Schedule 3 medications

Question 1

Levenorgestrel (postella)

Answer 1

• consider professional standards, ethics and duty of care. Patient’s wellbeing is priority
• Age - consider referring patients under 16 years of age. If patient is unable to get timely access to a GP or sexual health clinic, consider whether they are mature enough to understand your advice, pharmacist should try to persuade patient to inform their caregiver, it is in the patients best interest to receive treatment
• Time since intercourse - most effective within 24 hours, but effective up to 72 hours after intercourse. If more than 72 hours after intercourse, refer for copper IUD or other medical treatment. Inform pt that the pill is not 100% effective and to do pregnancy test after 2 weeks.
• Safety and efficacy - safe in pregnancy and breastfeeding. Will not end pregnancy. Less effective in malabsorption disorders or vomiting and diarrhoea.
• advanced provision - fine, but consider written information and counselling
• Adverse effects - nausea and vomiting, may increase heaviness of period. If pt vomits within 2 hours of taking dose, it should be repeated.
• Document supply
• can use patient question sheet to gather info
• counsel on contraceptive choices
• sexual assult - refer to GP and encourage patient to notify police. provide info on helplines

Question 2

famciclovir tablets for cold sores (1500mg once only)

Answer 2

SIGNS AND SYMPTOMS OF COLD SORES:

• prodromal stage - tingling or burning or itching before lesions occur
• small clusters of lesions that are painful, fluid filled and may eventually erupt. they then dry and form a scab. Normal duration is 7-10 days.
• refer patients under the age of 18
• treatment when a hard crust has already formed - hydrocolloid patch to reduce risk of bacterial infection. generally self limiting.
• most effective if treated within 24 hours of symptom onset
• not recommended in pregnancy
• when to refer: immunocompromised patients, mouth lesions, signs of bacterial infection, lesions in areas other than lips or face
• counselling: see doctor if lesions continue to appear. May cause nausea, diarrhoea or headache. Trigger factors: stress, dry and chapped lips, fatigue, menstruation, upper respiratory tract infection

Question 3

PPI’s OTC

Answer 3

ALARM SYMPTOMS AND WHEN TO REFER
* difficulty swallowing
* suspected GI bleeding
* unintentional weight loss
* <18 years, or >55 years with recent onset of symptoms
* continuation of symptoms after 2 weeks of PPI therapy
*family history of GI cancer
* long term NSAID therapy
ADVICE
* smoking cessation
* avoid foods that aggravate symptoms
* elevate bed head
* avoid large, late meals
* take once daily
* relief will not be immediate, can take with antacid
ADVERSE EFFECTS
* GI upset - nausea, diarrhoea
* headache
*