Patient Counselling drugs Flashcards
What is the useful mnemonic to remember when counselling patients on medications?
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
What is the action of SSRIs and how is this explained to a patient?
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.
Timelife of SSRIs - how often to take and when?
once daily
In what form do SSRIs come in?
Normally tablet - think they may have liquid now?
For how long should someone be on antidepressants?
3-6 months after feeling better (taper off)
How long does it take for SSRIs to have any effect?
4-6 weeks
What are the important side effects to be aware of with SSRIs?
- GI disturbance - diarrhoea, nausea, vomiting, appetite change/weight change - and GI bleeds
- Headaches
- Drowsiness (can take at night)
- Anxiety (for first 2 weeks)
- Withdrawal
In addition to the usual side effects, what can citalopram also cause, which sometimes requires monitoring/testing before initiating?
Prolonged QTc - requires ECG
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?
It can cause hyponatraemia - patients should not actively undertake a low salt diet
If the patient needs supplementary advice surrounding SSRIs, which websites would be useful to signpost?
mind
How does methotrexate work?
It is a disease modifying agent which has both reduced inflammation and suppresses the immune system.
What is the timeline - how frequently do they take, methotrexate?
Once weekly with folic acid at another time, build up dose slowly
How long does it take for methotrexate to start working?
4-6 months
What tests need to be performed when starting methotrexate?
FBC, LFTs and U&Es
- before starting
- every 2 weeks until therapy stabilised
- then every 2 - 3 months
What are the side effects that methotrexate can cause? (4)
- Alopecia
- Headaches
- GI disturbances
- Myelosuppression
What advice should be given to patients with regards to myelosuppression?
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
What should patients avoid while taking methotrexate?
Alcohol - it can cause liver toxicity
When is methotrexate contraindicated? (5)
- In pregnancy, or if trying to get pregnant - including males
- Hepatic impairment
- Breast feeding
- Active infection
- Immunodeficiency
What supplementary advice is given to patients taking methotrexate? (3)
- No NSAIDs/aspirin
- Get annual flu jab
- Visit arthritis.org.uk for more info
How does lithium work and who is it for?
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
How often do they need to take lithium?
One or twice daily, depending on brand, and if it works is usually lifelong
What are the different forms that lithium comes in? (3)
- Tablet
- Capsule
- Syrup
How long does it take for lithium to have an effect?
1-2 weeks
What tests need to be done before/during when lithium is taken?
- FBC
- U&Es
- TFTs
- bHCG
- 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
What are the side effects of lithium? (8)
- Abdominal pain
- Polyuria
- Polydipsia
- Metallic taste
- Nausea
- Fine tremor
- Weight gain
- Oedema
What are the symptoms of lithium toxicity? (3)
- Anorexia, diarrhoea, vomiting
- Neuromuscular - dysarthria, dizziness, ataxia, muscle twitching, tremor
- Apathy, restlessness
What are the complications of lithium?
- Renal toxicity
- Nephrogenic diabetes insipidus
- Hypothyroidism
When is lithium use contraindicated? (7)
- In pregnancy 1st trimester - though have to really work out the risks vs. benefits here
- Breast feeding
- Cardiac disease
- Significant renal impairment
- Addison’s disease
- Low sodium diets
- Untreated hypothyroidism
Which website is useful to recommend to patients who are starting lithium?
www.bipolaruk.org.uk
What is the general mechanism of action of atypical antipsychotics?
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.
What are the different forms atypical antipsychotics can be given?
Tablet and depo injection
What is the length of treatment for antipsychotics?
Long term, to keep the symptoms from returning
How long does it take for antipsychotics to take effect?
Several days or weeks
Are any tests required before commencing/during treatment with antipsychotics?
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)
What are the side effects that anti psychotics can cause? (5)
- Antidopaminergic - parkinson-like ; tardive dyskinesia, tremor, movement disorders
- Anti-cholinergic; constipation, dry mouth
- Anti-histaminergic; weight gain, dizziness, drowsiness
- Anti-adrenergic; hypotension
- Acts on tubular infundibulum pathway so can cause amenorrhoea, galactorrhea, gynaecomastia etc.
What are the complications of antipsychotics? (3)
- Neuroleptic malignant syndrome (high fever and muscle rigidity)
- Agranulocytosis
- Withdrawal
When are antipsychotics contraindicated? (2)
- Phaeochromocytoma
2. Liver failure
Antipsychotics should be used with caution in patients with which conditions? (6)
- Epilepsy
- Diabetes
- Glaucoma
- Parkinsons
- Prostate/heart/kidney problems
- Pregnancy
What is the action of a statin?
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.
When should a statin be taken?
Once daily, at night
How long does it take for a statin to take effect?
It reduces the risk over many years, is taken lifelong
What needs to be check before starting someone on a statin?
LFTs - before, at 3 months and 12 months
What are the important side effects to inform a patient of before starting statins?
- Muscle aches/pains
- Hair loss
- Itching
- GI disturbance - nausea, sickness, diarrhoea, abdominal pain
