Pharmacists' Reminders and Patient Safety Quiz

Sympathomimetics

• Pseudoephedrine is a vasoconstrictor used to treat congestion of mucous membranes in the upper respiratory tract.
• It should not be given to children under 6 years old in over-the-counter cough and cold medicines.
• Monoamine oxidase B inhibitors increase the risk of a hypertensive crisis when taken with pseudoephedrine.
• Counselling points for pseudoephedrine include:
  • Do not take for longer than recommended by your doctor.
  • Limit caffeine and chocolate intake to avoid nervousness, shakiness, and a fast heartbeat.
  • Take with or without food, but take with food if it causes an upset stomach.

Beta2-adrenoceptor Agonists

• Salbutamol is a short-acting beta2-adrenoceptor agonist used to treat acute asthma and prevent allergen- or exercise-induced bronchospasm.
• Beta-blockers (such as propranolol) may antagonize the effects of salbutamol.
• Counselling points for salbutamol include:
  • Read the manufacturer's printed information leaflet from inside the pack before using the inhaler.
  • Use the inhaler properly to ensure effective treatment.

Nitrates

• Nitroglycerin (glyceryl trinitrate) is a coronary vasodilator used to treat and prevent angina.
• It should be supplied in glass containers and discarded after 8 weeks in use.
• Counselling points for nitroglycerin include:
  • Dose may be repeated at 5-minute intervals if required, but not more than 3 doses.
  • Interacts with avanafil (sildenafil).

Adrenaline

• Adrenaline is a sympathomimetic used in cardiopulmonary resuscitation, acute hypotension, and emergency treatment of acute anaphylaxis.
• Non-cardio-selective beta-blockers can enhance the pressor response to adrenaline.
• Counselling points for adrenaline include:
  • Carry two injection devices at all times to treat symptoms until medical assistance is available.
  • Administer a second injection 5-15 minutes after the first if symptoms do not improve.

Antimuscarinics

• Hyoscine butylbromide is an antimuscarinic used to relieve symptomatic gastro-intestinal or genito-urinary disorders characterized by smooth muscle spasm.
• Contraindications include gastro-intestinal obstruction, myasthenia gravis, significant bladder outflow obstruction, and urinary retention.
• Counselling points for hyoscine butylbromide include:
  • Avoid driving and skilled tasks, as antimuscarinics can affect performance.
  • Rise slowly after sitting or lying down to lower the chance of dizziness or fainting.

Antidiarrheals

• Loperamide is an antipropulsive used to treat acute and chronic diarrhea.
• Contraindications include active ulcerative colitis.
• Counselling points for loperamide include:
  • Avoid large overdoses, as they can cause serious cardiovascular events, including fatalities.
  • Cimetidine and clarithromycine can inhibit the metabolism of loperamide.