osce explaining Flashcards
levothyroxine
CI
how it works
course and how taken
monitering required
side effects
adrenal insuff or cardiac disorders
– A synthetic version of thyroxine, the hormone produced by your thyroid gland
– It is given to bring your thyroid activity back up to normal
– Once daily tablet before breakfast
– Taken long term
– Dose changes take 4-6 weeks to take effect
– TSH test every 2-3 months until stable
– When TSH level stable, check annually
rare when levels stable bc replacing normal hormone
hypothyroid
hyper
statin
CI
how it works
course and how taken
monitering required
side effects
preg
stops liver making cholesterol
high cholesterol = problem w arteries which inc risk of heart stroke n kidney
OD tablet evening
long term
decreases risk over many yrs
Review in 4 weeks, then every 6-12 months (with lipid profile as required) → dose may be titrated up if target not met
– LFTs before starting, at 3 months and at 12 months (statins cause altered LFTs)
– Muscle pains
– Headache
– Itching
– Also nausea, sickness, diarrhoea, abdominal pain
– Rhabdomyolysis – tell doctor if you experience unexpected muscle pain
– Some statins interact with grapefruit juice
metformin
CI
how it works
course and how taken
monitering required
side effects
– Significant renal impairment
– Ketoacidosis
– Low BMI
– Increases your response to insulin so your cells take up more glucose from your blood
– Also reduces the amount of glucose produced by the live
– Once, twice or three-times daily tablet with meals
– Taken long term
– Monitoring required
– U&Es before starting, then annually
– HbA1C every 3-6 months until stable, then 6 monthly at diabetic check ups
– Nausea, diarrhoea, abdominal pain, weight loss
– Lactic acidosis – metformin must not be taken on the day of or for 2 days after having general anaesthetic or X-ray contrast media
iron tablets
CI
how it works
course and how taken
monitering required
side effects
none
replces body store of iron mineral req to make red blood cells
– 1-3 times daily tablet or syrup (depending on brand)
– Works best if taken without food, but most take with meals as iron can irritate the stomach
– Takes 3-4 weeks for Hb to normalise, then further 3 months to replenish iron stores
moniter hb in 3-4 wks to see response
– GI irritation (nausea, sickness, diarrhoea/constipation, abdominal pain)
– Black/green stools
– Metallic taste
SSRI
CI
how it works
course and how taken
monitering required
side effects
suicidal risk
mania
– Antidepressants alter the balance of some of the chemicals in the brain (neurotransmitters)
– SSRI antidepressants affect a neurotransmitter called serotonin
– Imbalance of this and other neurotransmitters is thought to play a part in causing depression and other conditions
OD tabet
may be gradually stopped 6mths after feeling better
effects in 4-8wks
no monitering req
– GI (diarrhoea, nausea, vomiting)
– Appetite and weight change
– Headaches
– Drowsiness (can take at night)
– Anxiety for 2 weeks
– Withdrawal
– May increase risk of suicide in younger patients
methotrexate
CI
how it works
course and how taken
monitering required
side effects
– Pregnancy (including male partner)
– Breast-feeding
– Hepatic impairment
– Active infection
– Immunodeficiency
It is a ‘disease-modifying agent’ which both reduces inflammation and suppresses the immune system
– Early use improves outcome and symptoms
– Once weekly tablet with a folic acid tablet on another day
– Same day each week
– Dose built up slowly
– Taken long-term if effective
– Takes 3-12 weeks to work
– FBC, LFTs, U&EsBefore starting
– Then, every 2 weeks until therapy stabilised
– Then, every 2-3 months
– Patient should be given monitoring book
– Alopecia
– Headaches
– GI disturbance – advise not to take with NSAIDs/aspirin
– Myelosuppression (infections, unexpected bruising/bleeding, anaemia) – seek medical advice if you have unexplained bruising/bleeding or have infective symptoms, and get annual flu jab
– Liver and lung toxicity
lithium
CI
how it works
course and how taken
monitering required
side effects
– 1st trimester pregnancy
– Breast-feeding
– Cardiac insufficiency/rhythm disorder
– Significant renal impairment
– Addison’s disease
– Low sodium diets
– Untreated hypothyroidism
– Mood stabiliser
– Exact mechanism unknown
– Thought to interfere with neurotransmitter release and receptors
– Once or twice daily tablet/liquid
– Taken long-term if effective
– Takes 1-2 weeks to work
– Before starting – FBC, U&Es, TFTs, βHCG, ECG
– Check lithium level after 5 days, then every week until stable for 4 weeks, then every 3 months
– Check TFTs, U&Es, Ca2+ every 6 months
– GI (abdominal pain, nausea)
– Metallic taste
– Fine tremor
– Water symptoms (thirst, polyuria, impaired urinary concentration, weight gain and oedema)
– Renal toxicity
– Nephrogenic diabetes insipidus
– Hypothyroidism
– Lithium toxicity symptomsGI (anorexia, diarrhoea, vomiting)
– Neuromuscular (dysarthria, dizziness, ataxia, impaired coordination, muscle twitching, tremor)
– Others (drowsiness, apathy, restlessness)
atypical antipsyhotics
CI
how it works
course and how taken
monitering required
side effects
hepatic impairment
phaeochromocytoma
– Schizophrenia thought to be caused by problems with dopamine receptors in your brain
– Atypical antipsychotics work by blocking these receptors
– Tablet daily or depot injection every 2-4 weeks
– Dose built up over a week or two
– Dose adjusted depending on response
- takes several days or weeks to work
– Before treatment, at 3 months, 12 months, then annually: pulse, BP, weight, waist circumference, ECG, HbA1C, fasting glucose, lipid profile, prolactin
– Weight checks weekly for 6 weeks
– Anti-dopaminergic (tardive dyskinesia, tremor, movement disorders)
– Anti-cholinergic (constipation, dry mouth)
– Anti-histaminergic (weight gain, dizziness, drowsiness)
– Anti-adrenergic (hypotension)
– Neuroleptic malignant syndrome (high fever and muscle rigidity)
– Agranulocytosis (clozapine)
– Withdrawal
– Hyperglycaemia and diabetes
– Hyperprolactinaemia (sexual dysfunction, menstrual disturbance, galactorrhoea etc.)
– Prolonged QT
levodopa
CI
how it works
course and how taken
monitering required
side effects
glaucoma
– Levodopa is a replacement for some of the dopamine which your brain in no longer able to produce
– This will help to reduce your symptoms, particularly your rigidity and slow movements
– Given with carbidopa (inhibits peripheral levodopa degeneration)
– 3-4 times daily tablet with food (reduces nausea)
– Taken as long as it works effectively – after 5 years most suffer ‘on-off’/‘wearing off’ phenomena (switch between mobility and immobility that occurs before the next dose is due after prolonged levodopa use) and dyskinesias
– Fast-acting
no monitering req
– Psychosis
– Nausea and vomiting
– Dyskinesias
– Postural hypotension
– ‘On-off’/‘wearing off’ phenomena
– Impulsive behaviour
– Dizziness
insulin
CI
how it works
course and how taken
monitering required
side effects
n/a
– Insulin allows the cells of your body to take up glucose from the blood and use it for energy
– This means insulin reduces the blood glucose level
– In people with diabetes, insulin may be needed because the body cannot produce it or use it effectively
– Injected using injection pen at a 90˚ angle
– Usually injected to different sites around the lower abdomen and upper outer thighs/buttocks
– Capillary glucose monitoring is done before each meal and before bed
– It should also be checked if there are any symptoms of a high/low blood sugar (explain)
– Weight gain
– Sharp injuries (pens should be disposed of in sharps bin)
– Hypoglycaemia (educate patient about management)
– Lipodystrophy at injection sites
bisphosponates
CI
how it works
course and how taken
monitering required
side effects
– Pregnancy
– Dysphagia/abnormalities of oesophagus
– Recent peptic ulcer
– Significant renal impairment
– Unable to sit upright for 30 minutes
Prevents bone from being broken down and helps to rebuild new bone
– Remember lifestyle factors can also help with this, such as exercise, not smoking (we can help), and eating a well-balanced diet
– Once daily or once weekly tablet
– Swallow tablet with full glass of water
– Take at least 30 minutes before food or anything other than water
– Be upright for 30 minutes after swallowing
– Taken long term
– Monitoring required
– Regular dental check-ups (risk of osteonecrosis of jaw)
– Headache
– Heartburn, bloating, indigestion
– GI (diarrhoea/constipation, abdominal pain)
– Seek urgent medical advice if symptoms of = Osteonecrosis of the jaw, Dysphagia/odynophagia, Upper GI bleeding/black stools
