Community pharmacy survival guide (Ver 2.1)
Last updated = 3rd Sept 2011
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Part 1 OTC Guide
System Condition Page System Condition Page
RESPIRATORY Cough 1 DERMATOLOGY Psoriasis 10
Nasal / sinus 1 Dandruff 10
congestion Seborrhoic 10
Sore throat 2 dermatitis
Hayfever / 2 Athletes foot 10
rhinitis Warts & varrucas 10
EYE Conjunctivitis 3 Calluses 11
Blepheratitis 3 Scabies 11
Styes 3 Insect bites 11
Dry eyes 3 Head lice 11
EAR Otitis externa 4 Prickly heat 11
Ear wax 4 Sunburn 11
CENTRAL NERVOUS Headache 5 Shingles 11
SYSTEM Threadworms 12
Nausea & 5 MUSCULOSKELETAL Musculoskeletal 13
Travel sickness 5 Sciatica 13
W OMENS HEALTH Cystitis 6 PAEDIATRICS Chicken pox 14
Vaginal thrush 6 Croup 14
Primary 6 Whooping cough 14
dysmenorrhoea Meningitis 14
Premenstrual 6 MISCELLANEOUS Malaria 15
syndrome Ali 16
Hot flushes 6 Flomax 16
MOUTH Ulcers 7 Vitamins 17
Cold sore 7
Oral thrush 7
Gingivitis 7 Part 2 Prescription Guide
Broken tooth 7 Topic Page
Wisdom tooth 7 SCRIPTS 17
Post tooth 7 MISSED PILLS 19
extraction EHC 20
MAXIMUM DOSES 20
GASTROINTESTINAL Dyspepsia 8 GENERIC TO BRAND 21
Diarrhoea 8 PRESCRIPTION 24
Constipation 8 CHARGES
Part 1 OTC Guide
COUGH 1st line expectorant Choice Details
Refer if guaiphenesin Benylin Chesty Coughs > 6
- chest pain years
- > 3 weeks Robitussin Chesty Cough >
- pain on inspiration 6 years
- persistent nocturnal cough 1st line suppressant
in child Refuse if: asthmatic /COPD /pregnant
dextromethorphan Covonia Bronchial Balsam >
- wheeze and/or short of
6 years /hepatic or renal impairment.
Vicks cough syrup with
honey > 6 years Real world: If asthma/COPD is stable and
Meltus Dry Coughs with not severe then can use.
congestion > 12 years
2nd line suppressant
pholcodine pholcodine > 6 years Refuse if: (see dextromethorphan)
Pavacol-D (if diabetic) > 6
3rd line suppressant
codeine > 18 years Refuse if: (see dextromethorphan)
1st line under 6 years Refuse: products with an indication of
Baby Meltus Cough Linctus (> 3 months) 'coughs and colds' to < 6 years if contains:
Beechams Veno’s Honey and Lemon (> 1 year) - antihistamines eg diphenhydramine,
Benylin Children’s Tickly Coughs (> 3 months) chlorphenamine, brompheniramine
Benylin Tickly Coughs (Non drowsy) (> 1 year) - antitussive eg dextromethorphan,
CalCough Tickly (> 3months) pholcodine
Care Glycerin Lemon & Honey with Glucose (> 1 year) - expectorant eg guaifenesin
Simple linctus paediatric (> 1year) - decongestants eg psuedoephedrine,
Tixylix Baby Syrup (> 3 months) phenylephrine, ephedrine,
NASAL / SINUS 1st line oral
CONGESTION & pseudoephedrine Sudafed > 12 years Interaction: isocarboxazid, moclobemide,
SINUSITIS Sudafed syrup > 6 years phenelzine,
runny nose (rhinorrhoea) tranylcypromine, TCAs and MAOIs within
blocked nose previous 2 weeks.
headache Refuse if: pregnant, hypertension,
pain under eyes and in jaw hyperthyroidism, renal impairment.
Do not use near bedtime (keeps you
Real world: if hypertension well controlled
can use short term.
1st line topical
oxymetazoline Sinex > 6 years Interactions: (see pseudoephedrine)
xylometazoline Otrivine > 12 years Refuse if: pregnant, unless o.k'ed by Dr.
Real world: o.k. in breastfeeding
Otrivine child > 2 years If hypertension well controlled can use.
Use drops if < 6 years, spray if > 6 years.
1st line painful sinuses
paracetamol + pseudoephedrine Sinutab > 6 years
ibuprofen + pseudoephedrine Nurofen Cold and Flu > 12
steam inhalation Head over steaming water with towel over
head for 10 min, at least 2x daily.
1st line baby
normal saline drops normal saline drops > birth
2nd line baby
menthol Karvol capsules / drops > 3 Refuse if: < 3 months, can cause apnoea
months (i.e. stop breathing for a few seconds)
Olbas for children > 3
SORE THROAT 1st line
Refer if benzocaine Merocaine > 12 years
- > 2 weeks Dequacaine > 12 years Real world: o.k in breastfeeding
- excess tonsil exudate with
fever and swollen glands Tyrozets > 3 years Real world: o.k in breastfeeding
- hoarseness > 3 weeks 1st line pregnant
benzydamine Difflam spray > 6 years
HAYFEVER / RHINITIS 1st line general symptoms
- nose = itchy, runny, loratadine (least sedating) loratadine > 2 years Refuse if: glaucoma, prostate hypertrophy,
blocked, sneezing liver impairment.
- eyes = itchy, watery Real world: o.k. in breastfeeding.
- throat = itchy
When pollen count is high, stay indoors,
close windows and door. Avoid grassy
areas, shower and wash hair after being
2nd line general symptoms
chlorpheniramine (sedating) chlorpheniramine Refuse if: as above
Real world: in breastfeeding should not be
used more than a week, as causes
drowsiness in baby.
1st line nasal symptoms
beclometasone Beconase > 18 years Refuse if: glaucoma.
fluticasone Flixonase > 18 years Real world: o.k. in breastfeeding.
Takes up to 3 weeks to start working
Use continuously over summer.
1st line occular
sodium cromoglycate Opticrom Allergy No minimum age specified.
Optrex Allergy Real world: can be used at any age and
o.k. in breastfeeding .
Remove contacts lenses.
CONJUNCTIVITIS Features of 3 different causes of conjunctivitis
- red or pink eyes Bacterial Viral Allergic
- discomfort = burning or
gritty (but not sharp/severe) Eyes affected Both (one after other) Both Both
- discharge = mucopurulent Discharge Purulent Watery Watery
(or watery if viral cause) Pain Gritty Gritty Itchy
Refer if: Redness Generalised/diffuse Generalised Generalised/fornicles
- contact lens wearer (can Associated symptoms None Cough + cold Rhinitis
supply once o.k'ed)
- other eye drops being
used 1st line bacterial/viral
- actual pain (not gritty chloramphenicol chloramphenicol > 2 years Refuse if: pregnant or breastfeeding, or
feeling) history of blood disorders.
- vision affected Interaction: with bone marrow depressant
- pregnant / breast-feeding drugs.
- glaucoma Do not wear contact lens during treatment,
can restart hard and disposable straight
after treatment, soft lens to be restarted 24
hrs after treatment finished
Contagious so do not share towels etc
1st line allergic conjunctivitis
sodium cromoglycate Opticrom Allergy No minimum age specified.
Real world: can be used at any age.
Optrex Allergy Remove contacts lenses.
2nd line allergic conjunctivitis
antazoline + xylometazoline Otrivine-Antistin > 5 years Refuse if: glaucoma
Interaction: MAOIs within previous 2
weeks, isocarboxazid, moclobemide,
Maximum 5 days use.
BLEPHARITIS 1st line
cause = unknown, eyelid hygiene Apply warm compress to eyes for 5-10 min. Massage eyelids to push out
- majority of lid margin the mucus like fluid, from eyelid glands.
inflamed + red Mix baby shampoo with warm water (just a few drops or make a 50%
- sore eyes, irritation, solution). Dip cotton bud into solution and squeeze out excess. Use to clean
itching, burning the eyelid margins, and eye lashes.
- crusty debris or skin flakes Alternatively use only boiled and cooled water to clean.
around eyelashes, Do the above twice daily during flareups, then once daily as prophylaxis.
- excessive tearing / or dry
- usually coexisting
psoriasis or dandruff.
STYES 1st line
cause = bacteria, hot compress Apply for 20 min 3-4 times daily to bring
- infection of the root of an external stye to a head.
eye lash, Usually self-limiting, resolve spontaneously.
- swollen eye lid Contagious so do not share towels etc.
- painful to touch 2nd line
topical antibiotic Brolene / Golden eye Only if hot compress fails.
DRY EYE 1st line cheap
burn hypromellose hypromellose 0.3 % Refuse if: pregnant.
feel tired 1st line efficacy
gritty carbomer 940 Viscotears Refuse if: pregnant.
Refer if: GelTears Refuse if: pregnant.
- child (as uncommon)
- medication induced e.g.
diuretics, anticholinergics 2nd line efficacy
isotretinoin, HRT polyvinyl alcohol Sno Tears 1.4 % Refuse if: pregnant.
Liquifilm Tears 1.4 %
1st line pregnancy
wool fats simple eye ointment
OTIS EXTERNA To distinguish between types of infection
- irritation External (externa) Middle (media) Inner
- discharge (not Itch +
mucopurulent) Pain + +
refer if: Discharge + +
Deafness + + +
- ear pain < 6 years
- inflammation of pinna Dizziness / tinnitus +
1st line otitis externa
choline salicylate Earex Plus > 1 years
2nd line otitis externa
acetic acid Earcalm spray > 12 years
EAR WAX 1st line
- ear discomfort hydrogen peroxide Otex No min age specified
- feeling of fullness 2nd line
- slight hearing loss
arachis oil (peanut oil) Cerumol Refuse if: peanut allergy.
CENTRAL NERVOUS SYSTEM
TENSION 1st line
headache < 15 days each month = acute paracetamol
headache > 15 days and last > 6 months = chronic ibuprofen
Pain = bifrontal or bioccipital, generalised and
non-throbing, 'tight-band' like, gradual onset and tends to worsen
Not aggravated by movement, but can increase if stressed
MIGRAINE 1st line
last 1-72 hours soluble paracetamol
phase 1 = change in mood or behaviour
phase 2 = headache (may be with aura) soluble aspirin
phase 3 = lethargy for few hours ibuprofen
Pain = unilateral, throbbing, moderate-severe
Movement aggravates pain 2nd line
Nausea/vomiting in 1/3 patients Migraleve > 10 years Refuse if: pregnant, glaucoma,
Photophobia, phonophobia prostate enlargement
Imigran > 18 years See page 16
1 st line nausea & vomiting
Buccastem M > 18 years Refuse if: pregnant, parkinsons,
CLUSTER Refer to: GP, as OTC is not
Usually men 40-60 years effective
Typically same time each day for 10min-3hrs
Acute attacks for weeks or months then remission for months or
years. 50 % suffer at night time, 2-3hrs after sleeping.
Unilateral orbital pain, 'red-hot poker' like, also conjunctivitis, nasal
INSOMNIA 1st line
refer if: diphenhydramine Nytol > 16 years Refuse if: glaucoma, prostate
- < 16 years enlargement.
- > 3 weeks duration
- medication induced:
NAUSEA + VOMITING 1st line post prandial
domperidone Motilium 10 > 16 years Refuse if: pregnant, parkinsons
1st line migraine
prochlorperazine Buccastem M > 18 years Refuse if: pregnant, parkinsons
disease, epilepsy, glaucoma.
TRAVEL SICKNESS 1st line for effectiveness
hyoscine journeys up to 4 hrs Joy-Rides > 3 years Refuse if: pregnant, glaucoma,
Kwells >10 years S/E = drowsiness. Dry mouth
can be overcome with sucking
Junior Kwells > 4 years
cinnarizine journeys 4-8 hrs Stugeron > 5 years Refuse if: pregnant, glaucoma,
meclozine journeys > 8hrs Sealegs > 2 years
promethazine Avomine > 5 years
W OMENS HEALTH
CYSTITIS 1st line
- dysuria Potassium citrate Cystopurin Refuse if: pregnant, taking ACEi, K sparing
- diuretics, spironolactone.
- nocturia Sodium citrate Cymalon Refuse if: pregnant, hypertension, renal
- haematuria impairment.
Real world: no clinical consequence of
Na+ in sachets if hypertension well
- age < 12 years controlled.
- immunocompromised Tastes horrible so dilute well.
- vaginal discharge
VAGINAL THRUSH 1st line significant discharge
- itchy, sore vulval lips, intravaginal clotrimazole Canesten intravaginal
- cream coloured discharge, cream/pessary/tablet
(little or no odour) 2nd line
fluconazole (oral) Diflucan One Interaction: anticoagulants, ciclosporin,
Canesten Oral phenytoin, rifampicin, sulphonylureas,
- 1st occurrence
tacrolimus, theophylline, statins
- 2 episodes in last 6
1st line if only external symptoms
- age < 16 years, or > 60 clotrimazole topical Clotrimazole cream Can also apply to penis if irritating rash.
- pain lower abdomen or
- diabetes poorly controlled
- previous history of STD
PRIMARY 1st line
- lower abdominal cramping ibuprofen ibuprofen
- approximately 6 hr before
bleeding, lasting for 2-3 2nd line
days naproxen Feminax ultra 15-50 years
- back pain
- nausea / vomiting 3rd line
hyoscine butylbromide Buscopan cramps Interaction: antihistamines, TCA,
Refuse if: glaucoma, myasthenia gravis,
cardiac problems, hyperthyroidism
MENORRHAGIA 1st line
- heavy periods that recur tranexamic acid Refuse if: breast feeding, renal damage,
every month previous blood clot, haematuria, taking
cycle must be 21-35 days and regular (i.e. 3 days variation in cycle COC pill
refer if: length)
- polycystic ovaries
- family history of
- taking oestrogen alone
- taking tamoxifen
PREMENSTRUAL 1st line
Cause = unknown, possibly Vit B6 (pyridoxine) 100mg tabs
hormonal changes e.g. 100mg
oestrogen, and serotonin in
brain. 2nd line
- agitation calcium calcichew = 500mg Avoid: in renal impairment
- breast tenderness 1200mg elemental elemental Ca2+/ tablet
- bloating Ca2+/day
- abdominal pain
evening primrose oil
HOT FLUSHES 1st line
Due to vasomotor instability Soya If severe or not relieved by OTC then refer
due to hormone levels to GP, may prescribe HRT or SSRI's
Vitamin E 800iu daily
BREASTFEEDING fine in breastfeeding:
colour hair, bleach hair, straighten
hair, perm hair.
MOUTH ULCERS 1st line
refer if: choline salicylate Bonjela > 16 years
> 3 weeks 2nd line
drug related e.g. NSAIDS, lidocaine Anbesol Refuse if: in 3rd trimester of
cytotoxics, sulfasalazine benzocaine Rinstead pregnancy
COLD SORE 1st line prodome phase
Cause = Herpes simplex Aciclovir cream Aciclovir cream Both must be applied within hours of
virus 1 prodome phase starting.
Reduce healing process by 1 day.
1st line prodome phase Both have same efficacy but Compeed
(aesthetic) hides the disfiguring cold sore. Not known
Occlusive dressing Compeed patch to be harmful in pregnancy or
1st line after prodome phase
Blistex relief cream
Carmex lip balm
Lypsyl cold sore gel
To minimise spread:
Avoid touching cold sore unless applying cream. Dab on the cream,
as rubbing damages skin. Wash hands before and after applying. Do
not share cutlery, towels. Avoid kissing until completely healed.
Avoid new born babies, pregnant, immunocompromised.
ORAL THRUSH 1st line
- creamy/white soft elevated miconazole Daktarin Oral Gel > 4 Refuse if: pregnant
- painful + sore, Interaction: warfarin
- red underneath patches
refer if: Scrape plaque off before applying.
- diabetic Use for a further 2 days once cleared up.
- > 3 weeks
- painless lesion
GINGIVITIS 1st line
- swollen + reddened gums chlorhexidine gluconate Corsodyl 0.2 %
- bleed easily 2nd line
- halitosis (bad breath)
TEETHING 1st line Teeth break through at 6-9 months age
- pain paracetamol paracetamol (sometimes from 3 months).
- swollen gums
- red, hot cheeks Apply vasoline or aqueous cream around
- excessive dribbling 2nd line mouth and chin to prevent soreness from
topical analgesic Bonjela Teething Gel > 2 dribbling. Remove dribble with a cloth as
months soon as it happens.
Calgel teething gel>3months
BROKEN TOOTH If no red spot (nerve) visible on broken surface, it can be repaired by dentist.
Avoid hot and cold foods.
KNOCKED OUT TOOTH Rinse in milk and store in cheek (adult) or in milk.
Refer to dentist ASAP.
WISDOM TOOTH Dissolve salt in hot water and keep in mouth for few minutes. Repeat 2 hourly
Avoid chewing food on sensitive side.
Clean mouth after food.
TOOTHACHE If no defect in tooth ibuprofen If fails refer to dentist.
If defect in tooth oil of cloves Apply to cotton bud.
If sensitivity to touch/temp Sensitive toothpaste
DYSPEPSIA 1st line
upper abdominal discomfort antacids antacids Note: contain NaCl hence caution if
flatulance 2nd line
alginates Gaviscon > 6 years Liquid more effective. Use tablets to carry
Gastric ulcer, pain 1hr post
Gaviscon Advance > 12
meal when stomach empty
Duodenal ulcer, relieved by
eating, pain wakes patient
few hrs after eating H2 r antagonist Pepcid AC >16 years Refuse if: pregnant.
aggravated by fatty
foods Zantac 75 > 16 years
Pepcid Two (Ca2+ Mg2+
Refer if: anatcid)
- 1st time sufferer and >45 4th line
- weight loss PPI Zanprol (omeprazole)
- difficulty swallowing Pantoloc (pantoprazole)
1st line pregnancy
DIARRHOEA 1st line
Refer if: loperamide Imodium > 12 years Real world: o.k. in breastfeeding.
- recent tropical travel 2nd line
- unable to drink fluids bismuth Pepto-Bismol > 16 years Refuse if: pregnant.
- blood + mucus in stool 3rd line
- severe abdominal pain
< 1 years and duration > 1 morphine Diocalm Dual Action > 6
< 3 years and duration > 2 Simultaneously For < 1 years use boiled + cooled water
days oral rehydration therapy (ORT) ORT Continue breast/bottle feeding as normal
> 3 years and duration > 3 Adults can stop food for 24hrs + avoid
days cow’s milk
ORT can be kept in fridge for 24hrs.
CONSTIPATION 1st line
senna senna Time of onset 6-12 hrs
bisacodyl tabs Dulcolax tabs > 4 years Avoid milk/antacids with e/c tabs.
glycerol suppository glycerol > infants Time of onset 30-60 minutes
lactulose lactulose > 1 month Time of onset 48-72 hrs
1st line pregnancy
ispaghula husk Fybogel > 6 years Time of onset 48-72 hrs
Increase fluid intake, esp. pear juice / apple
2nd line pregnancy
lactulose lactulose > 1 month
1st line child
lactulose lactulose > 1 month Dosage from the cBNF 2009:
1month - 1year = 2.5ml BD
1 - 5 years = 5ml BD
5 - 10 years = 10ml BD
>10 years = 15ml BD
docusate (stool softner/stimulant) Diocyty > 6 months 6months - 2years = 12.5mg TDS
2 - 12 years = 12.5-25 mg TDS
can be mixed with milk or squash
IBS 1st line
abdominal pain esp. lower mebeverine Colofac IBS > 10 years 20 min before food
bloating 2nd line
mucus on stools alverine Spasmonal > 12 years
diarrhoea on wakening +
hyoscine Buscopan > 6 years Refuse if: glaucoma, myathenia gravis,
peppermint oil Colpermin > 15 years Refuse if: peanut allergy
HAEMORRHOIDS 1st line
Germaloids HC spray > 14
Anusol Plus HC > 18 years
2nd line Germaloids > 12 years
3rd line Anusol > 12 years
PSORIASIS 1st line skin
Salmon-pink lesions with coal tar Exorex cream (plaque Also use emoilients.
silvery scales = plaque psoriasis)
psorias 1st line scalp
coal tar T/Gel (scalp psoriasis)
Redness of scalp, or
inflammation and thick Polytar (scalp psoriasis)
scaling extending behind
ears = scalp psoriasis
DANDRUFF 1st line
scalp = dry, itchy, flaky hypoallergenic shampoo > birth
ketoconazole Nizoral > birth
selenium Selsun Can discolour hair, so test on small patch
SEBORRHOIC 1st line adults
infantile form = craddle ketoconazole Nizoral If fails, refer to GP.
red, mildly itchy scaly 1st line baby
rash, affects centre of olive oil olive oil > birth Apply overnight then wash with gentle
face, scalp, eyebrows shampoo in the morning.
eyelids 2nd line baby
lauryl ether Dentinox Cradle Cap
Shampoo > birth
ATHLETES FOOT 1st line
white + soggy skin in toe terbinafine Lamisil AT cream - leather shoes/sandals best
webs athletes foot + jock itch - no socks if possible (or cotton socks)
- itchy - wash+dry thoroughly before applying
- smell treatment
Lamisil spray > 16 years
- skin surface excluding - fungal powder for shoes
athletes foot + jock itch
face and hands
+tinea corporis - contagious no sharing towel, no bare
Refuse if: pregnant foot walking
refer if: - continue for 3 days once lesions cleared
- signs of infection 2nd line
ketoconazole Daktarin Gold > birth
- failed treatment
athletes foot + jock itch
clotrimazole clotrimazole > birth
all fungal infections
bifonazole Canesten AF once daily apply ON only
athletes foot only
FUNGAL NAIL 1st line
refer if: amorolfine Curanail > 18 years - apply once weekly
- >2 nails affected only licensed if distal lateral subungual onychomycosis (DLSO) i.e. - one pack lasts 3 months (need ~2 for
- diabetic spreading from the tip of the nail to the base. fingernails, ~3-4 for toenails)
- destroyed nail due to
- not DLSO
WARTS + VERRUCAS 1st line
cause = human papilloma salicylic acid Bazuka Extra Strength Refuse if diabetic.
virus Occlusal (no lower age Refuse if diabetic.
- raised hyperkeratoic stated)
papule 2nd line
- thrombosed black
vessels visible within the glutaraldehyde Glutarol Refuse if diabetic.
wart formaldehyde Veracure Refuse if diabetic.
cryotherapy Wartner > 4 years Refuse if: pregnant
10 | P a g e
CORNS 1st line
hard localised corns on See ‘Warts + verrucas’ above See ‘Warts + verrucas’ above Refuse if diabetic.
top of toes
central hard dry skin
surrounded by painful
raised yellow ring of
Soft corns between toes =
CALLUSES 1st line
caused by friction + remove precipitating factor Refuse if: diabetic.
SCABIES 1st line
cause = mite permethrin Lyclear Dermal Cream > 2 Itch can continue for weeks after successful
pruritis (diffuse) finger + months treatment
toe webs, wrists, penile + 2nd line itch may increase initially
scrotal area, beneath apply at bedtime
malathion Derbac M > 6 months
breasts + nipples treat all family
wash bedding + clothes
possibly worse at night + 1st line itching
crotamiton Eurax cream > 3 years Refuse if: pregnant
1st line itching (severe)
contagious up to 6 weeks promethazine Phenergan > 2 years
before itch develops
INSECT BITES 1st line if multiple bites
1st line pregnancy
hydrocortisone hydrocortisone > 10 years
1st line isolated mainly itching
crotamiton Eurax cream > 3 years Refuse if: pregnant.
HEADLICE 1st line
malathion Derbac M > 6 months Repeat after 1 week
phenothrin Full Marks Liquid > 6 months Repeat after 1 week
ACNE 1st line
benzoyl peroxidase Panoxyl Use 2.5% or 5%. 10% is too irritating.
Use for up to 12 weeks to determine if
PRICKLY HEAT/ HEAT 1st line Stay in cool areas
calamine lotion Have a cool shower
RASH/ SWEAT RASH
2nd line Wear cotton clothes
cause = blocked sweat hydrocortisone hydrocortisone > 10 years
Miliaria crystalline = tiny
clear spots that look like
beads of sweat
Miliaria ruba = tiny red
SUNBURN 1st line mild after washing use soft towel to pat dry (do
refer if: any moisturiser or aftersun lotion not rub skin)
- large areas blistered can put creams in fridge to cool
100% aloe vera cream/gel stay out of sun until settles.
1st line itchy
1st line pain
paracetamol / ibuprofen
ECZEMA 1st line
Itchy emollients E45
Red Oilatum bath oil
Dry 2nd line flare ups
hydrocortisone hydrocortisone > 10 years Not for face or anogenital or broken skin.
- treatment failure 3rd line flare ups
clobetasone Eumovate > 12 years Not for face or anogenital or broken skin.
11 | P a g e
SHINGLES 1st line Low adherance dressing on blistered rash to
If post herpetic neuralgia paracetamol decrease irritation.
severe refer to GP. May co-codamol 8/500 Wear loose fitting cotton clothes to decrease
prescribe 1st line topical itch irritation.
tricyclics Ice cubes wrapped in cloth or cool bath.
calamine Note: is contagious until all the blisters have
1st line topical herpetic neuralgia crusted over.
capsacin cream Balmosa
THREADWORM 1st line
Caught from infected mebendazole Ovex > 2 years Refuse if: pregnant.
humans. Treat all family. Can repeat dose 14 days
Night-time perianal itching later if reinfection occurs.
White/cream threadlike Strict hygiene measures. Wash around back
passage each morning.
piperazine Pripsen Piperazine > 3 Refuse if: pregnant, renal / hepatic
12 | P a g e
MUSCULOSKELETAL 1st line topical
ibuprofen ibuprofen > 12 years Refuse if: pregnant, gastric ulcers, renal
Real world: Can use if hypertension is well
controlled, and in asthmatics if NSAIDS
used previously and < 12 years if o.k'ed by
2nd line topical
mucoploysaccharide polysulphate Movelat > 12 years Refuse if: pregnant, asthma.
Real world: Can use in asthmatics if
NSAIDS used previously (contains
3rd line topical
capsaicin Ralgex cream 0.12%
SCIATICA 1st line
Pain radiating from the paracetamol ± codeine Continue moderate activity. Avoid bed rest.
lower back down the leg 90% with unilateral sciatica recover with
ibuprofen ibuprofen Refuse if: pregnant, gastric ulcers, renal
Real world: Can use if hypertension is well
controlled, and in asthmatics if NSAIDS
13 | P a g e
CHICKEN POX 1st line fever
cause = varicella zoster paracetamol > 2 months
- 3 days prodomal fever,
headache, sore throat 1st line itching
- small red lumps develop chlorpheniramine > 1 year
into vesicles which crust
2nd line itching
- begin on head and neck
calamine in aqueous cream
move onto trunk (sparse on
- luke warm baths
- contagious 48 hrs before
- wear smooth cotton clothes
1st spots appear until all
- cut nails short to stop secondary infection
- no school until all lesions crusted over. No air travel until 6 days after last spot disappears.
- avoid contact with babies < 4 months, immunocmpromised, pregnant women
- if pregnant women comes into contact with chickenpox and not had chickenpox before (or unsure) refer to GP
within 24 hours, who may test her immune status and prescribe immunoglobulins against varicella.
Note you can catch chickenpox from someone with shingles.
CROUP Cause = viral infection Calm and reassure the child and sit upright.
Oedema and narrowing of airway Paracetamol and cool drinks to lower fever.
Wakes at night with severe bouts of a barking cough
Noise on inspiration = stridor
-breathing becomes rapid or wheezy
-very noisy inspiration
-drooling and unable to swallow
WOOPING COUGH Cause = bacterial infection Refer to GP for antibiotics.
Cold like symptoms followed by a cough Usually lasts 6-8 weeks.
Violent bursts of coughing, then whoop may be heard on inspiration Infectious for 3 weeks from when coughing
in 50 % of cases starts OR until you finish antibiotic course.
Vomiting can occur
MENINGITIS Four most highly suggestive symptoms of meningitis:
- neck pain / stiffness
- leg pain
14 | P a g e
M ALARIA Insect repellent
diethyloluamide (DEET) up to 50% > Advisory committee on malaria recommendations say o.k in pregnancy,
2months breastfeeding and age > 2 months
Drug chloroquine proguanil atovaquone mefloquine doxycyline
Brand avloclor paludrine malarone larium
Class P P POM (usually private Rx ) POM (usually private Rx) POM (NHS Rx allowed)
Regime 1 wk before, 4 wk 1 wk before. 4 wk 1-2 days before, 1wk after 2-3 wk before, 4 wk after 2 days before, 4 wk
after after after
Dose (adult) 2 weekly 2 daily 1 daily 1 weekly 1 daily
Note in child > 1 years, can crush and give
in milk, honey or jam
Side effects nausea nausea nausea nausea nausea
vomiting vomiting diarrhoea vomiting diarrhoea
diarrhoea diarrhoea abdo pain depression / anxiety
blurred vision headache headache
Refuse if epilespy pregnant
psoriasis renal / hepatic
renal / hepatic
Interactions ciclosporin warfarin
Notes These can be prescribed on a NHS script, and you will - affects pill, use
get paid, but, the doctor will be asked by the PCT why precautions for first 3
they put it on a NHS script. So always ring the doctor to weeks
confirm they intended to put it on a FP10 rather than a - rarely ↑ skin
private script. photosensitivity, so use
high protection sun
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ALLI orlistat Alli Refuse if: chronic bowel problems, bile
flow problems, pregnant, breast-feeding
works by ↓ absorption of fat aged 18 Interaction: amiodarone, ciclosporin,
by the intestinal lining. BMI 28 anticoagulants, acarbose
Refer if: 1 capsule TDS immediately before, during or up to 1 hr after a main If severe diarrhoea, makes pill less effective
- no ↓ weight after 12 weeks meal. hence use extra precautions.
- diabetic Max use = 6 months Take 1 multivitamin at bed time.
FLOMAX tamsulosin Flomax relief MR Refuse if: taking doxazosin, indoramin,
prazosin, terazosin, verapamil.
Refer if: aged 45-75
- pain on urination symptoms for at least 3 months
- bloody / cloudy urine supply 2 weeks, then:
- urinary incontinence - if improvement, can supply further 4 weeks, and then they must see
- unstable diabetes their GP, who will make an assessment if it is safe to continue to use
- liver, kidney, heart disease - if no improvement, no further supply, and refer to see GP
- postural hypotension
- cataracts operation due
IMIGRAN sumatriptan Imigran recovery
< 18 or >65 years
pregnant or breastfeeding
4 migraines ever
first migraine was within 12 months
first ever migraine and aged >50 Can supply once o.k’ed by GP
must be diagnosed with migraine If not, refer
or answer ‘Yes’ to 2/3:
in the last 3 months has it interfered
with your activities at least 1 day?
do you suffer from nausea or
does light bother you?
how many attacks each month 4, refer
how long does the headache last if < 4 or >24 hours, refer
no treatment is taken?
how many days a month do you 10, refer
have a headache?
in between the attacks, do all the If not, refer
symptoms go away?
do the migraines follow a similar If not, refer
pattern each time?
refer if any of following:
- unilateral motor weakness
- double vision
- clumsiness or uncoordinated movements
- reduced level of consciousness
- seizure-like movements (fits)
- a recent rash with a headache
- headache confined to the back of the head
- recent marked deterioration in migraine (duration, severity or
frequency of attacks)
women taking pill refer Can be supplied if o.k’ed by doctor
taking SSRI refer
taking St Johns wort stop
how many cardiovascular risk if 3, refer
- post menopausal women
- men > 40 years
- high cholesterol
- smoke > 10 / day
- obesity (i.e. BMI > 30)
- father or brother had MI or angina
<55 years, or, mother or sister >65
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liver, kidney, diary products, eggs, margarine, butter, fish oils
bread, wholegrain cereals, breakfast cereals, pulses, nuts, liver
dairy products, wholegrain cereals, breakfast cereals, meat, green
meat, fish, nuts, breakfast cereals, wholemeal bread
B5 pantothenic acid
meat, milk, eggs, pulses
meat, fish, breakfast cereals, pulses, nuts
liver, kidney, eggs, fish, pulses, vegetables
B9 folic acid
liver, kidney, wholegrain cereals, pulses, green vegetables
meat, fish, eggs, milk, cheese, breakfast cereals
C ascorbic acid
citrus fruit, fruit juice, berries, potatoes, green vegetables
oily fish, margarine, butter, eggs, fish
wholegrain cereals, wheat germ, vegetables, eggs, nuts
green leafy vegetables, fruit, nuts, wholegrain
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Part 2 Prescription Guide
POM SCRIPTS Problem Options Note
valid for 6 months Missing signature - ask patient to go back to get signed do not dispense if drug likely to
- if regular patient and regular meds, be abused and patient not
and has run out, dispense and get known to you.
Missing date ring surgery to find out date written,
dispense, and then send to surgery
to get dated later
Missing GP practice stamp ask patient to take back to surgery to
Missing age for child <12 years ask parent and fill in yourself
SLS missing do not dispense will not get paid if no SLS
ACBS missing can dispense
No PIL in the box - ask patient if they have access to
the internet, they can get a copy of
the PIL from the Electronic
Medicines Compendium website,
just type ‘emc’ into google.
Emergency supplies At patient’s request Real world: don’t supply any
- can supply anything except CD sch 1, 2 & 3 drugs of abuse unless old lady
- must be certain the medication has been prescribed previously who has it regular and is known
- maximum 30 days supply to you
record: date supplied, drug details, patient
name + add, cost
label on box should state: ‘emergency supply’
At Dr’s request
- can supply anything except CD sch 1, 2 & 3 (but can supply
phenobarbitone for epilepsy)
- the Dr must send you the script ASAP
record: date supplied, drug details, Dr name
+ add, patient name + add, when
script arrives (date script received,
date on script)
Faxed You can dispense anything (except CD sch 2 & 3) against a fax.
Repeat’s If has the words ‘repeat’, you dispense once as normal, then dispense
however many times it states e.g. ‘repeat 4’ = dispense once plus a further 4
times, so 5 times in total.
Note: the 1st dispensing has to be within 6 months from the date on the
script. The others can be whenever. There is no maximum number of
If only states ‘repeat’ then after the 1st dispensing you can dispense once
more (unless it’s a pill, in which case you can repeat a further 5 times, but
they all have to be dispensed within 6 months from the date on the script)
If it’s a private script, stamp it each after each dispensing and hand back to
the patient each time, until the last dispensing where you keep it for 2 years
as per a normal private script.
Private scripts If you think it may be a fake, ring through directory enquiries to get the
number of the surgery to confirm. If Dr’s is closed then say you cannot GMC tel: 01619236602
dispense until next day e.g. ‘it’s normal procedure for us to contact the
surgery to confirm they have issued a private script if we’re not familiar with
the surgery’ (otherwise anyone could print off a prescription on their home
computer !). If it’s something ‘safe’ like antibiotics for a kid, just dispense it.
record: date supplied, date on script
patient name + add
Dr name + add
script: stamp and add ref no
Medical exemption A permanent fistula (for example caecostomy, colostomy, laryngostomy or Must apply using form FP92A
ileostomy) requiring an appliance or continuous surgical dressing. available from Dr surgery.
A form of hypoadrenalism (for example Addison's disease) for which specific
substitution therapy is needed.
Diabetes insipidus or other forms of hypopituitarism.
Diabetes mellitus, except where treatment is by diet alone.
Myxoedema (hypothyroidism requiring thyroid hormone replacement).
Epilepsy requiring continuous anticonvulsive therapy.
Continuing physical disability which means the person can't go out without
the help of another person. Temporary disabilities do not count even if they
last for several months.
Undergoing treatment for cancer/side-effects of cancer treatments.
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Pre-payment certificate if > 4 items in 3 months Ring tel: 0845 850 0030
if > 12 items in 12 months
FP10, green the entire script can be computer generated (except the signature) If there is a ‘minor’ legal problem
valid for 28 days (for CD with the script, you can ask what
sch 2, 3 & 4). if issued by dentist must state ‘for dental treatment only’ the medication is being used for.
If it’s an emergency script for
The 28 day period starts when handing out CD sch 2 drugs you must ask if they are patient, patients cancer pain, or palliative care,
from the ‘appropriate representative or healthcare staff. If healthcare staff, must ask for proof of think twice before refusing to
date’. This is either the name + add (can be work or home), however, you can still supply if no ID supply.
date the Dr signed the available and not suspicious.
script, or, he may have
written a separate ‘start the prescribers address must be in the UK.
date’ on the script.
Choose whichever is repeats are not allowed for CD sch 2& 3 (but are allowed for CD sch 4) for CD sch 4, the 1st dispensing
the later date. has to be within 28 days of the
The first dispensing
must be within 28 days Installment’s of CD’s are not allowed on a green FP10. They should use a Options:
from the date the Dr blue FP10 MDA. We will not get paid for dispensing it in installments. - Dr will send a new blue script
signed the script or the - agree with Dr to dispense only
start date he stated on a single dose to cover today,
the script. and get new blue script
Any owing must also be - agree with Dr to dispense
collected within this 28 entire quantity as a single dose
day period. today.
CD’s private scripts must be on FP10PCD for CD sch 2 & 3 (including Temazepam, but not
required for CD sch 4 & 5)
must state ‘prescriber identification number’ for Sch 2 & 3 (including
Temazepam, but not required for CD sch 4 & 5). This number starts with ‘6’
dentists and other prescribers must also use this form (but not vets)
should only have CD sch 2 &3 drugs written on them, as these scripts need - only dispense the CD, and not
to be sent away, so you would be unable to comply with the regulation which the POM
requires you to keep the private script of a POM for 2 years. - new scripts with the CD and
the POM separate.
FP10 MDA, blue Can only prescribe CD sch 2, buprenorphine, suboxone, and diazepam.
The maximum duration of treatment on one script should be 14 days, but the
Dr can prescribe longer (they will be chased up by the PCT).
The gap between the date next to the signature, and the date of the 1st
dispensing can be more than 28 days.
If they have missed 3 days do not supply.
Someone else can pick up an unsupervised methadone dose if they have a
signed note from the patient (a note is required for each pick up). If this
occurs out the blue for the 1st time, you should ring the patient to confirm
they have written the note. Ask the D.O.B and the quantity to verify your
speaking to the correct person. Any doubt, refuse.
Once they are holding the methadone bottle, you have completed your
dispensing. If they drop the bottle do not redispense. They must get another
script. Same if they vomit in front of you (nice).
CD vet script additional requirements:
valid for 28 days must declare that CD is prescribed for an animal or herd under his care.
VET SCRIPT Script must state:
valid for 6 months name + add + telephone no + qualifications of vet
name + add of owner
species + identification (i.e. name)
add of animal only if different from owner
must have administration instructions (as directed is not o.k)
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MINISTRY OF A few Lloyds pharmacies have a contract with the MoD to dispense Give a till receipt if it clearly shows a
scripts for them, on FMed 296 forms. You do not charge the soldier. ‘NHS prescription charge’ has been
Lloyds will charge the MoD directly later on. paid. If it’s not clear give a NHS
Occasionally they will take the FMed 296 to a different pharmacy. Here Give a till receipt. Write the
you treat it as a private script, and charge the soldier the full cost. reference number from the POM
Occasionally the words ‘private prescription’ will be written on the FMed register, so the base can ring you
296. The soldier can take it to any pharmacy. Here you treat it as a later to check it’s genuine.
private script, and charge the soldier the full cost.
If a soldier goes to an NHS hospital, walk in centre etc they should get a
normal FP10 and they should pay the normal prescription charge.
A CD sch 2 & 3 must be written on a FP10 CDP. A few Lloyds
pharmacies will not charge the soldier directly (they charge MoD
If they take it to another pharmacy charge the soldier the full cost.
MISSED POP If you forget a pill, take it as soon as you remember and carry on with the next pill at the right time.
If the pill was more than 3 hours (12 hours for Cerazette) overdue you are not protected. Continue normal pill-
taking but you must also use another method, such as the condom, for the next 2 days.
MISSED COC Advice from family planning association:
Use chart below (except if taking Qlaira):
Advice from BNF:
If miss 1 pill (i.e. >24 hrs) take the missed pill STAT, and then resume normal pill taking (even if this means
taking 2 at once).
No additional precautions necessary.
If miss 2 or more, take active pill STAT, then resume normal pill taking.
Also abstain or use condom for next 7 days. If these 7 days run beyond the end of the pack, start the next pack
STAT (i.e. miss the usual 7 day break). EHC only required if 2 or more missed from the first 7 tablets in the pack
AND unprotected sex occurred since finishing the last pack.
20 | P a g e
EMERGENCY levonorgesterol Levonelle 1500 16 years - take ASAP
- swallow whole
- if vomit within 2 hours take another
CONTRACEPTION (EHC) - next period can be early or later, but if
within 72 hours? if longer, refer later than 5 days OR abnormal do a
was your last period normal? if abnormal and had previous pregnancy test
sex, could already be common S/E = nausea/vomiting, lower
pregnant, refer abdominal pain, irregular bleeding until
any other medications? refer if: period, tiredness, headaches.
antiepileptics - use barrier method until next period
antituberculosis - contains lactose (142mg)
anti HIV 95% effective day 1
ciclosporin 85 % effective day 2
St Johns wort 58 % effective day 3
breast cancer? refer
- can be used if breastfeeding (take straight
liver disease, bowel disease (e.g. refer after feeding baby, then drain milk using
Crohns)? pump for 6 hours and throw away, then can
pregnant already? refer restart feeding as normal, hence only tiny
amounts will remain on the milk)
previous ectopic pregnancy? refer
previous fallopian tube infection? refer
any allergy to previous pills? if allergic to levonorgesterol,
M AXIMUM DOSAGES almotriptan 2 in 24 hrs
frovatriptan 2 in 24 hrs
naratriptan 2 in 24 hrs
rizatriptan 5mg = 4 in 24 hrs
10mg = 2 in 24 hrs
sumatriptan 50mg tab = 6 in 24 hrs
100mg tab = 3 in 24 hrs
6mg S/C = 2 in 24 hrs
10mg nasal = 4 in 24 hrs
20mg nasal = 2 in 24 hrs
zolmitriptan 2.5mg tab = 4 in 24 hrs
5mg tab = 2 in 24 hrs
5mg nasal = 2 in 24 hrs
paramax 6 in 24 hrs
3 in 24 hrs (age 12-19)
migraleve pink 2 in 24 hrs
yellow 6 in 24 hrs
loperamide 8 in 24 hrs
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GENERIC TO BRAND Bath emoilients
liquid paraffin 25% emulsiderm
isopropyl myristate 25% dermol 600
benzalkonium chloride 0.5%
light liquid paraffin 37.8% hydromol
isopropyl myristate 13%
light liquid paraffin 46% diprobath
isopropyl myristate 39%
light liquid paraffin 52.5% oilatum plus
light liquid paraffin 63.4% oilatum range
liquid paraffin 65% doublebase
light liquid paraffin 82.8% cetraben
liquid paraffin 91% E45
cetyl dimeticone 5%
soya oil 82.95% balneum plus
soya oil 84.75% balneum
white oat fraction, oatmeal aveeno range
benzalkonium chloride 0.1% conotrane
dimeticone 350 22%
dimeticone 20% vasogen
zinc oxide 7.5%
benzyl alcohol 0.39% sudocrem
benzyl benzoate 1.01%
benzyl cinnamate 0.15%
zinc oxide 15.25%
titanium dioxide 20% metanium
titanium peroxide 5%
titanium salicylate 3%
white soft paraffin 13.2% cetraban emollient cream
light liquid paraffin 10.5%
isopropyl myristate 15% doublebase gel
liquid paraffin 15%
light liquid paraffin 6% oilatum cream
white soft paraffin 15%
light liquid paraffin 70% oilatum shower gel
benzalkonium chloride dermol range
cinchocaine Proctosedyl / Uniroid-HC
ointment or suppository
hydrocortisone 0.275% Xyloproct (in fridge)
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Eye drops 20 drops in approx 1ml
hypromellose 0.3% Tears Naturale
dextran ‘70’ 0.1%
insulin aspart NovoRapid
insulin lispro Humalog
soluble insulin prb Humulin S
soluble insulin pyr Actrapid
insulin lispro Humalog Mix
soluble insulin prb Humulin M3
soluble insulin pyr Mixtard
sodium alginate 1000mg Gaviscon Advance
potassium bicarbonate 200mg
sodium alginate 500mg Gaviscon Relief
sodium bicarbonate 267mg
desogestrel 150mcg Marvelon
gestodene 75mcg Femodene / ED
levonorgestrel150mcg Microgynon 30
norethisterone 1mg Loestrin 20/30
norgestimate 250mcg Cilest
desogestrel 75mcg Cerazette
norethisterone 350mcg Micronor / Noriday
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knitted viscose primary N-A dressing
paraffin gauze paranet
knitted polyester with triglycerides atrauman
absorbent perforated with adhesive cosmopor E
absorbent perforated plastic film melolin
vapour permeable adhesive film mepore film
vapour permeable adhesive film with mepore ultra
absorbent pad tegaderm with pad
soft polymer urgotul
soft gel with polyurethane foam allevyn gentle
silicone gel with polyurethane foam allevyn gentle border
absorbent soft silicone with mepilex
as above plus adhesive border mepilex border
thin absorbent soft silicone with mepilex lite
as above but plus adhesive border mepilex border lite
non-adherent soft polymer with urgotul duo
as above plus adhesive border urgotul duo border
semi-permeable hydrocolloid duoderm extra thin
hydrocolloid plastic foam, semi- granuflex
as above with adhesive border granuflex bordered
hydrocolloid fibres in soft non-woven aquacel
polyurethane foam film allevyn range
calcium alginate sorbsan
UK TO USA UK name US name
Benzylpenicillin Penicillin G
Chlormethine (mustine) Mechlorethamine
Folinic acid/ calcium folinate Leucovorin/ leucovorin calcium
Liquid paraffin Mineral oil
macrogol Polyethylene glycol 3350
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Nicotinic acid Niacin
Sodium aurothiomalate Gold sodium thiomalate
Sodium cromoglicate Cromolyn sodium
Tetracosactide (tetracosactrin) Cosyntropin
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