OSCE REVISION

Legal prescription requirements (Standard NHS, Private):

1. Signature of prescriber Must match the prescribers name
2. Address of prescriber
3. Date on prescription valid for 6 months or 28 days if CD sch. 1,2,3,4
4. Particulars of prescriber particulars that indicate the type of
appropriate practitioner e.g. Dr. and GMC number
5. Name of patient
6. Address of patient including house number/name and full postcode, if
homeless NFA, not required for EEA
7. Date of birth or age of the patient if under 12 years if it says
Mr./Mrs. then assume patient is over 12 years but check age in case
elderly
Legal prescription requirements (EEA or Switzerland):
1. Patient details full name and date of birth
2. Prescriber details prescribers name, professional qualifications, direct
contact details including email address, telephone/fax number with
international prefix, work address including the country in which they
work
3. Prescribed medicines details name of the medicine (brand name
where appropriate), pharmaceutical form, quantity, strength, and dosage
details
4. Prescriber signature
5. Date of issue valid for up to six months from the appropriate date,
schedule 4 CD for 28 days
- EVEN IF WRITTEN IN DIFFFERENT LANGUAGE, STILL LEGALLY
ACCEPTABLE
- PHARMACIST NEEDS TO HAVE ENOUGH INFORMATION TO ENABLE
SAFE SUPPLY OF MEDICINES, CONSIDERING PATIENT CARE AND
WELL BEING
- SCHEDULE 1, 2 AND 3 CDs AND MEDICINAL PRODUCTS WITHOUT
MARKETING AUTHORISATION VALID IN THE UK CANNOT BE
DISPENSED IN THE UK WHEN PRESCRIBED BY A PRESCRIBER IN
AN EEA COUNTRY OR SWITZERLAND
Prescription requirements of Schedule 2 and 3 Controlled Drugs:
1. Signature of prescriber
2. Particulars of prescriber particulars that indicate the type of
appropriate practitioner e.g. Dr. and GMC number
3. Prescribers address
4. Date of prescription
5. Dose must be clearly defined
6. Formulation must be stated, abbreviations are acceptable
7. Strength only needs to be written on prescription if more than one
strength exist
8. Total quantity must be written in both words and figures e.g. tablets,
capsules, ampoules, millitres
9. Quantity prescribed/duration max 30 days
10.
Name of patient

11.
Address of patient if patient doesnt have a fixed address (e.g.
homeless or witness protection scheme) no fixed abode/NFA is
acceptable
12.
Dental prescriptions for dental use only
13.
Instalment direction where the prescription is intended to be
supplied in instalments a valid instalment direction is required
Categories of Veterinary Medicines
- POM-V Prescription-only medicines that can only be prescribed by a
veterinary surgeon
and supplied by a veterinary surgeon or pharmacist
with a written prescriptions
- POM-VPS Prescription-only medicines that can be prescribed and
supplied by a veterinary surgeon, a pharmacist or a suitably qualified
person or an oral or written prescription
- NFA-VPS A category of medicine for non-food animals that can be
supplied by a veterinary surgeon, a pharmacist or a suitably qualified
person; a written prescription is not required
- AVM-GSL An authorised veterinary medicine that is available on
general sale
Veterinary Cascade
- Where available it is a legal requirement to: supply a licensed
veterinary medicine
- Only where above is not possible: an existing licensed veterinary
medicine for another species or different condition can be
considered
- Only where above is not possible: a licensed human medicine or an
EU-licensed veterinary medicine can be considered
- Only where the above is not possible: extemporaneous or specifically
manufactured medicines can be considered
Prescription requirements for POM-V, POM-VPS and medicines
supplied under the veterinary cascade:
1. Name, address, telephone number, qualification and signature of
the prescriber
2. Name and address of animal owner
3. Identification and species of the animal and its address (if
different from owners address)
4. Date valid for 6 months or shorter if indicated by the prescriber
(Sch 2, 3 and 4 CDs are valid for 28 days)
5. Name, quantity, dose and administration instructions of required
medicine
6. Any necessary warnings and if relevant the withdrawal period
7. Where appropriate a statement highlighting that the medicine is
prescribed under the veterinary cascade
8. Where Sch 2 or 3 CDs have been prescribed a declaration that
the item has been prescribed for an animal/herd under the care
of a veterinarian
9. If prescription is repeatable the number of times it can be
repeated
Clinical check:
- Check drug is suitable for indication

Correct dose, correct frequency

Suitable formulation
Suitable quantity
Suitable duration
Drug is suitable for age of patient
Dose is suitable for age of patient
Drug is suitable for ethnicity of patient
Contra-indications or cautions
Any interactions
Any warnings required
To be taken before/after food

Accuracy check:
1. Label against prescription
2. Product against prescription
3. Label against product
1. Label and Prescription
a. Name of patient prefix e.g. Mr./Mrs./Miss. Etc
b. Name of the medicine
c. Dose
d. Strength
e. Formulation
f. Quantity
g. Duration
h. Directions
i. Label warnings/specific medicine warnings
2. Product and Prescription
a. Name of medicine
b. Correct product inside the box
c. Correct PIL inside box
d. Strength
e. Formulation
f. Drug release type
g. Correct quantity
h. Expiration date
i. Spoon if liquid dosage form
3. Label and Product
a. Name of medicine
b. Strength
c. Formulation
d. Quantity
e. Duration
f. Drug release type
g. Direction
h. Expiration date

Counselling
Dispensing a prescription overall:
1. Introduction and confirm the correct patient
2. What is the medicine and why they are taking it
3. Dosage
4. Medicine related advice side effect, cautions, best way to take
5. Lifestyle habits contributing to health, exercise, diet, smoking, alcohol
6. Any questions
Dispensing a prescription in detail:
1. Introduce yourself as the pharmacist
2. Explain the purpose of the consultation
3. Confirm identity of patient by asking name and address or date of birth
4. Ask about allergies
5. Ask if they take any other medicines
6. Ask if they have taken the medication before
7. Explain why they are taking the drug
8. Any specific medicine related points
9. Explain correct dosing
10.If you forget to take a dose, miss the dose and continue as prescribed the
next dose, DO NOT take a double dose
11.If there are any changes see your doctor or pharmacist
12.Side effects at least 3 inform doctor
13.State if they need to take with water/before or after food etc.
14.Explain any warning side effects which need to be reported or looked out
for
15.Suggest healthy lifestyle advice exercise, diet, smoking, alcohol
16.Refer patient to PIL
17.Do they understand
18.Ask if the patient has any questions
Responding to symptoms:
1. Introduce yourself as the pharmacist
2. Recap and confirm the symptoms
3. Explain the diagnosis
4. Explain the proposed cause of symptoms
5. Explain type of treatment and how to use it
6. Explain what the type of treatment does
7. Suggest one preparation
8. Propose additional advice
9. Other specific condition related advice

10.
11.
12.
13.
14.

Maintain eye contact

Build rapport
Speak clearly
Use appropriate, patient friendly language
Logical flow

Chicken Pox
Observed behaviours
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0

Introduction as the pharmacist

Recaps and confirms the childs symptoms flu like symptoms,
fever, fatigue, aching body, headaches, loss of appetite
Explains what diagnosis CHICKEN POX
Explains proposed cause of symptoms - viral
Explains type of treatment and how to use cooling
gels/mouses/lotions, antihistamines, pain relief
Explains what treatment does
Suggestions of one of the following calamine lotion, cooling gels,
poxclin, chlorphenamine, paracetamol, DO NOT GIVE NSAIDS
Drink plenty of water keep hydrated
Avoid scratching to prevent scarring keep fingernails clean and
short
Loose-fitting clothes, smooth, cotton fabrics are best and will help
skin from becoming sore and irritated
To prevent spreading the infection, keep children off nursery or
school until all spots crust over
Keep away from public areas because can expose to risk groups
such as pregnant women, new-born babies and people with
weakened immune systems
IF BLISTERS BECOME INFECTED REFER surrounding skin becomes
red and sore
IF CHILD HAS CHEST PAIN, DIFFICULTY BREATHING REFER
FEVER THAT LASTS LONGER THAN 24HRS
Communication skills maintains eye contact
Communication skills builds rapport
Communication skills speaks clearly
Communication skills uses appropriate, patient-friendly language
Communication skills consultation had a logical flow

MA
RK

Cradle Cap
Observed behaviours
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5

Introduction as the pharmacist

Recaps and confirms the childs symptoms yellow or brown,
greasy scaly patches on scalp, affected part of skin appears red
Explains what diagnosis CRADLE CAP
Explains proposed cause of symptoms overactive sebaceous
glands, too much sebum causes flakes to stick to scalp
Explains type of treatment and how to use shampoos, oils
Explains what treatment does
Suggestions of one of the following Dentinox Shampoo, Capasal
Therapeutic shampoo
Avoid using shampoos based on peanut oil or groundnut oil allergies
Do not scratch or pick at it so an infection doesnt develop
Gently wash your babys hair and scalp with baby shampoo can
help prevent the build up of scales
Massaging baby oil or natural oil, such as almond or olive oil into
their scalp at night can help loosen the crust, gently remove loose
crust with soft cloth or baby rush in morning
WASH AWAY ANY REMAINING OIL with baby shampoo leaving any
oil on the head could clog pores and cause flakes to stick
REFER IF BABY NOT RESPONDING TO TREATMENTS
INFLAMED OR INFECTED REFER
IF ANY ITCHING/SWELLING REFER

MA
RK

1
6
1
7
1
8
1
9
2
0

Communication skills maintains eye contact

Communication skills builds rapport
Communication skills speaks clearly
Communication skills uses appropriate, patient-friendly language
Communication skills consultation had a logical flow

Colic
Observed behaviours
1
2

3
4
5
6
7
8
9

Introduction as the pharmacist

Recaps and confirms the childs symptoms excessive frequent
crying, occurs in evening and the same time each day, baby
becomes flushed, clench their fists, draw their knees up and arch
their back
Explains what diagnosis COLIC
Explains proposed cause of symptoms no specific reason,
doesnt mean baby is unwell or unhealthy
Explains type of treatment and how to use simeticone: break up
gas bubbles in GI tract, removing cows milk, lactase drops break
down lactose, hypoallergenic formula
Explains what treatment does
Suggestions of one of the following Simeticone, Lactase drops,
Hypoallergenic formula
Removing cows milk if not tolerating cows milk, mother have a
dairy free diet whilst taking calcium supplement.
Make sure baby does not have Soy milk hormones disrupt sexual

MA
RK

1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0

and hormonal development

Parental advice look after own well being, can be stressful, get
family support or friends.
Hold your baby, in different positions
Use fast flow teat, preventing baby from swallowing air by feeding
upright, always burp the baby, gently massage baby tummy
Bathe baby in warm water
Changes to diet, breastfeeding women should avoid caffeinated
and alcoholic drinks.
REFER if weak, high pitched continuous cry, seem floppy when
picked up, takes less than a third of usual amount of fluids, passes
less urine than normal
Communication skills maintains eye contact
Communication skills builds rapport
Communication skills speaks clearly
Communication skills uses appropriate, patient-friendly language
Communication skills consultation had a logical flow

Teething
Observed behaviours
1
2

Introduction as the pharmacist

Recaps and confirms the childs symptoms red swollen gums, red
flushed face or cheeks, dribbling more than usual, waking more at
night, inconsistent feeding, rubbing gums, biting, chewing or
sucking
Explains what diagnosis TEETHING

MA
RK

4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
1
5
1
6
1
7
1
8
1
9
2
0

Explains proposed cause of symptoms new teeth

Explains type of treatment and how to use teething rings (place
in fridge), paracetamol/ibuprofen, teething gels (local
anaesthetic/mild antiseptic), teething granules
Explains what treatment does bonjela: relieves the pain,
ibuprofen/paracetamol: relieve pain
Suggestions of one of the following bonjela,
ibuprofen/paracetamol, teething rings
Gently rubbing over the affected gum with clean finger may ease
pain
Cool, sugar free drinks
Try chilled water in a bottle/cup if cant eat yet
Rash on chin after dribbling? Apply petroleum jelly as a barrier
cream
REFER if high temperature
REFER if diarrhoea

Communication skills maintains eye contact

Communication skills builds rapport
Communication skills speaks clearly
Communication skills uses appropriate, patient-friendly language
Communication skills consultation had a logical flow

Conditions and treatments: responding to symptoms

Constipation
- Arises when a patient experiences a reduction in their normal bowel habit
with more difficult defecation and/or hard stools
- Very common all age groups, most common in the elderly 25-40% over
65 have constipation
- Women 2-3 times more likely to suffer than men and 40% of women in
late pregnancy suffer constipation
Symptoms
- Discomfort on passing of stools
- Abdominal discomfort or cramps
- Bloating
- Feeling of emptying of rectum
- Feeling of obstruction or blockage
- Need to manually assist defecation
Causes of constipation
- Eating habits/lifestyle most likely
o Poor fluid intake
o Travel
o Deficiency in dietary fibre intake
o Pregnancy as hormonal changes slow down gut movements as the
baby takes up room and exerts pressure on the bowel
o Reduced mobility
o Change in lifestyle or environment
o Ignoring of reflex to defecate
- Medication likely
o Most exert action by decreasing gut motility thereby causing
constipation
o Opiates
o Aluminium salts
o Antidepressants
o Anti-Parkinsons medication should be on laxatives
o Anticholinergic antihistamines
o Iron
o Phenothiazine antipsychotics
o Laxative abuse
- Underlying conditions unlikely
o Irritable bowel syndrome
o Pregnancy
o Depression
o Functional disorders (children
- Colorectal cancer/HIV very unlikely

Diagnosis
- Establish the patients current bowel habit compared to normal
- This will establish if the patient is suffering from constipation
- Then concentrate on determining the cause blood present? Pain on
passing stool? Other symptoms? Changes in diet? Lifestyle?

Specific Questions to ask

- Change of diet or routine?
o Constipation usually has a social or behavioural cause
o Usually some event that has precipitated the onset of symptoms
- Pain on defecation?
o Usually due to a local anorectal problem referral
- Presence of blood?
o Bright red specks in the toilet or smears of blood on the toilet tissue
indicate haemorrhoids or anal canal fissure
o If blood is mixed in the stool then referral is necessary
o A dark stool that is black/tarry is indicative of a bleed higher up in
the GI tract
- Duration acute or chronic?
o Chronic if it has lasted longer than 6 weeks
o Cases of more than 14 days with no identifiable cause or previous
investigation by the GP should be referred
- Lifestyle changes
o Changes in job/marital status can precipitate depressive illness that
can manifest with physiological symptoms such as constipation

Trigger points indicative of referral

- Pain on defecation causing patient to suppress the defactory
reflex check for anal fissure
- Patients aged 40 years and over with a sudden change in bowel
habits with no obvious cause could be a danger symptom for rectal
carcinoma
- Greater than 14 days duration with no identifiable cause
suspects underlying cause requiring fuller investigation by GP
- Tiredness check for anaemia or thyroid dysfunction
- Blood in the stools
- If a child refer
Treatment
- Should take a stepped care approach
- Uncomplicated non drug treatment is 1st line for all patient groups
- Simple dietary and lifestyle modifications will relieve majority of cases
- Any possible changes to medication currently on
- Lifestyle measures
o Increase dietary fibres (30g daily) fruits, cereal, brown bread, rice,
pasta, bran flakes
o Increase fluid intake minimum 1.6L (8 glasses) for women and 2L
(10 glasses) for men of water a day
o Increase in exercise walking to work, about 30 mins a day if they
can give the patient mobility
o Toileting go when needed, unhurried, establish a regular routine
and position
- OTC treatment
o Bulk forming agents
Increases faecal volume like fibre
Retains fluid in the stool thereby softening the faeces
Must maintain fluids as could potentially cause gut
obstruction
Side effects: - flatulence and bloating in the first few weeks
Works in 12-24 hours
E.g. wheat bran, Isphagula husk (Fybogel), Sterculia,
Methylcellulose
o Stimulant laxatives
Stimulates nerves in large intestine increasing peristalsis and
gut motility
Works in 8-12 hours take at bedtime to go in the morning
Side effects: - abdominal cramps, diarrhoea, lazy bowel
E.g. senna, bisacodyl, glycerol, sodium picosulfate
o Osmotic laxatives
Draw water from intestinal wall into the lumen
Raises intra-luminal pressure increasing volume of contents
stimulating peristalsis
Not for chronic use
4-72 hours to work
Side effects: - abdominal pain, bloating

 E.g. lactulose, macrogols and magnesium salts

o Faecal softeners/lubricants
Lowers surface tension of intestinal content
Docusate sodium and liquid paraffin

Diarrhoea
- An increase in frequency of the passage of soft or watery stools
relative to the usual bowel habit for that individual
- Acute less than 7 days
- Persistent more than 14 days
- Chronic more than a month
Symptoms
- Passing of frequent, soft watery stools
- Irritation of stomach lining
- Stomach cramps
- Nausea
- Fever
- Loss of appetite
- Dehydration
Causes of Diarrhoea
- Infective causes most likely
o Bacterial
Shingella, Salmonella, E.coli, Bacillus
Contaminated food/drink
Travellers diarrhoea E.coli
o Viral
Acute gastroenteritis
Rotavirus
o Protozoa tropical
- Non infective cases
o Anxiety
o Emotional upset
o Medication - likely
Metformin, iron
o Alcohol
o Coffee
o Sweets high in sorbitol content
- IBS, giardiasis, faecal impaction unlikely
- Ulcerative colitis and Crohns disease, colorectal cancer,
malabsorption syndromes very unlikely
Diagnosis and Specific Questions
- Frequency and nature of the stools
o What does it look like watery without blood, or is there blood and
mucus present?
o Watery without blood shows that it is infective and so self limiting

o Diarrhoea associated with blood and mucus referral to eliminate

invasive infection
o Blood IBD
Periodicity previous history of recurrent diarrhoea should be referred
Duration refer if greater than 4 days in adult, or 2/3 days in
child/elderly
Onset of symptoms any new foods/changes to the diet
Abdominal pain?
Travel?
Signs of dehydration
o Unsatisfied thirst
o Dry tongue/mouth
o Poor urine output
o Rapid breathing
o Lethargy/confusion
o Cold, clammy, wrinkly skin

Trigger points indicative of referral

- Change in bowel habit in over 50s may have sinister pathology
- Following recent travel rule out giardiasis
- Duration longer than 2/3 days in children/elderly at risk of dehydration
and associated symptoms
- Presence of blood in stools, faecal impaction in elderly, severe abdominal
pain further investigation by GP
- Malaise or fever
- More than 4 days in an adult
- <1 year old 1 day
- <3 years old 2 days
- Older 3 days
- Chronic and recurrent

Treatments
- Maintain oral hygiene wash hands regularly to prevent spread
and transmission
- Oral rehydration therapy is 1st line dioralyte
o Can be given to all age groups
o Small light meals
o No side effects
o Over 1 year old
o Glucose 75mmol/L
o Sodium 75mmol/L
o Potassium 20mmol/L
o Chloride 65mmol/L
o Citrate 10mmol/L
- OTC provide symptomatic relief for social reasons
- Loperamide 2nd line
o Opioid analogue, slows intestinal tract time by decreasing bowel
motility through action on opioid receptors in the guy
o Can increase fluid absorption and electrolytes
o Over 12 years
- Bismuth subsalicylate
o Effective in travelers diarrhoea
o Reduces intestinal motility
o Over 16 years
- Kaolin and morphine
o Utilises the constipating side effect of morphine and adsorbent
properties of kaolin

Dyspepsia
- An umbrella term used generally used by healthcare
professionals to refer to a group of upper abdominal symptoms
that arise from five main conditions
o Non ulcer/functional indigestion
o Gastro-oesophageal reflux disease (GORD, heartburn)
o Gastritis
o Duodenal ulcers
o Gastric ulcers
- Extremely common 25-40% in western hemisphere experience symptoms
- Higher in women than men
Causes
- Non ulcer/functional dyspepsia when no specific cause can be found
for a patients symptoms
- GORD - decreased muscle tone leading to oesophageal sphincter
incompetence
- Gastritis - increased acid production attributable to H. pylori infection or
acute alcohol ingestion
- Duodenal (95%) and gastric (80%) ulceration H. Pylori, it produces
toxins that stimulate the inflammatory cascade, NSAIDs and low dose
aspirin can medically induce ulcers
Clinical features of Dyspepsia
- Vague abdominal discomfort (aching) above the umbilicus associated with
belching
- Bloating
- Flatulence
- A feeling of fullness
- Nausea and/or vomiting
- Heartburn
- Retrosternal heartburn is the classic symptoms of GORD
Diagnosis and specific questions
- Age
o Incidence increases with age, young adults dyspepsia with no
specific pathology, older specific pathology
- Location
o Pain above umbilicus and centrally located in the epigastric area
o Pain below the umbilicus will not be due to dyspepsia
o Pain behind sternum/breastbone most likely to be heartburn
o If patient can point to specific area in abdomen unlikely to be
dyspepsia
- Nature of pain

o Aching, discomfort dyspepsia

o Gnawing, sharp, stabbing unlikely to be dyspepsia
Radiation
o Pain that radiates to other areas of the body is indicative of more
serious pathology referral
o May be cardiovascular in origin if pain is felt down the inside aspect
of the left arm
Severity of pain
o If described as debilitating or severe refer
o Mild to moderate for dyspepsia
Associated symptoms
o Persistent vomiting with or without blood is suggestive of ulceration
or even cancer refer
o Black and tarry stools refer
Aggravating or relieving factors
o Pain shortly after eating and relieved by food or antacids are classic
symptoms of ulcers
o Symptoms can be brought on by certain types of food e.g. caffeine
containing products, alcohol, spicy food
Social history
o Bouts of excessive drinking associated with dyspepsia
o Eating on the move/quickly

Trigger points Indicative of referral

- ALARM signs and symptoms
o Anaemia
o Loss of weight
o Anorexia
o Recent onset of progressive symptoms
o Melaena, dysphagia and haematemesis
- Pain described as severe, debilitating or wakes them at night

Persistent vomiting
Referred pain

Treatment
- Lifestyle
o Dont eat before bedtime
o Stress reduction
o Smaller portions
o Eat slowly
o Give enough time for food to digest before undertaking activities
o Dont wear tight fitting clothes that hold the stomach in
o Extra pillows when sleeping elevate the head
o Alcohol reduction/smoking cessation
- OTC treatments
o Alginates gaviscon, 5-10mL after meals and bed time
1st line treatment for GORD
Sponge like matrix that floats on top of stomach contents
Often in combination with antacid to help neutralize acids
Not to be used in children, no likely side effected
OK if pregnant
o Antacids rennies, 2 tabs chewed 1 hour after meal and at
bedtime, no more than 12 tablets in 24 hours
Neutralize stomach acids
Relatively fast acting 1hour
Good for isolated symptoms
May have some interactions
OK if pregnant
o H2 Antagonists Ranitidine (zantac), over 16, 1 tablet whole
when needed, if symptoms persist for more that an hour
can take another, max 2 tablets in 24 hours, no more than 6
days
Block actions of histamine which activates signal cells in
stomach to release HCl acids
Fast acting 1 hour
Abdominal pain, diarrhoea and constipation
OK if pregnant, can cause diarrhoea if breast feeding
o PPIs Zanprol (omeprazole), over 18, 2 tabs once daily
before food, see GP if still needed after 4 weeks or not
working after 2 weeks
Inhibit the H+/K+-ATPase enzyme of parietal cells which
secrete HCl acids

They are potent and can be used for recurring symptoms

Headache, diarrhoea, constipation
Avoid if pregnant or breastfeeding

Eye Conditions
Red
-

Eye
Conjunctivitis inflammation of the conjunctiva
Characterised by redness, irritation, itching and discharge
Redness of eye and conjunctivitis is the most common ophthalmic
problem
- Can be viral or bacterial (collectively infective) or allergic

Incidence of Red eye

- Bacterial conjunctivitis, allergic conjunctivitis most likely
- Viral conjunctivitis, subconjunctival haemorrhage - likely
- Episcleritis, Scleritis, Keratitis, Uveitis unlikely
- Acute closed angle glaucoma very unlikely
Causes of conjunctivitis
- Bacterial conjunctivitis
o Staphylococcus 50% +
o Streptococcus pnuemoniae 20%
o Moraxella
o Haemophilus influenza
- Viral conjunctivitis
o Adenovirus
- Allergic conjunctivitis
o Pollen
Specific questions to ask a patient with Red Eye
- Discharge present
o Mostly seen in conjunctivitis
o Watery viral and allergic
o Purulent bacterial
- Visual changes
o Any loss of vision or haloes should be viewed with caution,
especially if scleral redness is present
- Pain/discomfort/itch
o True pain associated with conditions requiring referral

o Pain associated with conjunctivitis is gritty/foreign body type pain

- Location of redness
o Redness concentrated near around coloured part of eye indicates
more sinister pathology
o Generalised redness and redness towards corner of the eyes is
more indicative of conjunctivitis
- Duration
o Minor eye problems are self limited to a few days
o Ocular redness apart from subconjunctival haemorrhage and
allergic conjunctivitis lasting longer than a week requires referral
- Photophobia
o Associated with sinister pathology
- Other symptoms
o Signs and symptoms of an upper respiratory tract infection point
towards a viral cause of conjunctivitis
o Vomiting suggest glaucoma
SYMPTOMS
Bacterial
Viral
Allergic
Eyes affected
Both, but one eye Both
Both
often affected first
by 24-48 hours
Discharge
Purulent
Watery
Watery
Pain
Gritty feeling
Gritty feeling
Itching
Distribution of
Generalised and
Generalised
Generalised but
redness
diffuse
greatest in
fornices/corners
Associated
None commonly
Upper respiratory Rhinitis
symptoms
tract
infection/cold/cou
gh symptoms
Conditions to Eliminate
- Subconjunctival Haemorrhage
o Is the rupture of a blood vessel under the conjunctiva
o A segment or the whole eye will appear bright red
o It occurs spontaneously but can be precipitated by coughing,
straining or lifting
o No pain, symptoms resolve in 10-14 days without treatment
o Can look more severe if taking aspirin or warfarin
o Patient with history of trauma should be referred
- Episcleritis
o Inflammation of the episcleral which lies just beneath the
conjunctiva and adjacent to the sclera
o This results in only part of the eye becoming red and so is
segmental
o Usually only one eye is affected
o Usually painless/dull ache
o More common in young women
o Self limiting in 2-3 weeks but can take upto 8 weeks for symptoms
resolve

Treatments
- Viral conjunctivitis
o No OTC products
o Highly contagious so follow stict hygiene measures
o No sharing of towels and wash hands frequently
- Bacterial conjunctivitis
o Self limiting, 65% have a clinical cure in 2-5 days without treatment
o Chloramphenicol Drops/ointments (GOLDEN EYE
ANTIBIOTIC DROPS/OINTMENT, OPTREX INFECTED EYE
DROPS/OINTMENT)
Licensed in children 2+
Drops 1 drop every 2 hours for the first 48 hours, then 4
times a day for a maximum of 5 days treatment
Ointment if used with drops, only 1cm to inside of eyelid at
night
Ointment if used alone then 3-4 times daily
Avoid in those with blood and bone marrow problems
Avoid if pregnant
Blurring of vision, transient stinging, burning warn about
driving or operating machinery
Stop wearing soft contact lenses as preservatives can
damage them
Store in fridge but remove for a while before administering to
warm up to room temperature
o Propamidine isethionate 0.1% (GOLDEN EYE DROPS) 1 or 2
drops upto QDS, 12 years +, refer if no improvement
o Dibromopropamidine isethionate 0.15% (GOLDEN EYE
OINTMENT) apply once or twice daily, 12 years +, refer if not
improvement
- Allergic conjunctivitis
o Mast cell stabilisers Sodium cromoglicate
Prophylactic agent

 Has to be given continuously whilst exposed to the allergen

1 or 2 drops into each eye 4 times a day
6 years +
Local irritation, blurred vision Ok if pregnant
o Sympathomimetics and Anti-histamines
Reduces redness of the eye
Limited to short term use to prevent rebound effect
Naphalozine 1-2 drops, TDS/QDS
Combo product Otrivin Antisin
Avoid in glaucoma and C/I in MAOIs and moclobenmide due to
risk of hypertensive crisis

Administration of Eye drops

1. Wash your hands
2. Tilt your head backwards, until you see the ceiling
3. Pull down the lower eyelid
4. Place a thin line of ointment along the inside of the lower eyelid
5. Wipe away any excess ointment from the eyelids and lashes using the
clean tissue
6. After using ointment, vision may be blurred but will soon be cleared by
blinking
Full
-

referral list
Associated vomiting
Photophobia
Clouding of the cornea glaucoma
True eye pain
Redness caused by a foreign body
Irregular shaped pupil
Abnormal reaction of pupil to light
Redness localised around the pupil
Distortion of vision

Ear/Octic Conditions
Otitis Media - common
- Rapidly accumulating effusion in middle ear
- Most common in children aged 3-6
- In older children, pain/earache is predominant feature and is throbbing
- In young children, pain is manifested as irritability and ear
tugging/rubbing
- Fever/loss of appetite
- Physical presentation of red/yellow, bulging tympanic membrane
- Pain resolves on the rupture of tympanic membrane releasing
mucopurulent discharge
- Mostly resolves in 3 days with no treatment
- Should be managed with analgesia Paracetamol or ibuprofen
- Unless systemically unwell or under 2 years of age and have discharge
referral to GP
Otitis Externa most common, caused by trauma
- Refers to generalised inflammation throughout the EAM
- Often associated with infection
- Usually acute but may become chronic (3 months +) in children
- Incidence increases during the summer
- People who swim are 5 times more likely to develop it
- More common in adults and women
- Primary infection, contact sensitivity can both cause it
- Local causes include trauma, discharge from middle ear, general causes
e.g. seborrhoeic dermatitis, psoriasis and skin infections
- Common with ear wax impaction

Characterised by itching and irritation depending on severity can

become intense
Leads to scratching of the EAM resulting in trauma and pain
Usually only one ear is infected
On examination, external ear, ear canal or both appear red, swollen or
eczematous

Specific questions to ask a patient: Otitis Externa

- Symptom presentation principal symptom of acute otitis externa is
itch/irritation and pain
- Discharge
o Otitis media is most common cause of ear discharge and usually
mucopurulent
o Discharge with Otitis Externa (if any), is not mucopurulent
- Systemic symptoms
o Otitis externa shouldnt present with any systemic symptoms
o Fever and cold symptoms usually present in otitis media
o In all forms of dermatitis, systemic symptoms should not be present
Referral points of Otitis Externa
- Generalised inflammation of the pinna
- Impaired hearing in children
- Mucopurulent discharge
- Pain on palpitation of the mastoid area
- Patients showing signs of systemic infection
- Slow-growing growths on the pinna in elderly
- Symptoms that are not improving and have been present for 4 days +
OTC treatments for Otitis Externa
- Choline Salicylate (Earex plus, choline s. 21.6% and glycerol
12.62%)
o > 1 year, completely fill EAM with drops and plug with cotton wool
soaked drops
- Acetic acid (earcalm spray)
o >12 years 1 spray into affected ear TDS
o Continue 2 days after symptoms have disappeared
o No improvement or worsening after 48 hours Refer
o Dont use for longer than 7 days
Earwax impaction
- Ear wax is produced in the outer third of the cartilaginous portion of the
ear canal by the ceruminous glands
- Used for mechanical protection of tympanic membrane, trapping dirt,
repelling water and exerting protection against bacterial/fungal infection
- Most common external ear problem
- Clinical features include gradual hearing loss, ear discomfort, recent
attempts to clean ears, itching, tinnitus and dizziness
Specific questions to ask a patient: Ear wax
- Course of symptoms
o Gradual hearing loss with ear wax impaction

Associated symptoms
o Dizziness and tinnitus indicate inner ear problem so refer
o Ear wax impaction rarely causes tinnitus, vertigo or true pain
History of trauma
o Check if person has recently tried to clean ears
o This often leads to wax compaction
Use of medicines
o If a patient has used an OTC medication correctly this would require
referral for further investigation

Referral of Ear Wax Impaction

- Dizziness or tinnitus suggests an inner ear problem
- Pain originating from the middle ear
- Fever or malaise in children
- Associated trauma related conductive deafness
- Foreign body in the EAM
- OTC medication failure
OTC treatments for Ear Wax Impaction
- Oil based products Cerumol Ear drops (arachis peanut oil,
57.3%)
o 5 drops into affected ear 2/3 times daily for 3 days
o In between, administration of cotton wool smeared in petroleum
jelly should be applied to retain liquid
- Oil based products Cerumol Olive Oil Drops (olive oil 100%)
o 2/3 drops instilled twice a day for upto 7 days
o In between, administration of cotton wool smeared in petroleum
jelly should be applied to retain liquid
-

Peroxide based products exterol

and otex
Docusate waxol
Sodium bicarbonate
Glycerin earwax advance and
earex plus

Colic
- Excessive crying usually in the
first few weeks of life and
usually resolves by age of 3-5

months
Defined as crying for more than 3 hours a day for more than 3 days a
week for more than 3 weeks
Patients parents/carer may not necessarily wait for 3 weeks as it can be
very distressing

Symptoms of Colic
- Excessive high pitched crying usually in late afternoon/evening (6pm)
- Face may appear flushed
- May pass gas when crying
- Clench their fists
- Arching of the back
- Drawing up of knees to their tummy
- Bloated tummy
- Crying outbursts are not harmful the baby will continue to feed and gain
weight as normal
Causes

Unknown but thought to be multifactorial

Linked to disorder of GI tract
Spasmodic contraction of smooth muscle causes pain and discomfort
Allergy to cows milk or lactose intolerance
Trapped wind
Hormonal imbalances

Specific questions to ask patient: Colic

- Crying quality
o High pitched crying with facial flushing, drawing up of knees, fist
clenching are commonly observed in colic
- History of crying
o Excessive crying is not isolated and will have been present for
some time
o Acute infections are sudden in onset and baby will not exhibit a
long-standing history of excessive crying
- Aggravating factors
o Hunger, thirst, too hot, cold, trapped wind
Trigger points indicative of
- Infants that are failing to put on
- Medication failure
- Over anxious parents

Reduced urine
output
Pale skin
High fever

referral
weight

Treatments available for Colic

- Re-assure the parent that the child is normal, thriving and healthy
- Non medical treatment
o Comforting the baby while crying hold them
o Wind the baby after feeding, sit upright during feeding to avoid
trapped air
o Avoid picking up and putting down too many times
overstimulation
o Try holding baby in different position
o Background white noise may help
o If breast feeding reduce caffeine intake, spicy food, alcohol
o Use a fast flow teat
- Review the feeding technique underfeeding can result in excessive
suckling and therefore excess air being swallowed resulting in colic like
symptoms
- Consider removal of cow milk from babys and mothers diet or try
hypoallergenic milk formula
- Medical treatment
o Simeticone Infacol and Dentinox simeticone drops (2.5ml
from syringe or to the bottle, max 6 doses in 24 hours)
Pharmacologically inert no side effects, interactions
Gentle relief of trapped wind or griping pain
Can be safely prescribed to all infants
With or just after each feed
Try for one week, if not improvement, stop treatment and
refer
o Lactase enzyme Colief infant drops
Breaks down lactose present in milk to glucose and galactose

Reported to improve colic symptoms

Safe/natural and may help in short term lactose intolerance
Bottle - 4 drops to bottle every time the baby is fed
Breastfeeding - add few tablespoons of breast-milk and 4
drops of Colief and give to baby then continue
breastfeeding as normal

Chickenpox
- Mild, common childhood illness
- Caused by the varicella zoster virus
- Transmitted by droplet infection coughing and sneezing and, due to fluid
from blisters
- Remains dormant in the body for upto 14 days before any symptoms are
seen incubation period
- Spotty blistering red rash then appears which can cover the whole body
- These normally appear in clusters behind ears, face, scalp, chest, belly,
arms and legs
- Appear as small red lumps which turn into fluid filled blisters and then
crusted spots
- Most infectious period is when red rash appears
- When spots have crusted it is no longer contagious

Before the rash appears there are flu like symptoms nausea, fever,
aching, headache, feeling unwell, loss of appetite
Most infectious 1-2 days after the rash appears (1-2 days) until all blisters
have crusted over (5-6 days)

Treatments of Chickenpox
- No known cures
- Clears without the need for treatment
- Symptomatic treatments exist fever, pain and high temperature
o Mild painkiller Paracetamol, Calpol NSAIDs 2nd line due to
potential skin problems
o Itching soothing emollient creams calamine lotion
o Itching sedating antihistamines chloramphenamine
piriton
General advice
- Itching
o Ensure the child has short clean fingernails so doesnt infect or scar
from scratching
o Put socks on hands overnight
- Fever
o Wear loose, smooth, cotton clothes
o Avoid sponging with cool water may irritate further
- Hydration
o Maintain a high fluid intake
o Sugar free ice lollies
Prevention of spread
- Keep at home for at least 5 days
- Stay at home until the blister has crusted over
- Avoid contact with pregnant women, new borns or those with weak
immune systems
- Maintain hygiene wipe down toys, and surfaces
- Wash bedding/clothes more regularly
Referral of Chickenpox
- Suspected meningitis
- Signs of infection
- Rash for over 2 weeks
- Fever lasting longer than 24 hours
- Vomiting
- Neck stiffness
Cradle Cap
- Appears as large yellow, greasy scales and crusts on the scalp
- This can become thick and cover the whole scalp
- Can affect other areas such as the face and napkin area
- Common harmless condition doesnt usually itch or cause discomfort
Causes of Cradle Cap
- Characterised by increased cell turnover rate
- Cause linked to overactive sebaceous glands

Babies may also retain their mothers hormones for several weeks/months
making the babies glands more active
Excessive sebum causes old cells to stick to the scalp instead of drying
and falling off
It is not contagious and isnt caused by poor hygiene or allergy

Symptoms
- Harmless condition
- Doesnt itch or cause discomfort to the baby
- Occurs on scalp, face, nose, groin, ears, neck, skin folds, knees and
armpits
- Greasy yellow patches on scalp
- Scales eventually start to flake and effected area appears red
- Hair can come away with the scales/flakes
Treatment
- Most cases clear in own time
- Gently washing with shampoo can help prevent build up
- Baby oil, natural oil, almond oil, olive oil can be used to loosen
crusts
- Wash more frequently, dont pick as it can cause infection
- Stronger shampoos can help loosen it
o Dentinox Cradle Cap shampoo 2 applications repeated at
each bath time until scalp is clear then use as necessary
o Contains sodium lauryl sulfate which is a cleaning agent
that de-greases the skin
o Wash hair 2-3 times a week
Referral
- Speak to GP in case of uncertain diagnosis
- Severe cradle cap
- Swelling
- Bleeding
- On face or body
- Inflamed/infected
- OTC treatment failure

Teething
- Teething is when a babys milk teeth come through the gums at around
the age of 6 months causing irritation
Symptoms of Teething
- May have no pain or discomfort
- Gum can be sore or red

Flushed cheeks on the side of face where teething is occurring

Gnawing/chewing gums
Rubbing of ear on same side as the tooth
More frequent dribbling
Waking up at night
Generally unsettled
Inconsistent feeding

Cause of teething is the emergence of new milk teeth through the

gums
Treatments of Teething
- Teething rings
o Provide something safe to chew on, easing pain, distraction
technique
o Can be cooled in a fridge
o Can use a wet flannel
- Teething gels bongela teething gel/calgel
o Over 4 months old
o Sugar free gel can be rubbed on
o Contains a mild local anaesthetic which can numb pain
o Can contain antiseptic to prevent infection
o Rub onto babys gums with a clean finger
- Can give baby something healthy to chew on veg/fruit
o Stay near by in case they choke
o Avoid items with lots of sugar decay risk
- Pain killers - Calpol
o If baby is in pain/high temp
o Small doses of ibuprofen or Paracetamol
o Should be sugar free
o No aspirin
- Tips
o Cool drinks sugar free
o Comfort and play with baby to distract it
o Prevent teething rashes by wiping excess dribble from the chin
Referral for Teething
- Severe symptoms lasting longer than a few days
- 18 months and no teeth
- Visible signs of tooth decay
- Double row of teeth
- Small jaw defect
- Facial injury

Private Prescription Registers

1. Reference e.g. Book A, Page 8, Item 1 or A/8/1
2. Prescription date
3. Supply date
4. Medicine details
a. Name

b. Quantity
c. Formulation
d. Strength of medicine supplied
5. Prescriber details
a. Name and address of practitioner
b. GMC number
c. Telephone number
6. Patient details
a. Name and address of patient
Controlled Drugs Register
1. Class - look for drug subtitle in the BNF
2. Name of Drug/Brand what is written on prescription/BNF
3. Strength
4. Form drug formulation on prescription
5. Date supplied todays date
6. Name and address of person/firm supplied patient name/address
7. Prescribers details prescriber name and address
8. Person collecting/representative patient name/address
9. Proof of identity yes
10.Proof of identity of person collecting provided yes
11.Quantity supplied quantity on the prescription
12.Balance take away the quantity supplied from total
13.Name of pharmacist Vivek Patel, UCL SoP, London, WC1 XXX, (GPhC
number)
14.If a mistake is made sign, date and GPhC number

Diabetes
- Type 1 diabetes mellitus: the body's failure to produce sufficient insulin
- Type 2 diabetes mellitus: resistance to the insulin, often initially with
normal or increased levels of circulating insulin
- Gestational diabetes: pregnant women who have never had diabetes
before but who have high blood sugar (glucose) levels during pregnancy
are said to have gestational diabetes

Driving
- Drivers with diabetes may be required to notify the Driver and Vehicle
Licensing Agency (DVLA) of their condition depending on their treatment,
the type of license, and whether they have diabetic complications
- If hypoglycaemia occurs, or warning signs develop, the driver should:
o Stop the vehicle in a safe place;
o Switch off the ignition and move from the driver's seat;
o Eat or drink a suitable source of sugar;
o Wait until 45 minutes after blood glucose has returned to normal,
before continuing journey.
Type 2 Diabetes
- First line treatment life style interventions including diet and exercise
- If this doesnt control glucose levels after 3 months use metformin or
sulphonylureas
- Metformin is the drug of first choice in overweight patients in whom strict
dieting has failed to control diabetes, may also be considered as an option
in patients who are not overweight
- Sulfonylureas are considered for patients who are not overweight, or in
whom metformin is contra-indicated or not tolerated
- When combination of strict diet and drug therapy fails use a
combination of metformin and sulfonylurea
Metformin
- Increases sensitivity of cells to insulin allowing the body to make better
use of lower insulin levels
- Drug of 1st choice in overweight patients in whom strict dieting
has failed to control diabetes, also considered in those who are
not overweight
- When combination of strict diet and metformin treatment fails combine
with sulfonylurea
- Usually once daily with breakfast may be increased to twice daily
- Take tablet with or immediately after a meal at the same time each
day
- Side effects nausea, diarrhoea, abdominal pain, weight loss
- Complications lactic acidosis
- Contra-indications renal impairment, ketoacidosis, low BMI
- If a dose is missed, take as soon as you remember unless it is
close to the next dose time
Sulfonylureas Glibenclamide, Gliclazide, Glimepiride, Glipizide,
Tolbutamide
- Augment insulin secretion and are only effective when there is some
pancreatic beta cell activity present
- Considered for patients who are not overweight or in whom metformin is
contra-indicated or not tolerated
- When combination of strict diet and sulfonylurea treatment fails
combine with metformin

Glibenclamide long acting, greater risk of hypoglycaemia, avoided in

elderly,
- Gliclazide or tolbutamide shorter acting alternatives
- Can encourage weight gain, avoid in pregnancy and hepatic impairment
- Nausea, vomiting, diarrhoea, constipation
Hypoglycaemia
- Shaky, anxiousness, sweating
- Initially 10-20g glucose either glass of lucozade, coke, 2 teaspoons of
sugar or 3 sugar lumps
- If necessary repeat after 15 minutes
- Then a snack containing carbohydrate sandwich, fruit, milk biscuits
Alendronic Acid (bisphosphonate)
- Treatment of Postmenopausal osteoporosis 10mg daily/70mg once
weekly
- Stops break down of bones, but new bones are still made
- Tablets should be swallowed whole with plenty of water while sitting or
standing
- To be taken on an empty stomach at least 30 minutes before breakfast
- Patient should stand or sit upright for at least 30 minutes after taking
tablets can do some housework or go for a shower in this time/get ready
- Side effects oesophageal reactions, abdominal pain, distension
- If pain when swallowing, severe oesophageal irritation occurs,
worsening heart burn then seek medical advice
- Likely that you may require some calcium supplement to further
strengthen the bone, discuss with the GP
- Dental check ups also vital can occur in the jaw see dentist regularly,
maintain good oral hygiene, report any oral symptoms to your dentist/GP
- Life style advice
o Quit smoking? Risk factor
o Maintain oral hygiene brush twice a day, floss
o Maintain an adequate dietary intake of calcium/Vit D milk,
yoghurt, cheese or take supplements
o Regular exercise walking/cycling/weight bearing 30 minutes
o
Levothyroxine (thyroid hormone)
- Hypothyroidism over 18 years, initially 50-100 micrograms once daily,
maintenance dose 100-200 micrograms once daily
- Over 50 initially 25 micrograms OD and maintenance dose of 50-200
micrograms
- Take at least 30 minutes before breakfast or any caffeine containing
liquids/other medication
- Side effect diarrhoea, vomiting, anginal pain
Doxycycline (tetracycline)
- Acne vulgaris (usually) 100 mg OD
- Capsules should be swallowed whole with plenty of fluid during meals
while sitting or standing to avoid reflux/irritation
- Avoid using indigestion remedies
- Absorption is affected by heavy metals
- Side effects nausea, vomiting, diarrhoea

Use sun screen (may make skin sensitive to sunlight), wash face regularly,
be careful with what products you use in case it aggravates the skin

Benzoyl peroxide (quinoderm cream) (topical preparations for acne)

- Acne vulgaris apply 1-2 times daily, preferably after washing face with
soap and water, start treatment with lower strength preparations
- May bleach clothing, hair, avoid broken skin
- If first time using the product, patch test
- Apply a thin layer
- Be careful not to use too many product as to dry the skin out, causing a
re-bound effect so the skin produces more oil, aggravating the skin
- Side effects skin irritation (if you get this, reduce the frequency until
irritation subsides)
- Finish the entire course
- Clean sheets, clean towels, dont keep touching the face
Loestrin (combine oral contraceptive)
- Combined oral contraceptive pill one tablet once daily and the same
time every day
- If reasonably certain you arent pregnant, can be started on any day of
the cycle, if not then day 1-5 of the cycle
- If the pill is missed, take as soon as possible and carry on with the next
pill at the correct normal time
- If more than 2 pills are missed, you may not be protected, so abstain from
sex or use an additional method of contraception
- If you vomit within 2 hours of taking the pill, take another
- Continual basis
- May have menstrual irregularities
- After 21 days there will be a 7 day break you should have your period in
this time
- Increased risk of venous thromboembolism esp. whilst travelling with 3
hours of immobility, risk can be reduced by appropriate exercise during
journey and wearing graduated compression hosiery travel socks
Co-beneldopa (1 part benserazide hydrochloride and 4 parts
levodopa)
- Parkinsons disease 50mg 3-4 times daily initially, maintenance 400800mg daily in divided doses, elderly 50mg once or twice daily, increased
by 50 mg every 3-4 days (
- with or after food, with food helps reduce side effects such as nausea
- Increases the levels of dopamine in the brain
- Co-formulation helps with the side effects
- Excessive daytime sleepiness and sudden onset of sleep can
occur with co-beneldopa so exercise caution when driving or
operating machinery
- Side effects nausea, vomiting, taste disturbances
- Read additional information PIL
- May colour urine which is completely normal
- Join Parkinsons UK for more information

Life long medication meet regularly with GP as tolerance can

develop so can discuss dosage changes
o Eat healthily reduce levels of saturated fats, less fried
foods, grilled meats etc, include 5 portions of fruit and veg,
reduce salt intake
o Exercise gradually increase exercise brisk walking,
climbing stairs etc

Carbamazepine (anti-epileptic drugs)

- Epilepsy, prevents seizures initially 100-200mg 1-2 times daily,
increased slowly to usual dose of 0.8-1.2g daily in divided doses (elderly,
initial dose is reduced)
- May make you sleepy, do not drive or use tools or machinery
- Do not stop taking this medicine unless told to by your doctor
- Side effects headache, drowsiness, nausea
- Only allowed to drive if they have been seizure free for one year, subject
to attacks while asleep only, if drowsy dont drive
- Avoid drinking alcohol
- Avoid drinking grapefruit juice
- Make sure every time you collect this medicine it is the same type and
brand unless changed by doctor as each brand works differently in the
body
- Seek immediate medical attention if you experience symptoms such as
fever, mouth ulcers, bruising or bleeding
- Do not share the medicine with anyone else
- Did you know you are exempt for paying for prescriptions as you have
epilepsy?
Proton Pump Inhibitors Esomeprazole, Lansoprazole, Omeprazole,
Pantoprazole, Rabeprazole
- Medicines used to inhibit gastric acid secretion by the blocking of the
H+/K+ATPase proton pump of the gastric parietal cell
- They are effective short term treatment for gastric and duodenal
ulcers
- They are often used in combination with antibacterials for the
eradication of H. pylori
- Used for the treatment of dyspepsia and gastro-oesophageal reflux
disease (GORD)
- Used for prevention and treatment of NSAID-associated ulcers
- Side effects GI disturbances (nausea and vomiting, abdominal pain,
flatulence, diarrhoea and constipation
- Rebound acid hypersecretion and dyspepsia may occur after stopping
prolonged treatment
Simvastatin (statin)
- High cholesterol lowers cholesterol 10-20mg daily at night
- Before or after food
- Dont drink grapefruit juice as it increases amount of drug in the body

Seek medical advice in case of unexplained muscle pain, tenderness or

weakness
Long term medication so take regularly

Glyceryl Trinitrate tablets Nitrates

- A medicine that acts to dilate blood vessels to increase the amount of
blood and oxygen reaches the heart
- Lasts for only 20-30 minutes
- Carry these tablets around at all times
- Can take one tablet before physical exertion to prevent anginal
attacks/symptoms
- Dissolve tablets under the tongue, dont swallow or chew
- Can also be taken when required for treatment of anginal chest
pain
- Take one tablet and dissolve under the tongue and take a break
for 5-10 minutes
- If the pain doesnt ease within a few minutes take another dose
- If the pain continues for 15 minutes in total then call an
ambulance
- 300 microgram tablet most effective when first used
- You will need to store tablets in a bottle with the cap tightly and
get a new supply within 8 weeks of opening as they have short
shelf life
- Tolerance may develop
- Sublingual: prophylaxis and treatment of angina
- Injection: control of hypertension and myocardial ischaemia
- Cautions hypothyroidism
- Contra-indications hypersensitivity to nitrates
- Side effects postural hypotension so get up slowly, throbbing
headache, dizziness
- Lifestyle
o Eat healthily reduce levels of saturated fats, less fried
foods, grilled meats etc, include 5 portions of fruit and veg,
reduce salt intake
o Moderate exercise start slowly keep tablet with you at
all times
o Consider joining a healthy eating or weight loss group
o Consider stop smoking?
o Reduce alcohol intake?
Aspirin antiplatelet
- Used to reduce the risk of a blood clot in the body by thinning the
blood
- 75mg OD
- Rarely causes stomach irritation
- If you need a painkiller, take Paracetamol over NSAIDs such as
ibuprofen as they can increase the blood thinning properties
- Do not take indigestion remedies 2 hours before or after you take
this medicine
- Swallow this medicine whole, do not crush or chew
- This medicine contains aspirin, do not take anything else containing
aspirin

Long term medication so maintain regular contact with your GP for check
ups
Lifestyle
o Stop smoking? Greatly increases risk of blood clotting
o Eat healthily reduce levels of saturated fats, less fried
foods, grilled meats etc, include 5 portions of fruit and veg,
reduce salt intake
o Exercise gradually increase exercise brisk walking,
climbing stairs etc

Angiotensin Converting Enzyme Inhibitors Captopril, Enalapril,

Ramapril
- Inhibit the conversion of angiotensin I to angiotensin II
- Used in heart failure usually combined with a beta blocker (must stop
potassium supplement/diuretics except for low dose spironolactone)
- Hypertension most appropriate initial drug for hypertension in younger
Caucasian, Afro-Caribbean and over 55 year old patients first dose at
bed time
- Used in early and long-term management of patients who have
had myocardial infarction
- Side effects hypotension, renal impairment and persistent dry cough
- If you experience a persistent cough inform your GP
- Lifestyle
o Stop smoking? Greatly increases risk of blood clotting
o Eat healthily reduce levels of saturated fats, less fried
foods, grilled meats etc, include 5 portions of fruit and veg,
reduce salt intake
o Exercise gradually increase exercise brisk walking,
climbing stairs etc

Beta-adrenoceptor blocking drugs Atenolol, Bisoprolol Fumarate

- Used to slow the heart rate Hypertension, Arrhythmias, Angina and as
an adjunct in heart failure
- Fatigue, coldness of extremities, sleep disturbances with nightmares
- Do not stop taking this medicine unless your doctor tells you to stop
- Lifestyle
o Stop smoking? Greatly increases risk of blood clotting
o Eat healthily reduce levels of saturated fats, less fried
foods, grilled meats etc, include 5 portions of fruit and veg,
reduce salt intake
o Exercise gradually increase exercise brisk walking,
climbing stairs etc
Methadone
- Opioid dependence

Long acting opioid

Used for abstinence of heroin
Dose will be increased slowly as dose can be cumulative resulting in
toxicity
May need to come in everyday for supervised administration
Tolerance develops
If you miss 3 days this tolerance will be lost and dose will need to be
reduced as patient is at risk of overdose
Supportive care programme may be offered
Shouldnt take any other street drugs
Avoid alcohol
Stop smoking services?