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Patient Counselling Medications > Patient Counselling drugs > Flashcards

Patient Counselling drugs Flashcards

1
Q

What is the useful mnemonic to remember when counselling patients on medications?

A

ATHLETICS
A - action
T - timeline e.g. once daily
H - How to take
L - length of treatment
E - effects (how long before you feel the effects)
T - tests
I - important side effects
C - complications & contraindications
S - supplementary advice

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2
Q

What is the action of SSRIs and how is this explained to a patient?

A

SSRIs are antidepressants that alter the balance of some of the chemicals in the brain, thought to play a part in causing depression and other conditions. They mainly affect the chemical known as serotonin.

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3
Q

Timelife of SSRIs - how often to take and when?

A

once daily

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4
Q

In what form do SSRIs come in?

A

Normally tablet - think they may have liquid now?

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5
Q

For how long should someone be on antidepressants?

A

3-6 months after feeling better (taper off)

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6
Q

How long does it take for SSRIs to have any effect?

A

4-6 weeks

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7
Q

What are the important side effects to be aware of with SSRIs?

A
  1. GI disturbance - diarrhoea, nausea, vomiting, appetite change/weight change - and GI bleeds
  2. Headaches
  3. Drowsiness (can take at night)
  4. Anxiety (for first 2 weeks)
  5. Withdrawal
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8
Q

In addition to the usual side effects, what can citalopram also cause, which sometimes requires monitoring/testing before initiating?

A

Prolonged QTc - requires ECG

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9
Q

In addition to the usual side effects SSRIs cause, which other one not mentioned yet is important to monitor, and sometimes dietary information is given surrounding it?

A

It can cause hyponatraemia - patients should not actively undertake a low salt diet

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10
Q

If the patient needs supplementary advice surrounding SSRIs, which websites would be useful to signpost?

A

Beyond Blue
Healthdirect.gov.au

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11
Q

How does methotrexate work?

A

It is a disease modifying agent which has both reduced inflammation and suppresses the immune system.

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12
Q

What is the timeline - how frequently do they take, methotrexate?

A

Once weekly with folic acid at another time, build up dose slowly

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13
Q

How long does it take for methotrexate to start working?

A

4-6 months

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14
Q

What tests need to be performed when starting methotrexate?

A

FBC, LFTs and U&Es
- before starting
- every 2 weeks until therapy stabilised
- then every 2 - 3 months

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15
Q

What are the side effects that methotrexate can cause? (4)

A
  1. Alopecia
  2. Headaches
  3. GI disturbances
  4. Myelosuppression
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16
Q

What advice should be given to patients with regards to myelosuppression?

A

If they have any sign of fever/signs of infection - go to A&E, or if they experience unexpected bleeding/bruising/anaemia
Can also cause pulmonary toxicity - so be aware for shortness of breath

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17
Q

What should patients avoid while taking methotrexate?

A

Alcohol - it can cause liver toxicity

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18
Q

When is methotrexate contraindicated? (5)

A
  1. In pregnancy, or if trying to get pregnant - including males
  2. Hepatic impairment
  3. Breast feeding
  4. Active infection
  5. Immunodeficiency
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19
Q

What supplementary advice is given to patients taking methotrexate? (3)

A
  1. No NSAIDs/aspirin
  2. Get annual flu jab
  3. Visit arthritis.org.uk for more info
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20
Q

How does lithium work and who is it for?

A

Lithium is generally prescribed for bipolar disorder as it is a mood stabiliser. The exact mechanism is unknown, but it is thought to interfere with neurotransmitter release and second messenger systems

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21
Q

How often do they need to take lithium?

A

One or twice daily, depending on brand, and if it works is usually lifelong

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22
Q

What are the different forms that lithium comes in? (3)

A
  1. Tablet
  2. Capsule
  3. Syrup
23
Q

How long does it take for lithium to have an effect?

A

1-2 weeks

24
Q

What tests need to be done before/during when lithium is taken?

A
  1. FBC
  2. U&Es
  3. TFTs
  4. bHCG
  5. ECG
    Lithium levels need to be checked after 5 days, 12 hours post dose, and then every week until stable for 4 weeks, and then every 3 months
    - the TFTs and U&Es and calcium are checked every 6 months
25
Q

What are the side effects of lithium? (8)

A
  1. Abdominal pain
  2. Polyuria
  3. Polydipsia
  4. Metallic taste
  5. Nausea
  6. Fine tremor
  7. Weight gain
  8. Oedema
26
Q

What are the symptoms of lithium toxicity? (3)

A
  1. Anorexia, diarrhoea, vomiting
  2. Neuromuscular - dysarthria, dizziness, ataxia, muscle twitching, tremor
  3. Apathy, restlessness
27
Q

What are the complications of lithium?

A
  1. Renal toxicity
  2. Nephrogenic diabetes insipidus
  3. Hypothyroidism
28
Q

When is lithium use contraindicated? (7)

A
  1. In pregnancy 1st trimester - though have to really work out the risks vs. benefits here
  2. Breast feeding
  3. Cardiac disease
  4. Significant renal impairment
  5. Addison’s disease
  6. Low sodium diets
  7. Untreated hypothyroidism
29
Q

Which website is useful to recommend to patients who are starting lithium?

A

Bipolar Australia
Beyond Blue

30
Q

What is the general mechanism of action of atypical antipsychotics?

A

Schizophrenia is caused by an over-activity and sometimes under-activity of chemicals in transmission of messages in the brain. Olanzapine etc. work by blocking the receptors in the brain that are involved in transmitting these messages.

31
Q

What are the different forms atypical antipsychotics can be given?

A

Tablet and depo injection

32
Q

What is the length of treatment for antipsychotics?

A

Long term, to keep the symptoms from returning

33
Q

How long does it take for antipsychotics to take effect?

A

Several days or weeks

34
Q

Are any tests required before commencing/during treatment with antipsychotics?

A

Often LFTs should be monitored as they can impair liver function
ECG is normally required as can cause prolonged QTc (can lead to toursades des pointes)

35
Q

What are the side effects that anti psychotics can cause? (5)

A
  1. Antidopaminergic - parkinson-like ; tardive dyskinesia, tremor, movement disorders
  2. Anti-cholinergic; constipation, dry mouth
  3. Anti-histaminergic; weight gain, dizziness, drowsiness
  4. Anti-adrenergic; hypotension
  5. Acts on tubular infundibulum pathway so can cause amenorrhoea, galactorrhea, gynaecomastia etc.
36
Q

What are the complications of antipsychotics? (3)

A
  1. Neuroleptic malignant syndrome (high fever and muscle rigidity)
  2. Agranulocytosis
  3. Withdrawal
37
Q

When are antipsychotics contraindicated? (2)

A
  1. Phaeochromocytoma
  2. Liver failure
38
Q

Antipsychotics should be used with caution in patients with which conditions? (6)

A
  1. Epilepsy
  2. Diabetes
  3. Glaucoma
  4. Parkinsons
  5. Prostate/heart/kidney problems
  6. Pregnancy
39
Q

What is the action of a statin?

A

A statin stops the liver making cholesterol. Cholesterol is one of the things which predisposes to artery problems causing heart disease, stroke and kidney disease.

40
Q

When should a statin be taken?

A

Once daily, at night

41
Q

How long does it take for a statin to take effect?

A

It reduces the risk over many years, is taken lifelong

42
Q

What needs to be check before starting someone on a statin?

A

LFTs - before, at 3 months and 12 months

43
Q

What are the important side effects to inform a patient of before starting statins?

A
  1. Muscle aches/pains
  2. Hair loss
  3. Itching
  4. GI disturbance - nausea, sickness, diarrhoea, abdominal pain
44
Q

What is the standard starting dose of escitalopram for adults?

A

10 mg OD (either morning or night, just same time every day).

45
Q

What is the standard starting dose of lithium?

A

300 mg OD or BID, increasing to 900 mg/daily. Dose then titrated up or down based on blood levels to a stable 0.6-1 mEq/L.

46
Q

What is the standard starting dose of atorvastatin?

A

10 mg - 20 mg OD, in one tablet. Some patients may be prescribed as high as 40 mg OD, depending on their cholesterol results.

47
Q

What is the MoA of Warfarin (layman terms)?

A

Warfarin is a prescription medication that interferes with normal blood clotting (coagulation). It is also called an anticoagulant. Warfarin blocks an enzyme in the liver that normally uses vitamin K to making clotting factors, therefore there are less clotting factors and your blood takes longer to clot.

48
Q

Patient: “Why do I need to take warfarin?”

A

Warfarin is prescribed for people who are at increased risk for developing harmful blood clots. This includes people with a mechanical heart valve, an irregular heart rhythm called atrial fibrillation, certain clotting disorders, or a higher risk of a clot after hip or knee surgery.Warfarin does not dissolve clots, but it keeps them from increasing in size and moving to another part of the body. This allows the body’s natural systems to break down a clot over time, and helps reduce the chance of clots developing in people with a higher risk of forming clots. Warfarin prevents and treats serious medical problems caused by blood clots.

49
Q

What monitoring is required with warfarin?

A

The goal of warfarin therapy is to decrease the clotting tendency of blood, but not to prevent clotting completely. Therefore, the blood’s ability to clot must be carefully monitored while a person takes warfarin. The dose of warfarin is adjusted to maintain the clotting time within a target range, based on the results of periodic blood tests. These tests can be done in a laboratory or using a portable device at home. We test your blood for something called the INR or international normalised ratio - this is a standardised way of measuring how long it takes for a blood clot to form in your blood sample. An ideal INR value for a patient is between 2 and 3. We give you regular blood tests to make sure it is in this range and change your warfarin dose based on your results.

50
Q

What does an INR below 2 mean?

A

Increased risk of blood clots

51
Q

What does an INR above 2 mean?

A

Increased risk of bleeding

52
Q

How often will I need to test my blood for INR on warfarin?

A

Once we have stabilised your INR to between 2-3, a normal monitoring regimen is every 4 to 6 weeks.

53
Q

What are some important side effects of warfarin?

A
  1. Bleeding. This is the most important side effect.This includes serious, life-threatening bleeding such as bleeding into the brain or internal bleeding, which is rare, and minor bleeding such as easy bruising, gum bleeding, or nosebleeds, which are common and can occur with any anticoagulant. Signs of internal bleeding include severe headache or changes in strength in one part of the body, blood in the urine, bloody or dark stool, or vomiting blood.
    2.Warfarin can also cause a rare side effect called skin necrosis or gangrene, which can cause dark red or black areas on the skin. This complication is more likely in people with an inherited clotting disorder called protein C deficiency, which is very rare

Patient Counselling Medications (1 decks)

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