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Prescribing > Medication Counselling > Flashcards

Medication Counselling Flashcards

1
Q

What is the general approach that should be taken to medication counselling?

A

ATHLE(IT)CS

A - Action
What the Rx is and how it works

T - Timeline
When to take them meds

H - How to take
PO, SC, topical

L - Length of Rx

E - Effects
Usual time before effects become apparent and the important SEs

T - Tests
Monitoring blood tests that are required

C - Contraindications

S - Supplementary advice
Offer written literature

ICE
SUMMARISE

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2
Q

Antipsychotics - Action

A

Schizophrenia is caused by an over-activity of chemicals that transmit messages in the brain.
Antipsychotics work by blocking the receptors in the brain that respond to the over-active chemicals, and reduce the signals being sent.

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3
Q

Antipsychotics - Timing and How to take

A

(Antipsychotic) is a tablet that is taken once a day, or can be given as an injection every few weeks

We will start at a low dose and then gradually build it up depending how you respond

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4
Q

Antipsychotics - Length

A

Usually patients take these medications long term if they are working for them

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5
Q

Antipsychotics - Effects (how long to take effect)

A

It usually takes a few weeks before you will start to see an effect

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6
Q

Antipsychotics - Effects (important side effects)

A

Important SEs:
(contact the doctor if you experience)

  • Weight gain and increase blood sugar levels (increases the risk of diabetes, strokes and heart attacks) so its important to keep a healthy diet on these medications and also we will monitor blood tests to make sure this isn’t happening to you.
  • Movement problems
    e. g. restless legs, muscle spasms/ twitches, tremor, stiffness
  • Constipation, dry eyes, dry mouth and trouble passing water
  • Drowsiness
  • Lightheaded

Contact doctor immediately if:

  • feeling very hot, shaking and having very stiff muscles
  • (clozapine only) sore throat and fever
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7
Q

Antipsychotics - Tests

A

All antipsychotics:
3 monthly HbA1c, lipids, BMI and BP

Clozapine:
Weekly FBC for 18/52 then fortnightly for the rest of the year then monthly

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8
Q

Lithium - Action

A

Mania is thought to be due to an imbalance of the chemicals that transmit messages in the brain. The exact way in which lithium works is unknown, but it is thought that it helps to re-establish the normal signals that the nerves in the brain produce

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9
Q

Lithium - Timing and How to take

A

Lithium tablets are usually taken once a day, at the same time every day

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10
Q

Lithium - Length

A

If you respond well to the medication then you may be carry on taking it for the rest of your life

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11
Q

Lithium - Effects (how long to take effect)

A

It might be a few weeks before you start to notice an effect

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12
Q

Lithium - Effects (Important side effects)

A

Important SEs

  • Damage to kidneys/ thyroid gland (but we regularly check blood tests so we can correct changes early)
  • Common = tremor, feeling thirsty, going to the toilet more often, weight gain, swelling, drowsiness
  • Teratogenic!
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13
Q

Lithium - Effects (if you overdose)

A

Dangerous if you take too much (keep well hydrated and always mention to doctors you are taking lithium as other medications can interact)

look out for:

  • Diarrhoea and vomiting
  • Coarse tremor
  • Being very thirsty and passing lots of urine
  • Slurring speech
  • Feeling unsteady when walking
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14
Q

Lithium - Tests

A
  • Lithium levels weekly then 3 monthly when stable

- U&Es and TFTs 6 monthly

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15
Q

Lithium - Contra-indications

A
  • 1st trimester of pregnancy (may be unavoidable)
  • Breast feeding
  • Pre-existing untreated renal impairment or hypothyroidism
  • Untreated hyponatraemia
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16
Q

SSRIs - Action

A

Depression is thought to be due to an imbalance of chemicals that transmit messages in the brain.
Anti-depressant medications work by re-adjusting the balance of some of those chemicals (particularly one called serotonin)

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17
Q

SSRIs - Timing and How to take them

A

SSRIs are tablets that you take once per day, at the same time every day

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18
Q

SSRIs - Length

A

If you respond well we would usually carry on with it until things have been stable for 6-9 months

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19
Q

SSRIs - Effects (how long it takes to have an effect)

A

It usually takes 4-6 weeks before you notice any effect

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20
Q

SSRIs - Effects (important side effects)

A

Important SEs:
- Initially may feel more anxious/ jittery, and some people have thoughts about ending their life (it is really important to talk to someone if this happens - will give phone numbers)

  • Insomnia
  • Headaches
  • Weight gain or weight loss
  • GI upset
  • Loss of libido, or sexual difficulties

It is important to make an appointment if experiencing these NEVER SUDDENLY STOP TAKING THEM - as can have bad withdrawal effects. Important to reduce the dose slowly

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21
Q

Bisphosphonates - Action

A

Osteoperosis is a condition where the bones become brittle as the cells within the bone are causing bone breakdown.
Bisphosphonates work by slowing down the activity of those cells, and therefore helping the bone to become denser

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22
Q

Bisphosphonates - Timing and How to take them

A

These are tablets that you take once per week

It is important you take them first thing in the morning, on the same day every week

Make sure you have an empty stomach, and then take them with a full glass of water

Keep upright (either standing or sitting up straight) and don’t eat anything for 30 minutes after taking them

23
Q

Bisphosphonates - Effects (important side effects)

A

Important SEs:

  • Acid reflux (common)
  • Bloating and indigestion
  • Change in bowel habit
  • Rarely - can damage bone in jaw so it’s important to have regular check ups at the dentist, watch out for pain in the mouth and loose teeth
24
Q

Bisphosphonates - Contra-indications

A
  • Pregnancy

- Stomach ulcers

25
Q

Donepezil - Action

A

Donepezil is a medication that we give to help with your memory, and slow the progression of memory disorders like Alzheimer’s disease.
It works by blocking the breakdown of a stimulant chemical in your brain, increasing brain signal transmission

26
Q

Donepezil - Timing and How to take them

A

It is a tablet that is taken in the evening

27
Q

Donepezil - Length

A

If the medication is working we will carry it on until it doesn’t seem to be having an effect any more

28
Q

Donepezil - Effects (important side effects)

A

Important SEs:

  • Tummy upset
  • Insomnia
  • Headaches
  • Dizziness and feeling light headed
  • Vivid/ scary dreams. hearing/ seeing things that are not there
29
Q

Donepezil - Tests

A

Monitoring is with a memory test at 6 weeks

Then every 6-12 months

30
Q

Warfarin - Action

A

Warfarin is a medication that thins the blood. It works by decreasing the levels of the factors in our blood that trigger blood clots to form

31
Q

Warfarin - Timing and How to take

A

It is a tablet that is taken in the evening (so that if the INR is high that day it can be lowered/ omitted earlier)

It is important to take at the same time every day

We start at a low dose and adjust according to blood test results (your dose may change a lot at the beginning)

32
Q

Warfarin - Length

A

Differs depending on the indication

33
Q

Warfarin - Effects (Advice that needs to be given to the patient)

A

Warfarin thins the blood which increases your risk of bleeding so:

  • Try to avoid activities that risk injury
  • If you notice a big bruise, are bleeding heavily or passing black/ tarry stools it is important to see a doctor
  • Avoid taking Ibuprofen or Aspirin as they can increase the bleeding risk from your stomach
  • Avoid alcohol (effects how warfarin is broken down by the body)
  • Mention to doctors and dentists that you are on warfarin as it interacts with lots of medications and it increases your bleeding risk
  • Teratogenic
  • Avoid cranberry juice and spinach
34
Q

Warfarin - Tests

A

Measure blood levels twice a week for the first two weeks then every week until stable

Then 6-8 weekly after stable

We may need to check more regularly if levels are not stable

35
Q

Statins - Action

A

A statin is a medication that works to decrease the level of bad cholesterol in the blood stream.
By dropping down the bad cholesterol levels, the risks of conditions such as heart attacks and strokes can be decreased

36
Q

Statins - Timing and How to take them

A

It is a tablet that is taken once a day, in the evening

37
Q

Statins - Length

A

Usually we would recommend that you carry on taking statins for a long period of time as they work to decrease your risk over a long period of time

38
Q

Statins - Effects (Important side effects)

A

Common SEs:

  • Muscle aches and pains (common and tend to fade with time. However, if severe or you notice your urine go very dark it is important to see the doctor. this is rare.)
  • Headache
  • Tummy upset
  • Rarely - liver damage
39
Q

Statins - Tests

A
  • LFTs when you start taking them then in 3 months, then after a year
  • Cholesterol levels every 6 months (to check the statin is working well and is the right dose)
40
Q

Statins - Contraindications

A
  • Pregnancy

- Advise the patient to avoid grapefruit

41
Q

Methotrexate - Actions

A

Methotrexate is a medication that works by dampening down the immune system, and by reducing the activity of the immune system it helps to prevent our immune system from damaging and attacking our own cells

42
Q

Methotrexate - Timing and How to take

A

It is a tablet that you take once a week

You must take it on the same day every week and take a folic acid tablet on the other days

43
Q

Methotrexate - Length and How long it takes it have an effect

A

It should start working within 6 months. If it does then we will continue it in the long term

44
Q

Methotrexate - Effects (important side effects)

A

Important SEs:

  • Hair loss
  • Headaches
  • Stomach upset
  • Teratogenic - swap med if want a baby

Rare but serious:
Suppression of bone marrow (report to a doctor if you notice any of the following)
- Abnormal bleeding (avoid aspirin and ibuprofen)
- More tired and breathless than normal
- Fever

Liver damage (so don’t drink excessive alcohol)

Lung damage - so if become breathless or get a persistent cough see a doctor

45
Q

Methotrexate - Tests

A

FBCs, U&Es, LFTs every 2 weeks until dose stabilised

then every 3 months

46
Q

Levodopa - Action

A

Levodopa is a tablet that works by replacing a chemical called dopamine in the brain. It is the chemical that is lacking in the brains of people with Parkinson’s disease

47
Q

Levodopa - Timing and How to take

A

It is a tablet you take three times per day

It is best to take with food

48
Q

Levodopa - Length and time it takes to have an effect

A

You should see effects very quickly
If it works for you we will carry it on long term (but we may have to add in another medication for it to carry on working)

49
Q

Levodopa - Effects (important side effects)

A

Important SEs:
(tell us if experience any of these as can give another medication to reduce them)
- Tummy upset
- Light- headedness
- It can cause people to have vivid dreams or nightmares
- Some people may experience strange sensations, such as hearing or seeing things that aren’t there
- Involuntary movements

50
Q

Metformin - Action

A

Metformin is a tablet that works to decrease your blood sugar by increasing the amount of sugars taken up by and stored in the liver

51
Q

Metformin - Timing and How to use

A

It is a tablet, usually start on one a day and gradually increase the dose as needed.
It is best to take in the morning with food (same time every day)

52
Q

Metformin - Length

A

If it is working we will carry it on long term

53
Q

Metformin - Effects (important side effects)

A

Important SEs:

  • Diarrhoea (common)
  • Weight loss, tummy pain, nausea

Rarely can increase levels of acid in blood so if you become very unwell the see a doctor

54
Q

Metformin - Tests

A

U&Es yearly

Prescribing (4 decks)

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