oral typhoid vaccine working.
Drink at least 2L of fluids a day (recommended fluid intake)
Try cystitis sachets OTC (for cystitis only)
Try cystopurin OTC
NRT for smoking cessation
Action: nicotine replacement - releases nicotine substance into the body to bind to nicotinic receptors and satisfy nicotine withdrawal/craving
Timeline: 8-12 weeks
How to take: can be taken in the form of a patch (apply on waking and remove at bed time), chewing gum, spray (under tongue), inhaler, lozenges, sublingual tablets. Licensed for use in pregnancy, breastfeeding and those aged 12+. Advise not to smoke at all while using NRT
Length of treatment: usually 8-12 weeks
Effects: effects are seen within minutes of nicotine delivery
Tests: CI in severe CVD (arrhythmias, post-infarction periods, recent cerebrovascular accident (TIA, stroke)
Important side effects: Nausea, dizziness, flu like symptoms, palpitations, dyspepsia, hiccups, insomnia, vivid dreams and myalgia
Complications: small risk of dependence on nicotine, but this is much safer than cigarettes.
Supplementary advice: works better when given a long acting (patch) and short acting (gum, nicotine stick, spray) in combination. Also more effective in combination with behavioral interventions
Bupropion for smoking cessation
Action: antidepressant that has been shown to be effective for smoking cessation by also being a non-competitive nicotinic receptor antagonist. Also has effects of an appetite suppressant and inhibits reuptake of dopamine and noradrenaline
Timeline: begin taking 2 weeks before trying to quit smoking to allow for adjustment to drug and side effects. Take OD for 8-12 weeks.
How to take: tablet taken orally
Length of treatment: 10-14 weeks.
Effects: up to 2-3 weeks to see effects.
Tests: CI in pregnancy and breastfeeding, bipolar illness and those under 18 YOs
Important side effects: seizures, insomnia, dry mouth, hypersensitivity reactions
Complications: seizures
Supplementary advice: lifestyle advice, works better with support of behavioural interventions
Varenicline for smoking cessation
Action; partial agonist to nicotinic receptors, both blocks and stimulates receptor when bound leading to reduced cravings and blocks action of nicotine from smoking
Timeline: begin taking 1-2 weeks prior to target quit smoking date
How to take: take one tablet daily for 3 days, then twice daily for 4 days, then 1mg twice daily for 11 weeks. Reduce to 500mcg twice daily if not tolerated. May help ease side effects by taking with water and take the second pill at dinner time not bedtime to avoid nausea and abnormal dreams.
Length of treatment: 12 week course, a further 12 weeks can be considered in those who stop smoking but feel they need further support.
Effects: within 1-2 weeks
Tests: CI in pregnancy, breastfeeding and under 18 YOs
Important side effects: Nausea, usually resolves within a few days of taking, insomnia, abnormal dreams, headaches and flatulence
Complications: none.
Supplementary advice: lifestyle advice, works better with support of behavioral interventions
Moderation vs abstinence with alcohol cessation
For those drinking >14 units of alcohol per week, experiencing health problems directly related to alcohol or are unable to function without alcohol (alcohol dependency)
Complete abstinence has better health benefits, but moderation is more realistic for some people
Abstinence is strongly recommended with: liver damage, heart disease, medications such as antipsychotics, pregnancy/wanting to become pregnant or may be recommended if they have tried moderation before and this fails
Detox for alcohol cessation
Detox is determined by level of alcohol dependency
Always consider the need for parenteral high potency B complex vitamins (Pabrinex) as thiamine prophylaxis for Wernike’s encephalopathy - MUST have resus facilities available in case of anaphylaxis if given via IM. give 250mg thiamine IM or IV once a day for 3-5 days
If the patient is well nourished and alcohol dependence is uncomplicated then give oral thiamine 300m daily during detox in daily divided doses.
Mild cases - managed at home using therapies or available support (drinking <10 units/daily for females and <15/daily for men with no withdrawal symptoms or recent drinking to prevent withdrawal symptoms.
High alcohol consumption >20 units a DAY or if previously experienced withdrawal symptoms - home detox with medication and supportive therapies is advised (usually given chlordiazepoxide)
Severe dependency - hospital or clinic for detox due to likelihood of severe withdrawal symptoms and needing specialist treatment and supportive therapies
Withdrawals in alcohol cessation
Symptoms are worst within the first 48 hours of cessation
They usually subside significantly within the first 3-7 days from cessation
Very common to experience insomnia which usually resolves within about 1 month
It is important to drink around 3L of fluids (water, squash, juice) a day during detoxing but avoid caffeinated drinks (tea, coffee, energy drinks) as these will worsen insomnia and can cause anxiety
Eat regular meals even if not feeling hungry, your appetite will return gradually
Try to relieve stress by reading, listening to music, going for walks or exercising etc.
If detoxing at home a nurse will regularly see you for support and to check your progress and withdrawal symptoms
Benzodiazepines in alcohol dependency
Action; reduces transmission of GABA inhibitory neurons, relieving symptoms of alcohol withdrawal.
Timeline: reducing dose of chlordiazepoxide given over 5-7 days is 1st line (taper from 20mg to 5mg depending on weight, sex, height, current liver function)
How to take: ideally see the patient daily and dispense medication daily, confirm abstinence from alcohol daily
Length of treatment: 5-7 days
Effects: within a few hours
Tests: confirm abstinence from alcohol daily for 5-7 days of taking. Bloods - LFTs taken before. CI in pregnancy, breastfeeding, liver disease, mental health issues such as psychosis, depression, OCD, phobias, personality disorders, myasthenia gravis, allergy, medication review.
Important side effects: drowsiness, dizziness, forgetfulness, aggressive behaviour, dependence
Complications: dependency
Supplementary advice: avoid driving or operating heavy machinery whilst taking these due to feeling drowsy and impaired reactions. Drinking alcohol increases the side effects of the drug so do not drink alcohol during this time. Counselling, group support therapies, CBT therapies, exercise, new hobbies or interests can help maintain abstinence.
Acamprosate for alcohol cessation
Action; used to help prevent relapse in people who have successfully achieved abstinence from alcohol. Used in combination with counselling to reduce cravings. Works by reducing the desire to drink alcohol
Timeline: usually begins as soon as withdrawal from alcohol begins and can last up to 6 months
How to take: swallow tablets with water, take OD - do not crush or break them. Do not take two doses together.
Length of treatment: about a year with regular reviews for compliance of alcohol abstinence and medication use
Effects: within a few weeks
Tests: Bloods - LFTs and U+Es before starting. CI in pregnancy and breastfeeding, medication review, allergies
Important side effects: diarrhoea, nausea and vomiting, flatulence, skin rash, reduced libido.
Complications:
Supplementary advice: counselling, group support therapies, CBT therapies, exercise, new hobbies or interests can help maintain abstinence.
Disulfram/antabuse for alcohol cessation
Action; causes unpleasant side effects if alcohol is consumed with it, deterring you from drinking. Causes nausea, chest pain, vomiting, throbbing headaches and dizziness. Works by interfering with the metabolism of alcohol by blocking the metabolism of acetaldehyde and increasing blood levels of this chemical. Only started by specialists due to potentially serious consequences of drinking alcohol during treatment
Timeline: from the beginning of withdrawal for up to 6 months.
How to take: must not have drunk alcohol within at least 24 hours of taking the first dose. Several daily divided doses a day then gradually reduced.
Length of treatment: up to 6 months
Effects: within ten minutes of drinking alcohol and can last for several hours
Tests: seen by healthcare team every 2 weeks for the first 2 months, and then every month for the following 4 months. Bloods - LFTs and U+Es before. CI in pregnancy, breastfeeding, heart conditions, HTN, stroke/TIA, liver or kidney problems, diabetes, epilepsy, porphyria, medication review and allergies
Important side effects:
Complications: N+V, abdominal pain, fatigue, paraesthesia, skin rash, reduced libido, mood swings
Supplementary advice: very important to avoid all substances with alcohol as they can cause the same reactions, such as mouthwash, aftershave, types of vinegar and perfume, paint thinners and solvents. It’s important to maintain abstinence up until a week after finishing the course as effects still last. Counselling, group support therapies, CBT therapies, exercise, new hobbies or interests can help maintain abstinence.
Naltrexone for alcohol cessation
Action; used to prevent relapse or limit the amount of alcohol someone drinks. Works by blocking opioid receptors (OPIOID AGONIST) and preventing alcohol’s effects on the body. Usually used in combination with other medication or counselling.
Timeline: can last up to 6 months or longer in some cases. Small dose (half tablet 25mg) to begin with then increased to 50mg OD
How to take: must not have had any opiate drugs within the last 10 days, including cough medicines, analgesia etc. may take only 3 days a week twice on these days or may take every day OD
Length of treatment: 6 months
Effects: a few hours/days
Tests: bloods - LFTs + U+Es. CI in pregnancy and breastfeeding, medication review and allergies.
Important side effects:
Complications: headaches, muscle aches, N+V, restlessness, abdominal pain, diarrhoea, constipation, dizziness, thirst, chills, loss of appetite, watery eyes, skin rash, erectile dysfunction, difficult passing urine, mood changes
Supplementary advice: also prevents opioid painkillers (morphine and codeine) from working so it is important to let any healthcare workers know you are taking this. If you feel unwell whilst taking this drug please stop immediately and seek advice from a GP/care team. Counselling, group support therapies, CBT therapies, exercise, new hobbies or interests can help maintain abstinence.
Nelmefene/selincro for alcohol cessation
Action; used to prevent relapse or limit alcohol intake. Works by blocking opioid receptors therefore stopping the action of alcohol in the brain and reducing cravings. Should only be taken if you’re receiving support to help reduce alcohol intake and continue treatment. It is recommended for those who have had an initial assessment and are still drinking >7.5 units/day men (>5 for women), no physical withdrawal symptoms or they do not need to stop drinking immediately
Timeline: indefinitely as needed
How to take: take one tablet a day on each day you anticipate drinking alcohol - take 1-2 hours before drinking. DO NOT TAKE MORE THAN ONE/DAILY. Do not crush tablets.
Length of treatment: indefinitely as needed
Effects: within 1-2 hours
Tests: CI in <18 YO, pregnancy, breastfeeding, mental health problems, seizures, allergies, medication review.
Important side effects: nausea, diarrhoea, dizziness, headache, sleeping problems
Complications:
supplementary advice: Counselling, group support therapies, CBT therapies, exercise, new hobbies or interests can help maintain abstinence.
Chloramphenicol eye drops for bacterial conjunctivitis and anterior blepharitis
Action: antibacterial eye ointment preparation. Works by destroying bacteria that may be causing the inflammation. Used in people over aged 2 YOs
Timeline: maximum of five days to be used every 2-4 hours, as infection improves can decrease this to 4 times daily. If given ointment ONLY apply this at night.
How to take: wash hands before use. Remove cap, tilt head back and pull down lower lid. Hold the bottle upside down near to the eye. Try to avoid touching the eye. Apply pressure to release one drop into the eye. Close your eyes for 1-2 minutes and gently press the side of your nose where the corner of your eye meets your nose to help keep the liquid in place. Repeat in the other eye if needed. (apply 1 drop 2 hourly for 2 days then 4 times daily for 5 days) or ointment (apply four times daily for 2 days then twice daily for 5 days)
Length of treatment: maximum 5 days.
Effects: should begin to improve within 48 hours.
Tests: CI in bone marrow disorder, blood disorders, allergies, pregnancy, breastfeeding, soft contact lenses, glaucoma, dry eye disease (sjogren’s), eye surgery within the last 6 months, suspected eye injury or FB, using other eye ointments.
Important side effects: temporary blurred vision, mild irritation or stinging
Complications: none?
Supplementary advice: avoid contact lenses, continue eye hygiene, massages and warm compresses.
Doxycycline (posterior blepharitis)
Action: antibacterial medication that works by killing bacteria causing the infection
Timeline:
How to take: 1-2 tablets daily depending on purpose orally. Must swallow whole. Avoid taking it immediately before bed.
Length of treatment: 5-7 days
Effects: should begin to improve within 48 hours.
Tests: CI in pregnancy, breastfeeding, <12 YOs, liver disease, kidney disease, SLE, myasthenia gravis, medication review, allergies.
Important side effects: abdominal pain, diarrhoea, headaches, yeast infection, dry mouth, throat irritation, anxiety, increased sweating.
Complications: allergies
Supplementary advice: increased sensitivity to light, avoid sunbeds and strong sun. do not take antacids within 2 hours of taking doxycycline (makes it less effective). Stops oral typhoid vaccine from working.
Topical antihistamines for allergic conjunctivitis/hay fever
Topical antihistamines (allergic)
Action: antihistamine, relieves itchiness from allergic inflammation. Blocks release of a chemical called histamine.
Timeline: 5-7 days.
How to take; wash hands before use. Remove cap, tilt head back and pull down lower lid. Hold the bottle upside down near to the eye. Try to avoid touching the eye. Apply pressure to release one drop into the eye. Close your eyes for 1-2 minutes and gently press the side of your nose where the corner of your eye meets your nose to help keep the liquid in place. Repeat in the other eye if needed. To be used 2-3 times daily in both eyes
Length of treatment: 1 week
Effects: within a few minutes
Tests: CI in soft contact lenses, HTN, hyperthyroid, diabetes, glaucoma, heart/blood vessel disease, chronic urine retention, pregnancy, breastfeeding, allergies, medication review
Important side effects: mild eye discomfort and temporary blurring or stinging
Complications: allergy
Supplementary advice: avoid contact lenses
sodium cromoglicate eye drops (allergic conjuncivtis or hay fever)
Action: relieves allergy/allergic rhinitis symptoms by reducing release of histamine helping to reduce inflammation. Also available as nasal spray, inhaler or oral capsules.
Timeline: use for 2 weeks
How to take; wash hands before use. Remove cap, tilt head back and pull down lower lid. Hold the bottle upside down near to the eye. Try to avoid touching the eye. Apply pressure to release one drop into the eye. Close your eyes for 1-2 minutes and gently press the side of your nose where the corner of your eye meets your nose to help keep the liquid in place. Repeat in the other eye if needed. To be used 4 times a day in both eyes
Length of treatment: 2 weeks during flares
Effects: within minutes/hours
Tests: soft contact lenses, dry eye disease, pregnant or breastfeeding or allergies
Important side effects: mild eye irritation, stinging or blurred vision
Complications: allergy
Supplementary advice: avoid rubbing eyes, avoid triggers and allergens, do not share towels.
Fusidic acid eye drops (bacterial conjunctivitis)
Action: kills staphylococcus bacteria helping clear the infection.
Timeline: BD for 7 days, use once in the morning and once in the evening
How to take: wash hands before use. Remove cap, tilt head back and pull down lower lid. Hold the bottle upside down near to the eye. Try to avoid touching the eye. Apply pressure to release one drop into the eye. Close your eyes for 1-2 minutes and gently press the side of your nose where the corner of your eye meets your nose to help keep the liquid in place. Repeat in the other eye if needed.
Length of treatment: 7 days
Effects: should begin to improve within 48 hours.
Tests: allergy, contact lenses, medication review
Important side effects: dry eyes, irritation, burning or itching. Temporary blurred vision
Complications: allergy
Supplementary advice: avoiding rubbing eyes, sharing towels with others, avoiding allergens or further irritation, warm compresses on the eyes up to 5 times daily.
