Medicines knowledge, 4

Question 1

Lis/dexamphetamine

• drug class

Answer 1

• CNS psycho-stimulant

Question 2

Lis/dexamphetamine

• common indications

Answer 2

• dex- narcolepsy & ADHD
• lisdex- binge eating disorder (2nd line) & ADHD
• acts as a stimulant by allowing the brain to focus on the task that is impt & stimulates the brain to suppress some impulsive behaviour, by making DA & NA work more effectively in brain

Question 3

Lis/dexamphetamine

• dose & directions

Answer 3

• lisdexamphetamine
  
  • ADHD: Adult, child >6 years, oral 20–30 mg once each morning; if necessary, increase the daily dose by 20 mg at intervals of at least a week. Maximum dose 70 mg daily
• dexamphetamine
  
  • ADHD: If total daily dose >5 mg, give in 2 or 3 doses (morning, lunch and afternoon).
  • 6–12 years, oral, initially 2.5 mg in the morning for 1 week; increase daily dose by 2.5–5 mg each week, according to response and tolerability, to a usual range of 0.5–1 mg/kg (maximum 40 mg) daily
  • >12 years, oral, initially 5 mg in the morning for 1 week; increase daily dose by 5 mg each week as clinically indicated to a usual range of 0.5–1 mg/kg (maximum 40 mg) daily
• CAL 5 & 12

Question 4

Lis/dexamphetamine

• Key counselling points/ ADV

Answer 4

• Avoid taking doses after early afternoon if you have trouble sleeping at night (this may make you feel drowsy next day)
• This medicine may also make you feel dizzy; do not drive or operate machinery if you are affected
• this medicine can cause dizziness, headaches, palpitations, loss of appetite, dry mouth, nausea
• lisdex- swallow the capsule whole or you can open it and mix the powder in soft food, eg yoghurt, or in a glass of water or orange juice (drink this straight away)

Question 5

Lis/dexamphetamine

• referral

Answer 5

• movement disorders, rash
• if he becomes withdrawn & doesn’t want to socialize

Question 6

Lis/dexamphetamine

• Monitoring

Answer 6

• intervals between dispensing rxs
• BP
• cardiovascular status
• psychiatric status
• height & weight in children
• movement disorders/ aggressive behaviour
• concentration/ focus

Question 7

Lis/dexamphetamine

• lifestyle/selfcare

Answer 7

• continue to use strategies to help stay focused on tasks, this medicine is only used as part of the total programme
• if you’re concerned about appetite/ weight, consult with dietician
• this medicine is important for you, it’s a medicine that some people can abuse, so it needs to be kept in a safe, secure place, also why any repeats for rx are kept in phar
• GP will monitor growth and weight (if child), they may suggest a “drug holiday” eg no medication on weekend or school holidays for chance to catch up on growth
• these medicines have been used for a long time now & there has been no long term problems with growth
• some ppl report improved behaviour in children by eliminating certain foods but no definitive evidence on additives/ preservative/ elimination special diets; Some additives have been shown to sometimes have a slight negative effect on children’s behaviour but doesn’t cause ADHD. Ensure a healthy, balanced diet→ monitor diet, dietician can assist with an appropriate diet.

Question 8

Risedronate

• drug class

Calcium carbonate

• drug class

Answer 8

• bisphosphonates
• calcium supplement? lol

Question 9

Risedronate

• common indications

Answer 9

• treatment of osteoporosis
• treatment and prevention of corticosteroid-induced osteoporosis
• paget’s disease of bone
• prevention of skeletal-related events in patients with malignancies involving bone
• throughout life, old bone is broken down and replaced with new bone. After the age of 35, bone loss may occur faster than your body can replace it. Excessive bone loss causes bones to become thinner and weaker, and therefore more likely to break
  
  • Osteoporosis is a disease that gradually weakens bones–> risk of broken bones
• works by slowing down the process of old bone being removed, which allows the boneforming cells time to rebuild normal bone

Question 10

Risedronate

• dose & directions

Answer 10

• adult, oral 5 mg OD or 35mg once weekly or 150mg once a month
• swallow whole; do not chew or suck on the tablet
• take in the morning with a full glass of plain water at least 30 minutes before food or drink
• stay upright during this time and until after you eat
• EC tablet may be taken with or without food but you must still remain upright for 30 minutes after taking them
• do not take antacids, calcium, iron or mineral supplements within 2 hours of risedronate as they may interfere with its absorption

Question 11

Risedronate

• key counselling points

Answer 11

• works by slowing down the process of old bone being removed, which allows the boneforming cells time to rebuild normal bone
• swallow whole, don’t crush or chew
• normal tablet: take 30m before food or drink
• EC: with or without food doesnt matter
• stay upright for atleast 30 mins after taking it
• don’t take antacids, calcium, iron or mineral supplements within 2 hours of risedronate as they may interfere with its absorption
• stop tablets and see your doctor immediately if you have pain on swallowing, or new or worsening heartburn
• there are rare complications with some dental procedures in people taking bisphosphonates; tell your doctor if you require any dental work and tell your dentist that you are taking this medicine (or have taken it in the past)
• Monthly dose
  • take on the same date of each month. If you miss a dose and your next monthly dose is:
  • more than 7 days away: take it the next morning and then return to taking it on your usual date
  • within 7 days: wait until your next dose and keep taking it on your usual date. Do not take 2 tablets in one week.

Question 12

Risedronate

• adverse effects

Answer 12

• all medicines have side effects but not everyone will experience them
• some common side effects: nausea, vomiting, diarrhoea, headache, hypocalcaemia, musculoskeletal pain (may rarely be severe and/or disabling)

Question 13

Risedronate

• referral

Answer 13

• if you get ain on swallowing, or new or worsening heartburn- DR
• Tell your doctor if you have severe pain in your bones, joints or muscles while taking this medicine

Question 14

Risedronate

• monitoring

Answer 14

• bone pain, joints or muscle pain
• renal function
• falls
• fractures
• heartburn, pain on swallowing
• BMD

Question 15

Risedronate

• lifetsyle/ monitoring

Answer 15

• to keep bones and muscles strong, have a healthy diet that includes enough calcium rich foods
  
  • for strengthening and building your bones
• vit D helps your body absorb calcium and keep your bones strong
  
  • forms in your skin when skin is exposed to the sun
  • fair skin: 5-10mins enough
  • darker skin: 9–50 minutes a day on most days
  • in food but usually not enough
  • vit d tablets
• regular exercise helps keep bones strong, it also builds muscles, improves your balance and keeps you flexible so you are less likely to fall
  
  • it is best to do a mixture of ‘weight bearing’ or impact exercises (e.g. walking, running, jumping, dancing), resistance training (with weights) and balance exercises