SPC- Elderly and children

WHat happens when we get older?

• Increased age means increased risk of certain disease states so symptoms presenting in the pharmacy may be the sign of something more serious

• Physiology changes drug handling, increasing the risk of ADR

• More likely to have medical conditions and/or on medicines that interact with OTC products.

• Increased chance of polypharmacy and adverse drug reactions.

Constipation in elderely

• Common in elderely due to reduced gut motility with age

• Could also be due to the long-term use of stimulant laxatives, causing a lazy gut.

DO..

• If bulk laxative given, advise patient to drink plent of fluid because gut is moving a bit slowe, bulk laxative could get stuck if not flushed through the system.

Diarrhoea

Referral time reduced to 48 hours instead of 72 hours

Dyspepsia in Elderley

recent dyspepsia for the first time over 55 years- REFER

Antihistamines

• Greater risk of sedative effects with sedating antihistamines which can be exacerbated. cetirizine okay

DO NOTS

• Acrivastine (Benadryl) not for >65 years

Analgesics

Paracetamol OK but check patient is not taking other paracetamol based products

• Is pain due to a fall? What was the cause of the fall?

DO NOTS

• NSAIDs- greater risk of gastric side effects & ulceration- counselling of great importance to takw with food.

• If taking long term, ensure has PPI cover or H2 antagonist to support

Vaginal thrush

Topical antifungals not licensed for vaginal candidiasis > 60 years-

REFER. some symptoms are caused by vaginal proplapse

Cystitis

Sodium and potassium citrate sachets- no upper age limit

but beware of complications,

Elderly women should ideally be referred, as they are more prone to pyelonephritis (kidney infection)

The elderly in general can develop UTI very quickly which can lead to more complications like falls and confusion.

Could be a sign od diabetes.

What cough and cold medicines should not be used in children under the age of 6?

– nasal decongestants (pseudoephedrine, ephedrine, phenylephrine, oxymetazoline, and xylometazoline)

– expectorants (guaifenesin and ipecacuanha)

– antitussives (dextromethorphan and

pholcodine)

– antihistamines (diphenhydramine, chlorphenamine, brompheniramine, promethazine, triprolidine, and doxylamine)

*chlorphenamine can be used for allergies for one and upwards but not for cold and flu

What is condeine lictus restrictions?

• It is reclassified from P to POM due to the risk of dependence, addiction and overdose.

• Is only licensed for he treatment of cough, chronic cough lasting over 8 weeks.

Cough and cold remdies for 6-12?

the ingredients at the top are fine and are available but you should have clearer advice on packaging/labelling and from the pharmacist.

• For 6-12 years, the products should be indicated for second-line use, recommended for a max of 5 days use.

• Self-care should be first.

What should cough and flu remedies have for 6-12 years?

1. should have strengthened warnings on the packaging and labelling.

2. All liquid cough and cold medicines (including those for adults) should be supplied in a child-resistant container.

3. Certain combinations (such as cough suppressants and expectorants) should be phased out.

Infants and children common requests

1. Hydrocortisone cream/Eumovate >10 years

2. Constipation- Check individual products (lifestyle then lactulose)

3. Oral Rehydration Sachets > 2 years

4. Antispasmodics- NOT recommended

5. Mebendazole > 2 years

6. Headlice- Check individual products

7. Chloramphenicol eye drops > 2 years

8. Lidocaine in Teething gels-MHRA alert Dec 2018

Elaborate on the lidocaine MHRA alert 2018 GSL to P

• Pharmacists should only recommend these products when local non-medicinal treatments, such as a teething ring or massaging the gum, have failed to provide sufficient relief.

• If oral lidocaine is to be used, remind carer or parents to read the PIL carefully, especially dose and administration, and to seek medical attention if no improvement

• Lidocaine authorised in adults for mouth ulcers or any condition should not be used for infant teething symptoms.

What ia an alternative to lidocaine priducts for pain releif of teething?

• Sugar-free paracetamol or ibuprofen suspensions, administered according to indication and dose for eight and age, may be considered for the relief of teething

Key principles to remeber in children ?

• Age restrictions for products: OTC/GSL vs prescribed on Rx

• Varying doses in different ages/ weights- care when more than one child in a household

• When responding to symptoms, the time you would wait until referral tends to be shorter

• Access PIL and SPC at www.medicines.org.uk/emc

What is the green book?

Has good information about vaccines and vaccine schedules, helps to identify common infections, including differentiating causes of rashes.