Rx Note

Introduction During my first year of university, the first key point that I was taught to remember is that the maximum recommended dose of paracetamol (acetaminophen) is 4 grams per day. In fact, the lecturer even highlighted that this will be in the final examination. Only later did I learn that a reduced maximum dose (typically 3 grams per day) is recommended for patients at increased risk of liver toxicity . Uses and Dosage Due to its safety profile, paracetamol is a very commonly used drug in both fever and pain management. Often, adult patients (customer) are counselled to take 2 tablets of paracetamol 500 mg up to 3 or 4 times a day (i.e. not more than 8 tablets of 500 mg paracetamol a day). Nonetheless, looking across the products available in the market, paracetamol presents in a number of Brands, such as Uphamol, Panadol, Pamol and Paracil. Combination with other medications (such as cough and cold or muscle relaxants), such as Febricol, Decolgen FX, Maxigesic, Norgesic, Sun...

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 Teething is the process in which the deciduous teeth (sometimes known as milk teeth or baby teeth) emerge through the gum. Most infants start teething around 6 months of age, but some can start as early as 3 months. Teething continues until the age of 2-3 years. NOTE: Primary tooth exfoliation occur as part of the process of permanent tooth eruption , which usually begins at approximately 6 years of age . Symptoms It is normal for infants whose primary teeth are erupting to be cranky, chew on objects, and have excessive drooling . Parents frequently report that their infants who are teething have fever, diarrhoea, or other systemic symptoms. Management The appropriate management of teething is to relieve local discomfort. Chewing on a chilled [not frozen] teething ring. For children who have been weaned, the supervise use of chilled fruit or vegetables (such as banana or cucumber) can be considered. The use of analgesics ( paracetamol suspension) for pain. Topical teeth...

Introduction Plantar fasciitis is one of the most common causes of heel pain . It involves inflammation of a thick band of connective tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Clinical Presentation Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning or after a period of inactivity . The pain typically lessens with gradually increased activity, but worsens toward the end of the day with prolonged weight bearing. The sensation of the bottom of the heel is quite painful, and the patient may complain of a burning sensation. Risk factors Peak incidence at age 40-60 years old Certain types of exercise, such as long-distance running, ballet dancing and aerobic dance Flat feet (pes planus) Obesity Prolonged walking or standing on hard surfaces Treatment Provision of education about the condition including its possible causes. Patients may have unrealistic expectations that med...

Introduction Please refer Clinical Pharmacokinetics Pharmacy Handbook for complete information of individuals drug on Pharmacokinetics Dosage Interaction Sampling Monitoring parameter Adverse drug reaction Dilution and administration Calculation Aminoglycosides Aminoglycosides include amikacin and gentamicin. Is hydrophilic drug. If patient if fluid overload, it is important to correct the fluid balance and resample. Exhibit concentration-dependent bactericidal activity. Post level relates efficacy of the drug. Pre-level , on the other hand, show how well the drug is cleared from the body. The clearance of aminoglycosides is directly related to renal function. Monitoring parameter, such as temperature, white blood cell count, C-reactive protein and culture & sensitivity result. Indicates clinical response of the patient. Toxic effect: Nephrotoxicity and ototoxicity. Ototoxicity is more likely when co-prescribed with loop diuretics (e.g. frusemide) or vancomycin. Nephrotoxicity ...

Introduction Low back pain affects 60-80% of people at some stage in their lives ( most common between the ages of 35 and 55 years) and is often recurrent . Acute back pain is generally regarded as lasting less than 6 weeks, subacute for 6-12 weeks and chronic longer than 12 weeks. Clinical Features Pain in the lower lumbar or sacral area is usually described as aching or stiffness. Depending on the cause, pain might be localized or more diffuse. In case of acute injury, the symptoms come on quickly, and there will be a reduction in mobility. Risk Factors Heavy physical work Frequent bending, twisting or lifting Prolonged static postures Smoking Obesity Physical inactivity NOTE: Low back pain can be caused by gastrointestinal problems (e.g. peptic ulcer or pancreatitis) or genitourinary conditions (e.g. kidney stones , pyelonephritis) but low back pain is not the major presenting symptom. Management Most patients (95%) who present in the pharmacy will have simple back pain that wi...

Introduction Osteoarthritis is a chronic musculoskeletal condition that affects the joint and peri-articular structures . The changes of osteoarthritis can affect the whole joint, including the cartilage, bone, synovial lining and synovial fluid. The most commonly affected joints are those of the hands (particularly the distal interphalangeal joints and the first carpometacarpal joints), the cervical spine, the lumber spine and the knees and hips. Symptoms The major symptoms of osteoarthritis are pain, stiffness and swelling , which can lead to impaired mobility and physical function. Pain is generally worse in the late afternoon and early evening but can also be worse in the morning soon after waking up. Stiffness following inactivity or morning stiffness in osteoarthritis is usually of shorter duration than in rheumatoid arthritis . The joint swelling in osteoarthritis may be bony (hard) due to osteophyte formation and/or spongy (soft) due to effusion or synovial thickening. Soft-ti...

Introduction Migraine is a common primary headache disorder or unclear aetiology. It occurs more commonly in women than in men. It is recurrent in nature and classically presents as moderate-to-severe head pain lasting 4-72 hours . It is typically unilateral with a pulsating quality, accompanied by nausea, vomiting, photophobia, and/or phonophobia, and may be preceded by aura that consists of sensory, motor or language symptoms. Visual auras (accounts for ~90% of auras experienced) can take many forms, such as scotomas (blind spots), fortification spectra (zigzag lines) or flashing and flickering lights. Photophobia and phonophobia often mean that patients will seek out a dark quiet room to relieve their symptoms. NOTE: Headache is not a disease state or condition but rather a symptom, of which there are many causes. Potential Trigger Factors Triggers and strategies to reduce migraine attacks Stress Maintain regular sleep pattern. Perform regular exercise. Modify work environment...

Introduction Insects Stinging insects - those that use some sort of venom as a defence mechanism or to immobilize their prey. Examples include bees, wasps and ants. Biting insects - those that feed off the blood supply of humans and other creatures. Examples include mosquitoes, ticks and fleas. Clinical Features Reactions to insect bites or stings are generally mild , but local or systemic reactions can occur due to hypersensitivity, allergic reaction, transmission of infection, or envenomation. Itching papules, which can be intense, is the hallmark symptom of insect bites. Weals, bullae and pain can occur, especially in sensitized individuals. Lesions are often localized and grouped together, and occur on exposed areas, for example hands, ankles and face. Scratching can cause excoriation, which might lead to secondary infection. In contrast, stings are associated with intense burning pain. Erythema and oedema follow but usually subside within a few hours. If systemic symptoms are ex...

Introduction Pain is 'an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage'. In other words, it is a subjective phenomenon . Hence, if a patient finds that he is in pain, then he is in pain. The function of acute pain is to alert the body to a potential threat , prevent the body from further damage (e.g. by moving away from the trigger), and learn to avoid similar harm in the future. NOTE: Older people are often reluctant to disclose pain for fear of being a burden or developing a drug dependence. Pain Assessment The most commonly used pain scales include Numerical rating scale : rates pain on a number scale, e.g. from 0 (no pain) to 10 (worst imaginable pain). Visual analogue scale : 10-cm-long lines labelled with an extreme at each end, usually "no pain at all" and "worst pain imaginable". Wong-Baker FACES Pain Rating Scale : uses pictures of faces with different expressions...