Common Ailments PGD

89 Pages·2016·4.97 MB·English

by  Val Bamber

Patient Group Directions for the supply of medication by
Community Pharmacists under the Common Ailments
Service
PGD
Drug Indication Page
No.
129 Miconazole 2% cream (30g) Athletes foot and 2
Intertrigo/Ringworm
130 Chloramphenicol 0.5% eye drops Conjunctivitis 7
(10ml)
131 Chloramphenicol 1% ointment (4g) Conjunctivitis 13
227 Hydrocortisone 1% cream (30g) Dermatitis 18
228 Hydrocortisone 1% ointment Dermatitis 22
229 Hydrocortisone 2.5% cream Dermatitis 26
230 Hydrocortisone 2.5% ointment Dermatitis 30
133 Scheriproct ointment (30g) Haemorrhoids 34
134 Scheriproct suppository (12) Haemorrhoids 38
135 Sodium cromoglicate 2% eye drops Hay fever 42
(13.5ml)
136 Beclometasone 50mcg nasal spray (200 Hay fever 46
dose)
137 Omeprazole 20mg capsules (28) Indigestion and reflux 51
231 Lansoprazole 30mg capsules (28) Indigestion and reflux 56
140 Miconazole 20mg/g oral gel (80g) Oral thrush 61
141 Nystan 100 000u/ml oral suspension Oral thrush 67
(30ml)
142 Mebendazole 100mg tablets (6) Threadworm 72
232 Mebendazole 100mg/5ml suspension Threadworm 75
143 Clotrimazole 10% cream (5g) Vaginal thrush 79
144 Clotrimazole 500mg pessary and Vaginal thrush 84
2%cream (1 & 20g)
PGD Pharmacist Authorisation Form 89

References
AWMSG – Common Ailments Scheme Formulary –
http://howis.wales.nhs.uk/doclib/WHC(2000)116.pdf
The National Assembly for Wales WHC (2000) 116 Patient Group Directions - Review
Of Prescribing Supply And Administration Of Medicines.
http://howis.wales.nhs.uk/doclib/WHC(2000)116.pdf Accessed August 2015
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PATIENT GROUP DIRECTION- NUMBER 129
Miconazole 2% Cream
1. Clinical condition
Situation Patients with athletes foot or intertrigo/Ringworm
Inclusion criteria Athletes foot - patients with an itchy, scaly, dry rash on the
bottom and sides of feet and between the toes.
Intertrigo – Itchy rash commonly affecting occluded skin
creases such as groin, under breasts and axillae
Ringworm – typically circular patch of skin, mild redness with
a well demarcated outer edge
Exclusion criteria  Patients with poorly controlled diabetes who have not been
reviewed by their GP in the last 3 months
 Patients with severe inflammation, signs of bacterial
infection, unresponsive rash or recurrent episodes
 Previous sensitivity or irritation to miconazole cream or any
of its ingredients
 Patients taking a contra-indicated medicine
 Patients who the pharmacist has assessed as not having
capacity to understand the nature and purpose of
treatment
Special warnings and  Miconazole Cream must not come into contact with the
precautions for use eyes
 If a reaction suggesting sensitivity or irritation should
If in doubt seek occur, the treatment should be discontinued
medical advice  Benzoic acid (E210) is mildly irritant to the skin, eyes and
mucous membranes
 Butylated hydroxyanisole (E320) may cause local skin
reactions (e.g. contact dermatitis), or irritation to the eyes
and mucous membranes
 Pregnancy - In animals miconazole nitrate has shown no
teratogenic effects but is foetotoxic at high oral doses.
Only small amounts of miconazole nitrate are absorbed
following topical administration. However, as with other
imidazoles, miconazole nitrate should be used with caution
during pregnancy
 Lactation - Topically applied miconazole is minimally
absorbed into the systemic circulation, and it is not known
whether miconazole is excreted in human breast milk.
Caution should be exercised when using topically applied
miconazole products during lactation
Action if patient is Refer to GP
excluded
Action if patient General self management advice as per Common Ailment
declines the Formulary
medication
Seek further advice Refer to SPC, BNF & the All Wales Common Ailments Service
Formulary
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2. Treatment
Name of Medicine
Miconazole nitrate
Legal Status POM
Route/Method Topical - Cutaneous use
Dosage 2% Cream
Form/Strength
Licensed or off licensed Licensed
use
Frequency Apply twice daily to affected skin.
Duration of treatment Treatment should be continued for:
 at least one week after all lesions have disappeared to
prevent relapse (athletes foot)
 7-14 days after all lesions have disappeared to prevent
relapse (intertrigo/ringworm)
Maximum or minimum Supply 1 x 30g tube of cream per episode.
treatment period Maximum of 2 episodes per year, plus for
intertrigo/ringworm, 2nd episode must be at least 6 months
after the first.
Adverse reactions Hypersensitivity can occur including urticaria, rash, pruritis
and application site reactions.

This list is not exhaustive. Please refer to the Summary of
Product Characteristics (SPC) for further information.
Significant drug Miconazole administered systemically is known to inhibit
interactions CYP3A4/2C9. Due to the limited systemic availability after
topical application, clinically relevant interactions are rare.
However, in patients on oral anticoagulants, such as warfarin,
caution should be exercised and anticoagulant effect should
be monitored.

This list is not exhaustive. Please refer to the current edition
of the BNF & Summary of Product Characteristics (SPC) for
further information.
Storage and Handling Do not store above 25ºC

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3. Advice to patient
Adverse Drug Reaction  Any adverse reaction to the medication must be
Reporting documented in the patients medical records
 Doctor/ GP should be informed
 Use the yellow card system to report adverse drug
reactions directly to the Commission on Human
Medicines (CHM). Guidance on the use of the yellow
card system is available in the current BNF or can be
accessed via
o the MHRA website
https://yellowcard.mhra.gov.uk/
o The link within the Choose Pharmacy application
o or contact Medicines Information
Written or verbal Athlete’s Foot
advice to patients  Wear footwear that keeps feet cool and dry
and/or carers  Wear cotton socks
 Change to a different pair of shoes every 2-3 days
 After washing, dry feet thoroughly, especially between
toes
 Do not share towels and wash them frequently
Intertrigo/Ringworm
 Wash the affected skin daily and dry thoroughly,
particularly in the skin folds
 Wash clothes and bed linen frequently to eradicate the
fungus
 Do not share towels and wash them frequently
 Wear loose-fitting clothes made of cotton or material
designed to move moisture away from the skin
Follow up advice Cream should be used for 7-14 days after disappearance of
all signs and symptoms.

4. Documentation and Audit Trail
Records A record must be made in the pharmacy patient medication
record (PMR) at the time of supply, detailing
 Patient name, address, date of birth
 Registered GP
 Name of medicine
 Strength and form supplied
 Dose / Quantity of medicine supplied

5. Staff Group
 Pharmacists registered with the General
Professionals to which
Pharmaceutical Council (GPhC)
PGD applies
 Pharmacist registered to provide the Community
Pharmacy Common Ailments Scheme
 All professionals must act within their appropriate Code
of Professional Conduct
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Additional requirements – access to:
Specialist
 British National Formulary (BNF) and BNF for Children
competencies or
– latest edition
qualifications
 AWMSG Common ailments scheme formulary – latest

update
All registered professionals are personally responsible for
Continued training and
their practice and in the exercise of professional
education
accountability there is a requirement to maintain and
requirements
improve their professional knowledge and competence

6. References
 Summary of product characteristics Daktarin 2% cream – eMC
https://www.medicines.org.uk/emc/medicine/6713 (accessed 25/8/15)
 BNF Online August 2015, Chapter 13 Skin, Section 13.10.2 Antifungal preparations
https://www.medicinescomplete.com/mc/bnf/current/PHP8030-miconazole-
nitrate.htm (accessed 25/8/15)
 AWMSG – Common ailments Scheme Formulary –
http://www.awmsg.org/docs/awmsg/medman/All%20Wales%20Choose%20Pharma
cy%20Formulary.pdf (accessed 25/8/15)

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PATIENT GROUP DIRECTION- NUMBER 130
Chloramphenicol 0·5% Eye Drops

1. Clinical condition
Situation For patients with conjunctivitis (bacterial) without visual
disturbance
Inclusion criteria Patients presenting with purulent discharge or mild severity
of red eye and one of the following:
 symptoms have been present for at least three days and
are not improving or
 condition has deteriorated over recent days or
 condition is severe or likely to become severe, providing
serious causes of a red eye can be confidently excluded
Exclusion criteria  Children under 2 years of age
 Pregnant or breastfeeding women
 Patients who wear contact lenses
 Patients complaining of visual disturbances
 Patients with significant photophobia
 Patients with a history of recent eye surgery
 Patients with restricted or painful eye movements
 Patients with redness and swelling around the eye
 Patients with a history of trauma or foreign body
 Where there has been no improvement in the person’s
signs or symptoms despite treatment
 Patients hypersensitive to chloramphenicol or any other
component of the drops.
 Patients with a known personal or family history of blood
dyscrasias including aplastic anaemia
 Patients taking a contra-indicated medicine
 Patients who the pharmacist has assessed as not having
capacity to understand the nature and purpose of
treatment
Special warnings and  Personal or family history of bone marrow problems
precautions for use  Prolonged use of chloramphenicol eye drops should be
avoided as it may increase the likelihood of sensitisation
If in doubt seek and emergence of resistant organisms. If any new
medical advice infection appears during treatment, the antibiotic should
be discontinued and appropriate measures taken
Chloramphenicol should be reserved for use only in
infections for which it is specifically indicated
 Blurring of vision can occur with the drops and patients
should be warned not to drive or operate machinery unless
their vision is clear
 Contact lens wearers - Advise patient to avoid wearing
contact lenses whilst eye infection is present and during
the course of treatment and to thoroughly cleanse contact
lenses before re-using them
Action if patient  Patients can be referred or self refer to the Wales Eye Care
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excluded service at an accredited optometrist, referral should be
recommended for all contact lens wearers
 Referral to GP
 Refer to A&E if reduced vision, significant photophobia,
recent eye surgery, restricted or painful eye movements
Action if patient  General self management advice as per Common Ailment
declines the Formulary
medication
Seek further advice Refer to SPC, BNF & the All Wales Common Ailments Service
Formulary

2. Treatment
Name of Medicine
Chloramphenicol 0·5% eye drops
Legal Status POM

Route/Method Topical - eye
Dosage 0·5% Eye Drops
Form/Strength
Licensed or off licensed Licensed use
use
Frequency The BNF recommended dosage for adults and children (aged
2 years and over) is one drop to be applied to the affected
eye at least every 2 hours then reduce frequency as infection
is controlled
Duration of treatment Continue treatment for 48 hours after healing
Maximum or minimum Supply one 10ml bottle for each affected eye per episode
treatment period Maximum of 2 episodes per year (second at least 6 months
after first)
Adverse reactions  Transient stinging, burning or irritation may occur on
application
 Blurring may occur. Patients should be warned not to drive
or operate machinery unless vision is clear
 BNF states that chloramphenicol eye drops are well
tolerated, however Chloramphenicol is absorbed
systemically from the eye and toxicity has been reported
(rarely) following chronic exposure. Bone marrow
hypoplasia, including aplastic anaemia and death, has
been reported following topical use of chloramphenicol.
Whilst the hazard is rare, it should be borne in mind when
assessing the benefits expected from the use of the
compound hypersensitivity reactions that may present as
angioneurotic oedema, urticaria, anaphylaxis, fever, and
vesicular and maculopapular dermatitis. In such instances
treatment should be discontinued immediately.

This list is not exhaustive. Please refer to the product SPC
for further information
Significant drug The concomitant administration of chloramphenicol with other
interactions drugs liable to depress bone marrow function should be
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avoided
This list is not exhaustive. Please refer to the current edition
of the BNF & Summary of Product Characteristics (SPC) for
further information
Storage and Handling Store in a fridge (stock) but can be stored at room
temperature once opened.

3. Advice to patient
Adverse Drug Reaction  Any adverse reaction to the medication must be
Reporting documented in the patients medical records
 Doctor/ GP should be informed
 Use the yellow card system to report adverse drug
reactions directly to the Commission on Human
Medicines (CHM). Guidance on the use of the yellow
card system is available in the current BNF or can be
accessed via
o the MHRA website
https://yellowcard.mhra.gov.uk/
o The link within the Choose Pharmacy application
o or contact Medicines Information
Written/additional  Advise patient that conjunctivitis is very contagious and to
advice to patient/carer exercise care with hand washing, using separate towels,
particularly before and after applying the drops
 Good eye hygiene is essential. Wipe with cooled boiled
water
 The patient should be instructed not to touch the eye or
eye lashes with the nozzle as this may contaminate the
medicine
 Advise patient that they may experience transient
irritation, burning, stinging or itching
 Advise patient that if blurring of vision occurs not to drive
or operate machinery until vision is clear
 On rare occasions hypersensitivity may occur
(wheeziness, fever, swelling of face, lips and tongue) in
which case treatment must be stopped immediately and
medical advice sought
 Advise patient not to wear eye make up as infection can
re-occur
 Once the treatment is completed the bottle(s) of eye
drops should be discarded
 If symptoms worsen despite treatment, seek medical
advice
 If chloramphenicol is used following the advice of a
doctor/optometrist in patients that normally wear contact
lenses – patients’ should be advised that lenses should not
be worn during the period of treatment. Hard contact lens
users and disposable contact lens users can start using
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