Key Medication Counselling Points

Front 1

Didronel PMO

Back 1

- Given in 90 day cycles
- 1 Didronel tablet daily for 14 days, then 1 Cacit tablet daily for 76 days
- For didronel: avoid food for at least 2 hours before and after oral treatment, particularly calcium containing foods such as calcium
- For didronel: avoid iron and mineral supplements and antacids
- Serum phosphate, serum alkaline phosphatase and (if possible) urinary hydroxyproline should be measured before starting and at intervals of 3 months

Front 2

Pyridoxine

Back 2

- Do not take on an empty stomach
- High doses for long periods of time not recommended

Front 3

Steroids

Back 3

- Do not stop suddenly if taken for more than 3 weeks
- Take in the morning
- Report any indigestion
- If patient has never had chickenpox, inform doctor when coming into contact with it
- Apply topical steroids thinly to intact skin
- Inform GP if psychological changes occur

Front 4

Cholestyramine

Back 4

- Other drugs should be taken at least 1 hour before or 4-6 hours after cholestyramine to reduce possible interference with absorption
- Mix the contents of one sachet with at least 150ml of water or other suitable liquid

Front 5

Ispaghula

Back 5

- Swallow carefully with water as it swells in contact with water
- Do not take immediately before going to bed
- Counsel on the importance of adequate fluid intake and a balanced diet high in fibre

Front 6

Slow K

Back 6

- Swallow whole with plenty of water during meals while sitting or standing
- Stop immediately if develop severe vomiting, abdominal pains or flatulence or gastrointestinal haemorrhage

Front 7

Amiodarone

Back 7

- Liver and thyroid function tests required before taking then every 6 months
- Chest x-ray required before treatment
- Measure serum potassium before treatment
- Stop if vision becomes impaired due to risk of corneal microdeposits
- Shield skin from sunlight

Front 8

Malathion

Back 8

- Rub into hair, allow to dry naturally, then remove by washing after 12 hours
- Repeat application after 7 days
- Do not use for 3 consecutive weeks
- Avoid contact with eyes and broken/secondarily infected skin

Front 9

Statins

Back 9

- Take at night
- Report any unexplained muscle pain, tenderness or weakness
- Should expect LFTs to be carried out every 6 months
- Patients may expect to suffer from headaches, nausea and gastrointestinal pain. These should improve as treatment continues
- Lifestyle and dietary changes also important for lowering cholesterol

Front 10

Isotretinion

Back 10

- Avoid wax epilation (risk of epidermal stripping), dermabrasion, and laser skin treatment during treatment and 6 months after stopping
- Avoid exposure to UV light
- Use sunscreen and emollient treatments from the start of treatment
- Women must practice effective contraception 1 month before, during, and 1 month after treatment
- Measure hepatic function and serum lipids before treatment, 1 month after starting then every 3 months onwards
- Take with or after food

Front 11

Dioralyte

Back 11

- Take according to fluid loss (i.e. after any loose motion)
- After reconstitution any unused solution should be discarded no later than 1 hour after preparation unless when stored in a fridge where it may be kept for up to 24 hours
- Reconstitute 1 sachet with at least 200ml water

Front 12

CFC-Free Inhalers

Back 12

- Works just as well as CFC inhalers
- Aerosol may feel and taste different
- Discuss any difficulties using the new inhaler with GP
- Doses may change in the switch

Front 13

Lithium

Back 13

- Baseline measurements of blood urea and electrolytes, serum creatinine, thyroid function, a full blood count and the exclusion of pregnancy are required before the initiation of treatment
- Measure serum creatinine every 6 months
- Thyroid function tests every 6-12 months
- Full blood count annually
- Serum lithium levels every 3 months
- Urea and electrolytes every 6 months
- Maintain adequate fluid intake and avoid dietary changes leading to a change in sodium intake or the sudden introduction or discontinuation of caffeine
- Alcohol intake should not exceed the recommended limits
- A treatment card is available for patients from the NPA
- Preparations may vary widely in bioavailability so monitoring may be required if brands are changed
- Initial symptoms of drowsiness are usually transient
- Signs of toxicity, including nausea, vomiting, tremor, lack of coordination, extreme thirst, diarrhoea and excessive urination, should be reported urgently
- Symptoms of hypothyroidism e.g. lethargy, feeling cold and weight gain should also be reported
- Do not take ibuprofen

Front 14

Doxycycline & Oxytetracycline

Back 14

- Do not take at the same time as milk, iron or zinc supplements, calcium supplements or indigestion remedies that may hinder absorption. Separate dose by at least 2 hours
- Swallow whole with plenty of water whilst sitting or standing
- Avoid exposure to the sun or use high factor sun cream

Front 15

Beta-blockers

Back 15

- Beneficial effects may not be immediate and there may be a worsening of symptoms
- Male patients may experience impotence
- Report any additional breathlessness, cold extremities or peripheral weakness
- Do not stop taking suddenly

Front 16

Alendronate

Back 16

- Normally only taken once a week
- Swallow whole with plenty of water whilst sitting or standing half an hour before food
- Remain upright for half an hour after taking
- Stop taking if the patient develops any symptoms of oesophageal ulceration

Front 17

Prazosin

Back 17

- Beware effects of 1st dose hypotension, lie down if dizziness, fainting or sweating develop and remain lying down until the symptoms abate

Front 18

Methotrexate

Back 18

- Make sure the patient is clear on the dose and frequency
- Report signs of infection
- Full blood count, renal and liver function required before starting treatment, repeated weekly after starting treatment until therapy stabilised and then every 2-3 months
- Avoid taking aspirin and other NSAIDs
- Determine if weekly dose
- Important to take folic acid too
- Avoid conception (applies to males and females) during for at least 6 months after stopping treatment
- Contact the GP immediately with signs of breathlessness or a cough

Front 19

HRT

Back 19

- HRT doesn’t provide contraception. Under 50, women are considered fertile until 2 years after their final period (1 year if over 50)
- HRT should be stopped 4-6 weeks before surgery
- Stop immediately if experiencing:
• Sudden chest pain
• Sudden breathlessness
• Unexplained swelling or severe pain in calf
• Severe stomach pain
• For others see BNF

Front 20

Combined oral contraceptives

Back 20

- Inform on when to take in the cycle
- Still at risk of STIs

Front 21

Tamoxifen

Back 21

- Report menstrual irregularities, vaginal discharge and pelvic pain or pressure
- Inform patient of the risk of endometrial cancer however the benefits outweigh the risks

Front 22

Acarbose

Back 22

- Chew with the first mouthful of food or swallow whole with a little liquid immediately before food
- To counteract possible hypoglycaemia, patients receiving insulin or a sulphonylurea as well as acarbose need to carry glucose with them

Front 23

Captopril

Back 23

- Renal function and electrolytes should be checked before starting
- Be aware or 1st dose hypotension, try to take the 1st dose before going to bed at night
- Discuss a troublesome cough with your GP, iron supplements may be useful
- Avoid potassium salts
- Consult a pharmacist before starting any other medications
- See GP if experiencing any symptoms of angioedema

Front 24

NSAIDs

Back 24

- Report symptoms of indigestion, wheezing or rashes immediately
- Take with or after food
- Diclofenac and indometacin have a tendency to cause dizziness – patients should be warned that caution is advised when driving
- Swallow EC and slow release preparations whole
- Do not take EC products at the same time as indigestion remedies

Front 25

Cyclosporin

Back 25

- Different brands have different bioavailabilities
- Total daily dose should be taken in 2 divided doses
- Avoid grapefruit or grapefruit juice for 1 hour before dose
- Mix solution with orange or apple juice or with water immediately before taking then rinse with more water to ensure total dose

Front 26

Ferrous Sulphate

Back 26

- May darken stools
- Contains iron, do not take with other iron products, keep out of reach of children as may be fatal in overdose
- Doses should be evenly spaced or at least 6 hours apart
- Do not take OTC antacids at the same time
- Can take with food to reduce gastric irritation however this may reduce absorption
- Constipation, diarrhoea and nausea are common

Front 27

Mefloquine

Back 27

- Check if recommended for area visited
- Start 2 ½ weeks before entering endemic area and continue for 4 weeks after leaving
- Important to also avoid mosquito bites and take prophylaxis regularly
- Immediately visit doctor if ill within 1 year after travelling, especially if within 3 months
- Tablet may be crushed and mixed with food such as jam or honey just before taking
- Dizziness or a disturbed sense of balance may affect performance of skilled tasks

Front 28

Clindamycin

Back 28

- Stop taking immediately and contact doctor if diarrhea develops
- Capsules should be swallowed with a glass of water

Front 29

Beconase nasal spray

Back 29

- Patients should be warned of unpredictable and occasionally severe alcohol interactions
- Reactions can occur within ten minutes and last several hours
- Patient should not ingest alcohol at all and should be warned of possible presence of alcohol in liquid medicines, remedies, tonics, foods, and even in toiletries
- Alcohol should also be avoided for one week after stopping

Front 30

Nicotine replacement therapy

Back 30

- Withdrawal symptoms include insomnia, anxiety, restlessness, and depression
- Chest symptoms such as increased secretions may occur initially due to the withdrawal of nicotine but these should abate within two to three weeks
- Try to avoid situations associated with smoking
- Encourage the patient to return with questions or difficulties
- Avoid access intake of caffeine As this may worsen the withdraw effects of nicotine
- List the benefits of smoking cessation such as improved taste and sense of smell, circulation and lung function, as well as money saving benefits

Front 31

HIV drugs

Back 31

- Regular dosing is important
- Keep an alert card with you at all times