CSB420 full

Oral formulation strengths

Simplest, self-admin. Safest w proper use.

Oral formulation weaknesses

Slow onset, may have irregular GIT absorption, 1st pass effect, other substances in GIT can affect solubility, unsuitable for unconscious/ vomiting pts/ immediate post-op

Rectal formulation strengths

When oral route unsuitable, when medications irritate GIT

Rectal formulation weaknesses

Absorption can be irregular + unpredictable, less convenieny, low pt acceptibility

Sublingual formulation strengths

Very fast onset, short duration, absorbed direct to systemic circulation, unconscious pts, anti-emetic drugs.

Buccal formulation strengths

Quick onset, long duration, absorbed direct to systemic circulation, unconscious pts, anti-emetics

Sublingual/ buccal formulation weaknesses

Some unpalatable + bitter, possible oral mucosa irritation, cannot administer large doses

Vaginal formulation strengths

No 1st pass, lower dose, less frequent, unaffected by GIT disturbances.

Vaginal formulation weaknesses

Local irritation, personal hygiene, influences intercourse, gender specific

Inhalation formulation strengths

Direct to site of action, no 1st pass, rapid absorption, lower dose

Inhalation formulation weaknesses

Administration difficulties, may induce cough, increased bronchial + salivery secretions

Topical formulation strengths

No 1st pass, slow continuous effect = constant levels

Topical formulation weaknesses

Slow onset, variable absorption, possible skin irritation, small doses

Parenteral strengths/weaknesses

IV: systemic via vein, very fast onset, 100% bioavailability.

subcutaneous: injected/ implanted, easiest, least painful.

IM: fast/ slow onset depending on formulation (aqueous/ oily).

po meaning

Per os = by mouth

pr meaning

rectally

Aur meaning

Auris = into ear

Au meaning

Auris uterque = both ears

Ou meaning

Oculus uterque = both eyes

Gtt meaning

Guttae = drops

Crem meaninh

Cremor = cream

Inj meaning

Injectio = injection

Irrig meaning

Irrigatio = irrigation

Liq meaning

Liquor = liquid

Lot meaning

Lotio = lotion

Mist meaning

Mistura = mixture

Supp meaning

Suppositorium = suppository

Tab meaning

Tabletta = tablet

Ung meaning

Unguentum = ointment

Influenza causes, transmission, incubation

Influenza viruses of orthomyxoviridae family.

Spread through inhalation - coughing + sneezing.

Incubation: 1-4 dsys w avg 48hrs

Influenza symptoms - check!

Fever, chills, severe malaise, headache, myalgia (esp back + legs), dry cough, dry sore throat, nasal obstruction.

Common cold causes, transmission

Acute, self limiting viral infection involving mucus membranes of upper respiratory tract.

Spread via direct hand contact w secretions from infected person/ object/ surface, inhalation of air containing droplets.

Common cold symptoms

Sore throat, sneezing, congestion, profuse nasal discharge, cough, headache, fever, malaise

COVID-19 cause, transmissionn

Virus: severe acute respiratory coronavirus (Sars-CoV-2).

Spread via inhalation, direct/indirect/closd contact w infected ppl via nose/ mouth secretions.

Covid-19 symptoms

Can be asymptomatic + contagious.

Fever, dry cough, dyspnoea, sore throat, aches + pains, diarrhoea, fatigue, headaches, loss of taste/ smell.

Respiratory red flags adults + infants

Adults/children: Very high temp, persistent cough, neck stiffness! (meningitis), vomiting, skin rash, photophobia, pale/ mottled skin, chest pain, strange breathing sounds/ difficulty, unusual drowsiness, ongoing sx (>10 days).

Infants: bulging fontanelle, high temp, lethargy, earache, persistant crying, 2-3 mo, strange high pitched cry! (croup), loss/ decreasec appetite.

Influenza Antivirals (neurominidase inhibitors)

For pts requiring hospitalisation/ have/ at risk of complications. Commence wi 48hr Sx onset, shortens Sx by 1 day.

Oseltamivir (tamiflu): capsule/ powder for oral solution.

Zanamivir (relenza): inhaled via diskhaler.

Peramivir (rapivab): single IV infusion.

Nonpharmacological respiratory illness Tx

Steam inhalations: in shower, not over bowl w towel.

Saline: use boiled water + cool, not tap (organisms).

COVID-19 Antivirals

Nirmatrelvir + ritonavir (paxloid): preferred oral (vs molnupiravir).

Decreases hospitalisation risk in 90% unvaccinated ppl.

Does not decrease Sx among non-hospitalised adults.

Very expensive (<$1000) + variable eligibility.

NSAIDs examples, MoA, effects

Aspirin, ibuprofen, diclofenac, naproxen.

Inhibit COX-1 (+ prostaglandins causing pain) = normal functioning GIT + kidneys -> GI toxicity + antiplatelet effects.

Inhibits COX-2 = increases w inflammation -> Anti-inflammatory + analgesic effects.

analgesic, antipyretic, anti-inflammatory effects.

NSAIDs precautions

asthma, coagulation disorders, dehydration, renal impairment, active GI bleeding/ PUD, pregnancy, BF = ibuprofen (shortest half life).

aspirin effects + precautions

analgesic, anti-inflammatory, antipyretic, antiplatelet.

associated w reyes syndrome = avoid use (analgesia/ fever) children under 16.

BF = avoid/ delay 1-2 hours post dose.

paracetamol effects, precautions

analgesic, antipyretic (not anti-inflammatory).

avoid - sodium restriction, hepatic damage.

safest for pregnancy + BF.

counselling: NSAIDs

do not take if dehydrated, esp w vomiting/ diarrhoea.

swollen ankles, breathing difficulty, black stools, dark coffee-coloured vomit = stop immediately.

do not take aspirin/ other NSAID simultaneously.

aspirin counselling

taking w food may upset stomach.

remove from packaging just before use, can degrade quickly wo protection.

common causes nasal congestion

common cold, flu, hay fever, sinus infection, vasomotor rhinitis (irritants), drug-induced rhinitis (OCP, aspirin, NSAIDs)

rhinosinusitis symptoms

nasal blockage (congestion/ obstruction), nasal discharge (+ nasal drip), facial pain/ pressure, worse w bending, reduction/ loss of smell

Tx nasal congestion

steam inhalation, saline solutions, decongestants

decongestants examples, MoA, precautions

pseudoephedrine, phenylephrine.

act on alpha adrenoceptors on vascular smooth muscle = vasoconstriction = reduced tissue swelling + nasal congestion.

do not use wi 14 days MAOI. prostatic hypertrophy, closed angle glaucoma, heart disease (inc HR + BP), hyperthyroidism, poorly controlled diabetes.

pregnancy (B2) = avoid, BF = safe, may reduce supply.

phenylephrine schedule, onset, peak, duration, comparison (to pseudoephedrine).

S2 in combo, acts wi 15-20 mins, peak 30-90 mins, lasts 2-4hrs.

less side effects, also works on alpha receptors, sig less CNS stimulation. efficacy not proven.

pseudoephedrine schedule, onset, peak, duration, counselling.

S3 (amphetamine), acts wi 15-30 mins, peak 30-60 mins, lasts 4-6hrs (CR = 12hr).

C: take last dose in afternoon (not after 4pm if subject to insomnia).

intranasal decongestants (metazolines), onset, duration, precautions/ counselling

oxymetazoline, xylometazoline, tramazoline.

onset 5-10 mins, lasts 6hrs.

safest route of admin, can be given for more pt groups.

rebound congestion w prolonged use (>3-5 days).

intranasal phenylephrine: onset, duration, precautions/ counselling

onset 15-30 mins, lasts 4hrs.

ephedrine preferred for children = less potent (S4 prescription only).

safest route of adminis, can be given for more pt groups.

rebound congestion w prolonged use (>3-5 days).

rhinitis medicamente

nasal mucosa receives less blood supply, nasal tissue breaks off + bleeds.

can occur dt prolonged intranasal decongestant use (>3-5 days).

remedy: oral decongestants, saline preps, corticosteroids. discontinue meds in 1 nostril = allow healing.

intranasal anticholinergics: use, precautions, directions

rhinorrhea dt allergy, common cold.

P: closed-angle glaucoma.

systemic absorption possible if travels down throat. clear nose before using.

sedating (1st gen) antihistamines: eg., use, schedule, pregnancy/ BF, CI, ADRs.

eg.

sedation = relieve symptoms (eg. runny nose) by drying action.

combined w phenylephrine = S2, otherwise S3 (unless day + night prep).

CI: dying mucous = may be difficult to cough up. elderly.

ok in pregnancy, lactation (may reduce milk, can pass to infant).

ADR: can develop tolerance, paradoxical effect w children (CNS stimulation), do not use <2 years

Red flags - cough

duration >2wks, persistent fever, chest pain.

new/ altered cough in: smoker >45yrs, immunosuppressed, visited country where TB endemic.

wheeze/ dyspnoea, recurrent noctural cough, pain on inspiration, ineffective cough medication, suspected ADR, stridor/ other respiratory noises (pertussis/ croup).

sputum: thick yellow/ green (bronchioectasis/ bronchitis), bloody (lung cancer/ TB), rusty (pneumonia), frothy + pink/ red (heart failure).

cough suppressants: opioid derivatives - list examples.

dextromethorphan, codeine, dihydrocodeine.

dextromethorphan: onset, duration, CI/Ps, DIs.

onset 15-30mins, lasts 3-6hrs.

no physical dependence potential.

CI/P: do not use in asthma, do not suppress chesty cough, high dose can cause hallucinations, generally well tolerated, can cause drowsiness. safe for pregnancy.

DI: serotonin toxicity (MAOIs, antidepressants, some analgesics eg. tramadol).

codeine: onset, duration, pregnancy cat, P

onset 15-30mins, lasts 4-6hrs.

safe for pregnancy (A).

potential for dependence + abuse. can cause drowsiness.

dihydrocodeine: duration, pregnancy, P.

lasts 4-6hrs. safe for pregnancy (A).

potential for abuse. sorbitol = decreases overdose/ addiction (liquid forms).

antitussive antihistamines: eg., effect, CI/P.

eg. brompheniramine, chlorpheniramine, diphenhydramine, promethazine.

anticholinergic effect = dries mucus (reduces cough). night time sedation = promotes sleep.

do not use if productive cough, do not use w expectorants. not rec for cough/ cold in children.

expectorants - irritants MoA + eg. + duration, MoA, safety, CI/P.

use in productive cough, help expel mucus from lungs.

MoA (irritants): increases volume by decreasing mucus viscosity = removal by ciliary transport + cough. eg. ammonium salts (senega, ammonia).

guaifenesin: 1st line for productive cough.

lasts 4hrs. irritates gastric mucosa = stimulates respiratory tract secretions.

pregnancy cat A, no clinically sig interactions, GI effects, increased cough.

expectorants - mucolytics: MoA, eg, + safety, P.

use in productive cough, helps expel mucus from lungs.

mucolytics: help break down thick + sticky mucus.

bromhexine: pregnancy cat A (safe), CNS + GI effects, allergy potential.

demulcents: eg, effects, safety, P.

eg. glycerin, honey, linctus.

soothe + coat throat, reduce irritation.

safe: children, pregnancy.

no evidence of efficacy.

Sore throat meaning, cause

discomfort at any part of pharynx.

most dt viral infection, self limiting - refer if suspected otherwise.

Local anaesthetics - eg. effect, duration, P.

lignocaine, benzocaine.

numb throat, provide temp relief from soreness. short DoA.

do not use in 3rd trimester pregnancy. care w hot food dt lowered heat perception.

Anti-inflammatories for sore throat purpose + eg.

proven efficacy in relieving sore throat pain.

Flurbiprofen (lozenge), benzydamine (lozenge/ spray/ mouthwash).

Antibacterials/ antifungals for sore throat

chlorhexidine, tyrothricin, dequalinium chloride, benzalkonium chloride.

not recommended for most cases = anti-virals instead.

Povidone-Iodine mouthwash/ gargle

antibacterial, antifungal, antiviral.

short time contact = short DoA. avoid in pregnancy + BF.

decreases plaque + gingivitis. can irritate skin + mucous membranes.

can use for sore throat, halitosis.

analgesia for sore throat

eg. paracetamol, ibuprofen, aspirin.

evidence of efficacy for sore throat.

Andrographis peniculata

complementary medicine widely used E + SE Asia, ayurvedic medicine.

Andrographolide: immunomodulatory, antipyretic, anti-inflammatory, antimicrobial/ antiviral (in vitro).

lowers Sx URTIs = reduces cough, sore throat, Sx overall.

P: allergic reactions, pregnancy, DIs, taste disturbance.

Echinacea (purpurea)

complementary medicine w immunostimulatory effects.

P: allergic reactions, DIs.

Pelargonium sidoides (umckaloabo)

native to south africa, used in europe.

mucolytic, antiviral, antimicrobial, immunomodulator.

P: allergic reactions, may interact w drugs that increase bleeding.

Camphor

from wood of camphor laurel.

inhibit transient receptor channels (same MoA as menthol, eucalyptus).

topical forms = reduce acute cough (chest rub).

Althaea officiinalis (marshmallow root)

forms protective coating on mucosal lining of respiratory tract.

low risk. available for dry cough - insufficient evidence.

Sabucus nigra (elderflower/ black elder)

antiviral properties esp influenza.

may decrease duration of flu Sx by 3-4 days.

Hedera Helix (ivy leaf)

expectorant - productive cough = reduces duration + intensity. associated w acute bronchitis + common cold. well tolerated.

SUSMP meaning

standard for uniform scheduling of medicines + poisons

poison definition SUSMP

any substance listed in a schedule of the SUSMP

medicine def SUSMP

a poison being used for therapeutic purposes (in human/ animal)

schedule 1

intentionally blank

schedule 2

pharmacy medicine

schedule 3

pharmacist only medicine

schedule 4

prescription only medicine

schedule 5

caution

schedule 6

poison

schedule 7

dangerous poison

schedule 8

controlled drug

schedule 9

prohibited substance

schedule 10

such danger to health = prohibited sale, supply, + use.

Appendix H

schedule 3 poisons permitted to be advertised

Appendix K

drug required to be labelled w sedation warning/s

Appendix L

requirements for dispensing labels for human + vetinary meds

Appendix M

additional controls/ supply requirements for poisons listed in S3 to allow them to be provided by a pharmacist.

MPMR meaning + purpose

medicines + poisons (medicines) regulation.

principal piece of legislation controlling use of medicines + poisons in QLD.

“a regulated substance must be dealth with in an authorised way” - MPMR specifies who is authorised, what they can do, and how they can use the substances.

additional MPMR drug categories

Diversion-risk: may be diverted for uses other than their intended purpose (eg. illicit use).

Monitored: schedule 8 medicines, other prescription-only medicines associated w abuse + drug-seeking (eg. sedatives, sleeping tabs). prescribing + supply = recorded on database.

High-risk: cannot be self prescribed. if required, a prescriber must get another to prescribe for them.

Restricted: limited to certain specialist practitioners dt therapeutic risks associated w use (eg. clomiphere, isotretinoin, thalidomides).

EPA/ Extended Practice Authorities purpose

authority to extend a practitioner’s scope of practice beyond that which is provided for in the MPMR.

• sell S4 meds wo prescription (UTIs).

• prescribe hormonal contraception.

• apply topical fluoride varnish.

• prescribe medicines for selected indications.

Legal requirements for handwritten paper prescription

prescribers name/ unique identifier, place of practice, phone/ pager number, qualifications.

pt name + address, date of birth (for monitored medicine).

medicine name, form + strength, how much may be dispensed/ given incl rpts, instructions for use, date for dispensing.

prescription date, prescriber’s signature.

Legal requirements for computer generated prescriptions

unique identifier (script no).

either total no. of medicines prescribed/ scoring or hatching of any blank space above/ below prescriber’s handwritten signature.

space for prescriber to include handwritten signature.