POM TO P

Question 1

Amorolfine 5% nail lacquer

Answer 1

• mild fungal infection of the nail
• MAX two infected nails
• 18 years of age

Question 2

When should amorolfine not be supplied?

Answer 2

• Patient below 18 years old
• During pregnancy and breast-feeding
• Patients who have shown hypersensitivity to API

Question 3

Nail infection- referral?

Answer 3

• Patients with underlying conditions such as DM and immunosuppression

Question 4

Tranexamic acid- Indication?

Answer 4

menorrhagia over several cycles in women 18 and over with regular 21-35 day cycles with n more than 3 days variability in each cycle

Question 5

Tranexamic acid- referral?

Answer 5

• Women under 18 or over 45 years old
• pt taking tranexamic acid for 3 cycles without reduction in bleeding
• breast-feeding
• obese/ diabetic
• pt taking unopposed oestrogen or tamoxifen

Question 6

Tranexamic acid- MOA?

Answer 6

• Antifibrinolytic which inhibits fibrinolysis which increased clot formation and reduces blood loos.

Question 7

Tranexamic acid- usual dose?

Answer 7

• TWO 500mg tabs TDS (MAX 4g per day) until symptoms are alleviated. Start when heavy bleeding has started.
• Should NOT be taken for more than 4 consecutive days

Question 8

Tranexamic acid- when should it not be supplied?

Answer 8

• Mild- moderate renal insufficiency
• active thromboembolic disease
• Haematuria
• Irregular menstrual bleeding
• Pt taking warfarin or other anticoagulants
• Oral contraceptives
• Pregnancy
• history of convulsions

Question 9

Tranexamic acid- Side effects?

Answer 9

• GI discomfort e.g. n/v, diarrhea- reducing dose will resolve this
• Visual disturbances- stop taking !!!
• Skin allergies (uncommon)
• Thrombolic events ( freq unknown)

Question 10

Tranexamic acid- Interaction?

Answer 10

• counteract the thrombolytic effect of fibrinolytic agents such as alteplase, tenecteplase, reteplase.

Question 11

Tamsulosin- Supply criteria?

Answer 11

• male pt aged 45-75 years
• Symptoms of BPH present for min of 3 months
• 2 weeks of supply can be made initially
• if improvement further 4 weeks supply can be made
• After 6 weeks, doc needs to make a clinical assesment and approve further supply.

Question 12

Tamsulosin - Precaution for use?

Answer 12

• If pt has planned surgery for glaucoma/ cataract
• caution with strong and moderate CYP3A4 inhibitors (ketoconazole and erthromycin)
• enhanced hypotensive effects if taken antihypertensives

Question 13

Tamsulosin- Counselling points?

Answer 13

• ONE capsule to be taken after the same meal each day
• MR should be swallowed whole
• Pt should see their doctor within 6 weeks of starting treatment
• Clinical review every 12 months with their GP
• Advise Pt to sit/lie down if they experience dizziness/weakness
• Drowsiness or dizziness may affect driving

Question 14

Sumatriptan- Indication?

Answer 14

• 5-HT1- receptor agonist for acute relief of migraine attacks with or without aura as a 50mg tablet

Question 15

Sumatriptan- Supply criteria?

Answer 15

• Migraine must be diagnosed by a doctor or pharmacist
• established pattern of migraine ( 5 or more attacks over at least one year)
• Single analgesics tried and ineffective

Question 16

Sumatriptan- Precautions for use?

Answer 16

• SSRI/ SNRI
• St John’s wort (hypericum perforatum)
• Combined oral contraceptives
• Heart disease risk factors ( CI in pt that have 3 or more risk factors e.g. diabetes, high cholesterol levels, smoking/ use of NRT)

Question 17

Sumatriptan- Counselling points?

Answer 17

• ONE 50mg tablet asap after migraine has started
• swallow whole with water
• single dose should relieve symptoms after 30min. if symptoms do not improve this time no further doses should be taken for the same attack.
• if second migraine attack within 24 hr a second dose may be taken
• -drowsiness so avoid driving
• migraine diary to help identify triggers