Prescription medicine counselling Flashcards
(27 cards)
Varenicline
How it works
Dose
Side effects
Lifestyle/medical advice
Used for smoking cessation. reduces the reward feeling experienced from smoking as well as the urge to smoke
Dose: 1 0.5mg once daily for 3 days, followed by 1 0.5mg tablet twice daily for 4 days, followed by one 1mg tablet twice daily thereafter for 11 weeks (12 weeks total). Start 1-2 weeks before intended stop date to build up levels while you smoke for a few more days.
Side effects: drowsiness, GI upset, mood changes
Lifestyle advice:
- this medicine may make you sleepy. avoid driving/operating heavy machinery if this happens
- consult doctor if you experience any unusual changes in your mood
- Make your car and home smokefree - get rid of any ashtrays and wash all your smokey clothes
- Surround yourself with friends and family who will support you through this time. remind yourself of your motivation for quitting and how it will benefit your overall health
Bupropion
How it works
Dose
Side effects
Lifestyle/medical advice
Reduces craving and withdrawal symptoms from smoking through dopamine reuptake inhibition.
Dose: 150mg once daily for 3 days, then 150mg twice daily for at least 7 weeks. Start 1 to 2 weeks before intended stop date. Note: doses need to be taken at least 8 hours apart
Side effects: dry mouth, sleep disturbance (very common), dizziness
Lifestyle advice:
- this medicine may cause some trouble sleeping. this usually goes away eventually, however if it continues to be a problem you can take the second dose earlier in the day, as long as it is at least 8 hours after the first dose
- may impair your ability to drive etc. take caution until you know how it affects you
Alendronic acid
How it works
Dose
Side effects
Lifestyle/medical advice
Reduces bone resorption into the blood, thereby promoting bone density
Dose - 1 tablet (70mg) once a WEEK
Side effects: oesophageal irritation, indigestion, joint swelling
Lifestyle advice:
- alendronate should be taken on an empty stomach at least 30 mins before food or any other medicines as this can affect how much is absorbed by the body
- swallow whole with plenty of water while standing or sitting, and do not lie down for at least 30 mins after taking - this can cause the medicine to get stuck in the GI system and cause oesophageal irritation and indigestion - let the doctor know if you experience difficulty swallowing or new/worsening heartburn
- let the doctor know if you experience changes to your eyes e.g. redness, blurred vision, pain
Glucagon kit
How it works
Dose
Side effects
Lifestyle/medical advice
Glucagon increases blood glucose by mobilising glycogen stores in the liver. Glycogen is the main storage form of glucose in the body.
Glucagon is reserved for insulin induced hypoglycaemia and should only be used in an emergency (patient is unconscious or cannot take glucose by mouth) - call for medical assistance
Symptoms of hypoglycaemia: dizziness, weakness, tiredness, irritability, sweating, fast heartbeat, trembling
How to use injection:
- remove syringe and powder from storage container and set powder on a flat surface
- remove safety cap from powder to expose rubber bung
- remove safety cap from syringe and insert into the bung. push plunger down to the bottom
- while keeping the syringe attached, mix the powder and water gently until solution is clear. then draw out all of the liquid into the syringe, making sure there are no air bubbles
- remove the syringe from the bung. the medicine is now ready to use.
- the medicine needs to be injected into a large muscle, such as the thigh or buttocks. insert the needle at 90 degrees and push the plunger down until all the medicine is gone.
- remove syringe and dispose in a sharps container
- recovery is expected within 10 mins. get patient to eat 15g of carbs (1 slice sandwich, banana) to prevent further hypoglycaemia. if patient is still unresponsive after 10 mins, IV glucose needs to be used.
Side effects: nausea, vomiting, abdominal pain. assess if person is able to eat or not, wait until they feel better
Lifestyle/medical advice:
-ensure friends and family know the signs of hypoglycaemia and how to give the injection
Methotrexate
How it works
Dose
Side effects
Lifestyle/medical advice
Inhibits cell division in autoimmune conditions by inhibiting the formation of a compound necessary for DNA synthesis
Dose: Dose is ONCE WEEKLY and is adjusted person to person. usual maximum dose is 25mg weekly.
Side effects:
- Blood dyscrasias - Patient should report signs such as mouth ulcers, brusing, sore throat
- Liver toxicity: Patient should report signs such as nausea, vomiting, abdominal discomfort, dark urine
- Respiratory disorders: Patient should report signs such as shortness of breath.
Lifestyle/medical advice:
- Can make skin more sensitive to sunlight. Wear sunscreen and appropriate clothing when necessary
- Effective contraception should be used for men or women taking methotrexate and for 3 months after stopping
- common pain relief such as ibuprofen and diclofenac can interact with methotrexate - discuss alternatives with doctor. Methotrexate affects the immune system - talk to the doctor about vaccinations. other interactions include penicillins and PPIs
- limit alcohol intake as methotrexate affects the liver
Symbicort - SMART therapy
Budesonide reduces airways inflammation and bronchial reactivity by reducing inflammatory mediators. Formoterol binds to beta receptors in the bronchi resulting in smooth muscle relaxation and bronchodilation
Symbicort is used as a preventer and a reliever as formoterol has a quick onset of action compared to other LABAs, and is preferred to conventional SABA therapy (also ICS or ICS/LABA combination).
Patients on SMART therapy should only be using symbicort as their reliever. a SABA should not be used. People often develop a reliance on their SABA and neglect preventative treatment, which can be harmful. SMART therapy improves symptom control and reduces risk of exacerbations
Dose: Symbicort 200/6 - 1-2 inhalations once or twice daily regularly for maintenance. 1 inhalation when required, repeated after a few mins (up to 6 inhalations per occassion) if needed. doses above 8 inhalations not normally needed, but can take up to 12 temporarily.
Side effects:
Formoterol: Fine tremor, headache, heart palpitations
Budesonide: throat irritation, oral thrush, hoarseness
Lifestyle/medical advice:
- it is important to rinse your mouth each time you use symbicort as it can cause oral thrush. If you notice symptoms like a sore white patches in the mouth, furry tongue, let your doctor or pharmacist know
- Sometimes inhalers can make your breathing worse. let the doctor know if this happens.
- Do not stop taking the inhaler unless advised by the doctor - can worsen asthma
Colchicine
How it works
Dose
Side effects
Lifestyle/medical advice
Improves gout symptoms by reducing inflammatory reaction to urate crystals
Dose: 2 tablets initially at the first sign of gout attack, followed by 1 tablet every 6 hours for 4 days. max 5 tablets on the first day, and 3 tablets on subsequent days. course not to be repeated within 3 days. total max of 12 tablets for entire course
Side effects: Diarrhoea, abdominal pain, nausea, vomiting
Lifestyle/medical advice:
- stop taking and see the doctor if you experience side effects such as nausea, vomiting, abdominal pain, DIARRHOEA even if symptoms have not been relieved
- avoid foods such as red meat, shellfish, alcohol. eat more vegetables, chicken, white fish. drink lots of water and try to exercise to keep weight down
Doxycycline - Acne
How it works
Dose
Side effects
Lifestyle/medical advice
Reduces bacteria in oil producing glands that causes acne inflammation.
Dose: 50-100mg once daily
Side effects: nausea, diarrhoea, indigestion, oesophageal irritation
Lifestyle/medical advice:
- take with food and a large glass of water. do not lie down for 30 mins after taking as the tablet can get stuck in your oesophagus/stomach and cause throat irritation/indigestion. stop taking and let the doctor know if this happens.
- do not take indigestion remedies, calcium or iron within 2 hours of taking doxycyline. this can affect the absorption of the medicine
- can make your skin more sensitive to sunlight. wear a good SPF sunscreen and keep well covered, even on a bright but cloudy day
Efudix
How it works
Dose
Side effects
Lifestyle/medical advice
Inhibits cell division and DNA/RNA synthesis - used for pre-malignant and malignant skin lesions.
Dose: apply thinly only to the affected area once or twice daily. usual duration 3 to 4 weeks.
Side effects: local irritation and reddening of skin (normal, let the doctor know if it is bothering you) - can use topical corticosteroid for severe discomfort, photosensitvity reactions.
Lifestyle/medical advice:
- wash hands before and after use. apply using a cotton bud or glove - apply only to the affected area. avoid applying to broken or sunburnt skin
- avoid spending too much time in the sun - can cause a rash.
- the cream may take a few weeks to start working. let the doctor know if you think it isn’t working.
Humira - How to use
Best sites to inject are the abdomen (staying a few cm away from the bellybutton) and the sides of the thigh. make sure to rotate the injection site each time. do not inject into skin that is red, tender, hard or bruised.
Keep the injection in the fridge until it is ready to use. the injection may be painful due to the cold temperature of the injection. you can let it warm up to room temperature before injecting.
wipe injection site clean with an alcohol wipe for 30 seconds.
there are 2 caps - a grey cap and a red cap. remove the grey cap first to expose the needle for injecting. then remove the red cap to expose the trigger for the injection.
the pen has a clear area on the side which shows the medication. check that it is clear and not cloudy before injecting.
Hold the pen firmly against the injection site at 90 degrees and push the trigger. hold the pen in place for about 10 seconds until the window on the side turns yellow. this means the medication has been dispensed.
discard the used pen in a sharps container.
Let the doctor know if you experience side effects such as bruising, sore throat, fever, persistent cough or bleeding.
Adrenaline (epipen) - how to use
Anaphylaxis
Anaphylaxis can occur in anybody, even to people who have never had a reaction before. Signs and symptoms of anapyhlaxis usually occur immediately after or within 20 mins of exposure to the allergen. symptoms include difficulty breathing, hoarseness, swollen tongue, swelling/tightness in the throat, wheezing, loss of consciousness. Abdominal pain and vomiting is a sign in insect stings.
People who use reliever inhalers should use them for breathing problems after using adrenaline.
Make sure to educate people about your allergy and signs to watch out for, as well as educating them on how to use your epipen if you aren’t able to use it yourself
Epipen comes in the case which should be removed before injection.
Call for medical assistance if you or someone you know is experiencing anaphylaxis. while they are on the way, get ready to use the epipen.
Place the injector in the palm of your hand and wrap your hand around it firmly. do not put your fingers, thumb or hand on either side of the auto-injector.
place the injector on the outer thigh and remove the blue safety cap by pulling straight up. the injector is now ready to use.
swing and push the auto-injector firmly on the thigh until you hear a click - the medicine is now being injected. you may feel some pressure from the injector. hold it firmly in place for about 3 seconds, then remove. the orange tip will cover the needle.
massage the area for 10 seconds.
the needle is strong enough to go through clothes, so you do not need to remove any clothing before hand
Redipred - asthma
How it works
Dose
Side effects
Lifestyle/medical advice
reduces inflammation in the airways associated with asthma. Used for asthma flare ups
Dose - 1-2mg/kg once daily for 3 to 5 days (max 40mg)
Side effects:
- stomach upset, nausea, vomiting; give with food to minimise this. if stomach upset or vomiting is constant, see the doctor
- can keep child awake at night. give in the morning.
- changes in vision, eye pain; see the doctor.
Lifestyle/medical advice:
- You might have some liquid left over after the course; throw it away after finishing the course
- redipred should help wheezing soon after taking it, but may take a few hours to have its full effect. if it does not help symptoms, let the doctor know
Isotretinoin
How it works
Dose
Side effects
Lifestyle/medical advice
Reduces sebum production and size of sebaceous glands (inhibits bacterial growth), and has anti-inflammatory properties
Dose: 10 to 20mg daily until lesions resolve (usually 3-5 months) then reduce to half dose for 4 months to prevent relapse and scarring.
Side effects:
Dryness of skin/eyes/lips and worsening of acne - make sure to regularly moisturise
Sunlight sensitivity - make sure to use a good SPF sunscreen
Decreased night vision - take caution if driving
Lifestyle/medical advice:
Contraception is essential while taking this medicine. Let the doctor know if you are or are planning to become pregnant. POP is not effective while taking isotretinoin.
acne may worsen at the start of treatment - this is normal. if you think it is not working after a time, consult the doctor
Do not donate blood during or 1 month after treatment
Retrieve cream - isotretinoin
Dose: Apply once daily at night. apply for 5 mins on the first night before washing off, 10 mins on the second night, then increase application time by 30 mins each night until application time is 2 hours, thereafter leave overnight before washing off.
Side effects: local reactions (burning, redness, dryness), sun sensitivity.
Lifestyle/medical advice:
Protect your skin from sunlight
avoid abrasive cleaners and other preparations to treat acne
SSRIs
How it works
Dose
Side effects
Lifestyle/medical advice
Inhibits reuptake of serotonin, allowing more to be available in the brain
Dose: dependent on the person. usually once daily dosing
Side effects:
Drowsiness, dizziness - take caution when driving
GI upset
trouble sleeping (strange dreams, insomnia)
Palpitations - let the doctor know
Lifestyle/medical advice:
The medicine may take a couple of weeks to start working properly. If you still feel like it’s not working after this time, consult your doctor
Do not stop taking this medicine without consulting your doctor first
TCAs
How it works
Dose
Side effects
Lifestyle/medical advice
blocks the reuptake of serotonin and noradrenaline.
Dose: dependent on person and choice of TCA. dosing is generally once daily.
Side effects:
Antimuscarinic - blurred vision, dry mouth, constipation
Drowsiness, dizziness, sleep disturbances
Sunlight sensivity
Lifestyle/medical advice:
Can make your skin more sensitive to sunlight - wear sunscreen
Can take a couple of weeks to start working
Can make you drowsy - take caution when driving
SNRIs - venlafaxine
How it works
Dose
Side effects
Lifestyle/medical advice
Blocks the reuptake of noradrenaline, while also inhibiting reuptake of serotonin and noradrenaline
Dose: 75mg daily increased if needed up to max 375mg daily
Side effects:
Drowsiness
Nausea/vomiting
dizziness, flushing, trouble sleeping
Lifestyle/medical advice:
Gabapentin
How it works
Dose
Side effects
Lifestyle/medical advice
Decreases the release of excitatory neurotransmitters associated with neuropathic pain and seizure propogation
Dose: individuialised to the patient
Side effects: GI upset, weight gain, mood fluctuations, drowsiness
Lifestyle/medical advice:
- May make you drowsy, take caution when driving
- Do not stop taking this medicine without consulting doctor; suddenly stopping can cause withdrawal effects including pain
- Let the doctor know immediately if you experience a rash, swollen lymph nodes, or fever.
- Let the doctor know if you experience any changes in your mood.
- Avoid indigestion remedies within 2 hours - affects absorption
Pregabalin
How it works
Dose
Side effects
Lifestyle/medical advice
Decreases release of excitatory neurotransmitters associated with neuropathic pain and seizure propagation
Dose: Individualised to patient. maximum 300mg twice daily
Side effects: Visual disturbances (blurred vision, visual field defects), GI upset, drowsiness, change of appetite/weight gain
Lifestyle/medical advice:
- Do not stop taking this medicine without consulting doctor. stopping suddenly can cause withdrawal effects e.g. insomnia, headache, diarrhoea.
- Can cause drowsiness; take caution when driving and avoid alcohol
- Let the doctor know immediately if you develop a rash, fever or swollen lymph nodes/lips/tongue etc.
- Can cause mood changes - let the doctor know if you experience any abnormal changes in your mood/thoughts
Serotonin syndrome
Serotonin syndrome is a rare, but potentially dangerous side effect that occurs in people taking multiple medicines that increase serotonin in the body.
too much serotonin leads to symptoms such as confusion, tremor, increased heart rate, sweating, fever etc.
Taking multiple drugs that increase serotonin for a long period of time increases the likelihood of developing serotonin syndrome. Some medicines known to increase serotonin are fine to be taken short term with other serotonergic drugs, but you should still let your doctor know of any new medicines you are taking e.g. OTC.
If you think you may be experiencing serotonin syndrome, see the doctor. Stopping the medication causing the problem may be enough - usually symptoms will disappear within 24-72 hours of stopping the medication.
If your doctor prescribes a new medication, let them know of other medicines you’re taking, including herbal and OTC products.
Sometimes the doctor will decide the benefits of prescribing multiple serotonergic drugs outweighs the risks - be aware of the symptoms of serotonin syndrome
Iron supplementation for children
Always calculate dose based on elemental iron, not the salt form of the iron.
e.g. ferodan is 150mg/5ml - equivalent to 30mg/5ml elemental iron
Doctor prescribes 60mg iron once daily - dose is 10ml once daily (30mg/5ml); NOT 2ml once daily (150mg/5ml)
Eye drops - Advice for patients
- To minimise systemic absorption (goes into the throat, nose etc), apply pressure to the tear duct for about 2 mins after administration
- if using multiple eye drops, administer them 5 mins apart to ensure the medicine is absorbed from each eye drops.
- for contact lens wearers, remove contact lenses before administration and do not reinsert them until 15 mins after administration
- do not touch the eyelids or surrounding areas with the dropper bottle - can cause infection
Ovestin - Menopause
How it works
Dose
Side effects
Lifestyle/medical advice
Ovestin reduces urogenital symptoms of menopause such as vaginal atrophy, vaginal dryness and pain
Dose: 1 applicatorful twice weekly for maintenance. initially 1 application once daily until improvement occurs
Side effects: irritation and itchiness, thrush, vaginal discharge
Lifestyle/medical advice:
Ovestin may damage condoms.
If you miss a dose, take it as soon as you remember, unless it is the day of your next dose. do not take 2 doses on the same day.
Allopurinol
How it works
Dose
Side effects
Lifestyle/medical advice
Reduces enzymes that form uric acid, reducing uric acid levels and thereby reducing risk of crystalisation of uric acid.
Dose: usually 100mg daily, increasing every 4 weeks until target serum urate levels are reached. - patient will need regular blood tests.
Note: allopurinol can cause an initial flare up of gout - prescribers will often co-prescribe pain relief (NSAIDs, colchicine) as prophylaxis.
Side effects:
Rash - contact doctor, GI upset (take with food)
Lifestyle/medical advice:
Lifestyle management is just as important when it comes to managing gout. Making simple changes can help reduce frequency of gout attacks. certain foods can increase uric acid levels, such as seafood, red meat and high amounts of legumes (beans, potatoes). Alcohol can also make gout worse. Opt for foods such as chicken and other vegetables, avoid alcohol and drink lots of water. keeping weight down can also reduce frequency of attacks, try to exercise for at least 30 mins a day (doesn’t have to be intense, walking is sufficient)
