Navigation Workshop Contraception and EHC

By Douglas Kelley,2014-05-20 15:50
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Healthy. Feeding about every 2-3 hours. Medicines (name, dose, freq?): Metronidazole 200mg three times a day for 7 days prescribed for dental abscess.

    Navigation Workshop 1

eBNF: non-steroidal anti-inflammatory 1 NSAID Non-steroidal

    drugs (NSAIDs) anti-inflammatory drugs

    ?eMC (PIL): Flagyl S is a white to cream 2 Flagyl S Orange and lemon

    suspension with a slight yellow tinge. It Suspension flavouring has an odour of oranges and lemons.

    eBNF: The symbol POM has been placed 3 POM Prescription Only

    against those preparations that are Medicine available only on a prescription issued by

    an appropriate practitioner.

    eMC: A pharmacodynamic interaction 4 Aspirin & Increased risk of

    between clopidogrel and acetylsalicylic Clopidogrel bleeding acid is possible, leading to increased risk

    of bleeding.

    eBNF: increased risk of bleeding when

    clopidogrel given with aspirin.

    eBNF: DPF - Dental Practitioners' 5 DPF Dental

    Formulary - list approved by the Practitioner’s Secretaries of State, and the Formulary preparations therein may be prescribed by

    dental practitioners on form FP10D

     eBNF: Not known to be harmful 6 Safe analgesic Paracetamol

    eMC: There is clinical and epidemiological in pregnancy evidence of safety of paracetamol in


    Netdoctor: There are no known harmful

    effects when this medicine is used during


    eBNF: ACBS Advisory Committee on 7 ACBS Advisory

    Borderline Substances, In certain Committee on conditions some foods (and toilet Borderline preparations) have characteristics of

    Substances drugs and the Advisory Committee on

    Borderline Substances advises as to the

    circumstances in which such substances

    may be regarded as drugs.

    Role Preparation for Dental Nurse Advisors May 2006

    Medicines Chest: Ibuprofen 200 mg 8 Ibuprofen Maximum 1200mg

    Dosage: Adults, elderly and young persons daily (OTC) over 12 years: 1 or 2 tablets to be taken 2

    or 3 times a day, with or after food.

    Maximum 6 tablets in 24 hours.

    eMC: Adults and children over 12 years:

    Initial dose two tablets taken with water,

    then if necessary, one or two tablets

    every four hours. Do not exceed six

    tablets in any 24 hours.

    ?eBNF: Sodium Fluoride Toothpaste 0.619% 9 Duraphat Sodium, Fluoride

    -Duraphat Toothpaste Toothpaste


    eBNF: Artificial Saliva, DPF - Supplies may 10 Artificial Saliva Supplies may be

    be difficult to obtain difficult to obtain

    Netdoctor: Aspirin: Take this medication 11 Take with or Aspirin &

    with or after food. Ibuprofen: Take this after food Ibuprofen medication with or after food.

    eMC: Tablets to be taken preferably after


    eBNF: DPF preparations prescribed by 12 FP10D NHS Dental

    dental practitioners on form FP10D prescription

    eMC: Regulatory affairs: General sales list 13 GSL Can be sold from

     may only be sold from a registered any locked premises, which is able to close to exclude premises the public.

    ?eMC: Once reconstituted Erythroped PI 14 Erythroped PI Once

    SF should be used within 7 days. SF Suspension reconstituted

    should be used

    within 7 days

    ?eMC: Paracetamol BP 250mg/5ml. 15 Medinol over 6 Paracetamol

    eBNF: paracetamol 250 mg/5 ml. - suspension 250mg per 5ml Medinol? Over 6

    Medicines Chest: Strawberry flavour oral

    suspension sugar-free colour-free and

    contains no alcohol or animal fats

    containing in 5ml:Paracetamol 250 mg

    Role Preparation for Dental Nurse Advisors May 2006

    eBNF: The CSM has advised that non-Contraindicated NSAIDs 16

    selective NSAIDs are contra-indicated in in patients with

    patients with previous or active peptic previous or ulceration active peptic


    Medicines Chest: pharmacy status (P) 17 P Sold under the

     supervision of a


    ?eBNF: Corsodyl?(GSK Consumer 18 Corsodyl Chlorhexidine

    Healthcare) Dental gel, chlorhexidine Dental Gel Gluconate Gel 1% gluconate 1%.

    eMC:Corsodyl Dental Gel

    Chlorhexidine Digluconate 1.0% w/w

    (equivalent to Chlorhexidine Digluconate

    Solution Ph Eur 5.325 % w/w)

    Netdoctor: This medicine contains two 19 Co-codamol Combination of

    active ingredients, paracetamol and codeine and codeine phosphate. paracetamol

    eBNF: Tablets should be swallowed whole 20 Tetracycline Tablets should be

    with plenty of fluid while sitting or Tablets swallowed with standing plenty of fluid Netdoctor: This medicine should be

    whilst sitting or swallowed whole with plenty of water while

    standing you are sitting or standing. This is to

    prevent the medicine irritating the throat.

    Avoid taking a dose just before going to eBNF: By mouth, 0.51 g every 46 hours 21 Paracetamol Maximum of 2

    bed. to a max. of 4 g daily tablets four times Medicines Chest: Dosage - Adults: 2 a day tablets every 4 hours. Maximum 8 tablets

    in 24 hours.

    ?Medicines Chest: Effervescent white 22 Solpadeine Combination of

    tablet containing: Soluble Tablets codeine, Codeine phosphate 8mg paracetamol and Paracetamol 500mg

    caffeine Caffeine 30mg

    cBNF: Due to association with Reye’s 23 Avoid in under Aspirin

    syndrome aspirin should be avoided in 16’s except in children under 16 years of age except in specific Kawasaki syndrome or for its antiplatelet

    circumstances action

    Role Preparation for Dental Nurse Advisors May 2006

    ?Medicines Chest: Round beveled edge Over the Paramol Tablets 24

    tablet marked ‘Paramol’ containing: counter

    Paracetamol 500mg and dihydrocodeine preparation tartrate 7.46mg containing


    ?Milligrams of eMC: Calprofen contains 100mg of 25 50mg of

    Calprofen that ibuprofen per 5ml spoon. Dose for 6-12 Ibuprofen can be given to a months: 2.5ml three times daily

    child of 8 months (per dose) Therefore 50mg three times daily

    ?Medicines Chest: Infants from birth 26 Dentinox Suitable from

    onwards Teething Gel Birth

    ?Medicines Chest: Infants under 2 months: 27 Bonjela Suitable for

    not recommended Teething Gel infants 2 months

    and over

    Herbal Medicines (via Medicines 28 Clove Oil Not recommended

    Complete): Repeated application of clove for repeated oil as a toothache remedy may result in application damage to the gingival tissue

    cBNF: Child 3-12 months 60-120mg every 29 Maximum 480mg

    4-6hours (max 4 doses in 24 hours) quantity of


    (mg) for non

    severe pain per

    24 hours for a

    child aged 4


    ??eBNF: Difflam (3M) 30 Benzydamine Difflam Spray

    Spray, benzydamine hydrochloride 0.15% Oromucosal Dental prescribing on NHS may be Spray 0.15% prescribed as Benzydamine Oromucosal

    Spray 0.15%

    Role Preparation for Dental Nurse Advisors May 2006

Workshop 2: Handling Medicines Calls

    Case Scenario 1

    Question A lady explains that she has broken her tooth. Her friend has told her ?Nurofen will help with the pain. Is this ok as she is pregnant?

    PERSON MEDICINES What further

    background ?Who is asking? Exact type of Nurofen: information do ?27 year old pregnant female Nurofen 200mg caplets you need to clarify the Any allergies/ medical Medicines (name, dose, freq?): question and conditions? None minimise the risks Paracetamol makes her feel sick when advising the Why asking about Medicines? caller? Pregnancy (stage, going well)? Unable to get an appointment at the 33 weeks. First pregnancy, all well. dentist till mid-week and needs something to help with the pain.

    Gather the further background information BEFORE searching for information.

    Medicines chest: What information ?Nurofen caplet contains Ibuprofen 200mg sources would

     you use? eBNF:

    Most manufacturers advise avoid (or avoid unless potential benefit outweighs risk);

    Third trimester: With regular use closure of fetal ductus arteriosus in utero and

    possibly persistent pulmonary hypertension of the newborn. Delayed onset and

    increased duration of labour


    Whilst no teratogenic effects have been demonstrated in animal experiments, the

    use of Nurofen during pregnancy should be avoided. The onset of labour may be

    delayed and duration of labour increased.


    This medicine is not recommended for use in pregnancy unless considered

    essential by your doctor. If taken in the third trimester it may delay labour, increase

    the length of labour and cause complications in the newborn baby.

    FAQ: Can Ibuprofen be taken during pregnancy?

    Use of ibuprofen during the third trimester is not recommended, unless treatment is

    under medical supervision.

    Ibuprofen is best avoided during the last weeks of pregnancy as it has been What advice

    associated with delayed labour, increased length of labour and also complications in would you give? the newborn. Or would you If paracetamol cannot be tolerated it would be best to discuss needing an earlier refer? appointment with your dentist.

    Role Preparation for Dental Nurse Advisors May 2006

    Workshop 2: Handling Medicines Calls

    Case Scenario 2

    Question A lady asks if it safe for her to take Metronidazole whilst breastfeeding?

    PERSON MEDICINES What further

    background Who is asking? Medicines (name, dose, freq?): information do 32 year old lady Metronidazole 200mg three times a you need to day for 7 days prescribed for dental clarify the Any allergies/ medical abscess. question and conditions? minimise the risks Has medicine been taken? Penicillin allergy when advising the Yes, one this morning caller? Baby? Why asking about medicines? 12 weeks. Born at term. Healthy. Feeding about every 2-3 hours Forgot to mention to dentist. Tried to

    speak to dentist / health visitor but

    dentist only available half day and

    the health visit does not work today.

    Gather the further background information BEFORE searching for information.

    eBNF: What information

    sources would Significant amount in milk; manufacturer advises avoid large single doses you use?


    Flagyl should not be given during pregnancy or during lactation unless the

    physician considers it essential; in these circumstances the short, high-

    dosage regimens are not recommended.


    This medicine passes into breast milk. It should be used with caution in

    breastfeeding mothers and only if the expected benefit to the mother is

    greater than any possible risk to the nursing infant. High dosage regimens

    should be avoided unless the mother stops breastfeeding during the course.

    Seek medical advice from your doctor.

    UKMI Central:


    ? (high dose)(eg IV or rectal) -Insufficient information relating to breast-

    feeding available to allow classification as a safe drug.

    ? (low dose)(eg oral 200-400mg tds) single course only - They either: Are

    not excreted in breast milk. Are not absorbed by the infant. Give very low

    levels in infant with no apparent effects.

    ? May change taste of breast milk

Role Preparation for Dental Nurse Advisors May 2006

    The information is conflicting refer to MI What advice

     would you give?

    MI Service answer:

    Or would you Breastfeeding mothers can be treated with low dose metronidazole courses

    refer? (200-400mg three times daily) without concern of untoward effects on the

     nursing infant. Metronidazole may change the taste of the breast milk;

    therefore the infant should be monitored for signs of poor feeding.

    In general, medicines should be avoided by mothers’ breastfeeding

    premature or low birth weight infants, or in infants who have any underlying

    medical conditions. The decision to treat should always be based on a risk

    versus benefit evaluation in each individual case.

Role Preparation for Dental Nurse Advisors May 2006

    Workshop 3: Adverse Drug Reactions

    Case Scenario 1

    ?Question Can you take Cuprofen if you have asthma?

    PERSON MEDICINES What further

    background Who is asking? Medicines (name, dose, freq?): information do 18 year old male Cuprofen Tablets Maximum you need to ? Strengthclarify the Why asking about Medicines? question and ? Wisdom tooth coming through and Ventolininhaler 2 puffs when minimise the risks ?mum recommended Cuprofen but required (not used for over 6 months) when advising the leaflet says not to be taken if caller? asthmatic Any allergies/ medical conditions?


    Gather the further background information BEFORE searching for information.

    Medicines Chest: What information

    sources would Tablets contain Ibuprofen 400mg you use?


    CSM warning (asthma)

    Any degree of worsening of asthma may be related to the ingestion of

    NSAIDs, either prescribed or (in the case of ibuprofen and others)

    purchased over the counter.


    Caution should be exercised in administering ibuprofen to patients with

    asthma and especially patients who have developed bronchospasm with

    other non-steroidal agents.


    Not to be used in people in whom aspirin or other NSAIDs, eg ibuprofen,

    cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal

    inflammation (rhinitis) or swelling of the lips, tongue and throat


    What advice Ibuprofen and other drugs like aspirin can cause allergic reactions such as would you give? asthma in some individuals.

Or would you If you haven’t taken ibuprofen or aspirin before then it may be best to

    refer? consider an alternative pain killer like paracetamol as this is safe in


Role Preparation for Dental Nurse Advisors May 2006

    Workshop 3: Adverse Drug Reactions

    Case Scenario 2 Question I’ve been prescribed a course of cephalexin capsules by my dentist is this

    ok as I have a penicillin allergy?

    PERSON MEDICINES What further

    background Who is asking? Medicines (name, dose, freq?): information do 55 year old female about herself Cephalexin 500mg capsules three you need to times a day for 5 days clarify the question and Why asking about Medicines? Any allergies/ medical conditions? minimise the risks Normal dentist on holiday and forgot Penicillin allergy breathing when advising the to mention about penicillin allergy difficulties caller?

    Gather the further background information BEFORE searching for information.

    eBNF: What information

    sources would The principal side-effect of the cephalosporins is hypersensitivity and about you use? 10% of penicillin-sensitive patients will also be allergic to the



    Before instituting therapy with cefalexin, every effort should be made to

    determine whether the patient has had previous hypersensitivity reactions to

    the cephalosporins, penicillins, or other drugs. Cefalexin should be given

    cautiously to penicillin-sensitive patients. There is some clinical and

    laboratory evidence of partial cross-allergenicity of the penicillins and

    cephalosporins. Patients have had severe reactions (including anaphylaxis)

    to both drugs.


    Use with caution in allergy to penicillin-type antibiotics

    What advice 10% of patients who have an allergic reaction to penicillin antibiotics may would you give? also have a reaction to a group of antibiotics called cephalosporins.

     Cefalexin is a cephalosporin antibiotic. Or would you

    refer? Recommend that patient contacts dentist who may suggest a more suitable


Role Preparation for Dental Nurse Advisors May 2006

    Workshop 3: Adverse Drug Reactions

    Case Scenario 3

    Question Previously I’ve been recommended to gargle aspirin when I have a sore

    throat but my pharmacist wont sell dispersible aspirin to me why is this?

    PERSON MEDICINES What further

    background Who is asking? Medicines (name, dose, freq?): information do 64 year old male Omeprazole 20mg capsules once you need to daily clarify the question and Why asking about Medicines? Any allergies/ medical conditions? minimise the risks When I last visited my dentist (at Peptic ulcer last year when advising the least 2 years ago) he recommended caller? gargling with aspirin when I get a sore throat. When I went to buy some from the pharmacy the

    pharmacist asked if I had any

    stomach problems and when I said

    I’d had an ulcer about a year ago

    they said they couldn’t sell them to


    Gather the further background information BEFORE searching for information.

    eBNF: What information

    sources would All NSAIDs are associated with serious gastro-intestinal toxicity; All NSAIDs

    (including selective inhibitors of cyclo-oxygenase-2) are contra-indicated in you use?

    patients with active peptic ulceration. The CSM also contra-indicates non-

    selective NSAIDs in patients with a history of peptic ulceration.


    4.3 Contraindications

    A history of, or active peptic ulceration,


    Not to be used in:

    Peptic ulcer or a history of this

What advice Aspirin and other drugs within the aspirin family have been associated with

    would you give? serious gastrointestinal adverse effects. The manufacturer’s licence

     prohibits aspirin being used by people who have previously had a peptic

    Or would you ulcer. It may be better to either try a paracetamol based painkiller or a

    refer? mouthwash, which you could gargle with. Your dentist will be able to advise

     on the most suitable product for your symptoms.

Role Preparation for Dental Nurse Advisors May 2006

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