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
