Medications Flashcards
1
Q
- What does PLAY stand for when counselling a patient on a new medication ?
A
- Person/patient
- Level of understanding
- About you (Hx)
- Why do you need this medication
2
Q
- What does ATHLETIC stand for when counselling a patient on a new medication ?
A
- Action
- Timeline
- How to take
- Length of treatment
- Effects
- Tests
- Interactions
- Contraindications
- Side effects
- Supplementary info
3
Q
- What does SCALP stand for when counselling a patient on a new medication ?
A
- Summaries
- Check their understanding
- Ask if they have any questions
- Leaflet
- P(follow)
4
Q
- What are the indications for atorvastatin ?
A
- Primary and secondary prevention of cardiovascular disease
- Familial hypercholesterolemia
5
Q
- What is the MOA for atorvastatin ?
A
- Statin
- Inhibits-5-HMG-CoA reductase an enzyme used to synthesize cholesterol
6
Q
- What is the dose of atorvastatin ?
A
- Primary prevention events = 20mg OD and can be increased up to 80mg OD
- Secondary prevention 80mg OD
7
Q
- What are side effects of atorvastatin ?
A
- Joint pain
- Muscle discomfort
- Nausea and vomiting
- Constipation
- GI discomfort
8
Q
- What monitoring should be done for atorvastatin ?
A
- Before starting LFTs, TFTs and U&E
- LFTs repeated at 3 months and 12 months
- If >3 times the upper limit of normal then stop
9
Q
- What rare but serious condition should patients be counselled on for atorvastatin ?
A
- Rhabdomyolysis
- Explain to the patient that if they develop unexplained muscle pain that they should seek medical advice
10
Q
- What medications does atorvastatin interact with ?
A
- Statins interact with macrolides resulting in exposed exposure which could lead to rhabdomyolysis
- Consider a different antibiotic or stopping atorvastatin during a course of macrolide antibiotics
11
Q
- What are the indications for levothyroxine ?
A
- Hypothyroidism
- Hyperthyroidism block replace with carbimazole
12
Q
- What is the MOA of levothyroxine ?
A
- Synthetic T4 hormone
- Identical to the natural hormone the thyroid produces
13
Q
- What are the side effects of levothyroxine ?
A
- Side effects are usually due to symptoms of hyperthyroidism
- Anxiety, flushing/sweating, fine tremors, diarrhoea, nausea and vomiting
14
Q
- What medications does levothyroxine interact with ?
A
- Antacids, calcium and iron supplements may affect absorption
15
Q
- How should levothyroxine be taken ?
A
- Taken in the morning 30 minutes before breakfast and drinks containing caffeine
- Absorption of levothyroxine is reduced by food and caffeine
16
Q
- How should levothyroxine be monitored ?
A
- TSH every 3 months until stable with dosing adjustments if required
- Afterwards TSH is monitored once yearly
17
Q
- What are indications of PPIs ?
A
- GORD
- Prevention of gastric and duodenal ulcers (with NSAID or steroids)
- Indigestion
- Treatment of gastric and duodenal ulcers and Helicobacter pylori in combination amoxicillin and (clarithromycin or metronidazole)
18
Q
- What is the mechanism of action for PPIs ?
A
- Proton pump inhibitors
- Bins to the H+/K+ ATPase pump inhibiting acid (H+) secretion
19
Q
- What are side effects of PPIs ?
A
- Nausea, vomiting, stomach pain, constipation and flatulence
- Long term – osteoporosis, clostridium difficle infection, hypomagnesaemia and Vitamin B12 deficiency
20
Q
- What are long term side effects of PPIs that should be communicated to patients ?
A
- Osteoporosis, clostridium difficle infection, hypomagnesaemia and Vit B12 deficiency
21
Q
- What interactions does omeprazole have ?
A
- SSRIs – risk of SS
- Reduces the effectiveness of clopidogrel
- Increases exposure to methotrexate
22
Q
- What are the indications for amlodipine ?
A
- HTN and angina
23
Q
- What is the MOA for amlodipine ?
A
- CCN acts on calcium channels and inhibits influx of calcium in the vascular smooth muscle resulting in reduced contractility and vasodilation
24
Q
- What are side effects of amlodipine ?
A
- SEs are linked to vasodilation of blood vessels
- Dizziness, flushing, palpitations, headaches, peripheral oedema and headaches
25
22. What are key counselling points with amlodipine ?
- Inform patients that amlodipine may make them feel dizzy. If this occurs they should not operate heavy machinery or tools (or cars)
- BP will be monitored during treatment every 6 months
26
23. What medications does amlodipine interact with ?
- Diltiazem and verapamil (non-dihydropyridine CCBS) these medications act on similar receptors increasing the risk of side effects and arrhythmias
- Simvastatin –increased exposure and therefore risk of rhabdomyolysis
- Hypotension when used with other medications and so patients should monitor for hypotension symptoms
27
24. What are indications for ramipril ?
- HF and HTN (under 55 or T2DM)
- Proteinuric renal disease
28
25. What is the mechanism of action for ramipril ?
- Prevent the conversion of angiotensin 1 to angiotensin 2 (a vasoconstrictor)
- This results in smooth muscle vasodilation leading to low blood pressure
29
26. What is the dose for ramipril ?
- Typical is 1.25 to 2.5 mg once daily
- Can be increased up to 10 mg once daily
30
27. What are side effects of ramipril ?
- A dry cough is the most common side effect (this occurs due to the accumulation of bradykinin)
- ACE-I can cause hyperkalemia and thus should be monitored
- Angioedema is a serious side effect and may compromise the airway and this patients should be advised to seek immediate medical attention should this occur
31
28. What are key counselling points of ramipril ?
- Patients should be informed of side effects of ramipril (dry cough and risk of angioedema)
- Check U&E before and after and monitor BP and adjust accordingly
32
29. How should ramipril be monitored ?
- U&E before treatment and then throughout treatment
33
30. What medications does ramipril interact with ?
- NSIADs reducing renal function and risking hyperkalaemia
- Increases lithium concentration
34
31. What are indications for bisoprolol ?
- HTN, HF
- AF
- Following an MI
35
32. What is the MOA for bisoprolol ?
- Antagonism of B1 receptors of the autonomic nervous system
- Reducing contractility of the heart (negative inotropic effect)
36
33. What is the dose of bisoprolol ?
- HTN or angina initially 5mg once daily (usually maintenance of 10mg OD)
- HF increased in increments and titrated for effects between 1.25mg-10mg OD
37
34. What are side effects of Bisoprolol ?
- Cold peripheries, headaches, syncope, erectile dysfunction, dizziness and hypotension
- Sleep disturbances e.g. walking up and nightmares
- Can cause bronchospasm due to B2 antagonism and thus should be avoided in patients with asthma
38
35. What medications does Bisoprolol interact with ?
- Non-dihydropyridine CCBs e.g. verapamil and diltiazem may result in complete heart block
- Can be used with dihydropyridine CCBs e.g. amlodipine and felodipine
- Should not be given with amiodarone – can result in complete heart block
39
36. What is colecalciferol used to treat ?
- Treat and prevent vitamin D deficiency
40
37. What are the indications for metformin ?
- Commonly used for treatment of T2DM
- Polycystic ovary syndrome
41
38. What is the dose of metformin ?
- 500mg daily
- Increased gradually to 2 grams OD
42
39. What are common side effects of metformin ?
- GI disturbance e.g. Abdominal pain; appetite decreased; diarrhoea and vomiting
- Taste disturbance (metallic)
- May cause B12 deficiency
- Can cause weight loss
- Rare risk of lactic acidosis
43
40. What are key counselling points of metformin ?
- Minor side effects of GI and taste disturbance, weight loss and appetite decrease
- But also the rare risk of lactic acidosis and to seek medical attention if symptoms such as abdominal pain, nausea, vomiting, SOB and muscle cramps
- U&E should be monitored before treatment and yearly after starting
- Should not be used if eGFR is <30ml/min/1.37m2
- Modified release metformin is available for GI upset
44
41. What should be monitored in metformin taking patients ?
- Can interact with radiological contrasts so should be withheld at least 48 hours before using intravenous contrast agents.
