Medicines knowledge, 2 Flashcards
1
Q
Warfarin
- drug class
A
- oral anticoagulant
2
Q
Warfarin
- common indications
A
- Prevention and treatment of VTE
- Prevention of stroke in patients with previous MI and increased embolic risk
3
Q
Warfarin
- dosing
A
- Adult, oral, usually 5 mg OD for 2 days, then adjust according to INR
- Usual maintenance dose, 1–10 mg OD taken at the same time each day
- Target INR: 2–3 for all indications except heart valves
4
Q
Warfarin
- key counselling points
A
- brand of tablets can’t be changed
- take tablets at the same time each day
- you need regular blood tests (INR) with this medicine; call for the result within 24 hours of the test and before the next dose, in case it needs adjusting
- watch out for effects such as diarrhoea, vomiting, infection or fever
- unexplained bruising, bleeding, pink, red or dark brown urine, or red or black faeces
- Warfarin is affected by vitamin K, which is found in certain foods. Eat a normal, balanced diet (including green vegetables) without varying it too much, to keep your intake of vitamin K stable
- avoid drinking large amounts of cranberry juice as this may increase the effects of warfarin
5
Q
Warfarin
- monitoring
A
- determine INR shortly before starting warfarin and then according to local protocol (eg every second day if warfarin 5 mg dose schedule is used) until INR is stable in the therapeutic range. In the long term, check INR at intervals of no more than 4 weeks
- determine INR more frequently in patients at increased risk of haemorrhage or if there are changes in the patient’s condition, eg:
- intercurrent illness (eg heart failure, hepatic disease, GI disturbances, infections, thyroid disorders)
- concurrent drugs
- diet (eg green, leafy vegetable consumption) and alcohol consumption
6
Q
Oxycodone
- drug class
A
- opioid analgesic
7
Q
Oxycodone
- common indications
A
- severe pain
- acute or chronic pain
8
Q
Oxycodone
- dosing
A
- oral acute pain
- initially 5–15 mg every 4 hours
- chronic non cancer pain in adult
- start as 4-8 week trial
- review every 1-2 weeks
- controlled release, oral 5–10 mg twice daily
- preferably after meals of with milk
9
Q
Oxycodone
- key counselling points
A
- do not break, crush or chew controlled release tablets
- be careful when you stand up as this medicine might make you feel dizzy if you stand up too quickly
- this medication may make you feel drowsy and may increase the effects of alcohol; if affected- don’t drive
- look after your teeth and mouth, and get dental checks regularly, as opioids may make your mouth dry which increases risk of dental caries
- ADV: N/ V, N may occur initially but will subside, constipation, urinary retention, mioisis, dyspepsia
10
Q
Oxycodone
- monitoring
A
- monitor for side effectcs such as constipation, dry mouth & nausea
- monitor for dependence & withdrawal symptoms
11
Q
Pregabalin
- drug class
A
- antiepileptic
12
Q
Pregabalin
- common indications
A
- focal, partial seizures
- neuropathic pain
13
Q
Pregabalin
- dosing
A
- Focal (partial) seizures
- initially 75 mg BD; if required, increase after 7 days to 150 mg BD, to a maximum of 300 mg BD after a further 7 days
- Neuropathic pain
- initially 75 mg at night for 3–7 days, then 150 mg daily in 1 or 2 doses. If required, increase after 7 days to 150 mg BD, and to a maximum of 300 mg BD after at least another 7 days
- can be with or without food
14
Q
Pregabalin
- key counselling points
A
- may cause drowsiness or dizziness; if affected, do not drive or operate machinery
- may also increase the effects of alcohol
- ADV: blurred vision, constipation, insomnia, ataxia, memory impairment, irritability
- avoid stopping abruptly (may cause anxiety, insomnia, headache, sweating, nausea and diarrhoea); gradually reduce dose over at least a wee
15
Q
Pregabalin
- monitoring
A
- adverse effects
- muscle cramps, rash, flushing, hallucinations, cognitive impairment- tell Dr
- seizures
16
Q
Tramadol
- drug class
A
- opioid analgesia
17
Q
Tramadol
- common indications
A
- severe pain
- chronic or acute pain
18
Q
Tramadol
- doses
A
- IR dose: 50-100mg q4-6h max: 400mg/daily (max 300mg/d for >75y)
- SR dose: 50-200mg q12h same max dose
19
Q
Tramadol
- key counselling points
A
- may cause drowsiness
- be careful when you stand up as this medicine might make you feel dizzy if you stand up too quickly
- be aware of dental hygiene: dry mouth, risk of dental caries
- ADV: CNS stimulation, weakness, sweating, sleep disorder, rash
- pain relief starts within 1 hour and peaks at 2–4 hours after administration of medicine
20
Q
Tramadol
- monitoring
A
- adverse effects; constipation, N/V
- dependence & withdrawal effects
21
Q
Levothyroxine
- drug class
A
- thyroid hormone
22
Q
Levothyroxine
- common indications
A
- hypothyroidism
- block-replacement regimen in hyperthyroidism
- suppressive regimen in thyroid cancer
23
Q
Levothyroxine
- dosing
A
- adult: 50-200mcg daily ~1.6mcg/kg ideal body weight
- elderly: 25-50mcg daily, increasing by 25mcg daily every 6 weeks
- should be taken in the morning, with water on an empty stomach
- take 30min or preferably 60 min before food
24
Q
Levothyroxine
- key counselling points
A
- if Eutroxsig or Oroxine brand, needs to be in the fridge
- take on an empty stomach, preferably before breakfast
- ADV: tachycardia, arrhythmia, excitability, insomnia, flushing, sweating, diarrhoea and excessive weight loss–> tell DR
25
Q
Levothyroxine
- monitoring
A
- symptoms of hyperthyroidism due to excessive dose: tachycardia, arrhythmia, excitability, insomnia, flushing, sweating, diarrhoea and excessive weight loss
- stop levothyroxine for a week and restart at lower dosage
- monitor for decreased bone density and fractures; they have been reported, particularly in overtreated postmenopausal women and patients with suppressed TSH
- lab tests for TSH levels & free T4 levels, thyroxine
- thyroid stimulating hormone
