Common Drugs Requiring Patient Counselling

ATHLETICS SSRI Methotrexate Lithium Atypical anti-psychotics Levodopa Bisphosphonates

Check
understanding
of condition
How it works Action Antidepressants alter the
balance of some of the
chemicals in the brain
(neurotransmitters). SSRI
antidepressants mainly
affect a neurotransmitter
called serotonin. An
altered balance of
serotonin and other
neurotransmitters is
thought to play a part in
causing depression and
other conditions.
Treatment Timeline Once daily
course
It is a ‘disease-modifying Mood stabiliser. Schizoprenia is caused by Levodopa works to Prevents the bone from
agent’ which has both an over-activity of replace some of the being broken down and
reduced inflammation Exact mechanism chemicals in transmission dopamine your brain is by helping to rebuild
and suppresses the unknown. of messages in the brain. no longer able to make. new bone.
immune system.
Thought to enter the cells Olanzapine works by This will help to reduce Remember lifestyle
Early use improves and interfere with blocking the receptors in your symptoms, in factors can also help
outcome and neurotransmitter release the brain that are involved particularly your rigidity with this, such as
symptoms. and second messenger in transmitting these and your slow exercise, no smoking
systems. messages between the movements. (we can help) and eating
nerve cells. a well-balanced diet.
Given with carbidopa
(inhibits peripheral
levodopa degeneration)
Once weekly with folic Once or twice daily Tablet daily or depot 3-4 times daily with Once weekly or smaller
acid at another time. depending on brand injection every 2-4 weeks food (reduces nausea) dose daily
Build up dose slowly.

How to take Tablet Tablet usually Tablet, capsule or syrup Tablet or depot injection Tablet Swallow tablet with full
Injection also available glass of water
Start at a small dose and
build up over week or 2. Take at least 30 minutes
Dose adjusted depending before food or anything
on the person's response other than water

Be upright for 30
minutes after
swallowing
Length of Stop 3-6 months after Long term Lifelong usually (if works) Long term (keeps As long as it works Long term
treatment feeling better (taper off) symptoms from returning) effectively
Regular reviews by After 5 years most
psychiatrist Tell doctor if wanting to suffer end dose
get pregnant deterioration (works for
shorter time) and on-off
effect (fluctuate
between severe
parkinsonism and
repetitive involuntary
movements)
Effects - time 4-6 weeks 4-6 months 1-2 weeks Several days or weeks Fast acting -
before
Tests - FBC, LFTs, U&Es Before starting - FBC, Occasional LFTs (may - Dental checkups –
U&Es, TFTs, βHCG, ECG impair liver function) before starting then
-Before starting regularly (risk of
-Then, every 2 weeks Check lithium level after 5 osteonecrosis of jaw)
until therapy stabilised days, then every week until
-Then, every 2-3 months stable for 4 weeks, then
every 3 months.
2+
Check TFTs, U&Es, Ca
every 6 months.

Side effects Important side GI (diarrhoea, nausea, Alopecia GI (abdo pain, nausea) Anti-dopaminergic (tardive Psychosis Headache
effects vomiting) + Appetite & Headaches Metallic taste dyskinesia, tremor, Nausea & vomiting Heartburn, bloating,
weight change GI disturbance Fine tremor movement disorders) Dyskinesias indigestion
Water symptoms (thirst, Anti-cholinergic Postural hypotension GI (diarrhoea/
Headaches Myelosuppresion polyuria, impaired urinary (constipation, dry mouth) constipation, black
Drowsiness (can take at 1. Infection (go to A&E concentration; weight gain Anti-histaminergic (weight BUT other drugs help stools, abdo pain)
night) if you have and oedema) gain, dizziness/ with these e.g.
Anxiety for 2w fever/other infection drowsiness) domperidone
signs) Lithium toxicity symptoms Anti-adrenergic (peripheral dopamine
2. Unexpected GI (anorexia, diarrhoea, (hypotension) antagonist) & selegiline
Withdrawal bleeding/ bruising/ vomiting) (MAO inhibitor - inhibits
purpura Neuromuscular dopamine degeneration
3. Anaemia (dysarthria, dizziness, in CNS so a lower
ataxia, in coordination; levodopa dose can be
muscle twitching, tremor) used)
Others (drowsiness,
apathy, restlessness)

Complications - Myelosupression Renal toxicity Neuroleptic malignant End-dose deterioration Osteonecrosis of the
Liver toxicity (careful of Nephrogenic diabetes syndrome (high fever and On-off effects jaw
alcohol) insipidus muscle rigidity)
Pulmonary toxicity (tell Hypothyroidism Agranulocytosis (swelling
& us if you get of mouth or throat or rash)
breathlessness/ SOB) Withdrawal

Contraindications Contraindications Contraindications Contraindications Contraindications Contraindications Contraindications

Suicide risk (→refer), past
psychiatric illness
Pregnancy (including 1st trimester pregnancy Liver failure Glaucoma Pregnancy
male if trying!) Breast feeding Phaeochromocytoma Dysphagia
Hepatic impairment Cardiac disease Cautions Stomach ulcers
Breast-feeding Significant renal Epilepsy, DM, glaucoma, Severe renal impairment
Active infection impairment Parkinsons, heart, prostate,
Immunodeficiency Addison's disease kidney problems,
Low sodium diets pregnancy
Untreated hypothyroidism

Supplementary www.mind.org.uk NO NSAIDs/ aspirin www.bipolaruk.org.uk www.rethink.org Parkinsons.org.uk www.Nos.org.uk

advice Get annual flu jab
Arthritisresearch.org.uk

© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision
 ATHLETICS Warfarin Levothyroxine Statin Metformin Iron tablets

Check
understanding
of condition
How it works Action Thins the blood. A synthetic version of the normal Statins stops the liver making Increases the sensitivity of Replace your body’s store of
hormone produced by the cholesterol. cells to insulin, thereby iron, a mineral required to
It does this by blocking vitamin K thyroid gland called thyroxine. allowing the body to make make red blood cells (which is
– the vitamin used by the body Cholesterol is one of the things better use of the lower insulin deficient)
to make proteins that cause the It is given to bring your thyroxine which predisposes to artery levels.
blood to clot. levels back up to normal. problems causing heart disease,
stroke and kidney disease.

It is important to also address

other risk factors…

Treatment Timeline Once daily (usually in the Once daily before breakfast Once daily in the evening Once daily with breakfast 1-3 times daily (depending on
course evening) (may be increased to twice brand)
daily)

How to take Tablet(s) Tablet Tablet Take tablet with or Work best if taken on empty
immediately after a meal at stomach but most take with
the same time each day food because iron can irritate
the stomach.

Tablet

Length of 3 months for DVT Lifelong Lifelong Lifelong if it works Usually ̴ 4 months
treatment 6 months for PE
Lifelong for AF (3-4 weeks for Hb to
normalise, then take for 3
months after that to replenish
stores)

Effects- time 2-3 days
before
Tests Start 5mg for 4 days then test
INR on day 5 and 8, adjusting
dose accordingly.
Started concomitantly with
LMWH if immediate effect is
required.
Then, regular INR checks by anti-
coagulation clinic – regularity
determined by INR stability
Few weeks Decreases risk over many years - 3-4 weeks
Start test dose then review in 2-3 Review in 4w, then every 6 U&Es before starting, then Hb in 3-4 weeks
weeks. months. annually
TSH test every 2-3 months until LFTs before starting, at 3 months
stable. & at 12 months.
(statins cause altered LFTs)
When TSH level stable, check
annually.

Side effects Important side Bleeding (1-2%) – tell doctor if
effects any unusual bleeding e.g.
bruises, dark stools, cuts take
longer to heal.
Also diarrhoea, rash, hair loss,
nausea.
Many drug interactions
Mainly with cytocrome P450
inhibitors/inducers (see notes on
drug interactions), steroids
Rare when thyroxine level stable Muscle pains Nausea, diarrhoea, abdo pain, GI irritation (nausea, sickness,
as it’s replacing a normal Hair loss weight loss diarrhoea, abdo pain)
hormone. Itching Coloured stools
Taste bad
May be hyperthyroid symptoms
if level is too high (vomiting, Also nausea, sickness, diarrhoea,
diarrhoea, headache, abdo pain
palpitations, heat intolerance) or
hypothyroid symptoms if level is
too low.

Complications - - Rhabdomyolysis Lactic acidosis -

&

Contraindications Contraindications Contraindications Contraindications Contraindications Contraindications

Pregnancy
Haemorrhagic stroke
Significant bleeding
Cautions
Patients at high falls risk
Supplementary Avoid liver, spinach, cranberry
advice juice, alcohol binges
No NSAIDs/ aspirin
Given anticoagulant book
- Pregnancy Renal impairment -
Ketoacidosis
Low BMI
NB. metformin must not be
taken on the day of, and for 2
days after, having general
anaesthetic or
X-ray contrast media
(increase lactic acidosis risk)
Free prescriptions for everything Avoid grapefruit If miss a dose, take as soon as -
if taking levothyroxine! www.bhf.org.uk remember unless it’s close to
next dose time
www.diabetes.org.uk

© 2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students’ finals OSCE revision