Part 1 - The 5 Drugs Flashcards
Aciclovir
Indication:
- Treatment and prevention of herpes simplex infections (for cold sores see also Aciclovir (skin))
- Shingles (varicella zoster virus reactivation)
- Acute chickenpox (varicella zoster) in immunocompromised patients
- Herpetic eye infections, see Aciclovir (eye)
Dosage:
Oral - 200mg-800mg up to 5 times daily depending on the condition being treated
IV - 5-10mg/kg over 1 hour, q8h
- Genital herpes simplex
See also Genital herpes
Initial infection, oral 400 mg 3 times daily for 5–7 days.
Recurrent infection, oral 400 mg 3 times daily (or 800 mg twice daily) for 5 days; or 800 mg 3 times daily for 2 days.
Initial or recurrent infection, HIV-positive, oral, 400 mg 3 times daily for 5–14 days.
Prevention, oral 400 mg twice daily.
- Other herpes simplex infections
Orolabial (oral herpes), treatment, oral 400 mg 5 times daily for 5 days in selected cases, eg severe infection, immunocompromised patient. A dose of 400 mg 3 times daily for 5–10 days can be used in HIV infection.
- Shingles, chickenpox
Shingles, oral 800 mg 5 times daily for 7 days.
Children 3 months to 12 years
- Less serious herpes simplex infections
Oral, 10 mg/kg (maximum 400 mg) 5 times daily for 5–7 days or until there are no new lesions. Use 20 mg/kg (maximum 400 mg) 5 times daily for 7–14 days in the immunocompromised.
- Chickenpox, shingles
Oral, 20 mg/kg (maximum 800 mg) 4 or 5 times daily. Use 20 mg/kg (maximum 800 mg) 5 times daily in the immunocompromised.
Monitoring:
- Treatment response
- Compliance
- Renal function
Counseling:
- Make sure to drink at least 1.5-2L of fluids to prevent formation of aciclovir crystals in the urine (especially in high doses)
- This medication may make you feel dizzy or confused. Make sure you are not affected by it before driving or operate any machinery
- Carry the course of medication with you for episodic treatments (first sign of symptoms)
- Taking 5 times daily = q4h
Alendronate
Indication:
- Prevention and treatment of osteoporosis (including post-menopausal and corticosteroid induced)
- Paget’s disease of bone
Dosage:
- Paget’s disease
Adult, 40 mg once daily for up to 6 months.
- Treatment of postmenopausal osteoporosis and osteoporosis in men
10 mg once daily or 70 mg once a week.
- Prevention of postmenopausal osteoporosis
5 mg once daily.
- Treatment and prevention of corticosteroid-induced osteoporosis
Adult, 5 mg once daily; 10 mg once daily for postmenopausal women not receiving oestrogen.
Children:
- Under 3 years or under or equal to 35kg: 10mg alt day
- Over 35kg: 10mg daily
Monitoring:
- Treatment response
- Compliance
- Bone mass density
- Side effect of the medication: especially severe pain in the bones, joints and muscle
- Full dental assessment before starting treatment to minimize risk of osteonecrosis of the jaw
Counseling:
- Take this medicine first thing in the morning on an empty stomach at least 30 minutes before food, drinks and other medicines (including vitamins and antacids).
- Take with a full glass of water and remain upright for at least 30 minutes.
- Stop taking the medicine and talk to your doctor immediately if you develop pain on swallowing; new or worsening heartburn
- There are rare complications with some dental procedures in people taking this medication. Tell your doctor if you require any dental work and tell your dentist that you are taking this medicine (or have taken it in the past).
- Tell your doctor if you have severe pain in your bones, joints or muscles while taking this medicine.
Allopurinol
Indication:
- Gout, long-term treatment
- Urate nephrolithiasis or acute uric acid nephropathy
- Hyperuricaemia secondary to disease, chemotherapy or radiotherapy, seek specialist advice
Dosage:
- Gout
Usually taken once daily; consider giving in 2 doses daily if GI adverse effects are troublesome.
Initial: Start with a low dose (generally no more than 100 mg daily) and slowly increase at monthly intervals (eg by 50–100 mg daily) according to response
Maintenance: 300-600mg daily. Maximum 900mg daily.
- Prevention of hyperuricaemia due to tumour lysis syndrome
Adult, usually 600–800 mg daily
Monitoring:
- Treatment response
- Compliance
- Liver and renal function
- Plasma urate concentration
- Urinary urate/ uric acid levels
Counseling:
- This medicine is taken continuously to prevent or reduce the frequency of gout attacks. If an attacks occur, it will not stop the attack or relieve the pain.
- Drink at least 1.5-2L of fluids per day to prevent precipitation of urate crystals in kidneys
- Take this medicine shortly after food to reduce the possibility of stomach upset.
- If you develop a rash, swollen lips or mouth, persistent fever or sore throat, stop taking allopurinol and tell your doctor immediately.
- This medicine may make you feel dizzy or drowsy; do not drive or operate machinery if you are affected.
- Wait until the attack has settled before starting allopurinol (it is not started during the acute phase because changes in plasma urate concentration may worsen and prolong the attack)
- Once treatment is established, continue allopurinol at the current dose, even during acute attacks
Alprazolam
Indication:
- Anxiety
- Panic disorder
Dosage:
- Anxiety
Adult, initially 0.25–0.5 mg 3 times daily. Range, 0.5–4 mg daily.
- Panic disorder
Adult, initially 0.5–1 mg at night, increased by 0.25–1 mg every 3 days until symptoms are controlled. Maximum 10 mg daily.
Monitoring: (CYP3A4 substrate)
- Treatment response
- Tolerance and dependence by checking interval of dispensing
- Blood counts
- LFT
Counseling:
- You may feel drowsy while taking this medication; drowsiness may persist the following day; avoid driving or operating heavy equipment until you know how you react.
- Avoid alcohol and other medications that may cause drowsiness while taking this drug.
- If you take this medicine regularly for more than 2–4 weeks your body may become used to it and in time, you may need a higher dose for it to continue to work. Regular review with the doctor is recommended.
- If you stop the medicine suddenly, you may have unpleasant effects (eg feeling anxious, difficulty sleeping). Discuss how to stop the medicine with your doctor first. These may not occur until several days after stopping, and can last for several weeks or longer after prolonged use. Discuss how to stop the medicine with your doctor first.
Amiodarone
Indication:
- Treatment for tachycardia
Dosage:
- Initial: 200-400mg tid for 1 week, then 200-400mg bd for 1 week
- Maintenance: 100-400mg daily
Monitoring:
- Treatment response
- Compliance
- Blood tests (therapeutic range plasma concentration: 1-2.5mg/L)
- ECGs
- Chest x-rays (acute inflammatory disorder, chronic fibrotic form)
- Thyroid functions (hypothyroidism mainly occur first 2 years after treatment)
- Eye tests (reversible corneal microdeposits)
- LFT
- Electrolytes
Counseling:
- Avoid sun exposure, wear protective clothing and use sunscreen (broad-spectrum, factor 30+ sunscreen containing titanium dioxide is recommended) when outdoors.
- Amiodarone interacts with grapefruit juice and many other drugs; avoid grapefruit juice and tell your doctor or pharmacist that you are taking amiodarone before starting any new medication.
- You will need regular blood tests, ECGs and chest x-rays while taking amiodarone.
- Tell your doctor if you develop shortness of breath or a dry cough, problems with your vision, weight loss, muscle weakness or worsening of your heart symptoms.
- Adverse effects may take months or years to appear
Amitriptyline
Tricyclic Antidepressant Indication: - Major depression - Nocturnal enuresis - Adjuvant in pain management - Migraine prophylaxis - Urinary urge incontinence
Dose:
Major depression: 25-150mg d. Max 300mg d. Initial 25-75mg d, increasing by 25-50mg every 2-3 days to 75-150mg d. (Daily dose may be divided or given as a single dose at night; maintenance dose is usually given at night)
Adjuvant in pain management, migraine prophylaxis: initial 10-20mg n, titrate up to Max 75mg at night in migraine and 150mg in pain management
Monitoring:
- Treatment effectiveness
- Depression: worsening symptoms and/or emergence of suicidality (especially in first month)
- Side effects (anticholinergics)
Counseling:
- You may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days. Try taking at night to reduce day time drowsiness.
- Orthostatic hypotension
- Label 1, 9
- Therapeutic response delayed by 2 weeks, and up to a month to know if it is working effectively
-
Amoxycillin
Antibiotic (Penicillins)
- Community-acquired pneumonia, exacerbation of chronic bronchitis
- Acute otitis media, sinusitis
- Eradication of H.pylori (with other agents)
- Gonococcal infection
- Epididymo-orchidsitis, acute prostatitis, acute pyelonephritis, UTI
- Non-surgical prophylaxis of endocarditis
- Acute cholecysitis, peritonitis
Dose:
Oral: 250-500mg q8h or 1g bd to tds. 1g tds can be used in severe infections e.g. Pneumonia (Child: 7.5-25mg/kg max 500mg q8h, severe infection 30mg/kg Max 1g q8h)
IM/IV: 250mg-1g q68h Max 12g d (eg to treat Listeria meningitis) (Child: 10-25mg/kg max 1g q8h, severe 50mg/kg Max 2g q4h)
Gonococcal: 3g stat
Monitoring: - Treatment effectiveness - Side effects For high dose treatment more than 10 days - Blood count - Creatinine - LFT
Counseling:
- Finish the whole treatment course
- Space dose evening throughout your waking hours
- If you develop sweeping of the face, lips or toughness; a rash; or difficulty breathing, seek immediate medical attention
Anastrozole
Aromatase inhibitors (Hormonal antineoplastic drugs)
Indications:
- Hormone receptor-positive early breast cancer in postmenoausal woman (adjuvant)
- Advanced breast cancer in postmentopausal women with:
: hormone receptor-positive disease (first line)
: disease progression after tamoxifen therapy
Dose:
1mg once daily
Monitoring:
- Treatment effectiveness
- Side effects (hot flushes, weakness, rash, headache, joint and muscle pain)
- BMD
Counseling:
- Ensure adequate dietary intake of calcium (eg 3-4 serves of diary foods each day)
- Ensure adequate sunlight exposure to produce vit D
- Advise on suitable calcium and vit D supplementation if necessary
Apixaban
Factor Xa inhibitor coagulant
Indication:
- Prevention of VTE following elective hip or knee replacement
- Treatment of acute VTE and prevention of subsequent VTE
- Non-valvular AF and a high risk of stroke or systemic embolism
Dose:
Prevention of emboli in AF: 5mg bd
Prevention of VTE after joint replacement: 2.5mg bd, commencing 12-24 hours after surgery. Continue for 10-14 days after knee replacement or 32-38 days after hip replacement
VTE: 10mg bd for 7 days, then 5mg bd for at least 6 months; Prevention of subsequent VTE: 2.5mg bd
Monitoring:
- Treatment effectiveness
- Side effects (bleeding, anaemia)
Counseling:
- Take about the same time every day; use a calendar to keep a record and to mark off the date after taking a dose
- Tell your doctor and pharmacist that you are taking this medicine before starting or stopping any other medication, herbal or over-the-counter medication. (CYP3A4 and P-GP inhibitor)
- Tell your dentist, podiatrist, physiotherapist or chiropractor that you are taking this medicine
- You need to see your doctor for regular checks, but tell your doctor immediately if you have any unexplained bruising, bleeding, pink, red or dark brown urine, or red or black faeces
- This anticoagulant is different than warfarin, and it does not require regular laboratory monitoring
- Consider earring warning bracelet or necklace
- This medication should not be stopped abruptly unless under medical advise
Amolodipine
Calcium Channel Blocker (dihydropyridine)
Indication:
Hypertension
Angina
Dose:
Initial: 2.5-5mg d. Increase after 1-2 weeks to maximum 10mg d
Monitoring:
- Treatment effectiveness (BP/Angina)
- Side effects (peripheral oedema)
Counseling:
- This medication could take up to 2 weeks to reduce your blood pressure
- This medication can initially cause dizziness, headache and flushing. These may decrease or disappear with continued use.
- If you develop swollen ankles, tell your doctor
Aspirin/dipyridamole
Antiplatelet
Indication:
- Secondary prevention of ischaemic stroke and transient ischemic attack
Dose:
- 200mg CR bd (Asasantin SR)
SE:
- GI upset (nvd)
- headache
- hot flushes
- hypotension
Monitoring:
- Treatment effectiveness
- Compliance
- Side effects
- Long-term use: GI bleeding, creatinine, LFT
Counseling:
- This medicine is absorbed best if taken on an empty stomach 1 hour before, or 2 hours after food. If it upsets your stomach, it can be taken with food or milk.
- Some people can get bad headache with this medication, especially at the beginning of treatment. Talk to your doctor if this happens.
Atenolol
Cardioselective Beta-blocker Indication: - AF (tachyarrhythmia) - Hypertension - Angina - MI - Prevention of migraine
Dose:
25-100mg d
Monitoring:
- Treatment effectiveness
- Compliance
- Side effects
Side effect:
- SOB, bronchospasm
- cold extremities
- reduce HR and BP
- fatigue, dizzy, reduce concentration
- impotence
Counseling:
- Label 9, 12+
- If experience cough, SOB, fatigue, cold feet or toes; seek medical advice
- DM: could mask symptoms of hypoglycaemia
Atorvastatin
Statins Indication: - Hyperchloestrolemia - Hypertensive patients with additional risk factors for heart disease - Mixed hyperlipidemia
Dose:
10-80mg d
Monitoring:
- Treatment effectiveness
- Compliance
- Side effects
- LFT
Side effects:
- myalgia
- WT
- rhabdomyolysis
- transient GI symptoms
- increase in transaminases
- insomnia
- dizziness
Counseling:
- Label: 18
- if experience dark urine (brown), muscle pain, tenderness or weakness, seek medical advice
- continue low fat diet and exercise
- consider life style changes: smoking, excess OH, physical inactivity
Azithromycin
Macrolides (Inhibits CYP3A4)
Indications:
- Treatment and prevention alternatives to penicillins and cephalosporins in allergic patients
- T&P Mycobacterium avium complex (MAC)
- T&P Pertusis
- Treatment choice of Chlamydial infection
- CAP
- Travellers’ diahorrea
Dose:
- 500mg d for 3 days (Travellers’ diahorrea)
- 500mg on day 1 and 250mg d for 4 days (Pertussis)
- 1g stat (Chlamydia)
Monitoring:
- Treatment effectiveness
- Side effects
Side effects:
- GI upset (nvd)
- abdominal pain
- Candida’s infection
- rash (SJ syndrome)
Counseling:
- This medicine interacts with many drugs; tell your doctor and pharmacist that you are taking this medicine before starting or stopping any medicines, including herbal and OTC products
- Even though you may start feeling better after a couple of days, really important to complete full course
Aspirin (analgesic/antiplatelet)
Non-opioid analgesic/ antiplatelet Indication: - Fever - Mild-to-moderate pain - Acute migraine - Kawasaki disease - Rheumatoid arthritis - Rheumatic fever - Anti-platelet
Dose:
- Analgesic: 300-900mg q46h prn. Max 4g/day (up to 8g/d for rheumatic fever)
- Anti-platelet: 75-100mg d
Monitoring:
- Treatment effectiveness
- Long-term: GI bleeding, creatinine, and LFT
Counseling:
- Take with food
- If you develop swollen ankles, difficulty in breathing, black stools or vomit that looks like coffee grounds, stop taking the medicine and contact your doctor immediately
- It may be advisable to stop taking aspirin 7 days before planned surgery and some dental procedures. Discuss with your doctor or dentist.
