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Jan Stuff > Drugs Counselling > Flashcards

Drugs Counselling Flashcards

1
Q

CI of Warfarin

A

Pregnancy
Bleeding Disorders

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2
Q

Treatment Course of Warfarin

A

Once a day in the evening

Dose changes take 2-3 days to take effect

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3
Q

Monitoring with Warfarin

A

5mg each evening

INR used to monitor (anticoagulation book will be provided)

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4
Q

Side effects of Warfarin

A

Bleeding

Rash, Hair Loss, Diarrhoea

Interactions with cytochrome inhibitors and Spinach, Alcohol, Liver, NSAIDs

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5
Q

CI of DOACs

A

Renal Impairment

Bleeding Disorders

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6
Q

How to take and how long?- DOAC

A

Once or Twice a day

FULL GLASS of Water while sitting UPRIGHT (like Bisphosphonates)

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7
Q

DOAC Monitoring

A

Just the Renal Function before and every year

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8
Q

SE of DOACs

A

Bleeding and GI Disturbance

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9
Q

Levothyroxine (no CI) how to take and how long?

A

Once a day before breakfast

Dose changes take 4-6 weeks to have any effect

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10
Q

Monitoring with Levothyroxine

A

TSH every 2-3 months until stable then once every year

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11
Q

SE of Levothyroxine (no CI)

A

Hyper/ Hypothyroidism symptoms

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12
Q

CI of Statin

A

Just Pregnancy

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13
Q

How to take statin and how long?

A

once in the evening

decreases risk of CVD over many years

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14
Q

Monitoring of statin

A

Lipids- check in 1 month, then every 6-12 months

LFTs- check before starting, at 3 months and at 12 months

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15
Q

SE of statins

A

Muscle Pains
Itching
Headache
Nausea and Diarrhoea

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16
Q

CI of Metformin

A

Renal Impairment

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17
Q

How to take Metformin

A

1-3 times a day with MEALS (M for Meals and M for Metformin)

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18
Q

Monitoring of Metformin

A

Kidney Function before starting and then every year (so the DOAC Monitoring)

plus HbA1c every 3-6 months until stable, then every 6 months

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19
Q

SE of Metformin

A

GI issues

Lactic Acidosis (avoid with CONTRAST PROCEDURES)

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20
Q

How to take Iron (NO CI)

A

1-3 times a day with meals (like METFORMIRON)

takes 3 weeks for Hb to be normal, then 3 months for Iron to be normal

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21
Q

Monitoring in Iron

A

Just Hb in 3 weeks

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22
Q

Side effects of Iron

A

GI side effects and black stools

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23
Q

SSRI CI

A

Suicidal
Mania

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24
Q

how to take SSRI

A

once a day

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25
Q

SE SSRI

A

GI
Anxiety for 2 weeks
Drowsiness

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26
Q

Methotrexate CI

A

Pregnancy and breast feeding
Liver Disease
Active Infection
Immunodeficiency

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27
Q

how to take Methotrexate

A

Once a week with Folic Acid on another day

Takes 3-12 months to Work

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28
Q

Monitoring with Methotrexate

A

FBC, LFT, U+Es

Before starting, every 2 weeks until stable then every 2 months

(you will get a methotrexate book)

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29
Q

SE Methotrexate

A

CHRPT Side effects

Cytopenia
Hepatotoxicity
Renal Toxicity
Pulmonary Fibrosis
Teratogenicity

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30
Q

CI Lithium

A

Breast Feeding/ Pregnant

Heart- Cardiac insufficiency

RASH acronym
- Renal Impairment
- Addisons
- Sodium LOW in diet
- Hypothyroidism

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31
Q

How to take Lithium

A

Once or twice a day (liquid or tablet)

Takes 1-2 weeks to work

32
Q

Monitoring with Lithium

A

Before Starting- FBC, U&Es, TFTs, Beta HCG, ECG

Check Lithium every week until stable for a month

then every 3 months

Thyroid and Renal every 6 months

33
Q

SE of Lithium

A

Fine Tremor
+

(imagine drawing a path from mouth down the GI system)
Dry mouth
Thyroid Dysfunction (Lithium affects Thyroid remember)
GI Disturbance
Polyuria and Polydipsia

34
Q

CI Atypical Antipsychotics

A

Hepatic Impairment (just ask about this)

Pheochromocytoma

35
Q

How to take Atypical Antipsychotics

A

Every 2-4 weeks- Tablet or Injection

36
Q

Atypical Antipsychotics monitoring

A

Before, 3 months and every year

(FULL examination for Heart, Weight, Diabetes, Lipids and Prolactin)

Weight checks initially once a week for 6 weeks

37
Q

SE Atypical Antipsychotics

Stopping Insanity Comes with High Stakes Remember NMS

A

Sedation
Increased Risk of Stroke
Cardiac Arrhythmias
Hyperprolactinaemia (Switch to Aripiprazole)
Sexual Dysfunction
Reduction in Seizure Threshold
Neuroleptic Malignant Syndrome (Measure CK)

////////////////////////

Just Atypical-
- Weight Gain
- Diabetes
- Dyslipidaemia

Clozapine- Confusion, Ataxia, AGRANULOCYTOSIS

38
Q

CI Levodopa

A

Glaucoma

39
Q

How to take Levodopa (NO MONITORING(?

A

3 times a day with FOOD (like METFORMIRON)

Mention end of dose, on/off and dyskinesia

40
Q

SE of Levodopa (NO MONITORING)

A

HIS (Hallucinations, Impulse Control Disorder, Sleepiness)

On/Off, EndofDose, Dyskinesia

41
Q

Insulin How to take

A

Depends on regimen- taken as injection

42
Q

SE Insulin

A

Weight gain

Hypoglycaemia and SHARPS InjuryM

43
Q

Monitoring Insulin

A

Glucose before each meal and before bed

44
Q

Bisphosphonate CI

A

Pregnancy
Renal Impairment

Also- Oesophageal DYSMOTILITY/ Peptic Ulcers recently

45
Q

how to take Bisphosphonates

A

Once a day or once a week

30 mins before eating, 30 mins of standing

Full glass of water

46
Q

Monitoring of Bisphosphonate

A

Regular Dental Checkups

47
Q

SE Bisphosphonate

A

Osteonecrosis of Jaw
GI SE
Upper GI bleeding and black stools and DYSPHAGIA/ Odynophagia

48
Q

Alcohol (or any) Dependence History

LIVER
Kidney
Heart

A

START with past medical history/ drug history to make it easy to transition into alcohol

Then SOCIAL HISTORY and ask about alcohol

/////

What do you drink? How much per day? How often?

Cut Down?
Annoyed?
Guilt?
Eye Opener?

Dependence- Are you able to get through your day without alcohol?
Withdrawal- What happens if you do not DRINK?
Tolerance- Do you find yourself having to drink more alcohol now than before to achieve the same effect

Mood- How would you rate your overall mood at the moment?
Insight- Do you think you are drinking more than usual?
Suicide- Have you every tried to harm yourself?
Hallucinations- Visual/ Auditory/ Tactile

Family and Friends- Who is at home with you? Who do you usually drink with?
Addictions
Medications and Medical History (but already covered)

49
Q

Management of Alcohol Dependence

A

Non Medical-
- Alcohol Anonymous
- One-to-one
- Family Therapy

Medical-
- Acamprosate- Reduces Cravings
- Disulfiram- Promotes Abstinence- makes you feel ill if you take alcohol
- Chlordiazepoxide- given for ACUTE WITHDRAWAL

50
Q

Smoking Cessation OSCE

A

Start with ICE (or with PMH then Social History if they do not know you have come to speak with them about smoking)

Smoking History- How many per day? How long have you been smoking for? Have they tried reducing before and how did it go? What were the challenges? What did they try?

Ask about TRIGGERS- stressors and what makes them want to STOP (Exacerbating and Relieving kinda like that)

ask about general health if relevant

/////

UNITED approach
Understanding- it would be useful for me to understand how smoking affects your life day to day, could you tell me more about it?

Non-negotiable- before we move on to options, are there any options you would like us not to cover today?

Identify Common Ground- Explain RISKS of Smoking- Risk to Lungs- COPD/ Lung Cancer, also associations with HEART CONDITIONS and blood clotting (MI/ Strokes) and also several other cancers. Also affects blood supply to legs and hands

Tensions Remaining- Any questions they have before you discuss options

Explore Solutions- Non-medication and medications
- NRT- patch is long lasting but does not act quickly, spray and gum act quick but are short lasting
- counselling (one to one or group), ARRANGE A FOLLOW UP with you as well

Decide together on the STOP DATE (when to start quitting smoking)

////////

STAR

Set a quit date (date to start the quitting, not the date to quit by)
Tell Family and Friends
Anticipate any challenges that they may face
Remove ALL Tobacco products

51
Q

SBAR

A

gather as much notes as you can in front of you so you dont need to memorise

Situation- Who and Where I am and CLARIFY WHO YOU ARE TALKING TO, Who the patient is, Why am I calling (only one sentence) (this is a patient who is going into respiratory arrest)

Background- Context for this specific situation (ONLY GIVE what is necessary)- only PMH and relevant drug history. Also give their current management and response

Assessment- Observations and positive findings

Recommendation- What I think it is (if you know only) and say ā€œIā€™d appreciate you coming down to review this patient in the next 5 minutes)

52
Q

Before Flexible Cystoscopy

A

NOTHING (Flex Cyst had no preparation)

53
Q

During Flexible Cystoscopy and Rigid Cystosopy

A

Anaesthetic Jelly used for flexible, GENERAL Anaesthetic or SPINAL for Rigid

Water Passed through Scope to look into bladder through urethra

54
Q

After Flexible Cystoscopy

A

After they pass urine, they are allowed home

There will be a follow up

55
Q

Before Rigid Cystoscopy

A

6- only have clear fluids, 2- NBM

And Standard preoperative assessment regarding drugs (so Rigid Cystoscopy is just bog standard pre operative prep)

56
Q

After Rigid Cystoscopy

A

Home after they have passed urine

Follow Up

ALSO
- It is rigid so there is no room for flexibility-
- No DRIVING/ ALCOHOL/ SIGNING LEGAL DOCUMENTS for 1 day
- Keep someone with you for 1 day

57
Q

Risks of Flexible AND Rigid Cystoscopy

A

BLADDER DAMAGE
Infection

HAEMATURIA is NORMAL for a few days

Dysuria/ Retention can happen

58
Q

Before Bronchoscopy

A

6 hours- only have clear fluids, 2- NBM

Stop
- Antiplatelets 1 week before
- Warfarin 5 days before
- DOAC 2 days before

59
Q

During Bronchoscopy

A

You can choose to have general anaesthesia or a throat spray (lidocaine)

A tube will be passed into your airways to have a look inside your lungs

60
Q

After Bronchoscopy (Same as Gastroscopy)

A

If you have the throat spray -
- No eating/ drinking for 2 hours because of throat spray

If you have the general anaesthesia-
- No DRIVING/ ALCOHOL/ SIGNING LEGAL DOCUMENTS for 1 day
- Keep someone with you for 1 day

61
Q

Risks of Bronchoscopy

A

Lung Infection/ Damage/ Collapse
Bleeding (Haemoptysis)

Sore throat/ nose

62
Q

Before Gastroscopy

A

Sips of clear Fluids from 6 hours, NBM from 2 hours

STOP ANTACIDS 2 weeks before

63
Q

During Gastroscopy

A

Throat Spray or Sedative (Same as Bronchoscopy)

Also AIR PASSED INTO TUMMY so you may feel bloated afterwards

64
Q

After Gastroscopy (Same as Bronchoscopy)

A

If you have the throat spray -
- No eating/ drinking for 2 hours because of throat spray

If you have the general anaesthesia-
- No DRIVING/ ALCOHOL/ SIGNING LEGAL DOCUMENTS for 1 day
- Keep someone with you for 1 day

65
Q

Risks of Gastroscopy

A

Perforation
Bleeding
Infection

Sore Throat/ Dental Damage

66
Q

Before Colonoscopy (this is a lil different to the others)

A

2 days before- LOW FIBRE DIET

1 day before- ONLY CLEAR FLUIDS (you can have a light breakfast in the morning)

2 hours before- NBM

///////////
Sodium Picosulfate Sachet the afternoon before and on the morning of the procedure
Stop IRON 1 week before
Stop Drugs that cause Constipation 4 days Before (AI ALOA)

67
Q

During Colonoscopy

A

General Anaesthetics

DRE before insertion of scope

Air inserted so you may feel like you need to go to the toilet

68
Q

After Colonoscopy

A
  • No DRIVING/ ALCOHOL/ SIGNING LEGAL DOCUMENTS for 1 day
  • Keep someone with you for 1 day
69
Q

Risks of Colonoscopy and Flexible Sigmoidoscopy

A

Perforation
Bleeding
Infection

Abdominal Discomfort

70
Q

Before Flexible Sigmoidoscopy

A

2 hours before- NBM (no rule on 6 hours but maybe mention anyway just in case)

Also
/////////////

Phosphate Enema 2 hours before (which you can take at home)

71
Q

During Flexible Sigmoidoscopy

A

DRE and NO SEDATION/ AIR INFLATION

72
Q

After Flexible Sigmoidoscopy

A

Follow Up

73
Q

Down Syndrome Screening

A

Combined Test at 10-14 weeks- BHCG, Nuchal Translucency and Pregnancy-Associated Plasma Protein

Quadruple Test at 14-20 weeks- BHCG, Inhibin A, Oestradiol, AFP

Second Line- Non-Invasive Prenatal Testing (if more than 10 weeks)

74
Q

NTD Screening

A

14-20 weeks- HIGH AFP is all you need

Anomaly Screen at 20 weeks confirms this

75
Q

Invasive Testing options or Screening Antenatally

A

Amniocentesis (>15 weeks)
Chorionic Villus Sampling (10-14 weeks)

DEFINITIVE but carries a 1% risk of miscarriage

76
Q

Birthing Options Station

A

Screen For Risk Factors (recommend HOSPITAL BIRTH if there are any)

1) Previous Pregnancies (ask about if a C Section was done, and if 6 or more children)
2) Current Pregnancy (Twins, Breech, Any problems with the baby)
3) Maternal Factors (Diabetes, Anaemia, Pre Eclampsia, Age>40)

///////////

Choosing the right place for the birth can have a positive impact on your relationship with your baby

1) Hospital (safest and can have anesthesia) BUT not personal
2) Midwife-run birthing centre (more likely to have a midwife you know, more comfortable and homely) BUT can NOT have epidural and may need to be transferred to a hospital if you have any complications
3) Home (evidence shows that it is as safe as hospital if it is your SECOND child) (more personal, private, relaxed) BUT can NOT have epidural and may need to be transferred to a hospital if you have any complications (How far is it?)

////////////////

Modes of Delivery

1) Vaginal
2) C Section- Recommended if Multiple Pregnancy, Maternal Infection, 2 more previous C Section and other Obstetrics issues)- if they want one ask why? is it pain?

///////////////////

Pain Relief

1) Natural (None)
2) Paracetamol
3) Codeine
4) Nitrous Oxide
5) Pethidine
6) Morphine
7) Epidural
8) Spinal if C Section

////////////

Water birth and Hypno Birth

1) Water birth- available in any environment- helps with anxiety
2) Hypno birth- mother is taught self hypnosis and controlled breathing

77
Q
A

Jan Stuff (6 decks)

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