Expand the boxes below to help gain the knowledge required to help counsel patients about starting medications. Use the information in conjunction with our notes on how to counsel patients.
Check for contraindications
– Pregnancy
– Significant risk of major bleeding
– Active bleeding
How the treatment works
– Thins the blood to treat or prevent blood clots
– It does this by blocking vitamin K – the vitamin used by the body to make proteins that cause the blood to clot
Treatment course and how it’s taken
– Once daily tablet (usually in the evening)
– Usually prescribed for 3 months for a DVT, 6 months for a PE, and lifelong for AF
– Dose changes take 2-3 days to take effect
Monitoring required
– Started at 5mg each evening
– INR on days 3,4 and 5 – warfarin dosing charts tell you how to adjust the dose
– Then regular INR checks by anticoagulation clinic – regularity determined by INR stability (patient will be given anticoagulation book)
Side effects
– Bleeding – seek medical advice if you have a significant head injury, prolonged nose bleeds, unusual headaches, blood in urine/stool/vomit, black stool, unexplained or severe bruising
– Also diarrhoea, rash, hair loss, nausea
– Many interactions (mostly with P450 cytochrome inducers/inhibitors) – patients should avoid liver, spinach, cranberry juice, alcohol binges, NSAIDs/aspirin
Check for contraindications
– Significant renal impairment
– Significant risk of major bleeding
– Active bleeding
How the treatment works
– Thins the blood to treat or prevent blood clots
– Many proteins are involved in blood clot formation – this medication blocks one of these proteins from working
Treatment course and how it’s taken
– Once or twice daily tablet/capsule
– Take with full glass of water whilst sitting upright
– Usually prescribed for 3 months for a DVT, 6 months for a PE, and lifelong for AF
Monitoring required
– None regularly
– Check renal function before and annually
Side effects
– Bleeding – seek medical advice if you have a significant head injury, prolonged nose bleeds, unusual headaches, blood in urine/stool/vomit, black stool, unexplained or severe bruising
– GI disturbance
– Irreversible if serious bleed occurs (except dabigatran)
Check for contraindications
– None
How the treatment works
– A synthetic version of thyroxine, the hormone produced by your thyroid gland
– It is given to bring your thyroid activity back up to normal
Treatment course and how it’s taken
– Once daily tablet before breakfast
– Taken long term
– Dose changes take 4-6 weeks to take effect
Monitoring required
– TSH test every 2-3 months until stable
– When TSH level stable, check annually
Side effects
– Rare when thyroxine level stable as it’s replacing a normal hormone
– Hyperthyroid symptoms (vomiting, diarrhoea, headache, palpitations, heat intolerance) may be experienced if dosage is too high
– Hypothyroid symptoms (cold intolerance, constipation) if dosage is too low
Check for contraindications
– Pregnancy
How the treatment works
– Statins stop the liver making cholesterol
– High cholesterol causes problems with your arteries, which increases your risk of heart disease, stroke, and kidney disease
– It is important to also address other cardiovascular risk factors…
Treatment course and how it’s taken
– Once daily tablet in the evening
– Taken long term
– Decreases risk over many years
Monitoring required
– Review in 4 weeks, then every 6-12 months (with lipid profile as required) → dose may be titrated up if target not met
– LFTs before starting, at 3 months and at 12 months (statins cause altered LFTs)
Side effects
– Muscle pains
– Headache
– Itching
– Also nausea, sickness, diarrhoea, abdominal pain
– Rhabdomyolysis – tell doctor if you experience unexpected muscle pain
– Some statins interact with grapefruit juice
Check for contraindications
– Significant renal impairment
– Ketoacidosis
– Low BMI
How the treatment works
– Increases your response to insulin so your cells take up more glucose from your blood
– Also reduces the amount of glucose produced by the liver
Treatment course and how it’s taken
– Once, twice or three-times daily tablet with meals
– Taken long term
– Monitoring required
– U&Es before starting, then annually
– HbA1C every 3-6 months until stable, then 6 monthly at diabetic check ups
Side effects
– Nausea, diarrhoea, abdominal pain, weight loss
– Lactic acidosis – metformin must not be taken on the day of or for 2 days after having general anaesthetic or X-ray contrast media
Check for contraindications
– None
How the treatment works
– Replace your body’s store of iron, a mineral required to make red blood cells
Treatment course and how it’s taken
– 1-3 times daily tablet or syrup (depending on brand)
– Works best if taken without food, but most take with meals as iron can irritate the stomach
– Takes 3-4 weeks for Hb to normalise, then further 3 months to replenish iron stores
Monitoring required
– Haemoglobin in 3-4 weeks to assess response
Side effects
– GI irritation (nausea, sickness, diarrhoea/constipation, abdominal pain)
– Black/green stools
– Metallic taste
Check for contraindications
– Suicidal risk
– Mania
How the treatment works
– Antidepressants alter the balance of some of the chemicals in the brain (neurotransmitters)
– SSRI antidepressants affect a neurotransmitter called serotonin
– Imbalance of this and other neurotransmitters is thought to play a part in causing depression and other conditions
Treatment course and how it’s taken
– Once daily tablet
– May be gradually stopped 6 months after feeling better
– Effects in 4-8 weeks
Monitoring required
– None
Side effects
– GI (diarrhoea, nausea, vomiting)
– Appetite and weight change
– Headaches
– Drowsiness (can take at night)
– Anxiety for 2 weeks
– Withdrawal
– May increase risk of suicide in younger patients
Check for contraindications
– Pregnancy (including male partner)
– Breast-feeding
– Hepatic impairment
– Active infection
– Immunodeficiency
How the treatment works
– It is a ‘disease-modifying agent’ which both reduces inflammation and suppresses the immune system
– Early use improves outcome and symptoms
Treatment course and how it’s taken
– Once weekly tablet with a folic acid tablet on another day
– Same day each week
– Dose built up slowly
– Taken long-term if effective
– Takes 3-12 weeks to work
Monitoring required
– FBC, LFTs, U&EsBefore starting
– Then, every 2 weeks until therapy stabilised
– Then, every 2-3 months
– Patient should be given monitoring book
Side effects
– Alopecia
– Headaches
– GI disturbance – advise not to take with NSAIDs/aspirin
– Myelosuppression (infections, unexpected bruising/bleeding, anaemia) – seek medical advice if you have unexplained bruising/bleeding or have infective symptoms, and get annual flu jab
– Liver and lung toxicity
Check for contraindications
– 1st trimester pregnancy
– Breast-feeding
– Cardiac insufficiency/rhythm disorder
– Significant renal impairment
– Addison’s disease
– Low sodium diets
– Untreated hypothyroidism
How the treatment works
– Mood stabiliser
– Exact mechanism unknown
– Thought to interfere with neurotransmitter release and receptors
– Treatment course and how it’s taken
– Once or twice daily tablet/liquid
– Taken long-term if effective
– Takes 1-2 weeks to work
Monitoring required
– Before starting – FBC, U&Es, TFTs, βHCG, ECG
– Check lithium level after 5 days, then every week until stable for 4 weeks, then every 3 months
– Check TFTs, U&Es, Ca2+ every 6 months
Side effects
– GI (abdominal pain, nausea)
– Metallic taste
– Fine tremor
– Water symptoms (thirst, polyuria, impaired urinary concentration, weight gain and oedema)
– Renal toxicity
– Nephrogenic diabetes insipidus
– Hypothyroidism
– Lithium toxicity symptomsGI (anorexia, diarrhoea, vomiting)
– Neuromuscular (dysarthria, dizziness, ataxia, impaired coordination, muscle twitching, tremor)
– Others (drowsiness, apathy, restlessness)
Check for contraindications
– Hepatic impairment
– Phaeochromocytoma
How the treatment works
– Schizophrenia thought to be caused by problems with dopamine receptors in your brain
– Atypical antipsychotics work by blocking these receptors
Treatment course and how it’s taken
– Tablet daily or depot injection every 2-4 weeks
– Dose built up over a week or two
– Dose adjusted depending on response
Taken long-term if effective (keeps symptoms from returning)
– Takes several days or weeks to work
Monitoring required
– Before treatment, at 3 months, 12 months, then annually: pulse, BP, weight, waist circumference, ECG, HbA1C, fasting glucose, lipid profile, prolactin
– Weight checks weekly for 6 weeks
Side effects
– Anti-dopaminergic (tardive dyskinesia, tremor, movement disorders)
– Anti-cholinergic (constipation, dry mouth)
– Anti-histaminergic (weight gain, dizziness, drowsiness)
– Anti-adrenergic (hypotension)
– Neuroleptic malignant syndrome (high fever and muscle rigidity)
– Agranulocytosis (clozapine)
– Withdrawal
– Hyperglycaemia and diabetes
– Hyperprolactinaemia (sexual dysfunction, menstrual disturbance, galactorrhoea etc.)
– Prolonged QT
Check for contraindications
– Glaucoma
How the treatment works
– Levodopa is a replacement for some of the dopamine which your brain in no longer able to produce
– This will help to reduce your symptoms, particularly your rigidity and slow movements
– Given with carbidopa (inhibits peripheral levodopa degeneration)
Treatment course and how it’s taken
– 3-4 times daily tablet with food (reduces nausea)
– Taken as long as it works effectively – after 5 years most suffer ‘on-off’/‘wearing off’ phenomena (switch between mobility and immobility that occurs before the next dose is due after prolonged levodopa use) and dyskinesias
– Fast-acting
Monitoring required
– None
Side effects
– Psychosis
– Nausea and vomiting
– Dyskinesias
– Postural hypotension
– ‘On-off’/‘wearing off’ phenomena
– Impulsive behaviour
– Dizziness
Check for contraindications
– N/A
How the treatment works
– Insulin allows the cells of your body to take up glucose from the blood and use it for energy
– This means insulin reduces the blood glucose level
– In people with diabetes, insulin may be needed because the body cannot produce it or use it effectively
Treatment course and how it’s taken
– Depends on the type of insulin regimens (see insulin)
– Injected using injection pen at a 90Ëš angle
– Usually injected to different sites around the lower abdomen and upper outer thighs/buttocks
Monitoring required
– Capillary glucose monitoring is done before each meal and before bed
– It should also be checked if there are any symptoms of a high/low blood sugar (explain)
Side effects
– Weight gain
– Sharp injuries (pens should be disposed of in sharps bin)
– Hypoglycaemia (educate patient about management)
– Lipodystrophy at injection sites
Check for contraindications
– Pregnancy
– Dysphagia/abnormalities of oesophagus
– Recent peptic ulcer
– Significant renal impairment
– Unable to sit upright for 30 minutes
How the treatment works
– Prevents bone from being broken down and helps to rebuild new bone
– Remember lifestyle factors can also help with this, such as exercise, not smoking (we can help), and eating a well-balanced diet
Treatment course and how it’s taken
– Once daily or once weekly tablet
– Swallow tablet with full glass of water
– Take at least 30 minutes before food or anything other than water
– Be upright for 30 minutes after swallowing
– Taken long term
– Monitoring required
– Regular dental check-ups (risk of osteonecrosis of jaw)
Side effects
– Headache
– Heartburn, bloating, indigestion
– GI (diarrhoea/constipation, abdominal pain)
– Seek urgent medical advice if symptoms of = Osteonecrosis of the jaw, Dysphagia/odynophagia, Upper GI bleeding/black stools
