OSCE medications Flashcards
Warfarin: how does it work?
- Thins the blood to treat or prevent blood clots
- It does this by blocking vitamin K – the vitamin used by the body to make proteins that cause the blood to clot
Warfarin: how to take it
- Once daily tablet (usually in the evening)
- Usually prescribed for 3 months for a DVT, 6 months for a PE, and lifelong for AF
- Dose changes take 2-3 days to take effect
Warfarin: contraindications
- pregnancy
- active bleeding
- risk of falls
Warfarin: monitoring
- Started at 5mg each evening
- INR on days 3,4 and 5 – warfarin dosing charts tell you how to adjust the dose
- Then regular INR checks by anticoagulation clinic – regularity determined by INR stability (patient will be given anticoagulation book)
Warfarin: Side effects
- bleeding
- diarrhoea and nausea
- many interactions: alcohol, NSAIDs
DOAC: how does it work?
- Thins the blood to treat or prevent blood clots
- Many proteins are involved in blood clot formation – this medication blocks one of these proteins from working
DOAC: how to take
- tablet once daily
- Take with full glass of water whilst sitting upright
- Usually prescribed for 3 months for a DVT, 6 months for a PE, and lifelong for AF
DOAC: contraindication
- Significant renal impairment
- Significant risk of major bleeding
- Active bleeding
DOAC monitoring
NONE- this is a great benefit
DOAC: side effects
- Bleeding
- GI problems
Levothyroxine: How they work
- A synthetic version of thyroxine, the hormone produced by your thyroid gland
- It is given to bring your thyroid activity back up to normal
Levothyroxine: how you take it
- once daily before breakfast
- long term medication
- can take 4-6 weeks to take effect
levothyroxine: contraindication
none
levothyroxine: monitoring
- TSH test every 2-3 months until stable
- When TSH level stable, check annually
levothyroxine : side effects
- rare when normal amount of hormone
- hyperthyroid symptoms
- hypothyroid symptoms
Statin: How it works
- Statins stop the liver making cholesterol
- High cholesterol causes problems with your arteries, which increases your risk of heart disease, stroke, and kidney disease
- It is important to also address other cardiovascular risk factors…
statins: how its taken
- once every evening
- taken long term
- decreases risk over many years
statins: contraindications
pregnancy
macrolides
statins: monitoring
– 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)
statins: side effects
- myalgia
- headache
- itching
- nausea, diarrhoea
- rhabdomyolysis
statins: interactions
grapefruit juice
statins: if patient reports myalgia
consider Rhabdomyolysis
metformin: how it works
- Increases your response to insulin so your cells take up more glucose from your blood
- Also reduces the amount of glucose produced by the liver
metformin: how its taken
– Once, twice or three-times daily tablet with meals
– Taken long term
metformin: contraindications
- Significant renal impairment
- Ketoacidosis
- Low BMI
metformin: monitoring
- U and Es
- HbA1c every 3-6 months until stable
Metformin: side effects
- 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: how they work
Replace your body’s store of iron, a mineral required to make red blood cells
iron tablets: how they are taken
- 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
iron tablet: contraindication
none
iron tablets: monitoring
Haemoglobin in 3-4 weeks to assess response
Iron tablets: side effects
- GI irritation (nausea, sickness, diarrhoea/constipation, abdominal pain)
- Black/green stools
- Metallic taste
SSRI: how it works
- 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
SSRI: how they are taken
– Once daily tablet
– May be gradually stopped 6 months after feeling better
– Effects in 4-8 weeks
SSRI: contraindication
– Suicidal risk
– Mania
SSRI: monitoring
none
SSRI: side effects
- GI
- appetite and weight change
- headaches
- drowsiness
- anxiety for 2 weeks
- withdrawal
- may increase risk of suicide in younger patients
methotrexate: How it works
– It is a ‘disease-modifying agent’ which both reduces inflammation and suppresses the immune system
– Early use improves outcome and symptoms
methotrexate: how its taken
- 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
methotrexate: contraindication
- Pregnancy (including male partner)
- Breast-feeding
- Hepatic impairment
- Active infection
- Immunodeficiency
methotrexate: monitoring
- FBC, LFTs, U&EsBefore starting
- Then, every 2 weeks until therapy stabilised
- Then, every 2-3 months
- Patient should be given monitoring book
methotrexate: side effects
- GI disturbance
- alopecia
- headaches
- myelosuppression
- infections
levodopa: how it works
- 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)
levodopa: how its taken
- 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
levodopa: contrainidcations
glaucoma
levodopa: monitoring
none
levodopa: side effects
- psychosis
- nausea and vomiting
- postural hypotension
- on- off phenomena
insulin: how it works
- 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
insulin: how its taken
- Injected using injection pen at a 90˚ angle
- Usually injected to different sites around the lower abdomen and upper outer thighs/buttocks
insulin: contraindication
none
insulin: monitoring
- 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)
insulin: side effects
- weight gain
- sharps injuries
- hypoglycaemia
- lipodystrophy
bisphosphonate: how they work
- 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
bisphosphonates: how they are taken
- 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)
bisphosphonates: contraindication
- Pregnancy
- Dysphagia/abnormalities of oesophagus
- Recent peptic ulcer
- Significant renal impairment
- Unable to sit upright for 30 minutes
bisphosphonates: side effects
- Headache
- Heartburn
- GI (diarrhoea/constipation, abdominal pain)
- Seek urgent medical advice if symptoms of =
- Osteonecrosis of the jaw,
- Dysphagia/odynophagia,
- Upper GI bleeding/black stools
