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Ooh.. I was asked this question by someone over the phone the other day.

I couldn’t help the person coz i didnt know what active ingredient was in lidoderm, it wasn’t in my ‘bibles’ … ishh so I had to refer her to the doctor, which i hate doin because it is such a simple question. Anyway Versatis is the one we commonly see in the dispensary – lidocaine 5% plasters, I have seen Lidoderm, and kinda knew it was the same stuff, but i wasnt sure. So my friend sent me the link online for Lidoderm http://www.lidoderm.com/ .. so we found out its exactly the same as versatis plasters.

Learnt another thing today. Great.

Just a reminder – lidocaine is a local anesthetic, that temporarily blocks pathway of pain signals along the nerves.

So if you followed my blog, ud know about the lady who bleed all over. She came back yesterday, to say thank you. To remind you, it is the lady that I tried to bandage, and sent her to the nearest surgery as the bleeding went on for hours. So she said the doctors applied steri strips for her to stop the bleeding. It is that simple. I thought about it only after she left, they are also called the butterfly strips. So now I know what to do with deep cuts!

2 queries that I had to look up today

1. Lump/swelling inside the mouth, on the gums. Red, and a lump bulging out. No pain. Didnt know what it was, referred.

2. Query on treatment for worms. At 1st customer said round worms, then later she said its threadworm, she got confused with ringworms. Anyway I looked it up in the bnf, so mebendazole, over the counter, can be used for all sorts of worms. However, it is only licensed as single dose of 100mg, and maximum packet size of 800mg. If it is threadworm, single dosing will be sufficient. However if it is round worm, whipp worm or others, they require several dosing a day for 3 days. So I guess we can only treat thread worm in the pharmacy? I sold 2 packets, ech with 4 tablets, so that makes it 800mg. For a family of 5. SO hopefully I didnt do anything illegal today

Went back to my pre-reg store today, nothing exciting happened .

There were not many queries for me today because the counter staff was quite good. But I had a boy showing me several round scaly patch on his body, above the chest and at the back near the shoulders. There were several round patches, individual ones, not joined together, but I could easily see 5 or more. They were the size of 5 penny or smaller. But they all got very obvious  edge, and its scaly not smooth, not itchy either. Well, one thing for sure it wasnt on the scalp or the groin area, so I gave him canestan 1%. I think is is ring worm. However, I have not seen many individual ones, it just made me wonder if it could be something else. Definately not pox too. I hope I was right, i know the antifungal cream wouldnt harm him. But I have also told the mom if the cream doesn’t help, go to the doctor.

Another query was from a staff, she is on warfarin, anti-hypertensive, glaucoma meds, and wanted travel sickness tablets. I know most of them will not be suitable ie the hyoscine hydrobromide or cinnarizine, due to the antimuscarinic effects. Bnf did say cautious with hypertension, angle closure glaucoma etc. Besides the motion sickness band, I would refer. What would you do?

I just remembered the other day, I saw a prescription for Maxalt Melt (Rizatriptan) for migraine. It was 5mg. One of my collegues brought up the issue to me that patient recently had 6 Maxalt on 26th July, Frovatriptan on 29th July, and 6 Maxalt again on 2nd Aug. This issue was definately worth looking into.

Anyone should not take 2 different anti-migraine treatments at the same time. However, bearing in mind the dates she had these tablets, they were 3days apart. With the Maxalt, maximum daily dose is 20mg, and for frovatriptan, up to 2 tablets a day. So she probably had several episodes within the last 7 days.

When the carer came, I managed to find out what was actually going on. So, patient had 6 episodes of migraine in the last 10 days. She started off with maxalt, then frovatriptan, now back to maxalt, maxalt melts in the tongue, thus work faster, I guess thats why she is given these instead of frovatriptan. The doctor has also started patient on Amitriptyline, which can be used as prophylactic treatment for migraine.

I did give out the maxalt melt this time, but I made sure carer was aware that she shouldnt take 2 treatments at the same time, and not exceed stated dose. If 1st tablet doesnt give any improvement, a second dose shouldnt be taken. Hopefully the amitriptyline will help to reduce the frequency of migraine in the future. One point to remember, overdosing on anti-migraine drugs ie. Triptans, can cause drug related headaches.

So today I was working near the harbour, where most tour busses stop. Because of its location, there were so many queries, especially from the visitors. The good thing is we were so quiet with prescriptions, we did only 52 items. It is the least I have ever seen so far. But that was really good, it gave me time to sort out all the queries Over the counter.

I think  I covered almost all conditions on the counter today! You name it. Lol.. Another very happy day for me.. Let me tell you what I’ve seen today, Im so proud! Iv never seen so many conditions in a day!

• Ring worm – I sold canestan 1% cream
• Atheletes foot – I didnt think it was atheletes foot, so I didnt sell the anti-fungal cream, just sold E-45 cream instead
• Injured palm/wrist – I measured her wrist, sold Tubigrip , and ask her to take paracetamol
• Coldsore/sore mouth – Only a tiny blister near the mouth, didn’t think it was coldsore, I sold blistex instead of zovirax, because it has been there for 3 days, zovirax wont help much.
• Migraine – Sold co-codamol effervescent tablets (I regretted this, because apparently codeine can slow down the movement in the gut, so may slow down absorption of the drug, I would sell soluble aspirin or soluble paracetamol the next time, I sold it to them because I knew Yellow Migraleve contains paracetamol + codeine, but now I think its not a good choice)
• Corns – Put on corn plasters for several customers
• Travel sickness tablets for a lady on baclofen and dihydrocodeine – sold boots hyoscine hydrobromide, mentioned about constipation to her
• Contact dermatitis due to new washing powder – sold hydrocortisone 1% cream, advised him to apply thinly once or twice daily, no longer than 7 days.
• Head lice for asthmatic and high blood pressure – sold malathion – Derbac-M
• Had several queries on wasp stings, bites etc..
• Had a lady coming in with a deep cut on her finger, that hasnt stop bleeding since 5 hours ago!!! Blood was still gushing out, and dripping everywhere, had to sit her down, got the 1st aid kit, bandage it up for her, and referred her to the nearest surgery. The cut was so DEEP! And I am scared of blood! Omg. And I remembered not to touch the blood!

My proud moment today – one of the corn ladies came back and told the counter staff, ‘I am ever so grateful, never experienced such great customer service from a pharmacy in the past’ Please say thank you to the pharmacist.. Wooohooo. That really made my day!

I don’t mind it
I don’t mind at all
It’s like you’re the swing set
And I’m the kid that falls
It’s like the way we fight
The times I’ve cried
We come to blows
And every night
The passion’s there
So it’s got to be right
Right?

No I don’t believe you
When you say don’t come around here no more
I won’t remind you
You said we wouldn’t be apart
No I don’t believe you
When you say you don’t need me anymore
So don’t pretend to
Not love me at all

I don’t mind it
I still don’t mind at all
It’s like one of those bad dreams
When you can’t wake up
It looks like you’ve given up
You’ve had enough
But I want more
No I won’t stop
Because I just know
You’ll come around
Right?

No I don’t believe you
When you say don’t come around here no more
I won’t remind you
You said we wouldn’t be apart
No I don’t believe you
When you say you don’t need me anymore
So don’t pretend to
Not love me at all

Just don’t stand there and watch me fall
Because I, because I still don’t mind at all

It’s like the way we fight
The times I’ve cried
We come to blows
And every night
The passion’s there
So it’s got to be right,
Right?

No I don’t believe you
When you say don’t come around here no more
I won’t remind you
You said we wouldn’t be apart
No I don’t believe you
When you say you don’t need me anymore
So don’t pretend to
Not love me at all

Everyone says life is like a ride on the roller coaster.. there will be ups and downs, twists and turns.. when you are having the best time of your life, you feel spirited, lifted.. you feel good. You are at the top, everything seems so fine, and you want it to stop there…but … u still cant avoid the down fall after..

However unlike a roller coaster ride, it will come to a halt and you can get down eventually.. but in life, when things go wrong and you’re faced with tons of obstacles ahead of you, you cant just say ‘ Hey, I want to get off now’ .. you still have to face it, deal with it.. be positive and hope it will all be fine someday. That’s life.

I am so proud of myself today. I am happy. Im glad I did something good for my patient! Woohoo.

Ok, I know you want to know what it was. It wasn’t sucha biggie really. Just a prescription for locorten-vioform ear drops. Doctor prescribed four times a day, I knew it wasn’t meant to be used that frequently, as it was a steroid drops, normally its about twice a day, so I looked it up and according to the BNF, 2-3drops twice a day for 7-10days! I rang up the surgery, clarified it, and explained to the patient, and he was really thankful! I sent the prescription back to the surgery for ammendment. But I gave out the ear drop with the correct directions on there. So thats the highlight of my day! yay!

Other things I’v learnt today :-

1. Naproxen not prescribable under NHS by a dentist. Alternative would be Ibuprofen, but patient allergic to it, next best option was diclofenac, which can be used for dental pain.

2. A lady with mouth ulcers wanted to buy something OTC. I found out she was breast feeding, so I wouldnt sell bonjela, it contains salicylic acid – aspirin related stuff – worried about reye’s syndrome- so I sold Iglu instead, that contains lidocaine, which is ok for breast feeding, as minimal quantity gets into breast milk.

Thats it for the day, I had a very pleasant, and smooth day today! Off tomorrow.

Have you watched Despicable Me 2010 Movie?? I saw the advertisement of Despicable Me when I was at the cinema for Toy Story 3.. Seemed like a really fun to watch cartoon! I can’t believe I still have to wait till October to watch it.. Oh no.. Im going home in August, I can actually watch it at home!! Silly me..I heard it is out already in Malaysia!! woohoo.. You’d think the release of new movies will be earlier in England eh, but NO.. they are so slow.. I remember a friend was telling me about Toy Story 3 few weeks ago, but I just watched it yesterday..

Check out the Movie Trailer here

Basically you can find all these information online.. whilst I was doing my little research on them, I thought I’d summarize it, save you all the looking up.

What are horse flies?

They are also known as forest flies or deer flies, range from 30mm – 60mm in length. They are very noisy during flight. If you are bitten, it would be by a female horse fly, because they require a blood meal for reproduction. They have tiny, serrated mandibles which they use to rip and slice flesh apart, thus the bite can be very painful, and last over a few days. After the bite, the affected site will develop into a red lump within minutes, it can be itchy, hot, and painful.

How do they look?

                      
                                  No! this is not a horse fly                                 This looks more like it lol

How to treat the bite?

You can just leave it and let it run its course - the symptoms mentioned above can last for a few days.. then slowly settles over weeks.. or treat the symptoms with Antihistamine cream or tablets to relief the itch and reduce the swelling by suppressing histamine release. or low potency topical steroid i.e. hydrocortisone 1% to reduce the inflammation. Im not very keen on selling the steroid cream, especially if the wound looks nasty, and a definate no no if the wound is slightly opened or raw, it will make it worse.

I recommended the previous customer to get some non-drowsy antihistamine, cetirizine is my favourite one to sell. Piriton (chlorphenamine),the traditional, drowsy antihistamine are most effective, but of course it can be  a pest if they have to drive or work or even if they are on holiday.

When to refer?

When there are signs of infection – very painful, hot, red and produces pus. I would also refer if they have used the counter treatments and still no improvements after a couple of days.