Darktar Darktar

1. Darktar Darktar Dr B Kelly

2. When/How to prescribe? • Define the problem • Only when necessary • Benefit outweighs the risk? • Discuss treatment options • Communication skills • Promote compliance

3. Prescribing in Gen. Practice • PACT- prescribing analysis + cost package • Quarterly report on prescribing habits and costs • Formulary • An agreed policy of prescribing • Limit prescribing and costs • Evidence based • Guidelines • Local/national

4. When to beware! • Elderly • Pregnancy • Children • Renal/Hepatic impairment • New drugs

5. 2 Options: Levonelle-2(not PC4!) IUD up to 5 days copper coil failure rate <1% Levonelle-2 Up to 72 Hours 2 Tablets 12 hours apart Up to 97% effective CI - Porphyria Progesterone Tumours Emergency Contraception

6. After prescribing emergency contraception should…. • Review patient • ?STD’s • regular contraception • ?pregnancy

7. Sore Ear • 100cases/year • Paracetamol • Ibuprofen • 80% resolve within 3 days • Amoxycillin (after day 4 ) • 125mg tid for 5/7 • current evidence • Avoid antibiotic • Limit use to after 3 days

8. Back Pain • Simple Analgesia • Encourage activity • Ibuprofen/ Diclofenac Also consider- • Diazepam 2-5mg tid

9. Red flags • <20yrs or >55yrs • Non-mechanical pain • Thoracic pain • PMHx of CA • Steroids • Weight loss • Widespread neurology • Structural deformity • HIV

10. Sore Throat • Beware Quinsy • Diagnosis of bacterial vs viral difficult • simple analgesics, increase fluids and salt water gargling • Antibiotics are of modest benefit- on avg reduce symptom duration by 16 hrs and complication rate. • BUT!-large NNT to prevent one episode. • CONSIDER DELAYED SCRIPT- no better by day 2/3 • Penicillin V 250mg QID for 10/7(not amoxicillin ?glandF • Erythromycin 250mg QID for 10/7

11. Acne • Topical • Azelaic Acid • Salicylic Acid • Benzoyl peroxide • Oral antibiotics • Oxytetracycline • Erythromycin • Minocycline • Hormonal • Dianette • Oral Retinoids • Roaccutane

12. ‘The Pill’ • Oestrogen & Progesterone Acts by inhibiting ovulation. 1 tablet daily for 21 days then 7 day break Note: • Contraindications • Side Effects • Not effective if taken with enzyme inducers eg. Antibiotics, anti-convulsants. • ‘7 day Rule’

13. Scabies • Permethrin • (Lyclear Dermal Cream) • 1 dose stat- apply over whole body then wash thoroughly 8-12 hrs later Repeat once if necessary after 7 days

14. Fever of Unknown Origin • Check ENT, Abdomen, Neck Stiffness, Rash, MSSU If no obvious cause: • Paracetamol • Ibuprofen • Fluids

15. “Flu” Most ‘flus’ are not true flus. • Paracetamol 1g QID • Ibuprofen 400mg Tid • Increase Oral Fluids • Antibiotics for secondary infections • Target at risk population with flu immunisations

16. U.T.I • Treat infection as per urine culture • Prophylaxis – usually trimethoprim • Investigate +/- Paediatrician due to potential complications

17. Head Lice • Permethrin • Lyclear Crème Rinse • 1 dose stat – apply to hair and scalp, leave 10 mins then rinse.

18. Diarrhoea • Increase fluid intake +/- Dioralyte • Antispasmotics eg hyoscine 20mg qid • Loperamide (imodium)

19. Impetigo Common and highly contagious. Staphylococcal infection • Flucloxacillin • Fusidic Acid (topical)

20. Nappy rash • Sparing of skin folds • simply advice • nappy area dry • aqueous cream (E45) • barrier cream (zinc paste) • Topical antifungal • Canesten HC

21. Psoriasis • Explain condition • Topical treatment • sailicylic acid • coal tar • vit D derivatives • dithranol • topical retinoids • topical steroids • Systemic/PUVA

22. Eczema • Very common • >30% of dermatology consultations • Also known as dermatitis • Atopic eczema commonest type • Remove contributory factors • Emollients • Topical steroids