P Meds Flashcards
1
Q
What is amorolfine 5%?
A
A Topical antimtcotic (antifungal) agent
2
Q
License age of amorolfine?
A
Over 18
3
Q
How many infected nails need to be referred?
A
More than 2
4
Q
How long does it take for amorolfine to work?
A
9-12 months for toenails
6months for finger nails
5
Q
Dose of amorolfine?
A
Apply once a week
Before applying, file down the nail
6
Q
When to review amorolfine treatment?
A
Approximately in 3 months. If symptoms worsen or have not improved by then, referral to doctor or prescriber
7
Q
Additional counselling points on amorolfine?
A
Wear impermeable gloves
Do Not use any nail vanish or artificial nails
Keep nails short and filed down
8
Q
When to refer pts for amorolfine?
A
Under 18 Preganacy and lactation Diabetes Immunocompromisrd More than 2 infected nails
9
Q
Chloramphenicol eye drops strength and ointment?
A
Drops = 0.5% Ointment = 1%
10
Q
Symptoms of conjunctivitis?
A
- Yellow purulent discharge and eyelids stuck together in the morning
- Swelling of the eyelids
- Irritated, itchy, red or watery eye and/or burning or gritty sensation in eye
11
Q
Dose of chloramphenicol eye drops?
A
1 drop into the eye every 2hrs for the first 48hrs then decrease dose to every 4hrs
Total of 5 days treatment
But if no improvement within 2 days, refer
12
Q
Dose of chloramphenicol ointment?
A
Apply approximately 1cm of ointment between the lower eyelid and the eye TDS to QDS
13
Q
When to refer pts when selling chloramphenicol?
A
Under 2 Using bone marrow depressant drugs Eye pain Glaucoma Recent eye infection Pregnancy and bf
14
Q
When to refer pts urgently when selling chloramphenicol?
A
Contact lens wearer (tends to be a different bacteria causing the infection so urgent referral) esp if came into contact with water
Clody looking eye Unusual pupil Affected vision Ohotophobia Eye surgery or laser treatment within the last 6 months
15
Q
Advice for contact lens wearer who are using chloramphenicol?
A
Don’t wear whilst using or for at least 24hrs after use
Don’t reuse old contact lens
Replace containers
16
Q
What’s the strength of ulpristal acetate?
A
30mg
17
Q
What’s the strength of levonorgestrel?
A
1500mcg
18
Q
Licensing age of levonorgestrel?
A
Over 16s
19
Q
What to do if pts wants levonorgestrel but is also taking enzyme inducers?
A
First refer for an IUD if can’t
Give 2 tabs
20
Q
Levonorgestrel is less effective in pts?
A
Who are over 70jg or with a BMI of over 26
Pts need to be informed of the risk
21
Q
What to do if pt wants ulpristal but also takes enzyme inducers?
A
Refer
22
Q
Administration advice on ulpristal and levonorgestrel?
A
If vomiting occurs within 3hrs, another tab should be taken as soon as possiblr
Both can be taken with food or without at any point in the Menstural cycle
With levonorgestrel, pts can take more than 1 tab within the same menstrual cycle but should be advice about possible cycle disruption
23
Q
Which condition needs to be referred when selling ulpristal?
A
Severe liver impairment
Severe asthma who are in oral glucocorticoid
24
Q
Which condition needs to be referred when selling levonorgestrel?
A
Severe liver dysfunction
Pts at risk of ectopic pregnancy
Severe malabsorption syndrome
25
Breast feeding advice and ulpristal?
Not recommend for a week after taking the dose
26
Breast feeding advice and levonorgestrel?
Appears in the milk but not harmful
| Just try to take the dose after giving BF
27
Contraception advice and ulpristal?
Can reduce the efficcacy of of COC and progesterone only contraception
The efficacy of ulpristal can be also reduced by progesterone
Restart progesterone containing contraception 5 days after dose and use a barrier method till then
28
Contraception and levonorgestrel?
Continue regular contraception
29
What age can you sell mometasone 0.05% nasal spray?
18 plus
30
How long can you use mometasone nasal spray?
Up to 3 months treatment
31
Indication of mometasone nasal spray?
For the treatment of the symptoms of seasonal hay fever or perennial allergic rhinitis for over 18
32
Dose of mometasone nasal spray?
2 sprays into each nostril od until symptoms are controlled, then one spray into each nostril daily
33
Direction for use of mometasone nasal spray?
Shake container well before use
Prime the spray (pump the spray 10 times until a fine mist is obtained, reprime with 2 sprays if the pump has not been used for 14 days)
Blow nose gently
Breath in slowly through nose, breath out through mouth
Wipe the nozzle with a clean tissue
34
When to discard mometasone nasal spray?
After 2 months of first opening
35
Common side effects of mometasone nasal spray
Nose bleed (epistaxis)
Headache
Pharyngitis
URTI
36
When to refer pts when selling mometasone nasal spray?
```
Nose infection
Recent nasal surgery ot trauma
No improvement within 14 days
Symptoms persist more than 3 months
Under 18
```
37
What's first line for teething?
Non pharmaceutical option, gentle running of the gum with a clean finger and allowing the child to bite on a clean and cool object
38
Second line for teething?
Paracetamol or ibuprofen
Lidocaine containing teething gel
39
How to apply Lidocaine containing teething gels?
Apply a pea sized blob to a clean fingertip and spread gently into the sore area of the gum. If necessary, repeat dose after 3hrs.
Max 6times/day
40
Orlistat p med dose?
60mg
41
Orlistat licensing age?
18 plus who are overweight or obese (BMI over 28)
42
What diet is advised when taking orlistat?
A lower fat, mildly hypocaloric diet to aid weight loss and minimise GI side effect
43
Who to refer when selling orlistat?
Pt taking antidiabetic meds esp acarbose
Pts taking antihypertensive meds
Pts taking anti Hypercholestrrolaemia meds
Pts taking amiodarone
Pts taking levothyroxine
Pts taking anti epileptic drugs (increased risk of convulsion when Co administered)
Pts who were unable to lose weight after 12 wks
Pts who experience rectal bleeding
Pts with kidney disease
44
Orlistat treatment duration?
Should not exceed 6 months
45
What to do when salleing orlistat?
Always check the pts BMI
46
Mode of action of orlistat?
Lonf acting inhibitor of GI lipase, blocks the absorption
47
Dose of orlistat?
120 mg up to 3 times a day, dose to be taken immediately before, during, or up to 1 hour after each main meal
48
How to take orlistat?
Take with water immediately before, during it up to one hour after each mean
If a meal doesn't contain fat, omit dose
49
When to refer pts when selling orlistat?
Pts taking ciclosporin or warfarin
Pt has chronic malabsorption sgndorme
Cholestasis
Preganant or bf
50
Interaction of orlistat?
Reduces oral contraception
Impairs absorption if fat soluble vitamins (A, D, E & K) so take multivitamin supplements at bedtime
51
Side effects of orlistat?
Oily leakage from rectum
Flatulence
Faecal urgency
Fatty oily stools
52
Which PPIs are available as OTC?
Omeprazole 10mg tavs
| Pantoprazole 20mg
53
Mode of action of PPI?
Inhibits gastric acid secretion by blocking the hydrogen potassium adenosine triphophatase enzyme system
54
Dose of p omeprazole?
10mg OD
| Swallowed whole with plenty of water before a meal. Should not be crushed or chewed
55
Dose of P pantoprazole?
20mg OD
| Swallowed whole with plenty of water before a meal. Should not be chwed or crushed
56
Licensing age for P omeprazole and pamtoprazole?
Over 18
57
When to refer pt when seeing omeprazole pantoprazole?
If pts taking nelfinavir for omeprazole, atazanavir for pantoprazole
If symptoms do not improve after 2wks
Pts over 55 who present with these symptoms for the first time or worsened
Over 45s who experience recurrent
Pregnancy or bf
ALARM SYMPTOMS
58
MHRA warning on PPIs?
Very low risk of subacute cutaneous lupus eythematosus
| Lesions tend to develop in sun exposed area of the skin
59
Action time of PPIs?
Relief after a day or so and efficacy increases after 3 or 4 days
Pts requiring immediate relief may take Simple antacids or antacid alginate combo for fee days along side PPIs until it takes effect
60
Licensing age for sildenafil?
Plus 18
61
What drugs have the potential to cause erectile dysfunction?
```
Antihypertensive
Antidepressants
Antipsychotics
cytotoxics
Recreational drugs
Diuretics
Fibrates
H2 antagonists
```
62
Erectile drusfucntion life style advice?
Regular exercise
Reduction in body mass
Smoking cessation
Reduced alcohol consumption
63
Life style risk factors for erectile dysfunction?
```
Sedentary lifestyle
Obesity
Smoking
Alcohol use
Cycling
```
64
Dose of sildenafil?
50mg tabs taken with water approximately 1hr before sexual activity
Max is one 50mg/day
Taking it with food can delay effect
65
Referral when selling sildenafil?
Coadminsiteration with riociguat, ritonavir, nitrates (nicorandil)
Pts with CV disorders like recent stroke, MI, unstable angina, severe cardiac failure
Mild to moderate hepatic impairment
Hypotebtion
Anatomican deformity in penis
Under 18
Severe renal failure
66
Side effects of sildenafil?
```
Headache
Flushing
Nasal congestion
Dizziness
Visual disturbances
Priapism (prolonged and sometimes painful erections lasting longer than 4hrs)
Severe skin recation
```
67
What anti malaria are available as p Meds?
Maloff protect (Atovaquone 250mg with proguanil 100mg)
Avloclor (chloroquine 250mg)
Paludrine (proguanil 100mg)
Paludrine/avloclor antimalarial travel pack (proguanil 100mg/chloroquine 250mg)
68
Maloff licensing age and duration?
Plus 18
| For up to 12 months
69
Dose of maloff?
1OD starting 1-2 days prior to entering and continued 7 days after trip
70
Refer whne selling maloff?
```
Diagnosed renal/hepatic impairment
Under 18s
Preg and bf
If needing treatment more than 12 eks
Pts who weight less than 40jg
```
71
Missed dose advice on maloff?
Take as soon as remembered
| Don't take 2 doses at the same time
72
Supply criteria for sumatriptan?
Migraine must be diagnosed by doctor or pharmacist
Established pattern of migraine (a history of 5 or more migraine attacks occurring over a period of at least one Yr)
Simple analgesics tried and ineffective
73
Dose of sumatriptan ?
One 50mg should be taken as soon as possible after the migraine has started
A single dose should relieve symptoms after 30mins, if symptoms do not improve in this time no further doses should be taken for the same migraine attack
If there is a second migraine attack within 24hrs a second dose may be taken
74
Referral when selling sumatriptan if pt is taking what drugs?
```
Ergotamine
MAOIs
Other triptans
Tricyclic antidepressants
SSRIs /SNRIs
```
75
Patient characteristics of refferal when selling sumatriptan?
Risk of CV risk
Under 18 or over 65
Pregnancy or Bf
Seizures
76
Symptom history referral when selling sumatriptan?
Headaches lasting for over 24hrs
Symptoms have chnages
First migraine occurring after 50
Four or more attacks/month
77
Contraindications in sumatriptan?
Hepatic impairment
Renal impairment
Cardiovascular disorders Inc hypertention
78
Supply criteria for tamsulosin?
Male pts aged 45-75
| Symptoms of BPH present for a minimum of 3 months
79
Supply duration of tamsulosin?
A 2wk supply of tamsulosin initially
If there has been an improvement in urinary symptoms within the initial 2wks, a further supply of 4wks can be made
After 6wks, a further supply can be made only when the pt confirms with the doctor his diagnosis
80
Dose of tamsulosin
400mcg to be taken after the same meal each day
81
Counselling points when selling tamsulosin?
See Dr within 6wks of starting the treatment
Have a clinical review with the doctor every 12 months
Sit down if any dizzinrss
May affect driving
82
Refer pts taking which drugs when selling tamsulosin?
Strong enzyme inhibitors like ketoconazole and eythromycin
Verapamil
Diclofenac
Warfarin
83
When to stop treatment with pt taking tamsulosin?
If no improvements after 14 days
84
What conditions need to be referred when selling tamsulosin?
```
Cloudy urine and fever
Postural hypotention
Heart, kidney, liver disease
Uncontrolled diabetes
Blurred cloudy vision
```
85
What's OTC trsnexamic acid licensed for?
Reduction of heavy Menstural bleeding over several cycles in women aged 18 plus with regular 21-35 day cycle, with no more than 3 days individual variabilities in cycle duration
86
Who to refer to a doctor when selling tranrxamic acid?
Under 18 and over 45
Pts who have been taking it for 3 Menstural cycle without a reduction jn bleeding
Bf
Obese or diabetic
PCOS
Pts taking tamoxifen or unopposed oestrogen
87
What heavy Menstural cycle considered as
Loss of 60-80ml or morr and affects women's physical, social and quality of life.
Iron deficiency anaemia = refer if this is the casr
88
Signs of endometrial cancer?
Irregular bleeding
Abnormal bleeding
Bleeding between periods
Prolonged periods
89
Sings and symptoms of cervical cancer?
Bleeding between periods
Pain during sex
Bleeding after sex
Bleeding after Menopause
90
How does tranexamic acid work?
Antifibrinolytic which inhibits fibrinolysis which subsequently increases clot formation and reduce blood loss
91
Dose of tranexamic acid?
Two 500mg TDS until symptoms are alleviated
| Take once bleeding has started
92
Max dose of tranexamic acid?
8 tabs a day (max 4g daily)
| Use if bleeding is very heavy
93
Tranexamic acid should not be taken for more than?
4 consecutive days
94
Do not supply tranexamic acid if?
```
Mild to moderate to severe renal imapirment
Active/previous thromboembolic disease
Haematuria
Irregular Menstural cycle
Pts taking warfarin, oral contraception
Pregnancy
History of convulsions
```
95
Side effects that prompt pt to see gp when taking tranexamic acid?
Visual disturbances
