community survival guide Ver 2 1

Document Sample
community survival guide Ver 2 1 Powered By Docstoc
					                   Community pharmacy survival guide (Ver 2.1)
Last updated = 3rd Sept 2011
To make comments or suggestions please visit www.otcguide.wikispaces.com
          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
                                                               Corns               10
EYE                Conjunctivitis     3                        Calluses            11
                   Blepheratitis      3                        Scabies             11
                   Styes              3                        Insect bites        11
                   Dry eyes           3                        Head lice           11
                                                               Acne                11
EAR                Otitis externa     4                        Prickly heat        11
                   Ear wax            4                        Sunburn             11
                                                               Eczema              11
CENTRAL NERVOUS    Headache           5                        Shingles            11
SYSTEM                                                         Threadworms         12
                   Insomnia           5
                   Nausea &           5     MUSCULOSKELETAL    Musculoskeletal     13
                   vomiting                                    pain
                   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
                   Menorrhagia        6
                   Premenstrual       6     MISCELLANEOUS      Malaria             15
                   syndrome                                    Ali                 16
                   Hot flushes        6                        Flomax              16
                                                               Imigran             16
MOUTH              Ulcers             7                        Vitamins            17
                   Cold sore          7
                   Oral thrush        7
                   Gingivitis         7           Part 2 Prescription Guide
                   Teething           7
                   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
                   IBS                9
                   Haemorrhoids       9
                                                          Part 1 OTC Guide
RESPIRATORY

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.
breath
                                                                    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
                                                                    years
                               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,
                                                                                                  xylo(oxy)metazoline
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
                                                                                                  awake).
                                                                                                  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
                                                                    years
                               All patients
                               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
                                                                    months




1|Page
                                                                                                                 RESPIRATORY

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
                                                                                       outdoors.
                               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
                                                                                       optimally  persevere.
                                                                                       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.




                                                                                                                    2|Page
EYE

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,
                                                                                                             phenelzine,
                                                                                                             tranylcypromine, TCAs
                                                                                                             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
eyes,
- 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.
                                                                           ointment
DRY EYE                          1st line cheap
burn                             hypromellose                              hypromellose 0.3 %                Refuse if: pregnant.
feel tired                       1st line efficacy
itchy, irritated
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
                                                                           Lacri-Lube
                                                                           Lubri-Tears




3|Page
                                                                                                                                   E AR

OTIS EXTERNA                                              To distinguish between types of infection
- irritation                                         External (externa)             Middle (media)                         Inner
- pain
- discharge (not          Itch                               +
mucopurulent)             Pain                               +                            +
refer if:                 Discharge                          +                            +
- mucopurulent
                          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.




                                                                                                                             4|Page
CENTRAL NERVOUS SYSTEM

HEADACHE
                                                                                   Different headaches
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
through day
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
                                                                            3rd line
                                                                            Imigran > 18 years            See page 16
                                                                            1 st line nausea & vomiting
                                                                            Buccastem M > 18 years        Refuse if: pregnant, parkinsons,
                                                                                                          epilepsy, glaucoma

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
congestion


INSOMNIA                          1st line
refer if:                         diphenhydramine                           Nytol > 16 years              Refuse if: glaucoma, prostate
- < 16 years                                                                                              enlargement.
- > 3 weeks duration
- medication induced:
  - sympathomimetics
  - MAOIs
  - carbamazapine
  - phenytoin
  - propranolol
  - fluoxetine
  - griseofulvin



NAUSEA + VOMITING                 1st line post prandial
                                  domperidone                               Motilium 10 > 16 years        Refuse if: pregnant, parkinsons
                                                                                                          disease.
                                  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,
                                                                                                          prostate hypertrophy.
                                                                            Kwells >10 years              S/E = drowsiness. Dry mouth
                                                                                                          can be overcome with sucking
                                                                                                          sweet.
                                                                            Junior Kwells > 4 years
                                  2nd line
                                  cinnarizine journeys 4-8 hrs              Stugeron > 5 years            Refuse if: pregnant, glaucoma,
                                                                                                          prostate hypertrophy.
                                  meclozine journeys > 8hrs                 Sealegs > 2 years
                                  promethazine                              Avomine > 5 years




5|Page
                                                                                                                                W OMENS HEALTH

CYSTITIS                       1st line
- dysuria                      Potassium citrate                       Cystopurin                       Refuse if: pregnant, taking ACEi, K sparing
-                                                                                                      diuretics, spironolactone.
- urgency
- nocturia                     Sodium citrate                          Cymalon                          Refuse if: pregnant, hypertension, renal
- haematuria                                                                                            impairment.
                                                                       Canesten Oasis
                                                                                                        Real world: no clinical consequence of
Refer if:
                                                                                                        Na+ in sachets if hypertension well
- age < 12 years                                                                                        controlled.
- diabetes
- 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,
refer if:
                                                                       Canesten Oral                    phenytoin, rifampicin, sulphonylureas,
- 1st occurrence
                                                                                                        tacrolimus, theophylline, statins
- 2 episodes in last 6
                               1st line if only external symptoms
months
- age < 16 years, or > 60      clotrimazole topical                    Clotrimazole cream               Can also apply to penis if irritating rash.
- pain lower abdomen or
dysuria
- pregnant
- diabetes poorly controlled
- previous history of STD
PRIMARY                        1st line
DYSMENORRHOEA
- lower abdominal cramping     ibuprofen                               ibuprofen
pain
- 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)
- >45
- obese
- diabetic
- polycystic ovaries
- family history of
endometrial cancer
- taking oestrogen alone
- taking tamoxifen
PREMENSTRUAL                   1st line
SYNDROME
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
- anxiety
- breast tenderness            1200mg elemental                        elemental Ca2+/ tablet
- bloating                     Ca2+/day
- abdominal pain
                               3rd line
- headache
                               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.




                                                                                                                                          6|Page
M OUTH

MOUTH ULCERS                   1st line
refer if:                      choline salicylate                        Bonjela > 16 years
> 3 weeks                      2nd line
recurrent diarrhoea
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
                                                                                                          breastfeeding.
                               1st line after prodome phase
                                                                         Blistex relief cream
                                                                         Cymex 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
patches                                                                  months
- 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)
                               hexetidine                                Oraldene
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
                               3rd line
                               teething ring
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.
                               Ibuprofen

TOOTHACHE                      If no defect in tooth                     ibuprofen                        If fails refer to dentist.
                                                                         paracetamol


                               If defect in tooth                        oil of cloves                    Apply to cotton bud.


                               If sensitivity to touch/temp              Sensitive toothpaste




7|Page
                                                                                                                  G ASTROINTESTINAL

DYSPEPSIA                      1st line
(INDIGESTION)
upper abdominal discomfort     antacids                             antacids                  Note: contain NaCl hence caution if
bloating                                                                                      hypertensive
flatulance                     2nd line
feeling full
                               alginates                            Gaviscon > 6 years        Liquid more effective. Use tablets to carry
hearburn
                                                                                              around.
Gastric ulcer, pain 1hr post
                                                                    Gaviscon Advance > 12
meal when stomach empty
                                                                    years
Duodenal ulcer, relieved by
                               3rd line
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
years
- weight loss                  PPI                                  Zanprol (omeprazole)
- difficulty swallowing                                             Pantoloc (pantoprazole)
                               1st line pregnancy
                               Gaviscon liquid
DIARRHOEA                      1st line
Refer if:                      loperamide                           Imodium > 12 years        Real world: o.k. in breastfeeding.
- recent tropical travel       2nd line
- elderly
- 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
day                                                                 years
< 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
                                                                                              juice
                               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




                                                                                                                             8|Page
G ASTROINTESTINAL

IBS                         1st line
abdominal pain esp. lower   mebeverine       Colofac IBS > 10 years      20 min before food
left quadrant
constipation/diarrhoea
bloating                    2nd line
mucus on stools             alverine         Spasmonal > 12 years
diarrhoea on wakening +
after meals
                            3rd line
                            hyoscine         Buscopan > 6 years          Refuse if: glaucoma, myathenia gravis,
                                                                         prostate hypertrophy.

                            4th line
                            peppermint oil   Colpermin > 15 years        Refuse if: peanut allergy
                                                                         Before food

HAEMORRHOIDS                1st line
                                             Germaloids HC spray > 14
                                             years
                                             Anusol Plus HC > 18 years


                            2nd line         Germaloids > 12 years


                            3rd line         Anusol > 12 years




9|Page
                                                                                                                             DERMATOLOGY

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
                             2nd line
                             ketoconazole                            Nizoral > birth
                             3rd line
                             selenium                                Selsun                        Can discolour hair, so test on small patch
                                                                                                   first.
SEBORRHOIC                   1st line adults
DERMATITIS
infantile form = craddle     ketoconazole                            Nizoral                       If fails, refer to GP.
cap

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
- diabetes
                             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
INFECTION
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)
- immunocompromised
- pregnant
- destroyed nail due to
severe infection
- 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.
                             3rd line
                             cryotherapy                             Wartner > 4 years             Refuse if: pregnant




                                                                                                                                10 | P a g e
DERMATOLOGY


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
inflammatory skin.
Soft corns between toes =
whitened appearance.
CALLUSES                      1st line
caused by friction +          remove precipitating factor                                         Refuse if: diabetic.
pressure
flattened yellow-white
thickened skin
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
after bath
                              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
                              loratadine                           loratadine
                              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
                                                                                                  working.
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
gland
2 types:
Miliaria crystalline = tiny
clear spots that look like
beads of sweat
Miliaria ruba = tiny red
papules appear
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
                              calamine lotion
                              1st line pain
                              paracetamol / ibuprofen
ECZEMA                        1st line
Itchy                         emollients                           E45
Red                                                                Oilatum bath oil
Scaly
Dry                           2nd line flare ups
                              hydrocortisone                       hydrocortisone > 10 years      Not for face or anogenital or broken skin.
Refer if:
- treatment failure           3rd line flare ups
                              clobetasone                          Eumovate > 12 years            Not for face or anogenital or broken skin.




11 | P a g e
                                                                                                                        DERMATOLOGY

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.
                              2nd line
                              piperazine                            Pripsen Piperazine > 3   Refuse if: pregnant, renal / hepatic
                                                                    months                   impairment.




                                                                                                                            12 | P a g e
M USCULOSKELETAL

MUSCULOSKELETAL           1st line topical
PAIN
                          ibuprofen                         ibuprofen > 12 years   Refuse if: pregnant, gastric ulcers, renal
                                                                                   impairment
                                                                                   Interaction: lithium
                                                                                   Real world: Can use if hypertension is well
                                                                                   controlled, and in asthmatics if NSAIDS
                                                                                   used previously and < 12 years if o.k'ed by
                                                                                   doctor.
                          2nd line topical
                          mucoploysaccharide polysulphate   Movelat > 12 years     Refuse if: pregnant, asthma.
                                                                                   Interaction: warfarin
                                                                                   Real world: Can use in asthmatics if
                                                                                   NSAIDS used previously (contains
                                                                                   salicylate)
                          3rd line topical
                          capsaicin                         Ralgex cream 0.12%
                                                            Balmosa 0.035%
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
                                                                                   conservative treatment.
                          2nd line
                          ibuprofen                         ibuprofen              Refuse if: pregnant, gastric ulcers, renal
                                                                                   impairment
                                                                                   Interaction: lithium
                                                                                   Real world: Can use if hypertension is well
                                                                                   controlled, and in asthmatics if NSAIDS
                                                                                   used previously.




13 | P a g e
                                                                                                                                      P AEDIATRICS

CHICKEN POX                  1st line fever
cause = varicella zoster     paracetamol > 2 months
virus
- 3 days prodomal fever,
headache, sore throat        1st line itching
- small red lumps develop    chlorpheniramine > 1 year
into vesicles which crust
over.
                             2nd line itching
- begin on head and neck
                             calamine in aqueous cream
move onto trunk (sparse on
limbs)
                             - luke warm baths
- contagious 48 hrs before
                             - wear smooth cotton clothes
1st spots appear until all
                             - cut nails short to stop secondary infection
lesions crusted
                             - 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
                             Refer if:
                             -breathing becomes rapid or wheezy
                             -very noisy inspiration
                             -drooling and unable to swallow
                             -persistent fever

WOOPING COUGH                Cause = bacterial infection                                                 Refer to GP for antibiotics.
                             Cold like symptoms followed by a cough                                      Usually lasts 6-8 weeks.
(PERTUSIS)
                             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:
                             - confusion
                             - photophobia
                             - neck pain / stiffness
                             - leg pain




                                                                                                                                       14 | P a g e
M ISCELLANEOUS

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



                                                                          Prophylaxis
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
               headache
Refuse if      epilespy               pregnant
               psoriasis              renal / hepatic
                                      impairment
               pregnant
               renal / hepatic
               impairment
               porphyria
               glucose 6
               phosphate
               dehydrogenase
               deficiency
               myasthenia gravis
Interactions   ciclosporin            warfarin
               digoxin
               cimetidine
               amiodarone
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
                                                                                                                         cream




15 | P a g e
                                                                                                                                  M ISCELLANEOUS

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
fever
- 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
                                 refer if:
                                 < 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
                                 vomiting?
                                 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
                                 - tinnitus
                                 - 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
                                 factors?:
                                 - post menopausal women
                                 - men > 40 years
                                 - diabetes
                                 - high cholesterol
                                 - smoke > 10 / day
                                 - obesity (i.e. BMI > 30)
                                 - father or brother had MI or angina
                                 <55 years, or, mother or sister >65
                                 years




                                                                                                                                       16 | P a g e
Vitamins       A
               liver, kidney, diary products, eggs, margarine, butter, fish oils
               B1 thiamin
               bread, wholegrain cereals, breakfast cereals, pulses, nuts, liver
               B2 riboflavin
               dairy products, wholegrain cereals, breakfast cereals, meat, green
               vegetables
               B3 niacin
               meat, fish, nuts, breakfast cereals, wholemeal bread
               B5 pantothenic acid
               meat, milk, eggs, pulses
               B6 pyridoxine
               meat, fish, breakfast cereals, pulses, nuts
               B7 biotin
               liver, kidney, eggs, fish, pulses, vegetables
               B9 folic acid
               liver, kidney, wholegrain cereals, pulses, green vegetables
               B12 cyanocobalamin
               meat, fish, eggs, milk, cheese, breakfast cereals
               C ascorbic acid
               citrus fruit, fruit juice, berries, potatoes, green vegetables
               D
               oily fish, margarine, butter, eggs, fish
               E
               wholegrain cereals, wheat germ, vegetables, eggs, nuts
               K
               green leafy vegetables, fruit, nuts, wholegrain




17 | P a g e
                                           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.
                                                                signed later
                     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
                                                                get ‘stamped’
                     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
                     repeats.
                     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
                                                                  drug details
                                                                  Dr name + add
                                                                  cost

                                                     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.
                     Hypoparathyroidism.
                     Myasthenia gravis.
                     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.


                                                                                                                                     18 | P a g e
Pre-payment certificate     if > 4 items in 3 months                                                         Ring tel: 0845 850 0030
                            OR
                            if > 12 items in 12 months
CD SCRIPTS
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
                                                                                                             appropriate date
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
                                                                                                             tomorrow
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)
                                                                                                             Options:
                            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.
(installement scripts)
                            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)




19 | P a g e
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
DEFENCE SCRIPT
                 Lloyds will charge the MoD directly later on.                                  paid. If it’s not clear give a NHS
                                                                                                receipt.

                 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
                 directly).
                 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.
                 Cerazette
                 Femulen
                 Micronor
                 Norgeston
                 Noriday


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
HORMONAL
                                                                                                  - 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)
                                                                antifungals
                                                                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,
                                                                refer




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




21 | P a g e
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
                   benzalkonium 6%
                   triclosan 2%
                   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


                                                    Creams
                   benzalkonium chloride 0.1%              conotrane
                   dimeticone 350 22%
                   dimeticone 20%                          vasogen
                   calamine 1.5%
                   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
                   chlorhexidine
                   isopropyl myristate
                   liquid paraffin


                                                 Haemorrhoidals
                   cinchocaine                             Proctosedyl / Uniroid-HC
                                                           ointment or suppository
                   hydrocortisone
                   cinchocaine                             Scheriproct
                   prednisolone
                   hydrocortisone 0.275%                   Xyloproct (in fridge)
                   lidocaine 5%




                                                                                      22 | P a g e
                                             Eye drops                      20 drops in approx 1ml
               bimatoprost                             Lumigan
               dorzolamide                             Trusopt
               hypromellose 0.3%                       Tears Naturale
               dextran ‘70’ 0.1%
               timolol                                 Ganfort
               bimatoprost
               timolol                                 Combigan
               brimonidine
               timolol                                 Azarga
               brinzolamide
               timolol                                 DuoTrav
               travaprost


                                              Insulin
               insulin aspart                          NovoRapid
               insulin lispro                          Humalog
               soluble insulin prb                     Humulin S
               soluble insulin pyr                     Actrapid
               insulin lispro                          Humalog Mix
               insulin protamine
               soluble insulin prb                     Humulin M3
               isophane
               soluble insulin pyr                     Mixtard
               isophane


                                              Liquids
               sodium alginate 1000mg                  Gaviscon Advance
               potassium bicarbonate 200mg
               sodium alginate 500mg                   Gaviscon Relief
               sodium bicarbonate 267mg


                                               Pills
               desogestrel150mcg                       Mercilon
               ethinylestradiol20mcg
               desogestrel 150mcg                      Marvelon
               ethinylestradiol 30mcg
               gestodene 75mcg                         Femodene / ED
               ethinylestradiol 30/35mcg
               levonorgestrel150mcg                    Microgynon 30
               ethinylestradiol 30mcg
               norethisterone 1mg                      Loestrin 20/30
               ethinylestradiol 20/30mcg
               norgestimate 250mcg                     Cilest
               ethinylestradiol 35mcg
               desogestrel 75mcg                       Cerazette
               norethisterone 350mcg                   Micronor / Noriday




23 | P a g e
                                             Dressings
            knitted viscose primary                 N-A dressing
                                                    N-A ultra
                                                    profore
            paraffin gauze                          paranet
                                                    jelonet
            knitted polyester with triglycerides    atrauman
            absorbent perforated with adhesive      cosmopor E
                                                    mepore
            absorbent perforated plastic film       melolin
            vapour permeable adhesive film          mepore film
                                                    tegaderm
            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
            polyurethane foam
            as above plus adhesive border           mepilex border
            thin absorbent soft silicone with       mepilex lite
            polyurethane foam
            as above but plus adhesive border       mepilex border lite
            non-adherent soft polymer with          urgotul duo
            absorbent pad
            as above plus adhesive border           urgotul duo border
            semi-permeable hydrocolloid             duoderm extra thin
            hydrocolloid plastic foam, semi-        granuflex
            permeable polyurethane
            as above with adhesive border           granuflex bordered
            hydrocolloid                            tegaderm
            hydrocolloid fibres in soft non-woven   aquacel
            pad
            polyurethane foam film                  allevyn range
                                                    biatin range
                                                    tegaderm range
                                                    tielle range
            calcium alginate                        sorbsan

UK TO USA                   UK name                                US name
            Aciclovir                               Acyclovir
            Azapropazone                            Apazone
            Benzylpenicillin                        Penicillin G
            Chlormethine (mustine)                  Mechlorethamine
            Ciclosporin                             Cyclosporine
            Colestyramine                           Cholestyramine
            Desferrioxamine                         Deferoxamine
            Dexamfetamine                           Dextroamphetamine
            Dextropropoxyphene                      Propoxyphene
            Dicycloverine                           Dicyclomine
            Dithranol                               Anthralin
            Ergometrine                             Ergonovine
            Folinic acid/ calcium folinate          Leucovorin/ leucovorin calcium
            Glibenclamide                           Glyburide
            Glutaraldehyde                          Glutaral
            Hyoscine                                Scopolamine
            Isoprenaline                            Isoproterenol
            Liquid paraffin                         Mineral oil
            macrogol                                Polyethylene glycol 3350
            Mepacrine                               Quinacrine
            Mesalazine                              Mesalamine
            Nicotinamide                            Niacinamide


                                                                                     24 | P a g e
               Nicotinic acid                    Niacin
               Norethisterone                    Norethindrone
               Orciprenaline                     Metaproterenol
               Pancreatin                        Creon
               Paracetamol                       Acetaminophen
               Pethidine                         Meperidine
               Phytomenadione                    Phytonadione
               Pizotifen                         Pizotyline
               Rifampicin                        Rifampin
               Salbutamol                        Albuterol
               Senna                             Sennosides
               Sodium aurothiomalate             Gold sodium thiomalate
               Sodium cromoglicate               Cromolyn sodium
               Sulfadimidine                     Sulfamethazine
               Suxamethonium                     Succinylcholine
               Tetracosactide (tetracosactrin)   Cosyntropin
               Torasemide                        Torsemide




25 | P a g e
26 | P a g e

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:22
posted:9/16/2012
language:Unknown
pages:27