Colchicine

(colgout, lengout)

MOA: inhibits neutrophil migration, chemotaxis, adhesion and phagocytosis in the inflammed area; reduces the inflammatory reaction to urate crystals but has no effect on uric acid production or excretion

Indications

relief of pain in acute gout

Accepted

prophylaxis of recurrent gout attacks including when starting urate-lowering treatment

Familial Mediteranean fever (FMF)

Acute (idiopathic or viral) pericarditis; recurrent pericarditis

Adverse effects

diarrhoea, nausea, abdominal discomfort, vomiting, pharryngolaryndeal pain

Counselling

• tell your doctor, dentist or pharmacist that you are taking colchicine so that they can choose medicines appropriately
• Avoid grapefruit juice as it may increase the amount of colchicine in your bloodstream and could increase the chances of side effects occuring
• Stop taking this medicine, and tell your doctor if you develop severe diarrhoea or muscle pain, tenderness or weakness; numbness or tinglign in your fingers or toes; unusual bleeding or bruising or an infection
•  Acute gout: don't take more than 3 tablets (1.5 mg) in acourse to treat acute gout or repeat the course within 3 days
• in an acute attack, start colchicine as soon as possible (most effective when started within 24 hours of onset of symptoms
• colchicine may be used instead of NSAIDs in heart failure as it does not cause fluid retention

Famciclovir

(Guanine analogues)

MOA: following phosphorylation by viral and cellular enzymes, guanine analogues inhibit viral DNA polymerase and DNA synthesis

indications

Treatment and prevention of herpes simplex infections

Shingles (varicella zoster virus reactivation)

Adverse effects

Headache, vomiting, diarrhoea, confusion (especially in the elderly), dizziness, rash

Counselling

Recurrent herpes simplex infections: carry a course of talets with you so that you can start them as soon as you notice symptoms

This medication may make you feel dizzy or confused. Don't drive or operate machinary if you are affected

Fexofenadeine

(less-sedative antihistamine)

(Telfast, fexal )

MOA: reduce the effects of histamine by binging to the H₁ receptor and stabilising it in an inactive form

Indications

Allergic rhinitis

chronic urticaria

Adverse effects

drowsiness, fatigue, headache, nausea, dry mouth

Dosage

Adult

Rhinitis: 120 mg daily in 1 or 2 doses or 180 mg once daily

Urticaria: 180 mg once daily

Child

6 months - 2 years, 15 mg BD

2-11 years, 30 mg BD

Counselling

this medicine may not work as well if you drink grapefruit juice within 4 hours of taking fexofenadine

Oral liquid: you can take this medicine with or without food, but if you take it with a fatty meal, it may not be absorbed as well

this medication makes some people sleepy; don't drive or operate machinary if this occur

Fluconazole

(Azoles)

MOA: fungistatic. Azoles impair the synthesis of ergosterol in fungal cell membranes leading to their breakdown; cell leakage and death occur by lytic activity of the host defence system

Indications

Acute and recurrent mucocutaneous candidiasis

Vulvovaginal candidiasis where topital therapy has failed

candidiasis due to susceptoble strains of Candida (not c. krusei)

Cryptococcosis: consolidation and suppression after induction treatment of meningitis or dissemminated disease; treatment of mild pulmonary disease

Coccidioidomycosis

Histoplasmosis

Primary and secondary prevention of candidal infection in immunocompromised people

Tinea corporis, cruris or pedis resistant to topical therapy

omychomycosis (if alternatives has failed or are not tolerated)

Adverse effects

anorexia, fatigue, rash, headache, dizziness (infrequent with ketoconazole), nausea, vomiting, abdominal pain, diarrhoea, elevated liver enzyme

Counselling

tell your doctor if you feel unusually tired, nauseous or are not eating, or if you notice dark urine, pale faeces or yellowing of the whites of your eyes or skin

this medicine interacts with many drugs; tell your doctor and pharmacist that you are taking this medicine before starting or stopping any medicines, including herbal and over-the-counter products.

Hydrocortisone (skin)

(DermAid, sigmacort, Hydrocortisone)

MOA: anti-inflammatory, immunosuppressive and antimitotic activity against cutaneours fibroblasts and epidermal cells. They are also vasoconstrictive

Indications

Inflammatory skin conditions

Fixed combination with clotrimazole or miconazole - inflamed fungal skin infections

Relief of inflammation and itch in conditions such as eczema and psoriasis

Adverse effects

Relative potency, patient age, site and extent of disease, product type, method of application and length of treatment determine the incidence and severity of adverse effects

Folliculitis, steroid rosacea, perioral dermatitis, skin atrophy, delayed wound healing, striae, purpura, depigmentation, telangiectasia, scneiform eruptions

Counselling

Apply enough to cover affected areas. Smooth gently into skin, preferably after bathing

Loratadine

(less-sedating antihistamine)

claratyne

MOA: reduce the effects of histamine by binging to the H₁ receptor and stabilising it in an inactive form

indications

Allergic rhinitis

Chronic urticaria

Adverse effects

drowsiness, fatigue, headache, nausea, dry mouth

Dosage

adult, 10 mg once daily

child

2-12 years, <30 kg, 5 mg once daily

1-2 years, 2.5 mg once daily

counselling

this medication makes some people sleepy; don't drive or operate machinary if this occurs

Methotrexate

(antimetabolites)

MOA: folic acid antagonist. Inhibits DNA syntensis and cell replication by competitively inhibit the conversion of folic acid to folinic acid, with cytotoxic, immunosuppressive and anti-inflammatory action.

indications

• According to treatment protocol, eg for breast cancer, bladder cancer, squamous cell cancer of head and neck, gestational trophoblastic disease, acute leukaemias, non-Hodgkin lymphomas, osteosarcoma, brain tumours, graft-versus-host disease
• Rheumatoid arthritis
• crohn's disease
• Ectopic pregnancy
• polymyositis, dermatomyositis

• take tablets strictly as directed. They should be taken once a week on the same day each week; they must not be taken every day
• Tell your doctor if you have a cough, difficulty breathing or signs of infection
• use of some medications together with methotrexate may lead to toxicity; tell your doctor and pharmacist that you are taking this drug
• Avoid excessive or prolonged sun exposure, wear protective clothing and use sunscreen
• this medicine may increase your chances of getting an infection. Contact your doctor immediately if you develop a fever (temperature of 38 celsious or more) or any other signs of infection
• this medicine may also cause you to bruise and bleed more easily. tell your doctor if usual bruising or bleeding occur  

Digoxin

(cardiac glycoside)

Sigmaxin, Lanoxin

MOA: slows heart rate and reduces AV nodal conduction by an increase in vagal tone and a reduction in sympathetic activity. Increases the force of myocadial contraction by increasing the release and availability of sotred intracellular calcium

Indications

AF and atrial flutter

Heart failure

side effects

May worsen arrhythmia (proarrhythmic effect)

Digoxin has a narrow therapeutic range; adverse effects are related to its plasma concentration and very few occur at <0.8 microgram/L (1 nanomol/L).

Digoxin usually has an effect on the ECG and may results in prolong PR interval, ST depression or T wave inversion (these changes do not necessarily indicate digoxin toxicity or myocardial ischaemia)

Anorexia, nausea, vomiting, diarrhoea, visual disturbances (eg blurred vision), drowsiness, dizziness, headache, rash, bradycardia, arrhythmia

Concentration monitoring

steady state is reached after 7 days if renal function is normal (half-life is 36 hours) this may be prolonged in renal impairment

take blood sample at least 6 hours after a dose to allow for distribution

Counselling

tell your doctor or pharmacist that you are taking digoxin before using any other medications including over-the-counter and herbal products

Amoxycillin/ clavulanic acid

(penicillins)

MOA : clavulanic acid inhibits beta-lactamase, which extends spectrum of activity of amoxycilin with clavulanic acid to cover many beta-lactamase produting organinisms

Indications

Hospital- acquired pneumonia

Epididymo-architis (urinary tract source)

PID (not sexually acquired)

UTI

bites and clenched fist injuries

Otitis media (unresponsive to amoxycillin)

Acute bacterial sinusitis (unresponsive to amoxycillin)

Acute cholecystitis (after IV treatment)

Melioidosis

Adverse effects

transient increase in liver enzymes and bilirubin, Amoxycillin/amplicillin rash

Counselling

this medicine is absorbed best if taken with food

Valaciclovir

(Guanine analogues)

MOA: following phosphorylation by viral and cellular enzymes, guanine analogues inhibit viral DNA polymerase and DNA synthesis

inidcations

• Treatment and prevention of herpes simplex infections
• Reduction of genetal herpes simplex transmission from people who have <10 episodes annually to partner without serological evidence of infection
• shingles (varicella zoster virus reactination), including ophthalmic diseasse
• prevention of CMV disease following organ transplantation

• Drink plenty of fluid (at least 1.5 L daily)
• Recurrent herpes simplex infections: carry a course of tablets with you so that you can start them as soon as you notice symptoms
• reduction of transmission of genital herpes: taking valaciclovir may help reduce your risk of giving genital herpes to your partner; using condome as well will alseo help
• This medication may make you feel dizzy or confused. Don't drive or operate machinery if you are affected

Allupurinol

(progout, allosig)

Xanthine oxidase inhibitors

MOA: reduces uric acid production by inhibiting xanthine oxidase, and lowers plasma and urinary urate concentrations. Allopurinol is metabolised to oxypurinol, which also inhibits xanthine oxidase.

Indications

Gout, long-term treatment

Urate nephrolothiasis or acute uric acid nephropathy

hyperuricaemia secondary to disease, chemotherapy or radiotherapy

common side effects

maculopapular or itchy rash

infrequent - nausea, vomiting, taste disturbance, diarrhoea, abdominal pain, headache, drowsiness, vertigo, arthralgia

counselling

• take this medicines shortly after food to reduce the possibility of stomach upset
• if you develop a rash, swollen lips or mouth, persistent fever or sore throat, stop taking allopurinol and tell your doctor immediately
• make sure that you drink lots of fluids during treatment
• this medicine may make you feel dizzy or drowsy; do not drive or operate machinary if you are affected
  

Amitriptyline

(tricyclic antidepressants)

Endep

MOA: TCAs inhibit reuptake of noradrenaline and serotonin into presynaptic terminals.

Although unrelated to the therapeutic effects of TCAs, they are also block cholinergic histaminergic, alpha1 adrenergic and serotonergic receptors.

Indications

Major depression

Nocturnal enuresis

Accepted

Adjuvant in pain management

Migraine prophylaxis

Urinary urge incontinence

common

sedation, dry mouth, blurred vision, mydriasis, decreased lacrimation, constipation, weight gain, orthostatic hypotension, sinus tachycardia, urinary hesitency or retention, reduced GI motility, anticholinergic delirium (particularly in the elderly and in parkinson's disease), impotence, lose of libido, other sexual adverse effects, tremor, dizziness, sweating, agitation, insomnia, anxiety, confusion

counselling

you may get side effects such as blurred vision, drowsiness and dry mouth. They may be troublesome but may lessen or disappear after about 7 days. Try taking this medicine at night to reduce daytime drowsiness. Discuss any problem with your doctor or pharmacist

You may feel dizzy on standing when taking this medicine. Get up gradually from sittig or lying to minimist this effect; sit or lie down if you become dizzy

Avoid driving and operating machinary until you know how you react to the medication and your doctor says that you can

These drugs may increase the effects of alcohol

Do not stop taking this medicine suddenlty unless your doctor tells you to

Metoclopramide

(Dopamine antagonists)

Maxolon

MOA: antagonist activity at D2 receptors in the chemoreceptor trigger zone in the central nervous system- this action prevents nausea and vomiting triggered by most stimuli.

indications

Nausea and vomiting

gastric stasis (eg after gastric surgery, diabetic gastroparesis)  

Difficult small intestinal intubation

Fixed-dose combination with paracetamol - migraine with nausea and vomitng

Adverse effects: akathisia, drowsiness, dizziness, headache

Counselling

this medicine may make you feel drowsy or dizzy; do nto drive or operate machinary until you know how metoclopramide affects you

use short term only (maximum of 5 days); risk of tradive dyskinesis increase with cumulative dose and length of treatment

Ibuprofen

(nurofen, advil)

NSAIDs -nonsteroid anti-inflammatory drug

Nonselective NSAID

MOA: have analgesic, antipyretic and anti-inflammatory actions. They inhibit synthesis of prostaglandins by inhibiting cyclo-oxygenase (COX) present as COX-1 and COX-2

• inhibition of COX-1 results in impaired gastric cytoprotection and antiplatelet effects
• inhibition of COX-2 resulst in anti-inflammatory and analgesic action
• reduction in glomerular filtration rate and renal blood flow occurs with both COX-1 and COX-2 inhibition

• Take oral doses with a glass of water. It may be taken without food but if this upsets your stomach, try taking it with a meal.
• Don't take this medicine if you are dehydrated, for example due to vomiting or diarrhoea, because it might increase the likelihood of side effects, particularly for children and elderly people. Talk to your doctor or pharmaicst if necessary
• If you develop swollen ankles, difficulty in breathing, chest pain, black stools or dark coffee-coloured vomit, stop taking the medicine and tell your doctor immediately
• infants and children toleratel low-grade fever (eg <38 -38.5ºC) well, often respond to fluids and comfort, and may not need medication
• Ibuprofen can reduce the antiplatelt activity of low-dose asspirin and potentially reduce or negate its cardioprotective effect

carbamazepine

(tegretol)

MOA: Prevents repetitive neuronal discharge by blocking voltage-dependent and use dependent sodium channel

Indications

Epilepsy, including simple and complex focal (partial) seizures, and generalised tonic-clonic seizure

 Trigeminal and glossopharyngeal neutalgia

Bipolar disorder

adverse effects

drowsiness, ataxia, dizziness, blurred vision, diplopia (double vision), headahce ( all dose-related), rash, dry mouth, abdominal pain, nausea, vomiting, anorexia, diarrhoea, constipation, asymtpomatic hyponatraemia, leucopenia, thrombocytopenia, increased liver enzyme (uaully not clinical significant)

Counselling

• Take with food to help prevent stomach upset. Swallow controlled release tablets do not chew or crush then
• this medicine may cause drowsiness, dizziness or blurred vision especially at the start of the treatment or when the dose is increased; if affected, do not drive or operated machinery
• Carbamazepine may also increase the effects of alcohol
• this medicine interacts with grapefruit juice and many other drugs; avoid grapefruit juice and tell your doctor and pharmacist that you are taking carbamazepine before starting any new medication including herbal and over-the-counter products
• Tell your doctor immediately if rash, sore throat, fever, mouth ulcers, bruising or bleeding occur
• Do not stop taking this medicine suddently unless your doctor tells you to

• increas dose slowly to allow for enzyme induction at start of treatment; steady-state plasma concentration may not be achieved for 2-4 weeks because of autoinduction of metabolism
• this may also help improve compliance by minimising severe drowsiness until tolerance develops
• use of controlled release tablets reduces peak concentration-related adverse effect (eg dizziness, blurred vision)
• Consider BMD monitoign, and vitamin D and calcium supplements to prevent osteomalacia and osteoporosis, in patients on long-term treatment, particularly those at high risk,e g elderly patients

Celecoxib

(celebrex)

(selective Cox2 inhibitor  NSAID)

MOA: have analgesic, antipyretic and anti-inflammatory actions. They inhibit synthesis of prostaglandins by inhibiting cyclo-oxygenase (COX) present as COX-1 and COX-2

• inhibition of COX-1 results in impaired gastric cytoprotection and antiplatelet effects
• inhibition of COX-2 resulst in anti-inflammatory and analgesic action
• reduction in glomerular filtration rate and renal blood flow occurs with both COX-1 and COX-2 inhibition

Haloperidol

(Antipsychotics)

MOA: Antipsychotic actions are thought to be mediated (at least in part) by blockade of dopaminergic transmission in various parts of the brain (in particular the limbic systems)

Evidence suggests:

• all effective antipsychotics block D₂ receptors
• differential blockade of other dopamine receptor (eg D₁) may influence therapeutic and adverse effects
• antagonism of other receptors may influence antipsychotic activity eg 5HT₂ antagonism with some agents

Indications

Acute and chronic psychoses

Acute mania

Tourette syndrome and other choreas

Adjunct in treatment of hallucinations due to alcohol withdrawal (if diazepam inddequate)

Intractable nausea and vomiting associated with cancer chemotherapy or radiotherapy

Accepted

Short-term management of acute, severe anxiety, agitation or disturbed behaviour in non-psychotic disorders

Adverse effects

Adverse effects traditionally associated with older agents appear to be less common or less severe with some of the newer antipsychotics. However, overall  tolerability may not be markedly different form the seen with older agents used in conservative doses

Common

sedation, anxiety, EPSE, orthostatic hypotension, tachycardia, blurred vision, mydriasis, constipation, nausea, dry mouth, urinary retention, sexual adverse effects, weight gain, hyperprolactinaemia (may result in galactorrhoea, gynaecomastia, amenorrhoea or infertility)

EPSE

Incidence is dose-related and is:

• highest with haloperidol, fluphenazine and trifluoperazine
• Lower with chlorpromazine, pericyazine
• Lowest with some of the newer agents (at recommended doses)

Counselling

taking your antipsychotic medicine regualarly is important:

• because stopping or taking it irrigularly is associated with high risk of relapse and suicide
• in order to prevent an episode, rather than taking if after symptoms occur

• even intermittent use of cannabis or amphetamine markedly decreases control of psychotic symptoms
• regular use of illicit drugs increases risk of relapse

•  what extrapyramidal side effects are and what you can do about them
• the risk of tradive dyskinesia with long-term antipsychotic treatment

Practice points

• use with a benzodiazepine to increase sedation for acutely psychotic patients
• Often used for the elderly because of the low incidence of hypotension and anticholinergic effects, but has a relatively high incidence of EPSE
• Use for nause and vomiting due to cancer treatment only when other agents are ineffective and increased risk of adverse CNS effects is acceptable. 

Thyroxine

(Eutroxig, Oroxine)

Indications

Hypothyroidism

Block-replacement regimen in hyperthyroidism

suppressive regimen in thyroid cancer and euthyroid goitre

Side effects

usually associated with excessive dosage; correspond to symptoms of hyperthyroidism,  eg tachycardia, excitability, insomnia, flushing, sweating, diarrhoea and excessive weight loss)

Worsening ischaemic symptoms may occur in those with ischaemic heart disease, even at reduced doses

 Decrease bone density has been reported, particularly in overtreated postmenopausal women and in suppressive regimens

Counselling

take thyroxine on an empty stomach, preferably before breakfast

tell your doctor if symptoms of  hyperthysroidism occur eg palpitations, excitability, insomnia, flushing, sweating or weight loss

Levodopa + Benserazide/Carbidopa

(madopar rapid, sinemet)

MOA: Levodopa is converted to dopamine in the brain and peripheral tissues, and replenises depleted striatal dopamine

 It is given with peripheral dopa decarboxylase inhibitor (benserazide or carbidopa) to reduce peripheral dopamine production and also reduce adverse effects ( eg nausea, vomiting, hypotension)

Indications

Parkinson's disease

Fixed dose combination with carbidopa and entacapone - parkinson's disease with motor fluctuation

Adverse effects common - anorexia, nausea, vomiting, orthostatic hypotension, dyskinesia, episode of sudden unpredictable loss of mobidity ("off effecct"), agitation, sudden sleep onset, drowsiness, depression, hallucination and confusion (especially in the elderly)

Counselling

• Take this medicine at the same time each day and in the same way (eg always before food)
• this medication may cause drowsiness; if affected do not drive or operate machinary
• Be careful when you stand up at this medicine might make you feel dizziness if you stand up too quickly

• do not stop taking this medicine suddently unless your doctor tells you to. - risk of withdrawal syndrome resembling the neuroleptic malignant syndrome (fever, muscle rigidity, rhabdomyolysis, profuse sweating, tachycardia, tachypnoea (abnormally rapid breathing), agitation)

• protein in food reduces the absorption of levodopa:

Irbesartan

(angiotensin receptor blocker)

(Karvezide)

MOA: competittively block binding of angiotensin II to type 1 angiotensin (AT₁) receptors. They reduce angiotnsin II induced vasoconstriction, sodium reabsorption and aldosterone release. They also reduce the effect of angiotnsin II on sympathetic nervous activity and growth factors

Indication

Hypertension (including fixed-dose combination iwth hydrochlorothiazide)

Reduction of renal disease progression in patients with thye 2 diabetes, hypertesion, and microalbuminuria ( >30 mg/24 hours) or proteinuria (>900 mg/24 hours)

Common side-effects: dizziness, headahce, hyperkalaemia, first-dose hypotesion, rash

Counseeling

• You may feel dizzy when your start taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy or light-headed
• Do not take potassium supplements while you are taking this medicine unless your doctors tells you to.
• Maximum antihypertensive effect oxxurs about 4-6 weeks after starting treatment.

Heparin

(heparins - unfractionated heparin)

MOA: inactivate clotiing factors IIa (thrombin) and Xa by binding to antithrombin III; LMWHs and danaparoid have a musch greater effect on factor Xa than on the thrombin

Indications

Prevention of VTE in surgical and high-risk medical patients

Treatment of VTE (venous thromboembolism)

Treatment of ACS (acute coronary syndrome)

Treatment of peripheral arterial occlusion

Prevention of arterial thrombosis during coronary angioplasty

prevention of extracorporeal thrombosis during haemodialysis

Prevention of extracorporeal thrombosis during cardiopulmonary bypass

Treatment of disseminated intravascular coagulation

Common adverse effects - bleeding, brusing and pain at injection site, hyperkalaemia, mild reversable thrombocytopenia ( reduce platelt count) (does not necessarily indicate increased risk of severe thrombocytopenia)

counselling

Tell your doctor immediately if you have any signs of bleeding (eg nosebleeds, black or tarry bowel motions, or unexplained bruising) during and after treatment

Atenolol

(beta-blockers)

Noten, tenromin

Beta-1 receptors

MOA: Competitively block beta receptors in heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver

Beta-blockers reduce heart rate, BP and cardiac contractility; also depress sinus node rate and slow conduction through the atriventricular (AV) node, and prolong atrial refractory periods

The affinity of individual beta-blockers for beta receptors varies

indications

Hypertension

Angina

Tachyarrhythmias

MI

Accepted: prevention of migraine

common adverse effects: bradycardia, hypotension, orthostatic hypotension (especially carvedilol, labetalol), transient worsening of heart failure (when treatment starts), nausea, diarrhoea, bronchospam, dyspnoea, cold extremities, exacerbation of Ray's phenomenon, fatigue, dizziness, abnormal vision, alteration of glucose and lipid metabolism

counselling

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

Gliclazide

sulfonylureas

MOA: increase pancreastic insulin secretion; may decrease insulin resistance

Indications

Type 2 diabetes

Common adverse side effects

Hypoglycaemia (risk is increased by advanced age, renal or hepatic impairment and interacting drugs), weight gain

Counselling

Swallow controlled release tablets whole; do not chew or crush them

take with food to minimise risk of low blood glucose (hypoglycaemia)

Drinking alcohol decreased your blood glucose. It can also mask warning of symptoms 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 docotr or diabetes educator if you are unsure

Ethinyloestradiol/Levonogestrel

Anuvulants or combined oral contraceptive

MOA: All combined oral contraceptives contain as oestrogen and progestogen. they inhibit ovulation, reduce receptivity of endometrium to implantation and thicken certival mucus to form a barrier to sperm

Indications: contraceptive

moderate acne (not controlled with topical agents) in women (Loette)

Accepted

moderate acne

menstrual disorders, eg heavy menstrual bleeding, dysmenorrhoea

endometriosis

premenstrual syndrome

Adverse effects

Tolerance to some adverse effects may develop during the first 3 months of use

Breakthrough bleeding, amenorrhoea, neausea, vomiting, breast enlargement and tenderness, headache, mood changes, changes in libido, increased BP, fluid retention, chloasma, acne, thrush

Counselling

If any of the following symptoms occur while on the pill, stop taking it and seek urgent medical advice; severe and sudden pain in the chest , severe headache, sudden blurred vision of loss of sight, unexplained tenderness or pain and swelling in one leg

make sure you know which are active (hormonal) pills and which are inactive. Packets vary in presentation; some brands recommend starting with inactive pills, depending on the day of the week

If no preceding hormonal contraceptive: for immediate contraceptive start with an active  pill within the first 5 days of your period starting. If you start active pills after this, use additional contraceptive methouds until you have taken active pills for 7 days

If changing from another COC: start taking active pills the day after you stop you old pill (on any day of your cycle). Additional contraceptive is not required

If changing from a progestogen-only pill: start taking the active pills without any interval and use additional contraceptive methods until you have taken active pills for 7 days

When is it less effective?

Effectiveness may be reduced by:

• some medicines; check with your doctor or pharmacist before starting or stopping any medicines, including herbal (particularly St John's wort) and over the counter product
• vomiting or diarrhoea (which also may be caused by some medications) or forgetting to take an active pill

• if you are late taking an active pill take it as soon as you remember and take the next pill at the usual time (this may mean taking 2 pills on the same day or at the same time)
• continue with the daily pill and use another contraceptive method until you have taken active pills for 7 days in a row (if the missed pill was in the last 7 days of active pills, finish the active pills in your present pact, then start the active pills in a new pack without any break). If the missed pill was in the first 7 days of active pills and you had unprotected sex during or after that time, seek emergency contraceptove. Start taking your pill again within 12 hours  of taking the emergency contraceptive tablets.

Ethinyloestradiol/Levonogestrel

Anuvulants or combined oral contraceptive

MOA: All combined oral contraceptives contain as oestrogen and progestogen. they inhibit ovulation, reduce receptivity of endometrium to implantation and thicken certival mucus to form a barrier to sperm

Indications: contraceptive

moderate acne (not controlled with topical agents) in women (Loette)

Accepted

moderate acne

menstrual disorders, eg heavy menstrual bleeding, dysmenorrhoea

endometriosis

premenstrual syndrome

Adverse effects

Tolerance to some adverse effects may develop during the first 3 months of use

Breakthrough bleeding, amenorrhoea, neausea, vomiting, breast enlargement and tenderness, headache, mood changes, changes in libido, increased BP, fluid retention, chloasma, acne, thrush

Counselling

If any of the following symptoms occur while on the pill, stop taking it and seek urgent medical advice; severe and sudden pain in the chest , severe headache, sudden blurred vision of loss of sight, unexplained tenderness or pain and swelling in one leg

make sure you know which are active (hormonal) pills and which are inactive. Packets vary in presentation; some brands recommend starting with inactive pills, depending on the day of the week

If no preceding hormonal contraceptive: for immediate contraceptive start with an active  pill within the first 5 days of your period starting. If you start active pills after this, use additional contraceptive methouds until you have taken active pills for 7 days

If changing from another COC: start taking active pills the day after you stop you old pill (on any day of your cycle). Additional contraceptive is not required

If changing from a progestogen-only pill: start taking the active pills without any interval and use additional contraceptive methods until you have taken active pills for 7 days

When is it less effective?

Effectiveness may be reduced by:

• some medicines; check with your doctor or pharmacist before starting or stopping any medicines, including herbal (particularly St John's wort) and over the counter product
• vomiting or diarrhoea (which also may be caused by some medications) or forgetting to take an active pill

• if you are late taking an active pill take it as soon as you remember and take the next pill at the usual time (this may mean taking 2 pills on the same day or at the same time)
• continue with the daily pill and use another contraceptive method until you have taken active pills for 7 days in a row (if the missed pill was in the last 7 days of active pills, finish the active pills in your present pact, then start the active pills in a new pack without any break). If the missed pill was in the first 7 days of active pills and you had unprotected sex during or after that time, seek emergency contraceptove. Start taking your pill again within 12 hours  of taking the emergency contraceptive tablets.

Oxymetazoline

(intranasal decongestants)

(dimetapp)

MOA: produce vasoconstriction in nasal mucosa, decrease nasal blood flow and congestion

Indications

Relief of nasal congestion associated with acute and chronic rhinitis

Facilitate intranasal examination

Adverse effects

Transient burning, stinging, increased nasal discharge, rebound congestion with prolonged use (>4-5 days)

Dose

Nasal spray 0.05%, 1-2 sprays into each nostril up to 3 times daily

Counselling

Do not use this medicine more than recommended or for more than 5 days as a time as it can worsen your sympotms when you stop using it

Risperidone

Antipsychotics

MOA:

Antipsychotic actions are thought to be mediated (at least in part) by blockade of dopaminergic transmission in various parts of the brain (in particular the limbic system). Evidence suggests

• all effective antipsychotics block D₂ receptor
• differential blockade of other dopamine receptors (eg D₁) may influence therapeutic and adverse effects
• antagonism of other receptors may influence antipsychotic activity, eg 5HT₂ antagonism with some agents.

Alendronate

(Fosamax)

MOA: Decrease bone resorption by inhibitng osteoclasts

Indications

Paget's disease of bone

Prevention and treatment of osteoporosis (including postmenopausal and corticosteroid induced)

Fixed-dose combination with colecalciferol (vitamin D3) - treatment of osteoporosis, when vitamin D supplementation is recommended

Adverse effects

Rare - alopecia

Nausea, vomiting, diarrhoea, headache, hypocalcaemia, musculoskeletal pain (may rarely be severe and/or disabling)

Counselling

Take in the morning with a full glass of plain water at least 30 minutes before food or drink. Remain upright during this time and until after you eat. Swallow whole: do not chew or suck on the tablet.

Do not take antacids, calcium, iron or mineral supplements within 30 minutes of alendronate as they may interfere with its absorpiton

Stop tablets and see your doctor immediately if you have pain on swallowing, or new worsening heart burn.

there are rare complications with some dental procedures in people taking biphosphonates; tell your 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.

Diazepam

(Antenex)

Benzodiazepines

MOA: Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting  in anxioltic, sedative, hypnotic, muscle relaxant and antiepileptic effects

Indications

Short-term management of anxiety, agitation

Acute alcohol withdrawal

Muscle spasm

Premedication

conscious sedation

status epilepticus

Accepted

Benzodiazepien withdrawal

Acute behavioural disturbance

Parasomnias (night terrors, sleepwalking)

Adverse effects

Drowsiness, oversedation, light-headedness, memory loss, hypersalivation, ataxia, slurred speech, dependence, effects on vision, eg blurred vision, impaired tracking

Counselling

You may feel drowsy while taking this medication; drowsiness may persist the next following day; avoid driving or operating heavy equipment until you know how you react

Avoid alcohol and other medications that may cause drowsiness while taking this drug

If you take this medicine regularly for more than 2-4 weeks your body may become used to it and in time, you may need a higher dose for it to continue to work. if you stop the medicine suddently, you may have unpresent effects (eg feeling anxious, difficuly sleeping). Discuss how to stop the medicine with your doctor first.

Amlodipine

(Calcium channel blockers)

MOA: Block inward current of calcium into cells in vascular smooth muscle, myocardium and cardiac conducting system via L‑type calcium channels.

Act on coronary arteriolar smooth muscle to reduce vascular resistance and myocardial oxygen requirements, relieving angina symptoms.

Dihydropyridines act mainly on arteriolar smooth muscle to reduce peripheral vascular resistance and BP. They have minimal effect on myocardial cells.

Non-dihydropyridines: diltiazem and verapamil act on cardiac and arteriolar smooth muscle. They reduce cardiac contractility, heart rate and conduction, with verapamil having the greater effect. Diltiazem has a greater effect on arteriolar smooth muscle than verapamil.

Indication

Hypertension (includes fixed dose combinations with olmesartan, almesartan with hydrochlorothiazide, telmisartan, valsartan, valsartan with hydrochlorothiazide

Angina

Common adverse effects:

Nausea, vasodilatory effects, including headache, flushing, dizziness, hypotension and peripheral oedema

** vasodilatory adverse effects usually subside with continued treatment (may require dose reduction)

Glyceryl trinitrate

(nitrates)

MOA: Provide exogenous source of nitric oxide (which mediates vasodilator effects). Predominantly venodilators; reduce venous return and preload to the heart, reducing myocardial oxygen requirement.

Indications

Prevention and treatment of stable angina

Heart failure associated with acute MI (infusion)

Accepted

Unstable angina (infusion)

Acute pulmonary oedema (infusion)

Adverse effects: headache, flushing, palpitation, orthostatic hypotension, fainting, peripheral oedema

Counselling

Patch

Apply to clean, dry skin on the chest area or upper arm. Make sure you know how to dispose of patches safety

Sublingual tablets or spray

Use during apisodes of angina or before activity expected to bring an angina

Sit or lie down before use as it may cause dizziness

Call an ambulance if symptoms are severe, get worse quickly or last for 10 minutes  

sublingual tablets

Place half to one tablet under your tongue; do not swallow i; after the pain has been relieved, you may spit out or swallow what is left of the tablet to avoid adverse effects such as headache

It is importatn to store these tablets properly or they may not work as well. Keep them in the original glass bottle away from moisture, heat and light. Do not them close to your body. Write the date on the bottle when you open it and discard any unused tablets 3 months later

Sublingual spray

Prime the spray before using it for the first time by pressing the nozzle 5 times, spraying it into the air. Prime it with 1 spray if hasn't been used for 7 days. Prime it with 5 sprays if it hasn't been used for more than 4 months

When ready to use, aim the spray under the tongue and press the nozzle once; do not inhale the spray

This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy

Budesonide (inhaled)

Corticosteroids (inhaled)

Pulmicort

MOA: Reduce airway inflammation and bronchial hyper-reactivity

Indications

Maintenance treatment of asthma

Croup

Accepted

COPD with FEV1 <50% and recurrent exacerbations despite treatment with long-acting beta2 agonist

Eosinophilic oesaphagitis