Dumfries & Galloway Minor Ailments Service Formulary 2014

Transcription

1 Dumfries & Galloway Minor Ailments Service Formulary 2014

2 BNF Chapter Contents Page Gastrointestinal System 2 Indigestion and dyspepsia 2 Constipation 2 Diarrhoea 3 Haemorrhoids 3 Respiratory System 4 Hay Fever 4 Cough and Nasal Congestion 4 Central Nervous System 5 Nausea and vomiting 5 Pain 5 Migraine 5 Infections 6 Threadworms 6 Obstetrics, gynaecology and urinary tract disorders 7 Vaginal infections 7 Alkinalisation of urine 7 Nutrition and blood 8 Vitamin supplementation in pregnancy 8 Eye 9 Bacterial conjunctivitis 9 Allergy 9 Dry eyes 9 Ear, nose and oropharynx 10 Ear wax 10 Nasal allergy 10 Mouth ulcers, teething and sore throats 10 Oral thrush 10 Skin 11 Eczema and allergy 11 Acne 11 Warts and verrucae 12 Boils 12 Athlete s Foot 12 Cold sores 12 Head lice 13 Scabies 13 Minor skin infections 13 Appendix 1 Summary of changes 14 1

3 BNF Section 1 Gastrointestinal system Indigestion and dyspepsia BNF Section Aluminium and magnesium containing antacids Aluminium Hydroxide Liquid Co-magaldrox SF Suspension 195/220/5(Maalox) 500ml 500ml BNF Section Other drugs for dyspepsia and gastro-oesophageal reflux disease Peptac Liquid (should be used 1 st line) Gaviscon Advance Only to be used for patients who are coming off long-term PPI treatment Gaviscon Infant SF Sachets 500ml 250ml, 500ml 15 dual sachets BNF Section Bulk forming laxatives Constipation Ensure adequate fluid intake. Not to be taken immediately before going to bed. Ispaghula Husk 3.4G/3.5G 30/60 BNF Section Stimulant laxatives Senna Tabs 7.5mg 30 Glycerin 4g Suppositories (Adult) 12 Bisacodyl 10mg Supps 12 Bisacodyl 5mg Tablets 28 BNF Section Osmotic laxatives Lactulose Solution 300ml/500ml Laxido Orange 30 2

4 Diarrhoea BNF Section 1.4 Antimotility drugs In adults and children over 12 years. Maximum strength 2mg, maximum dose 4mg and maximum daily dose 12mg. Loperamide 2mg Capsules 12 BNF Section Oral rehydration therapy Dioralyte Oral Powder 6/20 Electrolade Oral Powder 6/20 Haemorrhoids BNF Section Soothing haemorrhoidal preparations Anusol Cream 23g Anusol Ointment 25g Anusol Suppositories 12 BNF Section Compound haemorrhoidal preparations with corticosteroids Anusol Plus HC Ointment 15g Anusol Plus HC Suppositories 12 3

5 BNF Section 3 Respiratory system BNF Section Antihistamines Hay Fever Non-sedating antihistamines Cetirizine 10mg Tablets 30 Cetirizine SF Oral Solution 1mg/1ml 200ml Loratadine Tablets 10mg 30 Loratadine Oral Solution 5mg/5ml 100ml Sedating antihistamine Drowsiness may affect performance of skilled tasks (e.g. driving); sedating effects enhanced by alcohol. Chlorphenamine 4mg Tablets 30 Chlorphenamine Syrup/Oral Solution 2mg/5ml 150ml BNF Section 3.8 Aromatic Inhalations Cough and Nasal Congestion Menthol Crystals Menthol and Eucalyptus Inhalation, BP g 100ml BNF Section Topical Nasal decongestants Sodium Chloride Nose Drops Xylometazoline 0.1% nasal drops Xylometazoline 0.1% nasal spray Xylometazoline 0.05% paediatric nasal drops BNF Section Cough Suppressants Pholcodine Linctus 5mg/5ml Pholcodine Paediatric SF Linctus 200ml Dispense up to 200ml BNF Section Expectorants and demulcent cough preparations Simple SF Linctus Simple Paediatric SF Linctus 200ml Dispense up to 200ml 4

6 BNF Section 4 Central Nervous System Nausea and vomiting BNF Section 4.6 Drugs used in nausea and vertigo MHRA advice regarding domperidone: As of 4 th September 2014, domperidone is now classified as a Prescription Only Medicine and is therefore no longer available via the Minor Ailments Service. Prochlorperazine 3mg buccal tablets 8 BNF Section Non Opioid analgesics Pain Ibuprofen 200mg Tablets 42 Ibuprofen 400mg Tablets 42 Ibuprofen SF Suspension 100mg/5ml 150ml Paracetamol 500mg Tablets 32 Paracetamol SF 120mg/5ml Suspension 100ml Paracetamol SF 250mg/5ml Suspension 100ml BNF Section Antimigraine Drugs Migraine Sumatriptan 50mg Tablets (prescribe as Imigran Recovery) 2 5

7 BNF Section 5 Infections Vaginal Candidiasis (Oral treatment) FOR THE TREATMENT OF VAGINAL CANDIDIASIS PLEASE REFER TO BNF SECTION 7 (OBSTETRICS, GYNAECOLOGY AND URINARY TRACT DISORDERS) ON PAGE 7. Threadworms BNF Section Drugs for Threadworms Mebendazole 100mg Tablets 1 All family members should be treated at the same time, even if they have no symptoms, to prevent reinfection. Mebendazole is not licensed for use in patients aged under 2 years or in pregnant women. The following hygiene measures are recommended in all patients however in these two groups of patients, they should be regarded as the alternative to mebendazole:- Recommended hygiene measures On day 1:- Dust and vacuum the house Wash all sleepwear and bed linen For the next 2 weeks:- Morning shower or bath Ensure good hand hygiene Wear pants at night-time In children aged under 3 months, a 6 week hygiene regimen is recommended. 6

8 BNF Section 7 Obstetrics, gynaecology and urinary-tract disorders Vaginal infections All topical and oral azoles offer a 75% cure rate. In pregnancy, avoid fluconazole and use intravaginal treatment for 7 days instead BNF Section 5.2 Antifungal Drugs Can be sold to the public for vaginal candidiasis in women aged years, in a container or packaging containing not more than 150mg and labelled to show a maximum dose of 150mg. A national Patient Group Direction is available which allows the supply of single capsule POM pack of Fluconazole. Fluconazole 150mg Capsules 1 BNF Section Anti-infective drugs Clotrimazole Vaginal Tablets 500mg 1 Clotrimazole 10% Cream (prescribe as Canesten Internal) 5g Clotrimazole 500mg pessary PLUS clotrimazole 2% cream 1 combi pack (prescribe as Canesten Combi GSL pack) In pregnancy: Clotrimazole 100mg pessary (one pessary inserted 6 at night for 6 nights) Alkalinisation of Urine BNF Section Drugs used in urological pain Potassium Citrate solution 200ml Effercitrate Tablets 12 Cymalon 6 7

9 BNF Section 9 Nutrition and blood Fluid and electrolyte replacement in diarrhoea BNF Section Oral rehydration therapy See section on Diarrhoea on page 3 Vitamin supplementation in pregnancy BNF Section Drugs used in megaloblastic anaemias For use by females during pregnancy for a duration of 8 weeks Folic Acid 400microgram Tablets 90 8

10 BNF Section 11 Eyes Bacterial conjunctivitis BNF Section Antibacterial Eye Preparations Chloramphenicol Eye Drops 0.5% (2 years and over) Optrex Infected Eyes Eye Oinment (2 years and over) 4g A Patient Group Direction is available to cover the supply of chloramphenicol 0.5% eye drops to patients aged 1 and above. Allergy BNF Section Other anti-inflammatory preparations Sodium Cromoglicate 2% Eye Drops (endorse as Opticrom Allergy) 5ml/ Dry eyes BNF Section Tear deficiency, ocular lubricants and astringents Hypromellose 0.3% Eye Drops Viscotears Liquid Gel 10g 9

11 BNF Section 12 Ear, nose and oropharynx BNF Section Removal of Ear wax Ear wax Olive Oil B.P. Sodium Bicarbonate 5% Ear Drops Nasal allergy BNF Section Nasal Allergy Beclometasone Nasal Spray 100 or 180 doses See section on Cough and Nasal Congestion on page 4 for recommendations on nasal congestion. Mouth Ulcers, Teething and Sore Throats BNF Section Drugs for oral ulceration and inflammation Choline salicylate gel 15g Benzydamine 0.15% Mouthwash 300ml Benzydamine 0.15% Spray 30ml Hydrocortisone 2.5mg Buccal Tablets 20 BNF Section Mouthwashes, gargles, and dentifrices Chlorehexidine 0.2% Mouthwash 300ml Oral Thrush BNF Section Oropharyngeal Anti-Infective Drugs Miconazole Oral Gel 15g 10

12 BNF Section 13 Skin Eczema and allergy BNF Section Emollients E45 Cream Aquamax cream QV Cream Liquid paraffin and White soft paraffin 50/50 50g/125g 100g, 500g 100g 250g BNF Section Emollient Bath Additives Emulsifying Ointment (can be held under warm/hot running water to give a foamy bath additive) Hydromol Bath and shower emollient Oilatum Plus (for use where infection is present or is a frequent complication) 500g 350ml/500ml 500ml BNF Section Barrier Preparations Conotrane 200g BNF Section 13.3 Topical local anaesthetics and antipruritics Calamine Aqueous Cream Calamine Lotion Eurax Cream 100ml 200ml 30g/100g BNF Section 13.4 Topical corticosteroids Hydrocortisone 1% Cream 15g Acne BNF Section Topical Preparations for acne Quinoderm Cream Benzoyl peroxide 10% Aquagel (endorse as Panoxyl) 50g 40g 11

13 Warts and Verrucae BNF Section 13.7 Preparations for warts and callouses Salactol Paint Duofilm Paint Glutaraldehyde 10% solution (Glutarol) 15ml BNF Section 13.9 Shampoos and scalp preparations Ketoconazole Shampoo (Seborrhoeic Dermititis of Scalp) Polytar Liquid 60ml, 100ml 150ml Boils BNF Section Preparations for Boils Magnesium Sulphate Paste 50g Athlete's Foot BNF Section Antifungal preparations Clotrimazole 1% Cream 20g Miconazole 2% Cream 30g Terbinafine Cream 7.5g BNF sections Cold Sores Aciclovir 5% Cream 2g 12

14 Head lice BNF Section Parasiticidal Preparations Treatment of head lice should be in accordance with NHS Dumfries & Galloway Head Lice policy. Mousse, crème rinse and shampoo preparations are ineffective and should not be used. It has been shown that ONE application of NYDA has 94.9% cure rate. NYDA is licensed for patients aged 2 years and above. For patients aged under 2 years as well as those patients who are pregnant or breast-feeding, Hedrin should be considered as the 1 st line choice. When prescribing malathion, aqueous solutions should be used for children and those patients with asthma and/or eczema. PLEASE NOTE: At the time of going to print (August 2014), malathion 0.5% liquid was undergoing re-licensing and was unavailable. There was no date given by the manufacturers to indicate when they would expect it to be available again. Once the re-licensing process is complete however and it is available, it would be an appropriate treatment in the management of patients with head lice. NYDA (Dimeticone 92%) 1 st line choice 50ml/100ml Dimeticone 4% Lotion (Hedrin) 50ml/150ml Malathion 0.5% Liquid (Derbac M) 50ml/200ml Bug Buster Kit 1 Scabies BNF Section Parasiticidal Preparation Permethrin 5% Cream (Lyclear Dermal Cream) 30g Minor skin infections BNF Section Astrigents, oxidisers and dyes Hydrogen Peroxide 1% Cream (Crystacide) 25g 13

15 Appendix 1 Summary of changes Peptac is now the clear 1st line choice of alginate Gaviscon Advance now has a stipulation that it should only be used for patients stepping down PPI treatment Laxido replaces Movicol as the macrogol preparation of choice Oral rehydration therapies are now listed in the "Diarrhoea" section rather than under "Nutrition and Blood" Cetirizine Oral Solution has been added Menthol and Eucalyptus Inhalation, BP1980 has been added Topical nasal decongestants are now listed under the "cough and nasal congestion" heading rather than "Nasal allergy and congestion" Advice regarding the reclassification of domperidone as a POM medicine only Co-codamol 8/500mg has been removed to reflect current efforts to reduce its usage Oral and topical treatment have been merged into the same section under "Vaginal infections" in the "Obstetrics, Gynaecology and Urinary Tract Disorders" chapter Piperazine has been removed on account of it being discontinued New advice on recommended hygiene measures that should be implemented as part of the management of threadworm infections Viscotears Liquid Gel has been added Liquivisc Gel and Lacri-Lube eye ointment have both been removed as has Sno Tears eye drops Almond oil for the removal of ear wax has been removed and replaced instead with Olive Oil Adcortyl in Orabase has been removed on account of it no longer being available Benzydamine 0.15% Spray has been added Aqueous cream, Dermol 500 lotion, Diprobase and Epaderm Ointment have all been removed E45 Cream, Aquamax cream, QV Cream and Hydromol ointment have all been added Balneum, Dermol 200 shower emollient, Dermol 600 shower emollient, E45 Emollient bath oil, Emulsiderm and Oilatum Emollient have all been removed Emulsifying ointment, Hydromol Bath and Shower emollient and Oilatum Plus have all been added Zinc and Castor oil has been removed Quinoderm Cream has been added Panoxyl Aquagel 2.5% and 5% have been removed on account of them being unavailable at this time... Panoxyl Aquagel 10% remains Cuplex Gel and Formaldehyde 0.75% gel have been removed Salactol Paint and Glutaraldehyde 10% solution have both been added Sebco ointment has been removed Miconazole 2% cream for Athlete's Foot has been added Quellada M, malathion 0.5% lotion (Prioderm, Suleo M), permethrin (Lyclear), phenothrin 0.2% lotion (Full Marks) and phenothrin 0.5% liquid (Full Marks) have all been removed NYDA (Dimeticone 92% is now 1st line choice for head lice treatment... Hedrin and Derbac M remain in the Formulary as alternatives although at present, Derbac M is unavailable due to a re-licensing issue 14