POM to P Supply (Sumatriptan, Mini Pill & Sildenafil)

Question 1

What other symptoms can accompany migraines?

Answer 1

N+V
Sensitivity to light/sound/movement
With or without aura
Speech disturbances

Question 2

What are some triggers of a migraine?

Answer 2

Bright lights
Strong smells
Certain foods e.g. alcohol, cheese
Eye strain
Stress
Hormonal changes
Travel

Question 3

How should sumatriptan 50mg be taken?

Answer 3

As soon as possible after the onset of a migraine

Question 4

If migraine symptoms recur after taking the first sumatriptan tablet, what should the patient do?

Answer 4

A 2nd tablet may be taken at least 2h after the 1st tablet

Question 5

When do you refer a patient with a migraine who wishes to buy sumatriptan?

Answer 5

<18yrs or >65yrs
>50yrs experiencing a migraine for the first time
Patients who’ve had their first ever migraine within the last 12 months
Patients who have >4 attacks /month
If their migraine lasts >24h
If a woman if on the COC
Treatment failure
Patients with >3 CVD risk factors

Question 6

What CVD risk factors make a patient not suitable for buying sumatriptan?

Answer 6

If they have >3 of the following:

Men >40 yrs
Post-menopausal women
Hypercholesterolaemia
Smoker
Obese
Diabetes
Family history of heart disease

Question 7

What are some contra-indications of sumatriptan?

Answer 7

Hypertension
Using prophylactically
Allergy to sulphonamides
Previous MI/angina/coronary vasospasms/cardiac arrhythmia
Hepatic/renal impairment
Epilepsy

Question 8

What are some drug interactions associated with sumatriptan?

Answer 8

Ergotamine
MAO inhibitors
St Johns wort
SSRI - seek DR if lack of co-ordination occurs

Question 9

What age is sildenafil 50mg licensed for?

Answer 9

> 18 years old

Question 10

What is sildenafil used for?

Answer 10

Erectile dysfunction

Question 11

How does sildenafil work?

Answer 11

It is a phosphodiesterase type-5 inhibitor and acts by increasing blood flow to the penis

Question 12

How should sildenafil 50mg be taken?

Answer 12

One tablet 1h before sexual activity (empty stomach better)
Max. 1 tablet a day

Question 13

What are some contraindications for the supply of sildenafil?

Answer 13

Allergy to excipients
Taking with ritonavir
Taking with nitrates e.g. nicorandil/NO
Severe CVD disorder
Hepatic impairment
Hypotension
<18 yrs
Deformations of the penis

Question 14

What are some common side effects of sildenafil?

Answer 14

Headache
Flushing
Dizziness
Visual disturbances
Priapism - painful erections lasting >4h

Question 15

What sugar is contained in the film coating of sildenafil?

Answer 15

Lactose - so check for allergies

Question 16

Can a patient drink alcohol with sildenafil?

Answer 16

Advise not to drink large amounts with it as it can effect the mans ability to get an erection

Question 17

What pharmacy advice can you give for a patient who’s taking sildenafil for the first time?

Answer 17

Weight management
Smoking cessation
Diet advice
Physical activity
Alcohol reduction
Reducing stress/anxiety

Question 18

What is Gina 10mcg vaginal tablets used for?

Answer 18

Local treatment of vaginal dryness and irritation during menopause

Question 19

Who can we supply gina to?

Answer 19

> 50 years old
Period over a year ago
Symptoms of dryness, soreness, itching, burning, painful intercourse

Question 20

What is the dosing of gina 10mcg vaginal tablets?

Answer 20

Initial dose: 1 tablet inserted daily for 2 weeks
Maintenance dose: 1 tablet inserted twice a week leaving 3/4 days between each dose

Question 21

When should a woman come back to the pharmacy if she has purchased gina?

Answer 21

After finishing the first pack at 7 weeks

Question 22

When should you not supply gina again after the patients 2nd visit to the pharmacy?

Answer 22

If symptoms worsen
No improvement in symptoms after second pack

Question 23

What are some contraindications for the supply of gina?

Answer 23

Allergy to ingredients - estradiol/lactose
Endometrial cancer
Undiagnosed genital bleeding
Acute liver disease
Active/recent thromboembolic disease
Current vaginal infections
If on other local oestrogen therapy, e.g. Vagifem