PBS top 100 drugs Flashcards
Adrenaline (epinephrine) Epipen
CLASS:
Sympathomimetic
INDICATIONS:
Anaphylactic reaction
DOSE:
150mcg (<20kg) - 300mcg (>20kg) SC stat
MONITORING:
Response, airways, DRABC
COUNSELLING:
Tell everyone you know what you’re allergic to and educate. Keep 2 Epipens at all times.
Call 000
Note expiry.
Remove cap - ‘Blue to the sky, orange to the thigh’.
Hold in for 10 secs and then massage for 10 secs. - can pierce clothes - avoid seam
Available S3. Store 15-25˚C. Check solution is clear before administering. Repeat after 5 min if no response.
Alendronate
CLASS:
Bisphosphate
INDICATIONS:
Paget’s disease
Osteoporosis prevention/tx
DOSE:
Osteo - 10mg daily OR 70mg weekly
Pagets - 40mg daily for 6 months
(comes in 10mg, 40mg, 70mg, combo packs)
MONITORING:
BMD
renal function
dental health
vitamin D and Calcium levels
COUNSELLING:
Swallow whole with a full glass of water first thing in AM 30 mins before breakfast.
Remain upright for at least 30 mins
Ensure weekly tablet taken on same day every week
L4a - no antacids, iron, calc w/i 2 hours of dose
Inform dr if new/worsening heartburn or musculoskel pain
Can -> NVD, headaches
Ensure regular dental checkups
Allopurinol
CLASS:
Xanthine oxidase inhibitor (reduces uric acid production/urate levels)
INDICATIONS:
Gout
Chronic symptomatic hyperuricemia
Prev tumour lysis syndrome
DOSE:
100mg(starting) - 600mg daily (MAX:900mg)
(Comes in 100mg, 300mg)
MONITORING:
Renal function
Liver function
Urate levels
For gout flares
COUNSELLING:
Take with food to reduce GI upset
Drink plenty of water to prevent urate crystals in kidneys
- L5* many interactions - check before taking any new meds/herbals
- L12* Can make dizzy initially - see how you feel before driving
Can -> NVD, taste disturbance
Inform dr/stop mmediately if rash develops
Should not be commenced during flare (unless on appropirate flare cover), can increase attacks initially (does not mean tx failure), continue taking even through flares
Alprazolam
CLASS:
Benzodiazepine (short acting 6-12 hours)
INDICATIONS:
Anxiety
Panic disorder
DOSE:
- 5-4mg daily in 3-4 doses (MAX 10mg)
* (Comes in 0.25, 0.5, 1, 2mg)*
MONITORING:
Sedation, respiratory rate, falls risk
Tolerance, dependence, diversion, duration of tx
Renal and liver func (reduce dose)
Blood counts
COUNSELLING:
L1 - sedation, see how you feel before driving
Alcohol/other sedatives will increase this effect
Ideally only for use ST and PRN
L9 - If have been taking long term, do not stop suddenly, dose titration required.
Can -> drowsiness, confusion, hypersalivation, ataxia, sexual dysfunction
Withdrawal effects = anxiety, dysphoria, insomnia, aggitation
Amiodarone
CLASS:
Antiarrhythmic
INDICATIONS:
Tx/proph of refractory tachyarrhythmias 2dary to AF, SVT(supraventicular tachy)
DOSE:
100-400mg daily (maint)
OR
(loading) 200mg tds, then 200mg bd
* (Comes in 100mg, 200mg)*
MONITORING:
Eye examination
Thyroid function
ECGs
chest xray
liver function
FBE
electrolyte balance
drug conc (TDM)
COUNSELLING:
- L5* - many interactions check before new drugs/herbals
- L8* - photosensitivity
- L18* - no grapefruit
Can -> exacerbation of arrhythmia, pulmonary toxicity, thyroid dysfunction, coneal microdeposits (regular testing is important)
Can also cause NV, taste disturbance, blue-grey skin pigmentation and vivid dreams
Has a long half life - so symptoms can take months/years to occur after starting and stop after ceasing
Amitripyline
CLASS:
Tricyclic Antidepressant
INDICATIONS:
Major depression
Nocturnal enuresis, urinary incontinence
Neuropathic pain
Migraine proph
DOSE:
25-150mg (MAX 300mg) -depression
Lower doses (ie10mg) for migrain and incont
(Comes in 10mg, 25mg, 50mg)
MONITORING:
BP, ECG (qt prolong)
suicidal thoughts, worsening of symptoms
clinical effect
liver func (dose reduction)
serotonin toxicity
COUNSELLING: L1, L5, L9, L13, L16
L1 - sedation. caution driving. take at night
Takes time to start working - start seeing difference in 1-2 weeks, full effect up to 8 weeks
Can make you feel worse before better - tell someone you’re on it to help monitor your mood, see dr if issue
Can -> drowsy, blurred vision, dry mouth, constipation, urinary retention (antislud) - these should go away
Can -> weight gain
L9 - do not stop suddenly. see dr for weaning plan
Amlodipine
CLASS:
Dihydropyridine Calcium channel blocker
INDICATIONS:
Hypertension
Angina
DOSE:
- 5-10mg once daily
* (Comes in 5mg, 10mg, combos)*
MONITORING:
BP
liver function
peripheral oedema (doesn’t respond to diruetics)
COUNSELLING: L9, L12*, L18
Take every day, it’s important to take even if you can’t feel it working.
Can take 2 weeks to reduce BP effectively
L9 - do not stop suddenly
L18 - Avoid grapefruit
Can -> dizziness, headache, flushing (these should go away)
Tell dr if ankles swollen
Does come in combo if needed
Amoxicillin
CLASS:
Penicillin Antibiotic
INDICATIONS:
CAP
Ear infections
Sinusitis
UTI
H. pylori
DOSE:
250-1000mg TDS
or
1g BD
Paed: 7.5-25mg/kg (MAX 500mg) TDS
(Comes in 250mg, 500mg, 1g, 25mg/ml, 50mg/ml, 100mg/ml)
MONITORING:
Response to therapy
Sensitiviy/resistance
Signs of allergy
Hepatic/renal func, FBC tx>10days
COUNSELLING:
Take with/without food (with food if GI upset)
Space doses evenly
Complete course
Can -> NVD, widespread rash
Look out for signs of allergy (swelling, diff breathing) - see dr
Suspension: fridge, shake, d28
Amoxycillin with Clavulanic acid
CLASS:
Penicillin antibiotic + beta-lactamase inhibitor
INDICATIONS:
HAP
Epididymo-orchitis , PID, UTI
Bite injuries
Ear infection (if amox hasnt worked)
Sinusitis
DOSE:
500mg/125mg-875mg/125mg BD (can up lower dose to TDS)
Paed: 7.5-20mg/kg (max500) TDS
or
22.5mg/kg (max 875) BD
(Comes in 500/125mg, 875/125mg, 125/31.25mg/5mL, 400/57mg/5mL)
MONITORING:
For allergy
hepatic/renal func, FBC tx>10days
Clin effect, sensitivity, resistance
COUNSELLING:
Space doses evenly
Best absorbed with food
Can -> NVD, widespread rash
If swelling/diff breathing cease and see dr
Suspension: fridge, shake, d28
Anastrozole
CLASS:
Aromatase inhibitor - hormonal antineoplastic (reduce tissue oestrogen conc)
INDICATIONS:
Hormone receptor-positive breast ca in post menopausal
DOSE:
1mg once dialy
MONITORING:
BMD, Vit D, Calcium, VitD+Cal supplements
Regular screening/cancer status
COUNSELLING: L12, 21, LA
Can -> hot flushes, vag dryness, weakness, rash, headache, naus, diarr, joint/muscle pain, periph oedema, carpal tunnel
Ensure adequate vit D and calc intake (may need supple)
Apixaban
CLASS:
Factor Xa inhibitor anticoagulant
INDICATIONS:
Prev VTE post knee/hip replacement
Tx acute VTE + Proph of subsequent VTE
Non-valvular AF (to prev stroke/embolism)
DOSE:
Post knee/hip replace
2.5mg BD for 10-14 (knee) or 32-38(hip) days
VTE treat
10mg bd for 7 days, then 5mg bd
Subs VTE proph
2.5mg BD
AF
5mg BD
MONITORING:
Signs of bleeding
Leg pain or swelling/presence of emboli
Renal function
Other meds
Renal func
COUNSELLING:
Take at same time everyday - use calender?
With or without food
- L10b* - do not take aspirin or other NSAIDS
- L18 -* avoid grapefruit
Look out for signs of bleeding (nosebleeds, unexpalined bruises, coffee coloured vomit, dark stools, discoloured urine) or bleeding that wont stop.
If you notice leg pain, swelling, feel weak, dizzy, SOB - see dr immediately
This medication doesn’t have a reversal to stop bleeding like warfarin - take care not to sustain serious injuries and go to ED if you do. Consider med alert bracelet or card in wallet.
Inform all health professionals you are taking this (dentists, pods, drs, pharmacists) and check with them before taking any new meds/herbals as there are many interactions
Aspirin
CLASS:
NSAID analgesic, antiplatelet
INDICATIONS:
Acute coronary syndrome
Hx of symptomatic atherosclerosis
Pain, infl, fever
DOSE:
antiplatelet - 100mg daily
analgesic - 300-900mg q4-6h (MAX 4g daily)
MONITORING:
Signs of bleeding or PUD
renal/liver function
Salicylate allergy or NSAID bronchospasm (esp in asthma)
COUNSELLING:
L9 - Take every day, do not stop suddenly
Do not double up with other NSAIDs (if using high dose)
Look out for signs of bleeding (coffee coloured vom, nosebleed, unexpl bruising, discoloured urine, dark stools)
Experience abdo pain, indigestion inform dr
Inform health professionals youre on it (may need to stop before surgery)
Should not be given to <16yo (Reye’s syndrome)
Aspirin plus Dipyrimadole
CLASS:
Dual antiplatelet
INDICATIONS:
Secondary prev of ischaemic stroke and TIA
DOSE:
CR 25mg aspirin/200mg dipyri BD
(Comes in 25/200mg CR, 200mg CR-dipyri only)
MONITORING:
Signs of bleeding or PUD
renal/liver function
Salicylate allergy or NSAID bronchospasm (esp in asthma)
COUNSELLING:
Take every day, swallow whole
L16 - can cause dizziness
Look out for signs of bleeding (coffee coloured vom, nosebleed, unexpl bruising, discoloured urine, dark stools)
Experience abdo pain, indigestion inform dr
Inform health professionals youre on it (may need to stop before surgery)
Atenolol
CLASS:
Selective beta 1 Beta-blocker
INDICATIONS:
HTN
Angina
Tachyarrhythmias
MI
Migraine proph
DOSE:
25mg-100mg daily
(Comes in 50mg)
MONITORING:
BP
Can worsen heart failure at start
Renal func
COPD, asthma (exacerbate)
Diabetes (mask hypogly)
Raynaud’s phenomenon (exacerb)
(But less likely in atenolol)
COUNSELLING: L9, L12*
L12 - May cause drowsy/dizzy when first starting - caution driving and standing. May feel lethargic for first few days
Take everyday - not a med you can feel working
L9 - Do not stop suddenly
Can -> cold extremities
Atorvastatin
CLASS:
HMG-CoA reductase inhibitor (statin)
INDICATIONS:
Hypercholesteraemia
HTN patients with addit heart disease risk factors
DOSE:
10-80mg once daily
(Comes in 10, 20, 40, 80mg, combos)
MONITORING:
Lipid levels (HDL, LDL, triglycerides)
Liver function, aminotransferase levels
Renal func
Myopathy, creatine kinase conc
COUNSELLING: L18, L21
Take at the same time each day (long acting, doesn’t matter what time)
Keep an eye on lipid levels. Combine with healthy lifestyle to reduce risk of heart disease.
L18 - Avoid grapefruit
If you experience unexplained muscle pain/weakness dark urine - see dr
Can -> mild GI upset, headache, sleep disturbance
Azathioprine
CLASS:
Immunosuppressant
INDICATIONS:
Prev organ trans rejection
Immune/inlfam diseases (rheum arth, IBS, lupus)
DOSE:
Org trans - 2-5mg/kg day 1, the 1-3mg/kg daily in 1-2 doses
Inflam dis - 1-3mg/kg daily in 1-2 doses
(Comes as 25mg, 50mg)
MONITORING:
FBC (leucopenia, anaemia)
liver/renal func
Signs of infection
COUNSELLING: L8, L21
Swallow whole. Take with food (to reduce stomach upset)
- L21 -* handle with care if administering (cytotoxic)
- L8 -* photosensitivity
Tell dr if signs of bleeding or infection
Can -> NVD, alopecia
Azithromycin
CLASS:
Macrolide antibiotic
INDICATIONS:
Chlamydial infection
Streptococcol pharyngitis/tonsilitis
CAP
Prev/tx of MAC (mycobacterium avium complex) inf
typhoid
Traveller’s diarrhoea
DOSE:
1g stat (chlam)
or
250mg-500mg daily
(Comes as 500mg)
MONITORING:
For allergic reaction
Clearing of infection, sensitivity, resistance
Hepatic func
ECG (torsades de pointes, QT prolong)
COUNSELLING:
Take with or without food.
Complete course
Can -> NVD
Inform dr if baby gets irritable or vomiting if feeding while taking azith (infantile hypertrophic pyloric stenosis
Betamethasone cream
CLASS:
Corticosteroid
Moderate (valerate) and Potent (dipropionate)
INDICATIONS:
Inflammatory skin conditions (eg eczema and psoriasis)
DOSE:
Diproprionate 0.05%
(Diprosone, Eleuphrat)
Valerate 0.02%, 0.05%, 0.1%
(Antroquoril, Betnovate)
Apply daily-BD (note: 0.02% up to QID)
MONITORING:
Clinical effect, skin atrophy
For infection
Duration of tx
Compliance to non-pharma advice
COUNSELLING:
Apply after bathing. Allow sufficient time to absorb before applying moisturiser (doesn’t matter which to apply first)
Not for long term use - only for flares
May make skin sensitive when first using
Do not apply to broken or infected skin
Ensure following non-pharma advice (ie: no soap, irritants/triggers, plenty of moisturiser)
Bisoprolol
CLASS:
Beta blocker (cardioselective beta-1)
INDICATIONS:
HTN
Angina
Tachyarrhythmias
MI
Heart failure
Migraine proph
DOSE:
- 25-10mg once daily
* (Comes in 1.25mg, 5mg, 10mg)*
MONITORING:
BP, heart rate, ECG
Can worsen heart failure at start - ensure stable on other therapies (ie acei) before starting bisop for heart failure
Renal func
COPD, asthma (exacerbate)
Diabetes (mask hypogly)
Raynaud’s phenomenon (exacerb)
(But less likely in bisoprolol)
COUNSELLING: L9, L12*
L12 - May cause drowsy/dizzy when first starting - caution driving and standing. May feel lethargic for first few days
Take everyday - not a med you can feel working
L9 - Do not stop suddenly
Can -> cold extremities
Budesonide plus Eformoterol
CLASS:
(Symbicort)
Inhaled corticosteroid plus LABA
INDICATIONS:
Asthma preventer and reliever
COPD
DOSE:
100mcg/6mcg - 400mcg/12mcg BD
(400/12 inhaler only suitable for COPD)
MONITORING:
Lung function - FEV1, peak flow
Inhaler technique
Compliance
Exacerbations/need for relievers
Asthma/COPD management plan
COUNSELLING: L14
This medication must be used everyday to work properly
Ensure correct inhaler technique (turbuhaler or rapihaler)
L14 - Rinse mouth out with water after each use
Can be used as a reliever
Can -> sore throat/voice horsness, oral thrush, tremours, palps, headache
Buprenorphine
CLASS:
Partial opioid agonist
INDICATIONS:
Chronic Pain (patches)
Acute pain (sublingual)
Opioid dependence (sublingual film)
DOSE:
Acute pain SL - 200-400mcg q6-8h prn
Chronic pain patch - 5mcg-40mcg/hour weekly
Opioid depend - 2-32mg daily
Comes in SL 200mcg, patch 5mcg/h, 10mcg/h, 20mcg/h, 30mcg/h, 40mcg/h
Subutex 0.4mg, 2mg, 8mg
Suboxone (w/ naloxine) 2/0.5mg, 8/2mg
MONITORING:
Effect on pain relief
Sedation, respiratory depression, falls risk
Renal, hepatic function
Skin reaction
Constipation
Dependence, diversion, tolerance
COUNSELLING:
Patch is applied once weekly - same day each week.
Can write date on patch or calender
Apply to unbroken, clean, dry, hairless skin on upper torso (if necessary, do not SHAVE hair, trim only).
Remove old patch before applyingnew one. Rotate patch site to minimise skin irration
Avoid patch direct exposure to heaters, electric blankets, etc as can increase dose released.
Know how to dispose safely.
L1 - sedation. can be increased by alcohol
Can cause constipation so stay hydrated and ensure fibre intake.
Can -> skin irritation (patch), NV,
Bupropion
CLASS:
Selective dopamine and noradrenaline re-uptake inhibitor
INDICATIONS:
Nicotine dependence
DOSE:
150mg daily (starting) - BD
(Comes in 150mg SR - Zyban SR)
MONITORING:
Neuropsychiatric symptoms, changes in mood/behaviour, thoughts of suicide
Response to therapy/progress
Renal and hepatic function
BP (if comb with NRT)
Contraind if hx of siexures
COUNSELLING: L5, L12*, L16*, LA
Plan a quite date and start buprop 7 days before that (takes time for it to be effective)
- LA -* Swallow whole
- L12/16 -* Can make you drowsy and dizzy be carefull getting up and see how you feel before driving while your body gets used to medication
Can -> insomnia, nightmares, diff concentrating, tremor, headache, dry mouth, constipation
(note some of these can be related to stopping smoking
If you notice rash, swelling, diff breath - stop and see dr imm
Limit alcohol intake - can increase risk of unpleasant effect
Can use NRT alongside - improves quit rate
*Can -> false positives in urine tests (ie amphetamine)
Cabergoline
CLASS:
Ergot-derived dopamine agonist
INDICATIONS:
Parkinson’s disease
Hyperprolacinemia, prevent onset of lactation
DOSE:
0.5mg-3mg once daily
or
1mg stat (prev of lact)
MONITORING:
Fibrotic disorders (bc ergot deriv)
hepatic function
Cardio evaluations
Behavioural changes - impulse disorder
Movement improvement
COUNSELLING: L12*, L16
Take with food, starting at night
L12/16 - Can cause dizzy/drowsy, careful standing and see how you fee before driving
Can -> leg cramps, NV, constipation, headache, periph oedema, sudden sleep onset
Inform dr if behavioural changes, can also effect impulse control
Calcipotriol
CLASS:
Topical vitamin D analogue
INDICATIONS:
Plaque psoriasis
DOSE:
Apply BD (can use less after init period) until improved
Comes in 0.005% cream (Daivonex), plus combo w/betameth0.05%(Daivobet)
MONITORING:
Hypercalcaemia (rare at rec doses) avoid use psoriasis extensive (too much exposure)
Skin improvement, skin irritation
COUNSELLING:
Apply to affected area(s) - not for face or extensive psoriasis (no more than 100g/week)
Wash hands after application to avoid transfer to other areas.
Do not use occlusive dressings.
Do not mix with other products (can destroy calcipotriol)
May need to use for 4-6 weeks for max improvement. Stop once improved recommence when next flare
L8 - photosensitivity
Can -> mild irritated skin after application
Calcitriol
CLASS:
1,25-dihydroxycholecalciferol, acvitve form of vitamin D
INDICATIONS:
Regulates calcium homeostatis and bone metabolism
Tx of osteoporosis
Prev corticosteroid-induced osteopor
Tx of hypocalcaemia in hypoparathyroidism, rickets, chronic renal dialysis
DOSE:
0.25microg daily
(up to 1mcg in hypoparathy, rickets)
Comes in 0.25mcg (Sical)
MONITORING:
Plasma calcium levels, Urinary calcium and phosphate
Cease if hypercal
Renal function
COUNSELLING: L5
Do not take calcium supps or other Vitamin D supps
Follow dr rec re: dairy intake
Tell dr if NV, constipation, headache, frequent urination, tiredness, thirst
Candesartan
CLASS:
Angiotensin 2 receptor antagonist (Sartan)
INDICATIONS:
HTN
Chronic Heart failure - part of therapy instead of ACEI
DOSE:
8mg-32mg once daily
(Comes in 4, 8, 16, 32mg, combos)
MONITORING:
BP
Electrolyte balance (esp potassium - caution supps and pot sparing diuretics)
Renal func (caution triple whammy)
Dehydration
COUNSELLING: L11,L12*, L16*, L21
Take everyday, wont nec feel it working
Monitor BP regularly. Can take 4-6 weeks to improve BP
L11 - do not take potassium supplements
Avoid NSAIDs
L12/16 - Can cause drowsy/dizzy when starting - caution driving/standing
If swelling, diff breathing - stop, see dr (angioedema)
Carbemazepine
CLASS:
Antiepileptic
Mood stabiliser
INDICATIONS:
Epilipsy - partial and generalised seizures
Trigeminal neuralgias (neuropathic pain)
Bipolar disorder
DOSE:
Epil - 200mg-1200mg daily (in div doses) (MAX 2g)
Trig neur - 100-800mg daily in div doses (MAX1.2g)
Bipolar - 400mg-1.6g(MAX) daily in div doses
(note: CR given BD)
* Comes in 100mg, 200mg, 200mg CR, 400mg CR. (Tegretol), 20mg/mL*
MONITORING:
Clinical effect (seizures, pain, mood)
Compliance
Changes in behaviour, mood, thoughts of suicide
Plasma conc (opt dosing or susp toxicity)
FBC (blood dyscrasias/bone marrow supp)
Rash, hypersensitivity
Sedation, eyes
BMD. VitD/Calc supps
hepatic func
COUNSELLING: L5, 9, 12*, 18, 21, B
Swallow whole (if CR)
- LB -* Take with food to reduce stom upset
- L9 -* Take every day- do not stop suddenly
L12 - Can make drowsy/blurred vision - see how you feel before driving
Limit alcohol can increase effects of ETOH
L18 - avoid grapefruit
Can -> visual disturbance, dry mouth, constipation, NV, rash
Tell dr if rash, sore throat, ulcers, bleeding, fever
Can reduce efficacy of COC, vag ring, progest OC, etonogestrel implant (rod) -seek other forms
Carbimazole
CLASS:
Antithyroid drug
INDICATIONS:
Grave’s disease
Thyroid storm
ST before thyroid surg or before/after radioactive iodine tx
DOSE:
Hyperthyr - 10-60mg daily (init), 2.5-40mg daily(maint) - div doses
Thyr storm - 60-80mg daily in div doses -grad reduced
Comes in 5mg (Neo-mercazole)
MONITORING:
FBC (agranulocytosis)
Hepatic function
Thyroid function (TSH)
COUNSELLING:
Can -> itch, mild rash in first 8 weeks (antihist may help), NV, arthralgia, headache
Tell dr if fever, sore throat, ulcer, rash, abdo pain, jaundice
Carvedilol
CLASS:
Non-selective beta-blocker (alpha1, beta1, beta2 receptors)
INDICATIONS:
HTN
Chronic heart failure
DOSE:
HTN - 12.5-50mg daily
HF - 3.125-25 BD (can 50mgBD if >85kg)
Comes in 3.125, 6.25, 12.5, 25, 50mg
MONITORING:
BP, heart rate, ECG
Can worsen heart failure at start - ensure stable on other therapies (ie acei) before starting carved for heart failure
Regular Opthalmic review
hepatic func
COPD, asthma (exacerbate)
Diabetes (mask hypogly)
Raynaud’s phenomenon (exacerb)
(esp since non selective)
COUNSELLING: L9, 12*, 16
L12 - May cause drowsy/dizzy when first starting - caution driving and standing. May feel lethargic for first few days
Take everyday - not a med you can feel working
L9 - Do not stop suddenly
Can -> cold extremities, visual disturbance
If you develop yellowing, dark urine, flu-like symptoms see dr
Antihyperglycaemics may need adjustment
Ceftriaxone
CLASS:
Cephalosporin antibacterial
INDICATIONS:
Empirical pneumonia, bact meningitis
Gonoccocol inf, PID, Epididymo-orchitis (sexually acquired)
Septicaemia
Salmonella, typhoid
DOSE:
1-2g daily (MAX 4g daily)
Comes in 500mg inj, 1g inj, 2g inj
MONITORING:
Hypersensitivity, allergy
Renal func
Clin effect, sensitivity, resistance
FBC if tx>10days
COUNSELLING:
Incompatible with Ca - do not give with ca-cont solutn
Can -> NVD, pain at inj site, headache, dizzy
Celecoxib
CLASS:
COX-2 selective NSAID
INDICATIONS:
RA
OA
Pain due to dysmenorrhoea or injury
DOSE:
100-200mg BD (higher dose ST only)
Comes in 100mg, 200mg
MONITORING:
Analgesic effect - if not working, try another
Signs of bleeding
Dehydration
Renal/hepatic function
BP, CVD risk
Full blood count if chronic use
COUNSELLING: L10a, 12*
With or without food
- L12 -* Can cause drowsy when first start
- L10a -* No more than one aspirin, don’t double up on NSAIDs
Be aware of signs of bleeding, dyspepsia
Do not take if dehydrated, ensure adequate fluid intake
Cephalexin
CLASS:
Cephalosporin antibiotic
INDICATIONS:
Staphylcoccal, streptococcal inf in mild pen allergy
UTI, epididymo-orchitis (non-sex)
DOSE:
250-500mg QID
or
500-1000mg BD
MAX 4g daily
Paed - 6.25-12.5mg/kg (MAX500mg) QID
Comes in 250mg, 500mg, 25mg/mL, 50mg/mL
MONITORING:
Renal func
Allergy
Clin eff, sensitivity, resistance, superinfection
FBC and neurotox in longterm tx/high doses
COUNSELLING:
With or without food - can take with food if GI upset
Until all finished
Susp: Fridge, shake, d28
Can -> NVD
Look out for signs of allergy
Chloramphenicol
CLASS:
Broad spectrum antibiotic
INDICATIONS:
Bacterial conjunctivitis
Infec proph post surgery/trauma
DOSE:
drops: 1 drops q2h for 2 days, then QID for 5 days
oint: TDS
* Comes in 0.5% drops, 1% oint*
MONITORING:
Clearing of infection
Worsening of symptoms
Visual changes
COUNSELLING:
Wash hands before and after
Complete course
Ensure knows how to admin eye drops
Do not wear contacts during tx
D28, don’t share eyedrops
Nonpharma - don’t scratch/touch, cut nails, contagious - stay away from school until discharge gone
Ciprofloxacin
CLASS:
Quinolones
INDICATIONS:
Salmonella
Shingellosis
Comp UTIs, epididymo-orchitis, prostatitis
Bone, joint inf
febrile neutropenia
CF infections
DOSE:
250-750mg BD
Comes in 250,500,750mg (C-flox, Ciprol)
MONITORING:
Renal func
Clinical effect, sens, resist
Tendon damage
ECG - QT prolong
COUNSELLING: L3b, 4a, 5, 8, 12
Empty stomach (abs better), drink plenty of fluids
Complete course
- L4 -* Avoid dairy, antacid, iron,zinc, calc supps within 2 hrs of dose
- L8 -* Photosensitivity
- L12 -* drowsy, caution driving
Can increase effects of caffiene
If any unexplained tendon pain, stop and see dr
Citalopram
CLASS:
Selective serotonin reuptake inhibitor
INDICATIONS:
Major depressive disorder
DOSE:
20-40mg once daily (10mg init in elderly)
Comes in 10, 20, 40mg (Celepram, Citalo)
MONITORING:
Clinical effect.
Worsening of symptoms
Movement disorders
Electrolyte balance (esp Na)
Serotonin tox
COUNSELLING: L5, 9, 12
Can take a couple weeks before notice changes and up to 8 weeks for max effect.
Can make symptoms worse before better, monitor mood and see dr if symptoms severe.
Best taken in morning - can cause sleep disturbance.
Take everyday even if feeling better.
L9 - don’t stop suddenly, gradual tapering required
- L12 -* Can make drowsy init - caution driving
- L5 -* Many med/herbal interactions - tell dr/pharm you are taking this.
Know signs of serotonin tox
Can -> NV, headache, insomnia, aggitation, dry mouth sexual dysfunction, weight change
Clarithromycin
CLASS:
Macrolide antibiotic
INDICATIONS:
Prev/tx mycobacterium avium complex
H. pylori
LRTI
DOSE:
250-500mg BD
MAX 1g BD
Comes in 250mg, 500mg (Klacid), 50mg/mL
MONITORING:
Clinical effect
Allergy
ECG - QT prolongation, torsades de points
Renal
Ototoxicity
COUNSELLING:
With or without food.
Complete course
L5 - many interactions
Can -> NV, taste disturbance, superinfection
Clomiphene
CLASS:
Synthetic ovulatory stimulant
INDICATION:
Anovulatory infertility
DOSE:
25-150mg once daily for 5 days
Comes in 50mg
MONITORING:
Visual disturbance
Liver function
BMI
Pregnancy (stop if not pregs after 6 cycles)
Ovarian hyperstimulation
COUNSELLING: L12
L12 - Can drowsy - caution driving
Tell dr if causes visual disturbances
Can -> hot flushes, NV, revers ovarian enlarg, abnorm uterine bleeding
Clopidogrel
CLASS:
p2Y12 antagonist, Antiplatelet
INDICATION:
Hx of symptomatic atherosclerosis
ACS (with aspirin)
DOSE:
75mg daily
(can loading dose 300mg)
Comes in 75mg, 300mg, combo w aspitin
MONITORING:
Signs of bleeding
Hepatic function
COUNSELLING: L9, 10a, 18
With or without food.
- L9 -* Take everyday do not stop suddenly
- L10a* - no more than one aspirin, NSAIDS increase bleeding risk
- L18 -* avoid grapefruit (decreases efficacy)
Know signs of bleeding
Can -> rash, diarrhoea, GI ulcer
Codeine
CLASS:
Opioid analgesic
INDICATION:
Pain
Cough suppression
Diarrhoea
DOSE:
30-60mg q4-6h. MAX 240mg/24hrs
Comes in 30mg, 5mg/mL, combo with aspirin or para or ibu
MONITORING:
Clinical effect
Sedation, resp dep (caution COPD), falls risk
Constipation
Renal/hepatic imp
Tolerance, dependence, abuse
Withdrawal symp if long term
Some ppl poor and ultrametabolisers
COUNSELLING: L1 (if>20mg dose)
L1 - sedation
Constipation (plenty fluid/fibre, lax?)
Can -> NV, dry mouth when first using
Only for short term use - can cause dependence
Not for <12yo
Colchicine
CLASS:
Gout medication (reduces inflam reaction to urate crystals)
INDICATION:
Pain relief during gout attack
Proph of gout attack
(also to prev flares during first 6 months of ULT)
Familial Mediterranean fever
DOSE:
Flare - 1mg stat, then 500mcg 3hrs later
Proph - 500mcg daily - BD
Comes in 500mcg (Colgout, Lengout)
MONITORING:
Renal/hepatic func (dose reduction)
GI effects
Full blood count (agranulocytosis, leucopenia)
Creatin kinase (rhabdomyalgia)
(better choice in HF cf nsaids)
COUNSELLING: L5, 18,
If attack - start at earliest sign of attack, can take para while waiting to work. use icepack
- L5 -* many interactions
- L18 -* avoid grapefruit
Stop taking if severe vom, diar, muscle pain/tender, numbness/tingling, unusual bleeding, infection -see dr
Cyproterone plus ethinylestradiol
CLASS:
COC
INDICATION:
Androgenisation and contraception in these women
DOSE:
1 tablet daily
(2mg cyproterone/35mcg ethinylestradiol)
Comes as Diane, Estelle, Brenda, Juliet
MONITORING:
BP
Risk factors for VTE or stroke (ie over 35, smoking, obese)
Cervical cancer screening
Compliance
COUNSELLING:
Make sure you know which are the active and which are the inactive (different brands recommend starting on inactive pills, some brands on active
Take 1 tab at same time every day (24 hour window)
If no preceeding horm cont:
start with active pill w/i first 5 days of period starting for immediate contraception (otherwise use extra prec for first 7 days of active
If changing from another COC
start taking active pills day after stopping old pill (on any day of cycle) – adit acontracep not required
If changing from POP:
start active pills without any interval – use adit cont for first seven days of active
While taking inactive pill, you will get a withdrawal bleed (but not everyone gets this)
Can -> Spotting, irregular bleeding (to be expected for first 3 months), mood changes, breast tenderness
If notice leg pain, swelling, diff breathing - see dr
Some medicines, vomiting, diarrhoea reduce effectiveness
If vom/diar in 2 hrs of taking pill, take another asap
If <24 hours late taking active – take asap, contraception NOT affected
If >24hr late taking pill:
take as soon as remembered (even if 2 pills taken at once)
Continue pill and use addit contracep until you have taken 7 days of active in a row
If missed pill was in last 7d, skip placebo pills
If pill was missed in first 7 days of active (ie: have not had seven consecutive actives – Use addit cont for next 7 days of taking active
- If sex was had, take morning after pill
Dabigatran
CLASS:
Direct thrombin inhibitor anticoagulant
INDICATION:
Prev VTE post knee/hip replacement
Tx acute VTE + prev of subsequent VTE
AF - prev stroke/emboli
DOSE:
Post knee/hip - 110mg stat, then 220mg once daily (10 daysfor knee, 28-35 for hip)
AF/acuteVTE/subs prev- 150mg bd
(110mg BD for >75yo/bleed risk/renal imp)
Comes in 75mg, 110mg, 150mg (Pradaxa)
MONITORING:
Renal/hepatic function
Clotting/bleeding risk
Signs of bleeding
COUNSELLING:
Swallow whole (opening cap can increase bleeding risk)
Take at same time everyday - mark calendar/record
L10b - do not take aspirin or other NSAIDS while on this
Tell dr pharmacist before starting any new meds/herbals
Let any health prof (inc dentist, pods) you are taking this
Know signs of bleeding
Med alert bracelet/wallet card?
Signs of clot - leg pain, swelling, diff breathing -> ED
Desvenlafaxine
CLASS:
Serotonin and Noradrenaline Reuptake Inhibitor (SNRI)
INDICATION:
Major depressive disorder
DOSE:
50mg CR - 200mg CR(max) once daily
Comes in 50mg CR, 100mg CR (Pristiq, desfax)
MONITORING:
Clinical effect
Changes in mood
Renal func
BP
Serotonin tox
Electrolytes (esp Na)
COUNSELLING: L5, 9, 12
Swallow whole. In the morning (insomnia)
L9 - Take every day. do not stop suddenly
Can take take 2 weeks before effect, 8 weeks for full effect
L12 - can make you drowsy init - caution driving
Can -> naus, constipation, dry mouth, insomnia, headache, sex dys, decreased appetite
Dexamphetamine
CLASS:
CNS psychostimulant
INDICATION:
ADHD
narcalepsy
DOSE:
ADHD - 2.5mg - 40mg (in div doses if >5mg)
Narc - 10mg-60mg daily in div doses
MONITORING:
Abuse/diversion
BP, cardio status
psychiatric status
height/weight (poss slow growth in kids)
Tics
COUNSELLING: L5, 12
L12 - Can cause drowsy /dizzy
Can -> NVD, dry mouth, loss of appetite, anxiety, aggitation, headache, palpitations, insomnia
If insomnia an issue, avoid taking after early afternoon
Do not continue if no effect after optimising treatment
Diazepam
CLASS:
Benzodiazepine
INDICATION:
ST for anxiety
Muscle spasm
Acute etoh withdrawal
status epilepticus
DOSE:
1-10mg TDS
Comes in 2mg, 5mg (Antenex, Valpam, Valium)
MONITORING:
Tolerance, dependence, diversion
Sedation, falls risk
Hepatic/renal func
Blood counts
Withdrawal
COUNSELLING: L1/1a, 9
L1/1a - sedation, sedation into next day
Can increase effects of ETOH
Not for long term
If long term, don’t stop suddenly, taper off slowly toreduce withdraw symp
Can -> light headed, dry mouth, headache, visual disturbance, dependence
Diclofenac
CLASS:
NSAID (non selec COX 1 and 2)
INDICATION:
Inflam pain - RA, OA, menstrual pain, injury
DOSE:
tab: 25-50mg TDS - MAX200mg daily
gel: 1% tds-qid, 2%bd
Comes in 12.5, 25, 50mg (tabs), 12.5, 25, 50, 100mg (supps), 1%, 2% (gel), fixeddose w/ misoprostol
MONITORING:
Pain relief
Signs of bleeding
BP, cardiovascular monitoring
renal/liver function (aminotransferase)
GI distubane (dyspep, bleeds)
Blood count
COPD/asthma/hypersensitivity
COUNSELLING: L10a, 12*, B
Swallow whole with food
L12 - can make drowsy
Ensure adequate fluids - do not take if dehydrated
L10a - no aspirin or other NSAIDs
Know bleeding signs
Leg pain, swelling, chest pain, SOB -> ED
Can -> nausea, dyspep, salt/fluid reten
Digoxin
CLASS:
Antiarrhythmic
INDICATION:
AF and atrial flutter
Heart failure
DOSE:
62.5 - 250mcg once daily
Can loading dose - 125-500mcg q4-6h
Comes in 62.5mcg, 250mcg
MONITORING:
ECG, HR
Renal function
Digoxin level
Dig tox (fatigue, malaise, NVD, dizzy, delirium)
Electrolyte abnorm and thyroid func (can affect conc)
COUNSELLING: L5
L5 - Many interactions
Can -> NVD, visual dist, drowsy/dizzy, rash
Diltiazem
CLASS:
Non-dihydropyridine Calcium Channel Blocker
INDICATION:
Angina
HNT (CR only)
AF/flutter
DOSE:
Angina/AF
- 30mgIR tds-qid (max 360daily)
- 180mg CR-360mg CR daily
HTN
- 180-360mg CR daily
Comes in 60mg ir, 180mg CR, 240mg CR, 360mg CR
MONITORING:
Hepatic function
BP
Symptom control
COUNSELLING: L5, 9, 12*
Swallow whole every day
L9 - do not stop suddenly
L12- drowsy when first starting
Can -> headache, flushing, dizziness, periph oedema (inform dr)
L5 - many interactions
Keep eye on BP, will take a couple weeks to reduce HTN
Domperidone
CLASS:
Dopamine antgonist antiemetic
INDICATION:
NV
Gastroparesis (idiopathic or diabetic)
Lactation stimulation
DOSE:
10-20mg tds-qid (MAX 80/day)
Comes in 10mg (motilium)
MONITORING:
ECG (QT)
hepatic/renal function
COUNSELLING: L18
NV - use for up to 1 week
Gastpar - for up to 4 weeks
Can -> dry mouth, headache, drowsiness
Is prokinetic - can increase rate of abs of other meds
Donepezil
CLASS:
Anticholinesterase inhibitor
INDICATION:
Alzheimer’s
DOSE:
5mg-10mg once daily
Comes in 5mg, 10mg (Aricept, Arazil)
MONITORING:
Clinical effect
Disease progression
Tolerability
COUNSELLING: L12, 16
L12/16 - drowsy/dizzy
Can -> NVD, dyspepsia, headache, insomnia, vivid dreams
(10mg more ass with s/e’s)
Give in evening unless vivid dreasm/insomnia occur
Dothiepin
CLASS:
Tricyclic antidepressant
INDICATION:
Major depression
DOSE:
25-150mg daily. MAX 300mg
comes in 25mg, 75mg (Dothep)
MONITORING:
Psychiatric stability
(Can manic in bipo, fatal in OD)
Serotonin toxicity
Cardiovascular problems (QT prolong, can exac angina, can cause heart block, BP)
Weight
Ocular pressure
can -> angle closure glaucoma
Seizure threshold
hyperthyroidism (enhanced response)
COUNSELLING:
Can get blurred vision, dry mouth, drowsy - should go away
Can dizzy on standing
Caution driving
Increase effects of alcohol
Do not stop suddenly
Can interact with may meds/herbals
Can take a few weeks before it starts working. Be aware of how you’re feeling and see doctor/someone if feelings become overwhelming
Doxycyline
CLASS
Tetracycline antibiotic
INDICATIONS
Acne, Rosacea
CAP, bronchitis, sinusitis
Chlamydial inf, PID, epididymo-orchitis (sex aq)
Proph malaria
Q fever
DOSE
100mg 1-2x daily
or
50-100mg once daily (acne)
Comes in 50mg, 100mg
MONITORING
Allergy
Clin eff
renal/hepatic func
superinfection
Contraind in <8 (bone defor, teeth discolor, enamal displasia)
Caution with tx with oral retinoids (inc risk of benign intracranial hypertension)
COUNSELLING
Swallow whole take with food/glass of milk (reduce stom upset) and large glass of water
Remain upright for at least 30 min (take in morning)
No zinc, iron, calc, antacid in 2 hrs of dose
Photosensitivity
Can -> GI upset
Duloxetine
CLASS
Serotonin and Noradrenaline Reuptake Inhibitor
INDICATIONS
Major depression
Gen anxiety disorder
Painful diabetic peripheral neuropathy
Neuropathic pain (not first line though, less eff than TCAs)
DOSE
30-60mg once daily
MAX 120mg daily (this dose used in gen anxiety dis)
Comes in 30mg, 60mg
MONITORING
Psych stability
(inc suicidal thoughts, clinical eff, can induce manic ep if used in bipolar)
Sero tox
BP
Electrolytes (hyponat)
Bleeding risk
Ocular pressure (angle-closure glaucoma)
Seizure risk
Renal/hepatic impair
COUNSELLING
Swallow caps whole
Take with food
Best in morning (insomnia)
Do not stop suddenly
Can make drowsy/dizzy caution driving
Many interactions
Can -> GI upset, dry mouth, sweating, urinary reten, headache, insomnia, sex dysf
Dutasteride
CLASS
5-alpha-reductase inhibitors
INDICATIONS
benign prostatic hyperplasia when prostate >30-40cm
DOSAGE
500microg once daily
Comes in 500mcg (Avodart)
and combo with tamsulosin cr (Duodart)
MONITORING
Side effects
Clinical effect
Prostate specific antigen (PSA)
(increase means inves for prostate cancer
Breast tissue changes
(poss link with breast ca)
Caution handling by women/pregwomen
COUNSELLING
Swallow whole (contents are throat irritating)
Can -> sexual dysfunction, poor semen qual/infertility
Note: dutas has a long half life (3-5 weeks)
If using as single agent, can take 6 months before improvement and 12-18 months for full effect
If taking combo with tamsulosin:
Take with food (to reduce s/es
CAn cause ortho hypo
Tamsulosin
CLASS
Selective alpha-blocker
INDICATIONS
Benign prostatic hyperplasia
DOSAGE
400microg once daily
Comes in 400mcg (Flomaxtra) and combo with dutasteride
MONITORING
BP (high risk hypoten)
Tx with other antihyp and volume depletions
(both inc risk of hypoten)
Need for cataract surg
(inc risk of intraop floppy iris syndrome)
Renal/hepatic func
Improv of BPH symp
oedema
COUNSELLING
Swallow whole
Can cause drowsy/dizzy caution standing, driving, machinery
Tell opthalm you are taking/have taken this med if you are going to have cataract surg
Can -> headache, nasal congest, blurred vision, dry mouth, urin incon, NV, mood changes
Will start working in 48 hours, full effect in 4-6 weeks
Enoxaparin
CLASS
Low molecular weight heparin
INDICATIONS
Prev VTE in surg patients/bedridden pts
Tx of venous thrombosis
Prev extracorporeal thrombosis during haemodialysis
Tx of acute STEMI, non-STEMI, unstable angina
DOSAGE
Prev VTE:
20mg - 40mg once daily (dep on risk, renal func)
Tx VTE:
1mg/kg BD - 1.5mg/kg once daily (dep on risk)
(1mg/kg once daily if poor renal func)
MONITORING
Bleeding and clotting risk
Renal/hepatic function
Need for surgery or spinal injection
Ability to administer
COUNSELLING
Injected subcut
Ensure they know how to use/dispose
Rotate site, can cause irritation/bruising at injection site
More risk of bleeding, bruising
Know signs of bleeding / clotting - tell dr
Tell dr/health prof you are on this
Erythromycin
CLASS
Macrolide
INDICATIONS
RTI
Rheumatic fever
Legionnaires disease
Campylobacter enteritis
Chlamydial infections
Acne
Rosacea
DOSAGE
(Note: 400mg ethyl succinate = 250mg base)
Base:
250-500mg BD-QID (Max 4g daily)
Ethyl succ: 400mg q6h (Max 4g daily)
Comes in 250mg base (Eryc), 400mg ethyl succinate (E-Mycin), 40mg/ml (eth succ), 80mg/ml (eth succ)
MONITORING
Clin eff
ECG (QT pro, tor d po) - esp with eryth and clarith
Drug interactions (esp eryth, clarith)
Infantile hypertrophic pyloric stenosis
Ototox
Superinf
FBC (blood dyscrasias)
Allergy
Hep function
renal func
COUNSELLING
Base: best abs on empty stomach (can take with food if stom upset)
Take until all taken
Can -> GI upset
Tell dr if allergy, hearing issues (esp if high dose), severe vom/diar, infant irritable/vom
Many interactions
Escitalopram
CLASS
Selective serotonin reuptake inhibitor
INDICATIONS
Marjor depression
gen anxiety dis
social phobia
OCD
DOSAGE
10-20mg once daily
comes in 10mg, 20mg (Esipram, Lexapro)
MONITORING
Clin effect
Psych stability
(increased suic ideation, can induce manic ep in bipolar)
Serotonin tox
hepatic func
Electrolytes (hyponoat)
risk of bleeding
ocular pressure (angle-closure glaucoma)
Compliance
QT prolong
Getting counselling/non-pharma support
EPSE
COUNSELLING
Best taken once daily in the morning
Take regularly - do not stop suddenly
Can take a few weeks to start working - full effect in around 8 weeks. Stay aware of how you feel and talk to dr/someone if start feeling really down or things become overwhelming
drowsy/dizzy - caution driving
Many interactions - tell dr/healthprof youre on it
Can -> gi upset, dry mouth, headache, dizziness, weight changes, sexual dysfunction
Esomeprazole
CLASS
Proton pump inhibitor
INDICATIONS
GORD
Zollinger-Ellison syndrome
H pylori eradication
Tx / prev NSAID ulcer/dyspepsis
Prev pep ulcer rebleeding
DOSAGE
20-40mg once daily
Zollinger-Ellison synd:
40mg BD
H. Pylori:
20mg BD
MONITORING
Clin effect
Review maint therapy (cease/reduce dose?)
Gastric bleeds
? inc risk of enteric inf/pneumonia
Fracture risk (long term use) consider cal or vit d suppl
B12 levels (long term use)
Rule out gastric carcinoma
Hepatic func
COUNSELLING
Swallow whole
Gen well tolerated but can -> GI disturbance, drowsy, insom, dry mouth
Tell dr if signs of gastric bleed (dark stool, coffee ground vom)
Etanercept
CLASS
TNF-alpha antagonists
INDICATIONS
Rheumatoid arthritis
Psoriatic arthritis
Juvenile idiopathic arthritis
Plaque psoriasis
DOSAGE
SC 50mg once weekly
or
SC 25mg twice weekly
MONITORING
FBC (blood dyscrasia)
Infection
Malignancies
Liver/renal func
heart failure, resp disease
(can worsen)
Vaccinations
(some can’t be given, consider immunising beforehand)
COUNSELLING
Contact dr immediately if signs of infection, bleeding, fever
Some vaccines can’t be given
Can -> injection site reaction, allergic reaction, abdo pain, dyspep
In RA- benefit after 1-12 weeks of tx
Exenatide
CLASS
Glucagon-like peptide 1 analogue (GLP-1)
INDICATIONS
T2DM
DOSAGE
SC-5-10mcg BD
or
SC 2mg once weekly
Comes in 5mcg, 10mcg (Byetta), 2mg (Bydureon)
MONITORING
BSL, HbA1c, disease progression
hypoglycaemia
tolerability (GI disturb)
pancreatitis
renal func
COUNSELLING
Ensure know how to admin/dispose
Rotate inj site
Know signs of hypogly
Reg check bsl, Hba1c
Can -> gi upset (should improve), dyspepsia, GORD, abdo pain, inj site reaction, taste disturbance
Tell dr if you dev unexplained severe abdo pain
Ezetimibe
CLASS
Cholesterol absorption inhibitor
INDICATION
Hypercholesterolaemia
DOSE
10mg once daily
Comes in 10mg (Ezetrol), combo with atorv or simva (Atozet or Vytorin)
MONITORING
Lipid profile (HDL, LDL, triglycerides)
Myopathy, creatine kinase
Pancreatitis
Cholelithiasis (gall stones)
Mood in elderly
Hepatic function
COUNSELLING
Take every day wont feel it working
Check lipids reg
Non-pharma advice
Tell dr if develop unexplained muscle pain, weakness
