POM to P Supply of Anti-Infective Agents Flashcards
What are the 3 legal classifications of drugs in the UK?
- POM (prescription only medicine)
- P (pharmacy medicine)
- GSL (general sales list medicine)
Which legal class do all new medicines fall into within their first 5 years on the market?
POM.
What is an example of a drug that has been reclassified from a POM to a GSL?
Esomeprazole (Nexium)
Which type of drug delivery is always a POM?
Injections (parental administrations)
What is the criteria for switching a drug from POM to P?
- The patient should be able to make an appropriate diagnosis
- The treatment should be efficacious
- The benefit to harm balance should be favourable
Which pharmacokinetic property of a drug should be extended if it is a GSL?
Its life-span.
What are some benefits of switching a drug from POM to P?
- Widen audience access
- Gives patients a choice
- Decrease health inequalities
- Strengthen the advisory role of pharmacists
What is an example of a drug that has been reclassified back to a POM due to a risk of heart problems?
Diclofenac tablets.
What is an example of a drug that has been deregulated from a POM to a P?
Ibuprofen.
What is amorolfine 5% nail lacquer used for?
It is used for the treatment of mild cases of fungal infections beneath the tips and sides of nails, affecting up to 2 nails.
When should you refer a patient who has a fungal foot infection?
- Diabetics
- Immuno-compromised
- If the fungal infection is affecting the whole nail or the base.
- If more than 2 nails are effected
What factors can increase the risk of fungal nail infections?
- Increasing age
- Smoking
- Presence of athletes foot
- Nail trauma
- Patient with psoriasis
Which part of the nail must only be treated using amorolfine 5%?
Only treat the lateral (sides) or distal (top edge) part of the nail.
If the whole nail is infected or the base (proximal), you must refer.
What is the appearance of a fungal nail infection affecting the whole nail (also known as onychomycosis)?
- Thickened nail
- Discolouration - yellow/white
- Crumbly/flaky/brittle
- May separate from the nail bed
Why dont we treat proximal or whole nail fungal infection?
Because amorolfine does not penetrate into the nail bed, so it would have no effect.
What should the patient do to the nail before applying amorolfine?
Patient must cleanse and file the nail first, then apply the drug like nail polish.
What should you ask a patient who is buying amorolfine for the first time?
- Their age
- How many nails affected
- Where in the nail
What type of effect does amorolfine have?
Fungicidal effect.
What does amorolfine inhibit, and what does this lead to?
It inhibits sterol biosynthesis, which disrupts the fungal cell membrane leading to cell death.
What happens when the amorolfine nail lacqeur is applied?
Once applied, the solvent evaporates and leaves a highly concentrated deposit of amorolfine film on the nail. Amorolfine then penetrates into the nail over the next 7 days.
What are some examples of counselling points when giving amorolfine?
- Patient has to adhere to it - it needs to be applied regularly for up to 9-12months (weekly).
- Nail must be filed down and clean
- Do not wipe any excess lacquer onto the neck of the bottle to avoid contamination
- Indirect athletes foot can occur if debris touches the skin around the nail when filing or wiping
What are some contra-indications of amorolfine?
- Do not supply to pregnant/breast feeding woman
- Only supply for >18years
- Not to be used in patients who have had a reaction to it in the past
What are chloramphenicol eye drops used for?
Acute bacterial conjunctivitis in adults, the elderly and children >2years.
When should you refer someone if they are wanting to purchase chloramphenicol?
- Pain in the eye
- Photophobia
- Cloudy vision
- Bloody discharge/bloodshot eye
- Blurred vision
- <2 years old
- Pregnant/breast-feeding
- Pre-existing eye conditions, e.g. glaucoma
- No improvement within 48h
What are the directions for the use of chloramphenicol?
Apply one drop into the infected eye every 2h for the first 48h, then 4h thereafter. Use for 5 days.
What are some counselling points to consider when giving chloramphenicol?
- Avoid sharing towels/facecloths/eye cosmetics as it can pass to others
- Do not share bottles
- Store in the fridge
- Should not miss work/school etc because of it
Why is oral chloramphenicol avoided in children/pregnancy?
Because it can cause grey baby syndrome.
What type of antibiotic is chloramphenicol?
It is a broad-spectrum bacteriostatic antibiotic used for gram +VE and -VE bacteria.
What is the mechanism of action of chloramphenicol?
It binds to the bacterial ribosomes and inhibits bacterial protein synthesis
What are some examples of symptoms of conjunctivitis?
- Inflamed, watery, pink eye
- Itchy eye
- Sticky eye discharge
What advice do you give to someone who is purchasing chloramphenicol, and wears contact lenses?
Ensure to stop using the contact lenses until 24h after treatment completion.
What are some examples of common side effects of chloramphenicol?
- Stinging of the eye
- Burning/tasting in the back of the throat
- Transient blurring of the eye
- Serious side effects (hypersensitivity reactions)
What are the 4 P anti-malarial prophylaxis drugs?
- Maloff Protect (atovaquone 250mg with proguanil hydrochloride 100mg)
- Avloclor (chloroquine 250mg) - given WEEKLY
- Paludrine (proguanil hydrochloride 100mg) - given DAILY
- Paludrine/Avloclor anti-malarial travel pack (proguanil hydrochloride 100mg/chloroquine 250mg)
- MUST REMEMBER ALL OF THIS
What are the 3 POM anti-malarial drugs?
- Mefloquine - do not give to epileptics or depressive patients
- Doxycycline - can cause photosensitivity, so protect skin
- Malarone - it is the POM of maloff protect
What is the duration of treatment for all the anti-malarials?
If using chloroquine and proguanil hydrochloride (paludrine/avloclor): 1 week before travel
If using mefloquine: 2-3 weeks before travel, and 2-3 weeks after travel
If using atovaquone with proguanil hydrochloride (maloff protect), or doxycycline: 1-2 days before travel
The rest are all 4 weeks after travelling.
Maloff Protect should be stopped 1 week after leaving.
What important question should you ask when choosing the right anti-malarial drug?
Identify where they are going, as each country has different resistance to malaria.
How should a patient who is travelling take Maloff Protect?
One tablet at the same time daily, with food or a milky drink to ensure max. absorption
What are some common symptoms of malaria?
- Fever
- Sweats & chills
- Headaches
- Muscle pains
- Lethargy (tiredness)
- Diarrhoea & vomiting
What are some examples of some points that can be covered during a travel advice consultation?
- Rehydration sachets
- Travel sickness tablets
- Travel first aid kit
- Sun protection, creams etc
- Diarrhoea medicine/ water purification tablets.
What are some contra-indications for the use of anti-malarial drugs?
- Under <40kg (dose needs to be adjusted)
- Use more than 12 weeks
- <18 years
- Renal/hepatic impairment
What are some examples of drugs that can interact with anti-malarial drugs?
- Metoclopramide
- Warfarin
- Tetracyclines
- Rifampicin
All of these drugs interact with enzyme inducers, and lowers their efficacy
What side effects are common when taking anti-malarials?
- GI side effects
- Headache
- Abdominal pain
