POM to P Flashcards
What is the Tranxemic acid indication restriction to sell as P?
menorrhoea heavy menstrual bleeding for 18 to 45 years old, with regular 21 to 35 days cycles, of no more than 3 days variation in duration.
What patient groups need to be referred when selling tranxemic acid as P?
And patients who consume which drugs?
breastfeeding obese diabetes polycystic ovary endometric cancer in first degree relative
if tried 3 cycles tranexamic with no improvement
beyond 18-45yo
symptoms to be concerned for referral:
1) endometrial cancer: bleeding in between periods, prolonged period, irregular/abnormal bleeding
2) cervical cancer: painful intercourse, bleeding after intercourse, bleeding between periods, bleeding after menopause.
What is the dose for tranexamic acid to sell P?
500mg tablets: 2t tds (max qid) for max 4 consecutive days)
tranexamic acid is CONTRA in which patient group and drugs, refer?
Haematuria (blood in urine)
Irregular menstrual bleeding
Renal
CLOT: thromboembolic disease or family Hx
convulsions Hx
warfarin or other anticoagulants oral contraceptives unopposed oestrogen and tamoxifen fibrinolytic drugs: ALTEPLASE STREPTOKINASE TENECTEPLASE UROKINASE
Side effects of tranexamic acid?
Gastrointestinal discomfort,
nausea, vomiting and diarrhoea are common, however reducing the dose will resolve these adverse effects.
visual disturbances- stop taking the tablets and to see their doctor.
allergic skin reactions (uncommon) thromboembolic events (frequency unknown).
Which side effect in tranexamic acid would require withdrawal?
disturbance of colour vision (SPC Menstralite)
What are the overdose symptoms for tranexamic acid?
Nausea, vomiting, postural hypotension=orthostatic hypotension.
Treatment for tranexamic overdose?
induce vomiting, gastric lavage, charcoal
anticoagulant (tranexamic stops bleed so cause too much fibrin to stay)
fluid to promote renal excretion
Drug interactions that may occur with tranexamic acid?
Anticoagulants — increased risk of thrombosis.
Oral contraceptives — increased risk of thrombosis.
Chlorpromazine — increased risk of bleeding.
(CKS)
What are the 3 criteria to supply sumatriptan 50mg as P? (Migraitan 50mg)
1) Migraine diagnosed by doctor or pharmacist.
2) history of migraine at least 5 migraines over at least 1 year
3) simple analgesic ineffective
What medications are contraindicated to sumatriptan?
Antidepressants of all sorts:
TCA, SSRI, SNRI, MAOI
5HT agonists: triptans
ergotamines (for headache)
buprenorphine/naloxone may result in serotonin syndrome
precaution if ORAL CONTRACEPTIVES increased risk of stroke
What are the referral points for sumatriptan?
heart diseases risk (high cholesterol, high blood pressure, diabetes, smoking)
beyond 18-65yo, or >50yo first time migraine
>4 attack in a month
headache lasted over 24 hours
symptoms changed
pregnancy and breastfeeding
renal, hepatic
HTN, IHD, angina, arrythmia
hx of: stroke, MI, seizure
NOT FOR PROPHYLATIC USE
Migraine together with what symptoms need referral? (suggest rare variant mirgraine)
Migraine with: headache with rash -(Basilar mirgraine) tinnitus double vision clumsy/un-coordinated, reduce consciousness (Hemiplegic migraine) unilateral motor weakness (Opthalmoplegic migraine) affect eye movement
cross sensitivity to sumatriptan?
sulfonamides: Thiosulfil Forte), sulfamethoxazole (Gantanol), sulfasalazine (Azulfidine), sulfisoxazole (Gantrisin),
how to counsel someone to take sumatriptan?
50mg stat after migraine, response should be within 30min. if symptoms recur, must be at least 2 hours before taking another 50mg tablet. no more than 2 tablets in 24h. if no response with first dose, do not take another dose. May cause drowsiness.
What side effects to tell a patient taking sumtriptan?
Following administration, sumatriptan can be associated with transient symptoms including chest pain and tightness that may be intense and involve the throat (see Section 4.8). Typically, such symptoms develop within 30 minutes of treatment and last for less than 2 hours. Where such symptoms are thought to indicate ischaemic heart disease, medical evaluation should be obtained immediately and no further doses of Sumibril/Migraitan should be taken until considered appropriate by a doctor.
Common side effects of sumatriptan:
Common (tens, within dentistry class):
CNS: drowsy, dizzy, sensory disturbance including paraesthesia and hypoaesthesia
Vascular: Flushing
Resp: Dyspnoa ( SOB= difficulty breathing)
INTENSE within 30min chest and throat:
Sensations of heaviness
Pain, sensations of heat or cold, pressure or tightness
Feelings of weakness, fatigue
What’s the age limit for chloramphenicol eye drops?
2yo and over
mechanism of action of chloramphenicol?
Chloramphenicol is a broad spectrum, bacteriostatic antibiotic which has activity against many types of Gram-positive and Gram-negative bacteria.
It exerts it’s antibacterial effect by binding to bacterial ribosomes and inhibiting bacterial protein synthesis.
Side effects of chloramphenicol?
stinging in the eye transiently
hypersensitivity: giant wheals; anaphylaxis, urticaria, fever, and vesicular and maculopapular dermatitis (characterised by bumps or blisters).
Bone marrow depression, anaemia recognised to reported very rarely in association with the topical administration of chloramphenicol.
CONTRA for chloramphenicol?
bone marrow problems and blood dyscrasias, such as aplastic anaemia.
Avoid concomitant administration with bone marrow depressant drugs.
when to discard the chloramphenicol eye drops or ointment?
Any remaining product should be discarded after the 5 day course of treatment.
When to refer conjunctivitis?
no improvement after how long?
other symptoms with it?
No improvement after 48 hours (rps)
concurrent rash or swelling on face or scalp
Symptoms for urgent A&E or eye hospital referral?
Cloudy, Unusual looking pupil
Affected vision, e.g. vision loss, reduced vision, blurred vision, double vision and halos around lights
Photophobia
Painful eye movements
Worsening symptoms despite chloramphenicol use
Contact lenses worn in the shower, or the eye with the contact lens in has come into possible contact with water
Eye surgery or laser treatment within the past 6 months
How long after choramphenicol use can a lenses wearer wear lenses again?
24 hours after chloramphenicol use, can use contact lense.
What strength Orlistat is P? 30mg 40mg 60mg 80mg 120mg 15mg
P is 60mg
POM is 120 tds
Age limit and weight limit for orlistat?
18+yo, no upper limit
weight BMI >28kg/m2
Orlistat needs to be taken apart from medicines as it affects absorption, which medicines are especially mentioned?
Refer to doctor: Antiepileptics narrow therapeutics_: ciclosporin, levothyroxine, Amiodarone warfarin, anticoagulants acarbose
Oral Contraceptives- reduce efficacy
Fat soluble vitamins (A,D,E and K) take at bedtime
Which co-morbidity require referral for orlistat?
hypertension
diabetes
cholesterol
as these will all improve with weight loss and medication requires adjustment in doses.
kidney disease
What the maximum duration of use for orlistat?
6 months
if not reach target 5% in 3 months, also stop
Patient forgot to take orlistat with her macdonalds, how long after she forgets can she still take it?
taken before, during or up to 1 hour of a main meal
What is the age restriction for tamsulosin P supply?
men aged 45 to 75
How long should the man have had LUTS symptoms for in order to supply Tamsulosin?
Symptoms of BPH present for a minimum of three months
