Medicines Knowledge Week 5 (Amitriptyline, Venlafaxine, Aripiprazole, Clozapine, Donepezil)

Question 1

Amitriptyline drug class

Answer 1

Tricyclic antidepressant (TCA)

Question 2

Amitriptyline indications

Answer 2

• Major depression
• Adjuvant in pain management
• Migraine prophylaxis

Question 3

Amitriptyline dosage range and timing

Answer 3

Depression: oral 25–75 mg daily, increasing by 25–50 mg every 2–3 days to 75–150 mg daily. Maximum 300 mg daily

> dose may be divided or given as single dose at night

Adjuvant in pain management, migraine prophylaxis: oral 10–25 mg at night initially; titrate up to a maximum night time dose of 75 mg in migraine and 150 mg in pain management.

Question 4

Amitriptyline counselling

Answer 4

You may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days

Try taking this medicine at night to reduce daytime drowsiness

These drugs may increase the effects of alcohol.

Question 5

Amitriptyline monitoring

Answer 5

Monitor patients for increased suicidal thoughts which can occur soon after starting antidepressants

Monitor for adverse effects such as seizures and prolonged QT interval

Question 6

Venlafaxine drug class

Answer 6

Serotonin and noradrenaline reuptake inhibitor (SNRI)

Question 7

Venlafaxine indications

Answer 7

Major depression

Generalised anxiety disorder

Social phobia

Question 8

Venlafaxine dosage range and timing

Answer 8

Adult, oral 75 mg once daily; if required, increase to 150 mg once daily.

Question 9

Venlafaxine counselling

Answer 9

Take with food to minimise stomach upsets

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

Do not open, crush or chew capsules, or put them in water.

Question 10

Venlafaxine monitoring

Answer 10

Monitor patients for increased suicidal thoughts which can occur soon after starting antidepressants

Check BP before starting treatment then check regularly while using venlafaxine

Question 11

Aripiprazole drug class

Answer 11

Antipsychotic

Question 12

Aripiprazole indications

Answer 12

Schizophrenia

Bipolar disorder as monotherapy

Question 13

Aripiprazole dosage range and timing

Answer 13

Schizophrenia: 10-15 mg once daily

Bipolar disorder: 15-30mg once daily

Question 14

Aripiprazole counselling

Answer 14

Taking antipsychotic medicine regularly is important because stopping it or not taking it regularly is associted with high risk of relapse and suicide

Consider whether a regular injection may suit you better than taking tablets

This medicine may cause drowsiness and may increase the effects of alcohol, cannabis or sleeping tablets. Do not drive or operate machinery if you are affected.

Question 15

Aripiprazole monitoring

Answer 15

Warn patients and carers of the possibility of impulse control disorders (bing eating, gambling, overspending) and monitor for such behaviours

Monitor weight, blood glucose, lipids, and blood pressure at baseline and regularly thereafter

Question 16

Clozapine drug class

Answer 16

Antipsychotic

Question 17

Clozapine indications

Answer 17

Schizophrenia in people unresponsive to, or intolerant of, other antipsychotics

Bipolar disorder

Question 18

Clozapine dosage range and timing

Answer 18

Adult, oral 12.5 mg on the first day, increased to 25–50 mg on second day

• If well tolerated, increase in 25–50 mg increments to 300 mg daily within 2–3 weeks. Then increase in 50–100 mg increments at 4–7‑day intervals if required. Usual range is 200–600 mg daily (maximum of 900 mg daily).

> doses upto 300mg are usually given as a single dose in the evening

Question 19

Clozapine counselling

Answer 19

This medicine may cause severe constipation; contact your doctor urgently if your bowel habits change and/or you have abdominal pain.

Your clozapine dose may need changing if you vary your caffeine intake (eg tea, coffee, cola drinks) or if you start or stop smoking tobacco

You will need to have regular blood tests and other checks while taking clozapine to help your doctor look out for serious side effects.

Question 20

Clozapine Monitoring

Answer 20

• Monitor patients closely for constiaption and ensure effective management
• Monitor for adverse effects such as hypertension (measure blood pressure) and myoclonic jerks

Question 21

Donepezil drug class

Answer 21

Anticholinesterases in alzheimers disease

Question 22

Donepezil indication

Answer 22

Alzheimers disease

Question 23

Donepezil dosage range and timing

Answer 23

Oral, initially 5 mg once daily for a minimum of 4 weeks. Increase to 10 mg once daily.

Question 24

Donepezil counselling

Answer 24

Take the tablet every night just before you go to bed.

It does not matter if you take it before, with or after food.

This medicine may cause dizziness or drowsiness; if you are affected, avoid operating machinery.

Question 25

Donepezil monitoring

Answer 25

Monitor for adverse effects such as seizures and hallucinations

Monitor for bradycardia in patients using drugs that can cause bradycardia, increases risk of bradycardia and hypotension.

Monitor for inappropriate sexual behaviours