Patient Group Direction For The Administration and Supply ...foi.nhsgrampian.org/globalassets/foidocument/foi-public-documents1... · UNCONTROLLED WHEN PRINTED Review Date: November

Patient Group Direction For The Administration And Supply Of

Medicines For Minor Illness By Nurse And Paramedic Practitioners Working Within Grampian Medical Emergency Department (GMED)

Lead Author: Medicines Management Specialist Nurse

Consultation Group: See relevant page in the PGD

Approver: Medicine Guidelines and Policies Group

Signature:

Signature:

Identifier: NHSG/PGD/GMED/ MGPG850

Review Date: November 2018

Date Approved: November 2016

Expiry Date: November 2019

A Patient Group Direction is a specific written instruction for the supply or

administration of named medicines in an identified clinical situation. It is drawn up locally by Doctors, Pharmacists and other appropriate professionals,

approved by the employer and advised by the relevant professional advisory committees. In most cases, appropriate clinical care is provided on an individual

basis by a specific prescriber to a specific individual patient. Patient Group Directions should only be considered where they offer a benefit to patient care

without compromising patient safety in any way.

Uncontrolled when printed

Version 3

UNCONTROLLED WHEN PRINTED Review Date: November 2018 Identifier: NHSG/PGD/GMED/MGPG850 - i - PGD For The Administration And Supply Of Meds For Minor Illness By Nurse And Paramedic Practitioners Working Within (GMED) – Version 3

This document is also available in large print and other formats and languages, upon request.

Please call NHS Grampian Corporate Communications on (01224) 551116 or (01224)

552245. Revision History: Date of change

Approval date of PGD that is being superseded

Summary of Changes

Section heading

September 2016

September 2014

2 Yearly Update to new PGD template.

September 2016

September 2014

Added monograph reference table. Medicines Monographs

Subject: Patient Group Direction Identifier: NHSG/PGD/GMED/MGPG850 Replaces: NHSG/PGD/GMED/MGPG687, Version 2.1 Keyword(s): PGD Patient Group Direction aciclovir amoxicillin cetirizine

chloramphenicol chlorphenamine co-codamol doxycycline erythromycin flucloxacillin fluorescein sodium fusidic acid gaviscon ibuprofen naproxen nitrofurantoin paracetamol phenoxymethylpenicillin penicillin v prednisolone prochlorperazine buccal rehydration salts salbutamol sodium citrate sumatriptan trimethoprim

Policy Statement: It is the responsibility of individual nurse, paramedic and their line managers to ensure that they work within the terms laid down in this PGD and to ensure that staff are working to the most up to date PGD. By doing so, the quality of the services offered will be maintained, and the chances of staff making erroneous decisions which may affect patient, staff or visitor safety and comfort will be reduced. Supervisory staff at all levels must ensure that staff using this PGD act within their own level of competence. The lead author is responsible for the review of this PGD and for ensuring the PGD is updated in line with any changes in clinical practice, relevant guidelines, or new research evidence. Review date: The review date for a PGD needs to be decided on a case-by-case basis in the interest of patient safety. The expiry date should not be more than 3 years from the date the PGD was authorised. Document: Drafted: March 2012 Completed: March 2012 Approved: March 2012, September 2014, November 2016

(published – April 2017)

UNCONTROLLED WHEN PRINTED Review Date: November 2018 Identifier: NHSG/PGD/GMED/MGPG850 - 1 - PGD For The Administration And Supply Of Meds For Minor Illness By Nurse And Paramedic Practitioners Working Within (GMED) – Version 3

Patient Group Direction For The Administration And Supply Of Medicines For Minor Illness By Nurse And Paramedic Practitioners Working Within Grampian Medical Emergency Department (GMED) Clinical indication to which this PGD applies Definition of situation/condition

This patient group direction (PGD) will authorise nurse and paramedic practitioners working within GMED to administer or supply pre-labelled medicines included in this PGD as listed in Appendix 3, to individuals who meet the criteria as described on each individual drug monograph, according to diagnosis, disease state and concurrent medicines. This PGD should be used in conjunction with the recommendations in the current British National Formulary (BNF), British National Formulary for Children (BNFC) and individual Summary of Product Characteristics (SPC).

Inclusion criteria

• Patients who attend GMED centres during the out of hours

periods.

• Patients in their own homes, care homes or community hospitals who require home visits from Nurse and Paramedic Practitioners working in GMED during the out of hours period.

Exclusion criteria

The patient may be administered or supplied a medicine specified in Appendix 3 under this PGD unless they: • have a known or suspected hypersensitivity to the product

or any of its ingredients. • have previously experienced an adverse reaction to the

medicine. • meet any of the exclusion criteria listed in the individual

monographs.

In these cases the patient must be referred to a GMED duty doctor.


Precautions and special warnings

The medicines specified in Appendix 3 under this PGD must be used only for the specific indication(s) and age group listed in the individual drug monographs. Patients of a different age group, or who are suffering from a condition other than that specified in the monograph, must be referred to a GMED duty doctor. • If there is any concern about the appropriate use of the

medicine in the specific indications given within the direction then medical advice should be sought.

• If there is any doubt about the correct diagnosis of the symptoms medical advice should be sought.

• Precautions listed in the individual monographs should be taken into account.

The medicine patient information leaflet should be consulted prior to the administration of the medicine.

Referral criteria

Patients who fall into the categories detailed in the exclusion criteria.

Action if excluded from treatment

Medical advice should be sought – refer to General Practitioner/Consultant (relevant medical practitioner). The reason why the patient was excluded under the PGD will be documented in the patient’s medical notes.

Action if patient declines treatment

Patient/parent/guardian should be advised of the risks and consequences of not receiving treatment. Record outcome in Patient Medication Record if appropriate and refer the patient to their General Practitioner/Consultant (relevant medical practitioner).

Consent

Prior to the administration of the drug, valid consent must be obtained. Consent must be in line with current NHSG “Staff Policy for Obtaining Consent for Clinical Procedures and Healthcare Interventions”. See link below. http://intranet.grampian.scot.nhs.uk/ccc_nhsg/15692.html?pMenuID=460&

http://intranet.grampian.scot.nhs.uk/ccc_nhsg/15692.html?pMenuID=460&

http://intranet.grampian.scot.nhs.uk/ccc_nhsg/15692.html?pMenuID=460&


Description of treatment available under the PGD Name of medicine

See individual drug monographs.

Legal status

Medicines referred to in this PGD are all either GSL (General Sales List), P (Pharmacy only) or PoM (Prescription-only Medicines) dependant on pack size.

Form/Strength

See individual product monographs.

Route/Method of administration

See individual product monographs. Via suitably labelled pack.

Dosage/Total Dose

See individual product monographs. Doses for children are expressed in specific age ranges, as per the BNF for Children, e.g. 5 years – 12 years refers to a child from their 5th birthday to the day before their 13th birthday. However a pragmatic approach should be applied and consideration should be given to a child’s weight in particular if a child is small for their age. Mean values for weight and height are given in the back pages of the BNF for Children. If there is any doubt this should be discussed with the GMED duty doctor.

Duration of treatment


Storage requirements


Follow-up (if applicable)

Patients should not be discharged or left at home if they feel unwell after treatment with a medicine specified in Appendix 3 of this PGD. If necessary a GMED doctor should be contacted for advice.

Advice to patient (Verbal)

Advice should be given on what to expect and what to do for major and minor reactions.


Advice to patient (Written)

The Patient Information Leaflet (PIL) contained in the medicine(s) should be made accessible to the patient, parent, guardian, or person with parental responsibility. Where this is unavailable, or unsuitable, sufficient information should be given in a language that they can understand. Copies of PIL and SPCs for all medicines can be found at http://www.medicines.org.uk or http://www.mhra.gov.uk/spc-pil/index.htm

Concurrent Medications/Drug Interactions

See individual product monograph, and refer to Appendix 1 of the current issue of the BNF and BNF for Children. Nurses and Paramedic Practitioners must be aware of, and familiar with, all concurrent medication prior to supply/administering a medicine from this PGD to a patient. They must be satisfied there are no clinically significant interactions before proceeding with supply/administration of the medicine.

Identifying and managing possible adverse reactions

See individual product monographs. This list is not exhaustive. Please also refer to current BNF/BNFC and manufacturers SPC for details of all potential adverse reactions. BNF: https://www.medicinescomplete.com/mc/bnf/current/ https://www.medicinescomplete.com/mc/bnfc/2011/ SPCs/PILs: https://www.medicines.org.uk/emc/ http://www.mhra.gov.uk/spc-pil/index.htm If an adverse reaction does occur give immediate treatment and inform relevant medical practitioner as soon as possible. Report the reaction to the MHRA using the Yellow Card System. https://yellowcard.mhra.gov.uk/

http://www.medicines.org.uk/

http://www.mhra.gov.uk/spc-pil/index.htm


https://www.medicinescomplete.com/mc/bnf/current/

https://www.medicinescomplete.com/mc/bnfc/2011/

https://www.medicines.org.uk/emc/


https://yellowcard.mhra.gov.uk/


Medical advice in cases of anaphylaxis Injections of IM adrenaline/epinephrine 1:1000 must be available to treat an anaphylactic reaction should this occur. Medical advice must be sought as soon as possible from a doctor if any patient develops any signs of hypersensitivity. If there is a delay in medical support arriving and the condition of the patient is deteriorating then an emergency ambulance must be called on 999 or direct via ambulance control or dial 2222 (hospital internal) according to local procedure, or seek urgent medical advice. (Refer to Patient Group Direction for the administration of adrenaline (epinephrine) in cases of suspected anaphylactic reactions by qualified health professionals) http://www.nhsgrampian.com/grampianfoi/files/PGD_Adrenaline.pdf

Facilities and supplies required

The following should be available at sites where the medication is to be supplied/administered:

• An acceptable level of privacy to respect patient’s right to

confidentiality and safety. • Resuscitation equipment. • Access to medical support (this may be via the telephone). • Approved equipment for the disposal of used materials. • Clean and tidy work areas, including access to hand

washing facilities. • Copies of the current PGD for the medicine specified in the

PGD. • PGD for the administration of Adrenaline (epinephrine) in

cases of suspected anaphylactic reactions by qualified health professionals.

Characteristics of staff authorised to supply/administer medicine under PGD Professional qualifications

Registered Nurses as recognised by the Nursing and Midwifery Council (NMC), and Registered Paramedic Practitioners as recognised by the Health and Care Professionals Council (HCPC).

http://www.nhsgrampian.com/grampianfoi/files/PGD_Adrenaline.pdf

http://www.nhsgrampian.com/grampianfoi/files/PGD_Adrenaline.pdf


Specialist competencies

Be competent to assess the patient’s capacity to understand the nature and purpose of the administration/supply in order for the patient to give or refuse consent. Has undertaken appropriate training to carry out clinical assessment of patients leading to a diagnosis that requires treatment according to the indications listed in the PGD. Be aware of current treatment recommendations and be competent to discuss issues about the drug with the patient. Is competent in the administration/supply of the drug.

Ongoing training and competency

Have attended basic life support training which is required to be updated annually. Have undertaken the NHS e-anaphylaxis training session (and annual updates) which covers all aspects of the identification and management of anaphylaxis. This can be accessed via eKSF, or the AT Learning® tool. Maintain their skills, knowledge and their own professional level of competence in this area according to their individual Code of Professional Conduct. The practitioner must be familiar with the SPC for all medicines supplied/administered in accordance with this PGD.

Professional managers/Lead Nurses will be responsible for:

Ensuring that the current PGD is available to staff providing care under this direction. Ensuring that staff have received adequate training in all areas relevant to this PGD and meet the requirements above. Maintain up to date record of all staff authorised to supply/administer drug specified in PGD.

Documentation Authorisation of administration and supply

Nurses and Paramedic Practitioners working within GMED NHS Grampian can be authorised to administer/supply the medicines specified in this PGD by their Nurse Manager or GMED GP.


All authorised staff are required to read the PGD and sign the Agreement to supply and/or administer Medicines under PGD (Appendix 1). A certificate of authorisation (Appendix 2) signed by the authorising doctor/manager should be supplied. This should be held in the individual practitioners records, or as agreed locally.

Record of administration/ supply

An electronic or paper record for recording the screening of patients and the subsequent administration/supply of the drug specified in this PGD must be completed in order to allow audit of practice. This should include: • Name and address of patient • Patient CHI No and date of birth • Details of parent/guardian, or person with parental

responsibility where applicable • Consultant/General Practitioner details • Risk group, if appropriate • Findings of physical examination, if appropriate • Drug manufacturer, batch number and expiry date

(Vaccines and injectable medicines) • Site where drug administered, dose and route of

administration • Record of quantity of medication supplied • Exclusion criteria, record why the drug was not

supplied/administered • Reason for giving • Consent to the administration (if not obtained elsewhere) • Signature and name in capital letters of practitioner who

administered the drug • Date drug given • Record of any adverse effects (advise patient’s doctor). These records should be retained: For children and young people, retain until the patient's 25th birthday or 26th if the young person was 17 at the conclusion of treatment. For 17 years and over retain for 6 years after last date of entry, for 3 years after death, or in accordance with local policy, where this is greater than above.


Audit

All records of the drug specified in this PGD will be filed with the normal records of medicines in each practice/service. A designated person within each H&SCP/practice/service will be responsible for auditing completion of drug forms and collation of data.

References

British National Formulary https://www.medicinescomplete.com/mc/bnf/current/ accessed 25/08/16 British National Formulary for Children https://www.medicinescomplete.com/mc/bnfc/2011/ accessed 25/08/16 Electronic Medicines Compendium http://www.medicines.org.uk Medicine Date of

Revision of Text

Date Accessed

Aciclovir Tablets (Actavis Brand) 30/08/16 16/09/16 Amoxicillin Capsules (Kent Pharmaceuticals Brand)

18/05/16 28/07/16

Cetirizine Tablets (Dr Reddy’s Brand) Cetrizine Solution (Fannin UK Brand)

11/01/16 28/07/16 06/05/16 28/07/16

Chloramphenicol Ointment (Martindale Brand)

26/05/16 28/07/16

Chorphenamine Tablets (GSK Brand) Chorphenamine Solution (Wockhardt Ltd Brand)

19/01/16 28/07/16 05/02/16 28/07/16

Co-Codamol Tablets (Zentiva Brand) Co-Codamol Effervesant Tablets (Zentiva Brand)

07/09/16 16/09/16 23/03/16 28/07/16

Doxycycline capsules (Kent Pharmaceuticals Ltd)

19/07/13 31/01/17

Erythromycin Tablets (Aurobindo Brand) Erythromycin Oral Suspension (Pinewood Healthcare Brand)

15/12/15 16/09/16 19/01/16 28/07/16

Flucloxacillin Capsules (Kent Brand) Flucloxacillin Oral Suspension (Actavis Brand)

13/04/16 16/09/16 01/03/16 28/07/16

Fluorescein Minims® Eye Drops (Bausch & Lomb Brand)

28/07/16 28/07/16

Fusidic Acid Eye Drops (Concordia Brand)

29/04/14 28/07/16

https://www.medicinescomplete.com/mc/bnf/current/

https://www.medicinescomplete.com/mc/bnfc/2011/

http://www.medicines.org.uk/


Medicine Date of

Revision of Text

Date Accessed

Gaviscon® Advance Tablets Gaviscon® Advance Oral Suspension

17/10/14 28/07/16 06/11/14 28/07/16

Ibuprofen Tablets (Accord Brand) Ibuprofen Oral Suspension (Actavis Brand)

16/08/16 16/0916 14/07/16 16/09/16

Naproxen Tablets (Actavis Brand) 07/09/16 16/09/16 Nitrofurantoin tablets (Dr Reddy’s Laboratories (UK) Ltd)

16/05/16 31/01/17

Omeprazole Capsules (Zentiva Brand)

07/09/16 28/07/16

Paracetamol Tablets (Zentiva Brand) Paracetamol Oral Suspension (Rosemount Brand) Paracetamol Suppositories (Intrapharm Brand)

23/03/16 28/07/16 15/02/15 28/07/16 18/02/15

28/07/16

Phenoxymethylpenicillin (Penicillin V) Tablets (Sandoz Brand) Phenoxymethylpenicillin (Penicillin V) Solution (Kent Brand)

06/03/15 28/07/16 13/04/16

28/07/16

Prednisolone Tablets (Actavis Brand) Prednisolone Effervescent Tablets (Concordia Brand)

21/01/16 28/07/16 28/08/15 28/07/16

Prochlorperazine Solution for Injection (SANOFI Brand) Prochlorperazine Buccal Tablets (Alliance Brand)

27/07/16 28/07/16 22/07/16

28/07/16

Rehydration Salts Dioralyte® 08/10/13 28/07/16 Salbutamol Inhaler (GSK Brand) 03/08/15 28/07/16 Sodium Citrate Micro-enema (Micolette®)

10/07/15 28/07/16

Sumatriptan Tablets (GSK Brand) 06/04/16 16/09/16 Trimethoprim Tablets (Accord Brand) Trimethoprim Oral Suspension (Pinewood Brand)

17/12/15 16/09/16 15/04/11 28/07/16


Management and Monitoring of Patient Group Direction PGD Consultative Group The consultative group is legally required to include a medical practitioner, a pharmacist and a representative of the professional group who will provide care under the direction Name: Title:

Frances Adamson Lead Author: Medicines Management Specialist Nurse Jennifer Clarke Pharmacist: Clinical Pharmacist Matt Donn Advanced Nurse Practitioner Wendy Fulton Advanced Nurse Practitioner Linda Harper Associate Nurse Director, Practice Nursing/Lead Nurse

GMED Jamie Hogg Medical Practitioner: General Practitioner, GMED Gillian Macartney Antibiotic Pharmacist Sandy Thomson Principal Pharmacist Authorising Managers

Dr Nick Fluck Medical Director, NHS Grampian Mr David Pfleger

Director of Pharmacy and Medicines Management, NHS Grampian Professor Amanda Croft

Director of Nursing, Midwifery and AHPs, NHS Grampian


Appendix 1

Health Care Professional Agreement to Supply/Administer Medicines Under

Patient Group Direction I:

(Insert name)

Working within:

e.g. H&SCP, Practice

Agree to supply/administer medicines under the direction contained within the following Patient Group Direction

Patient Group Direction For The Administration And Supply Of Medicines For Minor Illness By Nurse And Paramedic Practitioners Working Within Grampian Medical Emergency Department (GMED)

I have completed the appropriate training to my professional standards enabling me to supply/administer medicines under the above Patient Group Direction. I agree not to act beyond my professional competence nor outwith the recommendations of the Patient Group Direction. Signed:

Print Name:

Date:

Professional Registration No:


Appendix 2 Certificate Of Authorisation To Supply/Administer Medicines Under Patient Group

Direction This authorises:

Working within:

e.g. H&SCP, Practice

To supply/administer medicines under the following Patient Group Direction

Patient Group Direction For The Administration And Supply Of Medicines For Minor Illness By Nurse And Paramedic Practitioners Working Within Grampian Medical Emergency Department (GMED)

The above named person has satisfied the training requirements and is authorised to supply/administer medicines under the above Patient Group Direction. The above named person has agreed not to act beyond their professional competence nor outwith the recommendations of the Patient Group Direction Signed:

Authorising Manager/Doctor

Print Name:

Date:

GMED Minor Illness PGD Formulary


Appendix 3 Medicines Monographs

Drug Name Page Number

ACICLOVIR (SUPPLY) ............................................................................................. 14 AMOXICILLIN (SUPPLY) ......................................................................................... 16 CETIRIZINE (SUPPLY) ............................................................................................ 19 CHLORAMPHENICOL (SUPPLY) ............................................................................ 20 CHLORPHENAMINE (SUPPLY) .............................................................................. 22 CO-CODAMOL (SUPPLY) ....................................................................................... 24 DOXYCYCLINE [SUPPLY] ....................................................................................... 26 ERYTHROMYCIN (SUPPLY) ................................................................................... 28 FLUCLOXACILLIN (SUPPLY) .................................................................................. 31 FLUORESCEIN SODIUM (ADMINISTRATION) ....................................................... 33 FUSIDIC ACID (SUPPLY) ........................................................................................ 35 GAVISCON® ADVANCE (SUPPLY) ......................................................................... 37 IBUPROFEN (SUPPLY) ........................................................................................... 38 NAPROXEN (SUPPLY) ............................................................................................ 40 NITROFURANTOIN (SUPPLY) ................................................................................ 43 OMEPRAZOLE (SUPPLY) ....................................................................................... 45 PARACETAMOL (SUPPLY) ..................................................................................... 47 PHENOXYMETHYLPENICILLIN (PENICILLIN V) (SUPPLY) .................................. 50 PREDNISOLONE (ADMINISTRATION OR SUPPLY) .............................................. 52 PROCHLORPERAZINE - (Injection – ADMINISTRATION)/ (Buccal tablets – SUPPLY) .................................................................................................................. 55 REHYDRATION SALTS (SUPPLY) - (Dioralyte® oral powder) ................................. 57 SALBUTAMOL (ADMINISTRATION OR SUPPLY) .................................................. 59 SODIUM CITRATE micro-enema (ADMINISTRATION) ........................................... 61 SUMATRIPTAN (SUPPLY OR ADMINISTER) ......................................................... 62 TRIMETHOPRIM (SUPPLY) .................................................................................... 64

All medicines are in pre-labelled packs



Drug Name: ACICLOVIR (SUPPLY)

Drug Group: Antiviral

Drug Legal Status: PoM

Presentation: 800mg tablets [1 x 35] - soluble tablets

Route: Oral

Indication: Herpes zoster (shingles)

Inclusion Criteria: Treat if patients >50 years and within 72 hours of onset of rash, active ophthalmic symptoms, Ramsey Hunt Syndrome or eczema. Refer to: NHS Grampian Staff prescribing Guidance for the Empirical Treatment of Infections in Primary Care.

Exclusion Criteria:

(a) consent (b) age (c) disease states

(d) drugs

(e) other

Informed non-consent Patients under 50 years of age Allergy or hypersensitivity to aciclovir or any excipients of the tablets Renal impairment Anuria aminophylline ciclosporin zidovudine cimetidine mycophenolate probenecid tacrolimus theophylline Pregnancy or breast-feeding. Immunosuppression from any cause.

Dose: 800mg five times daily for 7 days

Nursing/Patient Advice

(a) administration Advise patient: (i) tablets may be dissolved in a quarter of a glass of water

and stirred before drinking, or swallowed whole with a drink of water.

http://intranet.grampian.scot.nhs.uk/foi/files/NHSGEmpP.pdf




Drug Name: ACICLOVIR (SUPPLY)

(ii) take at regular intervals and complete the course. (iii) ensure adequate fluid intake. (iv) treatment may reduce severity, duration of symptoms

and reduce complications, e.g. post herpetic neuralgia. (v) read the manufacturer’s patient information leaflet.

(b) side-effects/adverse reactions

Nausea, vomiting, diarrhoea, dizziness, fever, abdominal pain, headache, fatigue, rash, urticaria, pruritus and photosensitivity. Anaphylaxis, hepatitis, blood disorders, jaundice, dyspnoea, neurological reactions and acute renal failure have been reported on very rare occasions. Refer to BNF for other side-effects.

Storage: Store below 25°C.



Drug Name: AMOXICILLIN (SUPPLY)

Drug Group: Broad spectrum-penicillin antibiotic


Presentation: 250mg; 500mg capsules [1 x 21] Oral solution for reconstitution to 125mg/5mL, 250mg/5mL solution [1x 100mL]

Route: Oral

Indication: Acute infective exacerbation of COPD with purulent sputum and dyspnoea and/or increased sputum volume. Uncomplicated community acquired pneumonia (where CRB-65 = 0). Acute Otitis media where clinically indicated. Acute sinusitis where clinically indicated. Refer to: NHS Grampian Staff prescribing Guidance for the Empirical Treatment of Infections in Primary Care.

Inclusion Criteria: Patients over 1 month of age.

Exclusion Criteria:

(a) consent (b) age (c) disease states (d) drugs (e) other

Informed non-consent Neonates – under 1 month Allergy or hypersensitivity to penicillins, cephalosporins or any excipients of the capsules/solution. Previous penicillin-induced cholestatic jaundice or hepatitis immunocompromised patients. Severe renal impairment. Glandular fever. methotrexate probenacid Pregnancy or breast-feeding

Dose: Acute infective exacerbation of COPD Patient over 18 years: 500mg three times daily for 5 days Uncomplicated community-acquired pneumonia CRB-65=0. Patient over 12 years: 500mg three times daily for 5 days. Patient 5 to 11 years: 500mg three times daily for 5 days (supply 200mL).





Drug Name: AMOXICILLIN (SUPPLY) Patient 1 to 4 years: 250mg three times daily for 5 days (supply 100mL) Patient 1 month to 11 months: 125mg three times daily for 5 days (supply 100mL) Oral solution pack size is 100mL Acute Otitis Media Patient over 12 years: 500mg three times daily for 5 days Patient 5 years to 11 years: 500mg three times daily for 5 days (Supply 200mL ) Patient 1 year to 4 years: 250mg three times daily for 5 days (Supply 100mL ) Patient 1 month to 11 months: 125mg three times daily for 5 days (Supply 100mL) Advise parent/carer to return unused solution to community pharmacy Acute sinusitis Patient over 18 years: 500mg three times daily for 7days Patient under 5 - 17 years: 500mg three times daily for 7 days


(a) administration Oral solutions must be reconstituted with fresh tap water in accordance with the manufacturer’s instructions before being issued to patients. If patient under one year reconstitute with sterile water. Supply a 5mL spoon or oral syringe. Advise patient: (i) shake solution well before administration. (ii) store solution preparation in the fridge. (iii) take at regular intervals and complete the course unless

otherwise directed by a doctor. (iv) read the manufacturer’s patient information leaflet.



Drug Name: AMOXICILLIN (SUPPLY)


Hypersensitivity reactions including anaphylaxis rashes and urticaria (discontinue treatment). Transient nausea, vomiting, diarrhoea. Refer to BNF for other side-effects.

(c) other Acute Exacerbation of COPD – consider sputum sample for culture. Uncomplicated community-acquired pneumonia CRB-65=0 – advise patient if no signs of improvement in 48 hours or worsening symptoms to seek further medical advice. Patient taking coumarin anticoagulants should be advised to attend GP for INR monitoring within 3 days of starting the course. Patients taking allopurinol may develop a skin rash. Should this occur, they should be advised to stop taking amoxicillin and attend their GP.

Storage: Store below 25°C. Protect from light and moisture.



Drug Name: CETIRIZINE (SUPPLY)

Drug Group: Non-sedating antihistamine

Drug Legal Status: P

Presentation: 10mg tablets [1 x 30] 5mg/5mL solution [1 x 200mL]

Route: Oral

Indication: Relief of allergy such as hayfever, urticaria. Antihistamine of choice where the side-effect of drowsiness is problematic for patient.

Inclusion Criteria: Patient over 6 years of age.

Exclusion Criteria:


(d) other

Informed non-consent Patient under 6 years of age Allergy or hypersensitivity to cetirizine or any of the excipients of the tablets Renal impairment Pregnancy or breast-feeding

Dose: Patient over 12 years: 10mg once daily Patient 6-12 years: 5mg twice daily

Nursing/Patient Advice:

(a) administration Advise patient: (i) drowsiness can occur and may affect performance of

skilled tasks, e.g. driving. (ii) excess alcohol should be avoided. (iii) read manufacturer’s patient information leaflet.


Headache, dry mouth, dizziness, agitation, GI upset, pharyngitis, fatigue Refer to BNF and BNFC for other side-effects.




Drug Name: CHLORAMPHENICOL (SUPPLY)

Drug Group: Antibacterial eye ointment


Presentation: 1% eye ointment [1 x 4g] supply 2 x 4g if both eyes affected

Route: Topical

Indication: Acute purulent conjunctivitis Blepharitis if eyelid hygiene alone is not effective or signs of Staphylococcus infection Refer to: NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care

Inclusion Criteria: Patients over 1 month of age

Exclusion Criteria:

(a) consent (b) age (c) disease states (d) other

Informed non-consent. Neonates – under 1 month of age. Allergy or hypersensitivity to chloramphenicol or any of the excipients of the eye ointment. History of aplastic anaemia. Disturbances in vision except those due to matter in eye. Orbital cellulitis. Moderate to severe pain within eyeball. Pregnancy or breast-feeding.

Dose: Purulent Conjunctivitis: Apply 3-4 times daily to the inside of lower affected lid for 7 days or until symptom free for 48 hours. Blepharitis: Apply 4 times daily to the inside of lower affected lid. Apply for 7 days. Not to be used for longer than 7 days without review.


(a) administration Advise patient: (i) treatment should continue for 48 hours after eye has

returned to normal. (ii) not to wear contact lenses when using this product and for

24 hours after completion of treatment.





Drug Name: CHLORAMPHENICOL (SUPPLY)

(iii) use a separate tube for each eye. (iv) keep tube tightly closed. (v) return any unused ointment to the community pharmacy. (vi) read the manufacturer’s patient information leaflet.


May cause transient blurring of vision on administration. Warn patients not to drive or operate hazardous machinery unless vision is clear. Serious side-effects include hypersensitivity and anaphylaxis. Be alert to symptoms of anaphylaxis, allergic conjunctivitis, fever, periorbital oedema, urticaria or skin rash.

(c) other Refer to BNF and BNFC for other side-effects Blepharitis: advise patient to follow good lid hygiene care. Advise patient to seek medical advice if there is no improvement within 24 hours.




Drug Name: CHLORPHENAMINE (SUPPLY)

Drug Group: Antihistamine


Presentation: 4mg tablets [1 x 28/30], 2mg/5mL solution [1 x 150mL]

Route: Oral

Indication: Relief of allergy, including hay fever, food allergy, drug allergy, vasomotor rhinitis, urticaria, insect bites, stings. Relief of itch associated with chickenpox. (Where the side-effect of drowsiness is not a problem).

Inclusion Criteria: Patient over 1 year of age

Exclusion Criteria:


(d) drugs (e) other

Informed non-consent Patient under 1 year of age Allergy or hypersensitivity to chlorphenamine or any of the excipients of the tablets or solution Benign prostatic hyperplasia Urinary retention Pyloroduodenal obstruction Epilepsy Glaucoma Renal and hepatic impairment Respiratory disease including asthma Severe hypertension or cardiovascular disease Alcohol – due to increased risk of sedation. A non-sedating antihistamine is preferable. Patients treated with MAOIs within the last 14 days. Phenytoin. Tricyclic antidepressants, anxiolytics and hypnotics – due to increased risk of sedation. A non-sedating antihistamine is preferable. Pregnancy or breast-feeding.

Dose Patient 6-12 years: 2mg every 4-6 hours, maximum 12mg daily. Patient 2-5 years: 1mg every 4-6 hours, maximum 6mg daily. Patient 1-2 years: 1mg twice daily 4 hours apart, maximum 2mg in 24 hours.



Drug Name: CHLORPHENAMINE (SUPPLY) Patient under 1 year: Refer to GMED duty doctor. Tablets are not licensed for patient under 6 years. Solution to be supplied to patient under 6 years.


(a) administration (b) side-effects/adverse

reactions

Advise patient: (i) avoid alcohol. (ii) do not to drive or operate machinery. (iii) read the manufacturer’s patient information leaflet.

Drowsiness and psychomotor impairment that can seriously hamper the patient’s ability to drive and use machinery. Sedating effects are enhanced by alcohol and other sedating medicines. Disturbance in attention, abnormal co-ordination, dizziness, headache, nausea and fatigue. Antimuscarinic side-effects – urinary retention, dry mouth, blurred vision and GI disturbances. Allergic and anaphylactic reactions. Rarely paradoxical stimulation in children and elderly patients in high doses. Refer to BNF and BNFC for other rare side-effects. Syrup contains 6.3% alcohol and 2.36g sucrose.

Storage:

Store below 30°C. Solution – Protect from light.



Drug Name: CO-CODAMOL (SUPPLY)

Drug Group: Analgesic


Presentation: Codeine 30mg and paracetamol 500mg tablets [1 x 30]/ soluble and non-soluble.

Route: Oral

Indication: Moderate pain not controlled with paracetamol or ibuprofen (alone).

Inclusion Criteria: Patients 18 years of age and over.

Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs (e) other

Informed non-consent. Patients under 18 years of age. Allergy or hypersensitivity to paracetamol or codeine or to any of the excipients of the tablet. Prostatic Hypertrophy. Inflammatory or Obstructive bowel disorders. Addisons disease. Severe Renal or Hepatic Impairment. Conditions where morphine and opioids are contraindicated, e.g. acute asthma, respiratory depression, acute alcoholism, head injuries, raised intra-cranial pressure and following biliary tract surgery. Monoamine oxidase inhibitor therapy - concurrent or within 14 days of treatment. Paracetamol. Other opioid analgesics. Alcohol. Pregnancy or breastfeeding. In patients who are known CYP2D6 ultra-rapid metabolisers.

Dose: Patients over 18 years: One or two tablets every 4-6 hours, up to four times daily



Drug Name: CO-CODAMOL (SUPPLY)


(a) administration Advise patient: (i) take no more than 2 tablets at a time and no more than 8

tablets in 24 hours, leaving 4 to 6 hours in between doses.

(ii) avoid other paracetamol containing products. (iii) dissolve the soluble tablets in water before taking. (iv) may cause drowsiness and if affected, do not drive or

operate machinery. (v) avoid alcoholic drink. (vi) if taking colestyramine it should not be taken at the same

time as it may decrease the absorption of paracetamol. (vii) read the manufacturer’s patient information leaflet.


Constipation, nausea, vomiting, dizziness, light-headedness, confusion, drowsiness, blood disorders and urinary retention. Tolerance and dependence can occur, especially with prolonged high dosage of codeine. Adverse effects of paracetamol are rare but hypersensitivity including skin rash may occur. Refer to BNF for other side-effects. Metoclopramide and domperidone may increase the absorption rate of paracetamol.

Storage: Store below 25°C in a dry place. Protect from light.



Drug Name: DOXYCYCLINE [SUPPLY]

Drug Group: Antimicrobial


Presentation: 100mg capsules [1 x 14]

Route: Oral

Indication: If patient has penicillin allergy and/or intolerance to erythromycin: CAP (CRB65=0-1) Acute exacerbation of COPD, purulent sputum and dyspnoea Acute sinusitis, purulent nasal discharge

Inclusion Criteria: Patients over 12 years of age.

Exclusion Criteria:

(a) consent (b) age (c) disease states (d)drugs (e) other

Informed non-consent Patients under 12 years of age Hypersensitivity to doxycycline or any of the excipients or tetracyclines Primary treatment failure – no response in 48 hours CRB-65 > 1 Hepatic Impairment Renal Impairment Alcohol dependence Myasthenia Gravis Ergotamine and Methysergide Barbiturates, Carbamazepine, Primidone or Phenytoin Methotrexate Kaolin and Sucralfate Quinapril Warfarin Ciclosporin Rifampicin Retinoids Methoxyflurane Pregnancy and Breast-feeding



Drug Name: DOXYCYCLINE [SUPPLY]

Dose: Community-acquired pneumonia: CRB-65 = 0: 200mg stat then 100-200mg daily for 5 days. CRB-65 = 1: 200mg stat then 100mg for 5-10 days. Acute exacerbation of COPD: 200mg stat then 100mg daily for 5 days. Acute sinusitis: 200mg stat then 100mg daily for 7 days.


(a) administration Advise patient: (i) take with food or a meal (ii) take with a full glass of water, whilst sitting or

standing (iii) do not take indigestion remedies, or medicines

containing iron or zinc, 2 hours before or after you take this medicine

(iv) space doses evenly and complete the course (v) contraceptive advice – use extra precautions (vi) may cause dizziness and drowsiness. If affected do

not drive or operate machinery (vii) protect your skin from sunlight – even on a bright but

cloudy day. Do not use sunbeds (viii) read manufacturer’s patient information leaflet.

(b) side-effects/adverse

reactions

Hypersensitivity reactions including anaphylaxis GI symptoms, headache, rashes and photo-sensitivity reactions, anxiety, dry mouth, flushing, tinnitus Refer to BNF and BNFC for other side-effects.




Drug Name: ERYTHROMYCIN (SUPPLY)

Drug Group: Macrolide antibiotic


Presentation: 250mg enteric-coated tablets [1 x 28] 125mg/5mL, 250mg/5mL oral suspension for reconstitution [1x 100mL]

Route: Oral

Indication: For penicillin allergic patients in: Acute infective exacerbation of COPD with purulent sputum and dyspnoea and/or increased sputum volume. Uncomplicated community acquired pneumonia CRB-65 =0. Otitis media where clinically indicated. Acute tonsillitis where clinically indicated, Centor Criteria score 3 or 4. Cellulitis (afebrile and normally healthy patient). Impetigo with widespread lesions. Refer to: NHS Grampian Staff prescribing Guidance for the Empirical Treatment of Infections in Primary Care

Inclusion Criteria: Patients of 1 year of age or over.

Exclusion Criteria:


Informed non-consent. Patients under one year of age Allergy or hypersensitivity to erythromycin/macrolide antibiotics or any other excipients of the tablets or suspension Impaired hepatic or renal function Myasthenia gravis Acute porphyrias.

(d) drugs

aminophylline avanafilantibiotics – rifabutin calcium channel blockers clopidogrel colchicine domperidone dronedarone coumarin anticoagulants antiepileptics - carbamazepine, sodium valproate.






(e)

antihistamines - astemizole, mizolastine antimalarials - artemether, lumefantrine, artenimol with piperaquine antipsychotics - amisulpiride, clozapine,droperidol,pimozide, quetiapine, lurasidone ciclosporin cilostazol disopyramide domperidone edoxaban eletriptan ergotamine, dihydroergotamine ivabradine midazolam reboxetine rifabutin simvastatin, lomitapide tacrolimus, sirolimus telaprevir, simeprevir, saquinavir, rilpivirine theophylline tolterodine venlafaxine verapamil Breast-feeding

Dose: Acute infective exacerbation of COPD: for 5 days Uncomplicated community acquired pneumonia (CRB-65=0):for 7-10 days Otitis media: for 5 days Acute tonsillitis: for 7-10 days Cellulitis (afebrile patient): for 7-14 days Impetigo: for 7 days Patients over 18 years: 500mg four times daily Patient 8 –17 years: 250mg to 500mg four times daily Patient 2 – 7 years: 250mg four times daily Patient 1 - 2 year: 125mg four times daily


(a) administration Oral suspension must be reconstituted with fresh tap water in accordance with the manufacturer’s instructions before being issued to patients. Supply a 5mL spoon or an oral syringe. Advise patient: (i) shake suspension well before administration.




(ii) store suspension preparation in the fridge and use within

the time advised by manufacturer. (iii) take at regular intervals and complete the course unless

otherwise directed by a doctor. (iv) read the manufacturer’s patient information leaflet.


Nausea, vomiting, abdominal discomfort, diarrhoea, dyspepsia, headache, smell and taste disturbance, tooth and tongue discolouration, allergic reactions, skin reactions. Refer to BNF and BNFC for other side-effects.

Storage: Store below 25°C. Protect from light. Reconstituted oral suspensions should be stored in accordance with the manufacturer’s advice and used within the time specified.



Drug Name: FLUCLOXACILLIN (SUPPLY)

Drug Group: Penicillin antibiotic


Presentation: 250mg, 500mg capsules [1 x 28] 125mg/5mL, 250mg/5mL oral suspension for reconstitution [1 x 100mL]

Route: Oral

Indication: Impetigo (widespread) Cellulitis - afebrile and normally healthy patient Refer to: NHS Grampian Staff prescribing Guidance for the Empirical Treatment of Infections in Primary Care

Inclusion Criteria: Patient over 2 years of age

Exclusion Criteria:


Informed non- consent. Patient under 2 years of age. Hepatic or renal impairment. Hypersensitivity to penicillins, cephalosporins or any of the excipients of the capsules or suspension. methotrexate coumarin anticoagulants probenecid sulfinpyrazone. Pregnancy or breast-feeding.

Dose: Impetigo (extensive, severe or bullous): for 7 days Cellulitis(afebrile patient): for 7-14 days Patient over 18 years: 500mg four times daily Patient 10-17 years: 250mg to 500mg four times daily Patient 2-9 years: 125mg four times daily Patient under 2 years: refer to doctor Oral suspension pack size is 100mL.





Drug Name: FLUCLOXACILLIN (SUPPLY)

Nursing/Patient Advice (a) administration


Oral suspension must be reconstituted with fresh tap water in accordance with the manufacturer’s instructions before being issued to patients. Supply with a 5mL spoon or an oral syringe. Advise patient: (i) swallow capsules whole with water (ii) shake suspension well before administration (iii) store suspension preparation in the fridge and use within

the time advised by manufacturer (iv) take one hour before food or two hours after, on an

empty stomach (v) take at regular intervals and complete the course unless

otherwise directed by a doctor (vi) read the manufacturer’s patient information leaflet.

May cause nausea, diarrhoea, indigestion. Hypersensitivity reactions, rash - seek medical advise. Rarely: cholestatic jaundice - CSM has advised that this may occur up to several weeks after treatment with flucloxacillin has been stopped. Antibiotic-associated colitis. Refer to BNF and BNFC for other side-effects.

Storage: Store below 25°C. Protect from light and moisture. Reconstituted oral suspensions should be stored in accordance with the manufacturer’s advice and used within the time specified.



Drug Name: FLUORESCEIN SODIUM (ADMINISTRATION)

Drug Group: Ocular diagnostic agent


Presentation: 1% eye drops single use Minims® fluorescein

Route: Topical

Indication: For identification of corneal abrasions and ulceration of the eye.


Exclusion Criteria:


(d) other

Informed non-consent. Patients under 18 years of age.

Allergy or hypersensitivity to fluorescein or any of the excipients of the eye drops. Patients with soft contact lenses remove before use if driving home. Pregnancy and breast-feeding.

Dose: Single application of 1-2 drops should be instilled drop wise into affected eye to stain lesion. Excess may be washed away with sterile saline solution. Abrasions of the conjunctiva stain yellow or orange. Abrasions or ulcers of the cornea stain bright green. Foreign bodies are surrounded by a green ring.


(a) administration Should not be used if soft contact lenses are being worn.


May cause transient stinging and blurring of vision on administration. May stain skin or clothing. Warn patient not to drive or operate machinery until vision is clear.



Drug Name: FLUORESCEIN SODIUM (ADMINISTRATION)

Allergic-type reactions and hypersensitivity have been reported following administration of fluorescein eye drops. Be alert to symptoms of anaphylaxis, allergic conjunctivitis, periorbital oedema, urticaria or skin rash. Refer to BNF for other side-effects.

(c) other Each Minims® unit should be discarded after use. Advise patient any yellow stain in discharge will disappear within the hour.

Storage: Store below 25°C. Do not freeze. Protect from light.



Drug Name: FUSIDIC ACID (SUPPLY)

Drug Group: Antibiotic eye drops


Presentation: 1% viscous eye drops [1 x 5g]

Route: Topical

Indication: Purulent conjunctivitis in pregnant patient or allergy to chloramphenicol Blepharitis if eyelid hygiene alone is not effective or signs of Staphylococcus infection in pregnancy or allergy to chloramphenicol.


Exclusion Criteria:


Informed non-consent Neonates (under 1 month of age) Allergy or hypersensitivity to fusidic acid or any of the excipients of the eye ointment

Dose: Purulent Conjunctivitis: One drop instilled in eye twice daily for 7 days or until symptom free for 48 hours Blepharitis: One drop instilled in eye twice daily. Apply for 7 days Not to be used for longer than 7 days without review. Refer to: NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care


(a) administration Advise patient: (i) Blepharitis: good lid hygiene care (ii) Purulent Conjunctivis: treatment should continue for 48

hours after eye has returned to normal (iii) do not wear contact lenses when using this product and

for 24 hours after completion of treatment (iv) use a separate tube for each eye (v) keep tube tightly closed (vi) return any unused eye drops to the community pharmacy (vii) read the manufacturer’s patient information leaflet.





Drug Name: FUSIDIC ACID (SUPPLY)


Transient stinging and blurring of vision may occur after application. Hypersensitivity may occur. Refer to BNF and BNFC for other side-effects.




Drug Name: GAVISCON® ADVANCE (SUPPLY)

Drug Group: Alginate-containing antacid

Drug Legal Status: GSL

Presentation: Suspension [1 x 150mL] Tablets [1 x 20]

Route: Oral

Indication: Mild symptoms of gastro-oesophageal reflux. Dyspepsia, heartburn and flatulence associated with gastric reflux.


Exclusion Criteria:


Informed non-consent. Patients under 12 years of age. Hypersensitivity to any of the constituents. If patient is on a highly restricted salt diet as advised by doctor.

Dose: Patient over 12 years: 5-10mL after meals and at bedtime. 1-2 tablets to be chewed after meals and at bedtime. For 7 days maximum.


(a) administration

Supply a 5mL spoon with the suspension. Advise patient: (i) take after meals and at bedtime. (ii) shake suspension well before use. (iii) read patient information leaflet.

Storage: Store below 30°C. Store in original package. Do not refrigerate.



Drug Name: IBUPROFEN (SUPPLY)

Drug Group: Non-steroidal anti-inflammatory drug (NSAID)


Presentation: 200mg tablets [1 x 24] 100mg/5mL oral suspension [1 x 8 sachets] 100mg/5mL suspension [1 x 100mL]

Route: Oral

Indication: Patients over 18 years: Mild to moderate musculoskeletal pain and inflammation.

Patients under 18 years: Mild to moderate pain, pyrexia.

Inclusion Criteria: Patient over 6 months of age. Caution regarding elderly, patients over 65 discuss with a doctor.

Exclusion Criteria:

(a) consent

(b) age (c) disease states (d) drugs

Informed non-consent.

Patient under 6 months of age. Active Peptic ulcer or history of peptic ulcer Current or previous history of dyspepsia Hypersensitivity to the constituents and other NSAIDs including aspirin Asthma Severe renal and hepatic impairment Congestive cardiac failure Porphyria Patients with coagulation defects Patients with severe dehydration Uncontrolled Hypertension, Ischaemic Heart Disease, Peripheral Arterial Disease and Cerebrovascular disease. Ulcerative colitis and Crohns. coumarin anticoagulants anti-platelets, e.g. clopidogrel and aspirin ciclosporin corticosteroids dabigatran diuretics erlotinib lithium methotrexate pentoxyfylline



Drug Name: IBUPROFEN (SUPPLY)

(e) other

phenindione

probenicid quinolones tacrolimus Other NSAIDs SSRIs and venlafaxine sulphonylureas Pregnancy or breast-feeding.

Dose: Patient over 18 years: 400mg 3-4 times daily after food. Patient: 12-17 years: 300mg - 400mg 3-4 times daily after food. Patient 10-11 years: 300mg 3 times daily after food Patient 7-9 years: 200mg 3 times daily after food Patient 4-6 years: 150mg 3 times daily after food Patient 1-3 years: 100mg 3 times daily after food Patient 6 months to 1 year: 50mg 3-4 times daily after food

Caution: Elderly or frail are more susceptible to side-effects associated with NSAIDs and should be advised to take half the normal adult dose.


(a) administration Advise patient: (i) take with or after food (ii) read manufacturer’s patient information leaflet.

(b) side - effects

GI discomfort occasionally with GI bleed or ulceration Nausea, constipation, vomiting and diarrhoea Headache Dizziness/drowsiness Nervousness Insomnia Photosensitivity Rhinitis

Depression, Vertigo and Tinnitus are rare side effects.

Hypersensitivity reactions including rashes and bronchospasm and angioedema. Refer to BNF and BNFC for other side-effects.

(c) other Supply a 5mL spoon or 2.5mL/5mL oral syringe with the sachets and suspension.




Drug Name: NAPROXEN (SUPPLY)

Drug Group: Non Steroidal Anti-inflammatory Drug


Presentation: 250mg tablets x 28

Route: Oral

Indication: Musculoskeletal pain and inflammation associated with acute musculoskeletal disorders or arthritic conditions. Acute Gout.

Inclusion Criteria: Patients over 18 years of age. Use with caution in elderly patients

Exclusion Criteria:

(a) consent (b) age (c) disease states (d) drugs

Informed non-consent. Patients under 18 years of age. Allergy or hypersensitivity to naproxen or other NSAIDs including aspirin, or to any of the excipients of the tablet. Patients in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by NSAIDs. Active peptic ulcer or history of peptic ulcer. Asthma. Severe renal and hepatic impairment. Severe heart failure. Uncontrolled hypertension. Ischaemic heart disease, Peripheral Arterial Disease, Cerebrovascular disease. Porphyria. Patients with coagulation defect. Crohns disease and Ulcerative colitis. aspirin coumarin anticoagulants anti-platelets, e.g. clopidogrel and aspirin ciclosporin corticosteroids dabigatrin diuretics erlotinib lithium methotrexate




(e) other

pentoxyfylline phenindione probenicid quinolones Other NSAIDs SSRIs and venlafaxine sulfonylureas tacrolimus Pregnancy or breast feeding.

Dose: By mouth Acute musculoskeletal disorder Patient over 18 years: two tablets initially, then one tablet every 6 – 8 hours when required, up to a maximum of 5 tablets in 24 hours, with or after food. Acute Gout Patient over 18 years: three tablets initially, then one tablet every 8 hours, with or after food until attack has passed. Caution: Elderly or frail are more susceptible to side-effects associated with NSAIDs and should be advised to take half the normal dose for patients over 18 years.


(a) Administration


Patient advice: (i) swallow whole with plenty water. (ii) take with or after food. (iii) do not exceed the recommended dose. (iv) do not take other NSAIDs at the same time as this

medicine. (v) stop naproxen if there is no improvement in symptoms

or if indigestion develops and contact doctor for advice. (vi) advice patient to stop taking when acute gout resolves. (vii) advise patient to contact doctor if an adverse effect is

suspected. (viii) read the manufacturer’s patient information leaflet.

GI discomfort occasionally with GI bleed or ulceration Nausea and diarrhoea Headache/visual disturbances Dizziness/drowsiness/confusion Nervousness/palpitations




Insomnia/abnormal dreams/loss of concentration/cognitive dysfunction Depression Tinnitus Photosensitivity Hypersensitivity reactions including rashes, and bronchospasm and angioedema. Refer to BNF for other side-effects.

Storage: Store below 25°C in a dry place. Protect from light.



Drug Name: NITROFURANTOIN (SUPPLY)


Drug Legal Status: POM

Presentation: 50mg capsules [1 x 28]

Route: Oral

Indication: Acute uncomplicated urinary tract infection

Inclusion Criteria: Patients over 12 years of age

Exclusion Criteria:

(c) consent (d) age (e) disease states

d)drugs

Informed non-consent

Patients under 12 years of age

Allergy or hypersensitivity to nitrofurantoin other nitrofurans or any of the excipients of the capsules Acute porphyrias Renal and Hepatic Impairment G6PD Deficiency Anaemia Diabetes Electrolyte Imbalance Vitamin B (particularly Folate) deficiency Pulmonary disease Neurological disorders Risk of peripheral neuropathy Magnesium Trisilicate Sulfinpyrazone Probenacid Quinolones Pregnancy or breast-feeding.

Dose: Female patient 12 years and over : 50mg four times daily for 3 days Male patient 12 years and over: 50mg four times daily for 7 days



Drug Name: NITROFURANTOIN (SUPPLY)


(a) administration Advise patient:

(i) Take with or just after food or milk. (ii) This may colour your urine. This is harmless. (iii) Space doses evenly and complete the course. (iv) Contraceptive advice – use extra precautions. (v) May cause dizziness and drowsiness. If affected do not

drive or operate machinery. (vi) Treatment should be discontinued if acute pulmonary

reactions occur, e.g. fever, chills, cough, chest pain, dyspnoea.

(vii) read manufacturer’s patient information leaflet.


Hypersensitivity reactions, rash, itch, peripheral neuropathy, nausea, vomiting, diarrhoea and abdominal pain. Refer to BNF and BNFC for other side-effects.

May interfere with some tests for glucose in the urine.




Drug Name: OMEPRAZOLE (SUPPLY)

Drug Group: Proton pump inhibitor


Presentation: 20mg capsules [1 x 7, 1 x 28 capsules]

Route: Oral

Indication: 2nd line acid reflux following unsuccessful treatment with Gaviscon® Advance, indigestion, dyspepsia.

Inclusion Criteria: Patient over 18 years of age.

Exclusion Criteria:


(e) other

Informed non-consent Patient under 18 years of age Liver disease Antivirals – atazanavir, rilpivirine, saquinavir, tipranavir cilostazol clopidogrel clozapine digoxin erlotinib escitalopram itroconazole, ketoconazole methotrexate phenytoin St Johns Wort tacrolimus warfarin

Pregnancy or Breast-feeding

Dose: 20mg capsule once daily


(a) administration Advise patient: (i) swallow capsules whole. (ii) read manufacturer’s patient information leaflet.


GI disturbance Headache Dizziness Refer to BNF and BNFC for other side-effects.



Drug Name: OMEPRAZOLE (SUPPLY)

Storage: Store below 25°C. Store in the original container. Keep container securely closed.



Drug Name: PARACETAMOL (SUPPLY)

Drug Group: Non-opioid analgesic


Presentation: 500mg tablets 1 x 32 120mg/5mL oral suspension [1 x 12 sachets] 250mg/5mL oral suspension [1 x 10 sachets] 120mg/5mL suspension 1 x 100mL 120mg suppositories 1 x 10

Route: Oral (tablets/suspension/sachets) or rectal (suppositories)

Indication: Treatment of mild to moderate pain and/or pyrexia in patients over 3 months of age. Post immunisation pyrexia for babies aged 2-3 months of age.

Inclusion Criteria: Patients over 3 months of age (2 months if post immunisation pyrexia).

Exclusion Criteria:


Informed non-consent Patients under 3 months or under 2 months of age if not for post immunisation pyrexia. Alcohol dependence. Hypersensitivity to paracetamol or to any excipients. Renal or hepatic impairment. Other medicines containing paracetamol. Patients who have taken paracetamol in the previous 4 hours or who have taken the maximum paracetamol dose in the previous 24 hours. Oral coumarin anticoagulants (prolonged regular use may enhance the anticoagulant effect. INR should be checked if patient continues to take paracetamol for more than 5 days).

Dose: Patient over 16 years: 500mg – 1g tablets every 4-6 hours to a maximum of 4 doses in 24 hours. Patient 12 - 15: 480mg-750mg every 4-6 hours: maximum 4 doses in 24 hours. Patient 10 - 11 years: 500mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 8 - 9 years: 375mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 6 - 7 years: 250mg every 4-6 hours; maximum 4 doses in 24 hours.




Patient 4 - 5 years: 240mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 2 - 3 years: 180mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 6 months - 24 months:120mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 3 - 5 months: 60mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 2- 3 months: 60mg as a single dose for post immunisation pyrexia. May be repeated once after 6 hours if necessary. Suppositories Patient 18 years and over: 500mg to 1g every 4-6 hours; maximum 4 doses in 24 hours. Patient 12 - 17 years: 500mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 5 - 11 years: 250-500mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 1- 4 years: 125 – 250mg every 4-6 hours; maximum 4 doses in 24 hours. Patient 3-11 months: 60 – 125mg every 4-6 hours; maximum 4 doses in 24 hours.

Nursing/Patient Advice: (a) administration

Advise patient: (i) do not exceed recommended dose. (ii) do not to take other medicines containing paracetamol. (iii) if taking oral coumarin anticoagulants to have INR

checked if they continue to take paracetamol regularly for longer than 5 days.

(iv) if taking cholestyramine not to take at the same time as paracetamol as cholestyramine decrease the absorption of paracetamol.

(v) massage sachets before use. (vi) shake bottle for at least 10 seconds before use. (vii) read manufacturer’s information leaflet.


Hypersensitivity reactions including skin rashes and blood disorders have been reported rarely. Please refer to current BNF and BNFC.




(c) other Do not take other medicines containing paracetamol. Speed of absorption may be increased by metoclopramide and domperidone. Supply a 5mL spoon or 2.5mL/5mL oral syringe with the sachets and suspension.

Storage: Store below 25°C. Suspension – protect from light and store in original container.



Drug Name: PHENOXYMETHYLPENICILLIN (PENICILLIN V) (SUPPLY)

Drug Group: Penicillin antibiotic


Presentation: 250mg tablets 1 x 28 and 56 125mg/5mL, 250mg/5mL solution for reconstitution [1 x 100mL]

Route: Oral

Indication: Tonsillitis – where clinically indicated if Centor Criteria score 3 or 4 (History of fever, purulent tonsillitis, cervical lymphadenopathy or absence of cough) if present for 2 to 3 days. Refer to: NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care

Inclusion Criteria: Patients over 1 year of age.

Exclusion Criteria:


(e) other

Informed non-consent Patients under 1 year of age Hypersensitivity to penicillins or cephalosporins History of antibiotic associated colitis Previous penicillin induced cholestatic jaundice or hepatitis Immunocompromised patients Severe renal impairment methotrexate coumarin anticoagulants - discuss with doctor and see nursing advice below Neomycin phenindione probenecid sulfinpyrazone

Pregnancy or breast-feeding

Dose: For 7-10 days Patient over 18 years: 500mg four times daily Patient 12-17 years: 500mg four times daily Patient 6-11 years: 250mg four times daily Patient 1-5 years: 125mg four times daily Patient under 1 year: refer to doctor





Drug Name: PHENOXYMETHYLPENICILLIN (PENICILLIN V) (SUPPLY)


(a) administration Oral solutions must be reconstituted with fresh tap water in accordance with the manufacturer’s instructions before being issued to patients. Supply with a 5mL spoon or oral syringe. Advise patient: (i) shake solution well before administration. (ii) store solution preparation in the fridge and use within

the time advised by manufacturer. (iii) take at regular intervals and complete the course unless

otherwise directed by a doctor. (iv) take an hour before food or two hours after on an empty

stomach. (v) read the manufacturer’s patient information leaflet.

(b) side-effects/adverse

reactions May cause nausea, diarrhoea, indigestion, hypersensitivity reactions, rash. Advise patient to seek medical advice if a rash develops. Refer to BNF and BNFC for other side-effects.

(c) other Patient taking coumarin anticoagulants should be advised to attend GP for INR monitoring before the end of the course.

Storage: Store below 25°C Protect from light and store in original packaging. Reconstituted oral solutions should be stored in accordance with the manufacturer’s recommendations and used within the time specified.



Drug Name: PREDNISOLONE (ADMINISTRATION OR SUPPLY)

Drug Group: Corticosteroid


Presentation: 5mg plain tablets [1 x 28] 5mg soluble tablets [1 x 10]

Route: Oral

Indication: Acute Exacerbation of Mild to Moderate Asthma Refer to GMED Clinical Protocols – Treatment of Mild to Moderate Asthma and Treatment of Severe Asthma (FromB)BTS/SIGN British guideline 2016


Exclusion Criteria:


Informed non-consent Patients under 2 years of age Systemic infections unless specific anti-infective therapy is employed. Hypersensitivity to any ingredient. Ocular herpes simplex because of possible perforation. Recent myocardial infarction. Particular care is required when considering the use of systemic corticosteroids in patients with existing or previous history of severe affective disorders in themselves or in their first degree relatives. These would include depressive or manic-depressive illness and previous steroid psychosis. coumarin anticoagulants, e.g. warfarin antiepileptics including carbamazepine, phenytoin, primidone and barbiturates antifungals – itraconazole, ketonocazole, amphotericin ritonavir carbimazole ciclosporin erythromycin methotrexate rifamycins retinoids and tetracyclines See current BNF for full details.

(e) other Pregnancy or breast-feeding.




Dose Mild to moderate acute asthma/severe or life threatening acute asthma. Patient 2 years – 11 years; 1-2mg/kg once daily (max 40mg for up to 3 days, longer if necessary. Patient 12 – 17 years; 40-50mg daily for at least 5 days. Patient over 18 years; 40-50mg daily for at least 5 days.


(a) administration Advise patient: (i) plain tablets should only be taken by mouth and can be

swallowed with water. (ii) take with or after food. (iii) take tablets as a single dose in the morning. (iv) plain tablets should not be taken at the same time as

indigestion remedies. (v) the soluble form should be dissolved in water and taken

immediately. (vi) read manufacturer’s information leaflet. The pack size does not meet dose schedule. Sufficient packs should be supplied to patient to meet dose schedule and excess tablets should be removed from the over-labelled patient packs and returned to GMED, ECC, Aberdeen for destruction.

(b) Side effects/adverse reactions

Dyspepsia, nausea, hypokalaemia and hypersensitivity reactions. Steroid psychosis – psychological symptoms may arise after a few days of treatment. Advise patient/carer to seek medical advice if this occurs. Refer to BNF and BNFC for other side-effects.




(c) other It is important to be aware that contracting chickenpox during treatment or for a period afterwards can be dangerous. Advise the patient if they do not have a definite history of chickenpox and anyone in their family or regular contacts catches chickenpox it is important to contact a doctor immediately. Do not stop the treatment. It is also important the patient contacts a doctor if they contract chickenpox within a 3 month period after stopping treatment. Advise patient to take particular care to avoid contact with measles and to contact a doctor immediately if they or anyone in their family or regular contacts catches measles. Supply steroid card to patient and advise them to follow the advice. Read the manufacturer’s information leaflet.

Storage:

Store below 25°C in a dry place. Protect from light. Soluble tabs should be protected from light and moisture.



Drug Name: PROCHLORPERAZINE - (Injection – ADMINISTRATION)/ (Buccal tablets – SUPPLY)

Drug Group: Anti-emetic


Presentation: 12.5mg/1mL ampoules [1 x 10 x 1mL] (Administration) 3mg buccal tablets [1 x 10] (Supply)

Route: Intramuscular deep injection Oral Buccal tablets

Indication: Nausea and vomiting – not to be used in palliative care


Exclusion Criteria:


Informed non-consent Patients under 18 years of age Hypersensitivity to phenothiazines or any excipients Hypothyroidism Cardiac Disease Epilepsy Phaeochromocytoma Myasthenia gravis Narrow angle glaucoma Parkinson’s disease Pregnancy and breast-feeding Prostatic hypertrophy Renal or hepatic impairment Existing blood dyscrasias

(d) drugs (e)

Alcohol and other CNS depressants Antimalarials – artemether with lumefantrine, artenimol with piperaquine desferrioxamine lithium Other drugs known to prolong QT interval, e.g. citalopram,escitalopram,amiodarone, disopyramide, dronedarone,risperidone,methadone,droperidol,pimozide Ritonavir,atomoxetine

Pregnancy or Breast-Feeding

Dose: Administration: IM:12.5mg by deep IM injection (once only) Supply: Oral route: One or two 3mg buccal tablet(s) placed high between upper lip and gum twice daily.



Drug Name: PROCHLORPERAZINE - (Injection – ADMINISTRATION)/ (Buccal tablets – SUPPLY)


(a) administration Injection - Deep IM injection. Buccal tablets - should be placed high between the upper lip and gum, and left to dissolve. Advise patient: (i) may cause drowsiness and if affected not to drive or operate machinery. (ii) avoid alcoholic drink. (iii) photosensitisation – avoid exposure to direct sunlight and

use sunscreen. (iv) read the manufacturer’s patient information leaflet.


Dry mouth, drowsiness, dizziness, insomnia, agitation, mild skin reactions. IM injection can cause local pain or nodule formation and postural hypotension with tachycardia – particularly in the elderly use with caution. Respiratory Depression. Dyskinesias and dystonic reactions. Hypersensitivity reactions. Unexplained fever – discontinue. Neuroleptic malignant disease. Buccal tablets can cause local irritation. Refer to BNF for other side-effects. Diabetic patients – appropriate glycaemic monitoring required.

Storage:

Store below 25°C. Keep amps in the outer carton to protect from light. Discoloured solution should not be used.



Drug Name: REHYDRATION SALTS (SUPPLY) - (Dioralyte® oral powder)

Drug Group: Oral rehydration salts

Drug Legal Status: P/GSL

Presentation: 1 x 6 sachets

Route: Oral

Indication: Replacement of fluid and electrolytes lost through mild to moderate diarrhoea.


Exclusion Criteria:

(a) consent (b) age (c) disease state

Informed non-consent Patients under 1 month of age Known hypersensitivity to any of the ingredients Diabetes Low sodium or potassium diet Renal disease Liver disease

Dose: Patient over 12 years: The contents of 1-2 sachets after each loose bowel motion.

Patient 1-11 years: The contents of 1 sachet after each loose bowel motion

Patient 1 month to 11 months: One to one and a half times the usual 24 hour feed volume.

The contents of each sachet should be reconstituted with 200mL of fresh tap water. Use freshly boiled and cooled water for infants

(Refer to manufacturer’s advice in pack)


(a) administration Advise patient: (i) reconstitute with fresh water, in accordance with

manufacturer’s instructions.



Drug Name: REHYDRATION SALTS (SUPPLY) - (Dioralyte® oral powder)

(ii) In the initial stages of treatment of diarrhoea all foods,

including cow's or artificial milk, should be stopped. In breast fed infants it is suggested that the infant is given the same volume of Dioralyte as the bottle fed baby and then put to the breast until satisfied. Expression of residual milk from the breasts may be necessary during this period. After 24 - 48 hours, when symptoms have subsided, the normal diet should be resumed but this should be gradual to avoid exacerbation of the condition.

(iii) If patient is vomiting advise to take small amounts of

Dioralyte frequently. (iv) See GP if symptoms persist for 24 - 48 hours. (v) read the manufacturer’s patient information leaflet. Patients under 2 years of age should be advised to see a doctor if diarrhoea persists after 24 hours

(b) other Advise patient that after reconstitution any unused solution should be discarded 1 hour after preparation unless stored in a refrigerator when it can be stored for 24 hours.

Storage: Store sachets below 25°C. Protect from moisture.



Drug Name: SALBUTAMOL (ADMINISTRATION OR SUPPLY)

Drug Group: Beta2-agonist (reliever)


Presentation: 100microgram/dose metered dose inhaler [1]

Route: Inhalation

Indication: Relief of symptoms of acute mild to moderate asthma exacerbation in patients over 1 year of age (peak flow 50-75% of predicted or best) Refer to GMED Clinical Protocol – Treatment of Mild to Moderate Asthma Refer to GMED PGD Monograph for Prednisolone Refer to GP after administration.

Inclusion Criteria: Patients over 1 year of age.

Exclusion Criteria:

(a) consent

(b) age

(c) disease states

(d) drugs

Informed non-consent.

Patients under 1 year of age.

History of hypersensitivity to any of the ingredients.

Propranolol.

Dose: For the treatment of an acute exacerbation of moderate asthma all patients aged >1 year:

1 puff of salbutamol metered dose inhaler via a spacer, followed by 5 tidal breaths. If condition persists give one puff of β2 agonist every 30 seconds up to a maximum of 10 puffs with each puff to be inhaled separately and always followed by 5 tidal breaths.

If response is poor, patients under 18 years should be admitted to hospital.

Patients under 18 years presenting with severe asthma should be admitted to hospital immediately Supply Dose: (provide volumatic spacer if necessary) Patient over 1 year: 100 - 200 micrograms (1-2 puffs) as required up to four times daily.



Drug Name: SALBUTAMOL (ADMINISTRATION OR SUPPLY)


(a) administration After administration monitor pulse rate, respiratory rate and peak flow to demonstrate improvement. Demonstrate inhaler technique to patient. Give clear advice regarding worsening statement.


Fine tremor, nervous tension, headache, palpitations, tachycardia, disturbances of sleep, angioedema, urticaria, hypokalaemia, mouth and throat irritation, muscle cramps, nausea. Refer to BNF and BNFC for other side-effects.

(c) other Advise patient to have an asthma review at GP surgery within 48 hours. Advise patient inhalers can be returned to community pharmacy for recycling.

Storage: Store below 30°C. Protect from frost and direct light. The therapeutic effect of this medication may decrease when the canister is cold. The canister should not be broken, punctured or burnt, even when apparently empty.



Drug Name: SODIUM CITRATE micro-enema (ADMINISTRATION)

Drug Group: Osmotic laxative


Presentation: 5mL rectal tube [1]

Route: Rectal

Indication: Acute constipation


Exclusion Criteria:

(a) consent (b) age (c) disease states (d) other

Informed non-consent Patients under 3 years of age Do not use in patients with inflammatory bowel disease. Acute GI conditions If patient has had recent bowel surgery, check with a doctor first before administering any enemas

Pregnancy or breast-feeding

Dose: Rectal use. A single enema may be used once daily.


(a) administration Patient aged 3 years and over: Administer the contents of one micro-enema rectally, inserting the full length of the nozzle. Only insert half of the length in children. No lubricant is needed as a drop of the mixture can be used. The tube must be squeezed continuously as the nozzle is removed from the rectum to prevent the medicine being drawn back into the tube.


A slight cramp occasionally.. Excessive use may cause diarrhoea and fluid loss, which should be treated symptomatically.




Drug Name: SUMATRIPTAN (SUPPLY OR ADMINISTER)

Drug Group: 5HT1 –receptor agonist


Presentation: 50mg tablets [1 x 6]

Route: Oral

Indication: Treatment of acute migraine attacks with or without aura that have not responded to conventional analgesia

Refer to NHS Grampian Joint Formulary: 4.7.4.1 Treatment of the acute migraine attack

Inclusion Criteria: Patients over 18 years of age and under 65 years of age.

Exclusion Criteria:

(a) consent (b) age

(c) disease states

Informed non-consent Patients under 18 years of age Patients over 65 years of age Hypersensitivity to Sumatriptan, sulphonamides or any of the excipients Ischaemic heart disease Previous myocardial infarction Previous cerebrovascular accident or transient ischaemic attack Peripheral vascular disease Prinzmetal’s angin Coronary vasospasm Mild uncontrolled or Moderate or severe hypertension Phenylketonuria History of seizures Severe hepatic impairment

(d) drugs

MAOIs and 2 weeks after discontinuation SSRIs SNRIs St John’s Wort itraconazole ketoconazole lithium indinavir nelfinavir ritonavir ergotamine



Drug Name: SUMATRIPTAN (SUPPLY OR ADMINISTER)

(e) other

methysergide sulfonamides Other 5HT agonists Pregnancy

Dose: Patient 18 years and under 65 years: 50mg, may be repeated after at least 2 hours if migraine recurs. Maximum dose 300mg in 24 hours If patient does not respond to first dose then a second dose should not be taken for the same attack.


(a) administration Advise patient: (i) discontinue if tightness in throat and chest is intense and

seek medical advice. (ii) if causes drowsiness do not drive, use tools or machines. (iii) read the manufacturer’s patient information leaflet.


Sensations of tingling, heat, heaviness, pressure, tightness of any part of the body; flushing, dizziness, feeling of weakness, fatigue,myalgia, nausea and vomiting. Refer to BNF for other side-effects.

(c) other If patient is breast-feeding withhold breast-feeding for 12 hours after taking sumatriptan. Triptans are only effective once the headache phase of a migraine has started.




Drug Name: TRIMETHOPRIM (SUPPLY)



Presentation: 200mg tablets [1 x 14]

50mg/5mL oral suspension [1 x 100mL]

Route: Oral

Indication: Acute uncomplicated urinary tract infection

Inclusion Criteria: Patients over 6 months of age

Exclusion Criteria:


Informed non-consent Patients under 6 months of age History of allergy or hypersensitivity to trimethoprim or cotrimoxazole Hypersensitivity to any other ingredients Immunosuppression Blood dyscrasias Renal impairment amiodarone ciclosporin digoxin immunosuppressants mercaptopurine methotrexate phenytoin repaglinide rifampicin warfarin Avoid in the first trimester of pregnancy and breast-feeding

Dose: Female patient over 18 years : 200mg twice daily for 3 days Male patient over 18 years: 200mg twice daily for 7 days Patient 12 – 17 years: 200mg twice daily for 3 days Patient 6 – 11 years: 100mg twice daily for 3 days Patient 6 months to 5 years: 50mg twice daily for 3 days



Drug Name: TRIMETHOPRIM (SUPPLY)

Advise patients under 18 years to have follow up and review with own doctor. Refer to: NHS Grampian Staff prescribing Guidance for the Empirical Treatment of Infections in Primary Care


(a) administration Advise patient: (i) take at regular intervals and complete the course unless

otherwise directed by a doctor. (ii) read the manufacturer’s information leaflet. Pack size does not meet dose schedule. Excess tablets should be removed from the over-labelled patient pack and returned to GMED, ECC, Aberdeen for destruction.


GI disturbances, itch, rash, allergic reactions, photosensitivity. Refer to BNF and BNFC for other side-effects.

(c) other The suspension must be shaken well before use. Supply a 5mL spoon or oral syringe with the suspension.




Documents

Patient Group Direction For The Administration and Supply ...foi.nhsgrampian.org/globalassets/foidocument/foi-public-documents1... · UNCONTROLLED WHEN PRINTED Review Date: November