Class notes
BNF chapter summaries
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Notes cover all core subjects in pharmacy; Endocrine, Infections, Pharmacology, Drugs
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Pre Reg Notes Terbinafine tablets must have a blood test monitor the liver function
Cannot take Gaviscon and Omeprazole at the same time. As Gaviscon reduces the
stomach acid so. The gastric resistant capsule of omeprazole will be broken down in
the stomach. Therefore, there should be a two-hour gap between taking the
Gaviscon and Omeprazole
Doxycycline 50mg Acne
Trimethoprim can be given when acne is resistant to other antibacterial
Isotretinoin is reserved for last line and is teratogenic. Woman need of child bearing
age need to be on a pregnancy prevention programme
Isotretinoin can cause dry mouth
The prescription is only valid for seven days
Doxycycline 100mg capsules Pack sizes of 8. 2 on the first day and then take one
tablet thereafter
Chlamydia 100mg bd for seven days
Azithromycin 1g dose immediately 500mg bd OTC then 500mg once a day for 2 days
GORD Gaviscon infant
2 weeks use only
Infants under 4.5kg One sachet should be used infants over 4.5kg Two sachets
should be used
Bottle fed infants Mix each sachet into 115ml of feed in the bottle shake well and
feed as normal
Breastfed Mix each sachet with 1 teaspoon of cooled boiled water until a smooth
paste is formed. Add another 2 teaspoons of cooled boiled water and mix
No more than 6 sachets in 24 hours
Diarrhoea and Stomach upset
Bismuth Subsalicylate unsuitable for those taking any NSAIDS, Aspirin, renal
impairment and those patients taking blood thinning medication
Laxatives overuse can cause hypokalaemia
Koalin plus morphine 12 plus only 10ml tds max dose
IBS
Symptoms going on for six months
Changes in bowel habits, bloating and abdominal pain
Mebeverine 1 tablet 20 minutes before food Abdominal pain 135mg
Peppermint oil helps with the abdominal pain and bloating
3 portions of fruit per day
Soluble fibre such as oats are recommended
Intake of insoluble fibre such as bran should be discouraged
Where probiotics are used the patient should be trailed on them for 4 weeks
Haemorrhoids
Red spotting, excessive straining, incomplete bladder emptying
, Look for red flags so any unexplained weight lose, changes in bowel habits, duration
of bleeding for 3 weeks
Anusol
Anusol HC which is more potent
Motion sickness Kwells Take one tablet every 6 hours. Do not take this medicine more than
3 times in 24 hours
Hyoscine is fast acting but short duration of action
Antihistamines such as Cinnarizine Take 2 hours before the journey. Two tablets two hours
before travel and then one tablet every eight hours
Athletes foot
Terbinafine Lamisil 18 years and over
Clotrimazole 1% apply 2 to 3 times a day
Respiratory system start of low dose ICS if patient using SABA more than three times a
week, has night symptoms and has had two exacerbations in the last two years
5 to 12 years 200 to 400mcg day of beclomethasone
Greater than 12 years 200 to 800mcg per day then if symptoms not controlled patient is
trailed on leukotriene receptor antagonist according to NICE
BTS recommend a LABA such as salmeterol or formoterol as an add on to the low ICS
Patient presented with a prescription for metronidazole 400mg tablets. The patient`s main
concern was that she was breastfeeding and whether it was appropriate to still take them.
After referring to the metronidazole SPC it was clear that traces of the medicine will appear
in the breastmilk. The script for the metronidazole tablets was returned to the spine as
requested by the patient. Afterwards, the patient`s GP surgery was contacted and within a
few minutes a new prescription for metronidazole vaginal gel was issued. Administration of
metronidazole via the vaginal route produces lower plasma levels this would then
correspond to lower milk levels and so this route is considered compatible with
breastfeeding
Patient presented with a prescription for metronidazole 400mg tablets. The patient`s main
concern was that she was breastfeeding and whether it was appropriate to still take them.
After referring to the metronidazole SPC it was clear that traces of the medicine will appear
in the breastmilk. The script for the metronidazole tablets was returned to the spine as
requested by the patient. Afterwards, the patient`s GP surgery was contacted and within a
few minutes a new prescription for metronidazole vaginal gel was issued. Administration of
metronidazole via the vaginal route produces lower plasma levels this would then
correspond to lower milk levels and so this route is considered compa
High Risk drugs
,Amino glycosides
Vancomycin and Gentamicin
Ototoxicity and Nephrotoxicity
Nausea and Vomiting
Macrolides Erythromycin
GI discomfort
Alternative to pregnant woman who cannot take penicillin
Vision disorders
Headaches
Quinolones
QT interval prolongation
The risk of seizures with NSAID and Quinolones
Tetracyclines
Angioedema
Photosentivity reactions
Headaches Intracranial hypertension. Medication should be discontinued
Skin reactions
Cephalosporins
Thrombocytopenia, neutropenia
High Risk
Amiodarone
Arrythmias
200mg tds for one week, then 200mg bd for second week then maintenance dose of 200mg
Side effects
Corneal micro deposits Patient can be dazzled by headlights and so should avoid driving
Hypo or Hyperthyroidism Amiodarone contains iodine
Pulmonary toxicity shortness of breath or a cough develops
Hepatotoxicity discontinue if clinical signs of liver disease i.e. jaundice or dark urine
Amiodarone can cause skin reactions, can cause arrythmias
Contraindication
Patients with thyroid dysfunction
Iodine sensitivity
Sino atrial heart block
Amiodarone can induce arrythmias
Monitoring
Thyroid function tests
Liver function test
Serum potassium concentration
ECG
Chest X ray
Advise
Long half life even if you stop taking the medication
Broad spectrum sunscreen
, Urgent medical attention if patient develops signs of toxicity such as shortness of breath and chest pain, light
headedness and palpitations
Common interactions
Avoid calcium channel blockers such as verapamil and diltiazem increase the risk of cardiodepression
Increase the conc of antiepleptics such as phenytoin
Increase the anticoagulant effect of warfarin
Amiodarone and digoxin. Can increase the conc of digoxin. Reduce the dose of digoxin
Amiodarone and lithium cause QT prolongation
Amiodarone and statin can cause myopathy
Vancomycin
Has bactericidal activity works against aerobic and anaerobic gram positive bacteria
Indication
C diff infection
Bone and joint infections
Pneumonia and endocarditis
Side effects
Nephrotoxicity
Ototoxicity
Red mans syndrome
Discontinue if tinnitus occurs
Neutropenia and blood disorders
Trough conc 10 to 20mg per litre
Full blood count
Avoid loop diuretics such as furosemide
Loop diuretics can increase the risk of otoxicity
Increased risk of otoxicity and hepatotoxicity with ciclosporin and aminoglycosides
Warfarin
Once daily at the same time each day
INR assessed every 3 months
INR 2.5 Treatment of DVT or PE
AF
INR 3.5 target for recurrent DVT and PE
Mechanical prosthetic heart valve
Monitoring
INR
Side effects
Bleeding such as nose bleeds
Blue purple toe syndrome
Interactions
Cranberry juice acts as an enzyme inhibitor. This increases anticoagulant effect of warfarin
Antifungals such as daktarin increase the anticoagulant effect of warfarin
Chloramphenicol and macrolides can increase the anticoagulant effect of warfarin
Statins can also increase the anticoagulant effect of warfarin
Vitamin K
Maintain a similar vitamin k intake
SJW can reduce the effectiveness of warfarin
Antiepileptics can reduce effectiveness of warfarin
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