Self Directed Learning: Navigating the eBNF,
eMC, NetDoctor, MedicinesChest, and NHS Direct
Q&As (1)
Use the eBNF, eMC, NetDoctor, MedicinesChest and NHSD Q&As to answer the
following questions.
1
Can I buy Vermox®
from a pharmacy?
eBNF: Vermox POM
eMC – SPC: Vermox Legal Category POM.
NetDoctor: Prescription Only
MedicinesChest: No information.
NHS Direct Q&As: No information.
2
Name three side-effects
of amitriptyline.
eBNF: dry mouth, sedation, blurred vision
eMC – PIL: Amitriptyline tablets (Actavis) – allergic
effects, effects on the blood, effects on the endocrine
system and metabolism. No SPC for Amitriptyline tablets.
NetDoctor: dry mouth, drowsiness, blurred vision.
MedicinesChest: No information.
NHS Direct Q&As: No information.
3
How long will my
Zineryt® lotion keep
for?
eBNF: No information
eMC – SPC: 6.3 Shelf life - 2 years; 5 weeks after
constitution.
eMC – PIL: Do not use after the “Use before” date
that your pharmacist has put on the label.
NetDoctor: No information.
MedicinesChest: No information.
NHS Direct Q&As: No information.
4
Is it OK to take St
John’s Wort with
citalopram?
eBNF: Interaction between St John’s Wort and SSRIs.
Possible increased serotonergic effects when St John's
Wort given with SSRIs - avoid concomitant use.
eMC – SPC: Cipramil tablets. 4.5 Interaction with other
medicinal products and other forms of interaction.
Dynamic interactions between citalopram and herbal
remedy St John's Wort (Hypericum perforatum) can
occur, resulting in an increase in undesirable effects.
eMC – PIL: Cipramil tablets. Before using Cipramil. The
herbal remedy St John’s Wort (Hypericum perforatum)
should not be taken at the same time as this medicine.
If you already take a St John’s Wort preparation stop
taking the St John’s Wort and mention it to your
doctor at your next visit.
Netdoctor: There may be an increased risk of
side effects if citalopram is taken with the following, which
also enhance the activity of serotonin in the brain:
duloxetine, lithium, rasagiline, sibutramine, triptans
Role Preparation for Nurse Advisors: Handling Medicines Calls
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for migraine, eg sumatriptan, tramadol, tryptophan. The
herbal remedy St John's wort should not be taken with
citalopram for the same reason.
MedicinesChest: No information.
NHS Direct Q&As: No information.
5
What is the best way to
take my Fosamax®
Once-Weekly tablets?
eBNF: (Alendronic acid entry under Dose heading.)
Counselling - Tablets should be swallowed whole
with plenty of water while sitting or standing; to be taken
on an empty stomach at least 30 minutes before
breakfast (or another oral medicine); patient should
stand or sit upright for at least 30 minutes after
taking tablet
eMC – SPC: 4.2 Posology and Method of Administration.
To permit adequate absorption of alendronate:
'Fosamax' must be taken at least 30 minutes before
the first food, beverage, or medicinal product of the
day with plain water only. Other beverages
(including mineral water), food and some
medicinal products are likely to reduce the absorption
of alendronate (see 4.5 'Interaction with other
medicinal products and other forms of interaction').
To facilitate delivery to the stomach and thus reduce
the potential for local and oesophageal irritation/
adverse experiences (see 4.4 'Special warnings
and precautions for use'):
• 'Fosamax' should only be swallowed upon arising for
the day with a full glass of water (not less than 200 ml or
7 fl.oz.).
• Patients should not chew the tablet or allow the tablet
to dissolve in their mouths because of a potential
for oropharyngeal ulceration.
• Patients should not lie down until after their first food
of the day which should be at least 30 minutes after
taking the tablet.
• Patients should not lie down for at least 30 minutes
after taking 'Fosamax'.
• 'Fosamax' should not be taken at bedtime or before
arising for the day.
eMC – PIL: Fosamax Once Weekly 70mg tablets.
HOW TO TAKE FOSAMAX
Take one FOSAMAX tablet once a week.
Follow these instructions carefully to make sure you
will benefit from FOSAMAX.
1) Choose the day of the week that best fits your
schedule. Every week, take one FOSAMAX tablet on your
chosen day.
It is very important to follow instructions 2), 3), 4) and 5)
to help the FOSAMAX tablet reach your stomach
quickly and help reduce the chance of irritating your
Role Preparation for Nurse Advisors: Handling Medicines Calls
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gullet (oesophagus - the tube that connects your
mouth with your stomach).
2) After getting up for the day and before taking any food,
drink, or other medicine, swallow your FOSAMAX
tablet with a full glass of water only (not mineral water)
(not less than 200 ml or 7 fl. oz.).
• Do not take with mineral water (still or sparkling).
• Do not take with coffee or tea.
• Do not take with juice or milk.
Do not chew the tablet or allow it to dissolve in your
mouth.
3) Do not lie down — stay fully upright (sitting, standing or
walking) — for at least 30 minutes after swallowing
the tablet. Do not lie down until after your first food of
the day.
4) Do not take FOSAMAX at bedtime or before getting up
for the day.
5) If you develop difficulty or pain upon swallowing, chest
pain, or new or worsening heartburn, stop
taking FOSAMAX and contact your doctor.
6) After swallowing your FOSAMAX tablet, wait at least 30
minutes before taking your first food, drink, or other
medicine of the day, including antacids, calcium
supplements and vitamins. FOSAMAX is effective only if
taken when your stomach is empty.
NetDoctor: Your tablet should be taken on the same day
each week, in the morning at least 30 minutes before the
first food, drink or medicine of the day. The tablet should
be swallowed whole with a glass of plain water (at least
200ml, not mineral water) while you are sitting or standing
in an upright position. Do not chew or suck the tablet. You
should not lie down for at least 30 minutes after taking the
tablet. You should not eat or drink anything other than
plain water for at least 30 minutes after taking the tablet.
This is because food and some drinks (including mineral
water) can interfere with the absorption of the medicine
from the gut and hence make it less effective.
MedicinesChest: No information.
NHS Direct Q&As: No information.
6
What should I do if I
miss a dose of
levothyroxine 100mcg?
eBNF: No information.
eMC – SPC: No information.
Netdoctor: No information.
MedicinesChest: No information.
NHSD FAQ: What should patients do if they miss a dose
of their medicine? [UKMi Q&A N22.1] Fully referenced
answer.
eMC - PIL: Levothyroxine tablets 50mcg, 100mcg (Actavis)
If you forget to take a tablet take one as soon as you
remember, unless it is nearly time to take the next one.
Role Preparation for Nurse Advisors: Handling Medicines Calls
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Never take two doses together. Take the remaining doses
at the correct time.
7
I can’t swallow tablets.
Is it OK to crush my
olanzapine tablets?
eBNF: Tablets (Zyprexa®) are film coated, but an
orodispersible formulation (Velotab®) is available.
eMC – SPC: Zyprexa® 2.5mg, 5mg, 7.5mg, 10mg, 15mg,
and 20mg coated tablets. Zyprexa Velotab 5mg, 10mg,
15mg, and 20mg orodispersible tablets.
5.2 Pharmacokinetic Properties. Olanzapine
orodispersible tablet is bioequivalent to olanzapine coated
tablets, with a similar rate and extent of absorption.
Olanzapine orodispersible tablets may be used as an
alternative to olanzapine coated tablets.
eMC – PIL: Zyprexa® 2.5mg, 5mg, 7.5mg, 10mg, 15mg,
and 20mg coated tablets. You should take your
ZYPREXA tablets once a day following the advice of your
doctor. Try to take your tablets at the same time each
day. It does not matter whether you take them with or
without food. ZYPREXA coated tablets are for oral use.
You should swallow the ZYPREXA tablets whole with
water.
NetDoctor: No information.
MedicinesChest: No information.
NHS Direct Q&As: No information.
8
My doctor has
prescribed Topamax®.
Will I still be able to
drive?
eBNF: Topamax® contains Topiramate. Topiramate can
be given alone or as adjunctive treatment in generalised
tonic-clonic seizures or partial seizures with or without
secondary generalisation. It can be used as adjunctive
treatment for seizures associated with Lennox-Gastaut
syndrome. Topiramate is also licensed for prophylaxis of
migraine.
Under section 4.8.1 Control of epilepsy.
Patients suffering from epilepsy may drive a motor vehicle
(but not a heavy goods or public service vehicle) provided
that they have had a seizure-free period of one year or, if
subject to attacks only while asleep, have established a 3year period of asleep attacks without awake attacks.
Patients affected by drowsiness should not drive or
operate machinery. Guidance issued by the Drivers
Medical Unit of the Driver and Vehicle Licensing Agency
(DVLA) recommends that patients should be advised not
to drive during withdrawal of antiepileptic drugs, or for 6
months afterwards
eMC – SPC: 4.7 Effects on ability to drive and use
machines. Topamax can produce central nervous system
related adverse events and may be more sedative than
other antiepileptic drugs. Drowsiness is a likelihood. In
addition, there have been reports of visual
disturbances/blurred vision. Patients should be warned of
Role Preparation for Nurse Advisors: Handling Medicines Calls
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these and advised that if affected, they should not drive,
operate machinery and/or take part in activities where
such reactions could put themselves or others at risk.
eMC – PIL: Special Warnings. Topamax® may cause you
to be less alert than normal or experience blurred vision
or other types of visual disturbances. Make sure you know
how you are affected by this medicine before you drive,
use machines or do anything else that could put yourself
or others at risk.
NetDoctor – Epilepsy monograph: To hold a civilian
driving licence in the UK you need to have been seizurefree for 12 months, or only had seizures at night while
asleep.
MedicinesChest: No information.
NHS Direct Q&As: No information.
Role Preparation for Nurse Advisors: Handling Medicines Calls
September 2007 v1.0