III. METODOLOGIA
3.3. Población, muestra, muestreo, unidad de análisis
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 – today’s 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 doesn’t 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, don’t 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 aren’t 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)
- Parkinson’s disease – 50mg 3-4 times daily initially, maintenance 400-800mg 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 Parkinson’s 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 don’t 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
- Don’t 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, don’t 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 doesn’t 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 - Shouldn’t take any other street drugs
- Avoid alcohol
- Stop smoking services?