Drugs Requiring Patient Counselling Flashcards
Mnemonic to use for each drug
Check understanding + ATHLETICS
Action Timeline Tablet Length of treatment Effect- time before this occurs Tests Important side effects Complications and contraindications Supplementary advice
Methotrexate
Disease modifying agent that reduces inflammation and suppresses the immune system
Once weekly and the folic acid another day of the week
Tablet usually (injectable form)
Long term
4-6 months before positive symptoms
FBC UE LFT before starting, every 2 weeks until stable, then every 2/3 months
SE- alopecia, headache, GI, myelosupression (infection- AE, also bruising, bleeding and anaemia)
Complication- myelosupression, liver toxicity (alcohol), pulmonary toxicity (come back SOB)
Contraindication- pregnancy, hepatic impairment, breast feeding, active infection, immunodeficiency
No NSAIDS, aspirin, need flu jab every year, arthritis.org.uk
Warfarin
Thins the blood by blocking vitamin K- normally makes proteins that clots blood
Once daily (evening)
Tablet
3 months DVT, 6 months PE, lifelong if AF
2-3 days before it works
Test INR (blood test) on day 5 and 8 (adjust accordingly), then INR clinics (determined by stability). Can be every 3 months
SE- bleeding, bruises, GI disturbance and many drug interactions (grape fruit juice)- speak to doctor before buying OTC medications
Contraindications- pregnancy, haemorrhagic stroke, significant bleeding
Advice- avoid liver, spinach, cranberry juice, alcohol binge, grapefruit juice, NSAIDS, aspirin, give anticoagulation book, no St Johns Wort
Levothyroxine
synthetic version of normal hormone produced by thyroid gland called thyroxine- brings level back to normal
Once daily before breakfast
Tablet
Lifelong
Few weeks before effects seen
Start test dose then review in 2-3 weeks. TSH every 2-3 months until stable. TSH annually
SE- rare. If take too much may become hyperthyroid
Advice- fee prescriptions for everything when taking levothyroxine
Statin
Stop the liver making more cholesterol- one thing that can lead to heart disease, stroke, kidney disease etc. Areas other risk factors eg. Smoking
Once daily in evening
Tablet
Lifelong
It decreases risk over many years- hard to see effects
LFT before starting, at 3 months and 12 months. 4 week review and then review every 6 months
SE- muscle pain, hair loss, GI disturbance
Complications- rhabdomyolysis (dark urine, severe muscle pain)
Contraindications- pregnancy
Advice- avoid grapefruit and BHF.org.uk
Metformin
Increases the sensitivity of bodies cells to insulin, allowing body to make better use of low insulin levels
Taken once daily with breakfast (can be increased to 2)
Tablet- same time every day with food
Lifelong (if efficacious)
Effects- difficult to see. Similar to statin
Tests- UE before starting, then annually
SE- GI disturbance (diarrhoea, abdominal pain)
Complications- lactic acidosis (explain what this is)
Contraindications- renal impairment (metformin not taken on day of general anaesthetic or X ray contrast media- or for the 2 days following)
Advice- diabetes.org.uk
Iron tablets
Replace body’s store of iron, a mineral required to make RBC’s
1-3 times a day depending on brand
Tablet- works best on empty stomach but can take with food as it is an irritant
4 months (not usually lifelong)
3-4 weeks before effects seen
FBC (Hb) in 3-4 weeks
SE- GI irritation, coloured stools, bad taste
Steroid
J
Vancomycin
J
DOAC
J
Insulin
J
