OSCE medications Flashcards
1
Q
Warfarin: how does it work?
A
- 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
2
Q
Warfarin: how to take it
A
- 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
3
Q
Warfarin: contraindications
A
- pregnancy
- active bleeding
- risk of falls
4
Q
Warfarin: monitoring
A
- 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)
5
Q
Warfarin: Side effects
A
- bleeding
- diarrhoea and nausea
- many interactions: alcohol, NSAIDs
6
Q
DOAC: how does it work?
A
- 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
7
Q
DOAC: how to take
A
- 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
8
Q
DOAC: contraindication
A
- Significant renal impairment
- Significant risk of major bleeding
- Active bleeding
9
Q
DOAC monitoring
A
NONE- this is a great benefit
10
Q
DOAC: side effects
A
- Bleeding
- GI problems
11
Q
Levothyroxine: How they work
A
- A synthetic version of thyroxine, the hormone produced by your thyroid gland
- It is given to bring your thyroid activity back up to normal
12
Q
Levothyroxine: how you take it
A
- once daily before breakfast
- long term medication
- can take 4-6 weeks to take effect
13
Q
levothyroxine: contraindication
A
none
14
Q
levothyroxine: monitoring
A
- TSH test every 2-3 months until stable
- When TSH level stable, check annually
15
Q
levothyroxine : side effects
A
- rare when normal amount of hormone
- hyperthyroid symptoms
- hypothyroid symptoms
16
Q
Statin: How it works
A
- 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…
17
Q
statins: how its taken
A
- once every evening
- taken long term
- decreases risk over many years
18
Q
statins: contraindications
A
pregnancy
macrolides
19
Q
statins: monitoring
A
– 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)
20
Q
statins: side effects
A
- myalgia
- headache
- itching
- nausea, diarrhoea
- rhabdomyolysis
21
Q
statins: interactions
A
grapefruit juice
22
Q
statins: if patient reports myalgia
A
consider Rhabdomyolysis
23
Q
metformin: how it works
A
- 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
24
Q
metformin: how its taken
A
– Once, twice or three-times daily tablet with meals
– Taken long term
25
metformin: contraindications
* Significant renal impairment
* Ketoacidosis
* Low BMI
26
metformin: monitoring
* U and Es
* HbA1c every 3-6 months until stable
27
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
28
iron tablets: how they work
Replace your body’s store of iron, a mineral required to make red blood cells
29
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
30
iron tablet: contraindication
none
31
iron tablets: monitoring
Haemoglobin in 3-4 weeks to assess response
32
Iron tablets: side effects
* GI irritation (nausea, sickness, diarrhoea/constipation, abdominal pain)
* Black/green stools
* Metallic taste
33
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
34
SSRI: how they are taken
– Once daily tablet
– May be gradually stopped 6 months after feeling better
– Effects in 4-8 weeks
35
SSRI: contraindication
– Suicidal risk
– Mania
36
SSRI: monitoring
none
37
SSRI: side effects
* GI
* appetite and weight change
* headaches
* drowsiness
* anxiety for 2 weeks
* withdrawal
* may increase risk of suicide in younger patients
38
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
39
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
40
methotrexate: contraindication
* Pregnancy (including male partner)
* Breast-feeding
* Hepatic impairment
* Active infection
* Immunodeficiency
41
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
42
methotrexate: side effects
* GI disturbance
* alopecia
* headaches
* myelosuppression
* infections
43
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)
44
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
45
levodopa: contrainidcations
glaucoma
46
levodopa: monitoring
none
47
levodopa: side effects
* psychosis
* nausea and vomiting
* postural hypotension
* on- off phenomena
48
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
49
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
50
insulin: contraindication
none
51
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)
52
insulin: side effects
* weight gain
* sharps injuries
* hypoglycaemia
* lipodystrophy
53
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
54
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)
55
bisphosphonates: contraindication
* Pregnancy
* Dysphagia/abnormalities of oesophagus
* Recent peptic ulcer
* Significant renal impairment
* Unable to sit upright for 30 minutes
56
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
