MEDICATION COUNSELLING Flashcards
GENERAL STRUCTURE
what is the general structure for a medication counselling station?
OPENING CONSULTATION
- introduce self
- confirm name and DoB
- explain the reason for the consultation
ICE
WHAT IS THE MEDICATION?
HOW IS IT TAKEN?
HOW DOES IT WORK?
SIDE EFFECTS
LIFESTYLE ADVICE
WARFARIN
how would you explore ICE?
IDEAS
- have you heard of warfarin
- what do you already know?
- do you know why people take it?
CONCERNS
- is there anything that worries you about taking warfarin?
EXPECTATIONS
- what were you hoping we would discuss today?
WARFARIN
how would you explain how warfarin works?
- type of medication known as anticoagulant
- helps to thin blood, making it less likely that a dangerous blood clot can form
- can be used to treat people who have a previous blood clot in leg or lungs
- can prevent future blood clots in people at high risk e.g. irregular heart beat or artificial valve
- can be rapidly reversed with an antidote
WARFARIN
how would you explain INR?
- measure of how long blood takes to clot
- normal = 1
- since you are at higher risk of clots = 2-3
- will need to monitor INR every so often through a blood test
- will be frequent to start with (every 3-4 days) then every 1-2 weeks and then every 12 weeks
- dose of warfarin is adjusted according to your INR to keep it in the 2-3 range
WARFARIN
how would you explain how to take warfarin?
- same time each day
- tablets have different colours according to strength
- if missed dose, take as soon as you remember unless it is next day. If next day, skip missed dose
- inform doctor/nurse of missed doses at next appointment
- if unwell + not able to take meds, contact doctor as you may need more frequent testing or alternative
- tell doctor and pharmacist before taking any new medications, prescription or OTC
- continue taking medication unless told to stop by doctor
- not safe during pregnancy so should have effective contraception in place
- if planning to get pregnant, talk to doctor so alternatives can be discussed
WARFARIN
how would you explain what to do in less serious bleeding?
- normal to bleed more easily
examples: - periods heavier
- bleeding a little longer if you cut yourself
- occasional nosebleeds
- bleeding from gums with brushing teeth
- bruising more easily
- not dangerous + should stop by itself
- keep taking warfarin but tell doctor if it bothers you
WARFARIN
how would you explain serious bleeding?
- can be dangerous + needs urgent medical attention
- stop warfarin + call doctor or go to A&E
Examples - red pee or black poo
- large nosebleeds lasting >10 mins
- large bruises
- blood in vomit
- coughing up blood
- severe headaches, seizures, changes to eyesight or tingling in arms or legs
- bleeding from cut which will not stop
WARFARIN
how would you explain other side effects of warfarin other than bleeding?
COMMON
- mild rash
- hair loss
- are typically mild, contact doctor/pharmacist if they are bothersome
SERIOUS
- jaundice
- skin necrosis
- seek urgent medical attention if skin is yellowing or painful swollen areas of skin
WARFARIN
what is the lifestyle advice?
DIET
- avoid cranberry juice
- avoid drastic changes in food high in vit K e.g. broccoli, kale or spinach
ALCOHOL
- limit intake
- never binge drink
- major changes to alcohol can affect INR
OTHER
- take extra care when shaving or brushing teeth
- inform dentist that they take warfarin
WARFARIN
what should you advise about yellow booklets and alert card?
- all patients should be provided 2 yellow booklets, INR monitoring booklet and a patient info leaflet
- always carry anticoagulant alert card
- take INR monitoring book to each appointment with doctor/nurse
HRT
how would you explore ICE?
IDEAS
- have you heard of HRT?
- what do you already know about HRT?
- do you know why people take HRT?
CONCERNS
- is there anything that worries you?
EXPECTATIONS
- what were you hoping we would discuss today?
- what were you hoping HRT might be able to do for you?
HRT
how would you explain what HRT is?
- an effective treatment for menopause related symptoms
- have positive influence on other long term conditions
- reducing risk of osteoporosis, cardiovascular disease and strok
- aim is to restore low hormone levels that occur as a result of menopause
HRT
how would you explain how it is taken?
- many ways to take HRT
- most common = oral tablets
- other forms = skin patches, gels and implants such as mirena coil
- can try different forms to find ones that work for you
HRT
how would you explain how it works?
- menopause = when ovaries stop producing eggs
- therefore there are less hormones such as oestrogen and progesterone in the body
- results in hot flushes, weakened bones + vaginal dryness
- HRT replaces hormones with the hope of reducing symptoms + health problems
HRT
who is eligible for HRT?
- treatment of menopausal symptoms where risk/benefit ratio is favourable
- early menopause until age of natural menopause
- women under 60 who are at risk of osteoporosis + non-oestrogen treatments are not suitable
HRT
how would you describe the different types?
- cyclical = period in last 12 months
- continuous = LMP over 12 months ago
- oestrogen + progesterone = have uterus
- oestrogen only = no uterus
HRT
how would you explain the pros?
- reduction of frequency of hot flushes (up to 87%)
- improve mood
- improve vaginal dryness + overall sexual function
- can improve urinary symptoms such as increased frequency passing urine
- reduces risk of osteoporosis
- reduce risk of cardiovascular disease such as HTN + heart attacks
HRT
how would you explain the cons?
- oestrogen = breast tenderness, bloating, headaches + leg cramps
- progesterone = backache, pelvic pain, depression
- breakthrough bleeding in first 3-6 months in continuous combined HRT
HRT
what are the risks?
VTE
- increased risk of blood clots
- oral HRT increases risk by 2-3 times, but overall risk is low. Skin absorption reduces risk
ISCHAEMIC STROKE
- blood clot blocks blood supply to brain
- still very unlikely
- skin preparations do not carry this risk
BREAST CANCER
- small increased risk
- risk decreases when stop taking HRT
ENDOMETRIAL CANCER
- oestrogen only HRT increases risk of developing cancer of the lining of the womb
- no increased risk if taking combined HRT
HRT
what are the contraindications?
- current, past or suspected breast cancer
- oestrogen-sensitive cancer
- undiagnosed vaginal bleeding
- untreated endometrial hyperplasia
- previous idiopathic or current VTE
- active/recent angina or MI
- untreated HTN
- active liver disease
- pregnancy
BISPHOSPHONATES
how would you explore ICE?
IDEAS
- do you know anything about bisphosphonates?
- do you know what they are used for?
CONCERNS
- is there anything in particular worrying you?
- what is your number one concern?
EXPECTATIONS
- what were you hoping we would discuss today?
BISPHOSPHONATES
what would you explore in patient history?
- any fractures
- ever had DEXA scan which identified osteoporosis
- medications
- any heartburn or reflux
osteoporosis risk factors
- smoking
- alcohol
- steroid use
- menopause
BISPHOSPHONATES
how would you explain how they work?
- osteoporosis = thinning of bones which increases risk of fractures
- bisphosphonates prevent thinning + allow bones to gain strength over time to reduce risk of fractures
BISPHOSPHONATES
how would you explain how to take them?
- take once per week
- take on same day each week in the morning
- take tablet with large glass of water + sit upright for 30 minutes after taking it
- take at least 30 minutes before food or other medications
- if you miss a tablet, take in the morning after remembering. Never take two tablets on the same day
BISPHOSPHONATES
how would you explain how long it takes for treatment to work?
- takes 6 months to start strengthening bones
- will most likely not feel any different
- important to keep taking medication for long term benefits
- GP will review annually
BISPHOSPHONATES
what are the side effects?
OESOPHAGEAL IRRITATION
- oesophageal irritation + heartburn = sit upright after taking. Do not take NSAIDs as they can increase irritation
ABDOMINAL UPSET
- abdo pain, nausea + joint/muscle pain in first month
OSTEONECROSIS OF JAW
- osteonecrosis of the jaw = pain + ulcers in mouth + jaw
- seek urgent medical review
BISPHOSPHONATES
what lifestyle advice can be given?
- importance of diet + exercise
- weight bearing exercise e.g. walking, hikingm jogging or resistance training
- eat high calcium food e.g. dairy, leafy green veg, soya beans, nuts or boney fish
- stop smoking
STATINS
how would you explore patient history?
- previous heart attack
- previous stroke
- smoking
- alcohol
- HTN
- sedentary lifestyle
STATINS
how would you explain Q RISK?
10% = 1 in 10 risk of developing cardiovascular disease e.g. MI or stroke in next 10 yrs
cannot predict what will happen but can give indication that we might want to look at reducing risk
STATINS
how would you explain what statins are + how they work?
- cholesterol is essential for life + used by body in many processes
- too much of the wrong sort can increase risk of CVD and stroke
- statins work by limiting production of new cholesterol in the body whilst clearing bad cholesterol
- aims to reduce total amount of bad cholesterol + reduce risk of heart attacks and strokes
STATINS
how should they be taken?
- taken once daily at night
- if you miss a tablet, take one as soon as you remember. Do not take two tablets in the same day
STATINS
how are they monitored?
- blood test before treatment to check cholesterol + liver function
- blood test after 3 months + after 12 months
- will not feel beneficial effects but it is important to keep taking the medication consistently
STATINS
what are the side effects?
- muscle tenderness = common + not serious
- can cause muscle toxicity so any increase in muscle aches need to be reported
- can cause interstitial lung disease
- seek advice if develop cough, SOB or weight loss
common side effects = nausea, constipation, diarrhoea, headache + flatulence
are generally well tolerated + have proven long term safety record
STATINS
what are the key interactions?
- avoid grapefruit
- should discuss any new medications or supplements with doctor or pharmacist as some can interact and reduce effect
CORTICOSTEROIDS
what do you want to know from patient background?
- what condition they take steroids for
- current symptoms and management
- allergies
- contraindications
- pregnancy
- drug history
CORTICOSTEROIDS
which conditions are treated with corticosteroids?
RHEUM
- RA
- SLE
- polymyalgia rheumatica
- temporal arteritis
- sarcoidosis
GI
- crohn’s disease
- ulcerative colitis
RESP
- asthma + COPD
OTHER
- organ transplants
CORTICOSTEROIDS
what are the contraindications and cautions that you need to check for?
- diabetes
- epilepsy
- HTN
- liver disease
- stomach ulcers
- heart failure
- renal impairment
CORTICOSTEROIDS
how would you explain what corticosteroids are?
- medications to reduce inflammation or dampen down the immune system
- commonly used to treat conditions such as asthma, RA and skin conditions such as aczema
CORTICOSTEROIDS
how do you explain how steroids work?
- work by reducing inflammation or suppressing the immune system
- do this by changing how some cells behave
- reduces swelling, redness and pain from inflammation
CORTICOSTEROIDS
how should they be taken?
- taken at the same time each day (in the morning as they cause insomnia)
- with or just after a meal (typically breakfast)
- take all tablets at the same time
CORTICOSTEROIDS
what is the duration of treatment?
- depends on how well your body responds to treatment
- depends on nature and severity of condition
- try to use them for the shortest time possible to reduce side effects
CORTICOSTEROIDS
what should you do about missed doses?
- take it as soon as you remember
- if it is almost time for next dose, skip missed dose + resume usual schedule (don’t double dose)
CORTICOSTEROIDS
what is the monitoring?
BEFORE STARTING
- baseline BP, weight and eye exam
- blood test to check blood sugar + electrolytes
WHILST TAKING
- regular reviews
- monitor BP, blood sugar + weight
CORTICOSTEROIDS
what are the side effects?
SHORT TERM
- sleep disturbance + insomnia
- weight gain (increased appetite + water retention)
- mood changes
LONG TERM
- muscle + bone weakness
- stomach ulcers
- mental health problems
- increased risk of infection
- diabetes
- hypertension
- cataracts
if you notice new symptoms let your doctor know
will be reviewed regularly to monitor for side effects
most short term SE resolve when steroids are stopped
CORTICOSTEROIDS
what happens if steroids are suddenly stopped?
- dose needs to be reduced gradually
- very important to not stop suddenly
- can cause life-threatening condition called adrenal crisis = body’s natural production of steroids has been switched off
SYMPTOMS
- abdominal pain
- nausea
- dizziness
- fever
- headache
- weight loss
- feeling extremely tired or weak
if these symptoms occur, seek urgent medical attention
CORTICOSTEROIDS
what is a steroid emergency card?
- should always carry card if you take regular steroids
- important if you become unwell
- the healthcare team need to know you take steroids as missing doses or stopping suddenly can be life-threatening
CORTICOSTEROIDS
what are the sick-day rules?
- body would normally produce more steroids during illness
- because body is dependant on steroids being taken, it is important to increase dose when ill
- please contact us if you become unwell
METFORMIN
what do you want to know about patient history?
- symptoms and management
- why they need to take metformin
- allergies
- contraindications
- drug history
METFORMIN
what are the contraindications and cautions for metformin?
- any problems with liver or kidneys?
METFORMIN
how would you explain what metformin is?
- long term treatment to manage diabetes by helping control blood sugar levels
- first treatment we try in type 2 DM
- advantage = doesn’t cause blood sugar levels to drop too low
METFORMIN
how would you explain how metformin works?
- lowers blood glucose levels
- reduces glucose (sugar) taken up by the liver into blood + increases glucose uptake by cells
- important to control blood glucose as it can damage nerves and blood vessels over time
- result in loss of feeling in hands and feet, vision loss, heart disease and stroke
METFORMIN
how should it be taken?
- given in tablet form
- taken at the same time each day
- taken with food or just after eating
- dose will be increased slowly, this reduces chance of side effects
METFORMIN
what is the duration of treatment?
- treatment = lifelong
- will likely take it long term
- may need to change dose depending on blood sugar levels
METFORMIN
how would you explain the different types of metformin?
- standard and modified release
- if struggling with side effects of standard, can be changed to modified release which typically causes less stomach upset
METFORMIN
what should you do if you miss a dose?
- don’t take two doses together
- take next dose as normal
METFORMIN
what is the monitoring?
BEFORE
- blood test to check kidney function
DURING
- blood test to check kidneys at least once per year
METFORMIN
what are the side effects?
COMMON
- feeling or being sick
- diarrhoea
- stomach ache
- taste disturbance
- weight loss (beneficial)
RARE BUT SERIOUS
- B12 deficiency (breathless, tired, faint, pins and needles)
- tell doctor if you are unwell as could cause lactic acidosis (very tired, fever, breathless, chest pain, abdo pain, vomit)
- before scans, inform staff you are taking metformin as you may need to stop taking it
METFORMIN
what is the lifestyle advice?
DIET
- balanced diet
- fruit and veg
- limit starchy food e.g. potatoes, white bread, pasta
- minimise sugar, fat and salt
EXERCISE
- 150 mins exercise per week
- helps maintain healthy weight, blood sugar + reduce risk of heart disease, stroke and cancer
SMOKING + ALCOHOL
- no more than 14 units per week
- no more than 2 units per day
METFORMIN
what is the follow-up?
- HbA1c checked every 3 months + then every 6 months when stable
- annual diabetic review with foot exam, eye exam, BP + blood tests to check cholesterol
METHOTREXATE
how would you explain what methotrexate is and how it works?
- medication used to decrease inflammation
- will reduce symptoms associated with RA such as joint pain, swelling and stiffness
METHOTREXATE
how is it taken?
- take as prescribed on the same day each week
- taken with or without food
- will be prescribed a second medication called folic acid
- never take folic acid on same day as methotrexate
METHOTREXATE
what is important to know about methotrexate?
- should not be stopped without talking to doctor
- mention you are on methotrexate as it can affect medical decisions
- vaccines = may need to alter/suspend dose
- do not take anti-inflammatory meds e.g. ibuprofen
- do not take antibiotic e.g. trimethoprim
METHOTREXATE
what are the side effects?
COMMON
- loss of appetite
- nausea
- diarrhoea
- headaches
- tiredness
- hair loss
RARE BUT SERIOUS
- dark urine, yellowing skin
- sore throat, bruising, mouth ulcers, abo pain, vomiting
METHOTREXATE
what is the monitoring?
BEFORE
- will have FBC, U&Es and LFTs every 1-2 weeks at start of treatment
- TB and viral hep test before treatment
- pregnancy test
DURING
- once stabilised, should be monitored every 2-3 months
- require effective contraception
CLOZAPINE
how would you explain what it is and when it is used?
- sometimes medications do not treat symptoms of schizophrenia
- after trials of at least 2 other medications which have not worked
- referred to as treatment-resistant schizophrenia
CLOZAPINE
how is it taken?
- tablet or liquid
- dose is titrated up
- 6/10 people benefit
CLOZAPINE
what are the side effects?
COMMON
- sedation
- constipation
- tachycardia
- hypersalivation
- blood pressure changes
- hyperglycaemia
RARE BUT SERIOUS
- drop in white cells (agranulocytosis) = seek urgent medical attention if develop flu-like symptoms
- lowers seizure threshold
- heart complications (myocarditis + cardiomyopathy)
CLOZAPINE
what is the monitoring?
BASELINE
- ECG
- BP and pulse
- BMI
- FBC, U&Es, LFTs, prolactin, HbA1c + lipids
MONITORING
- blood test weekly for first 18 wks
- changes to every 2 weeks until 1yr
- monthly after 1yr
EPI-PEN
what should you include in your explanation?
- what it is
- the features
- when to use it
EPI-PEN
what is an epi-pen?
- been prescribed an epi-pen for allergies as you had a recent severe allergic reaction
- it is used to give adrenaline for the emergency treatment of a severe allergic reaction
EPI-PEN
what are the features?
- blue safety cap to stop it being accidentally activated
- viewing window, should check solution is clear + colourless
- check expiry date
EPI-PEN
when should it be used?
- used to treat allergic reactions, anaphylaxis
- symptoms vary but generally develop very suddenly
- include feeling faint, breathing difficulties, wheezing, fast heart rate, confusion or loss of consciousness
- should use epi-pen if in any doubt
EPI-PEN
how is it used?
- remove pen from carry case
- remove safety cap
- blue to sky, orange to thigh
- jab pen into upper outer thigh (can be used over clothes but not zips)
- hold in place for 3 seconds
- after using, dial 999
- keep legs raised
- if symptoms persist after 5-10 minutes, use 2nd pen
LEVOTHYROXINE
how would you explore ICE?
IDEAS
- do you know what hypothyroidism is
- have you heard of levothyroxine
- do you know what it is used for
CONCERNS
- anything in particular worrying you
EXPECTATIONS
- anything you are hoping to get from our discussion
LEVOTHYROXINE
what should you explore from history taking?
specific symptoms
- weight gain
- cold intolerance
- dry skin
- constipation
medications
- PPIs
- iron supplements
LEVOTHYROXINE
how would you explain what hypothyroidism is?
- thyroid = gland in neck
- produces hormone called thyroxine which regulates many aspects of metabolism such as heat control, weight and energy levels
- hypothyroidism = when thyroid does not produce enough thyroxine
- symptoms include weight gain, dry skin, constipation + feeling colder
LEVOTHYROXINE
how would you explain what levothyroxine is?
- medication that tops up level of thyroxine in people unable to make enough on their own
- can restore normal levels of thyroid hormone + prevent you feeling symptoms
LEVOTHYROXINE
how should it be taken?
- take every morning before breakfast
- food and coffee can reduce amount of medication absorbed
- will most likely need to take meds for rest of your life
- important to not stop taking med suddenly or change number of tablets without talking to doctor
- if you miss a tablet, take it as soon as you remember but avoid taking two doses to make up
LEVOTHYROXINE
what is the monitoring?
- blood tests 4-6 weeks after starting
- rechecked every 3 months until levels are stable
- then checked once per year once stable
LEVOTHYROXINE
what are the side effects?
too much levothyroxine
- heat intolerance
- palpitations + chest pain
- diarrhoea
- weight loss
- fine tremor
inadequate dose of levothyroxine
- cold intolerance
- weight gain
- low mood
- constipation
- dry skin
IRON SUPPLEMENTATION
how would you explore ICE?
IDEAS
- have you heard of iron supplements before
- do you know why iron is important
- have you been told that you have low iron before
CONCERNS
- any worries
- any concerns about physical health
EXPECTATIONS
- do you understand the benefits
- what are you hoping iron supplements will do
IRON SUPPLEMENTATION
what is the role of iron in the body?
- key role in lots of different processes including allowing RBCs to transport oxygen to tissue
- helps immune system fight infections
IRON SUPPLEMENTATION
what are the symptoms of iron deficiency anaemia?
- if left untreated, it can lead to a wide range of symptoms
- feeling tired
- out of breath
- dizzy
- palpitations
- headaches
- paler skin
IRON SUPPLEMENTATION
what are the causes of iron deficiency anaemia?
- because of blood loss = once levels have been restored, you should be able to stop taking it
- current diet does not provide enough = use supplements to replenish whilst trying to incorporate more iron in diet
- coeliac disease = reduces ability of bowel to absorb iron from food. Will need to take supplements long term
IRON SUPPLEMENTATION
when should it be taken?
- take 1 hour before meals
- if it makes you feel sick, can take just after a meal to reduce side effects
IRON SUPPLEMENTATION
how should it be taken?
if long term
- involve taking one tablet per day for the foreseeable
if treatment dose
- take once daily for 3-6 months
- levels will then be checked to see if you need to continue for longer
if IV
- has a risk of anaphylaxis so require constant monitoring during infusion
IRON SUPPLEMENTATION
what are the side effects?
- nausea
- constipation
- diarrhoea
- dark coloured stools
- metallic taste
many of the side effects will reduce with time
get in touch if struggling to cope
IRON SUPPLEMENTATION
what is the dietary advice?
- increase iron intake (red meat, leafy veg, dried fruit)
- increase vitamin C intake as it helps you to absorb iron (citrus fruit, orange juice)
LITHIUM
how would you explore ICE?
IDEAS
- have you heard of lithium
- what do you know about lithium
- do you know what it is used for?
CONCERNS
- any worries
EXPECTATIONS
- what were you hoping to get out of our discussion
LITHIUM
what should you explore in patient history?
- what has been going on in the lead up to you being prescribed lithium
LITHIUM
how would you explain what lithium is and how it works?
- works by changing the way your brain processes signals to stabilise your mood
LITHIUM
how should it be taken?
- same time everyday
- can be taken at any time
- if you miss a dose, don’t take double dose. Just take next dose as normal
- will be given book to record test results + doses. Important to keep it with you
LITHIUM
what is the monitoring?
- blood test once per week until dose becomes stable
- blood test needs to be at least 12 hours after previous dose
- once stable, blood tests are every 3 months
- check kidney function + thyroid function twice per year
- if it works, you will likely take it for foreseeable
LITHIUM
what are the side effects?
COMMON
- increased thirst
- increased volume + frequency of urination
- tiredness
- weight gain
- fine tremor
CONCERNING (TOXICITY)
- confusion
- drowsiness
- problems with vision
- loss of appetite
- difficulty speaking
- seizures
- excessive thirst
should seek urgent attention if have any concerning features
risk of toxicity is reduced by taking dose at same time each day
LITHIUM
what advice should you give about pregnancy?
- associated with birth defects in 1st trimester
- can be passed in breastmilk
- should use a reliable form of contraception such as implant or IUS to prevent pregnancy
- speak to psychiatrist if wanting to start a family so they can consider alternative medications
SSRIs
how would you explain what SSRIs are?
- type of medication used to improve mood
- low levels of chemical messenger called serotonin are thought to play role in low mood, sleep and energy issues in depression
- SSRIs increase serotonin which should improve symptoms + may help you to engage in activities and therapies
- some people feel benefits after 1-2 weeks but full benefit is generally seen after 4-6 weeks
SSRIs
how should they be taken?
- one tablet taken once per day
- doses are gradually increased until optimum dose
SSRIs
what should be done is a dose is missed?
- take it as soon as you remember unless next dose is due
- if next dose is due, omit missed dose + take next dose as normal
SSRIs
what are the effects of suddenly stopping SSRIs?
- flu-like symptoms
- electric shock sensations
- GI upset
- anxiety
- dizziness
- seizures
symptoms resolve once start taking SSRIs regularly again
SSRIs
what are the side effects?
COMMON
- nausea and abdominal pain
- changes to bowel habits
- agitation + anxiety
- headaches
- dizziness
- changes to sleep
- sexual dysfunction
LESS COMMON BUT SERIOUS
- hyponatraemia
- significantly worse mood
- suicidal ideation (seek medical attention immediately)
SSRIs
what are the interactions?
need to tell people you take SSRIs before being prescribed any new medication or before taking any recreational drugs
risk of serotonin syndrome
- where levels of serotonin are dangerously high
- if experiencing severe diarrhoea, racing heart, feeling sweaty or shivery, muscle twitches or confusion, seek medical attention
- ask doctor/pharmacist before taking over the counter medicines such as ibuprofen, or supplements such as st johns wort
SSRIs
what is the lifestyle advice?
DRIVING
- if experiencing side effects such as dizziness, drowsiness or blurred vision you should avoid driving or operating machinery
- if symptoms persist dr may change medication + should inform DVLA
HEAT SENSITIVITY
- in summer be conscious of heat sensitivity
- drink plenty of water
PREGNANCY
- inform doctor if you become pregnant whilst taking
- not recommended in first 3 months
- should have discussion about risks and benefits
SSRIs
what is the monitoring?
- will need to see doctor one week after starting SSRI to discuss how medication is working for you and if you have any side effects
- will then arrange to see you after 1 month
- contact doctor at any time if you are concerned
ACE INHIBITORS
how would you explain what HTN is and why it should be treated?
- is a common condition
- caused by multiple factors
- salt, poor diet, and lack of exercise
- try to treat by changing aspects of lifestyle
- sometimes require medication as well
- HTN increases the risk of other conditions such as heart disease, irregular heart rhythms, heart attacks + erectile dysfunction
- controlling BP reduces risks
ACE INHIBITORS
what is the general management of HTN?
LIFESTYLE
- limit daily salt intake to 6g
- reduce smoking and drinking alcohol (offer services + leaflets)
DRUGS
- various drugs can be used
- each drug works in a different way
- a combination may be used
- important to take medication each day
- let pharmacist/doctor know you take ACEi before starting any new medications
ACE INHIBITORS
what are the side effects of ACE inhibitors?
- dry cough (if not tolerable, can change to a different medication)
- tummy upset
- rash
- feeling sick
- dizziness due to low BP
rarer = swelling of face + neck (seek medical attention)
ACE INHIBITORS
what is the monitoring?
- annual BP check
- recommend buying own BP monitor to measure regularly
- blood tests before starting treatment + after every dose increase
- blood test each year once stable
ALCOHOL CESSATION
how would you go about discussing alcohol cessation?
SPIKES
S = setting
P = perception (ICE, what do you know about alcohol cessation?)
I = invitation (anything in particular you would like to cover?)
K = knowledge (risks and benefits, approach to cessation + how to maintain)
E = exploration (check if it all makes sense, any questions)
S = Summarise
ALCOHOL CESSATION
what are the risks of alcohol consumption?
- associated with a range of cancers
- increases risk of GORD
- cause cirrhosis + liver scarring + chronic liver disease
- anxiety + depression
- can affect relationships and employment
ALCOHOL CESSATION
what are the benefits of alcohol cessation?
- reduce risk of health conditions
- can help mood
- can help relationships + job
ALCOHOL CESSATION
what is the recommended approach to cessation?
- do not suddenly stop as it can cause delirium tremens (withdrawal shakes, confusion, hallucinations + seizures)
- can be life-threatening
- require social support (recommend alcoholics anonymous)
OPTION 1
- cut down slowly over a long period of time
- support services can go over this in greater detail
OPTION 2
- stop entirely and take medication (benzodiazepine) to prevent withdrawal
- can be done at home, at a detox unit or sometimes in hospital
ALCOHOL CESSATION
how can cessation be maintained?
- ways to help support
- drugs can help
- acamprosate = reduce cravings
- disulfiram = even a small amount of alcohol causes unpleasant hangover effect + bad vomiting
- can give leaflets
AMITRIPTYLINE
how would you explain what it is and how it works?
- type of tricyclic antidepressant
- can help with pain
- is a different dose to when it is used to treat depression
- thought to work by increasing serotonin in brain
- this changes the way your nerves receive pain signals so the pain goes away
AMITRIPTYLINE
how should it be taken?
- once daily
- can take 4-6 weeks to feel benefit
- do not stop suddenly as there is a risk of withdrawal
- let doctor know before stopping, as it needs to be tapered
AMITRIPTYLINE
what is the monitoring?
- won’t need any regular blood tests
AMITRIPTYLINE
what are the side effects?
- weight gain
- fatigue
- constipation
- drowsiness
- blurry vision
- dry mouth
- need to discuss with doctor before getting pregnant as need to weigh up risks and benefits.
- no evidence of birth defects, but no large studies done
DOAC
how would you explain how it works?
- affects proteins in your blood that help your blood clot
- reduces the risk of clots forming + causing strokes
DOAC
how should it be taken?
- tablet once or twice daily
- recommend taking lifelong unless told otherwise
- some medications of this class need to be taken with food
- important to not miss doses
DOACS
what are the side effects?
- bleeding
- bruising
(avoid contact sports) - if have prolonged bleeding, seek urgent medical attention
- let pharmacists know you are taking medication before taking anything new
DOAC
what is the monitoring?
- blood tests before starting to check liver and kidney function + clotting
- have follow-up in one month to check for any problems
- will then have check up every 3-6 months
GLICLAZIDE
how does it work?
- stimulates pancreas to secrete insulin which reduces blood sugar levels
- usually taken once per day in mornings
GLICLAZIDE
what are the side effects?
- weight gain
- tummy discomfort
- nausea
- low blood sugar (need to notice if feeling dizzy, weak, hungry, shaky, palpitations)
- would need to sit down, eat or drink something sugary
GLICLAZIDE
what lifestyle modifications can be done alongside drug treatment?
- lose weight
- stop smoking
- reduce alcohol consumption
- exercise regularly
GLICLAZIDE
what should you do about a missed dose?
- skip missed dose
- take next dose at usual time
- do not take 2 doses to make up for a forgotten dose
INSULIN
how is it taken?
- lots of different regimes
- most common = basal bolus
- inject long acting insulin to get you through the day + short acting insulin at meal times
- insulin is injected into fatty layer of tummy
- need to switch site daily to help it absorb better + prevent hard lumps
INSULIN
what are the side effects?
- hard lumps (rotate injection sites)
- swelling
- hypoglycaemia (sweating, anxiety, feeling hungry, blurred vision + trembling). Will need to eat or drink something sugary
INSULIN
what is the monitoring?
- check HbA1c every 3-6 months
- check blood glucose 4 times daily ( before each meal or large snack + before bed)
- aim for blood glucose 5-7
INSULIN
what is the advice for driving?
- required by law to check blood glucose no less than 2hrs before driving
- remember to check every 2hrs on long journeys
- carry lots of sugary snacks in case of low blood sugar
- if feeling low, stop as soon as it is safe, get out of drivers seat + measure blood glucose. Treat low + do not drive for 45 mins after symptoms have subsided
- must tell DVLA about diagnosis
LEVADOPA
how does it work?
- increases dopamine levels in the brain
- helps with symptoms of PD such as rigidity, shaking + slow movement
- give it with another drug (carbidopa) which increases levels of levodopa in the brain so it is more effective
LEVODOPA
how should it be taken?
- taken 3-4 times per day
- needs to be taken with food
- dose is slowly increased over time
- is a long term medication
- works quickly but can build up a tolerance to doses
LEVODOPA
what are the monitoring requirements?
no regular monitoring requirements
LEVODOPA
what are the side effects?
- hallucinations (suggests dose is too high)
- involuntary movement (when taken for a long time)
- dry mouth
- nausea and vomiting
- dizziness + falls (low BP)
OLANZAPINE
how does it work?
- is a type of antipsychotic
- reduces symptoms of schizophrenia e.g. hallucinations, paranoia or delusions
- work by blocking chemical called dopamine which is too high in brain
OLANZAPINE
what are the side effects?
- sedation
- weight gain
- drowsiness
- constipation
- dry mouth
- high blood sugars
OLANZAPINE
how should it be taken?
- should be taken everyday as prescribed
- can take a while to work (several weeks)
- if missed a dose, take as soon as remember
- do not take 2 doses at the same time to make up for a missed dose
- should not be stopped suddenly
- should discuss side effects with doctor
OLANZAPINE
what is the monitoring?
BEFORE TREATMENT
- height + weight
- ECG
- blood tests
OPIOIDS
why are they not good for chronic pain?
- body can build up a tolerance
- are very addictive
- may experience withdrawal + side effects when stopping
- have more side effects (drowsiness, constipation, dry mouth + hallucinations)
- can affect ability to drive + work
- can affect breathing + cause respiratory depression which can be fatal
PrEP
what is it?
- stands for pre-exposure prophylaxis
- medication taken before + after sex
- can help prevent being infected with HIV
- is a combination of 2 medications
- studies show it is up to 99% effective
PrEP
how should it be taken?
2 ways
DAILY DOSING
- taken everyday
- vaginal sex = 7 days of medication required before
- anal sex = 2-24hrs of medication required before
EVENT BASED
- take medication before sex + for period after sex (2 tablets before, 1 tablet after 24hrs, 1 tablet after 48hrs)
PrEP
what are the side effects?
- headache
- nausea
- upset stomach
all tend to settle within a few weeks
PrEP
what are the risks?
- can affect bone density + renal function
- HIV can become resistant to PrEP (should have HIV test every 3 months)
- need close monitoring if you have Hep B
PrEP
what is the monitoring?
- STI testing every 3 months
- HIV test every 3 months
- urine test every 3 months
- blood test once per year
PrEP
what vaccinations are recommended?
- Hep B
- Hep A
- HPV
PrEP
what should you do if you miss a dose?
- occasionally missing dose should not be an issue
- if missed multiple doses in a week, may require PEP
- PEP = not as effective as PrEP but still helpful in reducing HIV
CHILDHOOD IMMUNISATIONS
how would you explain the importance of vaccines?
- very safe and almost all babies have them
- reason is to protect baby from harm and to protect community as a whole
- dramatically lowers the risk of catching illness that could be extremely harmful in both short and long term
- aim to vaccinate enough people to stop diseases completely (like with smallpox)
CHILDHOOD IMMUNISATIONS
which vaccines are administered at 8 weeks?
- 6 in 1 vaccine (diptheria, hep B, HiB, polio, tetanus, whooping cough)
- rotavirus
- Men B
CHILDHOOD IMMUNISATIONS
which vaccines are administered at 12 weeks?
- 6 in 1 vaccine (diptheria, tetanus, polio, Hep B, Hib, whooping cough)
- PCV (pneumococcal)
- rotavirus
CHILDHOOD IMMUNISATIONS
which vaccines are administered at 16 weeks?
6 in 1 vaccine (diptheria, tetanus, polio, Hep B, Hib, whooping cough)
- men B
CHILDHOOD IMMUNISATIONS
which vaccines are administered at 12m?
Hib/men C booster
MMR (1st dose)
PCV (pneumococcal)
Men B
CHILDHOOD IMMUNISATIONS
what vaccines are given at 3yrs and 4months?
MMR (measles, mumps and rubella)
4 in 1 booster (diptheria, polio, tetanus, whooping cough)
CHILDHOOD IMMUNISATIONS
what vaccines are given at 12-13yrs?
HPV vaccine
CHILDHOOD IMMUNISATIONS
what are the side effects of vaccines?
- normal for child to cry + be upset from injection
- may be more irritable for 48hrs
- may have a bit of a temperature (give calpol + cold compresses)
SERIOUS/RARE
- allergy (complications of diseases are far more common than complications of vaccine)
CHILDHOOD IMMUNISATIONS
what is the link between autism and MMR?
- no link between them
- one paper was published many years ago which claimed a link
- it has since been discredited
- research was on a small group of individuals and the outcomes were biased
- the research has been withdrawn and the researcher has lost their medical licence
