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Dr B Kelly

When/How to prescribe?

Define the problem Only when necessary Benefit outweighs the risk? Discuss treatment options Communication skills Promote compliance

Prescribing in Gen. Practice

PACT- prescribing analysis + cost package• Quarterly report on prescribing habits and costs

Formulary • An agreed policy of prescribing

• Limit prescribing and costs

• Evidence based

Guidelines • Local/national

When to beware!

Elderly Pregnancy Children Renal/Hepatic impairment New drugs

Emergency Contraception

2 Options:

• Levonelle-2(not PC4!)

• IUD• up to 5 days

• copper coil

• failure rate <1%

o Levonelle-2• Up to 72 Hours

• 2 Tablets 12 hours apart

• Up to 97% effective

• CI - Porphyria

• Progesterone Tumours

After prescribing emergency contraception should….

Review patient ?STD’s regular contraception ?pregnancy

Sore Ear

100cases/year Paracetamol Ibuprofen 80% resolve within 3 days Amoxycillin (after day 4 )

125mg tid for 5/7

current evidence Avoid antibiotic Limit use to after 3 days

Back Pain

Simple Analgesia Encourage activity Ibuprofen/ Diclofenac

Also consider-• Diazepam 2-5mg tid

Red flags

<20yrs or >55yrs Non-mechanical pain Thoracic pain PMHx of CA Steroids Weight loss Widespread neurology Structural deformity HIV

Sore Throat

Beware Quinsy Diagnosis of bacterial vs viral difficult

simple analgesics, increase fluids and salt water gargling

Antibiotics are of modest benefit- on avg reduce symptom duration by 16 hrs and complication rate.

BUT!-large NNT to prevent one episode.

CONSIDER DELAYED SCRIPT- no better by day 2/3

Penicillin V 250mg QID for 10/7(not amoxicillin ?glandF

Erythromycin 250mg QID for 10/7

Acne Topical

Azelaic Acid Salicylic Acid Benzoyl peroxide

Oral antibiotics Oxytetracycline Erythromycin Minocycline

Hormonal Dianette

Oral Retinoids Roaccutane

‘The Pill’ Oestrogen & Progesterone Acts by inhibiting ovulation. 1 tablet daily for 21 days then 7

day break

Note:• Contraindications

• Side Effects

• Not effective if taken with enzyme inducers eg. Antibiotics, anti-convulsants.

• ‘7 day Rule’

Scabies

Permethrin

• (Lyclear Dermal Cream)

• 1 dose stat- apply over whole body then wash thoroughly 8-12 hrs later

Repeat once if necessary after 7 days

Fever of Unknown Origin

Check ENT, Abdomen, Neck Stiffness, Rash, MSSU

If no obvious cause:

Paracetamol

Ibuprofen

Fluids

“Flu”

Most ‘flus’ are not true flus. Paracetamol 1g QID

Ibuprofen 400mg Tid

Increase Oral Fluids

Antibiotics for secondary infections Target at risk population with flu immunisations

U.T.I Treat infection as per urine

culture

Prophylaxis – usually trimethoprim

Investigate +/- Paediatrician due to potential complications

Head Lice

Permethrin

• Lyclear Crème Rinse

• 1 dose stat – apply to hair and scalp, leave 10 mins then rinse.

Diarrhoea

Increase fluid intake +/- Dioralyte

Antispasmotics eg hyoscine 20mg qid

Loperamide

(imodium)

Impetigo

Common and highly contagious.

Staphylococcal infection

Flucloxacillin

Fusidic Acid

(topical)

Nappy rash

Sparing of skin folds

simply advice• nappy area dry

• aqueous cream (E45)

• barrier cream (zinc paste)

Topical antifungal• Canesten HC

Psoriasis

Explain condition Topical treatment

• sailicylic acid

• coal tar

• vit D derivatives

• dithranol

• topical retinoids

• topical steroids

Systemic/PUVA

Eczema

Very common >30% of dermatology

consultations Also known as dermatitis Atopic eczema

commonest type Remove contributory

factors Emollients Topical steroids