Pharmacist only medicines

Question 1

Kenalog - Contraindications/ cautions; alternatives when not appropriate

Lifestyle advice

Answer 1

Contraindicated in untreated oral infections e.g. thrush; hypersensitivity to corticosteroids; avoid in pregnancy

cautions- people with tuberculosis, diabetes, peptic ulcers should consult doctor

alternatives - orabase, bonjela

Lifestyle advice - avoid eating very hot or spicy food, if symptoms do not improve after a week see the doctor

Question 2

Mouth ulcers - when to refer

Answer 2

immunocompromised patients, smokers, ulcers lasting longer than 4 weeks, ulcer is not painful, frequent ulcers

Question 3

Mouth ulcers - causes

Answer 3

biting the inside of your cheek

eating very hot food and burning the gum

injury from a toothbrush (slipping while brushing)

reaction to medication

Question 4

Gastrosoothe - contraindications/cautions and alternatives

Lifestyle advice

Answer 4

contraindicated in chronic muscle disorders, GI obstruction, enlarged prostate, urinary retention, narrow angle glaucoma; avoid in pregnancy/breastfeeding and children

caution in elderly and children, cardiac disease, GI disorders

Alternatives - heat packs, chamomile tea

Lifestyle advice - if cramping gets worse or other symptoms appear e.g. diarrhoea, vomiting, bleeding - see the doctor; heat packs can provide relief; avoid eating until you start to feel better

Question 5

Gastrosoothe - when to refer

Answer 5

pain is more of a sharp pain than general discomfort

person is pregnant, child, other medical conditions

Question 6

Stomach cramps - causes

Answer 6

exercise

gas

dehydration from diarrhoea, vomiting

Question 7

Sumatriptan - contraindications/cautions

Answer 7

contraindicated in MAOI use within 14 days, heart disease; avoid in pregnancy and breastfeeding

caution in high BP, elderly, history of seizures

Question 8

sumatriptan - when to refer

Answer 8

migraine attacks are frequent

patient is under 18 or over 65

patient complains of double vision, tinnitus, weakness in eye muscles

Question 9

Chloramphenicol - contraindictations/cautions

Answer 9

not for use in children under 2 years, safe in pregnancy, not recommended in breastfeeding

Question 10

Chloramphenicol - when to refer

Answer 10

sensitivity to light

changes in vision

rash on face associated with eye symptoms

Question 11

Unisom - contraindications/cautions

Answer 11

children under 12, acute asthma, glaucoma, prostate problems, antidepressants

safe in pregnancy, avoid in breastfeeding

Question 12

Fluconazole - contraindications/cautions

Interactions

Answer 12

contraindicated in acute porphyria (liver disorder),, pregnancy, children under 16

interactions - medicines that prolong QT interval e.g. domperidone, ondansetron, amiodarone; citalopram, clopidogrel

Warn patient about rash - refer to doctor

Question 13

Hydrocortisone - contraindications/cautions

Answer 13

not safe in pregnancy, limited data in breastfeeding

contraindicated in skin infections, acne, ulcerations

Question 14

Hydrocortisone - lifestyle advice

Answer 14

contact doctor if you have any changes in vision

if no improvement after a week, see doctor

Question 15

Promethazine - contraindications/cautions

Interactions

Answer 15

safe in pregnancy, limited data in breastfeeding (probably safe)

contraindicated with MAOI use, CNS depression; avoid in children under 2

Interactions - with drugs that may prolong QT interval e.g. amiodarone, domperidone, ondansetron