Drugs Counselling Flashcards
CI of Warfarin
Pregnancy
Bleeding Disorders
Treatment Course of Warfarin
Once a day in the evening
Dose changes take 2-3 days to take effect
Monitoring with Warfarin
5mg each evening
INR used to monitor (anticoagulation book will be provided)
Side effects of Warfarin
Bleeding
Rash, Hair Loss, Diarrhoea
Interactions with cytochrome inhibitors and Spinach, Alcohol, Liver, NSAIDs
CI of DOACs
Renal Impairment
Bleeding Disorders
How to take and how long?- DOAC
Once or Twice a day
FULL GLASS of Water while sitting UPRIGHT (like Bisphosphonates)
DOAC Monitoring
Just the Renal Function before and every year
SE of DOACs
Bleeding and GI Disturbance
Levothyroxine (no CI) how to take and how long?
Once a day before breakfast
Dose changes take 4-6 weeks to have any effect
Monitoring with Levothyroxine
TSH every 2-3 months until stable then once every year
SE of Levothyroxine (no CI)
Hyper/ Hypothyroidism symptoms
CI of Statin
Just Pregnancy
How to take statin and how long?
once in the evening
decreases risk of CVD over many years
Monitoring of statin
Lipids- check in 1 month, then every 6-12 months
LFTs- check before starting, at 3 months and at 12 months
SE of statins
Muscle Pains
Itching
Headache
Nausea and Diarrhoea
CI of Metformin
Renal Impairment
How to take Metformin
1-3 times a day with MEALS (M for Meals and M for Metformin)
Monitoring of Metformin
Kidney Function before starting and then every year (so the DOAC Monitoring)
plus HbA1c every 3-6 months until stable, then every 6 months
SE of Metformin
GI issues
Lactic Acidosis (avoid with CONTRAST PROCEDURES)
How to take Iron (NO CI)
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
Monitoring in Iron
Just Hb in 3 weeks
Side effects of Iron
GI side effects and black stools
SSRI CI
Suicidal
Mania
how to take SSRI
once a day
SE SSRI
GI
Anxiety for 2 weeks
Drowsiness
Methotrexate CI
Pregnancy and breast feeding
Liver Disease
Active Infection
Immunodeficiency
how to take Methotrexate
Once a week with Folic Acid on another day
Takes 3-12 months to Work
Monitoring with Methotrexate
FBC, LFT, U+Es
Before starting, every 2 weeks until stable then every 2 months
(you will get a methotrexate book)
SE Methotrexate
CHRPT Side effects
Cytopenia
Hepatotoxicity
Renal Toxicity
Pulmonary Fibrosis
Teratogenicity
CI Lithium
Breast Feeding/ Pregnant
Heart- Cardiac insufficiency
RASH acronym
- Renal Impairment
- Addisons
- Sodium LOW in diet
- Hypothyroidism
How to take Lithium
Once or twice a day (liquid or tablet)
Takes 1-2 weeks to work
Monitoring with Lithium
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
SE of Lithium
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
CI Atypical Antipsychotics
Hepatic Impairment (just ask about this)
Pheochromocytoma
How to take Atypical Antipsychotics
Every 2-4 weeks- Tablet or Injection
Atypical Antipsychotics monitoring
Before, 3 months and every year
(FULL examination for Heart, Weight, Diabetes, Lipids and Prolactin)
Weight checks initially once a week for 6 weeks
SE Atypical Antipsychotics
Stopping Insanity Comes with High Stakes Remember NMS
Sedation
Increased Risk of Stroke
Cardiac Arrhythmias
Hyperprolactinaemia (Switch to Aripiprazole)
Sexual Dysfunction
Reduction in Seizure Threshold
Neuroleptic Malignant Syndrome (Measure CK)
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Just Atypical-
- Weight Gain
- Diabetes
- Dyslipidaemia
Clozapine- Confusion, Ataxia, AGRANULOCYTOSIS
CI Levodopa
Glaucoma
How to take Levodopa (NO MONITORING(?
3 times a day with FOOD (like METFORMIRON)
Mention end of dose, on/off and dyskinesia
SE of Levodopa (NO MONITORING)
HIS (Hallucinations, Impulse Control Disorder, Sleepiness)
On/Off, EndofDose, Dyskinesia
Insulin How to take
Depends on regimen- taken as injection
SE Insulin
Weight gain
Hypoglycaemia and SHARPS InjuryM
Monitoring Insulin
Glucose before each meal and before bed
Bisphosphonate CI
Pregnancy
Renal Impairment
Also- Oesophageal DYSMOTILITY/ Peptic Ulcers recently
how to take Bisphosphonates
Once a day or once a week
30 mins before eating, 30 mins of standing
Full glass of water
Monitoring of Bisphosphonate
Regular Dental Checkups
SE Bisphosphonate
Osteonecrosis of Jaw
GI SE
Upper GI bleeding and black stools and DYSPHAGIA/ Odynophagia
Alcohol (or any) Dependence History
LIVER
Kidney
Heart
START with past medical history/ drug history to make it easy to transition into alcohol
Then SOCIAL HISTORY and ask about alcohol
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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)
Management of Alcohol Dependence
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
Smoking Cessation OSCE
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
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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)
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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
SBAR
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 āIād appreciate you coming down to review this patient in the next 5 minutes)
Before Flexible Cystoscopy
NOTHING (Flex Cyst had no preparation)
During Flexible Cystoscopy and Rigid Cystosopy
Anaesthetic Jelly used for flexible, GENERAL Anaesthetic or SPINAL for Rigid
Water Passed through Scope to look into bladder through urethra
After Flexible Cystoscopy
After they pass urine, they are allowed home
There will be a follow up
Before Rigid Cystoscopy
6- only have clear fluids, 2- NBM
And Standard preoperative assessment regarding drugs (so Rigid Cystoscopy is just bog standard pre operative prep)
After Rigid Cystoscopy
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
Risks of Flexible AND Rigid Cystoscopy
BLADDER DAMAGE
Infection
HAEMATURIA is NORMAL for a few days
Dysuria/ Retention can happen
Before Bronchoscopy
6 hours- only have clear fluids, 2- NBM
Stop
- Antiplatelets 1 week before
- Warfarin 5 days before
- DOAC 2 days before
During Bronchoscopy
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
After Bronchoscopy (Same as Gastroscopy)
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
Risks of Bronchoscopy
Lung Infection/ Damage/ Collapse
Bleeding (Haemoptysis)
Sore throat/ nose
Before Gastroscopy
Sips of clear Fluids from 6 hours, NBM from 2 hours
STOP ANTACIDS 2 weeks before
During Gastroscopy
Throat Spray or Sedative (Same as Bronchoscopy)
Also AIR PASSED INTO TUMMY so you may feel bloated afterwards
After Gastroscopy (Same as Bronchoscopy)
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
Risks of Gastroscopy
Perforation
Bleeding
Infection
Sore Throat/ Dental Damage
Before Colonoscopy (this is a lil different to the others)
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
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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)
During Colonoscopy
General Anaesthetics
DRE before insertion of scope
Air inserted so you may feel like you need to go to the toilet
After Colonoscopy
- No DRIVING/ ALCOHOL/ SIGNING LEGAL DOCUMENTS for 1 day
- Keep someone with you for 1 day
Risks of Colonoscopy and Flexible Sigmoidoscopy
Perforation
Bleeding
Infection
Abdominal Discomfort
Before Flexible Sigmoidoscopy
2 hours before- NBM (no rule on 6 hours but maybe mention anyway just in case)
Also
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Phosphate Enema 2 hours before (which you can take at home)
During Flexible Sigmoidoscopy
DRE and NO SEDATION/ AIR INFLATION
After Flexible Sigmoidoscopy
Follow Up
Down Syndrome Screening
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)
NTD Screening
14-20 weeks- HIGH AFP is all you need
Anomaly Screen at 20 weeks confirms this
Invasive Testing options or Screening Antenatally
Amniocentesis (>15 weeks)
Chorionic Villus Sampling (10-14 weeks)
DEFINITIVE but carries a 1% risk of miscarriage
Birthing Options Station
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)
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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?)
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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?
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Pain Relief
1) Natural (None)
2) Paracetamol
3) Codeine
4) Nitrous Oxide
5) Pethidine
6) Morphine
7) Epidural
8) Spinal if C Section
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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
