Part 1 - Knowledge And Counselling Flashcards
Simvastatin (zocor)
CLASS:HMG-CoA reductase inhibitor
INDICATIONS: Hypercholesterolaemia, mixed hyperlipidaemia, high risk of cad, post MI
DOSE: 5-80mg once daily (at night)
COUNSELLING: rhabdo, grapefruit, diet and exercise
MONITORING: blood lipids, weight, food diary, liver function and creatinine clearance
Irbesartan (Avapro)
CLASS: angiotensin II receptor antagonist
INDICATIONS: hypertension, heart failure
DOSE: 75-300mg once daily
COUNSELLING: take at same time every day, first dose hypotension, lifestyle and diet
MONITORING: kidney function, blood pressure,
Atenolol (noten)
CLASS: beta blocker
INDICATIONS: hypertension, angina, arrhythmia
DOSE: 25-100mg daily, or prn for arrhythmia
COUNSELLING: first dose hypotension
MONITORING:blood pressure, ecg,
Hydrochlorothiazide (dithiazide)
CLASS: thiazides diuretic
INDICATIONS: hypertension; oedema associated with chronic heart failure, chronic renal failure, drug induced, premenstrual tension
DOSE: 12.5-100mg d
COUNSELLING: hypotension, frequent urination, take before 4pm to avoid nocturia,
MONITORING:blood oressure, kidney function, odeama, electrolytes, dehydration
Ramipril (tritace)
CLASS: ACE inhibitor
INDICATIONS: hypertension, diabetic nephropathy, reduction of risk of MI or stroke in patients with vascular disease, diabetes,
DOSE: 1.25-10mg once daily
COUNSELLING: hypotension, angiodaema (cease immediately), cough, skin reactions,
MONITORING: renal function, serum electrolytes, liver function in those with hepatic impairment, white blood cell counts (monitoring for leukopenia and bone marrow suppression),
Atorvastatin (Lipitor)
CLASS: HMG-CoA reductase inhibitor
INDICATIONS: Hypercholesterolaemia, mixed hyperlipidaemia, high risk of coronary artery disease, post MI
DOSE: 10-80mg once daily
COUNSELLING: Diet and exercise, grapefruit juice, muscle pain and risk of rhabdo (dark urine)
MONITORING: blood lipids, weight
Amlodipine
CLASS:calcium Channel blocker INDICATIONS: hypertension, angina, tachyarrhythmia DOSE: 5-10mg d COUNSELLING: hypotension MONITORING: blood pressure, ecg
Warfarin
CLASS: vitamin k antagonist
INDICATIONS: prevention of pulmonary embolism and VTE, treatmant of dvt, stroke prevention
DOSE: widely variable, once d according to INR
COUNSELLING: bleeding, vitamin k and green leafy vegetables,
MONITORING: INR, ultrasound for clot size, bleeding episodes
Clopidogrel
CLASS: Anti-platelet drug
INDICATIONS: Prevention of TE after stent insertion, prevention of stroke or MI in those with vascular disease
DOSE: can start with 300mg loading dose, then 75mg d as maintenance
COUNSELLING: bleeding, stomach upset
MONITORING: Bleeding,
Indapamide (as part of coversyl plus)
CLASS: Thiazide-like diuretic
INDICATIONS: hypertension, odeama associated with congestive heart failure, reduction of stroke risk in those with hypertension (in combination with perindopril)
DOSE: 1.5mg daily
COUNSELLING: hypotension,
MONITORING: serum electrolytes, kidney function, blood pressure, hydration,
Diltiazem (cardizem, vasocardol CD)
CLASS: calcium channel blocker INDICATIONS: hypertension, angina DOSE: 180-360mg once daily COUNSELLING: hypotension, lower limb oedema is common, headache, palpitations MONITORING: renal function
Aspirin
CLASS: NSAID, anti-platelet
INDICATIONS: Anti-platelet: Prophylaxis of acute MI, unstable angina, TIA, CVA in patients with known CV or cerebrovascular disease NSAID: inflammation, headache, etc
DOSE: Anti-platelet: 100mg once daily. NSAID: 300-900mg every 4 hours to a maximum of 2400mg daily (8 tablets)
COUNSELLING: increases bleeding risk (do not take if you have a clotting disorder), GI uspet and ulceration
MONITORING: for anti-platelet use: monitor blood flow to heart etc
Frusemide (lasix, urex)
CLASS: loop diuretic
INDICATIONS: Hypertension, oedema associated with heart failure, renal impairment and hepatic cirrhosis
DOSE: 20-40mg d for oedema, 40-80 mg d as a divided dose for hypertension. Maximum of 1 gram daily.
COUNSELLING: hypotension
MONITORING: renal function, serum electrolytes (calcium and potassium), blood pressure, blood glucose in diabetic patients, liver function
metoprolol (betaloc)
CLASS: Beta blocker INDICATIONS: hypertension, arrhythmia, angina DOSE: 50-100 mg d in one or two doses COUNSELLING: hypotension, MONITORING: blood pressure, ECG
Isosorbide mononitrate (Imdur, monodur)
CLASS: nitrate
INDICATIONS: prevention and treatment of angina, chronic heart failure, acute heart failure associated with MI and unstable angina
DOSE: Usually start at 60mg once d and can increase to 120mg once d. If headache occurs, reduce starting dose to 30mg once d.
COUNSELLING: headache, swallow whole (do not crush or chew), hypotension/dizziness, tachycardia, nausea,
MONITORING: blood flow to heart, blood pressure, side effects and symptom relief
Verapamil (isoptin)
CLASS: Calcium channel blocker
INDICATIONS: hypertension, angina
DOSE: Immediate release: 80-160mg bd or tds (maintenance dose usually 160mg bd). Slow release: 120-480mg once daily (maintenance usually 240mg once d)
COUNSELLING: Can cause constipation, First dose hypotension, dizziness, nausea, swallow whole, do not break tablets (SR)
MONITORING: blood pressure, renal function, serum electrolytes,
candesartan (atacand)
CLASS: Angiotensin II receptor antagonist
INDICATIONS: hypertension, heart failure,
DOSE: 4-32mg once daily
COUNSELLING: dizziness, hypotension, nausea, headache
MONITORING: blood pressure, renal function
Glyceryl trinitrate (GTN, nitrolingual pump spray, nitro-dur patches)
CLASS: Nitrate
INDICATIONS: Angina
DOSE: Pump Spray: PRN for angina. Patches: 5-15mg/24 hours.
COUNSELLING: Patches: rotate sites, 12 hour nitrate free period. Spray: for acute angina, spray under tongue, if no relief call 000. Headache, dizziness
MONITORING: blood pressure, angina relief
Nifedipine (adalat/adalat oros)
CLASS: calcium channel blocker
INDICATIONS: hypertension, chronic stable vasospastic angina
DOSE: conventional: 10-20mg bd, can increase to 40mg once daily. Extended release: 20-120mg once d titrated according to response.
COUNSELLING: Swallow ER tablet whole with water, hypotension, dizziness, nausea
MONITORING: renal function, blood pressure, angina symptoms
Enalapril (renitec)
CLASS: ACE inhibitor
INDICATIONS: hypertension, CHF, left ventricle failure
DOSE: 5-40mg in divided dose.
COUNSELLING: hypotension, exercise and diet, dizziness, nausea
MONITORING: blood pressure, ECG
Lercandipine (zanidip)
CLASS: calcium channel blocker
INDICATIONS: hypertension
DOSE: 10-20mg once daily
COUNSELLING: hypotension, dizziness, nausea, diet and exercise, smoking etc
MONITORING: renal function, blood pressure
telmisartan (micardis)
CLASS: Angiotensin II receptor antagonist
INDICATIONS: hypertension, heart failure
DOSE: 40-80mg once daily
COUNSELLING:
MONITORING: blood pressure, renal function
indapamide (natrilix)
CLASS: Thiazide diuretic
INDICATIONS: hypertension
DOSE: Immediate release - 2.5mg in the morning. ER: 1.5mg in the morning
COUNSELLING:
MONITORING: blood pressure, serum electrolytes, renal function
Prazosin (minipress)
CLASS: Selective aplha-1 receptor antagonist
INDICATIONS: Hypertension; severe refractory CHF; Raynaud’s phenomenon/ disease; urinary obstruction due to BPH in patients awaiting prostatic surgery
DOSE: 0.5-1mg bd or tds. Can increase to 20mg d in divided doses if necessary.
COUNSELLING:
MONITORING: blood pressure, urine output, renal function
carvedilol (dilatrend, vedilol)
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
Digoxin
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,
Mometasone (elocon/novasone)
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
Betamethasone (diprosin, antroquoril)
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:
metformin (diabex)
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,
Gliclazide
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
Thyroxine (oroxine, eutroxsig)
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
Risedronate (Actonel)
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,
Alendronate (fosamax)
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,
Latanoprost (xalatan)
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
Chloramphenicol (Chlorsig)
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
Timolol (tenopt, timoptol)
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
Hypermellose (genteal, polytears)
CLASS: ocular lubricant INDICATIONS: dry eye DOSE: 1 drop into affected eye prn COUNSELLING: instillation instructions, blurriness, irritation MONITORING: symptoms
Omeprazole (losec, acimax)
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
Esomeprazole (nexium)
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)
Pantoprazole (somac)
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
Ranitidine (zantac)
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,
Rabeprazole (pariet)
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
Lansoprazole (zoton)
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:
Monitoring for Zollinger-Ellison Syndrome
Basal Acid Output: should be less than 10mEq/Hour.
Fasting serum gastrin, secretin test and imaging.
Patients should undergo annual or 6 monthly review.
Prochlorperazine (stemetil)
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
Metoclopramide (Maxolon)
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:
Celecoxib
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:
Meloxicam (mobic)
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
Diclofenac (voltaren)
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
Allopurinol (Progout, Zyloprim)
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
Colchicine (lengout, colgout)
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.
Valproate (epilim)
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.
Carbemazepine (tegretol)
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
Lamotrigine (lamictal)
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
Sertraline (Zoloft)
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
Temazepam (Temaze)
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
Venlafaxine (efexor)
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:
Diazepam (valium)
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:
Citalopram (Cipramil, Talam)
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:
Paroxetine (Aropax, extine)
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:
Oxazepam (serepax)
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:
Fluoxetine (Prozac, Lovan)
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:
Amitryptilline (Endep)
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:
Mirtazipine (Avanza)
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:
Olanzapine (Zyprexa)
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:
Escitalopram (Lexapro)
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:
Nitrazapam (Mogadon, alodorm)
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:
Dothiepin (Dothep)
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:
Zolpidem tartrate (Stilnox)
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:
Bupropion (Zyban)
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.
Salbutamol (ventolin)
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:
Salmeterol with fluticasone (seretide)
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:
Prednisolone
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,
tiotropium (Spiriva)
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),
fluticasone (flixotide)
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
Ipratropium (Atrovent)
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
Turbutyline (Bricanyl)
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
Umeclidinium with Vilanterol (Anoro Ellipta)
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
Fluticasone and vilanterol (Breo Ellipta)
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
Umeclidinium (Incruse Ellipta)
CLASS: inhaled anticholinergic INDICATIONS: Maintenance of COPD DOSE: one inhalation daily COUNSELLING: antimuscurinic side effects MONITORING: lung function
Actilinium and eformoterol (Brimica Genuair)
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,
Paracetamol (panadol, Panadol osteo)
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,
tramadol
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
Oxycodone (endone, oxycontin)
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:
amoxicillin (amoxil, cilamox)
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:
cephalexin
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:
Amoxiclav (500/125 or 875/125)
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:
Roxithromycin (rulide, roxar)
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:
Doxycycline
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:
cefaclor (Karlor-CD)
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:
Norfloxacin
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:
ciprofloxacin
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:
Flucloxacillin (staphylex)
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,
erythromycin
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:
zopiclone (immovane, immrest)
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:
exenatide (byetta) injection
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,
Sifrol (pramipexole)
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,
Methotrexate
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
Azothioprine (Imuran)
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),
Leflunamide (Arava)
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
Phenytoin (dilantin)
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,
topirimate (topomax)
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
Galantamine (reminyl)
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
moclobemide (amira)
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.
reboxetine (edronax)
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
haloperidol (serenace)
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,
lithium
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
