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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:
o
Levonelle-2
• Up to 72 Hours
•
Levonelle-2(not PC4!)
•
IUD
• up to 5 days
• copper coil
• failure rate <1%
• 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
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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