Providing Information Flashcards
What information does a patient need to be told regarding Warfarin in pregnancy?
Warfarin is usually contraindicated in pregnancy due to its teratogenic effects and can cause nasal hypoplasia, bone stippling, bilateral optic atrophy and various degrees of intellectual disability in babies.
What is an important information that needs to be given to patient starting on gliclazide?
Gliclazide causes hypoglycaemia.
Gliclazide (sulfonylurea) causes hypoglycaemia and patient should be made aware of the symptoms of hypoglycaemia such as sweating as could be fatal if not addressed immediately.
Lithium use requires what to be checked?
Thyroid function should be checked at initiation and six monthly thereafter. The risk of hypothyroidism is increased five-fold in patients taking lithium.
Important information to tell patients about haloperidol?
Haloperidol can cause muscular spasm.
EPSEs can occur with use of haloperidol. Including acute dystonia, which is when sustained muscle contractions cause abnormal face and body movements such as facial grimacing, neck torticollis, oculogyric crisis or trismus.
Appropriate information to consider concerning lamotrigine in pregnancy?
The dose of lamotrigine should be adusted based on plasma drug concentration. Monitoring is required in pregnancy to minimise harmful effects to the unborn baby. The purpose of treatment is to prevent seizures by maintaining an effective dose of one or more antiepileptic drugs.
Advice regarding carbamazepine for epilepsy in pregnancy?
Carbamazepine is associated with teratogenic effects of the newborn and the woman should be referred to a specialist for advice.
This is also true for phenytoin, primidone, penobarbital and lamotrigine.
Information to provide regarding methotrexate to patient with RA?
Regular blood tests are required for methotrexate. Patients should have FBC, LFTs and U&Es monitored before commencing treatment. These shoould be repeated every 1-2 weeks until theray has stabilised and thereafter every 2 -3 months.
- Methotrexate is taken weekly.
- Methotrexate is associated with myelotoxicity and patients are urged to seek medical help when they have fever or symptoms of infection.
_ Methotrexate is highly teratogenic. Contraception is recommended during and for at least six months after treatment in men and women.
-Folic acid may be prescribed following administration of Mtx to reduce risk of myelotoxocity. There are various dosing regimens of folic acid bu they usually involve taking it on a different day than methotrexate is taken.
Information regarding paroxetine?
Paroxetine can cause decrease in libido. Common side effects of SSRIs include GI upset, insomnia, and sexual dysfunction (delayed ejaculation, reduced sexual desire, anorgasmia and impotence).
SSRIs are associated with an increased risk of bleeding. SSRIs should be used with caution in patients with a history of bleeding disorders especially GI bleeding and those on anticoagulants or NSAIDs.
Drugs for neuropathic pain?
Amitriptyline, gabapentin, pregbalin and duloxetine are used as first-line treatment for neuropathic pain.
Use of ACEi in pregnancy?
ACEis are associated with oligohydramnios and should be avoided in pregnancy. They may impact on fetal and neonatal blood pressure control and kindey function. Skull defects and cases of oligohydramnios have also been reported.
Most important information to provide patient regarding clozapine?
Clozapine can cause agranulocytosis, myocarditis and seizures.
Neutropenia and potentially fatal agranulocytosis can occur with clozapine use. FBC measurements are essential for safe prescribing. An FBC should be undertaken before starting treatment, weekly for first 18 weeks and then at least every two weeks. If FBC is stable after one year of treatment, FBC monitoring can be reduced to every four weeks.
What is the effect of alcohol on insulin treatment?
Excessive alcohol intake can cause hypoglycaemia. Alcohol causes hypoglycaemia by inhibiting gluconeogenesis and therefore enhancing the hypoglycaemic effects of insulin. Patients on insulin treatment should be advised to:
- Drink alcohol in moderation (no more than 14 units a week)
- Not drink alcohol on an empty stomach
- Eat a carbohydrate snack before and after drinking alcohol
- Measure their blood glucose regularly and maintain their blood glucose with carbohydrate intake.
Advice to patients regarding insulin injection site?
Try to rotate insulin injection sites to minimise skin damage. Using same site can lead to lipodystrophy, this presents as lumps under the skin due to the accumulation of fat at the injection site.
Advice to patients regarding insulin on sick days?
Illness causes an increased production of adrenaline and cortisol which stimulates gluconeogenesis and increase the blood glucose concentration. This means when unwell the insulin demand is actually greater. During a period of illness patients on insulin should adhere to the sick day rules:
- Never stop or omit insulin. The dose of insulin may need to be increased.
- Check blood glucose more frequently
- Check blood or urine ketone levels regularly
- Maintain the normal meal pattern
- Drink at least 3 litres of fluid per day to prevent dehydration.
Important information to communicate to the patient regarding atorvastatin?
- Atorvastatin and clarithromycin should not be taken together. Clarithromycin is a CYP3A4 inhibitor and may cause increased plasma concentrations of statins, possibly resulting in adverse effects such as myopathy.
- Atorvastatin can be taken in the morning or evening but should be taken at the same time every day. Simvastatin should only be taken in the evening. This is because most cholesterol metabolism occurs at night.
- Myalgia is a commonly reported SE. Treatment should be stopped if creatine kinase is markedly elevated or muscular symptoms are severe.
