POM to P Flashcards
1
Q
Give examples of POM to P switches
A
- amorolfine
- atovaquone and proguanil
- azithromycin
- chloramphenicol
- esomeprazole
- levenorgestrel
- naproxen 250mg
- omeprazole
- orlistat
- sildenafil 50mg
- sumatriptan 50mg
- tamsulosin 400mcg
- tranexamic acid
- uliprisal
- clotrimazole 2% cream
2
Q
Sildenafil (Viagra connect) OTC details
A
- 18 + yrs, men
- max = 8 tablets per sale, 1 tab a day
- advise to consult GP after 6 months for review of underlying conditions
- doesn’t work = GP
- 1 tab (50mg) 1 hour before sex, if taken after meal onset may be delayed
3
Q
Sildenafil ADRs
A
- reported via yellow card scheme
- flushing, headaches, vision disturbances, dyspepsia
4
Q
Don’t supply sildenafil OTC if:
A
- taking a-blocker
- taking enzyme inhibitors or nitrates
- acute MI, stroke, unstable angina, severe cardiac failure in last 6 months
- severe hepatic impairment
- hypotension (<90/60mmHg)
- uncontrolled HTN, valvular disease, cardiomyopathy
- visual disorders or optic neuropathy
- hypersensitivity
- galactose intolerance
- bleeding disorders/peptic ulcer disease
5
Q
Sumatriptan OTC details
A
- for migraines with or without aura that have been diagnosed by a pharmacist or doctor
- pt must have suffered for at least 1 year and have had at least 5 attacks
- age 18-65 yrs
- 1 tab (50mg) as soon as migraine starts. If this helps but migraine returns > 2 hours later - take another tab
- if first tab doesn’t work dont take another
- max = 2 tabs in 24 hours
6
Q
Sumatriptan ADRs
A
- asthenia
- dizziness
- dyspnoea
- flushing
- skin reactions
7
Q
Don’t supply sumatriptan OTC:
A
- undiagnosed migraines
- attacks that last > 24 hours
- 4 + attacks a month
- epilepsy
- hepatic impairment
- renal impairment
- CV history
- pregnant/breastfeeding
- MAOI
8
Q
Omeprazole OTC details
A
- 10mg caps for short term dyspepsia
- 18 + years
- 20mg OD, if symptoms improve reduce to 10mg OD
- may take a couple of days to work
- no improvement in 2 weeks = GP
- if tx still required after 4 wks = GP
9
Q
Omeprazole ADRs
A
- abdominal pain
- constipation
- dizziness
- headache
- nausea
10
Q
Don’t supply omeprazole OTC:
A
- red flag symptoms = dysphagia, unexplained weight loss, blood in stool/vomit, abdo masses, rectal bleeding
- over 55s with symptoms not responding to tx
- over 45s with new/unexplained symptoms
- recent gastric surgery
- hepatic impairment
- clopidogrel
- B12 deficiency
11
Q
Orlistat (Alli) OTC details
A
- weight loss in 18 +
- BMI > 28 and check on each supply
- 60mg TDS with low fat diet
- take immediately before, during or up to 1 hour after each meal
- OTC not exceed 6 months
- if unable to lose weight after 12 weeks see GP
- reduce absorption of fat soluble vits (DEAK) - take multivitamin at night
- can cause reduced effectiveness of oral contraceptives
12
Q
Orlistat ADRs
A
- oily stools
- flatulence
13
Q
Don’t supply orlistat OTC:
A
- diabetic
- cholestasis
- chronic malabsorption syndrome (e.g. Crohn’s/UC)
- pregnant/breastfeeding
- concurrent use of: oral anticoags, acarbose, ciclosporin, amiodarone, antiepileptics, levothyroxine
14
Q
Tamsulosin (Flomaztra XL) OTC details
A
- for BPH in males aged 45-75yrs
- no improvement after 2 wks = GP
- refer all to GP within 6 wks of OTC tx - urged to make record on patients PMR
- can be supplied to a 3rd party except in exceptional circumstances
- initial supply of 2 weeks, review if further 4 weeks supply required
- pt must have had symptoms for at least 3 months
- avoid fluids 1-2 hours before bed, avoid unnecessary use of decongestants
15
Q
Don’t supply tamsulosin OTC:
A
- orthostatic hypotension
- hepatic impairment
- previous prostate surgery
- planned cataract surgery
- vision impairment
- red flag symptoms: pain on urination, fever, haematuria, incontinence
