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MO1 > POM-P > Flashcards

POM-P Flashcards

1
Q

what are the most recent POM-P/GSL switches?

A
  • Amorolfine nail lacquer (GSL)
  • Desogestrel (P)
  • Estradiol (P)
  • Fexofenadine (GSL)
  • Naproxen (P)
  • Orlistat (P)
  • Mometasone Nasal spray (P)
  • Maloff Protect
    (Atovaquone/Proguanil) (P)
  • PPI’s
  • Pantoprazole (P)
  • Esomeprazole (GSL)
  • Omeprazole (GSL)
  • Sildenafil (P)
  • Sumatriptan (P)
  • Tamsulosin (P)
  • Tranexamic Acid (P)
  • Ulipristal acetate (P)
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2
Q

what is the indication for estradiol 10mch vaginal tablets?

A

Treatment of vaginal atrophy due to oestrogen deficiency in postmenopausal women
aged 50+, who have not had a period for at least 1 year, +/- uterus
* Vaginal atrophy: dryness, soreness, itching, burning, irritation, painful intercourse

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3
Q

what should the dose of estradiol 10mcg vaginal tablets be?

A

– Initial: one vaginal table daily for 2 weeks
– Maintenance: one vaginal tablet twice a week
* If symptoms return after break- maintenance
* If symptoms still not resolved initial then maintenance
– Switching from other topical oestrogen:
* If taking recommended dose >3 months, symptoms controlled, no health changes
– Benefit: can take 8-12 weeks

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4
Q

how should you administer estradiol 10mcg vaginal tablets?

A

– Intravaginal application using
– Open the blister pack at the plunger end.
– Insert the applicator in the vagina until resistance is met (8-10 cm).
– Release the tablet by pressing the plunger.
– Withdraw the applicator and discard

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5
Q

what are the contraindications for estradiol 10mcg tablets?

A

– Hypersensitivity or allergies to estradiol or any of the excipients
– Undiagnosed genital bleeding
– Untreated endometrial hyperplasia (thickening of the uterus)
– Women with an intact uterus previously treated with unopposed systemic oestrogens
– Angina, heart attack, ischaemic stroke (current, recent)
– Hx oestrogen dependent cancer: breast, ovarian, endometrial
– Hx venous thromboembolism
– Porphyria (blood disorder)
– Vaginal – untreated infection (unusual discharge, severe itching). Irregular bleeding
– Vulval dermatosis – change to colour/ texture
– Acute or previous liver disease- liver tests don’t return to normal

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6
Q

when should you refer someone presenting for estradiol tablets?

A

– No symptom improvement in 7 weeks
– <50 or
– menstruation <1 year ago
– Hx endometriosis/ endometrial hyperplaysia

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7
Q

how should you counsel someone on estradiol tablets?

A
  • Side effects
    – Headache; abdominal pain; vaginal discomfort,
    discharge, bleeding; steroid dependent cancer
  • Seek urgent medical attention if:
    – Jaundice or deterioration in liver function
    – Significant increase in blood pressure
    – New onset of migraine-type headache
    – Pregnancy
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8
Q

what is the indication for desogestrel (hana/lovima)? what age can it be given to?

A

indication:
* Contraception in women of childbearing age.
* Age:
* Safety and efficacy under 18y not established
* Hana: 18+
* Lovima: “benefits and risks of supply to adolescents under 16 years
should be carefully considered”

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9
Q

what is the dose and the side effects of desogestrel?

A
  • One daily
  • Can be used whilst breastfeeding
  • Side effects:
  • Irregular bleed patterns, mood altered, headaches, nausea, acne,
    breast pain/tenderness*, amenorrhoea, weight changes
  • Report severe abdominal/ chest pain, DVT, headaches
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10
Q

how should you initiate desogestrel?

A

Day 1 of period. If days 2-5 but will need to use an additional barrier method for first 7 days

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11
Q

how should you start a desogestrel pill after COC tablet/ patch?

A

No break: Start next day
After pill free period: 7 day barrier required

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12
Q

how should you start a desogestrel pill after a POP?

A

No break: start next day

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13
Q

how should you start desogestrel following miscarriage/ abortion?

A

ASAP or within 5 days, after- barrier required.

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14
Q

how should you start desogestrel following childbirth?

A

up to 21 days after birth. >= barrier required

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15
Q

how should you start desogestrel after EHC?

A

Levonorgestrel: Start straightaway and use an additional barrier method (e.g. condom) for 7 days.
Ulipristal: Wait 5 days after taking ulipristal and use an additional barrier method (e.g. condom). Then start desogestrel and continue using an additional barrier method for a further 7 days (12 days additional barrier method use in total).

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16
Q

what are the missed pill rules for desogestrel?

A

<12 hours late, take the missed tablet ASAP and take the next tablet at the
usual time, even if it leads to taking two tablets in one day.
* >12 hours late, take the forgotten tablet and take the next tablet at the
usual time, even if it leads to taking two tablets in one day. If more than one
tablet has been missed, only one of the missed tablets should be taken
immediately. An additional barrier method of contraception for the next 7
days.
* If vomiting occurs within 3-4 hours of tablet-taking, then the pill should be
considered ‘missed’

17
Q

when is desogestrel contraindicated?

A

Known or suspected sex-steroid sensitive malignancies (breast, uterine, ovarian).
– Active venous thromboembolic disorder.
– Presence or history of severe hepatic disease as long as liver function values have not
returned to normal.
– Irregular vaginal bleeding.
– Hypersensitivity to the active substance or to any of the excipients

18
Q

when should you refer someone for desogestrel?

A

– Significant interaction (Anti-convulsants, St John’s wort)
– Hx of thrombosis or breast cancer
– If the person has diabetes
– If the person has uncontrolled hypertension
– If the person experiences any serious side effects or signs and symptoms of adverse
effects e.g. depression, thrombosis, allergy, liver disease, breast cancer or ectopic
pregnancy
– If the person is due to have surgery or is immobile.

19
Q

what is the indication/ dose for omeprazole?

A

– OTC omeprazole is indicated for the short-term relief of heartburn
symptoms associated with acid reflux in adults aged 18 yrs +
* Dose
– The dose is 20mg once daily for up to 14 days
– No improvement after 2 weeks refer to prescriber

20
Q

when should you refer someone who presents for omeprazole?

A

– <18, >55 years new onset/ change in presentation
* >45 if recurrent GORD and taking OTC
– Red flags for gastric cancer:
* Dysphagia, unexplained weight loss, blood in stool or vomit, persistent vomiting,
epigastric mass, severe stomach pain, hx gastric ulcer

21
Q

what drug interactions does omeprazole have?

A
  • Omeprazole is metabolised by the liver through cytochrome P450 hence can delay the elimination of diazepam, phenytoin
    and warfarin.
  • Due to the decreased intragastric acidity, the absorption of ketoconazole or itraconazole may be reduced during omeprazole treatment,
  • Similarly, It may also alter the absorption of digoxin.
22
Q

what are other PPIs available?

A
  • Esomeprazole (GSL)
    – Licensed for short term use up to 14 days for reflux in adults.
  • Pantoprazole 20mg OD (P)
    – Up to 4 weeks, refer if no improvement after 2 weeks
  • Both 18+
  • Same referral points as Omeprazole
  • Lifestyle counselling
23
Q

what is the indication for orlistat?

A

– Weight loss in adults (18+) who are overweight or obese (body
mass index >28kg/m2)
– Need to check BMI at each supply

24
Q

what is the dose of orlistat?

A

– 60mg TDS immediately before, during or up to 1 hour after each
meal. If no meal/no fat miss tablet.
– Should be in conjunction with a low-fat diet
* Aid weight loss and minimise GI side effects
– Max 6 months treatment

25
Q

when should you refer someone presenting for orlistat?

A
  • <18 years or BMI <28 kg/m2
  • No weight loss after 12 weeks of treatment
  • Taking >6 months
  • Pregnant/ breastfeeding
  • Prescribed :
    – amiodarone, levothyroxine, antiepileptics, ciclosporin,
    warfarin, anticoagulants. Medication for diabetes,
    hypertension, hypercholesterolemia
  • Kidney disease, malabsorption, cholestasis
  • Rectal bleeding when taking
26
Q

what counselling should be given for orlistat?

A
  • Side effects: GI including leakage, flatulence, diarrhoea, urgency, fatty oil stools. (less likely if eat low fat diet)
  • Advise to take multivitamin at bedtime as ADEK are fat soluble vitamins.
  • Barrier methods if on contraceptive and persistent diarrhoea
  • Not a ‘quick fix’ should also be counselled on diet and exercise. Realistic weight loss targets: 0.5-1kg/ week
27
Q

what is the indication for fexodenadine?

A

– used to relieve symptoms of allergy such as hay fever, blocked nose and
itchy or watery eyes

28
Q

what is the dose/ side effects of fexofenadine?

A
  • Dose:
    – One tablet daily before a meal
  • Not to be used in pregnancy or breast feeding
  • Side effects:
    – headache, drowsiness, dizziness, nausea
    – Apple juice and orange juice decrease the exposure to fexofenadine
    – Impact on skilled tasks
29
Q

what is the indication/ dose for mometasone nasal spray?

A
  • Indication: treat symptoms of seasonal hay fever or perennial allergic rhinitis
  • 18+
  • Dose:
  • Two sprays into each nostril once a day until symptoms are controlled, then one spray into each nostril daily
  • Maximum 3 months treatment
  • Oral medicines and eye drops may be used in addition to relieve additional symptoms.
30
Q

what are the common side effects of mometasone?

A
  • Epistaxis (nose bleeds)
  • Headache
  • Pharyngitis
  • Upper respiratory tract infection
  • Nasal discomfort, nasal ulceration, irritated throat
  • People taking CYP3A inhibitors could be at increased risk
    of systemic side effects
31
Q

when should you not supply mometasone?/ when should you refer?

A

When not to supply
* Under 18 years of age
* For treatment periods of more than three months
* If person is hypersensitive to any of the ingredients
* If person has an untreated localised infection
around/within the nose
* If the person has had recent nasal surgery or trauma
* Cautions: steroid use

When to refer
* No improvement of symptoms after 14 days use
* Symptoms persist for more than three months

32
Q

what is the indication, dose and side effects for otrivine dual relief nasal spray?

A
  • Indication
    – Symptomatic treatment of nasal congestion and rhinorrhea in common
    colds
    – 18+
  • Dose:
    – 1 spray in each nostril up to maximum 3 times daily (At least 6 hours between each dose)
    – Maximum 7 days treatment – rebound congestion (stop sooner if improvement)
  • Side-effects:
    – visual disturbances, dizziness, fatigue, epistaxis, nasal dryness
33
Q

what are the contraindications for otrivine dual relief nasal spray?

A

hypersensitivity to ingredients, after nasal surgery, glaucoma
avoid during pregnancy/ BF

34
Q

who should you be cautious in when using otrivine dual relief nasal spray?

A

– hypertension, patients with long QT syndrome (increased risk
of serious ventricular arrhythmias), hyperthyroidism, diabetes
mellitus, hypertrophy of the prostate, stenosis of the bladder
bar, cystic fibrosis,
– MAOi treatment or who have received them in the last two
weeks, Tri and tetra-cyclic antidepressants treatment or who
have received them in the last two weeks, Beta 2-agonists
treatment, angle closure glaucoma

35
Q

what is the pack size restriction of oral lidocaine products?

A

Pack size restricted to 10g and packaging altered

36
Q

what is the current teething advice?

A

– Fist line: gentle rubbing of the gum with a clean finger and allowing the child to bite on a clean and cool object
– Paracetamol or ibuprofen suspension can be considered if appropriate
* If oral lidocaine products indicated - Apply a pea sized amount of gel to a clean fingertip and spread gently onto the sore area of the gum. If necessary, repeat the dose after 3 hours.
* Max 6 times in 24-hour period
* Check licensing – some brands >5 months only

MO1 (50 decks)

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