drugs

Question 1

counselling points for prednisolone

Answer 1

• single dose with food AM
• avoid contact with those with chickenpox, shingles, infections etc
• dont abruptly stop medication as can lead to hypotension, acute adrenal insufficiency
• carry steroid card around
• any NSAIDS, aspirin, anticoagulants and SSRI’s to be avoided with prednisolone
• if pt having for less than 3 weeks then can be abruptly stopped

Question 2

mtx

Answer 2

• swallow while sitting upright with glass of water
• diarrhoea –> signs of GI toxicity hence tretament must be stopped
• liver issues –> discontinue if an issue and abnormalities should return to normal in 2 weeks, start over again
• GI discomfort
• n+v (dont take another dose if v within a few hours of taking)
• take as soon as remember or day after if remember 3 or more days late then don’t take, take next dose at right time instead
• folic acid to be on a different day to mtx, 5mg once a week (can affect the absorption of mtx)
• NO NSAIDS
• full blood count and lft’s evert 1-2 weeks until therapy stabilised then 2-3 months
• try avoid unpasteurised milks and soft cheeses
• suitable contraception as teratogenic and wait 3 months after treatment finished to conceive

Question 3

latanoprost / brinzolamide

Answer 3

for glaucoma, one drop in affected eyes (both for peter) once a day, at night

• possible change in eye colour as inc in brown pigment can occur
• may get change sin eyelash hair (frequency, thickness etc)
• avoid contact with skin too regularly as can cause hyperpigmentation

Question 4

bisphosphonates

Answer 4

• take first thing in morning (empty stomach so goes out of stomach quicker too), before breakfast with glass of water ensuring sat up straight for 30-60 minutes afterwards also
• if take at any other time of day, avoid food 2 hours before and after, especially calcium or iron containing foods and supplements
• thigh, hip, or groin pain report to hcp
• DONT TAKE BEFORE BED OR SLEEPING
• common side effect includes oesophageal irritation so not NSAIDS but tell GP immediately and n+v de will subside over time
• report any ear pain or discharge
• maintain good oral hygiene
• corrosive so if not taken correctly may cause oesophageal burns (dont want reflux either) hence upright and loads of water to wash it down

Question 5

citalopram

Answer 5

SSRI, depressive illness, 20mg initially OD, max 40mg
- can start of 10mg if symptoms not that prominent
- increase dose at intervals of 3-4 after review
- makes you feel a little sleepy so maybe take at night
- takes 2-4 weeks to feel benefits of medication
- dont abruptly stop, dr will taper down when time to come off
- a long term medication, on it for atleast 4-6 months
- avoid alcohol as can make you feel worse
- can be taken with or without food
- might feel worse for the first few weeks but should pass after
- can get SE like dry mouth– chew sugar-free gum or sugar-free sweets- or sweating a lot– try wearing loose clothing, use a strong anti-perspirant and keep cool using a fan if possible
- Avoid st johns wort
sleep hygiene
- aim for 7-9hrs sleep, keep a regular cycle of sleeping and waking up similar times, hot baths before sleep, no blue light 1hr or so before sleeping

• exercising
• cutting down/stopping smoking
• doing things that make you feel better / happier
• will see gp regularly
• usually every 2-4 weeks for the first 3 months then longer if good response

Question 6

trimethoprim

Answer 6

200mg BD 7 days (with glass of water)

• if get abnormal heart tryhm is a side effect as get too much K in plasma
• have whole course of antibiotics
• if comes back see dr again, may need to prescribe diff AB’s
• drink plenty of water to flush bact out of system
• may help to avoid sex as can be painful until symptoms go but cant pass onto partner
• (for women) wipe back to front to prevent bact getting into vaginal area
• go to toilet very soon after sex
• dont drink too much OH or sugary drinks
• try to avoid tight underwear, opt for loose cotton

Question 7

nitrofutantoin

Answer 7

nitrofurantoin 100mg BD 3 days (with food or milk)
200mg BD 7 days (with glass of water)
- have whole course of antibiotics
- can get discoloured urine
- if comes back see dr again, may need to prescribe diff AB’s
- drink plenty of water to flush bact out of system
- may help to avoid sex as can be painful until symptoms go but cant pass onto partner
- (for women) wipe back to front to prevent bact getting into vaginal area
- go to toilet very soon after sex
- dont drink too much OH or sugary drinks
- try to avoid tight underwear, opt for loose cotton

Question 8

haloperidol

Answer 8

• extrapyrimidal side effects: involuntary or uncontrollable movements, tremors, shakes, restlessness, stiffness
• may need to have blood tests to monitor K+/Na+ levels
• OH consumption may make feel sleepy so avoid where possible
• aggitation, headaches and diffulty sleeping can be common side effects so be sure to follow sleep hygiene
• dont stop abruptly taking as can cause withdrawal symptoms

Question 9

morphine

Answer 9

• dont suddenly stop taking, dr will advise when its suitable to stop taking
• contact doctor if have any SOB or difficulty breathing
• dont drink as can make more drowsy etc
• dont crush or chew, have whole w glass of water
• if more than 4hrs late to take dose SKIP
• shake oramorph bottle and take when feel liek capsule isnt controlling pain well enough
• monitor for potential overdose by: resp depression, pinpoint pupils, unconscious

Question 10

lithium

Answer 10

• take at night
• bRAND SPECIFIC
• will have regular blood tests and contact w GP in first few weeks
• takes 5-7 days to feel effects as this when med completely stabilised in body
• dont abruptly stop, doctor will gradually reduce dose over few months when time to stop AS CAN make symptoms worse
• dont drink alcohol as this caan worsen symptoms and more exposure to lithium
• no NSAIDS with lithium, paracetemol is fine
• remember your purple lithium book as this is info in it regarding info on the med an alert card and blood test results
• want to drink and eat around the same amount of salt in a day all the time, stay hydrated and dont do anything which can cause excessive sweating (saunas) and not altering the amount of caffeine u drink drasticaly

Question 11

lithium monitoring

Answer 11

• regular blood tests to ensure plasma lithium levels between 0.6-0.8mmol/L
• initally 5-7 days after starting so reaches steady state (12hrs after last dose)
• then every 3 months (more freq if on ramipril or interaction med)
• renal and thyroid every 6 months
• if high, withhold med until comes down
• signs of toxicity: thirsty, blurred vision, lethargy, muscle weakness

Question 12

warfarin

Answer 12

• have initial dose then maintenance dose
• dose can change depending on INR reading
• will be given yellow book to record all INR readings
• avoid all leafy greens and things high in vit K
• never take more than 1 dose a day, if missed dose take it when remember unless its the day after then dont take
• NO NSAIDS NO ST JOHNS WORT
• no grapefruit and pomegranate juice
• INR 2-3 in ppl on warfarin with AF or any other clots

Question 13

amlodipine

Answer 13

• may not instantly feel effects but important to keep taking it
• candidate for NMS
• constipation and odema (ankles and legs)
• may get some dizziness so careful when driving
• avoid grapefruits and grapefruit juice
• take at same time each day, before or after food, with glass of water

Question 14

Rivaroxaban

Answer 14

• take with food as can affect the stop so food helps protect the stomach at same time each day
• look out for signs of bleeds and unexplained brusing and seek medical help
• interacts with quite a few medications so always buy meds from pharmacy
• high risk medication so carry DOAC card
• prevents blood from clotting as AF can cause clots

Question 15

ramipril

Answer 15

• used for hypertension
• can get dry cough
• take first dose at night as might get postural hypotension
• if dry cough an issue tell GP and can be switched onto an ARB instead
• take at night with a glass of water
• will require regular bp monitoring
• will be on it long term also
• can cause hyperkalaemia (high k+ levels so any muscle weakness or heart palpitations conctact doctor)

Question 16

bisoprolol

Answer 16

• used for hypertension
• can make you feel dizzy or tired
• dose is usually titrated up according to regular blood pressure monitoring
• tiration usually in steps of 1.25 to 2.5mg every 1-2 weeks
• lifestyle advice for hypertension

Question 17

mdi inhaler

Answer 17

• Put mouthpiece between teeth, close lips to form good seal
• Press down on canister once
• SLOW and STEADY inhalation
• Remove inhaler cap
• Hold inhaler upright
• Shake well
• Test/prime the inhaler
• Breathe out before using inhaler
• Sit upright or stand whilst taking
• After breathing in, remover inhaler from mouth
• Breathe out gently away from mouthpiece
• Wait 30 seconds and then repeat for the second dose
• Replace cap on inhaler
• Rinse mouth after use
• The inhaler should be cleaned every week
• Do not rinse metal canister

Question 18

rivastigmine

Answer 18

• 1.5mg BD and can be increased every 2 weeks
• dizziness and loss of apetite confusion and halluciinations and exacerbation of parkinsons symptoms
• monitor body weight
• caution with b blockers or diltiazem bc can cause bradycardia

Question 19

iron supplements

Answer 19

o 2 hours before alendronic acid or adcal
o Avoid having with milk products, tea, coffee, vit c improves the absorbtion so take orange juice etc
o Iron interacts w ca and prevents absortion in gi tract
o Gi disturbances like constipation
o Discolour stools
o Top up dietary intake of iron, red meats, spinach etc

Question 20

ropinerole

Answer 20

• best to take with food to avoid nausea before bed
• dont abruptly stop as can get neuroleptic malignant symdrome (high fever, unstable heart rate)
• dose will be titrated and altered to lessen the presence of side effects
• Impulse control disorders (inc with all dopamine agonists) so will excessively do one spec activity
• nausea and vom common se (as can bind to peripheral d rec in CTZ) , domperidone!
• Excessive sleepiness and sudden onset of sleep (so advise sleep hygiene to minimise this as much as possible
• Psychotic symptoms (hallucinations and delusions)
• Risk of hypotension
• tell dr is stop smoking or start smoking whilst on this as dose may need to be changed

Question 21

why would using foreign meds be an issue?

Answer 21

not subject to MHRA standards have a risk of being counterfeit, containing the wrong amount of active drug or contain toxic chemicals as there is no way of knowing what the drug contains.

Question 22

co-careldopa

Answer 22

• take 30-60 mins before a meal
• take at same time every day and making sure take at regular time intervals
• avoid with heavy meal, esp protein heavy as can affect the dist of it
• can take upto 7 days to work
• Excessive sleepiness and sudden onset of sleep (so advise sleep hygiene to minimise this as much as possible
• twitching and spasms are most common side effects along with impulse control disorder (tell doctor will be able to help with this)
• dont abruptly stop as this can cause neuroleptic malignant syndrome (high fever, unstable heart rate)

Question 23

entacapone

Answer 23

• taken at the same time as co-carel or co-beneldopa 30-60mins before
• if get any impusle control disorder symptoms then tell doctor immediately
• dont suddenly stop as can get NMS (high fever, unstable heart rate)
• bc taken with co-carl/benel can cause sudden onset of sleepiness and dizziness as causes hypotension
• uncontrollable movements with difficulty in performing voluntary movements and nausea common side effects

Question 24

co-beneldopa

Answer 24

• Dissolve your tablets in a quarter of a glass of water or orange squash (not fresh orange juice).
• Stir well and drink within half an hour.
• Take them 30 minutes before or one hour after meals.
• helps reduce the dyskinesia side effects of co-careldopa
• dont abruptly stop taking as can cause NMS (high fever, unstable heart rate)
• if get any impusle control disorder symptoms then tell doctor immediately
• might also experience on-off effects

Question 25

domperidone

Answer 25

- before meals as can impair absorbtion otherwise | - dont takae longer than 7 days without consulting a doctor

Question 26

lorazepam

Answer 26

- avoid long term use - avoid in elderly - avoid OH -

Question 27

fentanyl patch

Answer 27

- contains a strong opioid to help relieve any pain you feel - 1 patch to be used every 3 days! - Make sure your skin is completely dry, clean and cool and hariless before you put the patch on - Do not use soap or any other cleansers, creams, moisturisers, oils or talc before applying the patch - Do not stick a patch on straight after a hot bath or shower - Each patch is sealed in its own sachet and need to tear or cut open the sachet at the notch, shown by the arrow - Gently tear or cut off the edge of the sachet completely (if you use scissors, cut close to the sealed edge of the sachet to avoid damaging the patch) - Grasp both sides of the opened sachet and pull apart - Take the patch out and use straight away, dont use later - Keep the empty sachet to dispose of the used patch later - Use each patch once only - Do not use the patch if it has been divided, cut or looks damaged and dont divide or cut the patch - Make sure that the patch will be covered by loose clothing and not stuck under a tight or elasticated band - Carefully peel one half of the shiny plastic backing away from the centre of the patch. Try not totouch the sticky side of the patch - Press this sticky part of the patch onto the skin - Remove the other part of the backing and press the whole patch onto the skin with the palm of your hand - Hold for at least 30 seconds. Make sure it sticks well, especially the edges Step 4: Disposing of the patch - As soon as you take a patch off, fold it firmly in half so that the sticky side sticks to itself - Put it back in its original sachet and dispose of the sachet as instructed by your pharmacist - n,v, constipation and dizziness v common SE's - if breathing = shallow and weak URGENT MED HELP PATCH OFF - dont expose to any heat sources - REMOVE old patches before putting a new one on - dont abruptly stop taking as can lead to withdrawal symptoms (shaking, shivering, restlessness)

Question 28

fentanyl patch

Answer 28

- contains a strong opioid to help relieve any pain you feel - 1 patch to be used every 3 days! - Make sure your skin is completely dry, clean and cool and hariless before you put the patch on - Do not use soap or any other cleansers, creams, moisturisers, oils or talc before applying the patch - Do not stick a patch on straight after a hot bath or shower - Each patch is sealed in its own sachet and need to tear or cut open the sachet at the notch, shown by the arrow - Gently tear or cut off the edge of the sachet completely (if you use scissors, cut close to the sealed edge of the sachet to avoid damaging the patch) - Grasp both sides of the opened sachet and pull apart - Take the patch out and use straight away, dont use later - Keep the empty sachet to dispose of the used patch later - Use each patch once only - Do not use the patch if it has been divided, cut or looks damaged and dont divide or cut the patch - Make sure that the patch will be covered by loose clothing and not stuck under a tight or elasticated band - Carefully peel one half of the shiny plastic backing away from the centre of the patch. Try not totouch the sticky side of the patch - Press this sticky part of the patch onto the skin - Remove the other part of the backing and press the whole patch onto the skin with the palm of your hand - Hold for at least 30 seconds. Make sure it sticks well, especially the edges Step 4: Disposing of the patch - As soon as you take a patch off, fold it firmly in half so that the sticky side sticks to itself - Put it back in its original sachet and dispose of the sachet as instructed by your pharmacist - n,v, constipation and dizziness v common SE's - if breathing = shallow and weak URGENT MED HELP PATCH OFF - dont expose to any heat sources - REMOVE old patches before putting a new one on - dont abruptly stop taking as can lead to withdrawal symptoms (shaking, shivering, restlessness)

Question 29

donepezil

Answer 29

- with or without food AT NIGHT swallowed with glass of water - may take a few weeks until feel the effects - diahorrea, n+v all v common side effects - dose may change depending on how long been taking for, stick with whatever doctor says - can impair ability to drive so careful (cause tiredness, muscle cramps, dizziness) - dont have OH with this