Medicines Knowledge Week 5 (Haloperidol, Morphine, Sildenafil, Dutasteride +/- combinations, Oxybutynin)

Question 1

Haloperidol Drug Class

Answer 1

Typical antipsychotics

Question 2

Haloperidol drug indications

Answer 2

Acute and chronic psychoses

Acute mania

Tourette syndrome and other choreas

Adjunct in treatment of hallucinations due to alcohol withdrawal (if diazepam inadequate)

Intractable nausea and vomiting associated with cancer chemotherapy or radiotherapy

Short-term management of acute, severe anxiety, agitation or disturbed behaviour in non-psychotic disorders

Question 3

Haloperidol dosage range and timing

Answer 3

Comes in 500mcg tablets, 1.5mg tablets and 5mg tablets

Acute psychoses and mania
Oral, 5–10 mg every 2 hours as needed.

Short-acting IM, 0.5–10 mg every hour as needed.

Nausea and vomiting in oncology

Oral, 1–2 mg every 8 hours as needed.

Agitation, anxiety, disturbed behaviour, hallucinations due to alcohol withdrawal

Oral, 1–5 mg 2 or 3 times daily.

Question 4

Haloperidol Counselling (3 marks)

Answer 4

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.

You may feel dizzy on standing when taking this medicine. Get up gradually from sitting or lying to minimise this; sit or lie down if you become dizzy.

Tell your doctor if you start or stop smoking tobacco as your haloperidol dose may need changing.

Taking your antipsychotic medicine regularly is important:

>because stopping or taking it irregularly is associated with high risk of relapse and suicide

Question 5

Haloperidol Monitoring

Answer 5

check weight, BMI, waist circumference, blood glucose, lipids, BP (and, if clinically indicated, EEG, ECG and prolactin) at baseline and regularly thereafter.

routine full blood counts and liver function tests are advisable, particularly during the first months of treatment.

Monitor for clinical improvement

Question 6

Morphine Drug Class

Answer 6

Opioid Analgesic

Question 7

Morphine Indications

Answer 7

Severe pain

Opioid adjunct during general anaesthesia

Refractory chronic dyspnoea (on specialist advice)

Acute pulmonary oedema, adjunct

Acute or chronic pain

Question 8

Morphine Dosage Range and Timing

Answer 8

Chronic non-cancer pain: adult

Controlled release, oral 5–20 mg twice daily (start with 5 mg if opioid-naive or elderly). Review every 1–2 weeks; adjust dose according to response.

Acute pain: adult, child >50 kg

Conventional oral product, initially 5–15 mg every 4 hours (start with 5 mg in patients >70 years). Titrate dose according to response and sedation score,

also comes in oral liquid and either SC/IM injection

Question 9

Morphine Counselling

Answer 9

This medication may make you feel drowsy and may increase the effects of alcohol. If you are affected, do not drive or operate machinery. If you are very sleepy or have trouble staying awake, stop taking the medication and tell your doctor immediately.

Be careful when you stand up as this medicine might make you feel dizzy if you stand up too quickly.

Stay hydrated and try to stay mobile if possible to minimise the chances of constipation.

Chronic use: look after your teeth and mouth, and get dental checks regularly, as opioids may make your mouth dry which increases risk of dental caries.

Question 10

Morphine Monitoring

Answer 10

Monitor for respiratory depression, this is done by assessing the degree of sedation as this is what happens before respiratory depression. Sedation is best monitored by using a sedation score. Aim to keep the sedation score <2; a score of 2 represents early respiratory depression.

Monitor for adverse effects such as constipation with long term use, use a laxative containing a stimulant and stool softener if this occurs.

Question 11

Sildenafil drug class

Answer 11

Phosphodiesterase-5 inhibitor

Question 12

Sildenafil Drug Indication

Answer 12

Erectile dysfunction

Pulmonary arterial hypertension

Question 13

Sildenafil dosage range and timing

Answer 13

Comes in 25mg, 50mg and 100mg (20mg for PAH)

Erectile dysfunction

Take orally about 1 hour before sexual activity; no more than 1 dose daily.

Start with 50 mg; decrease dose to 25 mg or increase to a maximum of 100 mg depending on response and tolerability.

Pulmonary arterial hypertension (PAH)

Oral, adult, usually 20 mg 3 times a day; if poorly tolerated, consider reducing to 20 mg twice daily. Some people may require higher doses (specialist supervision).

Question 14

Sildenafil Counselling

Answer 14

If you take sildenafil with food it may take longer to work.

Do not take this medication if you already take nitrates as the combination may cause a serious drop in your blood pressure. This can happen even if you take them on different days.

This medication may cause visual disturbances and dizziness. If you are affected do not drive or operate machinery.

Tell your doctor immediately if you have any sudden loss of hearing or vision.

Question 15

Sildenafil Monitoring

Answer 15

Monitor for rare adverse effects such as tachycardia, sudden loss of hearing or vision.

Monitor blood pressure especially if taking other medications that lower blood pressure such as prazosin.

Question 16

Dutasteride drug class

Dutasteride with tamsulosin drug class

Answer 16

Dutasteride: 5 Alpha Reductase Inhibitors

Dutrasteride with tamsulosin: + selective alpha blocker

Question 17

Dutasteride indications

Answer 17

Symptomatic BPH with prostate >30–40 mL

Moderate-to-severe symptomatic BPH with prostate >30–40 mL

Benign Prostatic Hyperplasia

D + T = benign prostatic hyperplasia + relieving LUTs symptoms

Question 18

Dutasteride with Tamsulosin Dosage Range and Timing

Answer 18

Dutasteride Dose: Oral, 500 micrograms once daily.

Dutasteride with Tamsulosin: 1 capsule once daily.

d: 500mcg and t: 400mcg

Question 19

Dutasteride Counselling

Answer 19

D: Swallow whole; do not open or chew the capsules as the contents may irritate your mouth and throat.

• Avoid donating blood until 6 months after stopping dutasteride
  Men taking dutasteride should avoid donating blood to avoid transmission to pregnant women. Dutasteride is detectable in serum for up to 4–6 months after stopping treatment.

D and T: Take this medicine about 30 minutes after the same meal (eg breakfast) each day. Do not take it on an empty stomach as this may increase the risk of side effects, eg dizziness on standing.

The dutasteride reduces prostate volume and the tamsulosin provides rapid symptom relief.

>dutasteride significantly reduces prostate volume, improves symptoms and urinary flow, and reduces the incidence of urinary retention and prostate surgery.

Question 20

Dutasteride and Tamsulosin Monitoring

Answer 20

• Monitor for erectile dysfunction, ejaculation disorders, decreased libido, and breast tenderness and swelling. It can happen in some men taking dutasteride alone and dutasteride with tamsulosin.
• Monitor for improved symptoms of urinary flow and decreased urinary retention.

Question 21

Oxybutynin drug class

Answer 21

Anticholinergic

Question 22

Oxybutynin drug indication

Answer 22

Urinary urge incontinence

Question 23

Oxybutynin dosage range and timing

Answer 23

Comes in 5mg tab and 3.9mg/24 hours patch

Adult

• Oral*, usual range 2.5–5 mg 2 or 3 times daily; maximum 20 mg daily. For elderly patients, start with 2.5 mg at night; if necessary, increase dose slowly.
• Patch*, apply 1 patch twice a week (every 3–4 days).

Child

Child >5 years

Oral, initially 2.5 mg twice daily; if necessary, increase to 5 mg 2 or 3 times daily.

Question 24

Oxybutynin counselling

Answer 24

Patch

Apply to dry, unbroken skin on your abdomen, hip or buttock.

Remove and safely dispose of patch after 3–4 days and put a new patch on a different area (do not apply to the same place within 7 days).

>This medicine may cause drowsiness, dizziness or blurred vision; if affected, do not drive or operate machinery.

Take your medicine at about the same time each day.

Taking it at the same time each day will have the best effect. It will also help you remember when to take it.

Oxybutynin Sandoz may make you sweat less, causing your body temperature to rise. Take extra care to avoid becoming overheated during exercise or hot weather, since overheating may result in heat stroke.

Be careful driving or operating machinery until you know how Oxybutynin Sandoz affects you.

This medicine may cause drowsiness or blurred vision in some people. If you have any of these symptoms, do not drive a car, operate machinery, or do anything else that could be dangerous.

Be careful when drinking alcohol while you are taking this medicine.

Alcohol or other sedatives may increase the drowsiness that may be caused by Oxybutynin Sandoz.

Question 25

Oxybutynin monitoring

Answer 25

Monitor for symptom improvement, this includes delaying the urge to urinate and decrease frequency of urination.

Monitor for rare adverse effects such as fever or heat stroke