1. Role Preparation for Dental Nurse Advisors Handling Medicines Calls NAME Medicines Information Pharmacist NAME Medicines Information Service

2. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Morning Timetable Introduction & learning outcomes Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

3. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

4. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Morning Timetable Introduction & learning outcomes Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

5. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Aim To enable Dental Nurse Advisors to be able to handle medicines related calls safely and effectively within their area of competence and to know when and how to refer calls.

6. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Learning Outcomes Gather the necessary background information to clarify the question and minimise the risks when advising the caller. Navigate the key medicines information sources. Interpret information about medicines and turn it into appropriate advice. Be able to advise safely on the use of analgesics Know when and how to refer to the MI Service. Handle medicines calls safely and effectively

7. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Structure of MI Services UKMI - supports MI needs of NHS health professionals >½ million enquiries 2004 16 regional & 260 local centres Specialist services - pregnancy, breastfeeding, dentistry Training, websites, QA, drug reviews

8. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Name Medicines Information Service

9. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls NAME Medicines Information Service Staff Pharmacists Pre-registration students Secretarial support Technicians Service to NHS Direct Complex medicines calls MI skills training Quality Assurance National work 9am - 5.00pm TEL NUMBER

10. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Introduction & learning outcomes Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch Morning Timetable

11. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Navigating the eBNF, eMC netdoctor and NHSD FAQs

12. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls British National Formulary (BNF) Updated every six months Information on drugs generally prescribed in UK Designed for rapid reference Less detail on specialist areas Appendices at the back Dental Practitioners’ Formulary

13. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Dental Practitioner’s Formulary Provides list of items prescribable by dentists on the NHS Private prescriptions may be written for items not on the formulary Also available in the Drug tariff: http://www.ppa.org.uk/ppa/edt_intro.htmwww.ppa.org.uk/ppa/edt_intro.htm

14. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls eMC (Electronic medicines Compendium) Summary of Product Characteristics (SPC) and Patient Information Leaflets (PILs) Updated daily Information provided by manufacturers SPC - very detailed, written for healthcare professionals PIL - written for members of the public

15. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls NetDoctor Easy to Search Layman’s language Good for use, side-effects, drug interactions Medicines section written by pharmacists Updated daily

16. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Medicines Chest Online Book Published annually – Online version updated daily Guide to over the counter medicines Particularly useful for checking active ingredients Very little clinical information

17. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Medicines Complete

18. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Medicines FAQs Can a person on warfarin take paracetamol? Does paracetamol interact with antibiotics? Can paracetamol be taken during pregnancy? Can breastfeeding mothers take ibuprofen? Can ibuprofen be taken during pregnancy? What to do if you have missed a dose of antibiotics When can patients start drinking alcohol after finishing metronidazole? Which over-the-counter analgesics interact with alcohol? Which oral antibiotics interact with alcohol? Can breastfeeding mothers take over-the-counter analgesics? Is it necessary to stop clopidogrel, dipyridamole or low dose aspirin prior to minor surgery? Located on the Medicines & Pharmacy Microsite: http://nww.intranet.nhsdirect.nhs.uk/medpharm/ Single Source

19. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Quiz – Navigating Medicine Sources

20. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Morning Timetable Introduction & learning outcomes Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

21. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls

22. Morning Timetable Introduction & learning outcomes What is a medicine Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

23. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Handling a Medicines Call Clarify the question Plan search strategy & research problem Evaluate the information Tailor the answer/advice Refer to MI Record all stages

24. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls The Iceberg Theory This is what the caller may ask This is the rest of the story!! ?

25. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Essential questions to ask THE PERSON Age? Allergies/disease states? Pregnant: no. of weeks, going well, medicine taken already? Breastfeeding: baby age, term/pre-term, well/unwell, medicine taken already? THE MEDICINE Name, dose, frequency? Who is it for? What prescribed for? Why asking? Other medicines? Name, dose, frequency?

26. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Key Information Sources BNF / eBNF Electronic Medicines Compendium (eMC) Netdoctor NHSD Frequently Asked Questions (FAQ) Medicines Chest online Medicines Complete

27. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Standard Search Strategies Pointers to the best sources available to answer particular types of medicines call. Not a definitive list of sources and should check other sources as appropriate. No need to check every source in the search strategy for every call. Encourage best practice and sharing of expertise

28. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Reasons for Documentation Patient record in case of ongoing enquiry. Risk management. In case of query in the future. Record/evidence of how you arrived at the answer. Training.

29. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls What should be documented? Website e.g. eBNF, eMC, netdoctor All places looked including those where no information was found. Brief detail of information found. Brief detail of what was said to caller.

30. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Example documentation Is ibuprofen safe in 3rd trimester of pregnancy? eBNF: Malformations. eMC: No monograph. netdoctor: Do not use. Toxbase: Malformations. Advised to speak to GP / Dentist by end of day.

31. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Referral to the MI Service Complex medicines call. Difficult to interpret what is being asked. No information or it is unclear or conflicting. Not within your competency or a second opinion needed.

32. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Examples of Complex Medicines Calls Complex drug history Lots of medicines Unclear what is taken Unlicensed medicines Not on formulary Side effects Symptoms due to medicines Drug interactions Narrow therapeutic range medicines e.g. digoxin, warfarin Pregnant Medicines taken but info sources say avoid is to avoid Breastfeeding Medicines taken but info sources say to avoid Baby pre-term / unwell Uses / choice Contra-indicated Doses outside norm

33. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Morning Timetable Introduction & learning outcomes What is a medicine Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

34. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Analgesia A state of insensitivity to pain stimuli derives from Greek an-, "without", and - algia, "pain"

35. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Analgesics - Paracetamol Adult dosage: 0.5–1 g every 4–6 hours to a max. of 4 g daily; Childs dosage: Dependent on age of child Strength of paracetamol product Form of paracetamol Multi-constituent preparations

36. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Analgesics - NSAIDs Ibuprofen  Adult dosage:  400mg three times daily  Higher doses on prescription  Children from 3 months:  Dependent on age Non-Steroidal Anti-Inflammatory Drugs

37. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Contraindications & Cautions to NSAIDs Allergy to any NSAID or Aspirin Asthma Stomach ulcer or bleed Kidney, liver or heart conditions Blood clotting defects Hypertension Pregnancy or Breast feeding

38. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Adverse effects of NSAIDs Gastrointestinal effects: Nausea, diarrhoea, discomfort, bleeding Allergy: rashes, breathing difficulties Fluid Retention TAKE WITH OR AFTER FOOD

39. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Analgesics - Aspirin Adult Dosage: 300 - 900mg every 4-6 hours Maximum 4g daily Analgesic and antiplatelet dosages OTC products will recommend lower doses Child Dosage: Not to be given to children under 16 years old Reyes Syndrome Adverse effects and cautions similar to NSAIDs

40. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Analgesics – Combination products Not only painkillers contain analgesics BEWARE

41. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Workshop 2 - Medicines Calls

42. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Morning Timetable Introduction & learning outcomes What is a medicine Navigating key information sources Quiz Tea break Handling calls about medicines Medicine Calls Workshop 2 Lunch

43. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls

44. Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

45. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Adverse Drug Reactions Type A – predicted by mode of action, dose-related, common but not severe e.g. Diarrhoea with antibiotics Type B – unpredictable, not dose-related, can be severe/fatal e.g. Anaphylaxis with penicillins Unwanted effect that drug has on a person

46. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Incidence of Adverse Effects Very common>10% Common>1% Risk of dying from cancer if smoke 20 a day for 30 years Uncommon>0.1% Risk of being injured on the stairs in next 12 months Rare>0.01% Risk of dying in an accident at home in next 12 months Very rareup to 0.01% Risk of being killed by lightening

47. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

48. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Workshop 3 - Adverse Effects

49. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

50. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls

51. Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

52. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Drug Interactions One drug modifies the effect(s) of a second drug. More likely if taking several medicines.  Toxicity warfarin + erythromycin = greater risk of bleeding miconazole + quinidine = greater risk of arrhythmias  Efficacy penicillin + microgynon® = reduced contraception levothyroxine + rifampicin = more levothyroxine needed

53. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls One way medicines interact: Absorption of the drug Antacids can absorb other drugs e.g. Ciprofloxacin Cholestyramine (Questran  ) binds to many drugs so give 1 hour before or 4-6 hours after cholestyramine

54. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls More ways medicines interact: Metabolism of the drug DRUG LEVEL Metabolic Enhancers Smoking Alcohol Carbamazepine Phenytoin Rifampicin

55. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls More ways medicines interact: Metabolism of the drug Metabolic Inhibitors Cimetidine Ciprofloxacin Erythromycin Metronidazole DRUG LEVEL

56. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Narrow Therapeutic Range Drugs CARBAMAZEPINE CICLOSPORIN DIGOXIN LITHIUM PHENYTOIN THEOPHYLLINE WARFARIN

57. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

58. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Workshop 4 - Drug Interactions

59. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Afternoon Timetable Adverse drug reactions Workshop 3 Tea Break Drug interactions Workshop 4 Where are the risks? Close

60. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Where are the risks when handling a Medicines Call? Clarify the question Plan search strategy & research problem Evaluate the information Tailor the answer/advice Refer to MI Record all stages

61. Role Preparation For Dental Nurse Advisers: Handling Medicines Calls Learning Outcomes Gather the necessary background information to clarify the question and minimise the risks when advising the caller. Navigate the key medicines information sources. Interpret information about medicines and turn it into appropriate advice. Know when and how to refer to the MI Service. Handle medicines calls safely and effectively