CSB420 – Core Content to Remember

Core Pharmacy Concepts

  • Indication: The condition for which a medication is used, either labelled or accepted.

  • Precaution: Instances where a medication can be used, but necessitates care and monitoring.

  • Contraindication: Situations where a medication should not be used due to the risks outweighing the benefits.

  • Main Resources:

    • AMH (Australian Medicines Handbook): Provides information on dosages and precautions.

    • eTG (Therapeutic Guidelines): Offers guidelines on treatment protocols.

    • APF (Australian Pharmaceutical Formulary): Focuses on extemporaneous compounding and preparation of medications.

    • MIMS (Monthly Index of Medical Specialties): A comprehensive reference for medicines and their uses.

  • Patient-Centred Communication:

    • Building rapport with patients to establish trust.

    • Check understanding: Implementing the teach-back method to ensure patients comprehend their treatment.

    • Tailoring communication to address the patient's age, culture, and health literacy.

Clinical Reasoning & Respiratory Infections

  • Structured Approach to Clinical Reasoning:

    1. Collect information about the patient.

    2. Identify problems based on collected data.

    3. Decide if the case is suitable for pharmacy treatment.

    4. Develop a management plan based on the findings.

  • Common Conditions:

    • Upper Respiratory Tract Infections (URTI), colds, and influenza are typically viral infections that require:

    • Symptomatic care to alleviate symptoms.

    • Infection control measures to prevent spread.

    • Referral to healthcare professionals when specific red flags are present.

  • Red Flags for Referral:

    • Persistent high fever.

    • Shortness of breath (SOB) or chest pain.

    • Symptoms lasting longer than 10 days.

    • High-risk groups: individuals who are very young, elderly, or pregnant.

  • Non-Drug Management:

    • Always a consideration for care; includes encouraging rest, fluid intake, hygiene practices, and avoiding unnecessary antibiotic use.

Legislation, Schedules, and Dispensing

  • Medicine Scheduling:

    • Medicines are categorized into schedules to maintain a balance between access and safety.

    • The scheduling is indicated by codes (S2, S3, S4, S8), where a higher number indicates more stringent control.

  • Prescription Requirements:

    • Familiarity with the basic legal requirements for a prescription in various states or territories.

    • Knowledge of what essential information must appear on a dispensing label.

  • Counselling in Dispensing:

    • Important components include confirming the patient's identity, the medication being dispensed, dosages, directions for use, possible warnings, and follow-up procedures.

  • Safety in Dispensing:

    • Safe dispensing practices involve a structured workflow combined with verification steps to reduce the likelihood of medication errors.

Fungal and Candida Infections

  • Types of Infections:

    • Superficial/Cutaneous Infections: Commonly encountered and often manageable within pharmacy settings.

    • Dermatophytes: Affects keratinized tissues such as skin, hair, and nails.

    • Yeasts (Candida): Typically affect moist and flexural areas of the body.

  • Treatment Protocol:

    • Topical antifungals, such as azoles or allylamines, are the first-line treatments for localized skin infections; they should be continued for 1–2 weeks after symptom resolution.

  • Referral Criteria:

    • Referral is necessary for:

    • Extensive disease.

    • Nail involvement or infections on the face/genitals.

    • Broken skin or secondary infections.

    • Recurrent or persistent infections.

  • Management of Candida Infections:

    • Combined approach involving antifungal medications and addressing local environmental factors like moisture, irritants, and tight clothing.

Parasites and Ectoparasites

  • Headlice Management:

    • Confirmation of live lice presence is essential.

    • Appropriate treatment products must be selected, along with mechanical removal when necessary.

    • Contact tracing and environmental cleaning are crucial components of management.

  • Product Considerations:

    • Selection should be based on:

    • Patient age and condition of the scalp.

    • Pregnancy and breastfeeding status.

    • Resistance to treatments and patient preferences.

  • Threadworm Management:

    • Treatment should involve the entire household, repeating doses when necessary.

    • Emphasize hygiene practices such as handwashing, nail care, and washing of linens.

  • Scabies Management:

    • Usually requires prescription treatment and the management of contacts to prevent reinfection.

Allergy, Eye, Oral, and Pediatric Considerations

  • Allergy Management:

    • Differentiate between mild/moderate allergies and anaphylactic reactions.

    • Anaphylaxis: Characterized by airway, breathing, and circulation compromise; classified as a medical emergency.

  • Dry Eye Management:

    • Identify the underlying cause of dry eyes.

    • Selection of lubricants should be preservative-free for frequent use, especially for users of contact lenses.

    • Teaching correct instillation techniques for eye drops is crucial for effectiveness.

  • Oral Care Considerations:

    • Recognize common oral health issues such as ulcers, dry mouth, and risks of caries.

    • Determine when a referral to a dental professional is warranted.

  • Pediatric Pharmacy Practice:

    • Involves weight-based dosing and ensuring age-appropriate formulations.

    • Avoidance of contraindicated medications is paramount.

    • Supporting breastfeeding and providing appropriate health literacy is critical for optimal pediatric care.

Pharmaceutics and Formulation Crossover

  • Definition of a Medicine:

    • A medicine is defined as a drug combined with excipients specifically designed to deliver the therapeutic dose safely and effectively.

  • Key Pre-Formulation Properties:

    • Important properties to understand include:

    • Solubility: The capacity of the drug to dissolve.

    • pKa: The dissociation constant that quantifies the acidity or basicity of the drug.

    • LogP: A measure of hydrophobicity which predicts the partitioning between blood and tissue.

    • Stability: The longevity of drug efficacy under various conditions.

  • Strategies for Poorly Soluble Drugs:

    • May require specific strategies such as:

    • Salt formation to enhance solubility.

    • Reducing particle size to improve dissolution rates.

    • Selection of suitable dosage forms designed to optimize absorption and efficacy.

  • Route of Administration and Dosage Form Selection:

    • The chosen route impacts the onset of action, duration of effects, and overall patient adherence to the treatment plan.