Term
| eformoterol (OXIS) (comb.budesonide SYMBICORT) |
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Definition
CLASS: Long acting beta 2 agonist
INDICATION: Maintenance treatment of asthma when receiving inhaled corticosteroids (or use symbicort). Maintenance treatment of COPD. Symptom relief in patients already receiving inhaled corticosteroids and regular eformoterol (not often)
DOSE: 1-2 (6-12mcg) inhalations twice daily. Additional doses may be given for symptomatic relief for short term up to a max of 72mcg. reassess if required for >3 consective days (2days for symbicort 6)
COUNSELLING: Keep using this medicine every day even if you feel better. Tell your doctor ASAP if you need to use the medication in higher doses or more frequently than presribed. If you are using this for symptom relief as well, make sure your doctor has given you an Asthma Action Plan.
Store in cool, dry place (not bathroom)
*Turbuhaler technique
*Aerolizer technique.
Clean with dry tissue SHOULD NOT GET WET.
*wash mouth out after Symbicort
MONITORING: serum K particularly in those taking other medicines such as theophylline or diuretics |
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Term
salmeterol (SEREVENT accuhaler) (comb.fluticasone SERETIDE) |
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Definition
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Term
Salbutamol (VENTOLIN, ASMOL, AIROMIR)
*also known as albuterol |
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Definition
CLASS: short acting beta agonist
INDICATION: acute asthma, symptom relief during maintenance Tx of asthma and COPD, prevention of exercised induced asthma, threatened or established preterm labour (<34 weeks)
DOSE:
1-2 inhalations (100-200mcg) as required, or 5-15min before exercise, repeat 3-4 times daily if necessary
acute asthma: 4 puffs via spacer, repeat after 4 min if no improvement. if still no improvement-call ambo and continue 4 puffs/4min until ambo arrives. Max6-8/5min (adults)
nebuliser: 2.5-5mg; repeat 3-4 daily prn
COUNSELLING: make sure that your doctor has given you an asthma plan; tell your doctor if you need to use this medicine in higher doses or more frequently than prescribed; reguarly clean the plastic mouthpiece of your inhaler to prevent blockage of the nozzle (1. take out canister; remove cap; rinse cap and plastic mouthpiece under warm running water, shake, airdry, spray 1 into air to make sure nozzle is clear, 2 if puffer need before it is dry)
MONITORING: hypokalaemia - high doses, worsened by theophyllines, corticosteroids, diuretics, and hypoxia |
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Term
terbutaline (BRICANYL TURBUHALER/ELIXIR) |
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Definition
CLASS: short acting beta agonist
INDICATION: acute asthma, symptom relief during maintenance Tx of asthma and COPD, prevention of exercised induced asthma
DOSE:
(500mcg) as required, or 5-15min before exercise, repeat 3-4 times daily if necessary
acute asthma: 4 puffs, repeat after 4 min if no improvement. if still no improvement-call ambo and continue 4 puffs/4min until ambo arrives. Max6-8/5min (adults)
COUNSELLING: make sure that your doctor has given you an asthma plan; tell your doctor if you need to use this medicine in higher doses or more frequently than prescribed, clean mouthpiece with tissue
MONITORING:
Hypokalaemia - high doses, worsened by theophyllines, corticosteroids, diuretics, and hypoxia
Puffer technique
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Term
ipratropium (ATROVENT, AERON neb) |
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Definition
CLASS: anticholinergic (Promote bronchodilation by inhibiting cholinergic bronchomotor tone)
INDICATION: severe acute asthma, maintenance treatment in COPD and severe asthma
DOSE:
COPD & severe asthma: 2 puffs (40mcg) 3-4 D prn (M4 3-4D)
severe asthma: 6 puffs (120mcg) with spacer/2h with salbutamol
COUNSELLING:
Do not reduce or stop your inhaled corticosteroids even if you feel better after starting this drug.
Do not let the mist from the nebuliser get into your eyes. Close your eyes or wear eye protection.
Tell your doctor if you have any eye pain or discomfort, blurred vision, or visual halos.
*spacer care
*MDI care
*neb - Dilute solution for nebulisation to 2–3 mL with sodium chloride 0.9%
MONITORING:
Change in condition when changing btw spacer/MDI
Glaucoma (precaution) status: optic nerve imaging, visual field test
Puffer technique
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Term
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Definition
CLASS: anticholinergic (Promote bronchodilation by inhibiting cholinergic bronchomotor tone)
INDICATION: COPD
DOSE: 1 puff (18mcg) D
COUNSELLING:
Do not use for immediate relief of symptoms
Do not let the powder come into contact with your eyes
Tell your doctor if you have any eye pain or discomfort, blurred vision, or visual halos.
*handihaler
MONITORING:
Change in condition when changing btw spacer/MDI
glaucoma (precaution) status: optic nerve imaging, visual field test
Puffer technique |
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Term
theophylline (NEULIN SR tab, oral liq) |
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Definition
CLASS: THEOPHYLLINE (MOA Not entirely understood. Possible effects include bronchial smooth muscle relaxation, anti-inflammatory effects, increase in diaphragm contractility and CNS stimulation.)
INDICATION: maintenance Tx in severe asthma and COPD
DOSE:
M900mg D.
Initially: 10 mg/kg daily; maximum 300 mg daily. If initial dose is tolerated, increase dose after 3 days.
First increment: 13 mg/kg daily; maximum 450 mg daily. If the first increase is tolerated, increase dose after 3 days.
Second increment: 16 mg/kg daily; maximum 600 mg daily. Measure plasma concentration after 3 days at the highest tolerated dose.
*SR q12h, liq q6h
COUNSELLING:
1. May be taken with food to reduce to reduce stomach upset.
2. Do not crush/chew Nuelin SR tablets.
3. This medicine interacts with many other drugs (and smoking); ask your doctor or pharmacist before using any other medicines including herbal and over-the-counter products.
MONITORING:
Monitor plasma concentration
- initiation of treatment,
- if drug regimen is altered,
- if there is prolonged fever,
- if adverse effects (nausea, vomiting, diarrhoea, gastro-oesophageal reflux, headache, insomnia, irritability, anxiety, tremor, palpitations) suspected
- if patient stops or starts smoking.
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Term
cromoglycate (inhaled-MDI/DPI/neb INTAL, eye OPTICROM, intranasal RYNACROM) |
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Definition
CLASS: cromone (Act by inhibiting release of inflammatory mediators from mast cells)
INDICATIONS:
Maintenance Tx persistant asthma,Px of exercised-induced asthma;
Seasonal allergic conjunctivitis;
Prophylaxis of allergic rhinitis
DOSE:
inhaled MDI: 5-10mg 2-4 D, or 15min before exercise (M4puff bd)
inhaled DPI: 1 cap 3-4 D, or 15min before exercise (M8 cap D)
inhaled neb: 1 3-4 D (M6 D)
eye drops: 4-6 drops D - may take 2-4wks to get max effect
nasal spray: 1 spray/nostril 4-6(2%) 2-4(4%) D
COUNSELLING: inhaler
Do not use this medicine for relief of acute asthma; use short-acting reliever.
Do not reduce the dosage or stop taking this medicine unless your doctor tells you to.
Regularly clean the mouthpiece of your metered dose inhaler to prevent the nozzle blocking.
*MDI, DPI, neb
MONITOR: puffer technique(1-3month), respiratory function (peak flow)
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Term
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Definition
CLASS: leukotriene receptor antagonist - antagonises airway smooth muscle contraction and inflammation caused by leukotrienes.
INDICATION:
chronic asthma Px, Tx
seasonal allergic rhinitis Tx
DOSE: adult 10mg, 6-14y 5mg, 2-5y 4mg
COUNSELLING:
Take this medicine in the evening.
Do not use this medicine to relieve the symptoms of an asthma attack; use short-acting reliever.
MONITORING:
clinical monitoring of systemic corticosteroid withdrawal WHEN montelukast may be commenced (asthma systems worsening, joint pain, weakness, lethargy, depression)
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Term
Budesonide (PULMICORT) (comb eformoterol SYMBICORT) |
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Definition
CLASS: corticosteroid - reduce airway inflammation & bronchial hyper-reactivity
INDICATION: 'preventer' - maintenance treatment of persistant asthma
DOSE: 100-400mcg BID -> MAX 2000mcg/D (specialist)
COUNSELLING: Rinse mouth out after using; Do not use for immediate relief of symptoms; Keep using this medicine even if you are feeling better; Do not reduce the dosage or stop this medicine unless your doctor tell you to.
MONITORING
-respiratory function (peak flow)
-inhaler technique
(particuarly for very high doses/ high doses long term)
-Signs of adrenal dysfunction (esp during times of stress-> trauma, surgery, infection) (also when transferring from systemic steroids)
-Bone density loss (clinical unknown) ->BMD test
-Glaucoma, Cataract risk increased -> optometrist
-Growth rate- children height measured BUT benefit should be compared to risk. Most children reach target height |
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Term
Fluticasone (FLIXOTIDE) (comb salmeterol SERETIDE) |
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Definition
CLASS: corticosteroid - reduce airway inflammation & bronchial hyper-reactivity
INDICATION: maintenance treatment in persistent asthma; acute asthma; SERETIDE-severe COPD with repeated exacerbation inadequatley controlled with regular B2agonist therapy
DOSE: 100-200mcg BD; M1000mcg D; child: 50-100mcg BD
COUNSELLING:Rinse mouth out after using; Do not use for immediate relief of symptoms; Keep using this medicine even if you are feeling better; Do not reduce the dosage or stop this medicine unless your doctor tell you to. **Use a space with MDI, **Nebules may need to be diluted to obtain volume suitable for the nebuliser; use mouthpiece rather than mask if possible. Protect eyes with goggles. Protect skin with barrier cream.
MONITORING
-respiratory function (peak flow)
-inhaler technique
(particuarly for very high doses/ high doses long term)
-Signs of adrenal dysfunction (esp during times of stress-> trauma, surgery, infection) (also when transferring from systemic steroids)
-Bone density loss (clinical unknown) ->BMD test
-Glaucoma, Cataract risk increased -> optometrist
-Growth rate- children height measured BUT benefit should be compared to risk. Most children reach target height |
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Term
Belcomethasone (QVAR autohaler, puffer) |
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Definition
CLASS: corticosteroid - reduce airway inflammation & bronchial hyper-reactivity
INDICATION: maintenance treatment in persistent asthma
DOSE: 50-200mcg BD; M1000mcg D; child: 50 mcg BD M400mcg
COUNSELLING:Rinse mouth out after using; Do not use for immediate relief of symptoms; Keep using this medicine even if you are feeling better; Do not reduce the dosage or stop this medicine unless your doctor tell you to. **Use a spacer, NOT WITH AUTOHALER;
MONITORING
-respiratory function (peak flow)
-inhaler technique
(particuarly for very high doses/ high doses long term)
-Signs of adrenal dysfunction (esp during times of stress-> trauma, surgery, infection) (also when transferring from systemic steroids)
-Bone density loss (clinical unknown) ->BMD test
-Glaucoma, Cataract risk increased -> optometrist
-Growth rate- children height measured BUT benefit should be compared to risk. Most children reach target height
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Term
Ciclesonide (ALVESCO puffer) |
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Definition
CLASS: corticosteroid - reduce airway inflammation & bronchial hyper-reactivity
INDICATION: maintenance treatment in persistent asthma
DOSE: 80-320mcg D; M1000mcg D; child: 50 mcg BD M400mcg
COUNSELLING:Rinse mouth out after using; Do not use for immediate relief of symptoms; Keep using this medicine even if you are feeling better; Do not reduce the dosage or stop this medicine unless your doctor tell you to. **Use a spacer - reduced systemic effects, more effective drug delivery.
MONITORING
-respiratory function (peak flow)
-inhaler technique, inhaler device
(particuarly for very high doses/ high doses long term)
-Signs of adrenal dysfunction (esp during times of stress-> trauma, surgery, infection) (also when transferring from systemic steroids)
-Bone density loss (clinical unknown) ->BMD test
-Glaucoma, Cataract risk increased -> optometrist
-Growth rate- children height measured BUT benefit should be compared to risk. Most children reach target height
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Term
Nedocromil (TILADE puffer) |
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Definition
CLASS: cromone- inhibit release of inflammatory mediators from mast cells
INDICATION:maintenance of persistant asthma; prevention of exercise induced asthma
DOSE:4mg QID- may be reduced to BD if good control acheived; 4mg 15min before exercise.
COUNSELLING:
Do not use this medicine for relief of acute asthma; use short-acting reliever.
Do not reduce the dosage or stop taking this medicine unless your doctor tells you to.
Regularly clean the mouthpiece of your metered dose inhaler to prevent the nozzle blocking
MONITOR: puffer technique(1-3month), respiratory function (peak flow) |
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Term
Glibenclamide (DAONIL, GLIMEL) |
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Definition
CLASS: Sulfonylureas - inuslin secreter.
INDICATION: T2 Diabetes
DOSE: 2.5-20mg D in 1 or 2 doses (max 10mg single dose)
COUNSELLING: Take with food to minimise risk of low blood glucose
Avoid binge drinking (decreases BG, mask hypoglycaemia)
Make sure friends and family know how to recognise and treat hypoglycaemia.
MONITORING: weight, BGL, urine glucose, HbA1c, renal function (creatinine, urea, salts), hepatic function (ALT, AST, bilirubin, albumin, protein)
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Term
Hypoglycaemia - signs and symptoms, Treatment |
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Definition
SIGNS AND SYMPTOMS
cold, clamy, sweaty skin
difficulty concentrating
shakiness, lack of coordination
irritability, hostility
staggering gait
fatigue
hunger
headache
blurred vision
abdominal pain or nausea
fainting, unconciousness
Treatment
Mild-glucose or sucrose. NB: not sucrose if treated with acarbose GLUCOBAY.
Severe- glucagon SC/IM GLUCAGEN HYPOKIT. Give complex carbohydrates orally once patient has responded to prevent further hypoglycaemia. |
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Term
Gliclazide (DIAMICRON MR, GLYADE MR, NIDEM) |
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Definition
CLASS: Sulfonylureas - inuslin secreter.
INDICATION: T2 Diabetes
DOSE: 40 -320mg in 1 or 2 doses (Max 160mg single dose). MR tab: initially 30mg D, then increase according to response (>2week interval); M120mg. NB: 30MR=80mg
COUNSELLING: Take with food to minimise risk of low blood glucose
Avoid binge drinking (decreases BG, mask hypoglycaemia)
Make sure friends and family know how to recognise and treat hypoglycaemia.
MONITORING: weight, BGL, urine glucose, HbA1c, renal function (creatinine, urea, salts), hepatic function (ALT, AST, bilirubin, albumin, protein) |
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Term
Glimepiride (AMARYL, DIMIREL) |
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Definition
CLASS: Sulfonylureas - inuslin secreter.
INDICATION: T2 Diabetes
DOSE: 1mg D; M4mg D; start low, go slow (increase by 1mg>2week intervals)
COUNSELLING: Take with food to minimise risk of low blood glucose
Avoid binge drinking (decreases BG, mask hypoglycaemia)
Make sure friends and family know how to recognise and treat hypoglycaemia.
MONITORING: weight, BGL, urine glucose, HbA1c, renal function (creatinine, urea, salts), hepatic function (ALT, AST, bilirubin, albumin, protein) |
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Term
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Definition
CLASS: Sulfonylureas - inuslin secreter.
INDICATION: T2 Diabetes
DOSE: 2.5–40 mg daily in 1 or 2 doses; doses >15 mg daily should be divided.
COUNSELLING: Take with food to minimise risk of low blood glucose
Avoid binge drinking (decreases BG, mask hypoglycaemia)
Make sure friends and family know how to recognise and treat hypoglycaemia.
MONITORING: weight, BGL, urine glucose, HbA1c, renal function (creatinine, urea, salts), hepatic function (ALT, AST, bilirubin, albumin, protein) |
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Term
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Definition
INDICATION: T1D, T2D inadequately controlled by diet, and other oral antidiebetic drugs, and where oral antidiabetic drugs are contraindicated (pregnancy, surgery)
DOSE:
T1D- Basal Bolus regimen: use short/ultra-short SC bolus before each meal & long acting 1-2 daily (before bedtime and/or breakfast)
T1D- split-mixed regimen: short/ultra short comb with long acting 1-2 daily. If split, 2/3 mane, 1/3 nocte.
T2D- comb w oral: long acting usually 1D mane or nocte; increase dose in 2–4 unit increments at intervals of 2–4 days
T2D- monoTx: 1-2daily before morning and evening meals.
COUNSELLING:
Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you are unsure.
Insulin is injected under the skin (subcutaneous injection) usually in the abdomen, or less commonly in the thigh, upper arm or buttock. Pinch the skin to reduce the chance of injecting into a blood vessel. Rotate injection sites in the same general area to avoid swelling of fatty tissue (called lipodystrophy).
Use short-acting insulin 30 minutes before meals. Use ultra-short-acting insulin immediately before or soon after meals when necessary.
Gently rotate vials and cartridges of cloudy insulin in hands before use to ensure resuspension.
When mixing insulins, draw up short-acting insulin into the syringe first to avoid contaminating the vial with long-acting insulin. Do not mix insulin glargine LANTUS with other insulins.
Lifestyle: Regular Diet; Healthy diet: carbs fairly constant, low saturated fat, fibre increases satiety and slows absorption of carbs; Physical activity: care must be taken with T1D; Smoking cessation;
Foot care: Dry feet well, never walk barefoot, keep skin supple by moisturising, daily examination, brisk walking exercise.
MONITORING:
weight, BGL
microvascular complications: retinopathy (eye exam 1-2yearly), nephropathy (kidney function tests: CK, urea, salts), neuropathy (peripheral: skin redness, numbness, tingling, pain, cramps, look @ your feet everyday). Insulin device technique.
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Term
insulin aspart (NOVORAPID), insulin lispro (HUMALOG), insulin glulisine (APIDRA) |
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Definition
CLASS: ultra-short acting insulin (analogues)
INDICATION: T1D, T2D where lifestyle doesn't control BGL, oral antidiabetic medications do not work or C/I
DOSE: Depends on regimen, individual treatment endpoints, adjust according to BGM. Give immediately before meals.
COUNSELLING: Clear solution does not require mixing. Check if cloudy, if so, discard. If mixing, draw up first.
Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you are unsure.
Insulin is injected under the skin (subcutaneous injection) usually in the abdomen, or less commonly in the thigh, upper arm or buttock. Pinch the skin to reduce the chance of injecting into a blood vessel. Rotate injection sites in the same general area to avoid swelling of fatty tissue (called lipodystrophy).
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Term
neutral insulin (ACTRAPID, HUMULIN R, HYPURIN NEUTRAL) |
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Definition
CLASS: short acting insulin
INDICATION: T1D, T2D where lifestyle doesn't control BGL, oral antidiabetic medications do not work or C/I
DOSE: Depends on regimen, individual treatment endpoints, adjust according to BGM. Give 30 minutes before meals.
COUNSELLING:
Check if insulin is cloudy, if so, discard.
Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you are unsure.
Insulin is injected under the skin (subcutaneous injection) usually in the abdomen, or less commonly in the thigh, upper arm or buttock. Pinch the skin to reduce the chance of injecting into a blood vessel. Rotate injection sites in the same general area to avoid swelling of fatty tissue (called lipodystrophy).
MONITORING:
weight, BGL
microvascular complications: retinopathy (eye exam 1-2yearly), nephropathy (kidney function tests: CK, urea, salts), neuropathy (peripheral: skin redness, numbness, tingling, pain, cramps, look @ your feet everyday)
insulin device |
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Term
isophane (HUMULIN NPH, PROTOPHANE, HYPURIN ISOPHANE) |
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Definition
CLASS: long acting insulin (also known as isophane or intermediate acting insulin)
INDICATION: T1D, T2D where lifestyle doesn't control BGL, oral antidiabetic medications do not work or C/I
DOSE: Depends on regimen, individual treatment endpoints, adjust according to BGM. 1-2 daily.
COUNSELLING:
Resuspend pen/cartridge by rolling and moving up and down .
Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you are unsure.
Insulin is injected under the skin (subcutaneous injection) usually in the abdomen, or less commonly in the thigh, upper arm or buttock. Pinch the skin to reduce the chance of injecting into a blood vessel. Rotate injection sites in the same general area to avoid swelling of fatty tissue (called lipodystrophy).
MONITORING:
weight, BGL
microvascular complications: retinopathy (eye exam 1-2yearly), nephropathy (kidney function tests: CK, urea, salts), neuropathy (peripheral: skin redness, numbness, tingling, pain, cramps, look @ your feet everyday)
insulin device
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Term
insulin detemir (LEVEMIR), insulin glargine (LANTUS) |
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Definition
CLASS: long acting insulin analogue
INDICATION: T1D, T2D where lifestyle doesn't control BGL, oral antidiabetic medications do not work or C/I
DOSE: Depends on regimen, individual treatment endpoints, adjust according to BGM. insulin detemir (LEVEMIR) 1-2 D; insulin glargine (LANTUS) 1 D
COUNSELLING:
Resuspend pen/cartridge by rolling and moving up and down .
Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia; ask your doctor or diabetes educator if you are unsure.
Insulin is injected under the skin (subcutaneous injection) usually in the abdomen, or less commonly in the thigh, upper arm or buttock. Pinch the skin to reduce the chance of injecting into a blood vessel. Rotate injection sites in the same general area to avoid swelling of fatty tissue (called lipodystrophy).
Do not mix glargine (LANTUS)
MONITORING:
weight, BGL
microvascular complications: retinopathy (eye exam 1-2yearly), nephropathy (kidney function tests: CK, urea, salts), neuropathy (peripheral: skin redness, numbness, tingling, pain, cramps, look @ your feet everyday)
insulin device
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Term
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Definition
CLASS: Thiazolidinediones - insulin sensitiser, decrease hepatic glucose output
INDICATION: T2 diabetes- alone or with metformin and/or a sulfonylurea or with insulin
DOSE: 15-30mg D, M45mg with or without food.
COUNSELLING: Tell your doctor immediately if you have swollen feet or ankles, breathlessness, nausea, vomiting, abdominal pain, fatigue, loss of appetite or dark urine.
Lifestyle points on diet, physical activity, smoking, alcohol.
MONITOR: BG, HbA1c; weight gain, oedema, congestive heart failure exacerbation (oedema, breathlessness, fatigue, diminished exercise capacity)
Monitor liver enzymes at baseline, every 2 months for the first year, then periodically or when clinically indicated; stop treatment if jaundice occurs or if ALT rises >3 times ULN |
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Term
Rosiglitazone (AVANDIA), comb metformin (AVANDAMET) |
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Definition
CLASS: Thiazolidinediones - insulin sensitiser, decrease hepatic glucose output
INDICATION: T2 diabetes- alone or with metformin or sulfonylurea
DOSE: 4mg D, M8mg with food.
COUNSELLING: Tell your doctor immediately if you have swollen feet or ankles, breathlessness, nausea, vomiting, abdominal pain, fatigue, loss of appetite or dark urine.
Lifestyle points on diet, physical activity, smoking, alcohol.
MONITOR: BG, HbA1c; weight gain, oedema, congestive heart failure exacerbation (oedema, breathlessness, fatigue, diminished exercise capacity)
Monitor liver enzymes at baseline, every 2 months for the first year, then periodically or when clinically indicated; stop treatment if jaundice occurs or if ALT rises >3 times ULN
***Pioglitazone ACTOS has more favourable risk-benefit.
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Term
Sitagliptin (JANUVIA), comb with metformin (JANUMET) |
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Definition
CLASS: DPP-4 inhibitor; increases concentration of incretin hormones (GLP-1 & GIP)->suppression of HGP, slows gastric emptying, increases satiety, amplify glucose dependent secretion.
INDICATION: T2D -add to dual Tx of metformin with SU or TZD
DOSE: 100mg daily, with or without food; Decrease for renal impairment.
COUNSELLING: Tell your doctor if you notice any of the following and they worry you: signs of an infection of the breathing passages, including runny nose, sore throat, cough; soreness in the back of the nose and throat and discomfort when swallowing; headache.
May occasionally cause stomach discomfort and diarrhoea.
Lifestyle: diet, physical activity, smoking cessation, alcohol
MONITORING: BG, HbA1c, weight (thought not major side effect like TZDs and SUs) |
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Term
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Definition
CLASS: DPP-4 inhibitor; increases concentration of incretin hormones (GLP-1 & GIP)->suppression of HGP, slows gastric emptying, increases satiety, amplify glucose dependent secretion.
INDICATION: T2D -add to dual Tx of metformin with SU or TZD
DOSE: 50mg, M100mg(divided doses) daily, with or without food; No dose reduction in mild chronic kidney disease.
COUNSELLING: Tale dose in the morning for once daily dosing.
Lifestyle: diet, physical activity, smoking cessation, alcohol
MONITORING: BG, HbA1c, weight (thought not major side effect like TZDs and SUs)
Monitor liver enzymes at baseline, every 3 months for the first year, then periodically or when clinically indicated; stop treatment if ALT/AST are persistently >3 times ULN
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Term
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Definition
CLASS: alpha-glucosidase enzymes inhibitor-> delays absorption of CHO
INDICATION: T2D
DOSE: 50mg initially, increase up to 100mg TID according to response. M600mg.
COUNSELLING: Swallow tablet whole with liquid immediatley before a meal OR chew with first few mouthfuls of food.
See your doctor if you have persistant diarrhoea.
Lifestyle: diet, physical activity, alcohol, smoking.
MONITOR: BG, HbA1c, LFTs (monthly for 6-12months), flatulence + diarrhoea (patient should be monitored closely,dose reduced) |
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Term
Metformin (DIABEX XR, DIAFORMIN, FORMET), comb with glibenclamide (GLUCOVANCE) |
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Definition
CLASS: Biguanide, insulin sensitiser-> reduces HGP, increase cellular glucose uptake
INDICATION: T2 Diabetes
DOSE: 500mg 1-3 times daily. Increase up to 3g daily. Controlled release tablet: initially 500mg D (with evening meal)-> 2g daily .
Renal impairment: CrCl 60-90ml/min- M2g daily; 30-60ml/min- M1g daily
COUNSELLING: Take with meals to reduce stomach upset;
Tell your doctor immediately if you have a loss of appetite, nausea, vomiting, abdominal pain, cramps, fatigue, diarrhoea, or weight loss;
Drinking alcohol can affect control of your diabetes. It can also increase the risk of serious side effects. Limit your alcohol intake, avoid binge drinking and have something to eat when you drink alcohol.
MONITORING: Monitor renal function before starting treatment and every 4–6 months; For medical/surgical conditions- Serum B12, LFT, CV function.
BG, HbA1c |
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Term
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Definition
CLASS: Insulin secretalogue
INDICATION: T2 diabetes
DOSE: Initially 0.5mg before main meals incr 1-2weeks to M4mg with main meals. Longer tritation for hepatic impairment. Start with higher dose if transferring from other oral hypoglycaemics.
COUNSELLING: Take before main meals. DO NOT take a dose if skipping a meal.
Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
Make sure that you, and your friends and family, know how to recognise and treat low blood glucose (hypoglycaemia); ask your doctor or diabetes educator if you are unsure.
Lifestyle
MONITORING: BG, HbA1c, signs of microvascular complications.
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Term
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Definition
CLASS: incretin mimetic- GLP-1 analogue
INDICATION: T2 Diabetes
DOSE: initially 5mcg BD within 60min of morning and evening meals (or before 2 main meals >6hours apart). If initial dose is tolerate, increase to 10mcg BD.
COUNSELLING: Administer SC in thigh or abdomen. Pinch skin.
Inject exenatide in the 60 minutes before breakfast and dinner (or before your two main meals for the day, which should be at least 6 hours apart). Do not use it after a meal.
This medicine slows stomach emptying, which occasionally affects the absorption of some other medicines; antibiotics should be taken at least one hour before, or 4 hours after, injecting exenatide.
You feel some nausea, though this usually settles withing a couple of weeks.
Tell your doctor immediately if you develop unexplained severe abdominal pain.
Device
Lifestyle
MONITORING: BGL, HbA1c, weight (loss) |
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Term
Glucagon (GLUCAGEN HYPOKIT) |
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Definition
CLASS: Hormone- increases BG by activating HGP, decreases GI motility
INDICATION: Severe hypoglycaemia induced by insulin or hypoglycaemic agents
DOSE: Adult, Child>5years: SC, IM, or IV 1mg. Child<5year: 0.5mg SC, IM, IV
COUNSELLING:
SYMPTOMS OF HYPOGLYCAEMIA: cold sweat, cool pale skin, fatigue, nervousness or tremor, vision changes, drowsiness, anxious feeling, headache, and nausea. Treat this with sugar lollies or drink. If unconcious, use hypokit.
Make sure that your friends and family know how to recognise low blood glucose (hypoglycaemia) and how to give glucagon injection; ask your doctor or diabetes educator if you are unsure.
Give complex carbohydrates orally when person has responded to prevent recurrent hypoglycaemia
HOW TO PREPARE HYPOKIT:
1. Insert needle through rubber stopper of vial containing Glucagen & inject all the water from the syringe into the vial.
2. Without taking the needle out of the vial, gently shake the vial until the glucagen has completely dissolved & solution is clear.
3. Make sure plunger is completely down. Draw all the solution back into the syringe. Becareful not to pull the plunger out of the syringe.
4. Make an air shot & inject
The effect should be seen about 5-15min after inj.
NB: Protect from light and store at room temperature. Reconstituted glucagon should be used immediately after preparation.
MONITORING:
BGL, ?BGM technique ?BGM device |
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Term
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Definition
CLASS: Thyroid hormone- increase metabolic rate of body tissues. Regulates cell growth and differentiation.
INDICATION: Thyroid hormone deficiency, thyroiditis, hashimotos disease
DOSE: Initially 25-50mcg once daily; increase by 25-50mcg every 3-4 weeks prn according to TSH. Maintenance: 100-200mcg once daily.
COUNSELLING:
Take on an empty stomach, preferably before breakfast.
Tell your doctor if symptoms of hyperthyroidism occur, eg palpitations, excitability, insomnia, flushing, sweating or weight loss.
Store in refridgerator. Do not freeze. A blister strip may be removed from fridge and stored at <25C for 21 day, after 21 days discard any remaining tablets.
MONITORING:
T4, T3 and TSH. Symptoms of hyperthyroidism: palpitations, excitability, insomnia, flushing, sweating or weight loss.
Careful monitoring of diabetic control when oroxine therapy is initiated, changed, or discontinued (OROXINE might increase the dose or diabetic drugs required).
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Term
Carbimazole (NEO-MERCAZOLE) |
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Definition
CLASS: Antithyroid agent- blocks organic binding of iodine through inhibition of iodination of tyrosine.
INDICATION: Hyperthyroidism, induction of remission of primary, and secondary thyrotoxicosis, Graves disease.
DOSE: Initially 15-60mg/day (divided doses) mild-->severe. Maintenance: 10-15mg/day (but highly variable)
COUNSELLING: Tell your doctor immediately if you develop a fever, mouth ulcers, sore throat, rash, severe fatigue, nausea, abdominal pain or jaundice.
Itchiness and mild rashes may respond to antihistamines. Most likely to occur in first 8 weeks.
Other adverse effects that you may feel initially is nausea, tummy ache/discompfort.
MONITORING: Patient should be seen monthly for the first year, then 3-6monthly thereafter.
Bloods (leucopenia, agranulocytosis, anaemias). Agranulocytosis is rapid in onset making regular blood counts of questionable use.
Monitor creatine phosphokinase where myalgia is reported.
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Term
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Definition
CLASS: Antithyroid drug- prevents thyroid hormone synth, inhibits peripheral conversion of T4 to T3
INDICATION: Graves disease, thyroid storm, before thyroid surgery
DOSE: Hyperthyroidism: Initially 200-400mg daily in 2-4 divided doses for 3-4weeks. Thyroid storm: 600-800mg daily, in divided doses.
COUNSELLING: Tell your doctor immediately if you develop a fever, mouth ulcers, sore throat, rash, severe fatigue, nausea, abdominal pain or jaundice.
MONITORING: Measure liver function at baseline and when clinically indicated; stop PTU if significant abnormalities develop
Regular FBCs
Regular TFTs (initiation, then monthly T3, T4, TSH)
INR (warfarin patients).
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Term
Risedronate (ACTONEL, ACTONEL EC) |
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Definition
CLASS: Bisphophonate- inhibits osteoclast mediated bone resorption.
INDICATION: Osteoporosis, BMD preservation in long term steroid patients
DOSE: 5mg daily, or 35mg weekly, or 150mg monthly (COMBI calcium tab every other day, COMBI D calcium + vit D sachet every other day)
COUNSELLING:
Some dental procedures may have complications in people taking bisphosphonates; tell you doctor if you require any dental work and tell your dentist that you are taking this medicine (or have taken it in the past).
Food and drink (other than plain water) reduce the effect of risedronate if taken at the same time(except of ACTONEL EC); carefully follow the instructions about how to take this medication.
Take in the morning with a full glass of plain water at least 30min before food or drink(except for ACTONEL EC). Remain upright during this time and until after you eat. Swallow whole; do not suck, chew the tablet.
Do not take antacides, calcium, iron or mineral supplements within 2 hours of risedronate as they may interfere with its absorption. Stop tablets and see your doctor immediately if you pain on swallowing, or new or worsening heartburn.
If you miss your monthly dose and your next montly dose is more than 7 days away take it the next morning and return to taking it on your usual date. If the next dose is less than 7 days away wait until your next dose and keep taking it on your usual dose (Do not take 2 tablets in one week)
MONITORING: Osteonecrosis of the jaw. Dental assessment prior to commencing treatment (cancer, chemo, radiotherapy, steroids, poor oral hygeine, anaemia)
Serum calcium, renal function (serum creatinine)
BMD
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Term
alendronate (FOSAMAX, FOSAMAX PLUS) |
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Definition
CLASS: bisphophonate- decrease bone resorption by inhibiting osteoclasts.
INDICATION: osteoporosis, bone preservation in steroid pts.
DOSE: Daily (10mg)or weekly (70mg).
COUNSELLING:
Some dental procedures may have complications in people taking bisphosphonates; tell you doctor if you require any dental work and tell your dentist that you are taking this medicine (or have taken it in the past).
Food and drink (other than plain water) reduce the effect of risedronate if taken at the same time; carefully follow the instructions about how to take this medication.
Take in the morning with a full glass of plain water at least 30min before food or drink. Remain upright during this time and until after you eat. Swallow whole; do not suck, chew the tablet.
Do not take antacides, calcium, iron or mineral supplements within 2 hours of risedronate as they may interfere with its absorption. Stop tablets and see your doctor immediately if you pain on swallowing, or new or worsening heartburn.
If you miss your weekly tablet, take the next morning you remember but do not take 2 tablets on the same day.
MONITORING: serum calcium, BMD, weight (increased risk of fractures)
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Term
Zeledronic acid (ACLASTA) |
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Definition
CLASS: -Bisphosphonate- decrease bone resorption by inhibiting osteoclasts.
INDICATION: Osteoporosis, BMD preservation in steroid pts,
DOSE:- IV 4mg over >15min
COUNSELLING: drink at least 2 glasses of water before and after the infusion.
Some dental procedures may have complications in people taking bisphosphonates; tell you doctor if you require any dental work and tell your dentist that you are taking this medicine (or have taken it in the past).
Tell your doctor if you have severe pain in your bones, joints or muscles while taking this medicine.
Flu like symptoms (fever, headache) may occur in the days following the infusion; paracetamol may be taken to ease the symptoms.
MONITORING: Hydration before inj. Monitor Ca, PO4, Mg during treatment. Measure serum Creatinine before each dose, if renal function deteriorates, withhold dose until within 10% of normal range
BMD, weight, etc.
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Term
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Definition
CLASS: Increases bone formation and reduces bone resorption.
INDICATION: Post menopausal osteoporosis.
DOSE: 2g once daily at bedtime.
COUNSELLING: This medication is best taken at bedtime, at least 2 hours after eating, because food and drink (esp calcium products such as milk) can reduce absorption.
Mix the granules with water and drink immediately.
Seek medical advice if you develop a rash while taking this medication.
MONITORING:
Rash, fever, swollen glands, increased white cells are early signs of DRESS (Drug rash with eosinophillia and systemic symptoms)
BMD
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Term
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Definition
CLASS: Gonadotropin-releasing hormone (GnRH) agonist -> downregulates, causing hypoestrogenism, decreasing levels of FSH and LH.
INDICATION: Endometriosis, breast cancer, prostate cancer
DOSE: SC implant into anterior abdominal wall, 3.6mg/month for 6 months
COUNSELLING: To be inserted by your doctor.
MONITORING: Diabetes (monitor BG) because loss of glucose tolerance in male T2D,
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Term
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Definition
CLASS: Competitively antagonises oestrogen receptors in the hypothalmus, inhibiting negative feedback, increasing release of gonadotrophins (esp LH luetinising hormone) inducing ovulation
INDICATION: Anovulatory infertility
DOSE: 50-100mg once daily for days 2-6 of the menstral cycle. Specialist guidance.
COUNSELLING: Stop taking this medicine and tell your doctor if your vision alters; avoid driving or using machinery if you are affected.
May reduce milk supply.
MONITORING: LFT before starting treatment. Consider weight loss in overweight patients before reattempting treatment.
NB: May only be prescribed by obstetrician, gynaecologist or reproductive specialist.
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Term
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Definition
CLASS: Antidiuretic hormone (ADH) analogue
INDICATION: Pituitory diabetes insipidus (not enough ADH), nocternal enuresis, control bleeding in haemophillia
DOSE:
COUNSELLING: Tell your doctor immediately if you have headache, nausea, vomiting, or weight gain.
Wafer: Place on under tongue and allow it to dissolve; do not swallow
Give larger doses at night to prevent nocturia.
Restrict fluid intake when giving desmopressing for nocturnal enuresis.
Do not use if child has vomiting or diarrhoea (these are symptoms of hypoNa).
MONITORING: Hyponatraemia. Treat for 1-3 months, then withdraw to assess relapse.
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Term
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Definition
CLASS: anticholinergic- selective muscurinic M3 receptor antagonist. Helps relax bladder and increase capacity.
INDICATION: Urge urinary incontinence, overactive bladder with urgency
DOSE: initially 7.5mg, then increase to 15mg after 2 weeks. Once daily. With or without food.
COUNSELLING: Swallow tablet whole; do not crush chew tablet.
Consider pelvic floor exercises, or behavioural training.
MONITORING: Episodes of incontinence: stop if there is no benefit after 4 weeks.
Digoxin monitoring with initiation, dose change, or ceasing ENABALEX treatment. May cause voiding dysfunction, causing hesitency.
Elderly people more prone to anticholinergic affects (dry mouth, blurred vision, constipation and confusion) |
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Term
oxybutinin (DITROPAN tab, OXYTROL patch) |
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Definition
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Term
propantheline (PRO-BANTHINE) |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| Loop diuretics: frusemide, bumetanide, ethacrynic acid |
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Definition
Class: potent diuretic, inhibit sodium and chloride resorption in ascending loop of henley.
Indication: HT, oedema associated with HF and renal failure.
Dose: Frusemide initially 20-40mg once or twice daily (maintenance 20-400mg daily).
Counselling:
If taking it twice a day, take the first dose in the morning and the second dose before 6pm (lunch time).
You may feel dizzy on standing. Get up gradually from sitting/lying. Sit or lie down if you feel dizzy.
Low salt diet
Monitoring (long term use):
weight, electrolytes (Na, K, Cl), BG, Bloods, renal, hepatic.
NB:
use ethacrynic acid EDECRIN in sulphonamide allergy, But greater risk of ototoxicity.
In heart failure, if hypotension occurs, adjust diuretic, NOT ACEI/Sartan |
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Term
| Nitrates: GTN, isosorbide mononitrate, isosorbide dinitrate |
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Definition
Class: Nitrate-> provide exogenous source of nitric oxide-> vasodilation
Indication: Prevention and treatment of angina
Dose (Short acting) see counselling
Patch and slow release tablet.
Nitrate free period (10-12h/day)
Isosorbide mononitrate (30-120mg)
Swallow whole, do not crush or chew.
GTN Patch
choose area: no cuts sores, rotate site, trim very hairy skin
skin clean, cool, dry, free from creams, emollients, lotions
open sachet without scissors to reduce chance of cutting into patch
remove protective liner, stick on, hold with palm for 10-20sec. Run your finger around the patch edges.
Counselling:
· Short acting
o Sit or lie down before use: the drug may cause orthostatic hypotension
o 0.5-1 tablet or 1-2 sprays every 4 minutes. Maximum of 2-3 tablets.
o Call an ambulance if symptoms are severe, get worse quickly or last for 10 minutes.
o Sublingual tablet
§ Sit or lie down before use as the drug may cause dizziness.
§ Place tablet under the tongue, but do not swallow. Once angina has been relieved, spit out what is left of the tablet to avoid adverse effects such as headache.
§ Discard bottle three months from opening (write date of opening on bottle).
§ Protect from light, heat, and moisture. Do not carry close to the body.
§ Keep the tablets in the bottle.
o Sublingual spray
§ Prime the spray into the air before using it. 5 sprays if it has not been used for four months or for the first time. 1 spray if it has not been used for 7 days.
§ When ready to use, aim the spray under the tongue and press the nozzle once; do not inhale the spray
Longer expiry date- good for pt with intermittent symptoms.
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Term
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Definition
Counselling:
You may get a dry cough, see your doctor.
Do not take K supp.
You may feel dizzy on standing, get slowly. Sit or lie down if you feel dizzy.
Lifestyle.
Monitoring
Baseline. and regular BP, renal, hepatic, K, WCC.
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Term
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Definition
Counselling
This medicine may affect mental alertness. Driving/operation machinery
Do not stop taking this medicine abruptly unless....
Monitoring
weight? oedema. -> cease. |
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Term
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Definition
· Counselling:
o Don’t crush/chew controlled release tablets. If necessary, the capsules may be opened and sprinkled onto apple sauce and taken immediately.
o Verapamil may increase the effects of alcohol so that you are more easily affected and the effects last longer. Limit your alcohol intake until you know whether you are affected like this.
o Constipation
o Don’t stop taking this medicine abruptly unless your doctor or pharmacist tells you to.
o This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor vehicle or operate machinery.
o Do not remove from original packaging until dose required.
· Monitor
o LFTs
o PR interval (renal impaired)
o Digoxin toxicity (reduced elimination)
o Blood pressure |
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Term
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Definition
· Class: cardiac glycoside: positive inotropic, negative chronotropic
· Indication: HF, AF
· Dose: 62.5mcg-250mcg, less for elderly, or renal impaired. Loading dose.
Counselling
- Do not stop taking digoxin without talking with your doctor or pharmacist first
- Check your pulse at the same time each day and let your doctor know of any changes
- Maintain adequate potassium intake
- Common side effects you may experience include: GI upset, headache, and decreased heart rate
- Let your doctor or pharmacist know if you experience any swelling, palpitations, persistent diarrhea, visual disturbances or any other severe or persistent side effects
Monitoring
· Renal, electrolytes, digoxin toxicity inc. Resting HR
· TDM- narrow therapeutic range |
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Term
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Definition
· This medicine is usually taken once daily in the morning. If you are taking it twice a day, take the first dose in the morning and the second dose before 6 pm.
· You may feel dizzy on standing when taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
· Do not take potassium supplements while you are taking this medicine unless your doctor tells you to
· Monitor weight, electrolytes (potassium), renal function |
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Term
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Definition
· This medicine may cause dizziness or tiredness especially at the start of treatment or when the dose is increased; if affected, do not drive or operate machinery.
· If you feel dizzy, get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
· Do not stop taking this medicine suddenly unless your doctor tells you to.
· Take tablet in the morning.
· If has asthma/COPD use beta1 selective: metoprolol/atenolol
o If renal impaired, use BB which are eliminated by hepatic route (metoprolol)
o If hepatic impaired, use BB which are eliminated by renal route (atenolol)
· Caution Diabetes-> can mask hypoglycaemic attack (tachycardia, tremor). Atenolol probably safest.
· Heart failure
o HR, BP, clinical signs of heart failure need to be monitored during dose tritation
o Report increased tiredness, breathlessness or wheezing, swollen feet or ankles, difficulty with exercise or a swollen abdomen.
o Weigh yourself daily and consult your doctor if there is a weight gain of >1.5kg in 24hours. |
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Term
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Definition
postsynaptic alpha1 blocker-reduce peripheral resistance
FIRST DOSE HYPOTENSION-CAUTION elderly, hypovolaemic, diuretics
Dizziness on standing may occur especially when starting treatment or when the dose is increased. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy. Take the first dose at bedtime, but be careful if you get up during the night as you may feel dizzy.
This medicine may cause drowsiness or dizziness; do not drive or operate machinery if affected.
Tell your ophthalmologist you are taking, or have taken, this medicine if you are going to have cataract surgery.
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Term
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Definition
Adult, initially 125–250 mg twice daily for 2 days, then adjust by 250–500 mg daily at 2-day intervals. Maintenance, 125–500 mg 2–4 times daily. When used with other antihypertensives daily dose is usually 500 mg or less.
Counselling
This medicine may make you feel drowsy or light-headed especially at the start of treatment or when the dose is increased; if affected, do not drive or operate machinery.
You may feel dizzy on standing when you first start taking this medicine or when the dose is increased. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
Practice points
- it is used to treat hypertension in pregnancy but CNS and hepatic adverse effects limit its use in other patients
- the sedating effect of methyldopa is exacerbated by dose increases; increase dosage at night to minimise inconvenience of increased sedation
- monitor blood count and liver function during first 6–12 weeks of treatment
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Term
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Definition
Amiodarone- slows conduction
· Tachyarrhythmias
· Least negative inotropic agent and is well tolerated in HF
· Dose- 2 weeks of loading doses. Maintenance 100-400mg per day.
· Counselling
o Avoid sun exposure, protective clothing, sunscreen, etc.
o Grapefruit juice
o Regular blood tests, ECGs, chest xrays
o Tell your doctor if you develop:
§ SOB or a dry cough,
§ problems with your vision,
§ weight loss,
§ muscle weakness or
§ worsening of your heart symptoms
· Monitoring
o Baseline: serum K, TFT, LFT, lung function, ECG,
o Repeat 6 monthly
o Eye examination annually |
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Term
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Definition
Blocks voltage dependant sodium channels.
L1, L9
Monitor:
Rash (SJS), fever, swollen lips
Worsening depression
Tx with valproate-> decrease lamotrigine (25mg-50mg)
Tablets may be chewed, swallowed, dispersed.
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Term
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Definition
blocks voltage dependant Na channels
Counselling
Labels: A, B, L1, L12, L18
Monitoring:
Bloods (WCC)
BMD-> Vit + Calc
Skin reaction (SJS)
Worsening depression |
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Term
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Definition
Block voltage dependant Na channels.
Counselling
Lables: A, B, 9, 12, 13
Seek medical advice if rash occurs
Monitor
LFTs
BMD
worsening depression
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Term
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Definition
prevents repetitive neuronal discharge by blocking voltage dependant Na channels
counselling
If rash, fever, sore throat, mouth ulcers appear seek medical advice
L1, L5, L9, L12, L13
Visit dentist reguarly, good dental care can prevent enlarged gums.
Monitoring
TDM (when changing forms or neurological AE)
BMD
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