Drugs Flashcards

Question

Flecainide

Answer 1

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

Answer 2

***_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://_*** * ***_H_***epatic * 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.

Answer 3

***_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.

Answer 4

***_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.

Answer 5

***_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.

Answer 6

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

Answer 7

***_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

Answer 8

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

Answer 9

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.

Answer 10

***_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.

Answer 11

***_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

Answer 12

***_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

Answer 13

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.

Answer 14

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.

Answer 15

***_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

Answer 16

***_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.

Answer 17

***_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.

Answer 18

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.

Answer 19

***_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.

Answer 20

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

Answer 21

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

Answer 22

Class:// Beta-Blockers Indication:// HTN, angina, heart failure, tachyarrhythmia. Post mi, prevention of migraine. Dose:// 25-100 once or twice daily. CR: 23.75-190mg once daily. Monitoring:// HR, BP, ECG Hepatic Diabetes - may mask hypoglycaemia Asthma/COPD -may make worse. Counselling:// Swallow CR tablets whole. May cause dizziness or tiredness especially when starting or increasing dose. Do not drive or operate machinery if affected. If you feel dizzy, get up gradually from sitting or lying. Sit or lie down if you become too busy. Do not stop taking this medication suddenly unless told by your doctor. May cause your fingers and toes to become cold.

Answer 23

Class:// Antidepressant. Indication:// depression Dosage:// 15-45mg at night (max 60mg) Monitoring:// Interactions- (maoi) Seizures Mood - increased suicidal thought. FBE Counselling:// May cause drowsiness - don't drive. Don't stop abruptly. Increase appetite, weight gain May take a while to get full effect.

Answer 24

***_Class://_*** Leukotriene Receptor antagonist. ***_Indication://_*** Maintenance treatment of asthma Allergic Rhinitis Prevention of exercise-induced bronchoconstriction ***_Dose://_*** Adult: 10mg daily 6-15yo: 5mg daily Under 6yo: 4mg daily Prevention for Over 6yo: Give 2 hours before exercise. Max 1 dose in 24hrs. ***_Monitoring://_*** * Control of asthma symptoms * Reliever use * Mood? – Limited data state there may be neuropsychiatric adverse effects. * Lung Function ***_Counselling://_*** * Chewable Tablets (4mg and 5mg doses) – Chew thoroughly before swallowing. DO NOT SWALLOW WHOLE * Take this medicine in the evening. * Do not use to relieve acute asthma symptoms * Ensure you have an asthma action and management plan. * Tell your doctor if you notice any changes to your mood or behaviour.

Answer 25

Class:// NSAIDs Indications:// Pain due to inflammation RA OA Dosage:// IR: 250-500mg BD CR:750-1000mg ONCE daily MAX – 1250mg Monitoring:// - Renal fxn, - Hypersensitivity to NSAIDs - Hepatic, - GI adverse effects (Including hx of ulcers) - Cardiac Hx – Avoid use or use cautiously. Counselling:// - Take with or shortly after food. - 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.

Answer 26

***_Class://_*** Antiretroviral – Non-nucleoside reverse transcriptase inhibitor. ***_Indication://_*** HIV ***_Dose://_*** Adult – Initial – 200mg daily for 14 days. Maintenance – IR 200mg BD, CR 400mg daily ***_Monitoring://_*** * CD4 counts * Viral Load * Compliance * Drug interactions * Skin Rash – And other systemic effects, such as fever, conjunctivitis, oral lesions, muscle and joint aches * HEPATIC FUNCTION ***_Counselling://_*** * Labels: 5, 21, A\* * A: Swallow controlled release tablets whole * 5: This medication may have significant drug interactions, Ask your doctor or pharmacist if you are starting or stopping any medications, including OTC, vitamine, herbal medications, or complementary medications * Taking this medication every day is very important as resistance can develop to the medication quickly if not taken regularly. * Tell your doctor immediately if you develop a rash whilst taking this medication * (LIVER) Tell your doctor if you feel unusally tired, nauseated, are not eating, notice dark urine, pale faeces or yellowing of your skin or whites of your eyes.

Answer 27

Class:// Anti anginal Indications:// - Prevention and Tx of stable angina. Dose:// 5-20mg bd Monitoring:// Hepatic BP Ulcers - mouth, Gi and perianal. Counselling:// May make you feel dizzy- do not operate machinery if affected Dr- ulcers, wounds that are slow to heal. May cause a headache but this should reduce with ongoing use.

Answer 28

***_Class://_*** Oestrogen – Hormone replacement ***_Indication://_*** * Menopausal Symptoms – Hot flushes * Vulvovaginal symptoms due to estrogen deficiency * To improve reliability of cervical screening * Adjunct to vaginal surgery. ***_Dose://_*** Menopausal Symptoms: * Combined HRT – MUST be given with progesterone if the patient has an intact uterus. * 1-4mg daily. Vulvovaginal Symptoms: * Vaginal Cream or pessary – 0.5mg inserted into the vaginal at night for 2-3weeks, then reduce to twice a week. ***_Monitoring://_*** * Relief of symptoms * VTE risk * Smoking Status * History of VTE * Over 60 * Pap Smears * Breast Checks * Unexplained bleeding * Blood pressure * Mood * History of oestrogen- dependent tumor. * Hepatic Function. ***_Counselling://_*** * Take this medication once daily. * This is not for contraceptive cover, therefore you may still need to use additional contraceptives * 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.

Answer 29

***_Class://_*** Antipsychotic ***_Indication://_*** * Schizophrenia and related psychoses * Bipolar disorder * Acute and chronic Psychoses ***_Dose://_*** 5 – 20mg Once daily Also – Long acting IM injection – 105mg – 405mg every 2-4 weeks. ***_Monitoring://_*** * Weight * Blood Glucose – Retest if the patient gains weight whilst taking an antipsychotic. * BP * Lipids * FBE * Liver Fxn * COMPLIANCE!! * Clinical Improvemnet – consider other reasons for non-response * EPSE – Motor restlessness, tremor, rigidity, involuntary movements of the face mouth, or tongue. * Neuroleptic Malignant syndrome – Fever, Muscle rigidity, altered consciousness ad autonomic instability \*\*Tobacco SMOKING \* \* ***_Counselling://_*** • Take your medication regularly – irregular use is associated with risk of relapse or suicide. Take it to prevent an episode, not treat. * TELL your doctor if you start or stop smoking whilst taking olanzapine * Avoid using illicit drugs as even intermittent use can ↓control of Sx, and ↑ risk of relapse. * Understand what EPSE are, and what to do if you have them. * May cause drowsiness and ↑ effect of alcohol, cannabis, or sleeping tabs. * May feel dizzy on standing. * Withdraw antipsychotics slowly to avoid a relapse. * May cause weight gain

Answer 30

***_Class://_*** Neuraminidase Inhibitor ***_Indication://_*** Treatment of infection due to influenza A and B virus Prevention of influenza ***_Dose://_*** 75mg BD for 5 days. Decrease to 30mg BD or 30mg D in renal impairment ***_Monitoring://_*** * Renal * Mood – Rare reports of self-injury, delirium and abnormal behaviour in children. ***_Counselling://_*** * N&V is common in the first few days of using this medicine. * Take with food to help reduce this. * If swallowing capsules is difficult, you can take the contents of the capsule mixed in soft food eg yoghurt or honey. * The treatment is intended to shorten the time you have symptoms such as fever, headache, sore muscles, cough and sore throat. * Prevention – you may still get the flu even if you are taking this medication.

Answer 31

***_Class://_*** Anticholinergic ***_Indication://_*** Urinary Urge Incontinence ***_Dose://_*** ORAL: 2.5-5mg 2-3 times daily. MAX 20mg daily. PATCH: 1 patch TWICE a week – (3.9mg/24hrs) ***_Monitoring://_*** * Incontinence reduction * Dementia – Anticholinergics may worsen symptoms and antagonise effect of anticholinesterases. * Urinary Retention * Anticholinergic Side Effects (Dry mouth, Dry eyes, Urinary retention, Constipation, Headaches) ***_Counselling://_*** * Label 12 – May affect mental alertness or coordination – do not drive if affected * May cause dizziness, drowsiness, or blurred vision – do not drive if affected. * PATCH: Apply to dry, unbroken skin on abdomen, hip or buttock * Remove and safely dispose of patch after 3-4 days and put a new patch on in a different area – rotate sites (do not use the same site within days)

Answer 32

***_Class://_*** Opioid Analgesic ***_Indication://_*** Moderate-to-severe pain ***_Dose://_*** Starting 5-15mg Q4H – then titrate the dose to individual response and sedation score. More frequent dosing may be required. (eg. Oncology patients have Q30min) Controlled release – Total daily dose as determined by IR products. Give up to half the dose Q12H. Titrate to response and sedation. ***_Monitoring://_*** * Clinical effect * Sedation, respiratory depression * Constipation * Renal * Hepatic * Tolerance, Dependence * Withdrawal * CT. Monitor for withdrawal if swapping ***_Counselling://_*** * Do not break, crush or chew controlled release. * Oxycontin – Swallow Whole, make sure you wash it down immediately with water. If you have difficulty swallowing tablets speak to your doctor. * 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.

Answer 33

Class:// ACE inhibitors. Indications:// HTN Heart failure Diabetic nephropathy Prevention of progressive renal failure in patients with persistent proteinuria. Post MI Dose:// Arginine- 2.5-10mg once daily. Erbumine- 2-8mg once daily. Monitoring:// Electrolytes -esp potassium Renal (increase risk of hyperkalaemia) BP Counselling:// May feel dizzy on standing. Do not take potassium supplements Be aware of the differnet salts mean the same dose at slightly different mg.

Answer 34

***_Class://_*** Anti epileptic. ***_Indication://_*** Epilepsy – Simple and complex focal seizures, and generalise tonic-clonic seizures. Status Epilepticus ***_Dose://_*** 4-5mg/kg d in 1 or 2 doses. Usual range 200-500mg daily. 100mg phenytoin sodium = 92mg phenytoin. ***_Monitoring://_*** * Therapeutic Drug monitoring * Range = 10-20mg/L (total) or 1-2mg/L (free) * BMD, Vit D, calcium -if used long term * Diabetes – Hyperglycaemia. * Hepatic ***_Counselling://_*** * May make you feel drowsy or dizzy – do not drive or operate machinery. * May increase the effects of alcohol. * Interacts with many drugs – L5 * Visit the dentist regularly – good dental care is important and can help prevent enlarged gums due to phenytoin. * Tell dr immediately if sx such as fever, sore throat, rash, mouth ulcers, bruising or bleeding occur. * Do not stop taking this medication abruptly. * May cause some GI upset, such as nausea and vomiting.

Answer 35

***_Class://_*** 5HT2 Antagonist ***_Indication://_*** Prevention of recurrent migraine and cluster headache ***_Dose://_*** 0.5mg daily at night gradually increase to 1.5mg daily at night or in divided doses. MAX 3-4.5ng daily in 2-3 doses. ***_Monitoring://_*** * Migraine or Cluster headache recurrence * Epilepsy -increased risk of seizures. ***_Counselling://_*** * Label 1 – May make you feel drowsy especially when you first start. May increase the effect of alcohol – do not drive if effected. * Your appetite may increase whilst taking this medication and you may need to pay more attention to your diet to prevent weight gain.

Answer 36

***_Class://_*** Dopamine Agonist ***_Indication://_*** Parkinson’s Restless Legs Syndrome ***_Dose://_*** \*\*Adjusted to according to response\*\* 125mcg TDS initially. Up to max 1.5mg TDS (IR) 375mcg daily intially, max 4.5mg daily (CR) Restless Legs – 125mcg at night, MAX 750mcg night ***_Monitoring://_*** * Impulse control disorders * Renal * Hepatic ***_Counselling://_*** * Labels: 1, 9, 16, A\*, B * 1: May make you drowsy do not drive if affected. * 9: Do not stop taking this medication abruptly – gradually reduce dose over several days. * 16: May make you Dizzy on standing * A\*: Swallow controlled release tablets whole * B: Take with food to reduce nausea or stomach upset * Tell doctor if you notice any change in your behaviour – overspending, gamling or excessive sexual activity. * May cause NV

Answer 37

***_Class://_*** Corticosteroid ***_Indication://_*** Autoimmune or inflammatory disease – Acute asthma, COPD, Acute Gout, Croup ***_Dose://_*** 5- 60mg ONCE daily. Depending on indication and severity. Usual maintenance dose is between 2.5-15mg daily. ***_Monitoring://_*** * BSL * Lipids * Electrolytes – Sodium, Potassium * Weight * BP * Signs of infection * BMD (for chronic treatment) * Cataracts and glaucoma (Chronic Treatment) * Wound Healing (may be delayed) * Mood ***_Counselling://_*** * Labels – 9, B * Take this medication with food to help reduce stomach upset * Take this medication in morning, as it may give you more energy, and disrupt your sleep. * Tell your Dr if you have any signs of infection. * May affect your mood – you may feel more happy or sad than usual – talk to your dr if your have any concerns about this. * (Chronic use) – Do not stop taking this medication abruptly unless your doctor tells you to, the dose needs to be gradually reduced. * Tell all doctors, dentists, surgeons and other health professionals that you are taking this medication, or that you have taken them in the past, as you may need a higher dose if you are sick, * Consider wearing a medic alert bracelet, or carrying a card that details your treatment.

Answer 38

***_Class://_*** Anti- epileptic ***_Indication://_*** Neuropathic pain Focal seizures - adjunct ***_Dose://_*** 75-300mg BD (start lower in renal, elderly and frail patients). ***_Monitoring://_*** * Renal * Relief of pain * Sedation ***_Counselling://_*** * Label 12, 1, 9 * This medication can make you drowsy – do not drive if affected * This medication may cause dizziness or affect your mental alertness or coordination – do not drive if effected. * Do not stop taking this medication abruptly unless your doctor tells you to. * May take some time to get full effect of pain relief from this medication.

Answer 39

***_Class://_*** Antipsychotic ***_Indication://_*** Schizophrenia Bipolar disorder Adjunct in depression Generalised anxiety disorder ***_Dose://_*** 400-800mg Daily – in either 1 (CR) or 2(IR) doses 50-300mg ONCE Daily. GAD and Depression ***_Monitoring://_*** * Weight * Blood Glucose – Retest if the patient gains weight whilst taking an antipsychotic. * BP * Lipids * FBE * Liver Fxn * COMPLIANCE!! * Clinical Improvemnet – consider other reasons for non-response * EPSE – Motor restlessness, tremor, rigidity, involuntary movements of the face mouth, or tongue. * Neuroleptic Malignant syndrome – Fever, Muscle rigidity, altered consciousness ad autonomic instability * Monitor Thyroid FXN ***_Counselling://_*** * Take your medication regularly – irregular use is associated with risk of relapse or suicide. Take it to prevent an episode, not treat. * Avoid using illicit drugs as even intermittent use can ↓control of Sx, and ↑ risk of relapse. * Understand what EPSE are, and what to do if you have them. * May cause drowsiness and ↑ effect of alcohol, cannabis, or sleeping tabs. * May feel dizzy on standing. * Withdraw antipsychotics slowly to avoid a relapse. * May cause weight gain

Answer 40

***_Class://_*** Macrolide - Antibiotic ***_Indication://_*** Upper and Lower Respiratory Tract infections CAP Skin infections ***_Dose://_*** 150 bd OR 300mg d. MAX 300mg (150mg in Hepatic) ***_Monitoring://_*** * Hepatic Function * QT Prolongation (Risk factors for) * Cultures and Sensitivities of the bacteria ***_Counselling://_*** * Best absorbed at least 15 minutes before a meal. * IF it makes you feel sick – Take with food. * Take until all finished.

Answer 41

Class: Statin, HMG-CoA Reductase inhibitor. Indication: Hypercholesterolaemia High risk of coronary heart disease, with or without hypercholestrolaemia. Dose: 10-40mg d (MAX: 80mg) Monitoring: Hepatic function CK Renal Lipids Counselling: DR- if you have dark urine or unexplained muscle pain, tenderness or weakness. Avoid grapefruit juice AE- GI symptoms, headache

Answer 42

Class: dipeptidyl peptidase-4 inhibitors. Indications: T2DM Dose: 100mg once daily (lower in renal impairment) Monitoring: Hba1c, BSL RENAL FXN Counselling: With or without food. Monitor BSL whilst taking this medication. May cause N or Headache. May cause hypoglycaemia - especially if taking other medications to manage your diabetes- make sure you know the symptoms and how to treat this.

Answer 43

Class: Aldosterone Antagonist Indications: Primary hyperaldosteronism. Heart failure Refractory oedema associated with secondary hyperaldosteronism Adjunct in resistant HTN. Dose: 12.5-200mg d (max 400mg daily in ascites) Monitoring: Electrolytes - esp potassium and sodium Renal fxn. Hepatic function. Counselling: Do not take potassium supplements while taking this medication. May cause NV, Headache. May cause breast growth in males - see the doctor if this is a problem.

Answer 44

D: 5- Aminosalicylate I: RA, Ulcerative Colitis, Crohns Dose: 500mg – 4g daily in divided doses. M: * Renal * Hepatic * FBE * Folic Acid – impaired absorption * Response – Takes 1-3 months in RA. C: Take with food to reduce stomach upset. Your urine may become dark orange; your skin and tears may become yellow-orange and soft lenses may be permanently stained. AE: NVD May take some time to achieve full response if using for RA.

Answer 45

***_Class://_*** Triptans ***_Indication://_*** Acute relief of migraine (injection) Relief of cluster headache ***_Dose://_*** 50-100mg. Dose can be repeated after 2 hours, if the migraine recurs. Do not repeat the dose if there is not relief from the original dose. Max 300mg daily. Intranasal – 10-20mg into 1 nostril. Max 40mg daily. ***_Monitoring://_*** * Relief of migraine. * MAOI or Ergometrine – CI within 14 days of MAOI, and 24 hours of Ergotmetrine. * Hepatic -CI in severe impairment. * Cardiac history ***_Counselling://_*** * Label 12- May effect your metal alertness or coordination – do not drive if affected. * Most effective when taken at the first sign of the headache is developing and not earlier (during aura) or later (when headache is severe) * If there is no improvement with the first dose, do not repeat.

Answer 46

***_Class://_*** Selective Estrogen Receptor Modulator (SERM) ***_Indication://_*** Hormone receptor-positive advance breast cancer Hormone receptor-positive early breast cancer (Adjunct) Primary reduction of breast cancer risk in women at moderate-to-high risk ***_Dose://_*** 20mg ONCE daily. ***_Monitoring://_*** * VTE Risk * Pap Smears * Breast Checks * Unexplained vaginal bleeding ***_Counselling://_*** * Labels: 12, 21, A * A: Swallow whole * 12: May effect mental alertness, or coordination do not drive if affected – this is particularly when starting or increasing dose. * Tell Dr if you develop abnormal vaginal bleeding, discharge or pain, or pressure in the pelvic area whilst taking tamoxifen or after you stop taking it. * It is important to continue regular breast checks, and pap smears whilst on this medication. * Rare side effect is increase risk of clots – tell dr immediately if you develop any shortness of breath, chest pain or swelling and pain in your legs.

Answer 47

***_Class://_*** Selective Alpha-Blockers ***_Indication://_*** BPH ***_Dose://_*** 400mcg once daily ***_Monitoring://_*** * BP (Hypotension risk) * Tx with other antihypotensives and volume depletion. (increased risk of hypotension) * Need for cataract surgery – Intraoperative floppy iris syndrome * Renal * Hepatic * Improvement of BPH symptoms * Oedema ***_Counselling://_*** * Swallow whole * May cause drowsy / dizzy caution standing, driving and operating machinery * Tell ophthalmologist if you are taking this, or have ever taken this, if you have cataract surgery. * May cause headache, nasal congestion, blurred vision, dry mouth, urinary incontinence, NV, mood changes. * Will start working in 48 hours, full effect in 4-6 weeks.

Answer 48

***_Class://_*** Opioid Analgesic ***_Indication://_*** Moderate-to-severe pain ***_Dose://_*** IR: 50-100mg q4-6h MAX 600mg CR: 50-200mg TWICE daily. MAX 500mg ***_Monitoring://_*** * Clinical effect * Sedation, respiratory depression * Constipation * Renal * Hepatic * Tolerance, Dependence * Withdrawal * Interactions – Serotonin Syndrome ***_Counselling://_*** * Swallow CR tablets whole. * 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.

Answer 49

***_Class://_*** Benzodiazepine ***_Indication://_*** Short Term management of Insomnia ***_Dose://_*** 5-20mg at night. ***_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!

Answer 50

***_Class://_*** Opioid Analgesic ***_Indication://_*** Moderate pain ***_Dose://_*** IR: 50-100mg q4-6h MAX 600mg (MAX \>300mg if over 75yr) CR 12hr: 50-200mg q12hr MAX 400mg (300mg if over 75mg) CR 24hr: Start with 100-200mg ONCE daily. MAX 400mg ***_Monitoring://_*** * Clinical effect * Sedation, respiratory depression * Constipation * Renal * Hepatic * Tolerance, Dependence * Withdrawal * Interactions – Serotonin Syndrome ***_Counselling://_*** * Swallow CR tablets whole. * 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. * Check with your pharmacist or doctor if you want to start any other medications as there can be significant drug interactions. * 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.

Answer 51

***_Class://_*** Antibacterial ***_Indication://_*** Uncomplicated UTIs Prostatitis Epididymo-orchosis Mild-to-moderate PCP, with Dapsone (second line) ***_Dose://_*** Women: 300mg at night for 3 days. Men: 300mg at night for 7 days. Duration varies for indication. UTI prophylaxis – 150mg at night. ***_Monitoring://_*** * Potassium * Folic Acid (folate antagonist) * Renal * FBE ***_Counselling://_*** * Take ONCE daily at night with or without food. * Take until all finished. * May cause NV.

Answer 52

***_Class://_*** Antibacterial ***_Indication://_*** Treatment, Primary prevention and secondary prevention of PCP Shigellosis Melioidosis Primary prevention of cerebral toxoplasmosis in HIV patients Prevention and treatment of pertussis (if macrolide unsuitable) Community acquired MRSA infections, skin and soft tissue infections. ***_Dose://_*** 80/400 – 160/800mg q12h MAX 20/100mg/kg daily. Prevention – 80/400 – 160/800mg once daily, or 160/800mg once daily or 3 days a week, or 160/800mg BD on two days a week. ***_Monitoring://_*** * Potassium * Folic Acid (folate antagonist) * Renal * Hepatic * FBE * Fluid intake * Sulphonamide allergy * Signs of infection. ***_Counselling://_*** * Lables: 8, B, D * Take with food * Ensure you drink a lot of fluid whilst taking this medication (2-3L daily) * May cause a rash in the sun, avoid sun exposure, wear protective clothing and use sunscreen. * Tell Dr – if you get a sore throat, fever, a rash, cough, difficulty breathing, joint pain, dark urine or pale stools * May cause NVD

Answer 53

***_Class://_*** Long acting Inhaled Anticholinergic ***_Indication://_*** COPD ***_Dose://_*** 1 inhalation ONCE daily (62.5mcg) (SAME DOSE IF IN COMBO WITH Vilanterol) ***_Monitoring://_*** * Lung Function * Reliever Use * Signs of infection * Inhaler Technique * Anticholinergic Side Effects – Dry mouth, Blurred vision? ***_Counselling://_*** * Ensure patient knows how to use the inhaler (Slide the cap over, take a deep breath in, do not cover vents, check the counter (ELIPTA) * Do not take the inhaler out of the foil container until ready to use. * 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

Answer 54

***_Class://_*** Guanine Analogue – Anti-viral ***_Indication://_*** Shingles Herpes Simplex Virus Prevention of CMV disease post organ transplantation. ***_Dose://_*** * 500mg – 2g BD, TDS, or QID 500mg BD (Genital Herpes Simplex) 1g BD (Genital Herpes Simplex) 2g BD (Recurrent Cold Sores) 1-2g TDS (Shingles) 2g QID (CMV virus) *RENALLY ADJUSTED* ***_Monitoring://_*** * Renal Fxn * For improvement or recurrence of symptoms ***_Counselling://_*** * Drink plenty of fluids whilst taking this medication (At least 1.5L daily) * 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, NVD

Answer 55

***_Class://_*** Anti-epileptic ***_Indication://_*** Primary epilepsy and simple and complex focal seizures. Bipolar disorder Prevention of migraine when other tx have failed. ***_Dose://_*** 1-2g daily (in two doses) MAX 2.5g daily Start 600mg BD 200-400mg BD (Migraine) ***_Monitoring://_*** * Hepatic * FBE * BMD * Vit D * Calcium ***_Counselling://_*** * Take with food to reduce stomach upset. * Swallow Eneric Coated Tablets whole * May make you feel drowsy- if affected do not drive or operate machinery. May increase effects of alcohol. * Appetite may increase while taking this medication and may need to pay more attention to your diet to maintain your weight. * Tell Dr if you have sx such as fever, rash, abdo pain, vomiting, jaundice, bruising or bleeding. * Do not stop taking this medicine suddenly unless your doctor tells you to.

Answer 56

Class:// Serotonin and Noradrenaline Reuptake Inhibitors. Indications:// Depression General anxiety disorder Panic disorder Social phobia Dosage:// 75-150mg (little known about doses over 225mg daily) Monitoring:// Seizures Sodium BP, ECG Serotonin toxicity Hepatic Renal Counselling:// Be Careful driving or operating machinery until you know how this will affect you, Do not stop abruptly May cause - nausea, dry mouth, constipation or dizziness Swallow whole with food to minimise and Gi upset.

Answer 57

***_Class://_*** Imidazopyridine Hypnotic. ***_Indication://_*** Short-Term treatment of insomnia ***_Dose://_*** 5-10mg at night (IR) 6.25 – 12.5mg at night (CR) ***_Monitoring://_*** * Psychiatric / Mood – Depression, psychosis and schizophrenia may worsen. * Hepatic – Use low doses, avoid in severe ***_Counselling://_*** * Intended to make you feel sleepy, but you may feel less alert or drowsy the following day. Avoid driving or operating heavy equipment for at least 8 hrs after takng the tablet and possibly longer depending on how it affects you. * Do not take alcohol or other medications that may cause drowsiness whilst taking this. This may increase risk of walking or driving whilst asleep * CR – Swallow whole.

Answer 58

***_Class://_*** Immunosuppressant – Folic Acid antagonist ***_Indication://_*** Rheumatoid Arthritis Juvenile Idiopathic Arthritis ***_Dose://_*** 5-25mg ONCE a week (May be divided over the day, if the patient is not tolerating the dose) ***_Monitoring://_*** * Renal * Signs of Myelosuppression – Mouth ulcers, signs of infection. * FBE * Hepatic fxn * Pulmonary fxn tests * Chest Xray * Folate * Tolerance ***_Counselling://_*** * Label – 5, 8, 10a, 20, 21 * Take this medication strictly as directed by your doctor. It should be taken ONCE a WEEK on the same day (Methotrexate Mondays?) . It MUST NOT be taken every day. * L5 – This medication may have drug interactions that can increase its toxicity – ensure to ask your doctor or pharmacists before starting and stopping any medications, including OTC, natural or complementary medicines * L8- Avoid excessive sun exposure whilst taking this medication, cover up in the sun, and use sunscreen * L10a – Do not take aspirin for pain relief whist taking this medication * L21 – This medication is cytotoxic therefore it is very important that only the person taking the medication handles it. Wear gloves when handling the medication, and ensure proper storage and disposal. DO NOT HANDLE if pregnant. * Tell your doctor is you develop a cough, difficulty breathing, mouth ulcers or any signs of infection.

Answer 59

***_Class://_*** Dopamine Antagonists ***_Indication://_*** Nausea and Vomiting Gastric Stasis ***_Dose://_*** 10mg TDS PRN or 0.5mg/kg daily – depending on what is lower. ***_Monitoring://_*** * Relief of nausea * Renal * EPSE – especially risk of acute dystonia (sustained muscle contractions causing twisting, repetitive movements or abnormal postures) ***_Counselling://_*** * Label 12 – May affect mental alertness or coordination – do not drive if effected. * May make you feel drowsy or dizzy. * Use when needed up to 3 times a day.

Answer 60

***_Class://_*** P2Y12 Antagonists (Thienopyridine) ***_Indication://_*** ACS with Aspirin History of symptomatic atherosclerosis ***_Dose://_*** 75mg daily (Load at 300mg daily) ***_Monitoring://_*** * Bleeding risk ***_Counselling://_*** * Label 18,9,10a * 18- Do not take grapefruit juice whilst taking this medication. * 9- do not stop taking this medication as it is important to take to prevent the clots. * Know the signs of bleeding and what to do if they occur.

Answer 61

***_Class://_*** Beta-Blockers ***_Indication://_*** HTN Angina Tachyarrhythmias MI Prevention of migraine ***_Dose://_*** 25-100mg daily. ***_Monitoring://_*** * HR * BP * Renal * Asthma and COPD * Diabetes- can mask signs of hypo. ***_Counselling://_*** * Label 9, 12, 16 * May cause dizziness or tiredness especially when starting or increasing dose. Do not drive or operate machinery if affected. * If you feel dizzy, get up gradually from sitting or lying. Sit or lie down if you become too busy. * Do not stop taking this medication suddenly unless told by your doctor. * May cause your fingers and toes to become cold.

Answer 62

***_Class://_*** Loop Diuretic ***_Indication://_*** Oedema associate with heart failure, hepatic cirrhosis, renal impairment and nephrotic syndrome ***_Dose://_*** 20-400mg daily in 1 or 2 doses. MAX 1g daily. ***_Monitoring://_*** * BP * Renal Fxn * Electrolytes – Sodium and Potassium * Gout Flare * Weight ***_Counselling://_*** * Label 16 * Take in the morning. * If you have to take 2 doses, take the second one around lunch time, as it can keep you up at night with needing to go to the toilet. * This medication will make you need to go to the bathroom more often. * This may make you feel dizzy especially when starting or increasing the dose.

Answer 63

***_Class://_*** Quinolone Antibiotic ***_Indication://_*** Travellers Diarrhoea Uncomplicated UTIs Prostatitis Shigellosis Campylobacter Enteritis * Reserve for proven or suspected infections where other agents cannot be used – Resistance is increasing. ***_Dose://_*** 400mg TWICE a day ***_Monitoring://_*** * Cultures and sensitivities * Renal fxn * Tendon pain ***_Counselling://_*** * Label 4, 8, 12, 3b, D * Take on an empty stomach. * 4 – Do not take any antacids, calcium, iron or zinc supplements within 2 hours of a dose of this medication * 8 – Avoid excessive sun exposure whilst taking this medication – cover up and use sunscreen. * 12 – May affect your mental alertness or coordination – like brain fog – do not drive if affected. * D – Take until all finished * Tell the doctor if you experience any unexplained tendon pain – especially In your calf muscles – or numbness or tingling in your fingers or toes. * May affect how caffeine effects you – may need to decrease your intake whilst on this medication * Important to keep well hydrated whilst taking this medication.

Answer 64

***_Class://_*** Opioid Anti-diarrhoeal ***_Indication://_*** Diarrhoea Intestinal stoma ***_Dose://_*** 4mg stat, followed by 2mg after each loose bowel motion. Max 16mg daily. ***_Monitoring://_*** * Hydration * Relief of diarrhoea * Use * Hepatic Impairment * Do not use in Children ***_Counselling://_*** * Take TWO capsules initially then ONCE capsule after each loose bowel action. * May cause abdominal pain or bloating.

Answer 65

***_Class://_*** Calcium Channel Blocker ***_Indication://_*** HTN Angina ***_Dose://_*** 2.5 – 10 mg ONCE daily ***_Monitoring://_*** * BP * Oedema * Hepatic ***_Counselling://_*** * Label 9, 12, 18 * Do not taking this medication abruptly unless advised by your doctor. * This medication may affect your mental alertness or coordination especially when starting or increasing your dose – Do not drive if affected. * Do not have grapefruit juice whilst being treated with this medication. * This medication may cause some swelling in your ankles – See your doctor is this is a problem * Ensure you visit the dentist regularly, and maintain your oral hygiene to prevent overgrowth of your gums.

Answer 66

***_Class://_*** Progesterone ***_Indication://_*** Contraception HRT as adjunct to oestrogens Heavy menstrual bleeding ***_Dose://_*** 52mg inserted into the uterus once each 5 years. (Can be used for up to 7 years for women over the age of 45) ***_Monitoring://_*** * History of endometrial or cervical cancer * Postpartum – needs to be at least 4 weeks. * Patient should be advised to check for the strings to ensure it is still in place. * Signs of infection post insertion * Abnormal bleeding * Pap Tests * Breast Checks ***_Counselling://_*** * At first periods may be prolonged or irregular and spotting may occur. With time (3-4 months) bleeding should become lighter or even stop. If they become heavier, this may be a sign that the IUD has come out. * See a doctor if you have any signs of infection – fever, unusal vaginal discharge or pain low in your abdomen – the IUD can increase the risk of pelvic inflammatory disease. Most likely in the first 3 weeks after the IUD is inserted. * Make sure you regularly check for the prescence and length of the IUD string each month after a period as it may have been expelled unnoticed. * Contact your doctor if your cannot feel the strings. * The IUD should be replaced every 5 years. * If inserted within the first 7 days of your period, there will be immediate contraceptive cover. If inserted at any other time, allow 7 days before contraceptive cover. If changing from a COC – it can be inserted any time and will give contraceptive cover. Give 7 days before contraceptive cover starts

Answer 67

***_Class://_*** H2 antagonist. ***_Indication://_*** GORD Peptic Ulcer Disease Dyspepsia Stress ulcer prophylaxis ***_Dose://_*** 150-300mg daily in 1-2 doses. ***_Monitoring://_*** * Renal * Symptom Control ***_Counselling://_*** * Take TWICE a day or ONCE a day at night. * Speak to doctor if your reflux gets worse, or you get severe pain in your throat.

Answer 68

***_Class://_*** Selective Serotonin Reuptake inhibitor ***_Indication://_*** Major Depression Anxiety – social phobia, panic disorder PMDD ***_Dose://_*** 25 – 200mg daily. ***_Monitoring://_*** * Mood * Hepatic Function * Side Effects – Nausea and vomiting, sexual dysfunction, insomnia * Serotonin Syndrome * Sodium ***_Counselling://_*** * Take in the morning as this medication may effect your sleep, However, if it does make you feel tired, take the medication at night. * Label 12 – May effect your mental alertness or coordination, do not drive if affected. * Label 9 – Do not stop taking this medication abruptly * Label 5 – May have significant drug interactions * May take a few weeks to get the full effect of this medication. * May cause NVD, and sexual dysfunction

Answer 69

***_Class://_*** Nitrate ***_Indication://_*** Prevention of Angina ***_Dose://_*** 30 – 120mg daily ***_Monitoring://_*** * Reduction in angina symptoms * Blood pressure * Use (Are they having a nitrate free period?) * Treatment with a PDE5 inhibitor – (Sildenafil) ***_Counselling://_*** * This medication is not for acute relief of symptoms – ensure you have a plan to treat acute symptoms if they occur. * Swallow the tablets whole – they may be halved, but not crushed or chewed * Take when the angina symptoms are the most common – so at night for night time angina, and morning for daytime angina * Label 16 – May make you feel dizzy, sit or lie down if affected * Ensure that there is a nitrate free period – so don’t take the medication TWICE a day. Otherwise tolerance can develop to this medication. * May cause headache or flushing *

Answer 70

***_Class://_*** Phosphodiesterase-5 inhibitor (PDE 5 inhibitor) ***_Indication://_*** Impotence – Erectile Dysfunction Pulmonary Hypertension ***_Dose://_*** Start at 50mg and increase or decrease according to response 25-100mg once daily – roughly 60 minutes prior to sexual activity. ***_Monitoring://_*** * Return of function * Blood Pressure * Interactions * Cardiac History * History of vision problems – Sight only in one eye, or NAION ***_Counselling://_*** * Labels 16, 5 * Take the tablet 60 minutes before sexual activity. * Take it without food, however, if you take it with food it may take longer to work. * You still require sexual stimulation to achieve an erection – however, this should make it easier to achieve. * Do not take sildenafil if you already take nitrates – the combination can cause a serious drop in your blood pressure, even if you take them on different days. Additionally, you will not be able to use your GTN tablets or spray in an emergency whilst taking this medication. * L 16- this medication may make you feel dizzy – sit or lie down if affected. * L 5- This medication may have significant drug interactions – therefore speak to your doctor or pharmacist before starting any other medications. * Ensure you let health professionals know that you take this medication. * May cause a headache, flushing. * This medication may cause blurred vision, a blue-green tinge in your vision or light sensitivity – Do not drive if affected and speak to your doctor. * See your doctor immediately if you experience any hearing or vision loss.

Answer 71

***_Class://_*** 5HT3 Antagonist ***_Indication://_*** Nausea and Vomiting ***_Dose://_*** 4 – 12 mg 1 or 2 times daily PRN Max 32mg daily Commonly 4-8mg TDS prn is used. ***_Monitoring://_*** * Relief of nausea * Epilepsy – increased risk of seizures * Constipation * QT prolongation * Hepatic Fxn ***_Counselling://_*** * Oral wafer/ disintergrating tablet – Place on the tongue and allow to dissolve then swallow * May cause constipation – See your doctor or pharmacist if this becomes a problem. * Label 5 – May have significant drug interactions

Answer 72

***_Class://_*** Vitamin K Antagonist Anticoagulant ***_Indication://_*** * Prevention and treatment of VTE * AF and high risk of stroke or systemic embolism * Prevention of stroke in patients with a previous MI and increased embolic risk * Prevention of thromboembolism in patients with prosthetic heart valves. ***_Dose://_*** 1-10mg once daily – However, dose is individualised depending on INR ***_Monitoring://_*** * INR * Bleeding Risk * Compliance * Falls risk ***_Counselling://_*** * Labels 5,10a,21 * Take this medication at the same time daily, normally at night. * You will need regular INRs for this medication that will advise you what dose to take. * It is important to always use the same brand of warfarin as the brands are not interchangeable * Know the signs of bleeding and what to do if they occur * Maintain a healthy diet with a regular intake of foods high in Vitamin K – Such as green leafy vegetables. * It is important to only take one dose of this medication per day – set reminders on your phone or calender to remind you if you have had your dose today or not. * Label 5- This medication can have significant drug interactions – speak to your doctor or pharmacist before starting any new medications, even OTC, complementary, natural or vitamins. * Label 10a – Do not take aspirin whist taking this medciation. * Avoid excessive alcohol consumption whilst taking warfarin * Tell all doctors and health professionals that you are taking warfarin * Tell your doctor if you develop a painful, purplish, bruise-like rash.

Answer 73

***_Class://_*** Thyroid Hormone ***_Indication://_*** Hypothyroidism Block-replace regime in hyperthyroidism Suppressive regime in thyroid cancer or goitre ***_Dose://_*** 25-200mcg daily. 1.6mcg/kg ideal weight once daily – rounded to the nearest 25mcg. ***_Monitoring://_*** * Thyroid hormones * Symptoms of Hyperthyroidism * Cardiovascular disorders – Can worsen arrhythmias * BMD – more likely if excessive dose. ***_Counselling://_*** * Labels 4,6,3b * L 3b – Take on an empty stomach, 30 minutes before food or 2 hours after food. * Preferably before breakfast. * L 4- Separate this medication away from the dose of any iron, calcium, dairy products or antacids by 2 hours. * L 6- This medication should be kept in the fridge – however, a single sheet of the medication can be outside of the fridge for 14 days. * If you have any signs of hyperthyroidsism – palpitations, excitability, insomnia, flushing, sweating or weight loss – talk to your doctor immediately. * Eltroxin is not interchangeable with the other brands, if you want to change brands, it is important to speak to your doctor.

Answer 74

***_Class://_*** Drugs for infertility ***_Indication://_*** Anovulatory Infertility ***_Dose://_*** 25-100mg daily for 5 days, starting on day 2-5 of the menstrual cycle. MAX 150mg – Specialist guidance needed. ***_Monitoring://_*** * Pregnancy * Hepatic function * Ovarian Cysts – may increase in size ***_Counselling://_*** * Label 12 – may affect metal coordination do not drive if affected. * STOP this medication and see your doctor if you have any visual disturbances whilst taking this medication. Do not drive if affected * May cause hot flushes, abdominal discomfort.

Answer 75

***_Class://_*** Tetracycline Antibiotic ***_Indication://_*** CAP Exacerbation of Chronic Bronchitis Acute bacterial sinusitis PID Acne Rosacea Prophylaxis of malaria ***_Dose://_*** 50-200mg daily in 1 or 2 doses. ***_Monitoring://_*** * Hepatic * Cultures and sensitivities * Pregnancy ***_Counselling://_*** * Label 4, 8, A, B, D * Swallow Whole with food or milk and remain upright for 1 hour after taking the dose this is to prevent the tablets or capsules from sticking on the way to your stomach, which damages the lining of your stomach or throat. * Label 4 -Separate the dose from an iron, calcium, zinc or antacids by 2 hours. * Label 8 – This medication can make you more likely to get burnt in the sun – Cover up and use sunscreen * Label D – Use until all finished * *Malaria Prophylaxis:* Start taking 2 days before entering and continue taking until 4 weeks after leaving the endemic area. * Avoid mosquitos by using repellents and wearing long clothing. * See your doctor if you develop a febrile illness within 12 months after possible exposure.

Answer 76

C: Sodium Dipeptyl Peptidase 4 inhibitor I: T2DM D: 5mg daily M: - HbA1c - BSL C: L10 Take ONCE a day with or without food. Do not take aspirin with this medication Know what Hypos are and how to treat them especially if you are taking other medications for your diabetes. Try to avoid alcohol as it can effect the control of your diabetes - avoid binge drinking and eat when drinking

Answer 77

C: Potassium Sparing Diuretic I: Prevention of diuretic-induced hypokalaemia Hypertension Oedema due to heart failure, hepatic cirrhosis or nephrotic syndrome as an adjunct to thiazide or loop diuretic D: 2.5 -10mg daily. MAX 20mg daily M: Blood Pressure Electrolytes - Potassium especially. Renal Fxn Hepatic Fxn C: L11,12,16 Take this medication ONCE in the morning. If you are taking it TWICE a day, take the second dose before 6pm, as it may increase your need to go to the toilet. 11 - Do not take potassium supplements with this medication unless advised by your doctor. 12 - May effect your mental alertness or coordination - Do not drive if affects (May make you feel dizzy or drowsy) 16- This medication may make you feel Dizzy- sit down and get up slowly if affected. May cause NV or constipation.

Answer 78

C: Thiazide Diuretic. I: Hypertension Oedema associated with heart failure, hepatic cirrohisis, or nephrotic syndrome. Prevention of renal calculi associated with hypercalciuria D: 12.5 - 50mg once or twice daily. For oedema - 25-100mg daily OR Intermittently on 3-5 days a week M: - Blood pressure - Urate levels - If the patient has gout - May aggravate gout by diuretic induced hyperuricaemia. - Electrolytes - Potassium - can cause hypokalaemia - Renal fx C: Take this medication ONCE in the morning. If you are taking it TWICE a day, take the second dose before 6pm, as it may increase your need to go to the toilet. L16 - You may feel dizzy on standing when taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.

Answer 79

C: Anti-epileptic I: Focal (Partial) Seizures with or without secondary generalization, generalized tonic-clonic seizures Prevention of migraine D: 25-200mg once or twice daily. MAX 1g. However, different indication have slightly different ranges. M: Seizure control Renal Decreased sweating or hyperthermia - nephrolithiasis Sodium Bicarbonate - Metabolic Acidosis Vision changes or eye pain C: L1,9,12,21,A Avoid alcohol as it may worsen some of the side effects of topiramate. Tell your doctor immediately if your eyesight changes or you have eye pain. Make sure you drink enough water every day, especially if you have had kidney stones in the past. Topiramate may reduce or prevent sweating which may affect your body’s ability to cool down, especially in hot weather. Tell your doctor if this happens to you. L1- May make you feel drowsy or dizzy especially when starting or increasing the dose - Do not drive if effected. 9- Do not stop this medication abruptly unless advised by your doctor.

Answer 80

C: Tricyclic Antidepressant I: Major depression D: 25-150mg daily. Max 300mg M: Serotonin toxicity -interactions, use of MAOI Patient with Epilepsy - may increase seizure risk Hepatic Mood QT prolongation - monitor ECG Blood Pressure Anticholinergic Side effects C: L1,5,9,16 You may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days. Try taking this medicine at night to reduce daytime drowsiness. Discuss any problems with your doctor or pharmacist. These drugs may increase the effects of alcohol. L1- May make you feel drowsy or dizzy especially when starting or increasing the dose - Do not drive if effected. L5 - This medication may have drug interactions, speak to your pharmacist or doctor before starting any new medications. including OTC L9 - Do not stop this medication abruptly L16 - this medication may make you feel dizzy - sit or lie down if affected. May take a few weeks for the full effect of the medication, even though side effects may start earlier.

Answer 81

C: H2 Antagonist I: GORD, Dyspepsia, Dyspepsia D: 150-300 daily M: reduction in reflux Renal fxn C: Signs of bleeding ulcers

Answer 82

***_Class://_*** Anti-epileptic ***_Indication://_*** Seizures as both mono and adjunct therapy ***_Dose://_*** Initially 250-500mg BD. Increase to tolerance and response = Max 1.5g BD daily. ***_Monitoring://_*** * Seizure control * Mood * Renal fxn * History of learning disabilities or psychiatric problems – increased risk of behavioural effects. ***_Counselling://_*** * Label 1, 9 * L1- May make you feel drowsy or dizzy especially when starting or increasing the dose - Do not drive if effected. * 9- Do not stop this medication abruptly unless advised by your doctor. * May increase the effect of alcohol. * May affect your mood including causing depression, hostility, aggression, agitation, anxiety and nervousness.

Answer 83

***_Class://_*** P2Y12 inhibitor ***_Indication://_*** ACS with aspirin ***_Dose://_*** 180mg loading dose. Then 90mg BD for at least 12 months. ***_Monitoring://_*** * Signs and risk of bleeding. * Interactions – CYP3A4 inhibitors * Weight * Hepatic Fxn ***_Counselling://_*** * Label 10a, 18 * Know the signs of bleeding and what to do if they occur. * See your doctor if you have any shortness of breath or chest pain – as ticagrelor can worsen these. * Label 10a – Do not take more than one aspirin daily whilst taking this medication. * Label 18 – Do not have grapefruit juice whilst on this medication as it can increase your risk of bleeding. * May cause nausea and diarrhoea.

Answer 84

***_Class://_*** Proton Pump Inhibitor ***_Indication://_*** * GORD * Dyspepsia * Zollinger Ellison Syndrome * Reflux * Eradication of H. Pylori * Prevention and/or treatment of upper GI adverse effects of NSAID ***_Dose://_*** 20-40mg Daily – Higher doses can be used in Zolliger Ellisons Syndrome ***_Monitoring://_*** * Hepatic fxn * Relief of reflux symptoms * With long term use: monitor Magnesium, Vitamin b12, Vitamin D and calcium (increased fracture risk) ***_Counselling://_*** * Signs of GI bleeding * Label A, 5 * Swallow whole or dispersed in water. * May have interactions – check with your pharmacist and doctor.

Answer 85

***_Class://_*** Factor Xa inhibitor ***_Indication://_*** * Prevention of VTE post knee or hip replacement * Prevention of stroke in non-valvular AF * Treatment of acute VTE and prevention of further VTE ***_Dose://_*** 2. 5-5mg BD 2. 5mg in prevention of VTE post hip and knee, prevention of subsequent VTE or pt has any 2 of the following – weight under 60kg, age over 80 or serum creatinine over 133 ***_Monitoring://_*** * Bleeding Risks / signs * Renal fxn * Weight and age. ***_Counselling://_*** * Label 10b, 18 * Take the tablets at the same time each day – use a calendar to record that you’ve had your dose. * Tell your doctor and pharmacist that you are taking this medication before starting or stopping any other medication * Tell your health professionals that you are taking this medication * Know what the signs of bleeding are and what to do if they occur. * Consider wearing a warning bracelet or carrying a warning card. * L10b – do not take aspirin or any anti inflammatory drugs whilst taking this medication as it may increase your bleeding risk. * L18 – Do not have any grapefruit juice whilst taking this medication.

Answer 86

***_Class://_*** Anti-thyroid Drug ***_Indication://_*** Grave Disease Thyroid Storm Short-term treatment before thyroid surgery or after radioactive iodine treatment. ***_Dose://_*** Hyperthyroidism- 10-60mg intially in 2 or 3 doses Maintence: 2.5-40mg daily in single or divided doses. THYROID STORM – 60-80mg daily in divided doses. ***_Monitoring://_*** * Thyroid hormones * FBE * Hepatic ***_Counselling://_*** * Speak to your doctor ASAP if you have any signs of fever, mouth ulcers, sore throat, rash, severe fatigue, nausea, abdominal pain or jaundice.

Answer 87

***_Class://_*** Nitroimidazole Antibiotic ***_Indication://_*** C. Diff associated disease Dental infections Gram -ve and +ve Anerobic infections Protazoal Infections Aspiration Pneumonia Eradication of H. Pylori Bacterial Vaginosis. ***_Dose://_*** 200-400mg BD or TDS Max 4g daily Trichamoniasis – 2g stat is acceptable Giardasis – 2g daily for 3 days is acceptable. ***_Monitoring://_*** * Signs that the antibiotic is working: White cell counts, CRP, Cultures and sensitivities * Hepatic and renal function * Full blood counts and neurotoxic reactions if over 10 days of tx- ***_Counselling://_*** * Label 2, 5, B, D * Take the tablet WITH FOOD two or three times a day UNTIL ALL FINISHED * (Take Liquids 1hr before food) * May make you feel dizzy or confused avoid driving if affected * L 2- Avoid drinking alcohol during treatment and for 24hr after the last dose to prevent nausea, palpitations , headache and flushing * Stop takine metronidazole and see your doctor if you have numbness, pain, tingling or weakness in your hands or feet.

Answer 88

***_Class://_*** Cholesterol Intestinal Absorption inhibitor. ***_Indication://_*** Hypercholestrolaemia Familial Hypercholestrolemia - with a statin ***_Dose://_*** 10mg ONCE daily. ***_Monitoring://_*** Lipids Liver Creatinine Kinase - if indicated Signs of mypopathy - Muscle pain, weakness ***_Counselling://_*** Tell your doctor if you have any muscle pain, tenderness or weakness May cause abdo pain, diarrhoea or fatigue. These won't work to lower your cholestrol alone - you should have a healthy diet, with plenty of freash fruits and vegetables.

Answer 89

***_Class://_*** Selective dopamine and noradrenaline reuptake inhibitor ***_Indication://_*** Nicotine Dependence - Aid to stop smoking ***_Dose://_*** 150mg daily MANE for 3 days, then 150mg BD for 7-9weeks. Start 7 days before stopping smoking. ***_Monitoring://_*** - Have they quit smoking? - Decreases seizure threshold - Increased risk - Renal - Hepatic - MAOI in previous 14 days - interactions ***_Counselling://_*** - Swallow tablets whole - Start taking 1 week before stopping smoking - Take in the morning to reduce any sleep disturbances. - If you devlop a rash, swelling of the lips or mouth, or difficulty breathing, contact your doctor asap - Only small amounts of alcohol only whilst on this medication. can increase the risk of seizures - May have side effects that decrease your ability to drive. (dizziness or confusion) Dont drive if affected. Use nicotine replacement such as a spray or inhaler if a strong craving occurs.