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Our patient was prescribed vimovo for the first time.

Can you tell me why you were prescribed vimovo?

Did the doctor tell you how you should take this medication?

Can you repeat what they told you?

Can you tell me what other medications you are taking both prescribed and over the counter.

I see you are taking nurofen - when was the last time you took a nurofen tablet? Just to let you know that it is not advisable to take nurofen with vimovo? They are part of the same medication family and should not be taken together.

Reassurance given to patient that as he has only just started to take vimovo, it is not likely to be a cause of concern but emphasise the importance of following the patient leaflet guidelines. Ask patient to read the manufacturers guidelines.

Formulate a plan with the patient when is the best time for him to take this medication.

Discuss possible side effects - and explain that vimovo contains esemoprazole which helps to protect the stomach from the side effects normally associated with NSAIDS.

Advised to report any unusual effects when taking the tablets.

Agree to check in with patient in three days to see if the vimovo is helping with pain relief and if not, to refer back to GP.

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National Osteoporosis Guidelines Group UK (nogg.org.uk)

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amlodipine - Sarah, Christina & Elizabeth

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amlodipine - Sarah, Christina & Elizabeth

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Nurse- Hi Mary you have started on amlodipine by the G.P? Do you know what this is for?

Mary- I think it is for my blood pressure, it was a bit high

Nurse- Have you ever taken a blood pressure medication before?

Mary- No this is my first time

Nurse- Do you know the side effects of this medication?

Mary- No, I don't. I was just told to take it. the pharmacy told me not to take grapefruit with it. I don't take grapefruit anyway.

Nurse- Ok Mary, that is great that you are aware of the grapefruit. would you like me to go through the side effects with you?

Mary- Yes please

Nurse- the most common side effect that is linked with this medication is fluid retention. You could see this with ankle swelling. headaches, dizziness and tiredness are also common. they are quite mild, and it is just your body adjusting to the treatment. If your symptoms continue after 2 weeks, please call the clinic and leave us know.

Mary- ok thank you. I have been feeling well on it over the past week.

Nurse- Yes the blood pressure is good today. Mary do you know the symptoms of low blood pressure?

Mary- I'm not sure, I have always had high blood pressure.

Nurse- Ok so Mary, listening to you, You know the symptoms of High blood pressure, but unsure of how low blood pressure feels, will I go through that with you?

Mary- Yes- please.

Nurse- so if you take more of the prescribed dose- your blood pressure could drop- this could present with the feelings of light -headedness- dizziness- feeling faint, or weak. your skin could feel cold or clammy also. if this does happen Mary you would need to seek medical attention.

Mary- Ok Thank you

Nurse- Ok Mary, what do you think of all this information? is this too much for you, would you like some written information also?

Mary - Yes that would be great please.

Nurse- ok Mary- here is the written information for amlodpine. Is there anything else I can help you with today?

Mary- no thank you

Nurse- ok so Mary- you are scheduled to be seen again in 4 weeks. we can check the blood pressure again then, in the meantime- keep up the daily walks, these are so benefical for you and the blood pressure. Well done.

Mary- thank you

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IMPORTANT SAFETY INFORMATION

INDICATIONS AND USAGE

What is VIMOVO® (naproxen and esomeprazole magnesium)?

VIMOVO contains two medicines: naproxen, a nonsteroidal anti-inflammatory drug (NSAID) and esomeprazole magnesium, a proton pump inhibitor (PPI). VIMOVO is a prescription medicine used in adults and adolescents, 12 years of age and older who weigh at least 84 pounds (38 kg), who need to take naproxen for relief of symptoms of arthritis and who also need to decrease the risk of developing stomach ulcers caused by naproxen. The naproxen in VIMOVO is used for the relief of signs and symptoms of:

osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis in adults

juvenile idiopathic arthritis (JIA) in adolescents

What is VIMOVO ® (naproxen and esomeprazole magnesium)?

VIMOVO contains two medicines: naproxen, a nonsteroidal anti-inflammatory drug (NSAID) and esomeprazole magnesium, a proton pump inhibitor (PPI). VIMOVO is a prescription medicine used in adults and adolescents, 12 years of age and older who weigh at least 84 pounds (38 kg), who need to take naproxen for relief of symptoms of arthritis and who also need to decrease the risk of developing stomach ulcers caused by naproxen. The naproxen in VIMOVO is used for the relief of signs and symptoms of:

osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis in adults

juvenile idiopathic arthritis (JIA) in adolescents

The esomeprazole magnesium in VIMOVO is used to decrease the risk of developing stomach ulcers in people who are taking naproxen.

It is not known if VIMOVO is safe and effective in children less than 12 years of age or who weigh less than 84 pounds (38 kg). You should not take a naproxen tablet and an esomeprazole magnesium tablet together instead of taking VIMOVO, because they will not work the same way. Studies in people who take VIMOVO have not extended past 6 months.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about VIMOVO?

VIMOVO can cause an increased risk of a heart attack or stroke that can lead to death. This risk may occur early in treatment and may increase with longer use and with increasing doses of medicine containing NSAIDs.

VIMOVO can cause an increased risk of bleeding, ulcers, and tears (perforations) of the esophagus, stomach, and intestines. These events can occur at any time during use, without warning symptoms, and may cause death. Elderly patients and patients with a history of ulcer disease or stomach or intestinal bleeding are at greater risk for getting an ulcer or bleeding.

You should take VIMOVO exactly as prescribed, at the lowest dose possible and for the shortest time needed.

VIMOVO can cause serious side effects. Stop taking VIMOVO and call your doctor or go to your emergency department right away if you get:

Difficulty breathing, swelling of the face or throat. These could be signs of a serious allergic reaction.

Chest pain, shortness of breath, weakness in one part or side of your body, or slurring of speech. These could be signs of a serious blood clotting event.

Upper stomach pain, upset stomach, black, tarry stools, or vomiting of blood. These could be signs of an esophagus, stomach, or intestinal ulcer, bleed, or tear. Note: if you are also taking low-dose aspirin, you are at increased risk for esophagus, stomach, or intestinal bleeding.

Nausea, more tired or weaker than usual, itching, yellowing of the skin or eyes, right upper abdomen tenderness, and "flu-like" symptoms. These could be signs of a liver problem.

Shortness of breath, unexplained weight gain, or swelling of the arms, legs, hands, or feet. These could be signs of a serious heart problem.

Diarrhea that does not improve. This could be a sign of an infection called Clostridium difficile infection.

Any type of rash. This could be a sign of a serious skin reaction.

New or worsening joint pain or a rash on your cheeks or arms that gets worse in the sun. These could be signs of certain types of lupus erythematosus.

Decreased volume of urine or blood in urine. These could be signs of a kidney problem.

These are not all of the possible side effects of VIMOVO. Please talk to your doctor if you experience any symptoms that bother you or that do not go away. If you take too much VIMOVO, call your poison control center at 1-800-222-1222.
Who should not use VIMOVO?

DO NOT USE VIMOVO:

if you are allergic to naproxen, esomeprazole magnesium, omeprazole, any other PPI medicine, or any of the ingredients in VIMOVO. See the Medication Guide for a complete list of ingredients.

if you have had an asthma attack, hives, or other allergic reaction after taking aspirin or any other NSAIDs.

right before or after a heart bypass surgery called coronary artery bypass graft.

If you are in the 30th week of pregnancy until delivery

If you are taking a medicine that contains rilpivirine (Edurant, Complera, Odefsey) used to treat HIV-1 (Human Immunodeficiency Virus).

How should I take VIMOVO?

Take VIMOVO exactly as your health care provider tells you to take it. Take VIMOVO at least 30 minutes before a meal. Swallow VIMOVO tablets whole with liquid. Do not split, chew, crush, or dissolve the VIMOVO tablet. If you forget to take a dose of VIMOVO, take it as soon as you remember. If it is almost time for your next dose, do not take the missed dose. Take the next dose on time. Do not take 2 doses at one time to make up for a missed dose.

What are the possible side effects of VIMOVO?

The most common side effects of VIMOVO are inflammation of the lining of the stomach and diarrhea.

What other medications might interact with VIMOVO?

Avoid using VIMOVO while taking other naproxen-containing products or other non-aspirin NSAIDs, clopidogrel, St. John's Wort, or rifampin. NSAIDs may be present in over-the-counter medications for treatment of colds, fever, or insomnia; refer to the label of over-the-counter medications you are taking or ask your pharmacist. Do not use VIMOVO and low-dose aspirin until you talk to your health care provider. Tell your health care provider about all of the medicines you take as some medicines can react with VIMOVO and cause serious side effects.

What should I tell my health care provider?

Before starting VIMOVO, tell your health care provider if you have a history of ulcer disease or esophagus, stomach, or intestine bleeding, liver or kidney problems, high blood pressure, heart problems, asthma, low magnesium levels, ulcerative colitis or Crohn's disease, or are pregnant, trying to become pregnant, or breast feeding. Taking NSAIDs, such as VIMOVO, at about 20 weeks of pregnancy or later may harm your unborn baby. If you need to use VIMOVO for more than 2 days when you are between 20 and 30 weeks of pregnancy, your health care provider may need to monitor the amount of fluid in your womb around your baby. You should not use VIMOVO after about 30 weeks of pregnancy. Talk to your health care provider about the risk of bone fractures or a certain type of stomach growths or developing low magnesium or vitamin B-12 levels if you take VIMOVO for a long period of time. Also tell your health care provider about all of the medicines you take, including prescription or over-the-counter medicines, vitamins, or herbal supplements. Do not start taking new medicines without talking to your health care provider first.

Please see the Medication Guide and Prescribing Information or visit VIMOVO.com for additional information. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

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IMPORTANT SAFETY INFORMATION What is VIMOVO® (naproxen and esomeprazole magnesium)? VIMOVO contains two medicines: naproxen, a nonsteroidal anti-inflammatory drug (NSAID) and esomeprazole magnesium, a proton pump inhibitor (PPI).

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1. About furosemide

Furosemide is a type of medicine called a diuretic. It's used to treat high blood pressure, heart failure and oedema (a build up of fluid in the body).

It's also sometimes used to help you pee when your kidneys aren't working properly.

Diuretics are sometimes called "water pills/tablets" because they make you pee more.

Furosemide is only available on prescription. It comes as tablets and as a liquid that you swallow. It can also be given by injection, but this is usually only done in hospital.

Furosemide sometimes comes mixed with other diuretics or potassium.

2. Key facts

It's usual to take furosemide once a day in the morning. Some people take it twice a day - once in the morning and again at lunchtime.

Furosemide doesn't usually upset your tummy. You can take it whether or not you've eaten a meal or snack recently.

The main side effect of furosemide is peeing more often than normal. Most people need to pee about 30 minutes after taking furosemide, and again within a few hours.

Do not take furosemide after 4pm or you may have to wake in the night to go to the toilet.

Furosemide is also called by the brand names Frusol and Lasix.

3. Who can and cannot take furosemide

Furosemide can be taken by most adults and children, including babies.

However, furosemide isn't suitable for everyone. To make sure furosemide is safe for you, tell your doctor if you have:

had an allergic reaction to furosemide or any other medicine in the past

low blood pressure

symptoms of dehydration, such as being thirsty, having a dry mouth and dark pee

liver disease

difficulty peeing

a disorder of your adrenal glands called Addison's disease

an intolerance to, or you cannot absorb, some sugars such as lactose (in milk) or maltitol (in corn syrup)

Tell your doctor that you are taking furosemide if you're going to have:

a glucose test

a test (such as an X-ray or scan) that involves a dye containing iodine being injected into your blood

a major operation or a general anaesthetic to put you to sleep

4. How and when to take it

When will I take it?

It's usual to take furosemide once a day in the morning.

Sometimes you take it twice a day - once in the morning and again at lunchtime. Occasionally, you take it every other day.

You don't need to take furosemide at the same time every day. You can occasionally take it at a different time if it's more convenient for you, for example if you need to go out for a few hours in the morning and you won't be near a toilet.

But do not take furosemide too late in the day (after 4pm) or at night, otherwise you may have to wake up to go to the toilet. Your doctor or pharmacist will tell you the best times for you to take your medicine.

How much will I take?

Doses are usually lower for people over 65 years as they may be more prone to side effects.

For babies and children, your doctor will use your child's weight or age to work out the right dose.

How to take it

Furosemide doesn't usually upset your tummy so you can take it whether or not you've eaten recently.

Swallow the tablets whole with a drink of water.

If you're taking furosemide as a liquid, it will come with a plastic spoon or syringe to help you measure out the correct dose. If you don't have one, ask your pharmacist for one. Do not measure the liquid with a kitchen teaspoon as it won't give the right amount.

Some people take furosemide mixed with other diuretics or potassium:

with amiloride (also called co-amilofruse, Frumil or Frumil LS)

with spironolactone (also called Lasilactone)

with triamterene (also called Frusene)

with potassium (also called Diumide-K Continus)

What if I forget to take it?

Take your forgotten dose as soon as you remember, unless it is after 4pm in the afternoon. In this case, leave out the missed dose and take your next dose at the usual time. Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.

What if I take too much?

Too much furosemide can cause headaches, dizziness, a pounding or irregular heartbeat and fainting. You may also pee more than normal and feel thirsty.

The amount of furosemide that can lead to an overdose varies from person to person.

5. Side effects

Like all medicines, furosemide can cause side effects although not everyone gets them.

Side effects often get better as your body gets used to the medicine.

Common side effects

Common side effects of furosemide happen in more than 1 in 100 people. They include:

peeing more than normal, most people need to pee a couple of times within a few hours of taking furosemide - you may also lose a bit of weight as your body loses water

feeling thirsty with a dry mouth

headaches

feeling confused or dizzy

muscle cramps, or weak muscles

feeling or being sick (nausea or vomiting)

a fast or irregular heartbeat

Serious side effects

Some people have serious side effects after taking furosemide.

Tell your doctor straight away if you get:

unexplained bruising or bleeding, fever, sore throat and mouth ulcers - these could be signs of a blood disorder

severe tummy pain which could reach through to your back - this could be a sign of an inflamed pancreas (pancreatitis)

severe pain in your side or blood in your urine - these could be signs of inflamed kidneys

ringing in your ears (tinnitus) or loss of hearing

Serious allergic reaction

It's possible to have a serious allergic reaction (anaphylaxis) to furosemide.

These are not all the side effects of furosemide. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects

What to do about:

peeing more than normal - this will last for about 6 hours after taking furosemide. It's nothing to worry about, but if it's inconvenient for you, change the time you take furosemide to one that suits you better (provided it's no later than 4pm). If peeing a lot is still a problem for you, talk to your doctor or pharmacist.

feeling thirsty - it's important not to get dehydrated, but how much you drink will depend on why you're taking furosemide. Check with your doctor how much liquid you can drink while you're taking this medicine.

dry mouth - chew sugar-free gum or suck sugar-free sweets.

headaches - make sure you rest and drink fluids - ask your doctor how much you can drink while taking this medicine. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.

feeling confused or dizzy - if furosemide makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. Do not drive or use tools or machines while you're feeling dizzy or shaky.

muscle cramps or weak muscles - if you get unusual muscle pain or weakness which isn't from exercise or hard work, talk to your doctor. You may need a blood test to check what might be causing it.

feeling or being sick (nausea or vomiting) - take furosemide with or just after a meal or snack. Take small, regular sips of water or squash so you don't get dehydrated (ask your doctor how much fluid you can drink). It may help if you stick to simple meals and don't eat rich or spicy food. This side effect usually wears off after a few days. Talk to your doctor about taking an anti-sickness medicine if it carries on for longer.

7. Pregnancy and breastfeeding

Furosemide is not normally recommended in pregnancy or when breastfeeding. However, your doctor may prescribe it if they think the benefits of the medicine outweigh the risks.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking furosemide. These will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

Furosemide and breastfeeding

Small amounts of furosemide may get into breast milk. It's also possible that furosemide may reduce the amount of milk you produce.

If you need to take furosemide while you're breastfeeding, your doctor and midwife will monitor your baby's weight.

Talk to your doctor, as other medicines might be better while you're breastfeeding.

8. Cautions with other medicines

Some medicines interfere with furosemide to stop it working properly or increase the chances of you having side effects.

Tell your doctor if you're taking:

medicines to treat - or which have the side effect of - an irregular heartbeat, including amiodarone, digoxin, disopyramide, flecainide and sotalol

medicines that can change the level of potassium in your blood, such as potassium supplements, steroids, or other diuretics

medicines used to treat mental health problems, such as amisulpride, lithium, pimozide and risperidone

painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, ibuprofen and naproxen

medicines that treat high blood pressure, or those that have a side effect of low blood pressure

a medicine used to treat ulcers called sucralfate. Leave about 2 hours between the time you take furosemide and sucralfate.

Mixing furosemide with medicines that you buy from a pharmacy or supermarket

Some painkillers and remedies that you can buy from a pharmacy or supermarket contain a lot of sodium, which is found in salt. Too much salt can stop furosemide working properly.

Medicines that contain a lot of salt include soluble paracetamol and soluble co-codamol, and some remedies for heartburn and indigestion.

Speak to a pharmacist or doctor to see if these medicines are safe for you to take alongside furosemide.

Mixing furosemide with herbal remedies and supplements

There's very little information about taking herbal remedies and supplements with furosemide.

Medicine safety

Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions

How does furosemide work?

Furosemide is a type of medicine called a loop diuretic.

A diuretic makes your body get rid of extra fluid through your kidneys. A loop diuretic works on a specific part of the kidney called the "loop of Henle" to increase the salt and water you pee out.

This means you have less fluid in your tissues which helps get rid of oedema (swelling). You will also have less fluid in your blood, which helps reduce blood pressure.

How long does furosemide take to work?

Furosemide starts to work within an hour but it may take a few weeks to fully take effect.

If you're taking furosemide for high blood pressure, you may not have any symptoms. In this case, you may not feel any different when you take furosemide. This doesn't mean that the medicine isn't working. It's important to keep taking it.

How long will I take it for?

Depending on the reason why you're on furosemide, you may have to take it for a long time, even for the rest of your life.

Is it safe to take for a long time?

Furosemide is safe to take for a long time, but you will have to see your doctor or nurse every so often for blood and urine tests. These make sure the chemicals in your blood are properly balanced.

How often you need to see your doctor or nurse for these tests will depend on the reason why you're taking furosemide, if your dose has changed recently, or if you have any other health problems.

Can I come off furosemide now my blood pressure is lower?

Even if furosemide brings down your blood pressure successfully, it's best to carry on taking it. If you stop taking it, your blood pressure could go back up again.

If you need medicines to lower your blood pressure, you'll probably need them for the rest of your life.

Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.

What will happen if I come off it?

Talk to your doctor if you want to stop taking furosemide.

Stopping it may cause your blood pressure to rise - and this may increase your risk of heart attack and stroke.

If you're bothered by side effects, your doctor may be able to prescribe you a different medicine.

Are there similar medicines to furosemide?

There are other diuretics that work in a similar way to furosemide.

There are 3 different types of diuretic: loop diuretics (such as furosemide), thiazide diuretics and potassium-sparing diuretics. Each type of diuretic works on a different part of the kidney.

Like furosemide, bumetanide and torasemide are loop diuretics that can be used to treat heart failure. Torasemide can also be used to treat high blood pressure.

Thiazide diuretics, such as bendroflumethiazide and indapamide, are used in low doses to treat high blood pressure, and in higher doses to treat heart failure.

Potassium-sparing diuretics, such as spironolactone and eplerenone, can be used to treat heart failure. These can also be used if you lose too much potassium with other diuretics.

How much fluid should I drink while I'm taking furosemide?

It's usually best to drink normally while you're taking furosemide. A good rule is to drink enough fluid so that you're not thirsty for long periods. And to steadily increase your fluid intake when exercising and during hot weather. Passing pale, clear pee is a good sign that you're drinking enough.

However, if you have heart failure or kidney problems you might need to limit how much fluid you drink. Your doctor or nurse will tell you exactly how much you need to drink each day.

Is it safe to take furosemide when I'm ill?

If you're ill with a fever (a high temperature above 38C), sweats and shaking, being sick (vomiting) or have severe diarrhoea, contact your doctor as you may need to stop taking furosemide for 1 to 2 days until you are better.

You can start to take it again when you're eating and drinking normally. If you take furosemide when you have an illness that can make you dehydrated, it can make the dehydration worse.

Can I drink alcohol with it?

During the first few days of taking furosemide, it is best to stop drinking until you see how the medicine affects you. It may lower your blood pressure and make you feel dizzy.

If you feel OK, you can drink alcohol in moderation by following the national guidelines of no more than 14 units a week for men and women. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.

Can I take furosemide to lose weight?

If you're taking furosemide for high blood pressure or oedema (a build up of fluid), you may lose a bit of weight as your body loses water. But do not take furosemide specifically to lose weight.

Only take furosemide if it's been prescribed, and only for the reason your doctor has prescribed it for you.

Can I take furosemide before surgery?

Tell your doctor that you're taking furosemide if you're going to be put to sleep with a general anaesthetic for an operation or you're going to have a major operation - such as a Caesarean section - without a general anaesthetic.

Furosemide can reduce your blood pressure when it's used with a general anaesthetic.

Your doctor may advise you to stop taking furosemide 24 hours before surgery.

Is there any food or drink I need to avoid?

If you're taking a diuretic such as furosemide, it's important not to have too much salt in your food because this can stop it working.

Do not eat foods that have a lot of salt in them, such as processed foods or ready-meals. Do not add extra salt when you're cooking or at the table.

Also, do not buy salt substitutes instead of ordinary table salt, as they contain a lot of potassium, which can interfere with certain medicines or cause side effects.

Adults generally are advised to eat no more than 6 grams of salt a day. Your doctor will tell you if you need to eat even less than this.

Will it affect my contraception?

Furosemide won't affect any type of contraception.

However, some types of hormonal contraception, like the combined pill and contraceptive patch, aren't usually recommended for women taking furosemide. This is because some hormonal contraceptives can raise your blood pressure and stop the medicine working properly.

Talk to your doctor if you're taking hormonal contraceptives.

Will it affect my fertility?

There's no evidence that furosemide reduces fertility in men or women. However, if you're a woman and you're trying to get pregnant, talk to your doctor first as this medicine is usually not recommended in pregnancy.

Can lifestyle changes help?

You can boost your general health - plus the health of your heart - by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.

Stop smoking - smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke too.

Drink alcohol sensibly - drinking too much alcohol raises blood pressure over time and also makes heart failure worse. Men and women shouldn't drink more than 14 units of alcohol a week.

Be more active - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day can help.

Eat healthily - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to cut down on salt, however, it's important not to go on a low-salt diet while taking this medicine, as that could make your sodium levels too low. People need salt in their diet but eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.

Manage stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.

Vaccinations - if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS if you have heart failure.

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Furosemide: medicine to treat high blood pressure (hypertension) and oedema

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Furosemide is a type of medicine called a diuretic. It's used to treat high blood pressure, heart failure and oedema (a build up of fluid in the body). It's also sometimes used to help you pee when your kidneys aren't working properly. Diuretics are sometimes called "water pills/tablets" because they make you pee more.

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-Hi Mary how are you today?

I'm good but Dr Murphy started me on a new tablet for my cholesterol.

-Okay, did he tell you what your cholesterol level is ? What do you know about cholesterol?

Yes my cholesterol is 6.1 and all my relatives seem to be on a cholesterol tablet, but my mother and sister says it gives them a lot of leg pain and my brother says I cant eat grapefruit, is that right

-The Grapefruit actually increases the level of the drug in your system and so you may make side effects more common

-Also some people may experience leg pains but not every one. How about you come back into me in 2 weeks time and we can see how you are getting on. Here's is a leaflet from the IHF with other cholesterol lowering tips. You can have a read and if you have any questions we can discuss them when you come back in to me

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Learn How to Inject | Lantus® (insulin glargine injection) 100 Units/mL

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Learn How to Inject | Lantus® (insulin glargine injection) 100 Units/mL

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Patient Leaflets

What is a Patient Information Leaflet and why is it useful?

A Patient Information Leaflet (PIL) is the leaflet for patients containing information on taking a medicine, that is included with the medicine packaging. It is written by pharmaceutical companies as a patient version of the Summary of Product Characteristics (SPC). Changes to the PIL after your medicine was packed may mean that the version on medicines.ie may differ from the version found with your medicine. You can compare the "Leaflet prepared or revised date" towards the end of the leaflet in the pack with the version that is on the website to find out if there have been any changes to the information since your medicine was packed.

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Lantus 100 units/ml solution for injection in a cartridge | PIL | Medicines.ie

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PCN: Tell me how you are getting on with taking your new medication?

Pt: Honestly as its the first time I have had to take medication, I find it hard to remember every day. So I take it whenever I think of it.

PCN: I can understand this can be difficult at the beginning. But if you set an alarm on phone as a reminder to take tablets it might help.

Pt: That's a good idea, I never thought of that I will give it a go.

PCN: That's great I hope it helps. You get the most benefit from this medication when its taken on an empty stomach before bed, so it has time to work. You should not take more than one or two small glasses of grapefruit juice per day because large quantities of grapefruit juice can change the effects of Atorvastatin.

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Pt (Joe) presents with lumps to abdo from injecting insulin via insulin pen. Pt is a type 1 DM using 34 units of lantus in the am. The following is consultation between GP practice nurse and pt.

Nurse: Hi Joe, how are you

Joe: Hi Nurse look, I have a problem, look at my stomach, look at the lumps I have after injecting my insulin, even though I am alternating the sides as you told me

Nurse: Oh how long has it been like that?

Joe: ah maybe a few months, it doesn’t hurt so I thought it would go away

Nurse: How do you manage giving your injections?

Joe: Oh I’m very good at remembering, I give it everyday myself, I didn’t like it at the start but I don’t mind doing it now, but I don’t like the lumps (Specific: problem lipodystrophy)

Nurse: How do you feel about giving the injection in other areas of your body

Joe: Oh I didn’t know I could do that?

Nurse- Yes it can be given anywhere that has some fatty tissue, legs, abdo and arms are good sites.

Joe- Oh I can do that?

Nurse: Would you like to try injecting it into different sites and see if this helps reduce the lumps, lets go through this leaflet together about your medication, it contains helpful information including where to inject

Joe- That would be great thanks

Nurse: Then lets review in 1/12 to see if you have noticed an improvement.

Pointers from leaflets: sites to inject (show diagram and discuss through it), how to inject , alternate sites, discuss how the lumps can affect absorption of his insulin, storage of insulin, ensuring fresh needle, not using alcohol wipes can you show me how you inject your insulin and talk me through it.

Is there anything you don’t like about using your insulin? Is there anything else you would like to discuss today? Do you talk to anyone about your diabetes? Would you like to talk to someone else who has diabetes?

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Nurse.. Hello Joe, how are you? I believe you want to talk to me about your new medication?

Joe... Yes Nurse the Dr told me to take it but I do not know why or anything about it

Nurse.... The tablet is called Apixaban and it is from a group of medications called anti coagulants which means it prevents blood clots from forming.

Joe..... will that prevent a heart attack because my dad had a heart attack

Nurse.... it will also prevent clots in your legs, brain and lungs. As your blood will be thin, you need to be careful not to cut yourself as you will bleed easily. If you need to take any over the counter medication make sure you tell the GP or pharmacist that you are on Apixaban.

Joe.... Do I take the tablet in the morning with my breakfast?

Nurse.... You need to take one in the morning and one in the evening at the same time every day. It is your choice if you take your tablet with food or not as long as you take it with a glass of water.

Now Joe if you forget to take your tablet take it when you remember and take the next dose when it is due. NEVER stop taking this medication without talking to a Doctor

Joe.... Is there any side effects

Nurse... The most common side effect is bleeding and bruising so be careful not to bang yourself. Some people also get nausea, low Iron and you might feel dizzy. If this happens let us know.

As with all medication if you develop itching, rash or swelling let us us know straight. Joe, make sure you keep it in a safe place away from children.

There will be a card in the tablet box. Come back to me on Tuesday at 10am and I will fill it out for you and we can see how you are getting on with the new tablet.

Joe... That's great Nurse. Ill see you next week. You look after me so well.

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Nurse: Hi My name is Blaithin and I am the nurse looking after you today.

Patient; Hi my name is Katie and I am coming in for a check up as I have been feeling dizzy for the last couple of weeks.

Nurse: Your blood pressure is reading a little bit low. It is normal for you to feel a little dizzy if your BP is low 90/60mmHg. Has anything changed recently?

Patient: I recently had some ankle swelling and the GP prescribed some medication for it.

Nurse: this could be the potential cause for your dizziness. Do you know much about Furosemide?

Patient: Only that the Dr told me to take it in the morning.

Nurse: I have a patient information leaflet which we might go through, would that be ok?

Patient: Yes that would be great.

Nurse: So this medication is designed to remove the excess fluid in your body. Do you drink much water?

Patient: I only drink 2 glasses of water a day because I feel it makes my ankles worse.

Nurse: 2 glasses of water per day? Could we look to increase your intake? How many glasses do you think you could manage a day? Have you noted any other side effects or changes since starting your medication? Some patients report other side effects of this medication like headaches, Dizziness, dry mouth or increase in urination.

Patient: I have noticed that I am quite thirsty however I am conscious of my intake.

Nurse: Did you drive here today?

Patient: No I did not my daughter drove as she is very concerned about my dizzy spells and potential risk of falling.

Nurse: We might get the Dr to review you today. He might want to reduce your medication in light of your BP being low and the dizzy spells you are experiencing. Can I offer you a glass of water and we might recheck the BP in 10-15 mins.

Patient: Ok no problem.

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Good afternoon. You recently had a DXA scan which showed that you had confirmation of Osteoporosis (weak bones). You have been prescribed an injection called Prolia. This is a quick injection given every 6 months given just under the fatty tissue. Due to decreased bone strenght you are at a greater risk from a bone fracture. This injection will help maintain/improve your bone health. You must never stop this injection unless told by a Dr. It is very important to attend for a blood test no more than 3 months prior to your injection. We must check your calcium levels as the injection can cause one of your levels to drop significantly. It is hugely important to attend your dentist first prior to to your first injection. Any dental work required must take place first. It is very important that you have this injection every 6 months as even a couple of weeks late will impair the effect of the drug. Although you are now on this medication it is very important to look at your diet. How is your diet and do you take in enough protein, calcium and Vit D - very little Vit D can be gained from diet. It is important to take it in supplement form. We can prescribe it for you if you need it. Can we discuss your physical activity routine? How many days, if any, are you physically active. Any referrals required. ? risk of falls. Have you any allergies? Lets now review your other medications. Here is a patient information leaflet for you to look over and please. Do you have any questions? please voice any concerns and we can address them now

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Newly diagnosed type 2 diabetic patient.

Pt: Hello, the docotor told me I have diabetes and need to take this medication, what is it?

Nurse: Your new medication is called glucophage, it helps to lower your blood glucose to as normal a level as possible.

Pt: Are there any side effects?

Nurse: If you experience symptoms of hypoglycaemia such as weakness, dizziness, increased sweating, fast heart beating, visions disorders or difficulty in concentration, it usually helps to eat or drink something containing sugar.

Return if you are experiencing any gastrointestinal symptoms, do not crush or break the tablet as this may increase your risk of an upset tummy.

Pt: How long will I be on it?

Nurse: It is a staged approach based on your HBA1C, the dose may be reduced. It is also important to keep up with you lifestyle changes of healthly diet, excercies, vaccines, smoking cesation.

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GPN: Good morning Caroline, how are you?

PT: I'm ok but feeling very sick with that new medication.

GPN: Tell me how the medication is making you feel?

PT: I had a sick stomach with cramps and some episodes of diarrhoea

GPN: Ok, do you understand why you are taking that medication?

PT: yes my blood sugars were high

GPN: yes Caroline, you were trying to control you blood sugars with your diet for some time and they were not improving

PT: yes that's right

GPN: What strength of tablets were you taking and how often?

PT: I was prescribed 1G three times a day, but I have been so sick with nausea and diarrhoea I had to go to the out of hours doctor and they advised me stop the medicine and speak to my GP

GPN: so you are not currently taking any at the moment?

PT: no I'm not taking any

GPN: how are you managing your blood sugars at the minute?

PT:I am eating healthily and exercising

GPN: What are you eating for your meals?

PT: I have porridge made with water for breakfast, a salad for lunch and maybe a stir-fry for dinner.

GPN: Are you doing any exercise?

PT: yes I am walking 5 days per week

GCP: that all sounds really good, it seems you are following all the right advice.

GPN: what way were you taking your medications?

PT: I take them with each meal

GPN: good, it is important to to ensure you take them at the end of your meal

PT: yes I do

GPN: So going forward we need to put together a plan

PT: OK

GPN: how would you feel if we were to try 500mg three times a day and see how you tolerate that and if that goes well we can look at increasing it if needed

PT: Yes I am happy to do that, it sounds like a good plan

GPN: Great, so when you are taking them for 3 months we will redo your HBA1C and see if there is any improvement, we will also check your B12 as Metformin can reduce your B12

PT: I didn't realise by B12 could be affected, that would be great.

GPN: Great, so if you are experiencing an side effects like tummy cramps, nausea or diarrhoea please make sure you contact me.

PT: ok, I will

GPN: I am booking you in for a 4 week phone consultation just to ensure everything is going for you

PT: That's perfect, thank you very much

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RGN- welcome Suzanne I believe you have some questions about your new tablet Pantium, how can I help?

Suzanne- I asked the doctor to help with stomach issues and he started me on this. I take regular nurofen and I think this doesn’t help with my tummy.

RGN- ah I see so you have an upset tummy and the doc prescribed this.

Suzanne - yes I never heard of this before

RGN- ok this medicine is to help with your tummy, if you take the medicine in the morning 30min before food this will help with protecting your tummy.

Suzanne - how long do I have to take this medicine?

RGN- I will link with GP but we will review you in two weeks to see if your tummy is still upset and review the effectiveness of the new medication. Does that make sense can you repeat that back to me?

Suzanne - ok so I take it in the morning half hour before my food and I come back in two weeks.

RGN - if you feel any side effects like nausea, vomiting diarrhoea you need to stop taking the Pantium and come back to see us, will you remember that?

Suzanne-

Yes I think so, if I’ve any side effects come back immediately and if I don’t come back in two weeks,

RGN- not to overload you but there are some foods you might want to avoid to help with your tummy issues like caffeine and spicy foods, is that too much to remember?

Suzanne - I think I can manage to remember that.

RGN - just so I know we are on the same page will you repeat to me what we just discussed?

Suzanne- yea so I take it first thing in the morning 30 min before food, if I get side effects stop taking it and come back here, or if I’m ok to come back in 2weeks to see if it’s doing it’s job, and try to cut out caffeine and spicy food

RGN that’s it, well done, we can leave it at that I will see you in two weeks

Suzanne - thanks

HSE LINK https://www2.hse.ie/conditions/pantoprazole/

Suzanne, Jisna,Maeve,Chelsea,Miriam

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Check if you can take pantoprazole

Pantoprazole can be taken by most adults. Children should only take it on prescription.

It may not be suitable if you have:

had an allergic reaction to any medicines

liver problems

lactose intolerance

been treated for heartburn or indigestion continuously for 4 or more weeks

taken non-prescription medicines for indigestion on a daily basis

a stomach ulcer or recent stomach surgery

taken certain medicines for HIV

Pregnancy and pantoprazole

Pantoprazole is not recommended during pregnancy as there is no evidence it's safe.

If you're pregnant it's better to treat your symptoms without taking a medicine like pantoprazole.

Your GP or midwife may suggest eating smaller meals and avoiding fatty and spicy food. They may also suggest raising the top end of your bed so that your chest and head are above your waist when sleeping.

Your doctor may recommend a different medicine to help with ingestion or excess stomach acid if you are pregnant.

Breastfeeding and pantoprazole

Do not use pantoprazole if you're breastfeeding unless your GP tells you to. It is not known if pantoprazole gets into breast milk or if it can harm your baby.

Your GP might recommend a similar medicine called omeprazole if you are breastfeeding.

When you start taking pantoprazole

You should always take this medicine exactly how your doctor or pharmacist has described.

You should start to feel better within 2 to 3 days.

It may take up to 4 weeks for pantoprazole to work properly. You may still have symptoms during this time.

Do not take this medicine for more than 4 weeks without consulting a doctor.

The dose of your medicine depends on your condition. Your GP may increase or decrease your dose.

Depending on your illness, you may only take it for a few weeks or months. Some people need to take it for longer, even for many years.

Do not take pantoprazole for longer than 2 weeks without checking with your GP.

How and when to take it

Always take pantoprazole exactly as your GP or pharmacist has told you. Follow the advice on the label. If you're unsure, ask a GP or pharmacist.

It's usual to take it once a day in the morning.

If you take pantoprazole 2 times a day, take 1 dose in the morning and 1 dose in the evening.

It's best to take it 1 hour before a meal. Swallow tablets whole with water or juice.

If you forget to take it

If you take pantoprazole once a day, take the missed dose as soon as you remember, unless it's less than 12 hours until your next dose. In that case skip the missed dose.

If you take it twice a day, take the missed dose as soon as you remember, unless it's less than 4 hours until your next dose. In that case skip the missed dose.

Do not take a double dose to make up for a forgotten dose.

Side effects

Most people who take pantoprazole do not have any side effects.

If you do they are usually mild and go away when you stop taking it.

Talk to your GP or pharmacist if side effects get worse or do not go away after a few days.

Common side effects may include:

headaches

diarrhoea

feeling sick or vomiting

constipation

stomach pain or wind

See the patient information leaflet that comes with your medicine for a full list of side effects.

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Pantoprazole is a medicine to lower stomach acid. It's used to treat indigestion and heartburn. Read advice on taking pantoprazole

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The Health Products Regulatory Authority

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Our role is to protect and enhance public and animal health by regulating medicines, medical devices and other health products.

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Nurse: Welcome Mary, would it be ok if we look at your medication today?

Mary: Yes I would like to learn more about why I have to take aspirin every day.

Nurse: Can you remember what the Dr told you the aspirin is for?

Mary: I think he said it has something to do with the time I had a mini-stroke about a year ago, a TIA I think he said.

Nurse: Yes that's right Mary, TIA is short for transient ischaemic attack and means there was a temporary interruption to the blood supply to your brain. Aspirin was prescribed for what we call secondary prevention to reduce the risk of having a further TIA. Have you had any problems taking your aspirin?

Mary: No, I take it every morning, sometimes I think it gives me pain in my tummy.

Nurse: Do you take anything for this pain or for heartburn?

Mary: No, I didn't think to take anything for this.

Nurse: Do you take any pain medication for a headache or other pains?

Mary: I occasionally take paracetamol or neurophen for a headache.

Nurse: Paracetamol is fine to take at the recommended dose for a headache or any other mild pain you might experience Mary, but neurophen together with aspirin may irritate your tummy and also may increase your risk of having a tummy bleed. Long-term aspirin use increases your risk of a gastric bleed and it is a good idea to take your aspirin with food. As you are now 75 years of age it may be prudent to discuss with your Dr if a proton pump inhibitor would be beneficial. This medication, PPI for short, reduces the production of acid in your stomach which may stop the pain you can get in your tummy when you take your aspirin and will also reduce the risk of having a gastric bleed. As we get older our risk of having a gastric bleed while taking long-term aspirin increases. The side effects of long-term aspirin treatment are an increased risk of bleeding, mild indigestion, and stomach ulcers. If the Dr prescribes a PPI medication Mary you might experience some side effects, for example, constipation, diarrhoea, windy tummy, headaches, and abdominal pain, if you experience any of these and they are distressing or don't settle after a week or so please let us know. Have you any questions to ask me about these medications or any other medications?

Mary: That seems to be clear information, thank you.

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Patient: Nurse, I've been started on a new tablet for my diabetes. It's called metformin, do you know why I have to take it, I thought I could manage with just diet control?

Nurse: Well your doctor would have assessed your diabetes and your HBA1C and they would have determined that, at the moment, diet control isn't enough to manage your blood sugar levels.

Patient: Oh, so what does that mean nurse? Can I eat more sugar then if I'm on the tablet?

Nurse: No, you still need to adhere to your diabetic diet and possibly be more strict with it if you aren't already. The tablet will help to restore your body's response to insulin and keep your blood sugars under control.

Patient: My friend was on this tablet nurse and it didn't agree with her at all. Will it make me sick?

Nurse: Some of the side effects do include nausea so it's best to take the tablet with food. Other side effects are loss of appetite and metallic taste in your mouth. Be sure to contact your GP if you experience these.

Patient: I will do nurse thanks for explaining it all to me. I feel better about having to take the tablets now.

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Nurse: Hi Joe, I have received a referral from your GP to administer a Vitamin B12 injection. Were you aware your GP was sending me a referral?

Joe: Hi nurse, yes they mentioned something about an injection but what exactly is it for?

Nurse: Your recent blood tests showed that your Vitamin B12 level was low and we can replace that with a few injections. Have you been experiencing fatigue or lack of energy lately?

Joe: Yes I have been wrecked lately.

Nurse: That should improve after treatment. We will administer 3 doses per week for two weeks, and then you will get a top-up dose once every three months. Are you happy to proceed?

Joe: Where do I get the injection?

Nurse: The injection is administered into your muscle either in your upper arm or glute.

Joe: Yes I am happy to ahead.

Nurse: Before I start can I enquire if you are allergic to anything?

Joe: No, I am not.

**Post administration of injection**

Nurse: If you experience any side affects such as a rash, nausea or dizziness or anything that you may be concerned about please contact your GP and notify me afterwards. Your next dose is due in two days, can you please keep the other injection vials in the fridge and bring one with you on the day. Once all six doses have been administered you can book in for repeat bloods with your GP but I will remind you of that in two weeks.

Joe: Thank you nurse. See you on Wednesday.

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CRGN: Hi Anne, my name is Anne-Marie. I am a community registered general nurse, and I have recieved a referral from your GP to complete INR blood tests as required

Anne:Yes nurse I am on warfairn for the last 6 years. I was always popping down to my GP for regular INR blood tests to be completed as requested by the GP however I had a fall 3 weeks ago, and my mobility is still affected. The doctor felt a homevisit would help until I am back on my feet.

CRGN: No problem Anne, I am here to help. I would like to start by identifying that the PHN service do not complete blood tests however I can refer you to the Community Intervention Team (CIT). In order to complete this referral I need to ask you a few questions

Anne: That would be great. Thank you!

CRGN: Why are you on Warfairn? And what is your knowledge of this drug?

Anne: I am on warfairn for 6 years post a hospital admission where the Dr diagnosed me with having Atrial Fibrillation. I believe my knowledge to be quite basic- I know Warfairn is an anticoagultant to prevent clots in my blood

CRGN: Absolutely Anne this is a good explanation of your knowledge. Would you like me to give you a print out of the characteristics of the drug called Warfairn?

Anne: Yes please. My daughter told me that Cranberry juice can interact with Warfairn? Is this true?

CRGN: It has been documented by the British Heart Foundation that cranberry juice can increase the effect of Warfairn, so it is best to avoid drinking this.

Anne: Thank you. I will have a look at the website called British Heart Foundation on my ipad.

CRGN: Great Anne, knowledge is power. It is important to have a great understanding of the medication you are taking. I will refer you to CIT so that a home visit can be schedued for INR testing.

Anne: I am so relieved. I was worried about how I would get the blood test completed. I really appreciate your help.

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Nurse: Good Morning! How are you feeling?

Patient: I've been doing ok; I'm a bit nervous, though, since I haven't started the new Saxenda drug yet.

Nurse: Totally understandable. Starting medication can be intimidating. I am here to help you understand everything about Saxenda. Have you been able to read through the information leaflet?

Patient: Yes, I did, but I still have some questions. How does Saxenda work exactly?

Nurse: That's a great question. Saxenda is an injectable prescription that works by mimicking a hormone called GLP-1. It helps regulate your appetite and food intake. In other words, it signals to your brain that you are full, which can assist with weight loss.

Patient: That makes sense. How should I take the medication, and are there any instructions I should follow?

Nurse: Yes. Saxenda comes in a prefilled filled pen; you can inject it under the skin, typically in your lower abdominal area. It is important to use different injection sites to avoid potential reactions. The dose of saxenda usually starts low and gradually increases. I will demonstrate the injection process to you if you are comfortable.

Patient: yes, a demonstration would be very helpful. What about side effects? I read in the leaflet that nausea could be a side effect?

Nurse: Yes, Nausea is quite a common side effect, especially when starting Saxenda, but this improves over time as your body adjusts to the medication. Drinking water and starting on a lower dose can help manage this. However, please let me know if you experience severe or persistent side effects.

Patient: Thank you for that information. Are there any changes that I should make while on Saxenda?

Nurse: It is important to maintain a healthy diet and exercise routine. The medication is meant to complement a lifestyle change, not to replace it.

Patient: The sounds good. How often do you think I should check in with my progress?

Nurse: I recommend regular check-ins, especially in the first few weeks. We can monitor weight, etc, and discuss any new side effects. Don't hesitate to contact me with any questions or concerns between our appointments.

Patient: Thanks for the information and support; I feel more relaxed about starting Saxenda now.

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Nurse: Hi Mary how are you doing today?

Mary: I am only ok I have just been with the GP for symptoms of a UTI and I am a bit uncomfortable with it, I have pain on urination and I am constantly going to the toilet. He dipped my urine and it was positive for an infection so started me on nitrofuraton he said you would explain it to m .

Nurse: Oh I’m sorry to hear you are uncomfortable Mary, hopefully these antibiotics will help with the infection and symptoms. We have sent your urine sample off for analysis so that can tell us what type of infection you have and if you are on the right antibiotic.

Mary: Oh I do hope I am on the right antibiotic as I really want this infection gone. Can you tell me more about the antiobic.

Nurse : Of course Mary but I just wanted to ask a little bit first about maybe why you have developed a UTI so we can potentially stop this from happening again and cause you less discomfort?

Mary: Yes no problem I would really like to try avoid getting another UTI.

Nurse : Great Mary, I would like to start with your hydration? How much water do you drink on average each day?

Mary : Oh I am very bad with the water maybe two glasses but I do drink a lot of Tea.

Nurse: Yes who dosn’t love tea Mary. It is important to try and drink at least 2l of water a day to prevent a UTI. Drinking 2l of water can dilute your urine and lower the concentration of bacteria in the bladder which can prevent you from getting a recureent UTi.

Mary: Oh really gosh I never released how important drinking water was. So what will the tablets do how to they work ?

Nurse: Yes hydration is key really so it may be a good idea to increase the water intake. Nitrofurantoin is an antibacterial agent that is used to prevent and treat infections of the bladder, kidney and other parts of the urinary tract.

Mary: OK that sounds good and can I eat with them?

Nurse: The antibiotic should be taken at meal times with food or milk. This will help to avoid stomach upset and also to help the absorption.

Mary: How many tablets should I take?

Nurse: The prescription is for one tablet 100mg twice daily for three days.

Mary: Oh good three days is ok. What will happen if I still have symptoms after 3 days?

Nurse: If you still have symptoms after 3 days Mary you will need to come back to us with a repeat urine sample if the infection has not cleared. Sometimes it can be extended to 5 days but you will need to see the GP to discuss this.

Mary: ok that’s fine and is there any side effects?

Nurse: Yes there is some side effects Mary I will also give you the patient information leaflet to bring home. The most common side effects are feeling sick (nausea) and headaches, you may also experience loose stools, dizziness, drowsiness. If you do experience any side effects please ring us and let us know.

Mary: Oh I will of course.

Nurse: Just to note Mary the tablets can turn your urine a different colour a dark yellow ir brown this is normal and is not a reason to stop taking the medicine so don’t be alarmed!

Mary: Oh I am glad you told me that.

Nurse: Yes otherwise you may think something is not as it should be. Have you any other questions Mary?

Mary: No I am really happy thank you and I will do my best to drink 2l of water a day.

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RGN: Hi Pat, Thank you for coming in today for your CDM review. I'm going to start by asking you how did you get on in the cardiology hub.

Pat: I got on fine, they've started me on a new medication when I was in with them a month ago. I'm not sure about it, is it in the notes there?

RGN: I'll just have a look. Yes, I see you were started on a low dose of forxiga for your heart failure symptoms.

Pat: What does it do? I've no clue, I can barely say it.

RGN: Yes, it's a difficult one alright! It is a medication that can be used in a few different conditions. In your case its for your heart failure. Forxiga helps to protect your heart from any deterioration and should improve your symptoms. Have you noticed any difference at all?

Pat: Well actually my daughter was just saying how she's noticed I'm less short of breath.

RGN: That's brilliant she's noticed that and how do you feel?

Pat: Yeah, she's right to be fair, I can walk to the bathroom and back without stopping now. I've also noticed my legs are less swollen.

RGN: Great - its having the desired effect so. Now, there are a few things to watch out for with Forxiga, you can get a rare infection in the genital area so if you think you notice any signs of infection down there make sure to talk to your GP or go straight to hospital if out of hours, you would need antibiotics straight away if this happens.

Pat: Thanks Nurse, I didn't realise that. Is there anything else I need to be watching out for?

RGN: Taking this medication just make sure you drink your 1.5L of water/fluid a day and don't get dehydrated as you can become very unwell if this happens on this medication and the way this medication works can cause you to pass more urine than previously. If you are concerned please contact us or shannondoc out of hours or if you are very unwell you need to seek help in a&e. One other thing to mention is that sometimes this medication can cause urinary tract infections so that is something we would need to know about - if you notice fever, flank pain, pain when passing urine make sure to give us a call. I have the patient information leaflet here to give you and if you have any questions when you get home please feel free to give us a call and I can get back to you. I know there's a lot of information involved when starting a new medication.

Pat: Will do nurse, thanks for that. I'm taking one tablet once a day is that ok?

RGN: That's perfect, you can take it at any time of the day you like but it is ideal to take it at the same time every day. You can take it with water and with or without food.

RGN: So just in relation to the Forxiga, how do you feel about it now?

Pat: I feel a bit better about it all. I might have to contact you again if I forget something.

RGN: Absolutely, that's what were here for but you're doing everything right so don't worry. You've told me how you're less short of breath and have noticed your leg swelling has improved which is fantastic. You now know you can take it once a day at the same time every day. We've gone through some of the more serious adverse effects to look out for and you have the patient leaflet and can contact me to discuss anything else further you might need.

Pat: That's great, thanks nurse.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10453961/

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Nurse: Hi Mary, nice to see you. How have you things been since I saw you last?

Mary: Ah you know, not great. I broke my leg so I haven't been able to do the exercise I'd hoped and my eating has gone to pot.

Nurse: Oh that's a shame Mary, has your leg recovered now?

Mary: Yes it's much better but I was called in today to discuss my recent blood results so I'm a bit nervous.

Nurse: It's ok to be nervous coming in to a setting like this but very often we just want to give you the opportunity to ask any questions that you may have and in particular to explain your results to you and make a plan for the next review.

Mary: Ok, the girl on the phone said you want to check my weight and that, she said my cholesterol is high, what does that mean?

Nurse: So your cholesterol levels are a little over the normal range and unfortunately, as your activity level was reduced over the last few months due to your injury it just means that the cholesterol has built up a little while you were laid up. It's nothing to be worried about though, I brought you in today so I could discuss options with you. How would you feel about starting on a cholesterol lowering tablet called a statin?

Mary: Oh gee I don't know, Jimmy next door started on one of those and he got awful pains in his muscles.

Nurse: I totally understand your apprehension, often if we hear negative reviews about something it can be daunting, but I can assure you that not everyone has ill effects and if you do, we can reevaluate. How does that sound?

Mary: Ya alright, I really want to get my cholesterol back on track. Tell me more about this tablet.

Nurse: So it's a medication called Rosuva, and the doctor would like to start you on a relatively low dose to see how you tolerate it. We will bring you back in 6-8 weeks to recheck your bloods and see how you're getting on. If you take the tablet at the same time every day, it will help you to remember it. Does that sound like something you could try?

Mary: Ya, I'm hoping to get back walking more regularly and now that I'm not sitting at home all day, I'm hoping to improve my diet.

Nurse: That's great, Mary. Lifestyle changes can really help to improve cholesterol levels along with the medication so what we'll do is get you started and bring you back in 2 months time. Will I get you booked in with myself?

Mary: Ya nurse, that would be great, thank you. I feel much more at ease now that you've explained things to me.

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chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.novo-pi.com/ozempic.pdf

Nurse: What do you know about this medication?

Patient: It's for reducing weight and Diabetes.

Nurse: Would you like to know more about how it works?

Patient: Yes

Nurse: It increases the amount of insulin from the pancreas in response to food being eaten. This in turn helps with weight loss.

Patient: Are there any risks with this medication?

Nurse: The main risks are diarrhoea, nausea and vomiting. Less common side affects are vision disturbances, retinopathy, inform your doctor if you experience eye problems, such as changes in vision, during treatment with this medicine.

Uncommon inflamed pancreas (acute pancreatitis) which could cause severe pain in the stomach and back which does not go away. You should see a doctor immediately if you experience such symptoms.

Rare severe allergic reactions you should seek immediate medical help and inform your doctor straight away if you get symptoms such as breathing problems, swelling of face, lips, tongue and/or throat with difficulty swallowing and a fast heartbeat.

Injection Site Reactions In placebo-controlled trials, injection site reactions (e.g., injection-site discomfort, erythema) were reported in 0.2% of OZEMPIC®-treated patients.

Increases in Amylase and Lipase In placebo-controlled trials, patients exposed to OZEMPIC® had a mean increase from baseline in amylase of 13% and lipase of 22%. These changes were not observed in placebo-treated patients.

Increases in Heart Rate In placebo-controlled trials, OZEMPIC® 0.5 mg and 1 mg resulted in a mean increase in heart rate of 2 to 3 beats per minute. There was a mean decrease in heart rate of 0.3 beats per minute in placebo treated patients. Fatigue, Dysgeusia and Dizziness Other adverse reactions with a frequency of >0.4% were associated with OZEMPIC® include fatigue, dysgeusia and dizziness.

If you forget to use it and it's 5 days or less since you should have used Ozempic, use it as soon as you remember. Then inject your next dose as usual on your scheduled day, it is more than 5 days since you should have used Ozempic, skip the missed dose. Then inject your next dose as usual on your scheduled day. Do not use a double dose to make up for a forgotten dose. Do not stop using Ozempic without talking to your doctor. If you stop using it, your blood sugar levels may increase.

Diabetic diet should be adhered to despite taking this medication. Also to check BSLs especially for the first month while adjusting to the new medication.

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Effect of Dapagliflozin in Patients with Heart Failure: A Systematic Review and Meta-Analysis

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Heart failure (HF) is a major cause of recurrent hospitalization and death worldwide. Sodium-glucose cotransporter-2 inhibitors including dapagliflozin are anti-diabetic drugs with promising cardiovascular (CV) effects. We performed systematic review…

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Nurse: Good morning Teresa my name is Debbie I'm very pleased to meet you how can I help you today?

Teresa: Thanks for seeing me today. The doctor has told me that I have Asthma and that I have to start using an inhaler now when I feel my chest getting tight or wheezy. I'm not sure how to use it. I've never used an inhaler before and I'm a little bit nervous about side effects as I don't like taking medications.

Nurse: That's no problem at all. If it's ok with you I can explain how the inhaler works, some of the side effects you might experience, and how to use your inhaler.

Teresa: Thank you very much that would be great.

Nurse: The doctor has prescribed this medication for you to give you relief from your symptoms. It will relieve the tight feeling in your chest and help to reduce the wheezing you are experiencing. It will help to relax the muscles around the airways which will help the airways to open up so that you can breathe more easily. If I'm going too fast for you will you stop me. I don't want to overwhelm you.

Teresa: No thats ok I understand what you are saying will I be able to go back to my morning walk again I had to stop because my breathing was so bad and it scared me.

Nurse: I'm sorry to hear that. What we want is for you to resume your normal day-to-day activities and for you to feel safe doing that. You should be able to get back to your walk again with no problems. Well done for keeping up with your regular exercise. It's important that you always carry your inhaler with you in case you need it and you can use it up to 4 times a day if needs be. There will be days when you won't need it at all.

Teresa: My sister said she once had a nebuliser when she had a bad chest infection and her heart was racing after it will I feel like that?

Nurse: I'm not surprised to hear that. Yes some people can experience their heart beating a little faster after using their inhaler and your hands may feel a little shaky but this doesn't always happen to everyone and it wont last very long. It's also not unusual to have a headache and if you experience this and you are finding it difficult to cope with please come back to see the doctor again as he may be able to prescribe something different for you. There are loads of options. I'm going to give you some information to read at home in your own time and please contact me if you have any questions.

Teresa: Thank you that's very reassuring. Is the inhaler difficult to use?

Nurse: I think you will manage it very well. It's not difficult. Give your inhaler a little shake to make sure the medication inside is well-mixed. I want you to breathe out like this and put the mouthpiece of the inhaler in your mouth and close your lips around it. Now start taking a breath in and press down on the top of your inhaler at the same time. Try to hold your breath for as long as you are able and take the inhaler out of your mouth. Well done that's great. You're managing this very well. Sometimes you can get it wrong so if you see mist coming from the top of the inhaler or the sides of your mouth just start again you won't be overdosing.

Teresa: Thank you thats great. Would it be ok if I practice a little to make sure I'm getting the hang of it?

Nurse: That's a really good idea Practice makes perfect. Do you want to come back to me in 2 weeks so we can check your inhaler technique and you may have some questions that you would like to ask?

Teresa: That would be fantastic thank you so much.

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Doing an annual assessment of Mary to update her chart.

M = Mary

N=CRGN

N: Mary Do you have an up-to-date list of your medications for me to have a look at please

M: I do.  I have started a new tablet since you were here last.  I'm not sure what it's for.

N: If you dont know then show me and we will have a look together.

N: This is called zanidip, it is used for high blood pressure.  It keeps your blood pressure at a safe level.

M: I couldn't remember what the doctor told me. I've never had high blood pressure before.

N: It is a lot to take in when you have been just told there is something wrong with you. Have you read the patient information sheet that came with the packet?

M: No. I find it hard to understand them and get a bit muddled with all the facts.

N: Ok. Will we have a look together and I can help you understand the important parts?

M: Please Nurse that would be great

N: Do you take your Zanidip medication at the same time every day?

M: The pharmacist told me to take it first thing in the morning about 30 min before food. So I try my best to do that. So far I have not forgotten it

N: That's good that you got that information and you follow their advice. Whenever you get a new medication there's no harm in asking the pharmacist if its ok with your other tablets and how best to take it. They are the experts in all aspects of medications

M: I will. What are the side effects of Zanidip? I am afraid that my blood pressure will go down too much and I wont know what to do.

N: If you are worried about side effects then it will be good to understand them. The most common side effects are headache, feeling your heart beat fast or uneven, you might notice your face, neck, and upper chest get red in color or sometimes your ankles may get swollen or puffy. Do you ever experience any of these things?

M: No but at least I know of them now. What will I do if I get any side effects?

N: Give your GP or Pharmacy a ring and they will advise you. I can put their numbers in your phone for you if you like?

M: Yes please that be great, one less thing to worry about.

N: There are some less common things to be mindful of with Zanidip. Dizziness, heartburn, tummy or chest pain or feeling sick, diarrhoea, passing large volumes of urine, feeling weak, sleepy or tired.

M: That's a lot of side effects.

N: There are a lot but these are not very common, don't worry about them, just be mind full of them. This is a lot to take in at once, I will leave this paper work here on the table when we finish and you can have a read of it yourself, it might be a bit easier to digest when we are finished.

M: That would be great, I feel it a bit easier to understand already.

N: Would it be oK to talk a bit more?

M: Yes please, you make it easy and I feel I wont worry about it as much

N: Just another thing to be mindful of with Zanidip is alcohol and very fatty foods can increase the way it works, maybe cut down on fatty meals and they recommend not to consume alcohol while on Zanidip.

M: I don't drink anymore and I try and keep low fat for my blood sugars.

N: That's a good start for you then. They also advise not to consume any grapefruit products while on the medication.

M: I don't like grapefruit anyway so that be easy to keep to.

N: By your list, you don't seem to be on any other medication that works against it.

M: What if I forget to take my tablet?

N: The manufacturers advise that you just skip the dose altogether as taking more than the dose can be dangerous to your Blood Pressure. If you do take too much n error contact your GP or the hospital for advice. Do you keep your tablets somewhere handy?

M: I keep them in a box beside my bathroom sink. I go there first in the morning and it reminds me to have it taken well before food.

N: Mary do you feel a bit more knowledgeable about it now? Is there anything else you would like to ask?

M: I don't think so. If I think of anything else when I am reading the leaflet I will ring you, I have your number on my phone.

N: It be great for you to read it now we have discussed it and of course ring, if you need, and we can figure it out together. If you have any side effects contact your GP, pharmacy or hospital depending on how you feel, I have put the numbers on the fridge. You said you are on a low-fat diet and don't drink so keep that up and be careful of grapefruit. I will ring you to see how you are getting on with it in about 6 weeks, so I will chat you then.

M: I will, thanks for your help, nurse.

N: You said earlier you look after your blood sugars? Are you a diabetic?.................

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Nurse: Hi Ann, I am Kellie the Nurse. How are you?

Patient: Hello, Nurse. I am well have you got the results of my dexa scan?

Nurse: Your DXA scan confirmed osteoporosis, indicating weaker bones. To help try to protect your bones the doctor would like to prescribe an injection called Prolia. It's a small injection given every 6 months usually just under the skin on your belly. This injection is vital for maintaining or even improving your bone health and reducing fracture risks.

Patient: Okay

Nurse: We will need to check your bloods no more than 3 months before your injection to make sure your calcium levels are normal, as sometimes your calcium levels can drop when taking prolia.

Patient: Okay

Nurse: Before your first injection, it's important to visit your dentist for any necessary dental work. And please, stick to the 6-month schedule for your injections, as any delays can results in a drop in bone density.

Patient: I'll call the dentist today

Nurse: Is it okay if we discuss your diet and exercise ?

Patient: Yes

Nurse: How is your diet?

Patient: Not great

Nurse: Okay well I can give you some information on diet and we can discuss dietary adjustments if needed. Most people living in Ireland don’t get enough Vit D (the sunshine vitamin) so we may need to prescribe you a vit D supplement after we check your levels. How is your physical activity?

Patient:  I try to stay active a few times a week, but I could do better.

Nurse: Okay, exercise has loads of benefits, it reduces the rate of bone loss and lowers risk of fractures and can also reduce risk of falls. I could refer you to an exercise programme if that interest you?

Patient: Yes that all sounds good.

Nurse: Great, well here is a patient information leaflet for you to review, and feel free to give me a call to discuss any queries you have.

Patient: Thank you, Nurse. I will do that.

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GPN: Tell me about your medication

P: Oh yeah, I’m taking them

GPN: So, according to my records you’re taking Pantoprazole, Co-diovan, Calcichew D3 forte, and atorvastatin. Is that correct?

P: Yeah that sounds right.

GPN: Any issues with the medication?

P: No, all good. I take them most days, but I don’t take the Cholesterol one on the weekends. I like to go to the Pub on Sat and Sun and didn’t want to overload my liver, my neighbor said they had to stop theirs because of their liver.

GPN: I hear you’re worried about the effect of the medication and alcohol on your liver and have heard about people having to stop statins under certain circumstances. However, I can reassure you that it is usually safe to take your Statin while drinking alcohol. Would it be ok to talk to you about your alcohol consume later in the consult?

P: Yes, but I won’t change going to the pub!

GPN: That’s ok, I understand that this is important to you. Alcohol is not a contraindication to taking your statin. There are some foods and a few medications we need to be careful with, but your pharmacist would usually check interactions as well as the person prescribing your medication. It's important not to take the Statin with Grapefruit juice and you should avoid taking it at the same time as high fat foods. When do you take yours usually? P: in the evenings, just before bed. And it just take it with Water. GPN: That's perfect. The medications I was talking about you may need to watch out for is a certain group of antibiotics called Ciclosporins, the most common one we would use being called Clarithromycin or Klacid. We will also monitor your liver function regularly while you are on the Statin. And checking your last blood test, your liver function was within normal limits. So how do you feel about taking your statin now?

P: That’s good to know. I was worried about damaging my body with both but also about not taking the statin. So I’m glad to know I can do both.

GPN: I’m glad I was able to clarify and reassure you. I’ll give you the information leaflet from the HPRC website so you can have a list of medications at home yourself that can cause interactions. Just in case you get a prescription from an out-of-hour service where you forget to mention your other medications.

P: Thank you.

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GP nurse: Good afternoon Christy, how are you today?I’m Claire the nurse,come in and take a seat

Christy: thanks Claire

GPN: ok so today Christy, you are to have a 24 hour blood pressure monitor on, is that correct?

Christy: yes, unfortunately I am,I was with the doctor a few days ago and my blood pressure was sky high and I made the mistake of telling her I stopped all medications.

GPN: ok Christy, tell me why you stopped all the medications, were they give you any side effects?

Christy: No no nurse, I feel I don’t need them anymore.I am taking all natural stuff now, turmeric and apple cider vinegar with cayenne pepper…

GPN: that’s great you are looking after yourself by using more natural remedies but let’s take a look at the medications you were on previously, is that ok if we chat about them?

Christy: yeah nurse that’s fine but you won’t change my mind

GPN: thank you Christy.Ok so I see you are on Bisoprolol 5mg ,is that correct?And I see you have also been prescribed Lipitor 20mg?

Christy: yes that’s the two tablets I was on but not anymore.I feel great but my face is a little hot today and I have a headache that just won’t go away.

GPN: ok can I check your blood pressure before I attach the monitor?You BP may be a little elevated

Christy: yeah Nurse, I just had an argument with someone there and I know my blood pressure is up, I can feel it.

GPN: Christy it looks like your blood pressure is indeed raised today, we will check it again in a few minutes.Can I chat about the way Bisoprolol works and a little information about the side effects etc?

Christy: go on nurse sure while I’m waiting

GPN: ok so this medication is used for people with high blood pressure,this is when the pressure of the blood flow in the vessels becomes too high.If left untreated, there are a number of health issues associated with this, such as, stroke and bleeding behind the eyes.Along with the natural remedies, have you thought about other changes you could make in your daily routine ?I see here you smoke?

Christy: I didn’t know all of those could be caused by high blood pressure!Thats serious!I thought I would just get a few headaches…yes nurse I smoke 20 roll ups possibly more per day and to tell the truth nurse, I usually have a few cans of cider most nights.

GPN: ok Christy, it is ok if we chat a little about this?

Christy: ofcourse Nurse, I think I need to make a few changes.

GPN: ok let me start by saying well done,it’s not easy to admit these issues. High blood pressure has been shown to be closely linked to smoking and alcohol intake. Would you consider cutting down and even quitting smoking?I can refer you to the HSE Quit services which will support you through this.How would you feel about this?With the alcohol intake, we do recommend you have at least 2-3 nights free of alcohol. Maybe switch to the 00 beers non alcoholic.This will all help towards bringing down the blood pressure.Are you active most days?

I see you don’t have any allergies and you are not asthmatic or have an irregular heart beat. This tablet can interact with alcohol Christy, it can cause light headedness and dizziness when mixed. We will monitor your bloods as it can have effects on the liver also.How do you feel about the medication now you know a little more about it?

Christy: yes nurse I will try and reduce the smoking as it’s costing me a fortune as well as giving me blood pressure!Can you give me the number for the Quit service?The cans every night will have to stop too, it’s a bad habit I got in to during Covid so I must start by not drinking every night of the week. I walk to the shops and back for my groceries but nothing much.

I didn’t realise it can interact with alcohol, I was feeling pretty rough when I was taking it so it’s good to know it wasn’t just me. And look, I know I must make changes, it’s just all a bit overwhelming to change everything so maybe one thing at a time.

GPN: that’s a great idea Christy, let’s start with one change for the moment.What would you like to change first?

Christy: I think the smoking Nurse, I feel I want to change this.And I think I should go back on those yellow tablets for the blood pressure.

GPN: that’s great Christy, well done. Now when you go back on these tablets they do have some possible side effects; such as; abdominal pain, diarrhoea, nausea.But let us know if this happens and the doctor can chat to you and titrate the dose.Let’s put on the blood pressure monitor and go from there.Do you have any other questions Christy?

Christy: no nurse, thanks.

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Pt moving from diet and lifestyle controlled type 2 diabetes to medication

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GPN : Hello thanks for coming for your 6 monthly review , how are getting on ?

PT: I've noticed that my sugars have gone up and the doctor says my long term sugar is rising so I need to take tablets.

GPN: Ok you noticed that your sugars are rising, how has your diet and exercise been ?

PT: Well I feel I'm doing well, eat regularly and healthy, exercise 5 times/week with only occasional treats, I don't understand why the sugars are getting worse.

GPN: I hear that you feeling frustrated , you have been diabetic for over a year now and while diet and exercise are the first line of treatment for diabetes which you manged very well, diabetes is progressive so so if these changes are no longer enough we can prescribe medication to support your efforts. How do you feel about taking medication?

PT:I feel nervous as I hear it can make you feel sick.

GPN: I hear you anxious about the new medication. It s called glucophage and works by helps your body become more effective at making insulin which is needed to use glucose or sugar in your body, it also stops the production of you glucose in your liver. It can initially cause some gastric side effects like nausea, diarrhoea, abdominal discomfort but it usually settles within a couple of weeks. Are you willing to try it ?

Pt : Yes ok I'll give it a try, so what do I do now?

GPN: We'll make a plan. The doctor has prescribed a low dose, 500 mg twice daily, take with food to help prevent reduce symptoms. You continue to record your blood sugar before breakfast and hopefully you'll notice the readings coming down the goal is to get between 4 - 7. I'll give you an information sheet telling you about medication and a return appointment in 3 months to check your long term sugar to see improvement and see how your feeling. Any concerns in the meantime let me know.

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The HPRA advises healthcare professionals not to retain printed versions of Summary of Product Characteristics (SPC) documents. As these documents are subject to frequent content updates, including changes to safety and dose related information, we recommend that you visit our website as necessary to access the most up-to-date versions. If you have any queries about specific SPCs on our website then please e-mail info@hpra.ie

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The objective of the Health Products Regulatory Authority is to ensure in so far as possible, consistent with current medical and scientific knowledge, the quality, safety and efficacy of medicines available in Ireland and to participate in systems designed to do that throughout the European Union.

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Nurse(N): Hi Mary, my name is Roisin I'm the nurse here.

Patient(P): I have a history of AFIB. I was recently been switched from Warfarin to a new tablet called Apixaban to prevent blood clots. I used to have my INRs checked regularly and it gave me peace of mind. I'm told now that I don't need INR's anymore. Have I picked that you correctly? How will I know my levels are normal?

N: Okay Mary. Let me give you some peace of mind now again. You have picked that information correctly, Unlike warfarin, Apixaban doesn't require frequent monitoring.

I see you had your blood done before switching your INR was at the appropriate level before switching and your renal function was normal. We will need to check your renal blood again in 3 months to monitor that. I will give you a PIL that explains all you need to know about side effects etc. It also explains how Apixaban works (This medicine helps to prevent blood clots from forming by blocking Factor Xa, which is an important component of blood clotting.)

P: Thank you Roisin. I feel at ease now and it's great not having to have my blood checked regularly. I will make an appointment for 3 months.

N: I'm glad to help If you have any other questions feel free to pop in or we can arrange a telephone consultation. Use your PIL also for information. Inside the medication box, there is a patient Alert Card. It's important to fill that out and carry it with you.

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Nurse(N): Hello Mary, my name is Roisin and I'm the nurse here in the clinic. Mary, tell me what brings you in today?

Patient(P): Hi Roisin thanks for seeing me. I was a little concerned because my doctor switched my warfarin to a medication called apixaban. I've been taking apixaban now for a month I'm concerned because I used to have my INR checked regularly. The GP has told me that I don't need to do this anymore, is this true? How will I know my blood is at the correct level? I'm afraid that I might get a clot like before.

N: OK Mary I can see how you are concerned. What the GP told you is correct. Unlike warfarin, regular monitoring of INR is not required while on apixaban. Your blood was checked before commencing apixaban, and the switch was made when your INR was at the correct level. I will give you a patient information leaflet which gives you more information for example in it explains that  (This medicine helps to prevent blood clots from forming by blocking Factor Xa, which is an important component of blood clotting.)

P: OK Roisin thank you so much I feel at ease now I was afraid I had picked up the doctor wrong and I didn't want to bother him to ask him about the INR.

N: You are very welcome Mary feel free to come back if you have any more questions.