Rx Note

Introduction Irritable bowel syndrome (IBS) is a symptom-based gastrointestinal disorder characterized by chronic and/or recurrent abdominal pain or discomfort, bloating and altered bowel habits in the absence of other causes for these symptoms (i.e. absence of abnormality). IBS tends to be episodic, where the patient might have a history of being well for a number of weeks or months in between bouts of symptoms. The cause is unknown, although it is sometimes related to particular foods, and is often precipitated or aggravated by stress. A theory that it occurs due to miscommunication between the brain and the gut, and that gut coordination is affected (dysmotility). Accroding to predominant bowel habit, IBS has been subtyped as IBS with constipation IBS with diarrhoea IBS with mixed symptoms of constipation and diarrhoea (mixed type) Unclassified Indicative for Referral Blood in the stool Is unusual in IBS and can suggest inflammatory bowel disease (e.g. Crohn's disease and ulce...

Introduction Constipation is a very common symptom where public walks into a community pharmacy looking for self-treatment. Symptoms of constipation commonly include: Difficulty passing stools A feeling of incomplete evacuation Abdominal discomfort and bloating Gather Patient Information As a community pharmacist, the three things that you should do are: To establish the patient's current bowel habit compared with normal Constipation involves the passage of hard stools less frequently than is normal. "Normal" can be anything from two or three times a day to two or three times a week; it is the change that is important! To identify if there is any indicative of referral Longer than 14 days' duration with no identifiable cause Pain on defecation that might cause the patient to suppress the defecation reflex Constipation alternating with diarrhoea Blood in the stools Infants under the age of 3 months - to exclude organic causes such as Hirschsprung's disease Then co...

Introduction Parkinson Disease is a progressive movement disorder characterized by bradykinesia, resting tremor, muscular rigidity and loss of postural reflexes. It is due to a loss of dopaminergic neurons in the substantia nigra, as well as other dopaminergic and nondopaminergic areas of the brain. The prevalence of Parkinson disease increases with age. Non-motor complications of Parkinson disease are major causes of disability. Fatigue Neuropsychiatric symptoms, e.g. depression , anxiety , psychosis Sleep disturbances Autonomic symptoms, e.g. orthostatic hypotension, bladder dysfunction, constipation, sexual dysfunction Pain and other sensory symptoms Dysphagia Dementia - common in late disease, with a prevalence of 20-40%; Patients with Parkinson disease are at an increased risk of falls, poor nutrition, weight loss and a loss of muscle mass. Management Parkinson disease has no cure, so the principles of treatment are to Keep the patient functioning as long as possible with the ...

Introduction The Bristol Stool Chart or Bristol Stool Scale was developed at the British Royal Infirmary, England in 1997. It classifies stools (known as "faeces" or "poo") into 7 types. Interpretation Stool types 1 and 2 indicate constipation , while stool types 6 and 7 are associated with diarrhoea (and stool type 5 to some degree). Stool types 3 and 4 are normal (ideal) stools as they are easy to defecate while not containing excess liquid. External Links Stool form scale as a useful guide to intestinal transit time, 1997 Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome, 2016 Rome Criteria and a Diagnostic Approach to Irritable Bowel Syndrome, 2017 Digestive Disorders: What Your Poop Type and Color Mean, 2018 Continence Foundation of Australia - Bristol Stool Chart

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...

Introduction In everyday life, we often have to make decisions based on incomplete information. We use our analytical skills to gather information, assess the situation and make the best possible decision. Analytical thinking is the ability to break down a problem into its component parts and identify the relationships between them. Along with critical thinking, it is a crucial aspect of problem solving, decision making and data analysis. Case Study: Constipation In a community pharmacy setting, pharmacists often use their clinical reasoning skill to diagnose and recommend treatments for common minor symptoms such as cough , diarrhoea and gastric issues. For example, a 34-year-old mother brings her 4-year-old son to the pharmacy because he has been constipated for a few days. Before making any product recommendations, the pharmacist would first need to establish the following: Whether the diagnosis of constipation is correct Different people have different normal bowel habits, rangi...

Indications Clozapine is an antipsychotic that should be offered to people with schizophrenia whose illness has not responded adequately to treatment despite the sequential use of adequate doses of at least 2 different antipsychotic drugs (i.e. treatment resistant schizophrenia ). Also, it is used to treat psychosis associated with Parkinson's disease . Initiation Schedule Start treatment at a low dose and to increase dosage slowly. Many of the adverse effects of clozapine are dose-dependent and associated with speed of titration. Adverse effects (e.g. sedation, hypersalivation and hypotension) also tend to be more common and severe at the beginning of therapy. Taken at night. Blood pressure should be monitored hourly for 6 hours because of the hypotensive effect of clozapine. This monitoring is not usually necessary if the first dose is given at night. Missed Doses If, for any reason, a patient misses <2 days' clozapine, restart at the dose prescribed before the event. Do ...