Sem 2 Flashcards
1
Q
Pregabalin indication and mechanism of action
A
Neuropathic pain and adjunct therapy for epilepsy (GAD an unapproved indication).
Binds to T-type voltage gated calcium channels and decreases the release of excitatory neurotransmitters associated with neuropathic pain and seizure propagation.
2
Q
Pregabalin dosing
A
Neuropathic pain: 75mg BD, increased, if necessary, after 3-7 days to 150mg BD. Increased further, if necessary, after 7 days to maximum 300mg BD.
Adjuvant treatment for focal seizures with or without secondary generalisation: 75mg BD, increased, if necessary, after 3-7 days to 150mg BD. Increased further, if necessary, after 7 days to maximum 300mg BD.
3
Q
Pregabalin adverse effects
A
Relatively side effect free, sedation and ataxia.
Cognitive issues may be significant in elderly.
4
Q
Pregabalin precautions and safety in special populations
A
Renally cleared. >60 max dose is 600mg.
>30-60 max dose is 300mg.
>15-30 max dose is 150mg.
>15 max dose is 75mg.
5
Q
Pregabalin advice and self care
A
Two forms of contraception should be used.
Take with a large glass of water.
6
Q
Atypical antipsychotics examples (8)
A
amisulpride, aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone, and clozapine
7
Q
Atypical antipsychotics indication and mechanism of action
A
Schizophrenia, bipolar and other severe mental illnesses.
D2 PLUS 5HT-2A antagonists.
8
Q
Atypical antipsychotics adverse effects
A
Weight gain (particularly olanzapine)
Increased risk of diabetes.
Elevated lipids.
QT prolongation (particularly ziprasidone).
Postural hypotension and hypertension (risperidone, olanzapine, and quetiapine).
Movement disorders (less likely than typicals)
Sexual dysfunction/hyper gynaecomastia + osteoporosis (risperidone, paliperidone and amisulpride).
Sedation (clozapine, olanzapine + quetiapine).
Anticholinergic effects (clozapine + olanzapine).
Rare: Neuroleptic Malignant Syndrome (NMS). Muscular rigidity, pyrexia, confusion, urinary incontinence, disorientation, tachycardia and sweating. More common in young men on higher doses and associated with hot weather and exercise.
9
Q
Atypical antipsychotics contraindications
A
Contraindicated in comatose states, CNS depression and phaeochromocytoma.
10
Q
Atypical antipsychotics precautions and safety in special populations
A
Caution in CVD, potential for QT prolongation.
Caution in Parkinson’s/elderly – dopamine antagonist effects.
11
Q
Atypical antipsychorics monitoring
A
FBC, urea + electrolytes, LFTs initially then annually.
Lipids initially, at 3 months then annually.
Weight initially, regularly during first 3 months then annually.
FBG initially, at 4-6 months then annually.
ECG if CV risk factors.
BP initially and during dose titration.
Prolactin initially, 6 months, then annually if there are clinical concerns.
CVDRA annually.
12
Q
Citalopram and escitalopram indication and mechanism of action
A
Depression, anxiety, OCD
Inhibits reuptake of serotonin in the pre-synapse, increasing the available serotonin in the brain.
13
Q
Citalopram and escitalopram dosing
A
Escitalopram: 10mg daily, increased if necessary to 20mg.
Citalopram: 20mg daily, increased if necessary to 40mg.
14
Q
Citalopram and escitalopram adverse effects
A
QT prolongation (rare but serious)
Nausea, anxiety, insomnia, agitation, hypomania, worsening of depression and suicidal ideation can occur in first days to weeks.
Dose-related adverse effects include fatigue, impotence, increased sweating, somnolence, and insomnia.
Increased risk of bleeding.
Sexual dysfunction.
Serotonin syndrome (rare but serious).
Hyponatremia – monitor in high risk individuals. Most likely to occur during the first 4 weeks. Signs include dizziness, nausea, lethargy, confusion, cramps and seizures.
15
Q
Citalopram and escitalopram interactions and contraindications
A
Lithium, sotalol, omeprazole increases risk of QT prolongation (double up)
Lithium, st johns wort, sumatriptan, tramadol and pethidine increase the risk of serotonin syndrome.
16
Q
Citalopram and escitalopram precautions and safety in special populations
A
No information available for CrCl <20mL/min
17
Q
Clozapine indication and mechanism of action
A
Treatment-resistant schizophrenia
D1, D2, 5HT-2a and muscarinic receptor antagonist
18
Q
Clozapine adverse effects
A
Tachycardia, hypotension, myocarditis, fever, headache, sedation, seizures, constipation, nausea, vomiting, hypersalivation, weight gain, raised lipids, glucose impairment, blurred vision, urinary incontinence, agranulocytosis (leukopenia), eosinophilia, thrombocytopenia.
19
Q
Clozapine monitoring
A
Regular blood monitoring required for dispensing. Baseline FBC 10 days prior to commencing, then weekly FBC for 18 weeks. 28-day monitoring required thereafter and for 4 weeks discontinuation. Agranulocytosis tends to develop within the first 6 months of treatment and is not dose related. Neutropenia can occur at any time.
Constipation. Treat proactively.
Myocarditis symptoms develop within 1 month of starting, whereas cardiomyopathy has a latent onset of after 1 year but can occur at any time.
20
Q
Clozapine interactions and contraindications
A
Increased risk of neutropenia: antibiotics (co-trimoxazole, trimethoprim, nitrofurantoin), carbamazepine and antineoplastics associated with BMS.
Many interactions as it is a substrate for CYP450 isoenzymes. Carbamazepine, phenytoin, rifampicin, and omeprazole (inducers) can decrease clozapine plasma levels.
Plasma levels affected by smoking.
Erythromycin, ciprofloxacin, paroxetine, and fluoxetine (inhibitors) may increase clozapine effect. So may hormonal contraceptives.
Plasma concentration can also be increased by a high caffeine intake.
Clozapine can enhance the CNS effects of alcohol, CNS depressants and benzodiazepines.
21
Q
Clozapine precautions and safety in special populations
A
Liver disease: check LFTs regularly.
Renal: avoid in severe disease
22
Q
Clozapine advice and self care
A
Be aware of neutropenia symptoms (fever, sore throat, flu-like symptoms).
23
Q
Donepezil indication
A
Mild-severe Alzheimer’s disease and vascular dementia.
24
Q
Donepezil mechanism of action
A
Prevents breakdown of Ach, prolonging the effect at the synapse.
Reversible inhibitor, CNS selective
25
Donepezil dosing
5mg OD at bedtime, increased, if necessary, after at least 1 month to a maximum of 10mg daily.
26
Donepezil adverse effects
Anorexia, nausea, vomiting, diarrhoea, abdominal pain.
Drowsiness, hallucinations, agitation, dizziness, headache.
Heart block and sinus bradycardia.
27
Donepezil interactions and contraindications
Beta blockers, amiodarone, digoxin and diltiazem increase the risk of bradycardia.
Anticholinergic drugs: TCAs, sedating antipsychotics, overactive bladder medicines, sedating antihistamines and antiemetics can compete for the same receptors and decrease the effect of donepezil.
28
Donepezil precautions and safety in special populations
CYP2D6 polymorphisms are more related to response to treatment than drug interactions.
Caution in mild to moderate hepatic impairment.
29
Donepezil monitoring
Check HR before initiation. If under 60bpm, an ECG is recommended prior to commencing treatment.
Check pulse at monthly intervals during titration and 6-monthly thereafter.
Assess for falls risk.
Monitor body weight at baseline and regularly during treatment.
29
Fentanyl indication
Chronic cancer pain. For those with stable opioid requirements but cannot tolerate their current opioid due to side-effects such as constipation, have a deteriorating renal function, or cannot tolerate oral opioid administration.
30
Fentanyl mechanism of action
Agonists at opioid receptors. Specific for mu receptor.
31
Fentanyl adverse effects
Nausea, vomiting, constipation, sleepiness, visual disturbance, dizziness, skin reactions, sweating and headache.
Serious: respiratory/CNS depression, hallucinations, euphoria, myoclonic jerks.
32
Fentanyl interactions and contraindications
CYP3A4 inhibitors (ritonavir, ketoconazole, itraconazole, clarithromycin and erythromycin) increase fentanyl plasma levels
SSRIs, SNRIs and MAOIs increase the risk of serotonin syndrome.
33
Fentanyl precautions and safety in special populations
Metabolised by the liver – may have delayed elimination in hepatic impairment.
Avoid in pregnancy and breastfeeding.
34
Fentanyl advice and self care
Replace every 72 hours.
Titrate on other opioids then fentanyl started.
Avoid direct heat on the patch – leads to increased absorption and risk of adverse effects/toxicity.
35
Fluorouracil indication
Malignant and superficial pre-malignant skin lesions. Most oftenly prescribed for actinic keratoses and in-situ squamous cell carcinoma. Also occasionally used to treat superficial basal cell carcinomas.
36
Fluorouracil mechanism of action
Irreversibly binds to thymidylate synthetase, preventing formation of DNA and RNA and causing abnormal cell death.
37
Fluorouracil dosage
Apply thinly 1 to 2 times daily for 3-4 weeks.
Sometimes tretinoin is used before treatment to peel off the top layer of skin and allow fluorouracil cream to work best.
38
Fluorouracil adverse effects
Local irritation (use a topical corticosteroid): dryness, rash, pruritis, pain, erosion, crusting.
Changes in skin colour
39
Fluorouracil interactions and contraindications
Dihydropyrimidine dehydrogenase (DPD) deficiency. Can develop life-threatening systemic toxicity including neutropenia, stomatitis, diarrhoea, and neurotoxicity. This may present with fever, chills, fatigue, bloody diarrhoea, vomiting and abdominal pain.
40
Fluorouracil precautions and safety in special populations
Not to be used in pregnancy or breastfeeding
41
Fluorouracil advice and self care
Wash the area first with water, then dry. Rinse finger thoroughly after applying (Some patients prefer to wear a glove).
If only applying once a day – better to in the morning.
Avoid applying right before bed – cream may get onto bed linen.
Avoid mucous membranes.
Protect yourself from sunlight
42
Gabapentin indication and mechanism of action
Epilepsy and neuropathic pain
Binds to T-type voltage-gated calcium channels, reducing influx and decreasing the release of excitatory neurotransmitters associated with neuropathic pain and seizure propagation.
43
Gabapentin dosing
Epilepsy: Initially 300mg TDS, then increased according to response in steps of 300mg (in 3 divided doses) every 2-3 days. Usual dose 900-1800mg daily in 3 divided doses. Up to 3600mg daily in some patients.
Neuropathic pain: 300mg OD on day 1, then 300mg BD on day 2, then 300mg TDS on day 3, OR 300mg TDS on day 1, then increased according to response in steps of 300mg (in 3 divided doses) every 2-3 days. Up to maximum of 3600mg daily.
44
Gabapentin adverse effects
Drowsiness, dizziness, weight gain, peripheral oedema, ataxia.
Rare but serious: rash (DRESS), suicidality
Cognitive issues may be significant in elderly.
45
Gabapentin precautions and safety in special populations
Dose adjustment required in impaired renal function
46
Gabapentin advice and self care
Use 2 types of contraception
47
Hypnotics (Z drugs) indication and mechanism of action
Short term relief of insomnia
Binds to GABA-A receptor, increasing the amount of GABA (inhibitory neurotransmitter)
48
Hypnotics (Z drugs) dosing and adverse effects
7.5mg OD at bedtime
Incoordination, dizziness, drowsiness, confusion, amnesia
49
Hypnotics (Z drugs) precautions and safety in special populations
Reduce to 3.75mg in renal/hepatic impairment + elderly.
50
IV iron indications
When oral therapy is unsuitable or unsuccessful.
Patient with chronic renal failure who are receiving haemodialysis.
51
IV iron dosing
Ferric carboxymaltose (ferrinject) is advantageous as it can be given over 15 minutes rather than several hours. Must be administered IV (NOT SC or IM).
Maximum single IV dose 1000mg iron, with no more than 1000mg given per week.
52
IV iron adverse effects
Anaphylaxis. Make sure to have resuscitation facilities available. Monitor closely for hypersensitivity – especially in the first 5 minutes of administration.
Observe patient for 30-60 minutes following administration. Ferrinject is well-tolerated and associated with minimal risk of adverse reactions.
Most common: headache, dizziness, hypertension, nausea, abdominal pain, constipation, diarrhoea.
Other: hyperphosphataemia – especially in those with hyperparathyroidism or vitamin D deficiency
53
IV iron interactions and contraindications
Pre-existing hypophosphatemia
54
IV iron precautions and safety in special populations
Avoid during pregnancy if possible. Contraindicated in the first trimester. If administering, calculate dose based off pre-pregnancy weight.
Safe to use in breastfeeding.
No clinical data to support the use of IV iron carboxymaltose in children under 14 so cannot be recommended for paediatric use.
55
IV iron advice and self care
Oral iron not to be given for at least 5 days after last injection.
Contact doctor if experiencing: tiredness that is ongoing or getting worse, bone pain, muscle weakness, irritability, or confusion.
56
Lamotrigine indications
Seizure prevention (age 2 up)
Mood stabiliser in bipolar disorder (age 18 up)
57
Lamotrigine mechanism of action
Inhibits sodium voltage gated channels, decreasing the release of glutamate and affecting the membrane excitability.
58
Lamotrigine dosing
Start low and go slow
With valproate: initially 25 mg on alternate days for 14 days, then 25 mg once daily for further 14 days, thereafter increased by maximum 50 mg every 7–14 days; usual maintenance, 100–200 mg daily in 2 divided doses
Depends whether it is with valproate and/or enzyme inducing drugs
59
Lamotrigine adverse effects
Skin reactions most likely to occur within the first 8 weeks of treatment. Although often mild and self-limiting, can progress to severe and potentially fatal conditions – including SJS and toxic epidermal necrolysis.
Anticonvulsant hypersensitivity syndrome: high spiking fever, rash and/or hepatitis.
Dizziness, blurred vision and headache are common when initiating. Typically these are mild to moderate and resolve within the first few weeks.
Increased risk of anxiety, depression and suicidality.
60
Lamotrigine interactions and contraindications
Sodium valproate. Inhibits the metabolism of lamotrigine and therefore increases its plasma concentration increased risk of serious side effects.
Phenytoin, carbamazepine, phenobarbitone and primidone induce the metabolism and can result in subtherapeutic concentrations.
Ethinylestradiol/levonorgestrel induces the metabolism of lamotrigine and results in lower plasma concentrations.
61
Lamotrigine precautions and safety in special populations
Preferred drug (the two L’s) for pregnancy.
Known to deplete folate levels – should take folic acid 5mg per day if wanting to become pregnant for 4 weeks before conception and the first 12 weeks of pregnancy.
Concentration levels known to decrease during pregnancy (increased excretion)
62
Lamotrigine advice and self care
Seek medical advice immediately if a rash occurs within the first 8 weeks.
63
Melatonin indications
Short term primary insomnia (aged 55 and older)
Long term use (persistent and distressing insomnia secondary to a neurodevelopmental disorder such as autism, ADHD and have not responded successfully to behavioural or environmental approaches).
64
Melatonin mechanism of action
Hormone produced in the pineal gland that facilitates sleep onset.
65
Melatonin dosage
2-3mg 1-2 hours before bedtime
66
Melatonin adverse effects
Headache, diarrhoea, arthralgia (joint pain)
67
Melatonin interactions and contraindications
Avoid benzodiazepines and other hypnotics, caffeine and alcohol.
68
Melatonin precautions and safety in special populations
Not recommended in hepatic impairment
69
Melatonin advice and self care
Sleep hygiene is important
Take with food
70
Melatonin requirements of pharmacist supply
3mg or less IR
2mg or less CR
Aged 55+
For primary insomnia
Can supply 13 weeks
71
Ondansetron indication and mechanism of action
Nausea
5HT-3 receptor antagonist. Reduces the vomiting reflex both peripherally in the GIT and centrally at the chemoreceptor trigger zone.
72
Ondansetron dosing
Anywhere between 2-16mg q8h depending on age, weight, and indication. Maximum of 16mg in 24 hours.
73
Ondansetron adverse effects
Constipation, headache, dizziness, transient rise in LFT
74
Ondansetron interactions and contraindications
Phenytoin, carbamazepine and rifampicin: effect of ondansetron reduced.
Tramadol: decreases analgesic effects of tramadol and increases risk of serotonin syndrome
Do not use in QT prolongation
75
Ondansetron precautions and safety in special populations
Underlying heart conditions (congenital long QT syndrome, congestive heart failure, those predisposed to hypokalaemia or hypomagnesia, and those taking other medications that lead to QT prolongation or electrolyte disturbances).
Caution in renal/hepatic impairment (due to low evidence)
76
Oxybutynin indication
Urinary frequency, urgency and incontinence.
77
Oxybutynin mechanism of action
Relaxes smooth muscle by blocking muscarinic ACh receptors (all of them)
78
Oxybutynin dosing
5mg 2-3 times daily, increased to a maximum of 5mg QID.
Elderly: 2.5mg BD, increased if necessary
Start low and go slow
79
Oxybutynin adverse effects
Dry mouth, blurred vision, urinary retention, constipation, and confusion.
80
Oxybutynin contraindications
Contraindicated in uncontrolled angle-closure glaucoma.
Cognitive impairment/parkinsons: can precipitate confusion
Can exacerbate symptoms of hyperthyroidism, coronary heart disease, congestive heart failure, arrythmia, tachycardia, HTN and prostatic hypertrophy.
81
Oxybutynin advice and self care
Enquire about eye health before prescribing. Anticholinergics can aggravate glaucoma.
Contact doctor immediately if you notice a sudden loss of visual acuity or ocular pain.
82
Topiramate indications
Epilepsy and migraine prophylaxis
83
Topiramate mechanism of action
Blocks sodium channels, inhibits glutamate activity and enhances GABA activity.
84
Topiramate dosing
Migraine prophylaxis: 25mg OD nocte for 1 week, then increased in steps of 25mg daily at intervals of 1 week. Usual dose 50-100mg daily divided in 2 doses. Maximum 200mg daily.
Monotherapy in epilepsy: 25mg OD nocte for at least 1 week, then increased in steps of 25-50mg daily at intervals of 1-2 weeks. Usual dose 100-200mg daily in 2 divided doses. Maximum 500mg daily
Adjunctive therapy in epilepsy: 25-50mg OD nocte, or in 2 divided doses for at least 1 week, then increased in steps of 25-50mg daily at intervals of 1-2 weeks. Usual dose 200-400mg in 2 divided doses. Maximum 1g daily.
85
Topiramate adverse effects
Dizziness, drowsiness, slow or slurred speech
Flushing, tiredness or weakness
Dry mouth or throat, changes in taste, loss of appetite, weight loss, stomach upset.
86
Topiramate interactions and contraindications
Contraceptives: increased risk of breakthrough bleeding and possible contraceptive failure because topiramate induces ethinylestradiol metabolism. Use products with at least 35-50 micrograms of ethinylestradiol.
87
Topiramate precautions and safety in special populations
Dose adjustment in renal and hepatic impairment
Do not use in pregnancy.
88
Topiramate advice and self care
If withdrawal is required, do so gradually.
If ocular pain or visual impairment occurs, contact doctor and topiramate should be discontinued.
Decreased sweating and an increase in body temperature, especially after exposure to environmental temperatures have been reported. Ensure adequate hydration.
Causes sedation
89
Tramadol indication and mechanism of action
Pain
Agonist at opioid receptors and inhibits reuptake of serotonin and noradrenaline.
90
Tramadol dosing
IR: 50-100mg, not more than every 4 hours. Maximum of 400mg daily
SR: 50-100mg BD, increased if necessary, Maximum of 400mg daily
IV: 50-100mg q4-6h, maximum of 400mg daily
Post-operative pain: IM 100mg, then 50mg every 10-20 minutes if necessary during the first hour to a maximum of 250mg in the first hour, then 50-100mg q4-6h. Maximum 600mg daily
91
Tramadol adverse effects
Nausea, vomiting, dizziness, constipation, increased sweating, fatigue
Seizures (lowered threshold)
Serotonin syndrome: hyperthermia, agitation, slow continuous eye movements, dilated pupils, tremor, akathisia, deep tendon hyperreflexia and inducible or spontaneous muscle clonus
Elevated liver enzymes and rash
92
Tramadol interactions and contraindications
Epilepsy or history of seizures
SSRIs, TCAs, MOAIs, pethidine, lithium, st John’s wort, levodopa, cocaine and methamphetamine
93
Tramadol precautions and safety in special populations
Decrease dose in elderly
Contraindicated in children under 2 due to limited evidence
94
Aciclovir indication
External use of treatment for herpes labialis (cold sores)
95
Aciclovir mechanism of action
Prodrug of acyclovir triphosphate
Reduces the production of viral DNA by competitively inhibiting the viral DNA polymerase
96
Aciclovir dosing
Apply every 4 hours (5 times daily) for 5-10 days
Dab on gently. DO not re-use the same finger for more as it can contaminate the tube - use a different finger or a disposable applicator (e.g., cotton bud)
97
Aciclovir adverse effects
Transient stinging or burning
Less common: erythema, itching or drying of the skin
98
Aciclovir advice and self care
Not funded
Avoid contact with eyes and mucous membranes
99
Adrenaline indication and mechanism of action
CPR and anaphylaxis
Alpha and beta agonist
100
Adrenaline dosing
Epipen junior (150mcg) for patients 15-30kg
Epipen adult (300mcg) for patients > 30kg
Dose can be repeated every 5-15 minutes if no improvement
101
Adrenaline adverse effects
Pain at the injection site, tachycardia, nausea and vomiting
102
Adrenaline requirements of pharmacist supply
In medicines containing 1% or less and more than 0.02% adrenaline
103
Clotrimazole indication and mechanism of action
Vulvovaginal candidiasis
Interferes with amino acid transport into fungus
104
Clotrimazole dosage
1 applicatorful once daily before bed
1% = 6 days
2% = 3 days
10% = single dose
100mg pessary = 2 for 3 days, or 1 for 6 nights
500mg pessary = 1 once
Cream + pessary = 1 pessary once and cream to the anogenital area 2-3 times daily to relieve external symptoms
105
Clotrimazole adverse effects
erythema, stinging, blistering, oedema, pruritis, urticaria, local irritation
106
Clotrimazole precautions and safety in special populations
Oral antifungal treatment should not be used in pregnancy
107
Clotrimazole advice and self care
creams may reduce effectiveness of latex products
sexual intercourse before treatment completion may transfer infection to sexual partner
108
Clotrimazole requirements of pharmacist supply
pessary or cream (vaginal use)
109
Cyclizine indications and mechanism of action
nausea and vomiting
Insomnia
H1 antagonist
110
Cyclizine dosing
Nausea/vomiting: 50mg up to TDS
111
Cycylizine adverse effects
sedation and anticholinergic effects
112
Cyclizine requirements of pharmacist supply
aged over 2
in manufacturer's pack
nausea: 6 tablets
insomnia: 10 tablets
113
Famciclovir indication and mechanism of action
Herpes labialis
Is the prodrug of penciclovir
inhibits viral replication by inhibiting DNA polymerase, resulting in early chain termination
114
Famciclovir dosing
3 tablets (1500mg) as a single dose
115
Famciclovir adverse effects
nausea, vomiting, abdominal pain, diarrhoea, headache, sweating, fatigue, pruritis
Rarely: confusion
Very rarely: jaundice, dizziness, drowsiness, hallucinations, thrombocytopenia
116
Famciclovir precautions and safety in special populations
reduce dose in renal impairment
117
Famciclovir requirements of pharmacist supply
Oral use containing 500mg or less
No more than 3 tablets
In manufacturer’s pack
118
Fluconazole indication and mechanism of action
vaginal candidiasis
Inhibits ergosterol synthesis and increases cell membrane permeability.
Fungistatic
119
Fluconazole dosing and adverse effects
150mg stat
Nausea, abdominal pain, headache
Rare reports of skin reactions
120
Fluconazole interactions and contraindications
Inhibits CYP3A4
Not to be used in pregnancy (teratogenic)
121
Fluconazole advice and self care and requirements of pharmacist supply
take with food
in manufacturer's pack
122
Levonorgestrel indication and mechanism of action
Emergency contraception
Stops/delays the release off the egg until the sperm is no longer active in the body
123
Levonorgestrel dosing
1.5mg orally within 72 hours of intercourse
2.5mg if >70kg or BMI >26
124
Levonorgestrel adverse effects
Nausea and vomiting
Withdrawal bleed/menstrual irregularities
Headache, dizziness, breast discomfort
125
Levonorgestrel interactions and contraindications
Carbamazepine, phenytoin, topiramate, St John’s Wort (potential enzyme induction) – double dose.
126
Levonorgestrel requirements of pharmacist supply
Packs not containing more than 1.5mg
Pharmacist must be accredited
127
Miconazole indication and mechanism of action
Vaginal or oral candidiasis
Inhibits ergosterol synthesis and increases cell membrane permeability.
Fungistatic
128
Miconazole dosing
Vaginal: Insert 1 applicatorful (5 g) once daily before bed for 7 days
Oral: 2.5mL gel in the mouth QID. Place on the tongue and keep in the mouth for as long as possible before swallowing. Continue for at least 1 week after symptoms disappear.
129
Miconazole adverse effects
Oral: nausea, vomiting, rash
Vaginal: erythema, stinging, blistering, peeling, oedema, pruritis, urticaria and local irritation
130
Miconazole precautions and safety in special populations
Avoid oral treatment in hepatic impairment and CYP3A4 drugs
131
Naloxone indication and mechanism of action
Opioid overdose
opioid antagonist
132
Naloxone dosing
400mcg, if no response after 1 minute then give 800mcg. Still no response after a further minute: repeat dose of 800mcg.
133
Naloxone adverse effects
Nausea, vomiting, hypotension, tachycardia, headache, dizziness
134
Naloxone requirements of pharmacist supply
When supplied as ampoules with needles and syringes, or as a prefilled syringe
Provide instructions for use
135
Molnupiravir indication and mechanism of action
Mild to moderate covid
Prodrug of NHC
Is incorporated into the RNA and inhibits viral replication
136
Molnupiravir dosing and adverse effects
800mg (4 capsules) BD for 5 days
diarrhoea, nausea, dizziness
137
Molnupiravir requirements of pharmacist supply
Patient meets eligibility, is willing to undergo clinical assessment and the treatment is not contraindicated
138
Nirmatrelvir indication and mechanism of action
mild to moderate covid
Nirmatrelvir = Protease inhibitor, inhibiting viral replication.
Ritonavir = CYP3A4 inhibitor, boosting the activity of nirmatrelvir by increasing its concentration (decreasing metabolism)
139
Paxlovid dosing
300mg nirmatrelvir + 100mg ritonavir BD for 5 days
Renal function 30-60: 150mg nirmatrelvir + 100mg ritonavir BD for 5 days
140
Paxlovid adverse effects
Diarrhoea, vomiting, dysgeusia, headache.
Less common: hypertension, myalgia
141
Paxlovid interactions and contraindications
Cannot supply if eGFR less than 30.
Child-Pugh class C hepatic impairment
Pregnancy
142
Paxlovid requirements of pharmacist supply
Patient meets eligibility, is willing to undergo clinical assessment and the treatment is not contraindicated
143
Nitrofurantoin indication and mechanism of action
Uncomplicated UTI
Bactericidal
Inhibits synthesis of the cell wall, proteins, DNA and RNA
144
Nitrofurantoin dosing and adverse effects
100mg MR BD for 5 days
Discolouration of urine, stomach upset, loss of appetite.
Contact your doctor if you experience persistent cough, shortness of breath or numbness/tingling in hands or feet
145
Nitrofurantoin precautions and safety in special populations
Do not use in pregnancy or breastfeeding.
CrCl less than 60mL/min
146
Nitrofurantoin advice and self care
Take with food.
Avoid urinary alkalinisers (Ural)
147
Nitrofurantoin requirements of pharmacist supply
Accreditation required.
10x 100mg dosage units
16-65 years of age
148
Nystatin indication and mechanism of action
Oral or vaginal candidiasis
Binds to ergosterol in the cell membrane, leading to pores and cell death.
149
Nystatin dosing
Oral: 500,000 to 1 million units TDS. Continue treatment for 48 hours after clinical cure to prevent relapse.
Vaginal: 1 applicatorful 1-2 times daily for 2 weeks
150
Nystatin adverse effects
Oral: nausea, vomiting, diarrhoea
Vaginal: erythema, stinging, blistering, peeling, oedema, pruritis, urticaria, local irritation
151
Orlistat indication and mechanism of action
Adjunct in obesity
Lipase inhibitor reduces the absorption of dietary fat.
152
Orlistat dosing and adverse effects
120mg taken immediately before, during or up to 1 hour after each main meal (maximum TDS)
Oily leakage from rectum, cramps, bloating, diarrhoea
Vitamin deficiency
153
Orlistat requirements of pharmacist supply
BMI of greater than 30
154
Oseltamivir (Tamiflu) indication and mechanism of action
Treatment or prophylaxis of influenza
Reduces replication of influenza A and B by inhibiting viral neuraminidase
155
Oseltamivir (Tamiflu) dosing
Prevention (post-exposure): 75mg OD for 10 days, beginning within 48 hours of exposure.
Prevention (community outbreak): 75mg OD for up to 6 weeks
Treatment: 75mg BD for 5 days (10 days if immunocompromised), beginning within 48 hours of symptom onset
156
Oseltamivir (Tamiflu) adverse effects and precautions and safety in special populations
Nausea, vomiting, headache.
Serious but rare: GI bleeding, allergy
Reduce dose in renal impairment.
157
Oseltamivir (Tamiflu) requirements of pharmacist supply
Up to 10 dosage units
Aged 13 or over who have been exposed to influenza.
No more than 75mg
158
Prochlorperazine indication and mechanism of action
Nausea from migraines or ECP
D2, H1, alpha 1+2 antagonist. Acts on the CTZ
159
Prochlorperazine dosing
Acute: 20mg, then 10mg after 2 hours.
Prevention: 5-10mg 2-3 times daily.
160
Prochlorperazine adverse effects
Constipation, dry mouth, sedation,
Beware of QT prolongation
161
Prochlorperazine contraindications and requirements of pharmacist supply
CNS depression
No more than 10 tablets
162
Sumatriptan indication and mechanism of action
Migraines
Agonist of 5-HT 1B and 1D.
Leads to constriction of cranial blood vessels and inhibits release of pro-inflammatory neuropeptides
163
Sumatriptan dosing and adverse effects
1 tablet at onset of symptoms. Dose may be repeated after 2 hours if symptoms recur.
Dizziness, drowsiness, tingling, feeling warm, flushed or weak
164
Sumatriptan interactions and contraindications
MOAIs
IHD
Previous MI
Moderate to severe HTN
165
Sumatriptan precautions and safety in special populations
Reduce dose in hepatic impairment.
Caution in renal impairment
166
Sumatriptan requirements of pharmacist supply
In manufacturer’s pack
No more than 2 tablets
No stronger than 50mg
167
Triamcinolone indication and mechanism of action
Oral and perioral lesions
Synthetic corticosteroid which possesses anti-inflammatory, antipruritic and anti-allergic action
168
Triamcinolonce dosing and adverse effects
Apply a small amount to coat lesion with a thin film, preferably at night or after meals.
Occasional exacerbation of local infection, thrush or other candida infections
169
Triamcinolone requirements of pharmacist supply
0.1% or less and no more than 5g
170
Trimethoprim indication and mechanism of action
Uncomplicated UTI
Folate antagonist (reversibly inhibits dihydrofolate reductase)
bacteriostatic
171
Trimethoprim dosing and adverse effects
300mg OD nocte for 3 days (7 days in pregnancy or men)
GI upset
172
Trimethoprim precautions and safety in special populations
Do not use in first trimester.
Reduce dose in renal impairment
173
Trimethoprim requirements of pharmacist supply
Females aged 16-65
3 solid dosage forms
Extra accreditation required
