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pom to p Flashcards

1
Q

When can Amorolfine 5% nail lacquer (Curanail) be sold OTC?

A
  • Treatment of mild cases of distal and lateral subungual onychomycoses caused by dermatophytes, yeasts and moulds limited up to 2 nails.
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2
Q

Dose and directions for use for amorolfine 5% nail lacquer?

A

The nail lacquer should be applied to the affected finger or toe nails once weekly. Twice weekly application may prove beneficial in some cases.
Before the first application of Amorolfine , affected areas of nail (particularly the nail surfaces) should be filed down using the nail file supplied.
Before repeat application of Amorolfine, the affected nails should be filed down again. Treatment should be continued without interruption
until the nail is regenerated and the affected areas are finally cured. It takes at least six months (finger nails) and nine to twelve months (toe
nails) for the treatment. A review of the treatment is recommended every three months.

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3
Q

Considerations before OTC sale of amorolfine?

A
  • How many toes affected?
  • During the application of amorolfine no cosmetic nail lacquer or artificial nails shall be used.
  • Amorolfine should not be used during pregnancy and/or lactation unless clearly necessary
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4
Q

When should amorolfine OTC sale be refused?

A

<18 years age
- Patients with underlying conditions predisposing to fungal nail infections should be referred to a doctor. Such conditions include peripheral
circulatory disorders, diabetes mellitus, and immunosuppression.
- Patients with nail dystrophy and destroyed nail plate should be referred to their doctor.

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5
Q

When can azithromycin 500mg (Clamelle) be sold OTC?

A

Treatment of confirmed asymptomatic Chlamydia trachomatis genital infection in individuals aged 16 years and over and the epidemiological treatment of their sexual
partners(don’t need a test for these)

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6
Q

Dose and directions for use for azithromycin 500mg OTC?

A

A single 1g (2 x 500mg tablets) dose., It is not necessary to alter the dose in elderly.
Interaction with Antacids: In individuals receiving azithromycin and antacids, azithromycin should be taken at least 1 hour before or 2 hours after the antacid.

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7
Q

What considerations are there before supplying azithromycin OTC?

A
  • Vomiting: To reduce the risk of vomiting, advise the individual to take the dose before bed and at least 2hrs after food or drink.
  • Oral contraception: if vomiting or diarrhoea occurs whilst taking Clamelle 500mg tablets refer to the oral contraceptive’s instructions for measures to minimise the risk
    of contraception failure.
  • Diarrhoea/pseudomembranous colitis caused by Clostridium difficile has occurred. Due to this, patients with diarrhoea should be carefully monitored.
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8
Q

When should OTC azithromycin (clamelle) supply be refused?

A
  • Known hypersensitivity to azithromycin or any macrolide antibiotic, or any of the excipients .
  • If patient issuffering from a Symptomatic infection.
  • Symptomssuggestive of other STIs e.g. any unusual genital or anal swellings or lesions.
  • Children aged under 16 years.
  • Renal or hepatic impairment.
  • History of cardiac disease.
  • Individuals receiving ciclosporin, digoxin, ergotamine, terfenadine, theophylline, disopyramide, rifabutin and coumarin anticoagulant therapy, such as warfarin.
  • Individuals receiving azithromycin for treatment of other infections.
  • Pregnancy and breast feeding.
    • Clamelle 500mg tablets are contraindicated during pregnancy and lactation.
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9
Q

When can chloramphenicol 0.5% eyedrops/ 1% eye ointment be sold OTC?

A

Treatment of acute bacterial conjunctivitis in pts aged 2+

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10
Q

Dose and directions for use of chloramphenicol 0.5% drops/1% oint?

A
  • One drop in the infected eye every 2 hrs for the first 2 days then every 4 hrs for the next 3 days. Continue using drops even when symptoms improve up to 5 days of treatment.
  • For the ointment: 1cm of ointment to be applied to the affected eye 3-4 times a day.
  • store in fridge
  • throw away after 5 days use
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11
Q

Considerations before supplying OTC chloramphenicol?

A
  • Look out for disturbed vision, severe pain in the eye, photophobia, eye inflammation and associated rash on the scalp or the face. Cloudy eye, pupil looks unusual, suspected foreign body in the eye.
  • Has the patient had conjunctivitis in the RECENT past? glaucoma? Dry eye syndrome?, recent eye surgery/ laser treatment ?, eye injury ?, current use of eye drops/ointment ?, CONTACT LENSES?
  • If you supply to a patient who wears contact lenses, they cannot be worn during treatment and should leave a 24 hr gap after completion ofthe treatment.
  • Throw away infected eye makeup
  • Not recommended in pregnancy and lactation.
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12
Q

When should supply for OTC chloramphenicol be refused?

A
  • No to be used in hypersensitive patients, people who have had myelosupression during previous exposure to chloramphenicol, patients with
    history of blood dyscracias.
  • If patient has severe bacterial conjunctivitis topical use needs to be suplemented with systemic treatment; refer.
  • Patients on bone marrow suppressant drugs (Other chemicals/drugs known to cause bone marrow suppression include chloramphenicol, meclofenamic acid, phenylbutazone, quinidine, trimethoprim-sulfadiazine, albendazole and fenbendazole)
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13
Q

When can omeprazole 10mg (Zanprol) be sold OTC?

A
  • For short term relief of heartburn associated with acid reflux in adults 18+
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14
Q

Dose and directions for OTC omeprazole (zanprol)?

A

Two tablets once daily , if the symptoms improve the dose can be reduced to one 10mg tablet daily,. Use for maximum of 2 weeks treatment, if symptoms don’t improve refer. If the patient is needing it for more than 4 weeks then they should be referred to the doctor.

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15
Q

Considerations before supplying OTC omeprazole 10mg (zanprol)?

A
  • Caution in patients with medical conditions and in liver disease
  • PPIs can mask the symptoms of gastric cancer; Any patients who present with dyspepsia related conditions accompanied by bleeding, swallowing issues, recurrent vomiting or weight loss; these patients need to be ruled out of gastric malignancy before omeprazole is given.
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16
Q

When should supply of OTC omeprazole be refused?

A

<18
- Patientstaking indigestion remedies for 4 weeks+
- Patients over 45 who present with symptoms forthe first time and or those whose symptoms have recently changed AND 55+ with unexplained
dyspepsia (fullness, pain, nausea) THAT HAVE NOT RESPONDED TO TREATMENT. Patients 45+ with long term recurrent indigestion and heartburn
issues should be regularly reviewed by the GP. If they take regular daily heartburn remedies every day they should inform their doctor
- Pregnant and breastfeeding
- Interaction; diazepam, phenytoin, warfarin, itraconazole/ketoonazole, cilostazol, tacrolimus, voriconazole, digoxin
- Patients with long term symptoms of indigestion/ Heartburn
- Any swelling of the face, neck and tounge/throat would indicate allergic reaction and thus should be refered

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17
Q

OTC omeprazole counselling points?

A

May take a few days for it to work, immediate relief can be provided by antacid for a few days while omeprazole starts working. Lifestyle issues should also be flagged; avoid gastric irritants such as coffee,smoking, heavy meals,spicy food, fatty food, alcohol, SNAIDs.

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18
Q

When can esomeprazole 20mg (nexium) be sold OTC?

A

Short term treatment if reflux symptoms; heartburn and acid regurgitation in ADULTS

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19
Q

Dose and directions for esomeprazole 20mg OTC use?

A
  • One a day for up to 2 weeks. The effects might not be seen until 2-3 consecutive days of treatment. Once
    symptoms have relieved, treatment should be discontinued.
  • If no improvement after 2 weeks, refer
  • Very useful; tablets can be dispered in half a glass of non carbonated water, no other liquids should be used as the
    enteric coating can be affected. The water should be stirred until the tablet disintegrates and the liquid with the
    pelletes should be drug immediately/ within 30 minutes. Refill the glass with half a glass of water and re-drink.
    Don’t chew or crush the pellets.
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20
Q

Considerations before supplying OTC esomeprazole 20mg?

A
  • concomitant medication (same as omeprazole) –> Interaction; diazepam, phenytoin, warfarin, itraconazole/ketoonazole, cilostazol, tacrolimus, voriconazole, digoxin
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21
Q

When should supply of OTC esomeprazole be refused?

A
  • Pts on MTX, tacrolimus, phenytoin, warfarin, citalopram, imipramine, diazepam, protease inhibitors, clopidogrel.
  • Avoid in pregnancy, not to be given when breastfeeing
  • If patient is on another PPI or H2 antagonist concomittantly
  • If pt has previously had an allergic reaction to the drug
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22
Q

When can pantoprazole (Pantoloc) be sold OTC?

A

Indicated for short-term treatment of reflux symptoms (e.g. heartburn, acid regurgitation) in adults

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23
Q

Dose and directions for pantoprazole OTC use?

A
  • The recommended dose is 20 mg pantoprazole (one tablet) per day
  • The treatment should not exceed 4 weeks without consulting a doctor.
  • If no symptom relief is obtained within 2 weeks of continuous treatment, the patientshould be instructed to consult a doctor.
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24
Q

Considerations before supplying OTC pantoprazole?

A
  • Patientsshould not take another proton pump inhibitor or H2 antagonist concomitantly.
  • Patients may start to experience symptomatic relief after approximately one day of treatment with pantoprazole, but it might be
    necessary to take it for 7 days to achieve complete heartburn control.
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25
Q

When should pantoprazole OTC supply be refused?

A
  • Not recommended for use in children and adolescents below 18 years of age
  • Patients should be instructed to consult a doctor if: They have unintentional weight loss, anaemia, gastrointestinal bleeding,
    dysphagia, persistent vomiting or vomiting with blood, since it may alleviate symptoms and delay diagnosis of a severe
    condition. In these cases, malignancy should be excluded. They have had previous gastric ulcer or gastrointestinal surgery. They are on continuous symptomatic treatment of indigestion or heartburn for 4 or more weeks. They have jaundice, hepatic impairment, or liver disease. They are aged over 55 years with new or recently changed symptoms. long-term recurrent symptoms of indigestion or heartburn should see doc.
  • Especially, patients over 55 years taking any non-prescription indigestion
    or heartburn remedy daily.
    -, Pantoprazole should not be used during pregnancy. Pantoprazole should not be used during breast-feeding.
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26
Q

When can Orlistat be sold OTC?

A

Weight loss in adults 18+ who are overweight or obese (BMI> 28) in conjunction with a lower fat hypocaloric diet.

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27
Q

Dose and directions for Orlistat use?

A

60mg TDS, The capsule should be taken with water immediately before, during or up to 1 hr within each main meal. If the meal is missed OR contains no fat then
the dose should be omitted. No more than 3 caps in 24 hrs. max daily dose is 180mg. Patients are recommended to start a diet and exercise programme before
beginning treatment.

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28
Q

Considerations before supplying OTC orlistat?

A
  • Patient must be above 18 with a BMI greater than 28. Diet and exercise need to be used along side as it can only be used for 6 months. Must have BMI checked
    on each occasion
  • IMPORTANT; theoretical risk of reduced contraceptive cover. Asthe drug can reduce the bioavailability of the oral contraceptives and this can lead to unexpected
    pregnancy. Advise the use of an additional contraceptive method if they experience severe diarrhoea.
  • Vitamins(A,D,E,K) are fat soluble, hence reduced absorption when taking orlistat to reduce the likelihood of suffering from deficiency advise all users of orlistat
    to take a multivitamin at bedtime.
  • Side effects are horrible; GI related flatulence, oily leakage from rectum, feacal urgency, fatty ily stools. (less so if low fat diet used).
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29
Q

When should orlistat supply be refused ?

A
  • Diabetic patients
  • Amioadarone, levothyroxine, antiepileptics: increased risk of convulsions., acarbose, Cyclosporin, Anticoagsincludiong warfarin
  • Patients who have been using orlistat for 6 months/ If patient has been unable to lose weight after 1 year of orlistat
  • Kidney disease
  • Cannot use in chronic malabsorption syndrome
  • Cholestasis; when the flow of bile from the liver is blocked
  • Pregnant and breastfeeding
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30
Q

When can sumatriptan be sold OTC?

A
  • Indicated for the acute treatment of migraine attacks with or without aura; in adults 18-65
  • For OTC supply patietns need an established pattern of migraine (5+ migraine attacks in their medical history), the first attack should be longer than 12 months ago.
  • If the patient is 50+ or experiencing their first migraine attack they should see their GP, e- specially elderly , because it could be something more sinister.
  • Sumatriptan should be second line, patients should try analgesics or analgesics with a anti-emetic first .
31
Q

Dose and directions for use of OTC sumatriptan?

A
  • Single tablet assoon as the migraine starts. If the tablet works but after 2 hrs the headacche comes back you can take another one. Otherwise if the first tablet doesn’t work you cannot take another one. Cannot take prophylactically.
  • If four or more attacks a month they should be referred; the patient is still suitable for sumatriptan OTC but needs to see a doc for further evaluation.
32
Q

Considerations before supplying OTC sumatriptan?

A
  • Drowiness can be caused by the medicatiion; avoid driving
  • Excessive use of triptans can cause chronic daily headache
  • Caution men 40+, post menopausal women, , smokers 10+ a day, obese, diabetic, familial history of CVD.
33
Q

When should supply of OTC sumatriptan be refused?

A
  • Contraindicated in pts with history of CVD. Individuals with high CVD risk should not receive OTC sumatriptan. HTN patietns, MI, Peripheral vascular
    disease, vasospasms, arrhythmias, epilepsy/hisory of seizures, atypical migraine, histroy of cerebrovascular accident.
  • Women with migraine who are taking the COC: have an increased risk of stroke so refer if migraine is recent (ie within 3 months). OR if they have
    a worsening migraine attack or if they have migraine with an aura phase.
  • Cannot take any other concomitant triptan or ergotamine derivative
  • St johns wort, is contraindicated. MAOI’s (or if used within last 2 weeks due to long HL of MAOIs), pharmacodynamic interaction risk with ;p SSRI/
    TCA
34
Q

When can tamsulosin be supplied OTC?

A

Licensed indication; symptoms of BPH in males 45-75: symptoms include difficulty when starting urination , urinating more frequently or for longer,
needing to do so again shortly after urinating within a short period of time. Needing to get up to urinate several times a night.

35
Q

Dose and directions for OTC tamsulosin?

A

One 400mcg capsule swallowed whole after the same meal each day.

36
Q

Considerations before supplying OTC tamsulosin?

A
  • When you initially supply you only supply 2 weeks worth, if there has been improvement you can supply another further 4 weeks worth of treatment. If symptoms do not improve no furthersupply can be made .
  • Patients need to see their doctor within the first 6 weeks of starting treatment for a confirmation that they can continue taking OTC tamsulosin.
  • As a pharmacist you need to ensure that they have seen the GP within the time frame to continue supply. Also make sure the patient is seeing the doctor annually also for a review.
  • Patient must be between 45-75
  • Establish symptoms that are aligned with BPH
37
Q

When should OTC supply of tamsulosin be refused?

A

Symptoms that have been around for less than 3 months
• Prostate surgery patient
• Potenially undiagnosed diabetes
• Liver, kidney and heart problems
• Dizzyness, wekaness feinting when standing (postural hypotension)
• Cataract surgery planned / patient has blurred or cloudy vision that has not been seen by a GP or optician
• Don’t supply if patient is on the following medicines:
• Doxazosin, indoramin, prazosin, teraxosin, verapamil (ie those with significant alphablocking activity)
• Theoretical risk of hypotensive effect when tamsulosin given with blood pressure lowering drugs.
• Refer patients that have PAIN on urination in the last 3 months, fever that may be related to a urine infection, bloody or cloudy urine in last 3 months, leaking urine
(incontinence)

38
Q

Tamsulosin lifestyle advice?

A 
Lifestyle advice: avoid drinking 1-2 hours
before going to bed, reduce alcohol and
caffeine consumption, avoid constipation
(as constipation can put pressure on the
bladder). Avoid unnecessary use of
decongestants and antihistamines as
these can reduce symptoms.
39
Q

When can tranexamic acid (Cyclo F) be supplied OTC?

A

Available OTC for the relief of heavy menstrual bleeding OVER SEVERAL CYCLES in women aged 18 and overwith REGULAR 21-35 DAY CYCLES, with no more than 3 days individual variability in cycle duration .

40
Q

Dose and directions for use of OTC tranexamic acid?

A
  • Two 500mg tablets TDS when bleeding has started, until symptoms are aleviated. It wont work prophylactically therefore only use at start.. Should not be used for longer than 4 days consecutively
  • If menstrual bleeding is heavy the dose should be increased to a max of 8 tabs a day. Can use if periods remain regular and heavy.
41
Q

Considerations before supplying tranexamic acid?

A

What is heavy bleeding: other symptoms?

42
Q

When should OTC supply of tranexamic acid be refused?

A

<18 or 45+

  • Patients taking tranexamic acid for 3 cycles with no reduction in bleeding
  • Breastfeeding women/Pregnancy
  • Polycystitic ovary syndrome history of endometrial cancer in a first degree relative,
  • Women taking tamoxifen or oestrogen
  • Paients taking medicines which interact: anticoagulants, oral contraceptives
  • Renal impairment
  • ACTIVE THROMOBOEMBOLIC DISEASE, OR FAMILIAL THROMBOBLIC DISEASE HISTORY/ EVENT, HISTORY OF THROMBOPHILIA
  • Hematuria, irregular menstrual bleeding, patients on warfarin and other anticoags
43
Q

When can levonelle one step be supplied OTC?

A

For emergency contraception within 72hrs of unprotected sex/failure of a contraceptive method for patients 16+

44
Q

Dose and directions for use of OTC levonelle?

A

Take one tablet as soon as possible, if the patient vomits in the first three hoursthen they need to take another tablet. May be used at any point in the menstrual
cycle unless BLEED IS OVERDUE.Use a barrier method until the next period starts. The use of levonelle does not contraindicate the use ofregular hormonal contraception.

45
Q

Considerations before supplying OTC levonelle?

A
  • Don’t replace regular contraceptive methods with this, it doest work 100% of the time
  • If pt has had unprotected sex previously in the cycle no guarantee it will work. If period is delayed more than 5 days or abnormal bleeding has occurred at date of expected period; exclude pregnancy.
  • Ectopic pregnancies can occur with levonelle one stop, these can still occur despite presence of uterine bleeding.
  • Don’t recommend levonelle to patietns with risk of ectopic pregnancy.
46
Q

When should supply be refused?

A
  • Risk of ectopic pregnancy
  • Hepatic dysfunction, Metabolism enhanced by liver enzyme inducers
    Malabsorption syndromes; crohns can impair efficary
  • Repeated admin in once cycle is not recommended as it can disturb the cycle.
  • Drugs that can REDUCE EFFICACY; barbiturates, phenytoin, carbamaepine, herbal medicines with hypericum perforatum (st johns wort), rifampicin,ritonavitr, grisefulvin. Levonelle can increase risk of ciclosporin toxicity.lactose containing formulation therefore patietn with issues with; galactose intollerance, lapp lactase deficiency, glucose-galactose malabsorption whould
    not take this medicine
  • Avoid in pregnant women
47
Q

Other levonelle contraindications?

A
  • Menstrual periods are usually normal after levonelle but may occur earlier or later by a few days.If no withdrawal bleed occurs at the next pill free period following use of levonelle after regular hormonal contraception, rule out pregnancy.
  • Breast feeding mothers; these should take levonelle straight after a feed then keep a 8 hour break of breast feeding because it is secreted into the breast milk..
  • May increase possibility of cycle disturbances and thus hasthe potential to change the ovulation date and the potentialto modify fertility date.
48
Q

EllaOne OTC use?

A

Emergency contraception within 120 hours of unprotexted sex or contraceptive failure

49
Q

EllaOne dose and directions?

A

Take one tablet ASAP , it can be taken at any time during the cycle, if the patient vomitsthen they need to take another one. If a womans period is late, symptioms of pregnancy; exclude pregnancy
before you admin ellaOne.

50
Q

Considerations before supplying EllaOne?

A

Do not supply during severe hepatic impairment
• Not intended for use during pregnancy; however it wont interupt preg if taken
• If the menstrual period is more than 7 days late, abnormal in character or symptoms suggesting preg→ do a test
• Possibility of ectopic pregnancy; this may even be present if the patient has had uterine bleeding.
• EllaOne inhibits or postpones ovulation; if it has already occurred then it wont work therfore take it as soon as possible after sex
• After EllaOne periods can occur a few days earlier or later than expected
• DON’T USE LEVONELLE AND ELLA ONE AT THE SAME TIME
• After using Ella one in one cycle it doesn’t mean you are covered for the rest of the cycle; use barrier
• Ella one can reduce contraceptive action of other regular hormonal contraceptives; therfore if u continue using the regular hormonal contraceptive in the cycle be advised to use a reliable barrier.
• CYP3A4 inducers contraindicated as it reduces efficacy; Rifampicin, Phenytoin, Phenobarbital, Carbemaxepine, St john, long term RITonavir
• Don’t use in women with severe asthma treated by oral glucocorticoids
• Contains lactose; avoid in galactose intollerace, lapp lactase deficiency or glucose, galactose malabsorption.
• Interseting point about ritonavir is that it inhibits cyp enzymes normally but long term starts to induce them: therfore not recommended for concomittant use. ALSO ENZYME INDUCTION IS SLOW SO
EVEN IF THE WOMAN HAS STOPPED THE INDUCER WITHIN LAST 2-3 WEEKS THE EFFECTS ON ELLA ONE MAY STILL OCCUR.
• DO NOT USE WHILST BREAST FEEDING AS IT IS EXCRETED INTO BREAST MILK; AFTER TAKING ELLAONE OMIT BREASTFEEDING FOR ONE WEEK. Also it is recommended to express the breast milk, then
discard to stimulate lactation.
• Rapid return of fertility occurs aftrer ellaone therfore use barrier straight after for subsequent sexuaql acts.
• Can cause mild to moderate dizzyness and patietnsshould be advised not to drive if this occurs.

51
Q

Migraleve licensed indication for OTC use?

A

Licensed indication: For the short term treatment of acute moderate pain which is not relieved by Paracetamol,
ibuprofen or aspirin alone such as migraine attacks including the symptoms of migraine headache, nausea and vomiting.
Codeine is indicated in children older than 12 years of age for the treatment of acute moderate pain which is not
considered to be relieved by other analgesics such as paracetamol or ibuprofen (alone).

52
Q

Migraleve OTC dose and directions?

A

Dose and direction for use Adults and Children 15 years and over: Two Migraleve Pink tablets to be swallowed
immediately as it is known that a migraine attack has started or is imminent. If further treatment is required, two Migraleve
Yellow tablets every 4 hours. Maximum dose: 8 tablets (two Migraleve Pink and six Migraleve Yellow) in 24 hours.

Children 12 - 14 years: One Migraleve Pink tablet to be swallowed immediately it is known that a migraine attack has
started or is imminent. If further treatment is required, one Migraleve Yellow tablet every 4 hours.
Maximum dose: 4 tablets (one Migraleve Pink and three Migraleve Yellow) in 24 hours.

Children aged less than 12 years: Codeine should not be used in children below the age of 12 years because of the risk of
opioid toxicity due to the variable and unpredictable metabolism of codeine to morphine (see sections 4.3 and 4.4).
uration of treatment should be limited to 3 days if no effective pain relief is achieved the patients/carers should be
advised to seek the views of a physician.

53
Q

Considerations before migraleve OTC supply?

A
  • Can cause addiction.
    • For three days use only.
    • This medicine can make you feel sleepy. Do not drive while taking this medicine until you know how it makes you feel. See the
    leaflet inside for more information.
    • Migraleve is for use in acute moderate pain associated with migraine which has been previously diagnosed by a doctor and
    where other painkillers have not worked. Do not take lessthan four hours after taking other painkillers.
    • If you need to take it for longer than three days you should see your doctor or pharmacist for advice. If you take this medicine
    for headaches for more than three days it can make them worse.
    • Migraine should be medically diagnosed
54
Q

When should migraleve be refused?

A

In all paediatric patients (0 to 18 years of age) who undergo tonsillectomy and/or adenoidectomy for Obstructive Sleep
Apnoea Syndrome due to an increased risk of developing serious and life-threatening adverse reactions
• breastfeeding.
• patients for whom it is known they are CYP2D6 ultra-rapid metabolisers.

55
Q

Feminax express (ibuprofen 342) OTC use?

A

Rheumatic or muscular pain, backache,
neuralgia, migraine, headache, dental pain,
dysmenorrhoea, feverishness, symptoms of
colds and influenza.

56
Q

Dose and directions for feminax express use?

A

Short term use 1-2 tablets with water TDS. If the
product is needed for more than 10 days see
doc.
• Not suitable for under 12’s

57
Q

Considerations before supplying feminax express (ibuprofen)/ when should supply be refused?

A

Asthma, history of peptic ulcer, bleeding sever
hepatic/renal failure. Not suitable in the last
trimester of preganacy
• Don’t take if taking other NSAIDs

58
Q

Feminax Ultra (naproxen 250mg) OTC use?

A

Licensed indication:indicated for the treatment of primary dysmenorrhoea in women aged 15 to 50 years.

59
Q

Dose and directions for use for feminax ultra (naproxen 250mg)?

A

2 tabs initially then 1 after 6-8 hrs if needed. Then afterthat on second third days one tablet every 6-8 hours. No more than 3 tabs per day.
Maximum use for 3 days treatmetn Take with food

60
Q

When should feminax ultra supply be refused?

A

If history of active or previous history of peptic ulcer or GI bleeding. Other NSAIDs being taken at the same time.
Heart failure / renal failyure/ hepatic failure/ lasttrimester of pregnancy.
Caution in HTN patietns or mild tomoderate HF/ cardiac patients
Caution should be advised in patients receiving concomitant medications which could increase the risk of ulceration or bleeding, such as oral
corticosteroids, anticoagulants such as warfarin, selective serotonin-reuptake inhibitors or anti-platelet agents such as aspirin
The use of naproxen, as with any drug known to inhibit cyclooxygenase/prostaglandin synthesis, may impair female fertility and is not
recommended in women attempting to conceive. In women who have difficulties conceiving or who are undergoing investigation of fertility,
withdrawal of naproxen should be considered.
Anti-hypertensives:reduced anti-hypertensive effect.
Naproxen and other non-steroidal anti-inflammatory drugsmay increase the risk ofrenal impairment associated with the use of ACE-inhibitors.
• Diuretics: can decrease diuretic effect. The natriuretic effect of furosemide has been reported to be inhibited by some drugs of this class.
Diuretics can increase the risk of nephrotoxicity of NSAIDs.
• Cardiac glycosides:NSAIDs may exacerbate cardiac failure, reduce GFR and increase plasma glycoside levels.
• Lithium:Decreased renal elimination of lithium leading to increases in plasma lithium concentrations.
• Methotrexate: Possible enhancement of methotrexate toxicity due to decreased elimination of methotrexate.
• Ciclosporin:Increased risk of nephrotoxicity.
• Mifepristone:NSAIDs should not be used for 8-12 days after mifepristone administration as NSAIDs can reduce the effect of mifepristone.
• Corticosteroids:Increased risk of GI ulceration or bleeding. See section 4.4 Special Warnings and Special Precautions for use.
• Anti-coagulants and sulphonylureas:NSAIDs may enhance the effects of anti-coagulants,such as warfarin and heparin. See section 4.4
Special Warnings and Special Precautions for use.

61
Q

Daktarin oral gel (2% miconazole) OTC use?

A

Oral treatment of fungal infections of the oropharynx Miconazole gel is for use in adults, children and infants 4 months and older.

62
Q

Dose and directions for daktarin use?

A

Infants: 4-24 months: 1.25 mL (1/4 measuring spoon) of gel, applied four times a day after meals. Each dose should be divided into smaller portions and the gel should be applied to the affected area(s) with a clean finger. The gel should not be applied to the back of the throat due to possible choking. The gel should not be swallowed immediately, but kept in the mouth as long as possible.

Adults and children 2 years of age and older: 2.5 mL (1/2 measuring spoon) of gel, applied four times a day after meals.The gel should not be swallowed immediately,
but kept in the mouth as long as possible.The treatment should be continued for at least a week after the symptoms have disappeared.

For oral candidosis, dental prostheses should be removed at night and brushed with the gel.

63
Q

When should daktarin gel supply be refused?

A

Known hypersensitivity to miconazole, other imidazole derivatives or to any of the excipients listed in section 6.1.
• In infants less than 4 months of age or in those whose swallowing reflex is not yet sufficiently developed (see section 4.4)
• In patients with liver dysfunction.
• Coadministration of the following drugs that are subject to metabolism by CYP3A4: (See Section 4.5 Interactions with Other Medicinal Products and Other Forms of
Interaction)
• - Substrates known to prolong the QT-interval e.g., astemizole, cisapride, dofetilide, mizolastine, pimozide, quinidine, sertindole and terfenadine
• - Ergot alkaloids
• - HMG-CoA reductase inhibitors such as simvastatin and lovastatin
• - Triazolam and oral midazolam
• Ifthe concomitant use of Daktarin and anticoagulantsis envisaged, the anticoagulant effect should be carefully monitored and titrated (see section 4.5). It is advisable
to monitor miconazole and phenytoin levels, if these two drugs are used concomitantly.
• In patients using certain oral hypoglycaemics such as sulphonylureas, an enhanced therapeutic effect leading to hypoglycaemia may occur during concomitant
treatment with miconazole and appropriate measures must be considered (See Section 4.5 Interactions with Other Medicinal Products and Other Forms of Interaction).
It is important to take into consideration the variability of the maturation of the swallowing function in infants, especially when giving miconazole gel to infants
between the ages of 4 – 6 months. The lower age limit should be increased to 5 – 6 months of age for infants who are pre-term, or infants exhibiting slow
neuromuscular development.

64
Q

When can Daktarin cream (miconazole nitrate 2%) be used OTC?

A

For the treatment of mycotic infections of the skin and nails and superinfections
due to Gram-positive bacteria.
• Route of administration: Cutaneous use.
• Recommended dosage:
• For all ages:
• Fungal infections of the skin: Apply some cream to the lesions two times daily.
Rub the cream into the skin with your finger until it has fully penetrated. If the
powder is used with the cream, a once daily application of both formulations is
recommended. The duration of therapy varies from 2 to 6 weeks depending on
the localisation and the severity of the lesion. Treatment should be continued at
least one week after disappearance of all signs and symptoms.
• Nail infections: Apply the cream once or twice daily to the lesions. Treatment
should be prolonged for 10 days after all lesions have disappeared to prevent
relapse.

65
Q

When can Lamisil 1% be supplied OTC? (terbinafine)

A

Licensed indication: cream: The treatment of tinea pedis (athlete’s foot) and tinea cruris (dhobie itch/jock itch) caused by Trichophyton (e.g. T. rubrum, T. mentagrophytes, T. verrucosum, T. violaceum) and Epidermophyton floccosum. Adults and children over 16 years of age

66
Q

Lamisil directions for use?

A

Lamisil AT 1% Cream is applied once daily. Duration of treatment is one week for tinea pedis and tinea cruris. Relief of clinical symptoms usually
occurs within a few days. Irregular use or premature discontinuation of treatment carries the risk of recurrence. If there are no signs of
improvement after two weeks, the diagnosis should be verified by a physician. Lamisil AT 1% cream is for external use only. Method of
administration
• For cutaneous use.
• The affected area should be cleaned and dried thoroughly before application of Lamisil AT 1% Cream. The cream should be applied to the
affected skin and surrounding area in a thin layer and rubbed in lightly. In the case of intertriginous infections (interdigital, intergluteal, inguinal)
the application may be covered with a gauze strip, especially at night.
- Should be used with caution in patients with lesions where alcohol could be irritating. Should not be used on the face.
Lamisil solution:Treatment for tinea pedis (athlete’s foot).
• Lamisil Once 1% cutaneous solution isindicated for Adults 18 years of age and over. Adults 18 years of age and over: single administration.
Duration and frequency of treatment
• Lamisil Once 1% cutaneous solution should be applied once on both feet, even if lesions are visible on one foot only. This ensures elimination of
the fungi (dermatophytes) that might be found in areas of the foot where no lesions are visible.
• Relief of clinical symptoms usually occurs within a few days. If there are no signs of improvement after one week, patients should see a doctor.
There are no data on repeated treatment with Lamisil Once 1% cutaneous solution. Therefore a second treatment cannot be recommended
within a particular episode of athlete’s foot.
• Patientsshould wash and dry both feet and hands before applying the product. They should treat one foot, then the other.
• Starting between the toes, patients should apply a thin layer evenly between and all around the toes, as well as cover the sole and sides of the
foot for up to 1.5 cm. The product should be applied in the same way to the other foot, even if the skin looks healthy. The product should be left
to dry to a film for 1-2 minutes. Patientsshould then wash their hands. Lamisil Once 1% cutaneous solution should not be massaged into skin.
• Forthe best results, the treated area should not be washed for 24 hours after application. It istherefore recommended to apply Lamisil Once 1%
cutaneous solution after a shower or bath and wait until the same time the following day before washing the feet again.

67
Q

Calpol 120mg/5ml doses?

A

Age: 2-3 months: 2.5ml, if necessary, after 4-5 hours give a second 2.5ml dose - do not give more than 2 doses to ensure fever due to serious infection is quickly diagnosed

3-6 months: 2.5ml 4 times a day
6-24 months: 5ml 4 times a day
2-4 yrs: 7.5ml 4 times a day
4-6 yrs: 10ml 4 times a day

68
Q

Calpol 250mg/5ml doses?

A 
6-8 yrs: 5ml 4 times a day
8-10 yrs: 7.5ml 4 times a day 
10-12 yrs: 10ml 4 times a day 
12-16 yrs: 10-15ml up to 4 times a day
16+ yrs: 10-20ml up to 4 times a day

*shake bottle for 10 secs before use

69
Q

Ibuprofen 100mg/5ml doses?

A

Daily dosage of nurofen for children is 20-30mg/kg in divided doses

3-6 months weighing more than 5kg: 2.5ml 3 times in 24 hours
6-12 months: 2.5ml 3 to 4 times in 24 hours
1-3 yrs: 5mls 3 times a day
4-6 yrs: 7.5ml 3 times a day
7-9 yrs: 10ml 3 times a day

70
Q

When can eumovate/clobetasone 0.05% cream be supplied OTC?

A

Licensed indication in eczema and dermatitis for short term treatment and control of patches of eczema and dermatitis including atopic eczema and primary irritant and allergic dermatitis

71
Q

Dose and direction for eumovate use?

A

Only suitable in yrs 12 and above, apply to the affected area twice a day for up to 7 days, if treatment has helped after 7 days - stop, if not, refer to doctors

72
Q

Considerations before supplying eumovate?

A
  • should not be used on the face
  • can cause adrenal suppression in infants/children
  • do not get in eye - can cause glaucoma
  • should not be used for psoriasis as rebound exacerbation may be a problem
  • half a fingertip covers palm of hand
73
Q

When should eumovate supply be refused?

A
  • broken skin or lesions caused by infection with viruses (herpes simplex, chickenpox), fungi (candidiasis) or bacteria (impetigo)
  • acne
  • pregnant or breastfeeding

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