Pharmacology update

Emma SuppleFCPodS, DPodM, CMS, PGDip(Pod)

Drugs and the law• The Medicines Act of 1968, together with the Poisons Act

(1972) and the Misuse of Drugs Act (1971), regulates all retail and wholesale dealings in medicines and poisons

• Certain products can be sold or supplied by Registered Practitioners, provided that it is done in the course of their professional practice and the product has been made up in a container elsewhere than at the place where it is sold or supplied

• This applies to:• Medication products for external use which are GSL• Any P class medication that is for external use • Prescription only medicine

Chiropodists & Podiatrists Administration (1968 )

• 9% borotannic complex;• 10% buclosamide; 3% chlorquinadol; • 1% clotrimazole; 10% crotamiton; • 5% diamthazole HCL; 1% econazole nitrate; 1%

fentidor; • 10% glutaraldehyde; 0.4% hydrargaphen; 2%

mepyramine maleate; 2% miconazole nitrate; 2% phenoxypropan-2-ol; 20% podophyllum resin; 10% polynoxylin; 70% pyrogallol; 70% salicylic acid; 0.1% thiomersal

Atopic dermatitis

2% mepyramine maleate

10% crotamiton

Is it a fungus?

Moccasin Tinea pedis

1% econazole nitrate

• Ecostatin Cream

1% fenticlor

• is a chlorophenol compound which possesses antifungal properties

• Anti-inflammatory and anti pyretic

2% miconazole nitrate

• Miconazole is an imidazole antifungal used as miconazole base or nitrate in the treatment of superficial candidiasis , and of the skin infections dermatophytosis and pityriasis versicolor

• DAKTARIN

Onychomycosis

Nailstat. 1% clotrimazole

Tinea pedis

2006

• Sell or supply two additional pharmacy medicines for external use:

• Terbinafine

• Griseofulvin 1%

terbinafine

Verruccas

1975 changes

• Supplementary Orders (1975) permit SRCh’s access to obtain and administer some POM local anaesthetics in the course of their professional practice:

• Bupivacaine hydrochloride• Lignocaine hydrochloride• Mepivacaine hydrochloride• Prilocaine hydrochloride

The science of foot smells!

Pitted keratolysis

Plantar psoriasis

Patient Group Directives

• PGDs• Variable• Very Useful!

PRESCRIPTION ONLY MEDICINES

• Podiatrists who hold a certificate of competence may administer and/or supply a range of medicines in accordance with an exemption in the Medicines Act 1968, a Prescription Only Medicines Amendment Order (1998) in Statutory instruments 107 and 109 added a number of specified drugs.

Signed by authority of the Secretary of State for Health

•

Andy BurnhamMinister of State, Department of Health

17th October 2006

Sealed with the Official Seal of the Department of Health, Social Services and Public Safety

Andrew McCormickPermanent Secretary, Department of Health, Social Services and Public Safety

19th October 2006

• 10. Registered chiropodists against whose names are recorded in the relevant register annotations signifying that they are qualified to use the medicines specified in column 2."; and

• iii) at the end, add—

• " (e) Amoxicillin;

(f) Erythromycin;

(g) Flucoxacillin;

(h) Tioconazole 28% ; and

(i) Silver Sulfadiazine."

Silver sulfadiazine

• Flamazine cream is indicated for the prophylaxis and treatment of infection in burn wounds

• " 1. Registered chiropodists against whose names are recorded in the relevant register annotations signifying that they are qualified to use the medicines specified in column 2."; and

• (b) in column 2 (prescription only medicines to which the exemption applies), in paragraph 1, insert at the appropriate place in the alphabetical order of entries as they appear in that paragraph—

• " Adrenaline• Levobupivacaine hydrochloride• Methylprednisolone• Ropivacaine hydrochloride".

Chiropodists: sale or supply

• (a)Co-dydramol 10/500 tablets where the quantity sold or supplied to a person at any one time does not exceed the amount sufficient for three days’ treatment to a maximum of 24 tablets

• (b)Amorolfine hydrocholoride cream where the maximum strength of the amorolfine in the cream does not exceed 0.25 per cent by weight in weight

• (c)Amorolfine hydrocholoride lacquer where the maximum strength of the amorolfine in the lacquer does not exceed 5 per cent by weight in volume

• (d)Topical hydrocortisone where the maximum strength of the hydrocortisone in the medicinal product does not exceed 1 per cent by weight in weight.

• (e)Ibuprofen, other than preparations of ibuprofen which are prescription-only-medicines. In the case of ibuprofen an amount sufficient for three days’ treatment where the maximum dose is 400mg, the maximum daily dose 1.200mg and the maximum pack size 3,600mg.

2006 sell or supply five additional prescription only medicines:

• (Podiatrists must hold a certificate of competence in the use of these medicines)

• Silver sulfadiazine (Flamazine)• Amoxicillin • Erythromycin • Flucloxacillin • Tioconazole 28%

Administer an extended range of parenteral medicines:

• (Podiatrists must hold certificate of competence in the use of analgesics)

• Adrenaline (Epinephrine) Injection BP • Methylprednisolone • Levobupivacaine Hydrochloride • Ropivacaine Hydrochloride

Pharmacokinetics

• the study of how a drug is processed by the body with time:

• Absorption,distribution,metabolism and Elimination (ADME)

Pharmacodynamics

• -how drugs exert their action on the body

Analgesics and Non-steroidal anti-inflammatory Drugs (NSAIDs)

• Analgesics - pain relief e.g opioids• Anti-inflammatories• NSAIDs,COX 2s,Steroids,DMARDs

Rheumatoid arthritis

DMARDs

• The Disease Modifying Anti-Rheumatic Drugs (DMARDs)

• NOT analgesic and do NOT inhibit COX but DO suppress the inflammatory response mainly for RA and Psoriatic arthritis and sometimes bowel disease

• Standard DMARDs are methotrexate, gold injections, azathioprine, cylcosporin (all toxic)

• NEW DMARDs are anti-TNF drugs e.g infliximab, interleukin-1 receptor antagonist, thalidomide and anti-malarials

IGTN