My Music ParadiseLet the music spice up our lives

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?

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 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.

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.