Medicines Knowledge Week 4 (Lis/Dexamfetamine, Risedronate +/- combinations)

Question 1

Lis/Dexamfetamine Drug Class

Answer 1

Psychostimulants

Question 2

Lis/Dexamfetamine Drug Indication

Answer 2

ADHD
Narcolepsy

Question 3

Lis/Dexamfetamine dosage range and timing (2 marks)

Answer 3

Lisdexamfetamine

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.

Binge eating disorder

Adult, oral 30 mg once each morning; increase the daily dose by 20 mg at intervals of at least a week to the usual dose of 50 or 70 mg daily. Maximum dose 70 mg daily. Initial treatment period 12 weeks.

Dexamfetamine

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.

Narcolepsy

Adult, oral, initially 10 mg each morning; gradually increase as clinically indicated to a maximum of 60 mg daily in divided doses.

Question 4

Lis/Dexamfetamine Counselling (3 marks)

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.

If you drink alcohol, it could make some of the unwanted side effects worse. Your doctor may suggest that you avoid alcohol completely or reduce the amount of alcohol you drink.

>Lisdexamfetamine: 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/Dexamfetamine monitoring (2 marks)

Answer 5

Monitor cardiovascular function before starting treatment and during treatment. Also, monitor weight and height before treatment and during treatment.

Monitor to see if the psychostimulant is having an effect in the patient. This includes improved attention, focus and ability to concentrate.

Question 6

Risedronate Drug Class

Risedronate with Calcium Carbonate (other drugs affecting bone)

Answer 6

Bisphosphonates

Question 7

Risedronate Indications

Risedronate and Calcium Carbonate

Answer 7

Paget’s disease of bone

Treatment of osteoporosis

Treatment and prevention of corticosteroid-induced osteoporosis

Question 8

Risedronate dosage range and timing

Answer 8

Risedronate comes in 5mg, 30mg, 35mg, 150mg (once a month)

Paget’s disease

Adult, oral 30 mg once daily for 2 months.

Osteoporosis

Adult, oral 5 mg once daily or 35 mg once a week or 150 mg once a month.

AcrisCombi

One Acris 35mg Once-a-Week tablet (the small light-orange tablet) and 6 Calcium Carbonate 1250mg tablets (the light lavender tablets).

>Day 1
Take the Acris 35mg Once-a-Week tablet (light orange coloured tablet) in the morning, at least 30 minutes before your first meal, drink or medication of the day.

>Days 2 to 7
Take one calcium carbonate tablet (light lavender tablet) the day after you start taking the Acris 35mg Once-a-Week.

Continue taking one calcium carbonate tablet each day for the next 6 days.

Always take your calcium carbonate tablet with a meal.

Question 9

Risedronate Counselling

Answer 9

Take in the morning with a full glass of plain water at least 30 minutes before food or drink. Remain upright during this time and until after you eat. (Enteric coated tablets (Actonel EC^®) may be taken with or without food but you must still remain upright for 30 minutes after taking them.)

Quit smoking as it worsens osteoporosis

Ensure vitamin D status and calcium intake are adequate

Do not take antacids, calcium, iron or mineral supplements within 2 hours of risedronate as they may interfere with its absorption.

Swallow whole; do not chew or suck on the tablet.

Stop tablets and see your doctor immediately if you have pain on swallowing, or new or worsening heartburn.

Tell your doctor if you have severe pain in your bones, joints or muscles while taking this medicine.

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.

Risedronate counselling

Take calcium with food, it is better absorbed this way.

Question 10

Risedronate Monitoring

Answer 10

Monitor Bone Mineral Density (BMD)

Monitor Renal Function

Monitor for severe skin reactions including Stevens-Johnson syndrome, and allergic reactions including angioedema