What advice should patients be given if taking 2 or more eye application?
space out by 5 mins
apply ointment last
what time of day is best to apply eye ointment?
at night
What are the expiry dates of eye applications in different settings?
Home = 28 days hospital = 1 week outpatient/surgery = single application
Which preservative is used in eye applications and is likely to cause stinging and irritation
Benzalkonium chloride
Which lenses can be kept on during eye application and which lenses should be removed?
Hard lenses = can still use drops
Soft lenses = remove before use
which eye applications should patients never wear lenses during the use of?
ointments and oily eye drops
which drugs stain contact lenses?
rifampicin and sulfasalazine
which eye drops are mast cell stabilisers?
sodium cromoglicate
which eye drops are antihistamine
antazoline
azelastine
which eye drops are vasoconstrictors (reduce redness)
xylometazoline
naphazoline
what eye drops can be used for dry eyes?
Carmellose
Hypromellose
Which medication can be used for eye inflammation?
Topical corticosteroid
pred forte
what are the risks with ophthalmic corticosteroids
glaucoma and cataracts
increased risk of infection and exacerbation of infection
whats the treatment for corneal ulcer (possible blindess)
ciprofloxacin
What is first line in glaucoma and raised intraocular pressure?
prostaglandin - latanoprost (contraindicated in asthma)
beta blockers -betaxolol (Long eye lashes and darker iris colour)
what is second line in glaucoma?
sympathomimetics - brimonidine
carbonic anhydrase inhibitors - brinzolamide, dorzolamide eye drops
oral acetazolamide
what are the symptoms of closed-angle glaucoma?
cloudy eye
n and v
intense eye pain
rainbow-coloured rings around
what are the properties of different skin formulations?
Ointments - greasy, most hydrating
Creams - less greasy, dry out quicker
Gels - high water content suitable for scalp face application
lotions - cooling effect, best for large hairy areas
which excipients should be avoided in neonates ?
salicylate
benzyl alcohol
Whats the MHRA on emollients?
fire hazard with paraffin based emollients
advice on emollients?
apply as often as possible apply in direction of hair growth apply after washing/ bathing bath emollients are slippy soak for 10-20 minutes
Which topical corticosteroids are mild?
Hydrocortisone <2.5%
which Topical corticosteroid are moderate?
Clobetasone
Betamethasone 0.025%
which topical corticosteroids are potent?
betamethasone 0.1%
hydrocortisone butyrate mometasone
which topical corticosteroids are very potent?
Clobetasol
Whats the dose of topical corticosteroids?
apply thinly no more than twice a day
How should steroids be applied with emollients?
apply emollient then wait 30 mins for maximum absorption
What is the treatment of Rosacea?
6-12 week course
Topical: metronidazole, azaelic acid, ivermectin
Oral: oxytetracycline, tetracycline, erythromycin
Redness; Brimonidine
what are the MHRA alerts on Brimonidine?
Cardiovascular effects
exacerbation of Rosacea
Whats the ideal method of contraceptions for patients taking Retinoids?
barrier plus COC for 1 month before and after treatment
POP is not effective
When and how often should the pregnancy test be taken for retinoids ?
first 3 days of menstrual cycle or up to 3 days before treatment
repeat every months and for 5 weeks after stopping
What are the rules of the pregnancy prevention programme?
2 tests to exclude pregnancy
Rx valid for 7 days, 30 days supply
Emergency supply requires negative pregnancy test
What are the side effects of Isotretinoin?
Hyperglycaemia Hypertriglyceridaemia high cholesterol pancreatitis hepatotoxicity
Skin peeling, dryness
What is the MHRA report on isotretinoin?
Rare reports of erectile dysfunction and decreased libido
What are the counselling points with retinoids?
Avoid wax epilation or dermabrasion/laser treatment during or 6months after
Photosensitivity
STOP if psychiatric reactions occur
What vaccines are given at 2 months?
First 5 in 1
Rotavirus
Pneumococcal
MenB
What vaccines are given at 3 months?
second 5 in 1
Rotavirus
What vaccines are given at 4 months?
Third 5 in 1
Pneumococcal
MenB
What vaccines are given at 12-13 months?
First MMR
boosters MenB, Pneumococcal
Hib/MenC
What vaccines are given in primary school?
3 years 4 months
2-6 years
3yrs4mnths - Second MMR, 4 in 1 (minus Hib)
2-6 years - Annual Flu Vaccine
What vaccines are given in Secondary school?
12-13 years girls
13-18 years
12-13 years: HPV
13-18 years: 3 in 1 (minus hib and pertussis), Men ACWY
What are the paracetamol doses for post immunisation fever?
60mg asap
60mg 4-6 hours later
No more than two doses in 24 hours
(Max 4 doses in 24hours in 4 months)
What are the ibuprofen doses for post immunisation fever?
50mg after vaccine
50mg 6 hours later
no more than two doses in 24hours
When are 3 doses of paracetamol allowed in post immunisation fever?
Men B at 2 months and 4 months (only give paracetamol in this case)
What patients are eligible for the Pneumococcal vaccine?
65 years
what patients are eligible for the shingles vaccine?
70 years
Drugs which can exacerbate psoriasis?
Lithium chloroquine hydroxychloroquine beta blockers NSAIDs ACE inhibitors
BLANCHe
Immunisation dose of Paracetamol for 4 month year olds?
60mg initially then 60mg every 4/6 hrs
MAX 4 doses