POM - P Switches/MHRA Alerts Flashcards
Amorolfine Nail Laquer
P Medicine
Indication: Mild Fungal Infections
Age: Over 18
Conditions: beneath tips + sides of the nail, only 2 nails can be infected in order to supply
Dose: Apply Once Weekly
Tx Length: 9-12 months (Toenails), 6 months (Fingernails)
Pharmacist to Review: every 3 months
DON’T SUPPLY:
- Pregnancy + Lactation
- Allergy
- Under 18s
- > 2 nails infected
REFER:
- Peripheral Circulatory Disorders
- Diabetes
- Immunosuppression
Anti-Malarials
Maloff Protect = P Medicine
4 Products Available as P Medicines
- Maloff Protect (only one with no resistance)
- Avlacor, Paludrine, Avaclor/Paludrine
Maloff Protect: Indication: prevention of malaria Age: Over 18 Conditions: > 40kg, up to 12 weeks Dose: 1OD, 1-2 days before travelling + 1 week after leaving
REFER:
- Taking Warfarin/DOACs
- Hx of Depression/Seizures
- Patients with TB
- Pregnant/Breastfeeding
Chloramphenicol Eye Drops 0.5% + Ointment 1%
P Medicine
Indication: Acute Bacterial Conjunctivitis
Age: Adults + Children > 2 years
Dose (Drops): 1 DR every TWO hours first 2 days, then 1 DR every 4 hours (during waking hours) for 5 days
Dose (Ointment Alone): 1cm TDS-QDS
Dose (Drops + Ointment): 1cm at night
DON’T SELL:
- Pregnant/Breastfeeding - Grey Baby Syndrome
- Under 2s
- Blood Dyscrasia
- Contact Lenses
REFER:
- Eye Pain, Swelling
- Glaucoma
Mometasone 0.05% Nasal Spray (Clarinaze)
P Medicine
Indication: hayfever/allergic rhinitis
Age: > 18 years
Duration: 3 months only
Dose: 2 SP One a Day until symptoms are controlled, then 1 SP
REFER:
- if symptoms don’t improve in 14 days
DON’T SELL:
- under 18
- longer than 3 months
- untreated infection around the nose e.g. herpes/nose surgery
Oral Lidocaine for Teething Children
GSL - P
Indication: Teething (AFTER non-pharmacological options) Max Pack Size: 10g Dose: 1 pea sized blob every 3 hours, max 6 times a day NOT authorised for teething: - Anbesol Adult Strength - Boots Mouth Ulcer Gel - Iglu/Iglu Rapid Relief Gel - Medijel
Orlistat (ALLI) - (P)
indicated for weight loss: 60mg Capsules TDS (to go alongside meals)
- 18 years old
- overweight/obese (>28 BMI)
- maximum 6 months treatment
REFER - meds essentially undergo less absorption
- diabetic meds
- antiepileptic meds
- hypertension/statins - dose adjustments might be needed
- no weight loss of 5% after 12 weeks
- amiodarone, levothyroxine
- contraception if diarrhoea!
Counselling:
- low-fat diets decrease the GI side effects from this medicine
- aim for 0.5-1kg per week
- fat soluble vitamins to be replaced - ACDEK
Tamsulosin
Indication: BPH
Age: 45-75 yers
Criteria:
- have to have had BPH symptoms for at least 3 months
- supply only 2 weeks to begin with, if improvement, 4 weeks of further supply
Referral:
- postural hypotension
- other alpha blockers
- no improvement after the 14 days (initial 2 week supply)
- after 6 weeks of treatment - need further supply from the Dr
Sumatriptan
Indication: migraines - can be diagnosed by doctor or pharmacist
Age: 18-65
Dose: 1 x 50mg tablet, ASAP after migraine has started, only take another dose in the 24 hours for a SEPARATE attack (not to repeat the dose like with prescribed doses)
Criteria:
- established pattern of migraines (previously had 5 attacks over a period of 1 year)
- tried simple analgesia
Referral:
- 4 or more attacks per month
- take serotonin drugs
- COC - contraindicated
- seizures, weakness, clumsy movements, tinnitus etc.
- 1st migraine after 50 years
- history of cardiac disease/arrrythmias/TIA, MIs
Sildenafil
Indication: Erectile Dysfunction
Age: 18+
Dose: 1 tab 1 hour prior to activity (max per day = 1 tab)
Referral
- CVD - MI/Stroke in past 6 months
- breathless/chest pain on exertion (/not fit for sex)
- concomitant alpha blocker tx
- on nitrates
- hypotension
- no symptoms of ED (cannot maintain an erection sufficient enough for sexual activity)
Desogestrel 75mcg (Hana/Lovima)
Lovima = Soya/Peanut Allergy !!!!
Indication: oral contraceptive (POP)
Age: to women of childbearing age incl. adolescents
Dose: 1 tab at the same time every day (missed pill > 12 hours)
Refer:
- blood clots/risk factors for clots
- undiagnosed vaginal bleeding
- suspected sex-steroid cancers
- PREGNANCY !
Advice OTC:
- start in day 1 for full protection
- day 2-5 onwards - use additional precautions for 7 days
- > 12 hours = missed pill, extra precautions for 7 days
- vomiting within 3-4 hours = follow missed pill rules
Proton Pump Inhibitors
Omeprazole 10
Pantoprazole 20
tabs - P
Indications: relief of acid reflex (regurgitation + heartburn)
Age: 18+
Dose: Omeprazole = 2 tabs OD, Pantoprazole 1 tab OD
Max Supply: 2 weeks
Refer:
- no improvement after 2 weeks
- over 55s with unexplained dyspepsia/other alarm features/first time symptoms
- over 4 weeks of heartburn remedies with no improvement
- over 45 and long term recurrent symptoms
Tranexamic Acid
Indications: heavy menstrual bleeding
Age: 18 - 45
Conditions: regular 21-35 day cycles, no more than 3 days in variability of the cycle
Dose: 2 x 500mg tabs TDS for 4 days maximum
Refer:
- tx failure = taking for 3 menstrual cycles and no reduction in bleeding
- obese/diabetic/PCOS/endometrial cancer
- taking other meds - anticoagulants, oral contraceptives etc
MHRA Update: AED Comprehensive Review in Pregnancy (2021)
Lamotrigine + Levetiracetam are relatively safe in pregnancy
Carbamazepine, Phenobarbital, Phenytoin + Topiramate are associated with major risk of congenital malformations
MHRA Update: COVID-Vaccines (2021)
adverse reactions to be reported through the Yellow Card App/Reporting Site
MHRA Update: SSRIs + Postpartum Haemorrhage (2021)
SSRI + SNRIs associated with increased risk of postpartum haemorrhage when used in the month before delivery
MHRA Update: Aminoglycosides + Mitochondrial Mutations
increased risk of deafness in patients with mitochondrial mutations
MHRA Update: Pregabalin + Respiratory Depression
reports of severe respiratory depression in those with
- compromised resp function
- respiratory/neurological disease
- renal impairment
- other CNS depressants
- older than 65
MHRA Update: Ulipristal Acetate 5mg (Uterine Fibroids dose)
risk of serious liver injury and hepatic failure with Esyma
MHRA Update: Acute Adrenal Insufficiency + Tablets/Granules in Children
risk of acute adrenal
insufficiency in children when switching from hydrocortisone tablet formulations to granules
MHRA Update: PEG laxatives + starch based thickeners
PEG in things like Macrogol counteracts the starch-based thickeners resulting in thin liquids, meaning those with dysphagia are at risk of fatal aspiration
MHRA Update: Levothyroxine + Switching Products
patients experiencing symptoms on switching between different levothyroxine products
MHRA Update: Chloramphenicol Eye Drops (Borax/Boric Acid) in Children < 2 years
CAN use these eye drops in these children as benefits outweigh the risks
MHRA Update: Topical Corticosteroids + Steroid Withdrawal Reactions
after long-term/inappropriate use of moderate-high potency - can get serious adverse effects on stopping
rebound flares can extend beyond the initial affected area
MHRA Update: Chloral Hydrate + Chloral Betaine restricted to 2 weeks treatment in children
in children with suspected/definite neurodevelopment disorders, treatment with chloral hydrate/betaine is restricted to 2 weeks for treatment of insomnia
MHRA Update: Yellow Fever Vaccine + checklist
there’s now a pre-vaccination checklist that’s standardised to better identify if it’s indicated/contraindicated
MHRA Update: Adrenaline Auto-Injectors
Emerged 300 + 500 - back on the market/for supply after correcting the failed devices that didn’t activate to deliver adrenaline
Carry TWO in-date pens at all times and replace them before they expire
MHRA Update: Haloperidol + Risks in Elderly
increased risk of adverse neurological + cardiac effects when used in elderly patients for the acute treatment of delirum
MHRA Update: Dapagliflozin NOT for Diabetes Type 1
NOT indicated for Type 1’s anymore - risk of DKAs which is known, but reviewed as Type 1’s are at higher risk of this than Type 2’s
MHRA Update (Feb 22): Hydroxychloroquine/Chloroquine + Macrolides
increased risk of cardiovascular events + mortality when given together (angina, chest pain etc)
be vigilant for psychiatric reactions associated with hydroxychloroquine/chloroquine
MHRA Update (March 22): Amiodarone - reminder of risks
Amiodarone has been associated with serious and potentially life-threatening side effects, particularly of the lung, liver, and thyroid gland.
STOP taking if:
- SOB
- yellowing of skin/eyes - liver
- any thyroid issues
- heartbeat is erratic/slow
- loss of eyesight
MHRA Update (March 22): Metformin in prengnancy is safe
The licence for metformin now reflects that it can be considered for use during pregnancy and the periconceptional phase as an addition or an alternative to insulin, if clinically needed.
MHRA Update (April 22): Pregabalin + risks during pregnancy
The review concluded that pregabalin use during the first trimester of pregnancy may cause a slightly increased risk of major congenital malformations in the unborn child.
