Workshop 1: Navigating the BNF, eMC, netdoctor and NHS ...



Self Directed Learning: Navigating the eBNF, eMC, NetDoctor, MedicinesChest, and NHS Direct Q&As (1)

Use the eBNF, eMC, NetDoctor, MedicinesChest and NHSD Q&As to answer the following questions.

|1 |Can I buy Vermox® from a pharmacy? |eBNF: Vermox POM |

| | |eMC – SPC: Vermox Legal Category POM. |

| | |NetDoctor: Prescription Only |

| | |MedicinesChest: No information. |

| | |NHS Direct Q&As: No information. |

|2 |Name three side-effects of amitriptyline. |eBNF: dry mouth, sedation, blurred vision |

| | |eMC – PIL: Amitriptyline tablets (Actavis) – allergic |

| | |effects, effects on the blood, effects on the endocrine |

| | |system and metabolism. No SPC for Amitriptyline tablets. |

| | |NetDoctor: dry mouth, drowsiness, blurred vision. |

| | |MedicinesChest: No information. |

| | |NHS Direct Q&As: No information. |

|3 |How long will my Zineryt® lotion keep for? |eBNF: No information |

| | |eMC – SPC: 6.3 Shelf life - 2 years; 5 weeks after constitution. |

| | |eMC – PIL: Do not use after the “Use before” date |

| | |that your pharmacist has put on the label. |

| | |NetDoctor: No information. |

| | |MedicinesChest: No information. |

| | |NHS Direct Q&As: No information. |

|4 |Is it OK to take St John’s Wort with |eBNF: Interaction between St John’s Wort and SSRIs. |

| |citalopram? |Possible increased serotonergic effects when St John's |

| | |Wort given with SSRIs - avoid concomitant use. |

| | |eMC – SPC: Cipramil tablets. 4.5 Interaction with other |

| | |medicinal products and other forms of interaction. |

| | |Dynamic interactions between citalopram and herbal |

| | |remedy St John's Wort (Hypericum perforatum) can |

| | |occur, resulting in an increase in undesirable effects. |

| | |eMC – PIL: Cipramil tablets. Before using Cipramil. The |

| | |herbal remedy St John’s Wort (Hypericum perforatum) |

| | |should not be taken at the same time as this medicine. |

| | |If you already take a St John’s Wort preparation stop |

| | |taking the St John’s Wort and mention it to your |

| | |doctor at your next visit. |

| | |Netdoctor: There may be an increased risk of |

| | |side effects if citalopram is taken with the following, which |

| | |also enhance the activity of serotonin in the brain: |

| | |duloxetine, lithium, rasagiline, sibutramine, triptans |

| | |for migraine, eg sumatriptan, tramadol, tryptophan. The |

| | |herbal remedy St John's wort should not be taken with |

| | |citalopram for the same reason. |

| | |MedicinesChest: No information. |

| | |NHS Direct Q&As: No information. |

|5 |What is the best way to take my Fosamax® |eBNF: (Alendronic acid entry under Dose heading.) Counselling - Tablets should be swallowed |

| |Once-Weekly tablets? |whole |

| | |with plenty of water while sitting or standing; to be taken |

| | |on an empty stomach at least 30 minutes before |

| | |breakfast (or another oral medicine); patient should |

| | |stand or sit upright for at least 30 minutes after |

| | |taking tablet |

| | |eMC – SPC: 4.2 Posology and Method of Administration. To permit adequate absorption of |

| | |alendronate: |

| | |'Fosamax' must be taken at least 30 minutes before |

| | |the first food, beverage, or medicinal product of the |

| | |day with plain water only. Other beverages |

| | |(including mineral water), food and some |

| | |medicinal products are likely to reduce the absorption |

| | |of alendronate (see 4.5 'Interaction with other |

| | |medicinal products and other forms of interaction'). |

| | |To facilitate delivery to the stomach and thus reduce |

| | |the potential for local and oesophageal irritation/ |

| | |adverse experiences (see 4.4 'Special warnings |

| | |and precautions for use'): |

| | |• 'Fosamax' should only be swallowed upon arising for |

| | |the day with a full glass of water (not less than 200 ml or |

| | |7 fl.oz.). |

| | |• Patients should not chew the tablet or allow the tablet |

| | |to dissolve in their mouths because of a potential |

| | |for oropharyngeal ulceration. |

| | |• Patients should not lie down until after their first food |

| | |of the day which should be at least 30 minutes after |

| | |taking the tablet. |

| | |• Patients should not lie down for at least 30 minutes |

| | |after taking 'Fosamax'. |

| | |• 'Fosamax' should not be taken at bedtime or before arising for the day. |

| | |eMC – PIL: Fosamax Once Weekly 70mg tablets. |

| | |HOW TO TAKE FOSAMAX |

| | |Take one FOSAMAX tablet once a week. |

| | |Follow these instructions carefully to make sure you |

| | |will benefit from FOSAMAX. |

| | |1) Choose the day of the week that best fits your |

| | |schedule. Every week, take one FOSAMAX tablet on your chosen day. |

| | |It is very important to follow instructions 2), 3), 4) and 5) |

| | |to help the FOSAMAX tablet reach your stomach |

| | |quickly and help reduce the chance of irritating your |

| | |gullet (oesophagus - the tube that connects your |

| | |mouth with your stomach). |

| | |2) After getting up for the day and before taking any food, drink, or other medicine, swallow |

| | |your FOSAMAX |

| | |tablet with a full glass of water only (not mineral water) |

| | |(not less than 200 ml or 7 fl. oz.). |

| | |• Do not take with mineral water (still or sparkling). |

| | |• Do not take with coffee or tea. |

| | |• Do not take with juice or milk. |

| | |Do not chew the tablet or allow it to dissolve in your |

| | |mouth. |

| | |3) Do not lie down — stay fully upright (sitting, standing or walking) — for at least 30 |

| | |minutes after swallowing |

| | |the tablet. Do not lie down until after your first food of |

| | |the day. |

| | |4) Do not take FOSAMAX at bedtime or before getting up for the day. |

| | |5) If you develop difficulty or pain upon swallowing, chest pain, or new or worsening |

| | |heartburn, stop |

| | |taking FOSAMAX and contact your doctor. |

| | |6) After swallowing your FOSAMAX tablet, wait at least 30 minutes before taking your first |

| | |food, drink, or other medicine of the day, including antacids, calcium supplements and |

| | |vitamins. FOSAMAX is effective only if taken when your stomach is empty. |

| | |NetDoctor: Your tablet should be taken on the same day each week, in the morning at least 30 |

| | |minutes before the first food, drink or medicine of the day. The tablet should be swallowed |

| | |whole with a glass of plain water (at least 200ml, not mineral water) while you are sitting or|

| | |standing in an upright position. Do not chew or suck the tablet. You should not lie down for |

| | |at least 30 minutes after taking the tablet. You should not eat or drink anything other than |

| | |plain water for at least 30 minutes after taking the tablet. This is because food and some |

| | |drinks (including mineral water) can interfere with the absorption of the medicine from the |

| | |gut and hence make it less effective. |

| | |MedicinesChest: No information. |

| | |NHS Direct Q&As: No information. |

|6 |What should I do if I miss a dose of |eBNF: No information. |

| |levothyroxine 100mcg? |eMC – SPC: No information. |

| | |Netdoctor: No information. |

| | |MedicinesChest: No information. |

| | |NHSD FAQ: What should patients do if they miss a dose of their medicine? [UKMi Q&A N22.1] |

| | |Fully referenced answer. |

| | |eMC - PIL: Levothyroxine tablets 50mcg, 100mcg (Actavis) If you forget to take a tablet take |

| | |one as soon as you remember, unless it is nearly time to take the next one. Never take two |

| | |doses together. Take the remaining doses at the correct time. |

|7 |I can’t swallow tablets. Is it OK to crush |eBNF: Tablets (Zyprexa®) are film coated, but an orodispersible formulation (Velotab®) is |

| |my olanzapine tablets? |available. |

| | |eMC – SPC: Zyprexa® 2.5mg, 5mg, 7.5mg, 10mg, 15mg, and 20mg coated tablets. Zyprexa Velotab |

| | |5mg, 10mg, 15mg, and 20mg orodispersible tablets. |

| | |5.2 Pharmacokinetic Properties. Olanzapine orodispersible tablet is bioequivalent to |

| | |olanzapine coated tablets, with a similar rate and extent of absorption. Olanzapine |

| | |orodispersible tablets may be used as an alternative to olanzapine coated tablets. |

| | |eMC – PIL: Zyprexa® 2.5mg, 5mg, 7.5mg, 10mg, 15mg, and 20mg coated tablets. You should take |

| | |your ZYPREXA tablets once a day following the advice of your doctor. Try to take your tablets |

| | |at the same time each day. It does not matter whether you take them with or without food. |

| | |ZYPREXA coated tablets are for oral use. You should swallow the ZYPREXA tablets whole with |

| | |water. |

| | |NetDoctor: No information. |

| | |MedicinesChest: No information. |

| | |NHS Direct Q&As: No information. |

|8 |My doctor has prescribed Topamax®. Will I |eBNF: Topamax® contains Topiramate. Topiramate can be given alone or as adjunctive treatment |

| |still be able to drive? |in generalised tonic-clonic seizures or partial seizures with or without secondary |

| | |generalisation. It can be used as adjunctive treatment for seizures associated with |

| | |Lennox-Gastaut syndrome. Topiramate is also licensed for prophylaxis of migraine. |

| | |Under section 4.8.1 Control of epilepsy. |

| | |Patients suffering from epilepsy may drive a motor vehicle (but not a heavy goods or public |

| | |service vehicle) provided that they have had a seizure-free period of one year or, if subject |

| | |to attacks only while asleep, have established a 3-year period of asleep attacks without awake|

| | |attacks. Patients affected by drowsiness should not drive or operate machinery. Guidance |

| | |issued by the Drivers Medical Unit of the Driver and Vehicle Licensing Agency (DVLA) |

| | |recommends that patients should be advised not to drive during withdrawal of antiepileptic |

| | |drugs, or for 6 months afterwards |

| | |eMC – SPC: 4.7 Effects on ability to drive and use machines. Topamax can produce central |

| | |nervous system related adverse events and may be more sedative than other antiepileptic drugs.|

| | |Drowsiness is a likelihood. In addition, there have been reports of visual |

| | |disturbances/blurred vision. Patients should be warned of these and advised that if affected, |

| | |they should not drive, operate machinery and/or take part in activities where such reactions |

| | |could put themselves or others at risk. |

| | |eMC – PIL: Special Warnings. Topamax® may cause you to be less alert than normal or experience|

| | |blurred vision or other types of visual disturbances. Make sure you know how you are affected |

| | |by this medicine before you drive, use machines or do anything else that could put yourself or|

| | |others at risk. |

| | |NetDoctor – Epilepsy monograph: To hold a civilian driving licence in the UK you need to have |

| | |been seizure-free for 12 months, or only had seizures at night while asleep. |

| | |MedicinesChest: No information. |

| | |NHS Direct Q&As: No information. |

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