Explaining medications OSCEs

Reason

Explain
Side effects?

Toxicity
Precautions

Warfarin test intervals

INR book
In case of emergency?
Always warn whom?
Dose

Important to

Finishup

Drugs and states which INCREASE

bleeding

Drugs and states which DECREASE

WARFARIN
AF
DVT
PE
TIA
Rheumatic Heart Dz
Prosthetic valve
Condition more likely form clots.
Warfarin less likely clots.
Jaundice,
Rash
aloecia
diarrhoea
bleeding
nausea
vomit
Bleeding: long time or in urine
Stop taking + inform Dr
Trauma
Alcohol (max 2 /d)
Don't change diet/vit K: liver, greens
Pregnancy 1st trimester
- every day/1wk
- every wk/3wk
- every mo/3mo
- every 8 wks
Dose and INR
Change often
always wear bracelet
Dentist
Same time
w/ or w/o food
mark calendar
don't double dose if missed
Keep taking
Attend clinic
thrombophilia screen
Understanding?
Questions?
Leaflet
antibiotics
anti-epileptics,
steroids
renal impairment
hepatic impairment
cardiac
failure
underweight <50 kg
hyperthyroidism
severe anaemia
thrombocytopenia
ulcer-healing drugs

bleeding/warfarin effect

vitamin K,
lipid lowering drugs
malabsorption problems
POST MI
Which?
aspirin
beta-blocker
ACE inhibitor
statin
Explain
Aspirin works by reducing the 'stickiness'
of platelets. Platelets help the blood to
clot if a blood vessel is cut.
Aspirin alternative?
Clopidogrel
Dose of Aspirin?
The usual dose of aspirin is 75 mg per day.
This is a low dose (anti-platelet dose).
Side effects of aspirin?
Uncommon.
Gut bleeding. i.e. tell dr if PUD
When asked to take Aspirin: What to do if PUD PPI to reduce stomach acid. Tell dr if abdo
already?
pains.
Why take four drugs??
Improve prognosis. prevent dz worsening and
reduce chance of MI.
What drugs Contraindicated with aspirin
NSAIDs, steroids, methotrexate.
e.g. arthritis
Reassure how?
SEs sound alarming, but benefits outweigh
problems.
Aspirin CVA if what dz?
Bleeding disorders eg. Haemophilia
Aspirin allergy symptoms
breathing difficulties, wheezing or a swollen
face and tongue if you take aspirin
Resp + Aspirin problem?
Asthma is brought on.
Beta blockers do what?
They ease the workload of the heart. This
prevents the heart rate from going too fast,
reduces blood pressure, and helps to stabilise
the electrical activity of the heart.
Betablockers are also used to treat what?
angina HTN
Betablockers not used in what heart dz?
certain heart problems.

Betablockers side effects?

beta blockers not used in what other dz?

ACEI why?

eg very slow pulse,

sick sinus syndrome,
second or third degree AV block.
Most have none.
cool hands and feet
sleeping problems
impotence
pins and needles
tiredness.
asthma, COPD with an asthmatic component.
Interfere with chemical in blood called
angiotensin.
Blocking this widens blood vessels, and lowers
the blood pressure, which eases the burden on
the heart.

ACEi first dose

ACE inhibitors also appear to have a direct

action on the heart which has a protective
effect.
Stay indoors for four hours or take before bed
very first dose causes a large drop in blood
pressure in a few people, and may cause a
faint.

ACEi renal precaution?

How statins work?

Cholesterol contributes to what?

Target cholesterol level

Statin blood tests? why?
Statin contraindicated in whom?

If dizzy, sit or lie down and it will usually ease

off.
If very dizzy, contact your doctor immediately.
In few ppl it is affected so:
Blood test before.
begin on Low dose.
Blood test 7-10d.
Standard @ 2-4wks.
Blood test annually.
Reduce cholesterol, which is made in liver
'fatty lumps' inside blood vessel lining
heart disease
strokes
other blood vessel problems.
5 mmol/l or to be reduced by 20-25%
blood test before starting
and 4-12 weeks later.
liver disease
pregnant
breastfeeding.