1. Darktar Dr B Kelly

2. When/How to prescribe? w Define the problem w Only when necessary w Benefit outweighs the risk? w Discuss treatment options w Communication skills w Promote compliance

3. Prescribing in Gen. Practice w PACT- prescribing analysis + cost package Quarterly report on prescribing habits and costs w Formulary An agreed policy of prescribing Limit prescribing and costs Evidence based w Guidelines Local/national

4. When to beware! w Elderly w Pregnancy w Children w Renal/Hepatic impairment w New drugs

5. Emergency Contraception  2 Options: Levonelle-2(not PC4!) IUD up to 5 days copper coil failure rate <1% o Levonelle-2 Up to 72 Hours 2 Tablets 12 hours apart Up to 97% effective CI - Porphyria Progesterone Tumours

6. After prescribing emergency contraception should…. w Review patient w ?STD’s w regular contraception w ?pregnancy

7. Sore Ear  100cases/year  Paracetamol  Ibuprofen  80% resolve within 3 days  Amoxycillin ( after day 4 )  125mg tid for 5/7  current evidence  Avoid antibiotic  Limit use to after 3 days

8. Back Pain  Simple Analgesia  Encourage activity  Ibuprofen/ Diclofenac Also consider- Diazepam 2-5mg tid

9. Red flags w 55yrs w Non-mechanical pain w Thoracic pain w PMHx of CA w Steroids w Weight loss w Widespread neurology w Structural deformity w HIV

10. Sore Throat  Beware Quinsy  Diagnosis of bacterial vs viral difficult  simple analgesics, increase fluids and salt water gargling  Antibiotics are of modest benefit- on avg reduce symptom duration by 16 hrs and complication rate.  BUT!-large NNT to prevent one episode.  CONSIDER DELAYED SCRIPT- no better by day 2/3  Penicillin V 250mg QID for 10/7(not amoxicillin ?glandF  Erythromycin 250mg QID for 10/7

11. Acne  Topical  Azelaic Acid  Salicylic Acid  Benzoyl peroxide  Oral antibiotics  Oxytetracycline  Erythromycin  Minocycline  Hormonal  Dianette  Oral Retinoids  Roaccutane

12. ‘The Pill’  Oestrogen & Progesterone Acts by inhibiting ovulation. 1 tablet daily for 21 days then 7 day break Note: Contraindications Side Effects Not effective if taken with enzyme inducers eg. Antibiotics, anti-convulsants. ‘7 day Rule’

13. Scabies  Permethrin (Lyclear Dermal Cream) 1 dose stat- apply over whole body then wash thoroughly 8-12 hrs later Repeat once if necessary after 7 days

14. Fever of Unknown Origin  Check ENT, Abdomen, Neck Stiffness, Rash, MSSU If no obvious cause:  Paracetamol  Ibuprofen  Fluids

15. “Flu” Most ‘flus’ are not true flus.  Paracetamol 1g QID  Ibuprofen 400mg Tid  Increase Oral Fluids  Antibiotics for secondary infections  Target at risk population with flu immunisations

16. U.T.I  Treat infection as per urine culture  Prophylaxis – usually trimethoprim  Investigate +/- Paediatrician due to potential complications

17. Head Lice  Permethrin Lyclear Crème Rinse 1 dose stat – apply to hair and scalp, leave 10 mins then rinse.

18. Diarrhoea  Increase fluid intake +/- Dioralyte  Antispasmotics eg hyoscine 20mg qid  Loperamide (imodium)

19. Impetigo Common and highly contagious. Staphylococcal infection  Flucloxacillin  Fusidic Acid (topical)

20. Nappy rash w Sparing of skin folds w simply advice nappy area dry aqueous cream (E45) barrier cream (zinc paste) w Topical antifungal Canesten HC

21. Psoriasis w Explain condition w Topical treatment sailicylic acid coal tar vit D derivatives dithranol topical retinoids topical steroids w Systemic/PUVA

22. Eczema w Very common w >30% of dermatology consultations w Also known as dermatitis w Atopic eczema commonest type w Remove contributory factors w Emollients w Topical steroids