Rx Note

Introduction In a community pharmacy setting, almost on a daily basis, we recommend oral antihistamine to our customers, which could be for prevention and treatment of symptoms in allergic rhinitis , allergic conjunctivitis, urticaria , or a variety of other allergic diseases. 1st and 2nd Generation As an overview, antihistamines can be classified into 1st and 2nd generation. This dichotomy was introduced in 1983 to indicate a major pharmacological difference between terfenadine and astemizole. Being less lipid soluble, the second generation antihistamines is thus believed to be less readily penetrated the blood brain barrier, and hence does not cause drowsiness. However, second generation antihistamines are still able to penetrate the blood brain barrier and may cause drowsiness (thought it rarely occurs). In fact, there are textbooks using the terminology of "less sedating antihistamines" to describe the second generation antihistamines, instead of "non-sedating antih...

Introduction A bruise (also known as contusion) is an injury appearing as an area of discoloured skin that is commonly caused by blunt impact , such as a fall, trauma or bump, resulting in damage of the soft tissues, including rupture of small blood vessels (capillaries) without cuts on the skin . Older people are more prone to bruising. NOTE: A haematoma is a larger collection of blood, usually caused by surgery, injury or greater trauma. Like a bruise, haematomas will usually be reabsorbed into the body. However, depending on the size, location and cause of the haematoma, the area may need to be drained surgically or take a longer period of time to resolve. Symptoms The blunt force trauma damages capillaries beneath the skin, causing blood to leak into the surrounding tissue. Skin discolouration is initially red or pink, gradually becoming blue, green and yellow. Most bruises heal in 1 to 2 weeks, but some take longer. NOTE: The characteristic colour changes of a bruise are due to...

Introduction Raynaud phenomenon is a common condition that is triggered by exposure to cold and/or stress , leading to vasospasm in the extremities (most commonly in the fingers and/or toes). The vasospasm causes the skin to turn white and then blue, which is followed by painful swelling when the affected areas warm and can result in amputation in severe cases. NOTE: Raynaud phenomenon can be a primary condition or can occur secondary to a connective tissue disease (e.g. systemic sclerosis) or other disease (e.g. arthrosclerosis, malignancy) Management For patients with uncomplicated Raynaud phenomenon (no progression to digital ulceration or critical ischemia), lifestyle changes are effective to control attacks. Avoid cold exposure, e.g. the use of gloves and warm clothing Smoking cessation Avoid vasoconstricting drugs, e.g. pseudoephedrine, phenylephrine, methylphenidate, beta blockers In more severely affected patients, particularly those with an underlying connective tissue diseas...

Introduction Since medicines taken by breastfeeding mothers may pass into breast milk, this article explores the safe use of over-the-counter medications while breastfeeding Medicines that passed into breast milk in small quantities rarely affects breastfed babies. Pain Paracetamol is considered compatible with breastfeeding when used in usual recommended doses to treat mild pain, such as headaches, toothaches, muscular pains or to reduce fever. NSAIDs are safe to help relieve pain and inflammation, but selective NSAIDs (COX-2 inhibitors) have limited data. Of the NSAIDs, ibuprofen is considered the drug of choice. Naproxen should be used cautiously in breastfeeding women due to its long half-life and has been documented to cause prolonged bleeding, anaemia and thrombocytopenia in a breastfed infant. Cough For a dry cough , a cough suppressant such as dextromethorphan is considered safe while breastfeeding. For a chesty cough , an expectorant such as guaifenesin or a mucolytic such ...

Introduction Given the potential for teratogenic effects of certain drugs, this article explores the safe use of over-the-counter medications during pregnancy. Products containing alcohol should be avoided. Pain The use of paracetamol (acetaminophen) in recommended doses during pregnancy has not be associated with an increased risk of miscarriage or still birth. Nonetheless, paracetamol should be used at the lowest effective dose for the shortest duration of time to effectively treat the mother and protect the health of the foetus (inconclusive data on adverse events such as wheezing and asthma in early childhood, adverse effects on male reproductive development and ADHD or autism spectrum disorders) An increase in foetal death or spontaneous abortion may been seen following maternal overdose if treatment is delayed. In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks' gestation because of the risk of Miscarriage in early pregnancy; however, evi...