Special Patient Groups [completed] Flashcards
What are some special patient groups?
Patients with:
Asthma
Diabetes
Kidney, Liver and Cardiovascular disease
and more…
Athletes
Pregnant people
Elderly
Children
What advice is there regarding giving medicines to pregnant patients?
Give as few medicines as possible at the lowest effective doses for as short a duration as possible
Are herbal medicines a safer alternative to conventional medicines?
NO - less regulation/ evidence for use in pregnancy and constituents may be toxic, have pharmacological activity or be contaminated.
When do medicines pose the greatest risk during a pregnancy?
3-11 weeks - risk of teratogenicity
Trimester 2 and 3 - there is still a risk to growth, functional development and toxicity
What can medications given short before term or during labour do?
Have adverse effects on labour and the neonate after delivery
What needs to be considered when supplying medication to women who are breastfeeding?
Does the medication pass into milk and how much - look at pH and lipid solubility?
Will this be harmful to the baby?
Will medicines affect supply of milk and what are the consequences of this - what alternatives may be given?
Will the medication affect the babies ability to suckle?
- Sedatives/codeine can affect suckling ability of baby –> cannot feed so effect on nutrition
When medicines are not contraindicated it is important that they are:
Taken after feeds wherever possible
At the lowest effective dose
Shortest duration of treatment possible
What are some common conditions that pregnant women may ask a pharmacy about?
Nausea and Vomiting
Pain and Fever
Coughs and colds
Threadworm
Headlice
Heartburn and Indigestion
Constipation
Haemorrhoids
Diarrhoea
Cystitis
Fungal Infections
Dermatitis
Hayfever and allergies
Conjunctivitis
Anti-malarials
What may the GP prescribe in women suffering from nausea and vomiting during pregnancy?
Antiemetics such as cyclizine or promethazine BUT only if ESSSENTIAL
What is available over the counter for women suffering from nausea and vomiting during pregnancy?
NOTHING
DO NOT GIVE TRAVEL SICKNESS MEDICINES
What is some self-care advice that can be given to women suffering from nausea and vomiting during pregnancy
Having a drink and a ginger biscuit before getting out of bed as ginger can help with nausea
Wearing travel BANDS used to prevent travel sickness
Maintaining hydration if vomiting
What can be provided to women suffering from pain and fever during pregnancy?
PARACETAMOL AT LOWEST EFFECTIVE DOSE AND SHORTEST DURATION
Are NSAIDs recommended during pregnancy?
Should be avoided, especially in the third trimester
What effect can aspirin and ibuprofen have during pregnancy especially in the third trimester?
Aspirin can impair platelet function
Aspirin and Ibuprofen can affect onset and duration of labour
What can be given to breastfeeding women who are experiencing pain?
Paracetamol and Ibuprofen
Why is OTC aspirin not allowed to be taken by breastfeeding women?
can pass through milk and cause Reye’s syndrome in the baby
What is reyes syndrome?
A condition that causes swelling in the liver and brain
Aspirin 75mg may be taken by breastfeeding women under what condition?
Prescribed by the GP and no other contraindications
What non-drug advice may be given to pregnant women experiencing back pain?
exercising in water
massage therapy
Why are many cough and cold medicines not used in pregnant or breastfeeding women?
They usually contain suppressants, expectorants and decongestants which are not licensed in pregnancy and breastfeeding?
What could be recommended to a patient with a cough or cold who is pregnant or breastfeeding?
Can take paracetamol for fever.
Use of steam inhalation, saline and nasal sprays, and NON MEDICATED glycerin pastilles to lubricate the throat
Make sure they are drinking plenty of fluids
What is the role of pseudoephedrine in cough and cold medicines?
Decongestant
What effect can pseudoephedrine have on breast milk?
Reduces breast milk production
What effect can codeine have if taken during breastfeeding?
Sedation of the infant
Effect on suckling ability
Constipation
Why do pregnant women commonly have heartburn?
Pressure of baby against stomach and hormonal changes. It is more common in the later stages as the baby gets heavier.
What medications can be given to treat heartburn in pregnant women?
Alginates such as gaviscon but they require caution
Why do alginates require caution in pregnancy?
High in sodium
if patient is predisposed to a high BP can lead to pre-eclampsia or eclampsia
What effect may aluminium based alginates have in pregnancy?
Can aggravate constipation
Can PPIs be recommended OTC in pregnancy?
No - omeprazole MIGHT be allowed but check product licensing and SmPC first
What is the recommended treatment for heartburn and indigestion in pregnant women?
Lifestyle and diet changes before drug treatment
- avoiding trigger foods
-propping up upper body when sleeping
-smaller meals
- try to not eat 3 hours before bed
- Drink plenty of fluid
What is the recommended treatment for constipation in pregnant and breastfeeding women?
First make changes to diet such as increasing fibre and sorbitol intake then if ineffective use drug treatment
What drug treatment is okay for constipation in pregnant and breastfeeding women?
Bulk forming (fybogel) and osmotic (lactulose) laxatives ONLY if dietary changes have been ineffective
Why are stimulant laxatives like Senna, docusate and bisacodyl not reccomended OTC in pregnancy?
They stimulate smooth muscle - uterus is made up of smooth muscle causing contractions.
Why are stimulant laxatives like Senna, docusate and bisacodyl not reccomended OTC in breastfeeding?
The baby can get colic and diarrhoea due to peristaltic activity if in breast milk
Why is it important for breastfeeding mothers to drink plenty of fluid?
A lot of their fluid intake is used to make milk so it is important they stay hydrated
Why are haemorrhoids so common in pregnancy?
Pregnant women likely to be constipated and there is pressure on the blood vessels in the anus and rectum due to the baby
When do symptoms of haemorrhoids resolve in pregnancy?
after baby is delivered
What products are not licensed for OTC use in pregnancy for the treatment of haemmorhoids?
Hydrocortisone
In general should haemorrhoids in pregnancy be treated OTC?
No.
Patient should be referred to the GP if this is their first time having haemmorhoids and if symptoms are very painful or severe
What lifestyle advice could be given for treating haemorrhoids in pregnancy?
Dietary advice
- increase fibre and sorbitol
- drink plenty of water
Discourage straining such as lifting heavy loads
What is the first line treatment for headlice in pregnancy and breastfeeding?
Dimethicone 4% (Hedrin)
(HEDRIN IS FIRST LINE IN ALL PATIENT GROUPS)
Wet combing with conditioner regularly
What is the first line treatment for THREADWORM in pregnancy and breastfeeding?
STRICT HYGIENE RULES ONLY FOR 4 -6 WEEKS
Washing hands thoroughly with soap and warm water
Keep fingernails short and avoid biting nails or scratching around the anus.
Shower every morning to remove eggs from skin
Change bed linen and nightwear daily
Do not shake out clothing or bed linen as this will distribute eggs.
Wash and dry clothing or bed linen in a hot cycle
Thoroughly dust and vacuum and clean bathroom.
Can we give OTC products such as piperazine and mebendazole (OVEX) to treat threadworm in pregnant and breastfeeding women?
NO
Are chloramphenicol and propamidine isetionate licensed for OTC supply in treating conjunctivitis in pregnant and breastfeeding women?
NO
What can be recommended to pregnant and breastfeeding women who have conjunctivitis?
Boil water and add salt to make a sterile saline solution to clean the eye with
what should be done if a pregnant or breastfeeding woman presents with cystitis?
Refer to GP
Why does pregnancy increase the risk of fungal infections - especially vaginal thrush?
Hormonal changes make it easier for fungi to stick to the epithelium
Are OTC antifungals reccomended in pregnancy?
No
When can clotrimazole be given to treat fungal infection in pregnancy?
When prescribed by the GP if ESSENTIAL
What fungal infection is common in infants and then can affect breastfeeding mothers?
Oral thrush
Which product is licensed OTC to give to infants experiencing oral thrush?
Miconazole gel for infants OVER 4 MONTHS
can be applied to mother’s nipple
What is the treatment for eczema/dermatitis in pregnant or breastfeeding individuals?
Emollients
Is Hydrocortisone 1% licensed to be given OTC in pregnancy?
NO
What is the recommended treatment for diarrhoea in pregnancy and breastfeeding?
Oral rehydration sachets if the specific product is licensed?
If diarrhoea in pregnancy and breastfeeding has lasted over 2-3 days the appropriate action would be to….
REFER
Is an amtimotility drug such as loperamide reccomended to treat diarrhoea in pregnancy and breastfeeding?
NO
True of false. Rhinitis can be aggravated by pregnancy.
True
What is the first line treatment for hayfever and allergic rhinitis in pregnancy and breastfeeding?
Allergen avoidance
What are some examples of barrier treatments for hayfever and allergic rhinitis in pregnancy and breastfeeding? How do these work?
Vaseline, Prevalin, Haymax
Coat the nasal mucosa to trap the allergen so it cannot get to receptors
True or false. Both sedating and non-sedating antihistamines should be avoided in pregnancy and breastfeeding.
True
Should be avoided unless prescribed
Can topical cromoglicate and antihistamines always be given in pregnancy and breastfeeding?
can be considered - would have to check specific product licensing and SPC
Should pregnant women avoid overseas travel if possible?
Yes
What antimalarials can be given to pregnant women who have to travel overseas?
Chloroquine and proguanil in areas with P.falciparum species.
BUT ONLY ON PRESCRIPTION
What should be prescribed alongside proguanil in pregnant women?
Folic acid
How does age affect risk of ADRs?
Higher risk as we get older due to changes in physiology and metabolism and excretion of drug.
How does age affect risk of certain diseases?
Increase in age - increase risk of certain disease states so symptoms presented in a pharmacy may have more sinister underlying cause
Why is constipation more common in the elderly?
Slowed down gut motility
What effect can long term use of a stimulant laxative have?
Lazy gut - gut becomes use to being stimulated by drug so usual reflexes stop working?
What is the referral time for diarrhoea in an adults vs an older person?
Adult is 72 hours.
Old person is 48 hours
Higher risk of dehydration
What should you do if a person over 55 presents with recent dyspepsia for the first time?
Refer - higher risk of ulcers, bleeds and gastric cancer
What can sedating histamines cause in older patients?
Sedating histamines such as chlorphenamine and promethazine can have stronger effects and can cause falls and confusion
Which antihistamine should be avoided in people over the age of 65?
Acrivastine (Benadryl)
What analgesic is generally okay for use in older patients?
Paracetamol. but should check if they are taking any other paracetamol containing products.
There is a greater risk of gastric ulceration in older people when taking….
NSAIDs
What should we check for in older patients before supplying NSAIDs?
Cardiovascular disease
History of gastrointestinal disorders
What cause of pain is common in older patients?
Falls
What should we do if an older patient presents with symptoms of cystitis in a community pharmacy and why?
Refer as it is more likely for the cystitis to develop into AKI/CKD.
What age group are topical antifungals (e.g. clotrimazole) not licensed in for the treatment of vaginal thrush?
Over 60 - would need to be referred
What are some symptoms of pyelonephritis (kidney infection)
Soreness in the lower back
Haematuria
Fever
Cold and flu medicines containing which ingredients should not be used in children under six?
nasal decongestants
expectorants
antitussives (cough suppressants)
antihistamines
When are antihistamines okay to be used in children under six?
Allergies
relief of itching such as in chickenpox
What do cough syrups for children contain and what do these do?
Demulsants which moisturise the throat.
THEY DO NOT SUPPRESS COuGH
What is the reccomended treatment for children under six with cold and flu symptoms?
Paracetamol
Ibuprofen
Vicks
Olbas oil (3 months +)
For children aged 6-12 years old cough and cold medicines continuing antitussives, suppressants, antihistamines, expectorants and decongestants are to be used for a maximum of how many days?
5 DAYS
Hydrocortisone cream is only licensed to be sold OTC for children over what age?
10 years
Which products for constipation are licensed OTC for use in children?
Lactulose and califig
Which products for constipation does the OTC licensing vary for use in children?
Senna and stimulant laxatives
Oral rehydration sachets such as dioralyte can be provided to children over…
2 years old
Give an example of an antispasmodic. Are these licensed to be given to children under the age of six.
Buscopan - tablets not licensed in children under 6 years old
What should be done if a child under 2 needs to be treated with mebendazole?
Refer to nurse or GP
What age group is chloramphenicol eye drops licensed in?
from 2 years and over
Why is lidocaine gel used in children and is this use first line for this condition?
Used for teething and not first line. Only used if teething ring and massaging the gum have failed.
What was the change in classification for lidocaine gels for teething?
GSL –> P
When should children be referred if they have had diarrhoea?
aged under 1 = 1 day
aged under 3 = over 2 days
older than 3 = 3 days
Why should parents take care administering medicines if there is more than one child in the house taking the same medication?
Dose may vary based on ages and weight
What are some common long term conditions that can be aggravated by OTC medicines?
Respiratory conditions
Cardiovascular Conditions
Diabetes
Epilepsy
Renal and Hepatic
Glaucoma
Prostate Hypertrophy
What analgesia should be avoided in patients with congestive heart failure and why?
NSAIDs as they cause sodium and water retention
Why should NSAIDs be avoided in patients taking warfarin, anticoagulants, and anti-platelets especially if over 65?
Can affect clotting
What two NSAIDs have the highest risk of thrombotic events?
Diclofenac
High doses of ibuprofen
Which NSAID has a generally lower thrombotic risk?
Naproxen
What migraine treatment is contraindicated in patients with 3 CVS factors, hypertension, previous heart attack, ischaemic heart disease and angina?
Sumatriptan
What can be given to patients with CVD if they have migraines?
Refer if very bad or recommend
Paracaetamol
Co-codamol
Migraleve
What can happen if minoxidil reaches the bloodstream after application?
Lowers blood pressure
Which cardiovascular condition is minoxidil not to be used in?
Hypertension
What should be done if a patient would like minoxidil and they have a CVS condition?
refer to GP
When is sildenafil contraindicated?
If taking nitrates including poppers
When sexual activity is INADVISABLE - recent MI, Stroke, unstable angina or severe heart failure
Severe hepatic impairment
Hypotension (less than 90/50)
What needs to be looked out for in diabetic patients?
Medicines that affect glucose levels
Slowed healing
Signs that diabetes is not controlled
Comorbidities
Sick day rules
What are some medicines not reccomended in patients with epilepsy?
Sumatriptan - CONTRAINDICATED
Piperazine (for threadworm but not commercially available anymore)
HIGH DOSES of antihistamines
What medicines should we avoid/use with caution in RENAL impairment?
Sumatriptan
Piperazine
Cystitis products high in potassium
Products high in sodium (alginates, effervescent tablets)
NSAIDS (can impact sodium and fluids)
Sympathimometics/Decongestants (can cause vasoconstriction and increase pressure in renal blood vessels)
What medicines should we avoid/use with caution in HEPATIC impairment?
Sumatriptan
NSAIDs (may have clotting changes in severe impairment)
Piperazine
What medicines should we avoid/use with caution in GLAUCOMA?
Antimuscarinics: Antihistamines
Hyoscine
Analgesia for headaches : headaches may indicate glaucoma getting worse
Sympathimometics = vasoconstriction increases IOP
What medicines should we avoid/use with caution in PROSTATE HYPERTROPHY?
Antihistamines
Hyoscine
Sympathimometics
Why may sports athletes use drugs?
Therapeutic use for medical conditions
Performance enhancement
Social and recreational use
Drug testing carried out by sports athletes can detect…
all medicinal products
What substances are prohibited all the time in and out of sports competitions?
Non-approved substances
Anabolic agents
Peptide hormones, growth factors and related products, mimetics
Beta 2 agonists
Hormone and metabolic modulators
Diuretics and masking agents - help hide or flush out illegal substances
What substances are prohibited during sports competitions?
All of the substances that are prohibited all the time as well as
Stimulants
Narcotics
Cannabinoids
Glucocorticoids
What substances may be prohibited in particular sports?
Alcohol - due to safety reasons such as in motorsports or archery
Beta-blockers - need for steady hand in archery
What resource can be used to check if licensed medicines are allowed in and out of competitions?
Global drug reference online
What are some commonly used supplements by athletes?
Carbohydrate drinks
Protein supplements
Amino acids
Vitamin Supplements
Glucosamine
Nutritional ergogenic supplements: creatine, caffeine, sodium bicarbonate and sodium citrate
As there is an increasing availability of commonly used supplements, there is a risk of….
supplements being laced.
What is the role of Informed Sport?
Testing batches of supplements for prohibited substances.
