Medicines Knowledge Week 3 (Carbamazepine, Levetiracetam, Tiotropium +/- combinations, Fluticasone +/- combinations, Prednisolone)

Question 1

Carbamazepine drug class

Answer 1

Antiepileptic drug

Question 2

Carbamazepine Indication (2 marks)

Answer 2

Epilepsy –> simple and complex focal (partial) seizures, and generalised tonic-clonic seizures

Bipolar disorder

Trigeminal neuralgia

Question 3

Carbamazepine dosage range and timing (2 marks)

Answer 3

Adult, oral, initially 100 mg twice daily; increase daily dose gradually by 100–200 mg every 2–4 weeks according to response.

• Usual range, 400 mg – 1.2 g daily in 2 or more doses; up to 2 g daily may be required.

Question 4

Carbamazepine counselling

Answer 4

Take with food to help prevent stomach upset.

Carbamazepine may also increase the effects of alcohol.

Do not stop taking this medicine suddenly unless your doctor tells you to.

Question 5

Carbamezapine monitoring (2 marks)

Answer 5

Monitor bone mineral density and the use of vitamin D and calcium supplements. To prevent osteoporosis.

Monitor for skin reactions.

Question 6

Levetiracetam drug class

Answer 6

Antiepileptic

Question 7

Levetiracetam indication

Answer 7

Monotherapy of focal (partial seizures)

Adjunctive therapy of myoclonic seizures

Question 8

Levetiracetam dosage range and timing

Answer 8

Monotherapy: Initially 250mg twice daily then upto 1.5g twice daily

Adjunctive therapy: Initially 500mg twice daily upto 1.5g twice daily

Question 9

Levetiracetam counselling

Answer 9

Levetiracetam may also increase the effects of alcohol.

Do not stop taking this medicine suddenly unless your doctor tells you to.

The mixture can be diluted in a glass of water.

Question 10

Levetiracetam monitoring (2 marks)

Answer 10

Monitor for adverse effects such as severe skin reactions

Caution in patients with history of psychiatric problems

Question 11

Tiotropium drug class

Answer 11

Anticholinergics –> lama

Question 12

Tiotropium indication (2 marks)

Answer 12

Chronic obstructive pulmonary disease

Maintenance treatment of moderate to severe asthma along with an ICS

Question 13

Tiotropium dosage range and timing?

Answer 13

Braltus and Spiriva handihaler: DPI 1 capsule inhaled once daily

Spiriva Respimat: 2 inhalations (of 2.5 micrograms) once daily –> same with asthma

Question 14

Tiotropium counselling

Answer 14

Do not allow the powder or mist to come into contact with your eyes

Tell your doctor if you notice any eye pain or discomfort

Do not drive or operate machinery until you know how this medicine affects you, it can cause dizziness or affect your vision

Question 15

Tiotropium monitor

Answer 15

Monitor for adverse effects such as constipation

Caution in patients with bladder obstruction –> symptoms may worsen

Question 16

Tiotropium is given with …? Dose?

Answer 16

olodaterol –> laba

• Tiotropium with olodaterol: Adult, 2 inhalations (2.5/2.5 micrograms) once daily.

Question 17

Tiotropium (LAMA) is given with ICS in asthma, what are examples of this?

Answer 17

Beclometasone 250-400mcg

Budesonide 500-800mcg

Ciclesonide 240-320mg

Fluticasone furoate 100mcg

Fluticasone propoionate 250-500mcg

Question 18

Fluticasone drug class

Answer 18

Inhaled corticosteroid (ICS)

Question 19

Fluticasone indication

Answer 19

Maintenance treatment of asthma and COPD

Question 20

Fluticasone dosage range and timing

Answer 20

Adult, child >12 years, Dry Powder Inhaler (DPI) 100–200 micrograms once daily.

Moderate to severe hepatic impairment: DPI 100 micrograms once daily

Question 21

Fluticasone counselling

Answer 21

• Make sure that your doctor has given you an asthma action plan
• Rinse your mouth with water, gargle and spit out after use.
• Use a spacer with the metered dose inhaler

Question 22

Fluticasone monitoring

Answer 22

Monitor for adverse effects such as allergic reactions and rash

Caution in patients with hepatic impairment (dose needs to be lowered)

Question 23

What is fluticasone used with? What are the doses?

Answer 23

Fluticasone furoate with umeclidinium and vilanterol (LAMA and LABA)

> DPI, 1 inhalation (100/62.5/25 micrograms) inhaled once daily –> for CPD

Fluticasone furoate with vilanterol (LABA)

> DPI 100/25 or 200/25 micrograms, 1 inhalation once daily –> for asthma and COPD

Question 24

Fluticasone counselling

Answer 24

• Use a spacer with the metered dose inhaler.
• Make sure that your doctor has given you an asthma action plan
• Rinse your mouth with water, gargle and spit out after use.

Question 25

Fluticasone monitoring

Answer 25

Monitor for adverse effects such as rash and angioedema

Caution in patients with hepatic impairment, use a lower dose

Question 26

Prednisolone drug class

Answer 26

Corticosteroids

Question 27

Prednisolone indication

Answer 27

autoimmune or inflammatory disease, acute asthma, COPD exacerbation, acute gout

Question 28

Prednisolone dosage range and timing

Answer 28

Acute asthma, oral 50 mg once daily for 5–10 days.

COPD exacerbation, oral 50 mg once daily for 5–14 days.

Acute gout, oral 20–50 mg once daily for 3–5 days.

Question 29

Prednisolone counselling

Answer 29

Take the tablets or oral liquid with food to help reduce stomach upset.

This medication may affect your mood, eg you may feel more happy or sad than usual.

Do not stop taking this medicine suddenly unless your doctor tells you to.

Question 30

Prednisolone monitoring

Answer 30

Monitor for adverse effects such as severe skin reactions and depression

Caution in patients with diabetes –> corticosteroids may cause hyperglycaermia and worsen diabetes control