Part 1 - Knowledge And Counselling Flashcards

Question

carvedilol (dilatrend, vedilol)

Answer 1

CLASS: Alpha1 and nonselective beta-blocker. INDICATIONS: Hypertension; adjunct to conventional treatments in symptomatic mild-severe CHF DOSE: 3.125-50mg daily (divided doses for higher strengths) COUNSELLING: Dizziness upon initiation of treatment, GI upset, peripheral oedema MONITORING: blood pressure

Answer 2

CLASS: Cardiac glycoside INDICATIONS: AF, heart failure DOSE: 62.5-500mcg d in divided doses COUNSELLING: diziness, drowsiness and headache, nausea MONITORING: serum drug levels (narrow TI) > 6 hours post last dose, ecg,

Answer 3

CLASS: Topical corticosteroid INDICATIONS: relief of skin inflammation and itch associated with eczema, psoriasis etc DOSE: once daily COUNSELLING: apply to affected area only, for short term use (less than 4 weeks duration), storage below 25 degrees, wash hands after use. MONITORING: symptom response

Answer 4

CLASS: Topical corticosteroid INDICATIONS: inflammatory skin conditions (psoriasis, dermatitis, eczema, sebhorric dermatitis) DOSE: apply 1-2 times daily for up to 4 weeks COUNSELLING: MONITORING:

Answer 5

CLASS: Biguanide INDICATIONS: T2D, PCOS DOSE: Conventional tablets: 500-1g tds with food COUNSELLING: Take with food, swallow whole, diet and exercise, GI upset (diarrhoea) MONITORING: blood glucose, weight,

Answer 6

CLASS: Sulphonylurea INDICATIONS: Type II diabetes DOSE: 40-320mg in 1-2 doses (max 160mg per dose) for conventional tablets. Max 120mg d of extended release tablets (in divided doses). COUNSELLING: diet and exercise advice, smoking etc MONITORING: blood glucose, weight

Answer 7

CLASS: Thyroid Hormone INDICATIONS: Hypothyroidism, TSH-responsive thyroid tumours DOSE: 50-200mcg d according to TSH levels COUNSELLING: Take with food, keep refrigerated, can keep out of fridge for 1 week then throw out, GI upset, menstrual irregularities, arrhythmia or tachycardia, irritability, headache MONITORING: TSH levels, T3 and T4, weight, blood glucose levels in diabetics

Answer 8

CLASS: Bisphosphonate INDICATIONS: Prevention and treatment of osteoporosis, preservation of bone mineral density in patients on long term corticosteroids, Paget's disease DOSE: 35mg once weekly, or 150mg monthly COUNSELLING: Take half an hour before food with a glass of water, remain upright for 30 minutes after taking, take on same day each week or same day of each month. May cause GI upset, jaw pain, MONITORING: Bone mineral density, calcium levels,

Answer 9

CLASS: Bisphosphonate INDICATIONS: Prevention and treatment of osteoporosis, preservation of bone mineral density in patients on long term corticosteroids, Paget's disease DOSE: 70mg weekly, or 5/10/40mg daily COUNSELLING: Take half an hour before food with a glass of water, remain upright for 30 minutes after taking, take on same day each week or same day of each month. May cause GI upset, jaw pain, MONITORING: Bone mineral density, calcium levels,

Answer 10

CLASS: Prostaglandin analogue INDICATIONS: Open angle glaucoma, ocular hypertension DOSE: 1 drop into affected eye at night COUNSELLING: Instil at least 5 minutes before or after any other drops. Apply pressure to tear duct immediately after installation to avoid draining the eye. remove contacts before instillation and wait at least 15 minutes before replacing them. Discard 28 days after opening. Can increase the brown pigment of the iris. Can cause blurred vision, eye irritation, changes in thickness, colour and number of eyelashes (non-permanent) MONITORING: Intra-ocular pressure

Answer 11

CLASS: Antibiotic INDICATIONS: Bacterial conjunctivitis DOSE: 1 drop into affected eye every 2-4 hours until improvement, then 1 drop qid for 5 days. Ointment applied at night. COUNSELLING: d28, do not need to refrigerate after opening, block tear duct upon instillation, eye irritation, blurriness MONITORING: Symptoms

Answer 12

CLASS: Beta blocker (non-selective) INDICATIONS: ocular hypertension (in the presence or absence of glaucoma) DOSE: 0.25% or 0.5% - 1 drop into affected eye bd. COUNSELLING: May exacerbate asthma MONITORING:intraocular pressure

Answer 13

``` CLASS: ocular lubricant INDICATIONS: dry eye DOSE: 1 drop into affected eye prn COUNSELLING: instillation instructions, blurriness, irritation MONITORING: symptoms ```

Answer 14

CLASS: Proton Pump Inhibitor INDICATIONS: GORD, erosive oesophagitis, tx of duodenal and gastric ulcer, combo therapy for H. Pylori ulcer, Zollinger Ellison Syndrome DOSE: 10-20mg daily COUNSELLING: headache, GI upset, swallow whole MONITORING:bone mineral density in those at risk of osteoporosis, response to treatment

Answer 15

CLASS: PPI INDICATIONS: GORD, erosive oesophagitis, tx of duodenal and gastric ulcer, ZE Syndrome DOSE: 20-40mg daily COUNSELLING: May cause headache, gastric upset, swallow whole. MONITORING: BMD in those at risk of osteoporosis, response to treatment, presence of H Pylori (urea breath test)

Answer 16

CLASS: PPI INDICATIONS: GORD, tx of gastric and duodenal ulcer, oesophagitis, ZE syndrome DOSE: 20-40mg daily COUNSELLING: swallow whole, may cause headache, gastric upset MONITORING: response to tx, H pylori (urea breath test), bone mineral density in those at risk of osteoporosis

Answer 17

CLASS: H2 receptor antagonist INDICATIONS: short term tx of gastric and duodenal ulcer, maintenance of duodenal ulcer, ZE syndrome, symptomatic tx of reflux oesophagitis non-responsive to antacids, tx of scleroderma oesophagitis DOSE: 150mg d or bd, or 300mg d. dose can be increased up to 900mg d in divided doses for ZE syndrome. COUNSELLING: May cause GI upset including constipation, nausea, abdo discomfort MONITORING: symptomatic relief,

Answer 18

CLASS: PPI INDICATIONS: GORD, tx of gastric and duodenal ulcer, oesophagitis, ZE syndrome DOSE: 10-20mg once daily COUNSELLING: swallow whole, may cause headache or gastric upset MONITORING: response to tx, H pylori (urea breath test), bone mineral density in those at risk of osteoporosis

Answer 19

CLASS: PPI INDICATIONS: treatment of benign peptic lesions unresponsive to H2 receptor antagonists, GORD, reflux oesophagitis, eradication of H pylori in combination tx, GORD, reflux oesophagitis DOSE: 30mg daily COUNSELLING: ODT: dissolve on tongue, do not chew or swallow whole. MONITORING:

Answer 20

Basal Acid Output: should be less than 10mEq/Hour. Fasting serum gastrin, secretin test and imaging. Patients should undergo annual or 6 monthly review.

Answer 21

CLASS: Dopamine antagonist INDICATIONS: Nausea and vomiting, vertigo due to Meniere's Syndrome and labrynthitis DOSE: 20mg stat, then 10mg every two hours. for prevention, 5-10mg tds COUNSELLING: may cause anticholinergic side effects (dry mouth, blurred vision, constipation), drowsiness, dyskinesias, MONITORING: response to therapy

Answer 22

CLASS: Dopamine antagonist, increases gastric motility INDICATIONS: Nausea and vomiting, relief of gastric retention, diabetic gastroparesis DOSE: 10mg tds (oral or parenteral) for a maximum of 5 days. COUNSELLING: Drowsiness, headache, dystonias MONITORING:

Answer 23

CLASS: Selective COX-2 inhibitor (NSAID) INDICATIONS: Symptomatic treatment of inflammatory conditions (RA, OA, ankylosing spondylitis, menstrual pain and musculoskeletal and soft tissue damage). DOSE: 100-200mg bd COUNSELLING: take with food, swallow whole, do not take other NSAIDs, may exacerbate existing asthma, GI upset, headache, aggravated hypertension, increased bleeding MONITORING:

Answer 24

CLASS: selective COX-2 inhibitor (NSAID) INDICATIONS: Symptomatic treatment of osteo and rheumatoid arthritis DOSE: 7.5-15mg once daily COUNSELLING: May cause GI upset, headache, MONITORING: symptomatic response

Answer 25

CLASS: non-selective COX inhibitor (NSAID) INDICATIONS: RA and OA, acute inflammation, primary dysmenorrhea. DOSE: 50-200mg daily in 2 or 3 divided doses. (25-100mg bd-tds) COUNSELLING: GI upset, may exacerbate asthma, can cause skin reactions particularly when applying topically MONITORING: renal and hepatic function in longer term treatment

Answer 26

CLASS: xanthine oxidase inhibitor INDICATIONS: uric acid deposition (gout, uric acid neprhropathy) DOSE: 100-300mg daily (maximum of 900mg daily in severe instances) COUNSELLING: Take with food to minimise GI upset. MONITORING: serum urate concentration, urinary uric acid levels

Answer 27

CLASS: INDICATIONS: Acute gout DOSE: Maximum of 6mg over 4 days. 1mg stat, followed by 0.5mg every 6 hours until relief. Max 2.5mg in first 24 hours. This regime should not be repeated for at least 3 days. COUNSELLING: If GI upset occurs, discontinue immediately even if relief has not been achieved. MONITORING:Complete blood counts are recommended at periodic intervals during long-term treatment due to the potential for bone marrow suppression while undergoing colchicine therapy.

Answer 28

CLASS: Antiepileptic INDICATIONS: focal epilepsy, mania DOSE: 600mg daily increasing by 200mg every 3 days until control is achieved. Usual range is 1000-2000mg per day in divided doses. COUNSELLING: Adverse effects include drowsiness, nausea and GI upset/pain (take with food to minimise risk), prolongation of bleeding time, weight gain, tremor, memory impairment MONITORING: LFTs prior to therapy and continued until stable for 6 months.

Answer 29

CLASS: Anti-epileptic INDICATIONS: complex or simple partial seizures, generalised tonic-clonic seizures, trigeminal neuralgia, mania and bipolar affective disorders. DOSE: initially 100mg bd, then titrated up to response (up to 2000mg daily in divided doses) COUNSELLING: Take with or soon after food. Do not chew tablets (can break in half). Dizziness and drowsiness, GI upset, allergic skin reactions. Leukopenia MONITORING: plasma drug concentration, BMD for osteomalacia, monitor for skin reactions, full blood count

Answer 30

CLASS: anti-epileptic INDICATIONS: partial and generalised seizures, prevention of depressive episodes in patients with bipolar DOSE: initial dose is 25mg once daily and titrated up by 50-100mg every two weeks until response achieved (up to 200mg d) COUNSELLING: If skin rash occurs, stop taking lamictal and see doctor ASAP. Drowsiness, dizziness, headache and fatigue should resolve in a couple of weeks, GI disturbance, irritability, weight gain. Depressed patients may benefit from CBT or counselling. Do not stop taking lamictal suddenly. MONITORING: seizures, depressive episodes

Answer 31

CLASS: SSRI INDICATIONS: Depression, OCD, panic disorder, social phobia, premenstrual dysphoric disorder DOSE: 50-100 mg daily. (25mg d for children with OCD). COUNSELLING: Take in the morning. Common side effects include drowsiness, headache, dizziness, insomnia, palpitations. Takes 2-4 weeks to gain full effect in depression, sometimes longer in OCD. MONITORING: Improved mood, counselling sessions

Answer 32

CLASS: Benzodiazepine INDICATIONS: Short term management of insomnia in adults DOSE: 10-30mg half an hour before bed COUNSELLING: Will cause drowsiness/sedation, only take before bed. May also cause dizziness, dry mouth, MONITORING: sleep studies in those with insomnia

Answer 33

CLASS: SNRI INDICATIONS: Major depression, GAD, social anxiety disorder, panic disorder DOSE: 37.5-225mg daily COUNSELLING: Swallow whole in the morning. Full effect takes at least 2 weeks, may cause drowsiness, headache, GI upset, sexual dysfunction, constipation, dry mouth MONITORING:

Answer 34

CLASS: Benzodiazepine INDICATIONS: anxiety, short term relief of anxiety, symptomatic relief in acute alcohol withdrawal, muscle spasm and stiffness DOSE: 5-40mg daily in divided doses COUNSELLING: fatigue, drowsiness, muscle weakness, ataxia (dose related). May develop tolerance, MONITORING:

Answer 35

``` CLASS: SSRI INDICATIONS: major depression DOSE: 20-40mg once daily in the morning COUNSELLING: may take two to three weeks for full effect to occur. May cause headache, dizziness, increased sweating, insomnia, dry mouth MONITORING: ```

Answer 36

CLASS: SSRI INDICATIONS: Major depression, OCD, Panic disorder, social phobia, GAD, PTSD DOSE: 20mg d titrated up in 10mg increments to max 60mg d based on response COUNSELLING: Do not stop taking immediately, dizziness, insomnia, drowsiness, headache. take with food. May take 2-3 weeks for full effect MONITORING:

Answer 37

CLASS: Benzodiazepine INDICATIONS: Anxiety and short term relief of anxiety symptoms, anxiety associated with depression, tremor/confusion/anxiety associated with acute alcohol withdrawal DOSE: 7.5-30mg tds-qid depending on severity of symptoms COUNSELLING: Drowsiness occurs most frequently when starting therapy but tolerance will build. MONITORING:

Answer 38

CLASS: SSRI INDICATIONS: Major depression, OCD, premenstrual dysphoric disorder DOSE: usually 20mg in the morning, to a maximum of 80mg daily as a divided dose. COUNSELLING: Adverse effects are dose dependent. May cause fatigue, GI upset, weight loss, sexual dysfunction. will take several weeks to achieve full response MONITORING:

Answer 39

CLASS: TCA INDICATIONS: Major depression, nocturnal enuresis DOSE: Usually 10-50mg daily. May be increased to up to 300mg daily under close monitoring. COUNSELLING: Take at night. Anticholinergic side effects, drowsiness and sedation, GI upset MONITORING:

Answer 40

``` CLASS: tetracyclic antidepressant INDICATIONS: Major depression DOSE: 15-45mg at night COUNSELLING: may take several weeks to have effect, take at night as it can cause sedation, GI upset and nausea particularly when starting treatment. do not cease abruptly. MONITORING: ```

Answer 41

CLASS: atypical antipsychotic INDICATIONS: schizophrenia and psychosis, acute manic or mixed manic depressive episodes in Bipolar I disorder, DOSE: 5-20mg once daily COUNSELLING: dissolve wafers on tongue or disperse in water, swallow tablets whole.May cause weight gain, drowsiness, constipation and dry mouth, MONITORING:

Answer 42

CLASS: SSRI INDICATIONS: Major depression, OCD, panic disorder DOSE: 10-20mg once daily in the morning COUNSELLING: May take 2-4 weeks for antidepressant effect. MONITORING:

Answer 43

CLASS: Benzodiazepine (sedative/hypnotic) INDICATIONS: Insomnia DOSE: 5-10mg before bed. May be increased to 20mg for inpatients. COUNSELLING: CNS depression, hangover feeling upon waking, generally well tolerated. MONITORING:

Answer 44

CLASS: TCA INDICATIONS: Major depression (has some anxiolytic properties) DOSE: 25-50mg tds, or once nightly dose of up to 150mg (max 200mg d) COUNSELLING: adverse effects include anticholinergic effects, drowsiness, changes in libido, GI upset MONITORING:

Answer 45

CLASS: hypnotic INDICATIONS: short term treatment of insomnia DOSE: 5-10mg immediately before bed COUNSELLING: Causes sedation, increased risk of sleep walking, sleep driving and sleep eating. nausea and headache. MONITORING:

Answer 46

CLASS: Dopamine and noradrenaline reuptake inhibitor INDICATIONS: nicotine dependence DOSE: 150mg d for three days, then 150mg bd thereafter. COUNSELLING: Start treatment while pt still smoking and set date to cease smoking within the first two weeks of zyban therapy. May cause insomnia, so try and time evening dose well before bed (keep 8 hours between doses). Commonly causes headache. MONITORING: Counselling sessions to encourage smoking cessation.

Answer 47

CLASS: short acting beta2 agonist INDICATIONS: for immediate relief of bronchoconstriction in asthma and COPD and acute asthma prophylaxis DOSE: 1-2 inhalations every 4 hours when required COUNSELLING: Prime inhaler before use (2 puffs if using for the first time ever, or after 5 days of no use). 1-2 inhalations every 4 hours when required. If relief is not achieved after the 4x4x4 method, it is an emergency. Shake well before use. Can cause rapid heart rate if overused. headache, nausea and fine tremor. develop asthma action plan with doctor, and use a spacer if possible. MONITORING:

Answer 48

CLASS: Long acting beta2 agonist with corticosteroid INDICATIONS: maintenance of asthma and COPD DOSE: 1-2 inhalations twice daily (25/125-50-500) COUNSELLING: use of MDI or accuhaler. rinse mouth after use to minimise risk of oral thrush. use daily even if not symptomatic. does not provide acute relief. MONITORING:

Answer 49

CLASS: corticosteroid INDICATIONS: inflammatory conditions (asthma, COPD exacerbation, inflammatory bowel disease etc) DOSE: 5-80mg daily titrated to effective dose. Need to titrate slowly off medication. COUNSELLING: take with food and swallow whole. May cause mood changes, insomnia, irritability, nausea, weight gain and rounding of the face MONITORING: BSL in diabetics, avoid close contact with people who have infectious diseases,

Answer 50

CLASS: inhaled anticholinergic INDICATIONS: long term maintenance of bronchospasm and dyspnoea associated with COPD, prevention of COPD exacerbation DOSE: one dose daily COUNSELLING: only pierce the capsule once, inhale long and deep and hold breath for ten seconds. use daily even if symptoms have improved. May cause anticholinergic side effects, MONITORING: lung function (FEV),

Answer 51

CLASS: inhaled corticosteroid INDICATIONS: prophylactic management of asthma in adults and children over 1 year of age DOSE: 100-1000mcg inhaled daily depending on severity COUNSELLING: not for use in acute asthma. Use daily as directed even if symptoms improve. If you need to use a reliever more frequently, see your doctor for review. rinse mouth after use (symptoms of oral thrush) MONITORING: frequency of acute asthma, lung function

Answer 52

CLASS: Inhaled anticholinergic INDICATIONS: maintenance of bronchospasm in asthma and COPD DOSE: 1-4 puffs tds or qid depending on age and severity COUNSELLING: shake well before use, spacer, inhalation technique, anticholinergic side effects MONITORING: FEV, frequency of acute asthma

Answer 53

CLASS: intermediate-acting beta2 agonist INDICATIONS: relief of bronchospasm in patients with asthma and COPD, acute prophylaxis of exercise induced asthma DOSE: 1-3 inhalations prn every 4-6 hours (max 12 inhalations daily) COUNSELLING: to be used when required, not necessarily daily. Peak relief after 30 minutes. MONITORING: lung function

Answer 54

CLASS: Long acting anticholinergic with LABA INDICATIONS: long term maintenance of COPD DOSE: One inhalation daily COUNSELLING: use every day even if symptoms have improved. Will not assist in acute exacerbation. do not shake the inhaler. MONITORING: lung function

Answer 55

``` CLASS: Inhaled corticosteroid with LABA INDICATIONS: maintenance of moderate to severe asthma, maintenance of COPD DOSE: One inhalation daily COUNSELLING: Rinse mouth after use. MONITORING: lung function ```

Answer 56

``` CLASS: inhaled anticholinergic INDICATIONS: Maintenance of COPD DOSE: one inhalation daily COUNSELLING: antimuscurinic side effects MONITORING: lung function ```

Answer 57

CLASS: long acting anticholinergic and LABA INDICATIONS: COPD in adults DOSE: one inhalation twice daily COUNSELLING: use every day, anticholinergic side effects, beta agonist side effects (tremor, hypertension, headache, dizziness). Use within 60 days of opening pouch. MONITORING: lung function, relief of symptoms,

Answer 58

CLASS: Analgesic INDICATIONS: Mild to moderate pain (headache, osteoarthritis, period pain, etc), fever DOSE: 500mg-1g qid to a maximum of 4 g daily in adults. 15mg per kg for children qid (max 500mg d). Osteo: 665-1330mg tds COUNSELLING: do not take other paracetamol products while taking this, nausea, GI upset MONITORING: pain response, temperature,

Answer 59

CLASS: Opioid analgesic INDICATIONS: moderate to severe pain DOSE: 50-100mg qid up to 400mg daily. Titrate dose according to severity of pain and response. (XR 50-200mg bd) COUNSELLING: drowsiness, constipation, dizziness, nausea and vomiting, MONITORING: response to pain

Answer 60

CLASS: opioid analgesic INDICATIONS: moderate to severe pain unresponsive to non-narcotic analgesia DOSE: 5mg up to 4 times a day, can titrate up to 80mg bd depending on tolerance and pain levels. COUNSELLING: drowsiness, constipation, nausea and vomiting, respiratory depression, MONITORING:

Answer 61

CLASS: Penicillin antibiotic INDICATIONS: staph and strep skin infections, respiratory infections, genitourinary tract infections, gonorrhoea and prophylaxis of endocarditis DOSE: 250-500mg every 8 hours, children 20-40mg/kg every 8 hours. continue for 2-3 days after symptoms cease. COUNSELLING: allergic reaction, nausea. can be taken with or without food.diarrhoea, thrush, MONITORING:

Answer 62

CLASS: cephalosporin antibiotic INDICATIONS: staph and strep infections of the respiratory tract, skin, middle ear, and genitourinary tract infections from E coli. DOSE: adults 125-250mg qid. can do 500mg bd. Max 4g d unless parenterally administering. Children 25-50mg/kg/d in divided doses. COUNSELLING: take with or without food. Try to evenly space doses (no need to wake in the middle of the night), tell dr if you develop severe diarrhoea, even if it is weeks after having cephalexin. May cause nausea, diarrhoea, indigestion, thrush MONITORING:

Answer 63

CLASS: Penicillin and beta lactamase inhibitor INDICATIONS: UTI (complicated and uncomplicated), upper respiratory tract infections, LRTI, skin infections DOSE: 1 bd for no more than 14 days, usually continue for 2-3 days after symptoms improve COUNSELLING: take with food. allergy, nausea, diarrhoea, thrush MONITORING:

Answer 64

CLASS: macrolide antibiotic INDICATIONS: URTI (tonsilitis, pharyngitis, sinusitis), LRTI (bronchitis, community acquired pneumonia), whooping cough, impetigo, skin infections, non-gonococcal genital infections. DOSE: 150mg bd or 300mg d. Children 50-150mg d. Take for 5-10 days. COUNSELLING: take on an empty stomach with a full glass of water. May cause nausea and GI upset, signs of allergy, MONITORING:

Answer 65

CLASS: tetracycline antibiotic INDICATIONS: prophylaxis of malaria, acne, rosacea, rickettsiae infections (Q-fever, typhus), psittacosis, respiratory tract infections, gonorrhoea, syphillis DOSE: Malaria prophylaxis: 100mg d starting 2 days before departure and continuing for 4 weeks upon return. Otherwise 200mg stat then 100mg d for 7 days total. 50mg d for acne. COUNSELLING: Take with food, do not lie down for 30 minutes after taking due to potential for reflux. May cause GI upset, photosensitivity reactions, oesophagitis, headache MONITORING:

Answer 66

CLASS: cephalosporin antibiotic INDICATIONS: upper and lower respiratory tract infections, skin infections and UTI DOSE: usually 250mg bd-tds. can be increased to 500mg bd-tds for more severe infections or less susceptible organisms. children 20-40mg/kg/d in divided doses max 2g d. COUNSELLING: diarrhoea, stomach upset, allergy. take with or without food. may affect results of urine glucose testing. thrush, C Difficile (severe watery diarrhoea may occur weeks after treatment - emergency) MONITORING:

Answer 67

CLASS: fluroquinolone antibiotic INDICATIONS: UTI (both complicated and uncomplicated), GI infections (shigellosis and travellers diarrhoea), suppression of chronic recurrent urinary tract infections. for treatment of adults only. DOSE: UTI: 400mg bd for 3-10 days. GI infections: 400mg bd for 5 days COUNSELLING: tendon pain - cease immediately and see doctor. Take 1 hour before or 2 hours after food, and at least 2 hours either side of supplements containing calcium, zinc, iron or antacids containing magnesium or aluminium (lowers absorption of norfloxacin). Swallow whole, do not break in half. May cause GI upset, nausea, photosensitivity. Drink plenty of water while taking this medicine (crystalluria) MONITORING:

Answer 68

CLASS: fluroquinolone antibiotic INDICATIONS: UTI, gonorrhoea, gastroenteritis, bronchial infections, skin and skin structure, bone and joint infections, skin infections and chronic bacterial prostatitis. DOSE: 250-750mg bd usually for 7-14 days depending on severity of infection. COUNSELLING: photosensitivity, tendon pain, take preferably on an empty stomach. nausea, vomiting. stop treatment if you get severe diarrhoea, visual disturbances, jaundice or severe skin rash. MONITORING:

Answer 69

CLASS: penicillin antibiotic INDICATIONS: staph and other gram pos infections: pneumonia, osteomyelitis, skin and soft tissue infections, cellulitis and infected burns. DOSE:250-500mg bd half to 1 hour before food. COUNSELLING: cholestatic hepatitis - particularly in those over 55 years and in treatment lasting more than 14 days. MONITORING: hepatic function especially in long term treatment, would cultures,

Answer 70

CLASS: macrolide antibiotic INDICATIONS: respiratory tract infections caused by streptococcus and mycoplasma. Skin infections caused by streptococcus and staph, bordertella pertussis (whooping cough), listeria, chlamydia, legionella, prevention of bacterial endocarditis DOSE: Adults: 1g per day (250mg aid or 500mg bd) for strep infection. For chlamydia, 500mg tds for 10 days. COUNSELLING: Take on an empty stomach, at least 1 hour before food. MONITORING:

Answer 71

CLASS: cyclopyrolone hypnotic INDICATIONS: short term treatment of insomnia DOSE: 3.75-7.5mg n before retiring. May be used for up to 28 days. COUNSELLING: take before bed, label 1, short term use only, sleep hygiene advice. drowsiness, headache, fatigue, sexual dysfunction, MONITORING:

Answer 72

CLASS: Glucagon-like peptide 1 agonist (increases insulin synthesis) INDICATIONS: adjunctive treatment in type 2 diabetes for patients on metformin, sulfonylureas or basal insulin. DOSE: 5ug bd for at least 1 month then increased to 10ug bd if tolerated. COUNSELLING: Inject no more than 60 minutes before meal. subcutaneous injection into thigh, abdomen or upper arm. keep refrigerated but do not freeze. do not use if solution has particles in it, or is cloudy or coloured. refrigerate until used, then store below 25 degrees for up to 30 days. signs of hypoglycaemia, sharps disposal. MONITORING: blood glucose monitoring, weight in obese patients,

Answer 73

CLASS: dopamine agonist INDICATIONS: parkinson disease and restless leg syndrome DOSE: 0.375mg-4.5mg daily. ER tablets once daily, immediate release tablets in 3 divided doses. start low and titrate up to response. with or without food. 0.125-0.75mg once daily for RLS COUNSELLING: take with a full glass of water. swallow whole ER tablets. If you want to cease for any reason, see Dr and decrease gradually. Side effects: label 1 drowsiness, nausea, constipation, dizziness, headache. Suggest sleep hygiene and aerobic exercise in those with restless leg syndrome. May cause somnolence and sleep attacks. MONITORING: BP monitoring at high doses and those with cardiovascular disease due to risk of hypotension,

Answer 74

CLASS: Folic acid antagonist INDICATIONS: Rheumatoid arthritis, psoriasis, crohn's disease, neoplastic disease (breast cancer, leukaemia, lymphoma) DOSE: 7.5-50mg weekly. can be in daily doses with a rest period, or a single weekly dose. COUNSELLING: Mouth ulcers may be sign of methotrexate toxicity. Nausea, GI distress, dermatitis, bone marrow suppression. Take on same day each week. Tell Dr if you produce a dry cough or difficulty breathing. May cause photosensitivity. MONITORING: liver function before and during treatment, pulmonary symptoms (dry, reproductive cough), renal function, full blood count, neurological symptoms

Answer 75

CLASS: immunosuppressant antimetabolite INDICATIONS: rheumatoid arthritis, organ transplant, lupus, and other autoimmune diseases DOSE: 1-4mg/kg/day depending on condition COUNSELLING: Take at least 1 hour before food. May cause GI upset (nausea, vomiting), headache, skin rashes, hair loss, MONITORING: regular complete blood counts, signs of bone marrow suppression (black tarry stools, unusual bruising or bleeding),

Answer 76

CLASS: immunomodulator INDICATIONS: rheumatoid and psoritic arthritis DOSE: 10-20mg once daily. May use loading dose of 100mg d for 3 days. COUNSELLING: diarrhoea, nausea, hair loss, rash MONITORING: Liver enzymes, routine blood counts, serum drug levels, blood pressure monitoring

Answer 77

CLASS: antiepileptic INDICATIONS: epilepsy (tonic-clonic, partial seizures) DOSE: 30-200mg tds (max 600mg d in adults, max 300mg daily in children) COUNSELLING: nausea, vomiting and constipation, changes in taste, insomnia, sedation, enlarged gums (good oral hygiene may reduce this). Will increase the effects of alcohol, do not drive until you know how this medication affects you. MONITORING: Narrow TI so regular serum drug levels, monitor for changes in mood such as suicidal ideation or depression, BP, ECG, respiratory function,

Answer 78

CLASS: anticonvulsant INDICATIONS: epilepsy and migraine DOSE: Adults: 25-1000mg d depending on whether it is mono therapy or add on therapy. can take as a single nightly dose or divided doses. Children: 0.5-6mg/kg/day to max of 500mg daily. Titrate according to response. COUNSELLING: LABEL 1, drowsiness, somnolence, diziness, blurred vision, nausea and diarrhoea. MONITORING: monitor patient for emergence of worsening depression, suicidal ideation or changes in mood or behaviour. Children are at risk of hyperthermia so should be monitored for decreased sweating. seizure frequency, migraine frequency

Answer 79

CLASS: anticholinesterase INDICATIONS: Alzheimer's disease DOSE: 8-24mg d as a single dose in the morning with food. start low and titrate to adequate response. COUNSELLING: decreased appetite, nausea, headache, weight loss, drowsiness, MONITORING: patient weight

Answer 80

CLASS: MAOI INDICATIONS: major depression DOSE: 300-600mg d in 2 divided doses (150-300mg bd) COUNSELLING: take with food, can take 4-6 weeks for full efficacy to be apparent, initial worsening of mood, sleep disturbances, restlessness, nausea, headache, dry mouth, MONITORING: patient should be closely monitored for worsening depression or suicidality particularly in first few weeks of treatment.

Answer 81

CLASS: SNRI INDICATIONS: major depression DOSE: 8-12mg d in divided doses COUNSELLING: anticholinergic side effects, initial worsening of symptoms, tell doctor if you have trouble urinating MONITORING: blood pressure, mood particularly on initiation of treatment

Answer 82

CLASS: dopamine antagonist (antipsychotic) INDICATIONS: management of psychosis, mania and tourettes syndrome, acute alcoholism (hallucinations, aggression), nausea and vomiting associated with radiation or malignancy, DOSE: nausea and vomiting: 1-2mg tds psychosis: 1-10mg tds for maintenance or up to 15mg every 2 hours for acute psychosis COUNSELLING: may cause movement disorders, drowsiness and sedation, nausea, MONITORING: ECG if given IV, plasma drug concentrations if patient smoking status or frequency changes,

Answer 83

CLASS: antipsychotic INDICATIONS: treatment and prevention of mania in bipolar, schizophrenia, personality disorder DOSE: acute mania (500-2000mg d in divided doses), maintenance (500-1g d in divided doses). COUNSELLING: take with food. Adverse effects: GI discomfort, mild nausea and diarrhoea, vertigo, muscle weakness, fine tremor of hands, fatigue. Signs of toxicity include abdominal pain, vomiting, twitching, ataxia MONITORING: serum drug concentration, thyroid function, cardiac and renal function