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Dr B Kelly
When/How to prescribe?
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Define the problem
Only when necessary
Benefit outweighs the risk?
Discuss treatment options
Communication skills
Promote compliance
Prescribing in Gen. Practice
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PACT- prescribing analysis + cost package
• Quarterly report on prescribing habits and costs
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Formulary
• An agreed policy of prescribing
• Limit prescribing and costs
• Evidence based
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Guidelines
• Local/national
When to beware!
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Elderly
Pregnancy
Children
Renal/Hepatic impairment
New drugs
Emergency Contraception
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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….
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Review patient
?STD’s
regular contraception
?pregnancy
Sore Ear
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100cases/year
Paracetamol
Ibuprofen
80% resolve within 3 days
Amoxycillin (after day 4 )
 125mg tid for 5/7
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current evidence
 Avoid antibiotic
 Limit use to after 3 days
Back Pain
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Simple Analgesia
 Encourage activity
 Ibuprofen/ Diclofenac
Also consider• Diazepam 2-5mg tid
Red flags
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<20yrs or >55yrs
 Non-mechanical pain
 Thoracic pain
 PMHx of CA
 Steroids
 Weight loss
 Widespread neurology
 Structural deformity
 HIV
Sore Throat
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Beware Quinsy
Diagnosis of bacterial vs viral difficult
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simple analgesics, increase fluids and salt water gargling
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Antibiotics are of modest benefit- on avg reduce symptom
duration by 16 hrs and complication rate.
BUT!-large NNT to prevent one episode.
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CONSIDER DELAYED SCRIPT- no better by day 2/3
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Penicillin V 250mg QID for 10/7(not amoxicillin ?glandF
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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’
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Oestrogen & Progesterone
Acts by inhibiting ovulation. 1 tablet daily for 21 days then 7
day break
Note:
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Contraindications
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Side Effects
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Not effective if taken with enzyme inducers
eg. Antibiotics, anti-convulsants.
•
‘7 day Rule’
Scabies
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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
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Check ENT, Abdomen, Neck
Stiffness, Rash, MSSU
If no obvious cause:
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Paracetamol
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Ibuprofen
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Fluids
“Flu”
Most ‘flus’ are not true flus.
 Paracetamol 1g QID
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Ibuprofen 400mg Tid
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Increase Oral Fluids
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Antibiotics for secondary infections
Target at risk population with flu
immunisations
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U.T.I
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Treat infection as per urine
culture
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Prophylaxis – usually
trimethoprim
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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
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Increase fluid intake +/- Dioralyte
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Antispasmotics eg hyoscine 20mg qid
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Loperamide
(imodium)
Impetigo
Common and highly contagious.
Staphylococcal infection
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Flucloxacillin
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Fusidic Acid
(topical)
Nappy rash
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Sparing of skin folds
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simply advice
• nappy area dry
• aqueous cream (E45)
• barrier cream (zinc
paste)
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Topical antifungal
• Canesten HC
Psoriasis
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Explain condition
 Topical treatment
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sailicylic acid
coal tar
vit D derivatives
dithranol
topical retinoids
topical steroids
Systemic/PUVA
Eczema
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Very common
 >30% of dermatology
consultations
 Also known as dermatitis
 Atopic eczema
commonest type
 Remove contributory
factors
 Emollients
 Topical steroids