Drugs Flashcards
Alendronate
Class:// Bisphosphonate Indications:// Paget’s disease of the bone. Prevention and treatment of OP Hypercalcaemia of malignancy Prevention of skeletal-related events in patients with malignancies of the bone. Dose:// OP 10mg daily, or 70mg weekly. Pagets: 40mg daily Monitoring:// Renal fxn Calcium and vitamin d Dental assessment - osteonecrosis of jaw. Swallowing ability Counselling:// Take with a full glass of water, at least 30 minutes before breakfast. Remain upright during this time. L4- do not take antacids, calcium, iron or mineral supplements within 30 minutes of alendronate. Take on the same day each week- set a reminder Stop and see dr if- pain on swallowing, or new or worsening heartburn. May cause nvd
Allopurinol
Class: xanthine oxidase inhibitor. Indications: Symptomatic hyperuricaemia, gout, prevention of tumor lysis syndrome. Dose: 100-600mg d, (MAX:900mg) Monitoring: Renal fxn, Hepatic fxn (can raise enzymes) Gout flares. Fbe - blood dyscrasias Counselling: Take with food (decrease GI effects) Dizzy/drowsy do not drive if effected. Stop and dr if: rash, swollen lips or mouth, persistent fever or sore throat. Will probably get gout flares in first few months of starting the medication. Ensure you know how to manage these. They will improve as it lowers the urate level. Dr will take blood tests to monitor your urate level
Amitriptyline
Class:// Tricyclics Antidepressants Indications:// Major depression, neuropathic pain, migraine prophylaxis, nocturnal enuresis. Dose:// 10-150 daily. Max 300mg. (Higher doses in depression than pain management) tds for nocturnal enuresis. Monitoring:// BP mood -may increase suicidal thoughts on initiation Sedation Seizures QT prolongation. Hepatic Counselling:// May cause blurred vision, drowsiness, and dry mouth. These should lesson after about 7 days of Tx. Take at night to reduce day time drowsiness. May feel dizzy on standing Avoid driving until you know how you react to this medication. May increase the effect of alcohol Do not stop abruptly.
Amoxycillin
Class://
Penicillin / Antibiotic
Indication://
CAP
UTI
Otitis media
Sinusitis
Acute Prostatitis
Dose://
250-1000mg TDS or 1g BD
Monitoring://
Hepatic
Renal - Long term
FBE - Long term
Allergy
Cultures and Sensitivity and Response
Counselling://
Monitor for allergy - SOB, Swelling - See dr
Space doses equally throughout the day.
Complete the course.
May cause NVD, widespread rash.
Aspirin
Class:// NSAID, Antiplatelet. Indication:// Acute coronary syndrome Hx of symptomatic atherosclerosis Pain, inflammation, fever Dose:// 75-150mg d 300-900mg q4-6h prn max 4g d. Monitoring:// Risk/signs of bleeding Renal Allergy Counselling:// Take the tablets out of the packaging just before use - degrades in the packaging Mix dispensable aspirin with water immediately before taking. Take with food. Be aware this can increase your risk of bleeding. Can cause Gi upset.
Azathioprine
Class://
Immunosuppressant
Indication://
Prevention of organ transplant rejection
Immune and inflammatory disease – RA, Inflammatory bowel disease, SLE (Lupus), Autoimmune hepatitis, atopic dermatitis, vasculitis.
Dose://
1-3mg/kg daily in 1-2 doses, adjust per response, however adjusted under specialist supervision.
Monitoring://
- FBE – Particularly White Cell Count
- Hepatic Function
- Signs of infection
- Renal
- Therapeutic Drug Monitoring of metabolites – Available but not common
Counselling://
- Labels:8, 21, A*, B
- A & B – Swallow tablets whole with food.
- 8 – Avoid excessive sun exposure whilst taking this medication – wear protective clothing and use sunscreen.
- Tell your doctor immediately if you have any signs of bleeding, brusing or signs of infection.
- May cause some NVD.
Baclofen
Class://
Muscle Relaxant
Indication://
Chronic Spasticity with MS and Spinal Cord Lesions
Chronic Spasticity of cerebral origin
Dose://
5-25mg TDS
Doses of 120-150mg daily may begiven in hospitalised patients.
Monitoring://
- Renal
- Hepatic
- BSL - if diabetic
- BP
- Respiratory depression
Counselling://
- L1,9,B
- B = Take tablets with food to minimise stomach upset.
- L1 – May cause drowsiness, dizziness or affect vision – do not drive if affected.
- L9 – Do not stop abruptly – May cause severe withdrawal effects such as anxiety, seizures or altered mental state.
- May increase the effects of alcohol
- NVD or C.
Betamethasone (Topical)
Class://
Corticosteroid
Indication://
- Inflammatory Skin Conditions
Dose://
- Apply 1-2 times daily.
- Diproprionate (0.05%) (potent)
- Valerate (0.02, 0.05, 0.1%) (moderate)
Monitoring://
- Clinical effect
- Skin atrophy
- Infection
- Duration of tx
- Compliance to non-pharmacological advice.
Counselling://
- Apply after bathing.
- Allow sufficient time to absorb prior to applying moisturiser.
- Not for long term use - only use for flare ups
- May make skin sensitive when first using
- Do not apply to broken or infected skin
- Ensure to follow non-pharmacological advice – No soap, avoid irritants/triggers, plenty of moisturiser.
Buprenorphine
Class://
Partial Opioid Agonist
Indication://
Moderate-to-severe pain
Opioid dependence
Dose://
Sublingual: 200-400mcg q6-8h
Patch: 5mcg/hr starting – MAX 40mcg/hr – do not increase dose at intervals of less than 4 days, or apply more than 2 patches at the same time
Change each patch every 7 days.
Opioid Dependence: 2-8mg starting – Maintenance – 12-24mg d. Upto 32mg d.
Monitoring://
- Clinical effect
- Sedation, respiratory depression
- Constipation
- Renal
- Hepatic
- Tolerance, Dependence
- Withdrawal
Counselling://
- Sublingual: Place tablet under tongue and keep in place until dissolved. Do not chew or swallow the tablet.
- Patch: Write the date and time of application on the patch with permanent marker, then apply to dry, non-irritated, hairless skin on upper torso. Check the patch is still applied on the days between patch changes.
- Remove after 7 days and put a new patch on a different area (avoid using the same area for 3 weeks).
- Do not wear more than 2 patches at one time.
- Whilst wearing the patch, do not allow it to come into contact with direct sources of heat such as electric blankets, heat pads, heat lamps, saunas and hot baths.
- Ensure you know how to dispose of the patches safely.
- May make you feel drowsy and may increase the effects of alcohol. Do not drive or operate machinery if affected.
- If you are very sleepy or have trouble staying awake tell dr.
- Be careful when your stand up as this may make you feel dizzy.
- Chronic use: look after your teeth and mouth, get dental checks.
- May cause nausea or vomiting – should get better with use.
- May cause constipation – may need to treat this. See dr or pharmacist if it is a problem.
Cabergoline
Class://
Ergot Derivative – Dopamine Agonist
Indication://
Parkinson’s Disease
Hyperprolactinemia – including Prolactinomas
Prevention of onset of lactation – for medical reasons.
Dose://
Parkinson’s: 0.5-1mg ONCE daily (starting) MAX 3mg ONCE daily.
Hyperprolactinaemia: 0.5mg each week in 1 or 2 doses. (Starting) MAX 2mg each week.
Supressing Lactation: 1mg as a single dose on day 1 postpartum.
Monitoring://
- Sx of fibrotic disorders (in patients on long-term treatment)
- Regular cardiovascular evaluation, including ECG
- Impulse control disorders
- Hepatic Impairment
Counselling://
- Take with food, starting at night
- Tell your doctor is you develop shortness of breath, cough, or chest pain
- May cause dizziness or drowsiness, if affected do not drive or operate machinery
- Be careful when you stand up too quickly
- Tell your doctor if you notice any changes in behaviour eg. Overspending, gambling or excessive sexual activity.
- If you are effected by nausea or vomiting, see your doctor as there is treatment options for this.
Carbamazapine
Class://
Anti-epileptics
Indication://
Epilepsy
Trigeminal and glossopharyngeal neuralgia
Bipolar Disorder
Dose://
100mg BD initially.
400mg-1.6g in 2 or more doses MAX 2g.
**Different ranges for different indications**
Monitoring://
- Therapeutic Drug Monitoring – not common. 4-12mg/L for epilepsy.
- FBE
- Skin reactions
- Mood
- BMD, Calcium and Vitamin D
- Hepatic
Counselling://
- Labels: 5, 9, 12, 13, 18, 21, A, B
- A – Swallow the controlled release tablets whole – Do not crush or chew.
- B – Take with food to minimise stomach upset
- 12 – May cause dizzy or drowsiness, or blurred vision especially when starting or increasing dose – do not drive if affected.
- 18- This medication interacts with grapefruit juice.
- 9 – Do not stop taking this medication abruptly.
- 5 -This medication may have significant drug interactions, therefore if you want to start any other medications, including over the counter, vitamins, or natural or complementary medicines, speak with your doctor or pharmacist.
- Carbamazepine increased the effect of alcohol
- Speak to your doctor if
- Rash, Sore Throat, fever, Mouth ulcers, bruising or bleeding occur.
Celecoxib
Class:// NSAIDs Indications:// Pain due to inflammation arthropathies. Pain, especially due to inflammation and tissue injury Dosage:// 100mg twice daily. May increase to 400mg daily, but only use short term. Monitoring:// Renal fxn, Hypersensitivity to NSAIDs or allergy to sulphonamides. Hepatic FBE, BP, weight, GI adverse effects. Cardiac (Ci in heart failure) Counselling:// Do not take if you are dehydrated, eg vomiting or diarrhoea, because it might increase the likely hood of side effects. If you develop swollen ankles, difficulty breathing, chest pain, black stools, dark coffee coloured vomit - stop taking this medication and see your doctor. Do not take aspirin for pain relief.
Cephalexin
Class:// cephalosporins Indications:// UTI Staph and strep infections if patients have mild penicillin allergies. Epididymo-chrosis Dose:// 250-500mg qid or bd. Max 4g d. Monitoring :// Cultures and sensitivities Renal fxn Allergy FBE Counselling:// Take until all finished May cause NVD Any signs of allergy - stop and see dr
Ciprofloxacin
Class:// Quinolone Indications:// Complicated UTI Bone or joint infections. Prostatitis. Dosage:// 250-750mg bd. Max 1.5mg Monitoring:// Seizures Renal fxn Cultures, sensitivities. Counselling:// Take on an empty stomach (1hr before, or 2 hrs after) Do not take dairy products, antacids, iron, zinc or calcium within 2 hrs of a dose. May increase the effects of caffeine Avoid sun exposure, protective clothing and use sunscreen. May cause dizzy/ drowsy - do not drive or operate machinery if effected. Alcohol may make this worse. Stop this medication if you Develop any tendon soreness or inflammation, or numbness or tingling in hands or feet.
Citalopram
Class:// Selective serotonin reuptake inhibitors. Indications:// Depression, Anxiety Disorders Bulimia Premenstrual dysphoric disorder Dose:// 20-40mg daily Monitoring:// QT prolongation Sodium Serotonin toxicity Hepatic Counselling:// Do not drive or operate machinery until you know how you are effected Do not stop abruptly Tell all Drs, pharmacists and dentists that you are taking as there may be significant interactions. May cause sexual dysfunction, if this a problem ensure you discuss this with your dr. May cause nausea, diarrhoea, or sleep disturbances.
Cyproterone with ethinylestradiol (Brenda, Estelle)
Class://
Combined oral contraceptive – Estrogen / Progesterone
Indication://
Androgenisation (mild-to-moderate hirsutism) and contraception in these women
Acne, Contraception, Menstrual disorders, endometriosis, PMS
Dose://
1 tablet daily.
2mg cyproterone/ 35mcg ethinylestradiol
Monitoring://
- Relief of symptoms – if being used for heavy bleeding, PMS or androgen-related conditions.
- VTE Risk
- Smoking
- History of VTE
- BP
- BP
- Pap Smears
- Breast Checks
- Breakthrough bleeding
Counselling://
- Take one tablet once daily, at the same time each day.
-
When to start:
- *Take the strip out and show the patient*
- If no previous hormonal contraception – Start in the coloured section in the first 5 days of your period – This provides immediate contraceptive cover. If you start when not on your period – Start with active tablets, and use additional contraceptives for 7 days.
- If Switching from other Pill – Start taking active pills after stopping the old pill.
- Changing from a POP – Start active pills without any interval form the POP, you need 7 days of active pill for contraceptive cover!
-
What to expect:
- Whilst taking the inactive pill you should get a withdrawal bleed. However this may not occur.
- Continue taking pills as normal however consider possibility of pregnancy if pll is not taken properly, or, TWO withdrawal bleeds are missed.
- Irregular bleeding is common in the first few months.
- The pill may be less effective fi taking certain medicines that interact with the pill. Including herbal medicines – SJW
- Or if you have vomiting, diarrhoea or forget to take active tablet
-
Missed Pills
- Vomiting within 2 hours of Pill - Take another pill ASAP.
- Less than 24 hours late – Take as soon as you remember – contraception not effected.
-
More than 24 hours – Take as soon as you remember, then take the next one at the normal time – this may mean taking two at the same time.
- You then need to take 7 active tablets until contraceptive cover will return.
- If the missed pill was in the last 7 days of a strip – Skip the inactive pills and continue with the next strip of actives.
- If the missed pill was in the first 7 days after inactive pills – and you had unprotected sex in this period – seek emergency contraception.
- There are rare side effects that can occur with use of this medication that you need to be aware of
- There is an increased risk of developing a clot therefore, if you have any difficulty breathing, chest pain or swelling and pain in the leg see your doctor immediately.
- There is an increased risk of breast cancer with use of this medication – therefore it is important to do regular breast checks and report any changes in your breast to the doctor to be checked out.
- While on this medication it is also important to get regular pap smears, and report any changes in vaginal bleeding for example if you have any irregular bleeding, heavy bleeding or bleeding after sex.
Dapaglifozin
Class:// Sodium-glucose co-transporter 2 inhibitors Indications:// T2DM Dose:// 10mg once daily. Monitoring:// Renal fxn (60 CI) Hepatic (avoid in severe impairment) HbA1c, BSL Dehydration Counselling:// Avoid dehydration - drink enough water. To control thirst. More likely to get genital infections - UTI or thrush. Good hygiene is important, and see dr or pharmacist if you think you have an infection. Your urine will test positive during treatment with this medication.
Desmopressin
C: Antidiuretic Hormone Analogue
I:
Diagnostic aid for differential diagnosis of polyuria
- Central (cranial) diabetes insipidus*
- Nocturnal enuresis* (see Desmopressin (genitourinary))
Nocturia due to idiopathic nocturnal polyuria (see Desmopressin (genitourinary))
Control of bleeding in patients with mild or moderate haemophilia and type I von Willebrand’s disease (seek specialist advice)
Control of bleeding in surgery in people with certain platelet disorders (seek specialist advice)
Dose –
Intranasal - 10-40mcg daily
Oral Tab - 200mcg - 1.2mg daily in divided doses Sublingual Wafer - 120-720mcg daily in divided doses
*Depends on the indication*
M:
- Water balance – especially if response to thirst is not working.
- Renal
- Sodium – risk of hyponatreamia.
- Contraidicated with HF
C:
Tell your doctor immediately if you have headache, nausea, vomiting or weight gain.
Wafer: place the wafer under your tongue and allow it to dissolve; do not swallow.
headache, nausea, abdominal cramps
Intranasal, local irritation, rhinitis, nosebleed
Diazepam
Class://
Benzodiazepine
Indication://
Short-term Anxiety
Acute Alcohol withdrawal
Muscle Spasm
Status Epilepticus
Benzo withdrawal
Acute behavioural disturbances
Parasomnias.
Dose://
1-10mg up to THREE times a day.
May be higher under specialist supervision.
Monitoring://
- Dependence – Physcial and psychological dependence, tolerance and misuse.
- Renal Fxn – Start lower.
- Hepatic Fxn – CI if encephalopathy is present. Mild-to-mod – use low dose
- Sedation and drowsiness
- Falls risk.
Counselling://
- May make you feel drowsy while taking this medication. Drowsiness may persist into the following day. Avoid driving or operating heavy machinery if affected
- Avoid alcohol or other medications that may make you drowsy while taking this medication
- If you take this medication regularly for longer than 2-4 weeks your body may become to use to it, and in time you may need a higher dose for it to work. If you stop this medication suddenly you make have unpleasant side effects (Anxious, difficulty sleeping). Discuss stopping this medications with your doctor first!
Digoxin
Class:// Antiarrythmic, cardiac glycoside Indications:// -Af and Atrial Flutter -heart failure Dose:// 62.5-250mcg once daily (Max 500mcg) Higher for loading dose (125-500mch q4-6h) Monitoring:// -Thyroid -Electrolytes -renal fxn -ECG - arrhythmias -therapeutic drug monitoring, -toxicity - fatigue, malaise, nvd, dizzy, delirium, anorexia Counselling:// L5- interactions Let your dr know if you experience any nvd, dizziness, visual disturbances, or a rash.
Domperidone
Class://
Dopamine Antagonist
Indication://
Nausea and vomiting
Gastroparesis
Lactation Stimulation
Dose://
10mg TDS MAX 30mg daily.
Monitoring://
- Relief of nausea
- QT prolongation
- EPSE
- Prolactin Level
- Interactions – QT prolongation
- Renal and Hepatic Fx – Dose adjustment.
Counselling://
- Take one tablet up to THREE times a day when required for nausea and vomiting.
- If your nausea is related to food, or using for gastroparesis – take 30-60minutes before food.
- May cause dry mouth or a headache.
Donepezil
Class://
Anticholinesterase
Indication://
Alzheimer’s Disease
Dose://
5-10mg daily (according to clinical response)
Monitoring://
- Drug interactions
- Drugs with anticholinergic effect
- Drugs that cause bradycardia (increased risk of bradycardia or hypotension)
- Clinical Improvement
Counselling://
- Usually taken at night, but can be taken in the morning if easier or if insomnia or vivid dreams occur.
- This medication does not sure Alzhiemers, or prevent the patient developing Alzhimers.
- This medication may make you feel dizzy or drowsy, do not take drive or operate heavy machinery if effected.
Exenatide
Class://
Glucagon-like peptide 1 analogue (GLP-1)
Indication://
- T2DM
Dose://
- Subcut – 5-10mcg BD
- Subcut – 2mg once a week
Monitoring://
- BSL, HbA1c
- Hypoglycaemia
- Tolerability (GI adverse effects)
- Pancreatitis
- Renal Fxn
Counselling://
- Ensure you know how to administer these and how to prescribe them.
- Rotate injection sites.
- Daily – Give 60 minutes prior to Breakfast and dinner (or your two main meals, which are at least 6 hours apart
- Do not use it after a meal.
- The medicine slows stomach emptying, which can reduce the absorption of some medications – Take antibiotics at least 1 hour before or 4 hours after injecting exenatide.
- Once weekly – Inject once a week on the same day each week, with or without food.
- Tell your doctor immediately if you develop unexplained severe abdominal pain.
- This medicine causes nausea and sometimes vomiting or diarrhoea, when you start taking this medication, but it usually reduces and stops within a short time. If affected drink plenty of water to avoid dehydration.
Famciclovir
Class://
Guanine Analogue – Anti-viral
Indication://
Shingles,
Herpes Simplex Virus
Dose://
125mg – 500mg 1-3 times daily.
Renally adjusted
Higher doses are used in immunecompromised patients.
Single Dose for cold sore = 1500mg
Monitoring://
- Renal Fxn
- For improvement or recurrence of symptoms
- Immune status.
Counselling://
- If you have recurrent herpes infections – carry a course of tablets with you so that you can start treatment as soon as you notice symptoms.
- May make you feel dizzy or confused – Do not drive if you experience symptoms.
- Headache, VD
Flecainide
C: Antiarrythmics
I:
SVT
Paroxysmal AF or atrial flutter associated with disabling symptoms
Maintenance of sinus rhythm following cardioversion
Serious ventricular arrhythmias refractory to other treatment (including DC cardioversion)
D:
Oral, 50–100 mg twice daily; increase by 50 mg every 4 days up to a maximum of 400 mg daily.
M:
- Concentration Monitoring – 0.2-0.9mg/l
- ECG – arrhythmias
- Electrolytes – Ensure distrubances are corrected before starting
- Renal
- Hepatic
C:
This medication may cause dizziness or affect your vision; if you are affected, avoid driving or operating machinery.
Infants: separate doses from milk feeds as absorption may be reduced.
May cause NVD
Flucloxacillin
Class://
Penicillin / Antibiotic
Indication://
- Staph Skin infections eg. folliculitis, mastitis, crush or stab injury
- Osteomyelitis
- Pneumonia
- Septicaemia
Dose://
250-500mg Q6H. (MAX: 4g daily)
Monitoring://
- Hepatic
- Renal - Long term
- FBE - Long term
- Allergy
- Cultures and Sensitivity
Counselling://
- Take on an empty stomach
- Monitor for allergy
- Space doses equally throughout the day.
- Complete the course.
- May cause NVD.
Fluconazole
Class://
Azole – Antifungal
Indication://
Acute or recurrent mucocutaneous candidiasis
Vulvovaginal candidiasis where topical therapy has failed.
Tinea resistant to topical therapy.
Onychomycosis – if alternatives have failed
Primary and secondary prevention of candidial infection in immune compromised patients
Dose://
50 – 400mg (depending on the indication) daily – Max 400mg daily (however, may have a loading dose at 800mg)
150mg STAT - Oral dose for vaginal thrush
Monitoring://
- Hepatic Function – Risk of Liver AE
- Risk of QT prolonged.
- Postassium – may cause HYPO kalaemia
- Renal Fxn – Dose reduction needed.
Counselling://
- Medications may have many drug interactions
- NVD and abdo pain are common side effects of these medications.
- See your doctor f you have unusally tired, nauseous or are not eating, also if you notic dark urine or pale stools, or yellowing of the skin or whites of the eyes.
Fluticasone
Class://
Inhaled Corticosteroids
Indication://
- Maintenance treatment of asthma
- COPD
- Eosinophilic oesphagitis
Dose://
Fluticasone Propionate – 100-200mcg BD MAX 1000mcg daily (50mcg for children)
Fluticasone Furorate with vilanterol – 100-200/25mcg ONCE daily.
Monitoring://
- Lung Function
- Inhaler technique
- Reliever use.
- Hepatic Fxn (for Fluticisone Furorate with vilanterol)
Counselling://
- Do not use this for relief of symptoms.
- Use this every day even if you feel better.
- Ensure you have an asthma action plan
- After using this medication rinse your mouth out with water, gargle and spit out.
- Use a spacer if using an MDI
- Check inhaler technique.
Gabapentin
Class://
Antiepileptic
Indication://
Focal seizures w or w/o secondary generalisation – ADJUNCT
Neuropathic pain
Dose://
100mg – 3.6g daily. (usually in 3 doses)
Seizures – 0.9-1.8g
Pain – 1.8-3.6g
Monitoring://
- Improvement of pain / control of seizures.
- Renal
- Sedation
- BP
Counselling://
- May cause dizziness or drowsiness, do not drive or operate machinery if affected.
- May increase the effects of alcohol
- Do not stop taking is medication abruptly.
Gliclazide
Class:// Sulfonylureas. Indications:// T2DM Dosage:// 40-320mg in 1 or 2 doses. 30-120mg once Daily! CR 30mg CR = 80mg IR Monitoring:// BSL, HbA1c Renal fxn Hepatic fxn Hypoglycaemia Weight Counselling:// Take with food to reduce GI effects Alcohol can decrease blood glucose and masks the warning sx of hypo. Avoid binge drinking, and eat when you drink Make sure you know the signs and sx of hypos and how to treat them. Also, make sure your family and friends understand this too. Swallow CR tablets whole. May cause weight gain
Glycopyrronium (Seebri, Ultibro (with indacterol))
Class://
Long acting inhaled anticholinergic
Indication://
COPD
Dose://
1 capsule (50mcg) ONCE daily (same with indacterol)
Monitoring://
- Lung function
- Reliver use
- Inhaler technique
- Anticholinergic adverse effect.
- Signs of infection
Counselling://
- Do not swallow the capsules – use them in the device and inhale them
- Do not use this medication for acute relief of symptoms.
- Take this medication every day, even if you feel better
- Tell the doctor if you notice any eye pain or discomfort, blurred vision or visual halos, or difficulty urinating.
- Do not drive until you know how this medication effects you – could make you dixxy or affect your vision
Hydroxychloroquinine
Anti malarial – Antiinflammatory/ immunesupressive effects.
I:
Rheumatoid arthritis (RA)
Discoid and systemic lupus erythematosus (SLE)
Treatment of malaria if chloroquine is not available
Accepted
Juvenile idiopathic arthritis
D:
200-800mg daily in 1 or 2 doses. (Depends on indications)
M:
- Ocular toxicity – Screening for early rentinaldamage
- FBE
- Renal
- Hepatic
C;
Take this medicine with food or a glass of milk to reduce stomach upset.
Tell your doctor promptly if you have any difficulty with your sight, particularly in seeing entire words or faces, reduced vision at night, intolerance of bright light or change in colour vision. Wear sunglasses when in bright sunlight; it may reduce the chances of eye problems.
This medicine may cause dizziness and blurred vision; if affected, do not drive or operate machinery.
AE: NVD
•may take approximately 2–6 months of treatment before benefit is seen in rheumatoid arthritis
Ibuprofen
Class:// NSAIDs
Indications://
Pain due to inflammation
Fever
Rheumatoid arthritis and Juvenile idiopathic arthritis
Dosage://
200-400mg THREE times daily. Maximum 2400mg daily.
Monitoring://
- Renal fxn,
- Hypersensitivity to NSAIDs
- Hepatic FBE, BP, weight,
- GI adverse effects (Including hx of ulcers)
- Cardiac Hx – Avoid use or use cautiously.
Counselling://
- Take doses with water. Can be taken without food, but if you get stomach upset take it with a meal.
- Do not take if you are dehydrated, eg vomiting or diarrhoea, because it might increase the likely hood of side effects.
- If you develop swollen ankles, difficulty breathing, chest pain, black stools, dark coffee coloured vomit - stop taking this medication and see your doctor.
- Do not take aspirin for pain relief.
Ipratropium
Class://
Inhaled Anticholinergic – Short acting
Indication://
Symptom Relief in Asthma and COPD
Dose://
MDI: 2-4 inhalations 3-4 times a day PRN (42-84mcg)
Neb: 250-50mcg 3-4 times daily PRN
Monitoring://
- Lung Fxn
- Inhaler Technique
- Preventer use
Counselling://
- This medications is used for relief of acute symptoms
- Check inhaler technique
- Do not allow the mist to come into contact with your eyes – if using a nebuliser close your eyes or wear eye protection
- Tell Dr if:
- Eye pain
- Discomfort
- Blurred vision
- Visual Halos
- Difficulty urinating
- Do not drive or operate machinery until you know how this medication effects you as it can make you dizzy or have blurred vision
- May cause dry mouth, Throat irritation or make you dizzy.
Isotrentinoin
Class://
Retinoids
Indication://
- Acne Vulgaris (Topical)
- Severe Cystic Acne (Oral)
Dose://
- Oral: 0.5-1mg/kg each day (1-2 doses). Continue until total cumulative dose is 120-150mg/kg. Tx course is usually 4-6m.
- Topical: Apply Once daily at bedtime
Monitoring://
Oral –
- Hepatic
- Lipids
- Psychiatric disorders
- BMD (long term tx)
- Visual changes
Counselling://
Oral-
- Absorbed best if taken with food.
- See your doctor ASAP if you have:
- Nausea
- Headaches
- Change in mood
- Vision changes – Poor night vision or blurring
- May cause dry lips, mouth and eyes
- Use white soft paraffin to treat dry lips
- Use lubricating eye drops to treat eye irritation
- Tell Dr if you cannot manage these, or if contact lenses become uncomfortable.
- Do not take Vitamin A supplements.
- Protect your skin from sunlight with protective clothing or broad spectrum sunscreen (SPF+ 30 or 50, containing a physical barrier – titanium dioxide or zinc oxide)
- Avoid waxing and dermabrasion during, and for 6 months after stopping
- These can scar or irritate your skin.
- Do not share this medication with others.
- Do not donate blood during tx and for 8 weeks after stopping tx.
- Female – Important to use adequate contraception before, during and for 1 months after tx, because birth defects can occur.
- May have an acne flare within the first few weeks of treatment. Most cases are mild and will improve with tx.
- Avoid using any topical anti acne preparations as these may increase the irritation.
Skins –
- Before applying, wash with mild soap and warm water. Rinse gently and pat dry.
- Apply enough to cover affected area (not just the pimples). Do not apply to eyes, lips or irritated areas, or in nostrils.
- Medications may cause irritation (Redness, stinging, peeling) especially during the first few weeks of treatment. To reduce this:
- Wait until skin is completely dry (20-30min) before applying.
- Apply a thin layer (using too much increases irritation and won’t make it work faster), a pea-sized amount is enough to cover a whole face.
- Avoid using other acne medications unless advised by Dr.
- Use a moisturiser in the morning.
- Avoid waxing treated areas
- The dr may tell you to apply the medication every other night or to wash it off after a period of time for the first couple of weeks.
Protect treated areas from the sunlight with protective clothing or broad-spectrum sunscreen
Lamotrigine
Class://
Anti-epileptic
Indication://
Focal and generalized seizures (mono or adjunct)
Bipolar disorder – to prevent depressive episodes
Dose://
*Depends on whether a patient is taking a drug that effects the metabolism, such as valproate or an enzyme inducer*
25mg (starting dose) – 200mg in 1-2 doses, in patients not taking valproate or taking valproate.
If taking an enzyme inducers – 50mg (starting) – 400mg daily in 1-2 doses.
Monitoring://
- Seizure control
- Interactions – Some medications may cause lamotrigine to require a dose adjustment.
- Hepatic Fxn
- Signs of rash or hypersensitivity.
Counselling://
- May cause drowsiness, dizziness or blurred vision - do not drive if affected.
- Increases the effect of alcohol
- Tell dr if you develop a rash, fever or swollen glands.
- Do not stop taking this medication abruptly unless advised by the doctor.
- NV
Latanoprost
Class:// Prostaglandin analogues. Indications:// glaucoma. Ocular HTN Dose:// 0.05% - 1 drop affected eye daily at night. Monitoring:// Intraocular pressure. Hx of intraocular inflammation - iritis, uveitis Counselling:// Ensure good eye drop technique. Use everyday. Use at night. May darken your eye colour with extended use. May darken and thicken eyelashes. May cause a bitter taste when instilled.
Leflunomide
Immunosuppressant
I:
Rheumatoid arthritis
Psoriatic arthritis
D:
oral 20 mg once daily. If poorly tolerated, reduce dose to 10 mg daily
M:
- Infection
- Renal
- Hepatic
- FBE
- BP
C:
Contact your doctor urgently if you develop mouth ulcers, skin problems, cough and difficulty breathing, persistent fever, sore throat, unusual tiredness, bruising, bleeding, paleness, abdominal pain or yellowing of the skin (jaundice).
Tell your doctor if you develop numbness or tingling in your fingers or toes.
Do not drink alcohol during treatment because it may increase the risk of liver damage, which is a rare side effect with this medicine.
AE : NVD
Some vaccines should not be given to people receiving leflunomide. Check with your doctor before receiving any vaccines.
Lercanidipine
Class://
Dihydropyridine Calcium Channel Blocker
Indication://
- HTN
- Angina
Dose://
10mg ONCE daily. MAX 20mg
Monitoring://
- Renal
- Hepatic
- BP
- Peripheral Oedema
Counselling://
- Take at least 15 minutes before food.
- Important to take every day, even if you don’t feel it working.
- Can cause headache, dizziness and flushing – these should go away with prolonged use.
- Tell your doctor if your ankles are swollen
Levodopa
Class://
Dopamine Precursor (With Decarboxylase inhibitor)
Indication://
Parkinson’s Disease
Dose://
IR: 50-100mg 2 or 3 times daily. MAX 2g daily.
Monitoring://
- Improvement of symptoms
- Nausea
Counselling://
- Take this medicine as the same time each day and in the same way (eg. Always before food)
- May cause drowsiness, if affected do not drive or operate machinery.
- Be careful when you stand up as this medication may make you feel dizzy if you stand up too quickly.
- Do not stop taking this medication abruptly, unless your doctor tells you to.
- Do not break fixed dose medications.
- May cause some GI upset such as NV or loss of appetite, you can take this with food if this is a problem. See your doctor if this continues.
Levonorgestrel With Ethyloestradiol (Levlen, Loette, Microgynon, Seasonique, Trifeme)
Class://
Combined oral contraceptive – Estrogen / Progesterone
Indication://
Contraception.
Moderate acne – not controlled by topical treatment
Menstrual Disorders – Heavy bleeding, dysmenorrhoea
Endometriosis
PMS
Dose://
1 Tablet Once Daily.
150/30 – levlen - normal
100/20 – Loette, Microlevlen – If they get side effects
125/50 – Microgynon 50 – If they are taking a medication that interacts with the pill
Triphasic – Trifeme
Extended cycle – Seasonique – Doesn’t have inactive tablets – may be better for PMS?
Monitoring://
- Relief of symptoms – if being used for heavy bleeding, PMS or androgen-related conditions.
- VTE Risk
- Smoking
- History of VTE
- BP
- BP
- Pap Smears
- Breast Checks
- Breakthrough bleeding
Counselling://
- Take one tablet once daily, at the same time each day.
-
When to start:
- *Take the strip out and show the patient*
- If no previous hormonal contraception – Start in the coloured section in the first 5 days of your period – This provides immediate contraceptive cover. If you start when not on your period – Start with active tablets, and use additional contraceptives for 7 days.
- If Switching from other Pill – Start taking active pills after stopping the old pill.
- Changing from a POP – Start active pills without any interval form the POP, you need 7 days of active pill for contraceptive cover!
-
What to expect:
- Whilst taking the inactive pill you should get a withdrawal bleed. However this may not occur.
- Continue taking pills as normal however consider possibility of pregnancy if pll is not taken properly, or, TWO withdrawal bleeds are missed.
- Irregular bleeding is common in the first few months.
- The pill may be less effective fi taking certain medicines that interact with the pill. Including herbal medicines – SJW
- Or if you have vomiting, diarrhoea or forget to take active tablet
-
Missed Pills
- Vomiting within 2 hours of Pill - Take another pill ASAP.
- Less than 24 hours late – Take as soon as you remember – contraception not effected.
-
More than 24 hours – Take as soon as you remember, then take the next one at the normal time – this may mean taking two at the same time.
- You then need to take 7 active tablets until contraceptive cover will return.
- If the missed pill was in the last 7 days of a strip – Skip the inactive pills and continue with the next strip of actives.
- If the missed pill was in the first 7 days after inactive pills – and you had unprotected sex in this period – seek emergency contraception.
- There are rare side effects that can occur with use of this medication that you need to be aware of
- There is an increased risk of developing a clot therefore, if you have any difficulty breathing, chest pain or swelling and pain in the leg see your doctor immediately.
- There is an increased risk of breast cancer with use of this medication – therefore it is important to do regular breast checks and report any changes in your breast to the doctor to be checked out.
- While on this medication it is also important to get regular pap smears, and report any changes in vaginal bleeding for example if you have any irregular bleeding, heavy bleeding or bleeding after sex.
Lithium
Indications:
- Prevention of manic or depressive ep in Bipolar Disorder.
- Tx of Acute Mania
- Schizoaffective disorders (Rarely)
Dose:
- 250-1000mg daily in divided doses (q12h if using CR)
Monitoring:
- Concentration Monitoring
- 8-12 hrs post a dose.
- Wait 5-7 days post dose change until stable, then every 3m.
- Acute mania – 0.5-1.2mmol/L, Prophylaxis- 0.4-1mmol/L
- Calcium
- Parathyroid
- Renal Fxn
- Thyroid Fxn
- If pt has cardiac disease – Monitor ECG
- TOXICITY
Counselling:
- Regular blood tests are important during tx.
- Be alert for TOXICITY!
- Extreme thirst, frequent urination, N&V, Blurred vision
- ESPECIALLY during illness, excessive sweating, or low fluid intake.
- If these occur – STOP taking the tablets, and see Dr immediately!!
- Take with food, but avoid having with HOT drinks.
- Swallow CR whole.
- Maintain a normal diet with regular salt and fluid intake.
- AVOID sodium bicarbonate (eg: Ural, Salvital) as this can make lithium less effective.
- Do not take NSAIDs whilst taking this medication. Ask your pharmacist before starting any OTC medications.
Melatonin
Class://
Indication://
Short term treatment of insomnia with poor sleep quality
Dose://
2mg 1-2hr before bed for up to 13 weeks.
Monitoring://
Hepatic
Effect – Sleep quality
Counselling://
Swallow controlled release tablets whole.
Do not drink alcohol while using melatonin.
Mesalazine
D: 5- Aminosalicylate
I: Ulcerative Colitis, Crohns
Dose:
- Mesal:* 250-500mg TDS (at least 30mins before food)
- Mezavant:* 2.4-4.8g ONCE daily (With food)
- Pentasa:* Up to 4g in divided doses according to response (Food does not matter)
- Salofalk:* 1.5-3g daily in 1-3 doses (Tablets at least 1hr before food, granules doesnt matter)
M:
- Renal
- Hepatic
- FBE.
C:
Taking in relation to food depends on the brand.
Brands are not interchangable.
AE: VD
Metformin
Class:// Biguanide (anti diabetic) Indications:// T2DM infertility associated with PCOS Dose:// IR:500-1000mg 2-3 times a day (MAX: 3g d) CR: 500-2000mg once daily. (Reduce in renal impairment) Monitoring:// Renal fxn. Hba1c, BSL Hepatic (avoid use in severe impairment) Counselling:// Take with or after food (to reduce GI upset) Swallow whole (CR) Dr if: loss of appetite, nausea, vomiting, abdominal pain, fatigue, cramps, diarrhoea and weight loss (lactic acidosis) Drinking alcohol can decrease the control of your diabetes. Make sure you eat when you drink and avoid binge drinking. May take a 2 weeks to see an effect from this mediation
