Little TV Addict

I was looking through the new protocol for EHC(Emergency hormonal contraception) from the Torbay NHS Care Trust. I found something useful and worth sharing. It’s the list of  Hepatic Enzyme Inducing Drugs, I’v always wanted to come up with a list myself, but I just havn’t got to it. This group of drugs accelerates metabolism and reduces the efficacy of many drugs especially drugs with a narrow therapeutic window i.e theophylline, it is also important to know that they do the same for contraceptive steroids. I think the 1st few on the list are the more common List of hepatic enzyme inducing drugs .

• Carbamazepine
• Griseofulvin
• Phenytoin
• Rifampicin
• St John’s Wort
• Barbiturates
• Modafinil
• Topiramate
• Primidone
• Tacrolimus
• Oxcarbazepine
• Ritonavir
• Rifabutin
• Bosentan
• Certain PPI
• Certain HIV drugs

For me, I try to remember the 5 that are highlighted in red, to make it easier, I came up with an acronym – C-GPRS, hope that was helpful!! Leave a comment to add any others to the list!

Finally, after 9 long months working in the dispensary, I get to work on the counter for a bit. So I have learnt something new today, would like to share it with you, and also I think jotting it down can help me enhance my memory.

Scenario

A middle aged lady in her 50’s asked for some cream for athlete’s foot. So upon going through all the WHAMM (questioning of when, how, age, medication history etc), I found out she is on warfarin. As we all know warfarin interacts with an awful lot of medications. Many pharmacists prefers to refer them to the doctor instead of offering any products over the counter. So knowing that she wants some cream for athlete’s foot, and she is on warfarin, what would be the most appropriate cream for her??

Comments

We all know that athlete’s foot is a fungal infection, so antifungal cream would treat it, but we have got several to choose from. One of my top recommendation would be Daktarin Gold (Ketoconazole 2% cream), other available creams are Daktarin cream (Miconazole) and Canestan cream (Clotrimazole 1%) or even Lamisil (Terbinafine). Forget about Lamisil because its too pricey. Upon checking Stockleys drug interactions and BNF (british national formulary), I found out that ketoconazole and miconazole (creams are absorbed into the bloodstream) both increases the plasma concentration of warfarin(thins the blood), which increases the risk of bleeding. So I offered Clotrimazole 1% cream (canestan).

Directions of use

Clean and dry feet, apply cream 2-3 times a day for at least 2 weeks, and up to 4 weeks. Many customers experience recurrent problems, an antifungal powder would be useful to prevent further infections. Powder can be sprinkled on shoes and socks, and if using it as a treatment, it should be sprinkled between toes, and all over the feet. It is advisable to also change stockings/socks daily for people who have recurrent fungal infections.

Hope this article was helpful for some of you.