Post on 13-May-2022
Walk-in Centres: Medication Standing Orders CHO Approved August 2017 Version 1
Introduction
The standing orders contained in this document apply only to the Walk-in Centres’ (WiC) located at the Belconnen Community Health Centre and the Tuggeranong Community Health Centre, ACT. Further WiC’s (with an identical model of care as the current WiC’s) at different locations may be introduced in the ACT at a future date and these Medication Standing Orders and Clinical Treatment Protocols will apply to these new sites.
Additionally, the standing orders are only for use by the WiC Registered Nursing staff (Advance Practice Nurses) in conjunction with the approved WiC Clinical Treatment Protocols.
This document has been written using the latest clinical evidence and the expertise of the members of the Walk-in Centres Staff and Walk-in Centres Clinical Advisory Group.
The following staff (including their role and qualifications) reviewed the MSO 2017 version 1:
• Tim Bethune, WiC Advanced Practice Nurse, Bachelor of Nursing • Wendy Kroon, WiC Nurse Practitioner, Master of Nurse Practitioner • Mariusz Stachura, WiC Nurse Practitioner, Master of Nurse Practitioner • Carol Chan, Lead Pharmacist for the Division of Rehabilitation, Aged and Community
Care, Bachelor of Pharmacy, Australian Association of Consultant Pharmacist (AACP) member.
• Dr. Marianne Bookallil, GP advisor ACT Health, MBBS, FRACGP, MPHTM, FAFPHM • Michelle Lambert, Clinical Nurse Manager Belconnen WiC, Bachelor of Nursing,
Graduate Certificate in Critical Care • Karina Stewart, Clinical Nurse Manager Tuggeranong WiC, Bachelor of Nursing,
Graduate Certificate in Child and Family Health • Naree Stanton, Assistant Director of Nursing WiC, Bachelor of Applied Science
(Midwifery), Post Grad Cert Public Sector Management
Abbreviation Detail
ACT Australian Capital Territory ADEC Australian Drug Evaluation Committee ADT Adult Diphtheria and Tetanus Booster ASAP as soon as possible BGL Blood glucose level CHO Chief Health Officer CNS Central Nervous System CrCl Creatinine clearance ED Emergency Department e.g. example GP General Practitioner HIV Human Immunodeficiency Virus IM Intramuscular IV Intravenous kg kilogram mcg microgram MDI Metered dose inhaler MET Medical Emergency Team min minute mL Millilitre mm Millimetre N/A Not applicable NSAID Non-steroidal anti-inflammatory drug SIDS Sudden infant death syndrome TCH The Canberra Hospital TD Tardive dyskinesia WiC Walk-in Centres
Medications Applicable to all Walk-
in-Centres
Date of Effect
Date of Last Review Date Order
Ends
CHO Approval Number
Page Number
Adrenaline/epinephrine 15 March 2018
August 2017 31 August 2019 9201729
Adult Diphtheria and Tetanus Booster
15 March 2018
August 2017 31 August 2019 9201731
Amethocaine/Tetracaine 15 March 2018
August 2017 31 August 2019 9201732
Amoxicillin 15 March 2018
August 2017 31 August 2019 9201733
Amoxicillin and clavulanate 15 March 2018
August 2017 31 August 2019 9201734
Aspirin 15 March 2018
August 2017 31 August 2019 9201735
Carmellose 15 March 2018
August 2017 31 August 2019 9201736
Ceftriaxone 15 March 2018
August 2017 31 August 2019 9201737
Cefuroxime 15 March 2018
August 2017 31 August 2019 9201738
Cefalexin - UTI 15 March 2018
August 2017 31 August 2019 9201739
Cefalexin – mastitis/ cellulitis
15 March 2018
August 2017 31 August 2019 9201740
Cefalexin - tonsillitis 15 March 2018
August 2017 31 August 2019 9201741
Chloramphenicol 15 March 2018
August 2017 31 August 2019 9201742
Ciprofloxacin 15 March 2018
August 2017 31 August 2019 9201743
Dermabond 15 March 2018
August 2017 31 August 2019 9201744
Dexamethasone 15 March 2018
August 2017 31 August 2019 9201745
Dexamethasone, Framycetin, Gramicidin
15 March 2018
August 2017 31 August 2019 9201746
Dicloxacillin – mastitis/ cellulitis
15 March 2018
August 2017 31 August 2019 9201747
Glucagon 15 March 2018
August 2017 31 August 2019 9201748
Ibuprofen 15 March 2018
August 2017 31 August 2019 9201749
Laceraine 15 March 2018
August 2017 31 August 2019 9201750
Levonorgesterel 15 March 2018
August 2017 31 August 2019 9201751
Lignocaine 1% with Adrenaline/epinephrine
15 March 2018
August 2017 31 August 2019 9201752
Lignocaine 1% 15 March 2018
August 2017 31 August 2019 9201753
Loratadine 15 March 2018
August 2017 31 August 2019 9201754
Metoclopramide 15 March 2018
August 2017 31 August 2019 9201755
Mupirocin 15 March 2018
August 2017 31 August 2019 9201756
Normal Human Immunoglobulin (NHIG)
15 March 2018
August 2017 31 August 2019 9201757
Oxygen 15 March 2018
August 2017 31 August 2019 9201758
Paracetamol 15 March 2018
August 2017 31 August 2019 9201759
Phenoximethylpenicillin 15 March 2018
August 2017 31 August 2019 9201760
Promethazine 15 March 2018
August 2017 31 August 2019 9201761
Rifampicin 15 March 2018
August 2017 31 August 2019 9201762
Roxithromycin 15 March 2018
August 2017 31 August 2019 9201763
Salbutamol 15 March 2018
August 2017 31 August 2019 9201764
Trimethoprim 15 March 2018
August 2017 31 August 2019 9201765
Walk-in Centres MEDICATION STANDING ORDER
ADRENALINE (Epinephrine) Adrenaline (Epinephrine) 1:1000 ampoules IMI
Approved Treatment Protocols
ADRE
NALI
NE (E
pine
phrin
e)
Anaphylaxis
Included Clients
Clients aged 2 or over
Excluded Clients
Exclusion Suggested Action(s) and Notes
There are no absolute contraindications to adrenaline in severe life threatening allergic conditions
Drug Interactions
Drug Suggested Action(s) and Notes
There are no absolute contraindications to adrenaline in severe life threatening allergic conditions
Dosing and Administration Information
Age / Weight Product / Strength Dose
Adult and children >50kg Adrenaline 1:1000/1mg in 1ml 500mcg IMI (0.5ml)
40kg Adrenaline 1:1000/1mg in 1ml 400mcg IMI (0.4ml)
30kg Adrenaline 1:1000/1mg in 1ml 300mcg (0.3ml)
25kg Adrenaline 1:1000/1mg in 1ml 250mcg (0.25ml)
20kg Adrenaline 1:1000/1mg in 1ml 200mcg (0.2ml)
15kg Adrenaline 1:1000/1mg in 1ml 150mcg (0.15ml)
10kg Adrenaline 1:1000/1mg in 1ml 100mcg (0.1ml)
Instructions
• Ensure that 000 is called and all first aid measures are attended; DRSABCD • Draw up Adrenaline 1:1000 (to a maximum of 500mcg) from ampoule preferably using a
1ml tuberculin syringe and 18G drawing up needle. Prime syringe with appropriate weight-specific dose and apply 23G needle
• Prepare patient for injection, locating vastus lateralis (upper outer thigh) • Swipe mid-anterolateral thigh well with Alco wipe • After injecting adrenaline, gently rub injection area on thigh for approximately 10
seconds • Record time, location and dose of adrenaline administered. Prepare second dose,
monitor patient Repeat doses of Adrenaline 1:1000 can be administered every 3-5 minutes as necessary
Adverse Drug Reactions / Side Effects
ADRE
NALI
NE (E
pine
phrin
e)
Reaction Advice for Clients and Notes
Anxiety, restlessness, tachycardia, respiratory difficulty, tremor, weakness, dizziness, headache, dyspnoea, cold extremities, pallor, sweating, nausea, vomiting, sleeplessness, hallucinations, palpitations, fear and flushing or redness of face and skin
These effects to be managed by ACTAS and ED
Psychomotor agitation, disorientation, impaired memory, psychosis, ventricular arrhythmias, and severe hypertension which may lead to cerebral haemorrhage and pulmonary oedema
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
Call 000 and request ACTAS response to Walk in Centre location.
References
MIMs online https://www.mimsonline.com.au Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date Order ends: 31 August 2019 CHO approval Number: 9201729
Walk-in Centre
MEDICATION STANDING ORDER
ADULT DIPTHERIA & TETANUS (ADT) BOOSTER IMMUNISATION
0.5 mL prefilled syringe
Approved Treatment Protocols
ADU
LT D
IPTH
ERIA
& T
ETAN
US
(ADT
)
Abrasions, Bites, Burns, Lacerations, Marine Stings, Paronychia, Spider Bites, Stings
Included Clients
Adults (age ≥18) who have sustained injuries deemed to be tetanus-prone (all wounds other than clean minor cuts) should receive a booster dose of ADT if more than 5 years have elapsed since the last dose of tetanus-containing vaccine
Definition: “The definition of a tetanus-prone injury is not straightforward, as tetanus may occur after apparently trivial injury, such as from a rose thorn, or with no history of injury. However, there are certain types of wounds likely to favour the growth of tetanus organisms. These include compound fractures, bite wounds, deep penetrating wounds, wounds containing foreign bodies (especially wood splinters), wounds complicated by pyogenic infections, wounds with extensive tissue damage (e.g. contusions or burns) and any superficial wound obviously contaminated with soil, dust or horse manure (especially if topical disinfection is delayed more than 4 hours).” Australian Immunisation Handbook, 10th edition
Excluded Clients
Exclusion Suggested Action(s) and Notes
Clients with no history of receiving the 3 dose primary tetanus course
Refer to ED – may require tetanus immunoglobulin
Allergy to ADT vaccine or known hypersensitivity to any of the vaccine components
Refer to ED – may require tetanus immunoglobulin
Moderate/severe acute illness with or without fever Refer to GP
Pregnancy or breast feeding mothers Refer to GP for likely dTPa
Drug Interactions
Drug Suggested Action(s) and Notes
No drug interactions need to be considered
Dosing and Administration Information
Dose Administration
Give 0.5mL via the intramuscular route
• The vaccine should be thoroughly shaken before use to ensure adequate dispersion when it is injected.
• The vaccine should appear as a suspension of white and grey particles in a colourless fluid.
• ADT vaccines should not be mixed with any other vaccine in the same syringe. • Cover the site quickly with a Band-Aid. Gently apply pressure for 1 or 2 minutes. Do
not rub the site as this will encourage the vaccine to leak back up the needle track, which can cause pain and may lead to local irritation.
Adverse Drug Reactions / Side Effects
ADU
LT D
IPTH
ERIA
& T
ETAN
US
BOO
STER
(AD
T)
Reaction Advice for Clients and Notes Redness, itching, swelling, burning or pain at the injection site. Small lump at injection site. Transient fever ≥38⁰C
This is common and may last for 1-2 days. Paracetamol might be required to ease the discomfort
Headache, lethargy, malaise, myalgia These are uncommon side effects and if the client is concerned refer to GP
Rash, urticaria or anaphylactic reaction May indicate allergic reaction advise client to seek medication attention urgently if this occurs
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
• Paracetamol is not routinely used before or at the time of vaccination, but may be recommended as required for fever or pain.
• The vaccinated person and/or parent/carer should be advised to remain in the WiC for a minimum of 15 minutes after the vaccination. The client should be close enough to WiC staff, so that the individual can be observed and medical treatment rapidly provided if needed.
• Vaccination of people receiving immunosuppressive treatment can take place, but may result in a reduced immunological response – may require antibody titres checked by GP post vaccination
• Mild common illnesses are not contraindications to vaccination • Too frequent booster vaccination will increase the risk of adverse reactions
References
MIMs online https://www.mimsonline.com.au The Australian Immunisation Handbook 10th Edition 2017
Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201731
Walk in Centre MEDICATION STANDING ORDER
Amethocaine (Tetracaine) 0.5% Eye drops (single use)
Approved Treatment Protocols
Amet
hoca
ine
(Tet
raca
ine)
1. For examination of a superficial foreign body in a single eye, that is suitable for removal with a moistened cotton bud.
2. In chemical injury, to assist immediate commencement of irrigation prior to transfer to ED.
3. Corneal abrasion protocol
4. Stye (hordeola) protocol
Included Clients
1. Patients presenting with a superficial foreign body to a single eye that is suitable for removal with a moistened cotton bud
2. Patients presenting with a chemical injury, to assist immediate commencement of irrigation prior to transfer to ED.
3. For person presenting with eye pain from a suspected corneal abrasion (age ≥ 6)
4. For use prior to gently expressing a pointing external stye
Excluded Clients
Exclusion Suggested Action(s) and Notes
Visible trauma or suspected/visible penetrating eye injury
Refer to ED
Hyphema Refer to ED
Loss of vision Refer to ED
Deep foreign body Refer to ED
History of eye surgery in last 3 months Refer to ED
Long term use Refer to ED
History of hypersensitivity or allergy to Amethocaine (Tetracaine) or any of the other ingredients
Refer to ED
Drug Interactions
Nil significant interactions
Dosing and Administration Information
Dose Administration
0.5% Amethocaine (Tetracaine)
1 drop into affected eye. May be repeated at 5 minute intervals to a maximum of 3 drops
Adverse Drug Reactions/Side Effects
Reaction Advice for Clients and Notes
Stinging on application Warn patient Allergy Redirect to GP or ED
Specific Counselling Points
Amet
hoca
ine
(Tet
raca
ine)
• Anaesthetic is temporary and reverses fully after 15-20 min • Do not rub or touch eyes • Protect eyes from dust or contamination • Safe in pregnancy, but occlude punctum with digital pressure if patient pregnant
References
MIMs online https://www.mimsonline.com.au Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval number: 9201732
WALK-IN CENTRES
MEDICATION STANDING ORDER
AMOXICILLIN 250mg in 5mL suspension
500mg capsules
Approved Treatment Protocols
AMO
XICI
LLIN
Acute Otitis Media, Acute Bacterial Sinusitis
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
History of non-immediate hypersensitivity reaction to penicillins/beta lactams
Refer to cefuroxime medication standing order
History of immediate hypersensitivity to a penicillin/beta lactam antibiotic
Refer to NP/GP
Known hepatic or renal impairment Refer to NP/GP
Known previous penicillin-induced cholestatic jaundice or hepatitis
Refer to GP
Clients with phenylketonuria (liquid formulations contain aspartame)
Refer to NP/GP if capsules not able to be taken
Clients with lymphoblastic leukaemia, chronic lymphocytic leukaemia, HIV infection or likely infectious mononucleosis
Have an increased risk of penicillin induced erythematous rash Refer to GP
Drug Interactions
Drug Suggested Action(s) and Notes
Warfarin Anticoagulant effects may be altered. Advise client that INR may change whilst taking amoxicillin and refer to GP for increased monitoring
Allopurinol Increased risk of skin rash. Advise client to stop treatment and see their GP should this develop
Probenecid Probenecid decreases the renal tubular secretion of Amoxicillin, dose will need to be adjusted Refer to GP
Methotrexate Penicillins may reduce the renal clearance of methotrexate resulting in toxicity – refer to GP
Dosing and Supply Information
AMO
XICI
LLIN
Dosing Supply Label & Instructions
Weight / Age Dose Strength Quantity
<10kg Refer to GP
10-12.5kg 175mg
(14 - 17.5mg/kg/dose)
250mg in 5mL
suspension
1 x 100mL suspension
Take 3.5mL every 8 hours for 5 days
12.6 - 15kg 225mg
(15 – 17.9mg/kg/dose)
250mg in 5mL
suspension
1 x 100mL suspension
Take 4.5mL every 8 hours for 5 days
15.1 – 17.5kg
275mg
(15.7 – 18.2mg/kg/dose)
250mg in 5mL
suspension
1 x 100mL suspension
Take 5.5mL every 8 hours for 5 days
17.6 – 20kg 300mg
(15 – 17mg/kg/dose)
250mg in 5mL
suspension
1 x 100mL suspension
Take 6mL every 8 hours for 5 days
20.1 – 22.5kg
350mg
(15.6 – 17.4mg/kg/dose)
250mg in 5mL
suspension
2 x 100mL suspension
Take 7mL every 8 hours for 5 days
22.6 – 25kg 375mg
(15 – 16.6mg/kg/dose)
250mg in 5mL
suspension
2 x 100mL suspension
Take 7.5mL every 8 hours for 5 days
25.1 – 27.5kg
425mg
(15.5 – 16.9mg/kg/dose)
250mg in 5mL
suspension
2 x 100mL suspension
Take 8.5mL every 8 hours for 5 days
27.6 – 30kg 450mg
(15 – 16.3mg/kg/dose)
250mg in 5mL
suspension
2 x 100mL suspension
Take 9mL every 8 hours for 5 days
Child >30.1kg OR
Adults
500mg
(16.6mg/kg/dose at 30.1kg)
250mg in 5mL
suspension OR
500mg capsules
2 x 100mL suspension
OR 1 x 20
capsules
Take 10mL every 8 hours for 5 days
OR Take ONE capsule every 8 hours for 5
days
Reconstitute suspension as per instructions on bottle
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes
Nausea, Vomiting, Diarrhoea Common side effects, if prolonged or worsening advise client to seek medical advice
Rashes May indicate allergic reaction, advise client to seek medical advice
Antibiotic associated colitis
This is a severe form of diarrhoea which has been associated with many antibiotics including amoxicillin. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.
Vaginal or oral fungal infection May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
Pregnancy and breast feeding: • Advise that amoxicillin is considered safe to use in pregnancy • Safe to use at recommended doses during breastfeeding. However observe the
breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush
• Amoxicillin is in ADEC category A, this means it is a drug that has been taken by a large number of women and women of child bearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus being observed.
Capsules and Suspension: • Take with or without food • Take antibiotic doses regularly • Complete the full treatment course. AM
OXI
CILL
IN
Suspension: • Store mixture in fridge • Shake well before use • Measure dose using a metric measure • If >1 bottle is supplied:
Bottles are the same and not intended to be taken together Open one bottle first and finish this before moving on to second bottle
Discard any unused suspension after 14 days
References
MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: online.tg.org.au/ Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Order Number: 9201733
WALK-IN CENTRES
MEDICATION STANDING ORDER
AMOXICILLIN + CLAVULANATE 400mg + 57mg in 5mL suspension
875 + 125mg tablets
Approved Treatment Protocols
AMO
XICI
LLIN
+ C
LAVU
LAN
ATE
Bites
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
Pregnant women Refer to NP/GP
History of immediate or non-immediate hypersensitivity reaction to penicillin/beta lactam antibiotic
Refer to NP/GP
Hepatic or renal impairment or previous penicillin-induced cholestatic jaundice or hepatitis
Refer to GP
Clients with phenylketonuria (liquid formulations contain aspartame)
Refer to NP/GP if capsules not able to be taken
Clients with lymphoblastic leukaemia, chronic lymphocytic leukaemia, HIV infection or likely infectious mononucleosis
Refer to GP
Drug Interactions
Drug Suggested Action(s) and Notes
Warfarin Anticoagulant effects may be enhanced. Advise client that INR may change whilst taking Amoxicillin and refer to GP for increased monitoring.
Allopurinol Increased risk of skin rash. Advise client to stop treatment and see their GP should this develop.
Probenecid Probenecid decreases the renal tubular secretion of amoxicillin, dose will need to be adjusted - Refer to GP.
Methotrexate Penicillins may reduce the renal clearance of methotrexate resulting in toxicity - Refer to GP
Dosing and Supply Information
AMO
XICI
LLIN
+ C
LAVU
LAN
ATE
Dosing Supply Label & Instructions
Weight / Age Dose Strength Quantity
< 10 kg Refer to GP
10 – 12.5kg
240/34mg
(19.2/2.7 – 24/3.4mg/kg)
400 / 57mg in 5mL
suspension
1 x 60 mL suspension
Take 3ml every 12 hours for 5 days
12.6 – 15kg 280/40mg
(18.7/2.7 – 22.2/3.2mg/kg)
400 / 57mg in 5mL
suspension
1 x 60 mL suspension
Take 3.5ml every 12 hours for 5 days
15.1 – 17.5kg
360/51.3mg
(20.1/2.9 – 23.8/3.4mg/kg)
400 / 57mg in 5mL
suspension
1 x 60 mL suspension
Take 4.5ml every 12 hours for 5 days
17.6 – 20kg 400/57mg
(20/2.9 – 22.7/3.2mg/kg)
400 / 57mg in 5mL
suspension
1 x 60 mL suspension
Take 5ml every 12 hours for 5 days
20.1 – 22.5kg
480/68.4mg
(21.3/3 – 23.9/3.4mg/kg)
400 / 57mg in 5mL
suspension
1 x 60 mL suspension
Take 6ml every 12 hours for 5 days
22.6 – 25kg 520/74.1mg
(20.8/3 – 23/3.3mg/kg)
400 / 57mg in 5mL
suspension
2 x 60ml suspension
Take 6.5ml every 12 hours for 5 days
25.1 – 27.5kg
560/80mg
(20.4/2.9 – 22.3/3.2mg/kg)
400 / 57mg in 5mL
suspension
2 x 60ml suspension
Take 7ml every 12 hours for 5 days
27.6 – 30kg 640/91.2mg
(21.3/3 – 23.2/3.3mg/kg)
400 / 57mg in 5mL
suspension
2 x 60ml suspension
Take 8ml every 12 hours for 5 days
30.1 – 32.5kg
680/97mg
(20.9/3 – 22.6/3.2mg/kg)
400 / 57mg in 5mL
suspension
2 x 60ml suspension
Take 8.5ml every 12 hours for 5 days
32.6 – 35kg 760/108mg
(21.7/3.1 – 23.3/3.3mg/kg)
400 / 57mg in 5mL
suspension
2 x 60ml suspension
Take 9.5ml every 12 hours for 5 days
35.1 – 37.5kg
800/114mg
(21.3/3 – 22.8/3.3mg/kg)
400 / 57mg in 5mL
suspension
2 x 60ml suspension
Take 10ml every 12 hours for 5 days
Child >37.6kg
OR
Adults
875/125mg
(23.3/3.1mg/kg at 37.6kg)
400 / 57mg in 5mL
suspension
2 x 60ml suspension
OR
10 x 875/125mg
tablets
Take 11ml every 12 hours for 5 days
OR
Take ONE tablet every 12 hours for 5 days
Reconstitute suspension as per instructions on bottle
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes
Nausea, Vomiting, Diarrhoea Common side effects, if prolonged see GP
Rashes May indicate allergic reaction, advise client to seek medical advice
Antibiotic associated colitis
This is a severe form of diarrhoea which has been associated with many antibiotics including amoxicillin. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.
Vaginal or oral fungal infection May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms
Pustular drug eruption (rare) Present to ED
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
Capsules and Suspension: • Take with food • Take antibiotic doses regularly • Complete the full treatment course • Consider tetanus prophylaxis. • Safe to use at recommended doses during breastfeeding. However observe the
breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush
Suspension: • Store mixture in fridge • Shake well before use • Measure dose using a metric measure
• If >1 bottle is supplied: Bottles are the same and not intended to be taken together Open one bottle first and finish this before moving on to second bottle
Discard any unused suspension after 7 days.
References
MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: online.tg.org.au/ Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201734
Walk in Centre
MEDICATION STANDING ORDER
ASPIRIN (Acetylsalicylic Acid)
300mg dispersible tablet Approved Treatment Protocols
Aspi
rin (
Acet
ylsa
licyl
ic A
cid)
For patients with chest pain
Included Clients
Patients with suspected cardiac related chest pain - administer whilst awaiting ambulance
Excluded Clients
Exclusion Suggested Action(s) and Notes
Allergy to salicylates, aspirin, or NSAIDs Do not give
Pregnancy Do not give
Active bleeding (known or suspected) Do not give
Known bleeding disorder (e.g. haemophilia) Do not give
Chest pain related to drug overdose Do not give
Aspirin-sensitive asthma Do not give
Known history of duodenal ulcers/peptic ulcer Discuss with paramedics
Drug Interactions
Drug Suggested Action(s) and Notes
Anti-coagulants Discuss with paramedics
Dosing and Administration Information
Dose Administration
300mg as a single dose 1 tablet dissolved in a small amount of water or chewed
Adverse Drug Reactions/Side Effects
Reaction Advice for Clients and Notes
GI upset/bleeding Review by paramedics/ED doctor Allergic reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis Review by paramedics/ED doctor
Specific Counselling Points
• Single dose only • Administer whilst awaiting ambulance/ paramedic attendance • Give oxygen via Hudson mask if patient is hypoxaemic (SpO2<94%)
References
ANZCOR Guideline 14.2 – Acute Coronary Syndromes: Initial Medical Therapy 2016
https://resus.org.au/guidelines/
Therapeutic Guidelines https://tgldcdp.tg.org.au
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date Order ends: 31 August 2019
CHO Approval number: 9201735
WALK-IN CENTRE
MEDICATION STANDING ORDER
Carmellose 0.5% Lubricant Eye Drops.
Approved Treatment Protocols
Carm
ello
se
Dry Eye Syndrome
Foreign Body in Eye
Included Clients
Adults and children > 2 years old – Dose on site only - do not supply
Excluded Clients
Exclusion Suggested Action(s) and Notes
Ocular trauma Refer to GP or ED
Drug Interactions
Drug Suggested Action(s) and Notes
Nil known N/A
Dosing and Administration Information
Dose Administer Instructions
Age Dose Strength Quantity
≥ 2 years 1 drop 0.5% solution 0.4mL per ampoule Instil 1 drop per eye PRN
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes
Possible eye irritation but not likely given nil preservatives in eye drops
May indicate allergic reaction Advise client to seek medical advice immediately
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
Carm
ello
se
If irritation persists or worsens, discontinue use and consult a GP
Safe to use in pregnancy and with breastfeeding
Carmellose ampoules are single use only and should be discarded immediately after use.
Refer the client to a community pharmacy for ongoing supply of Carmellose eye drops.
Suitable for use with contact lenses
Store below 25°C
References
MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: https://tgldcdp.tg.org.au/etgAccess Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019 CHO Approval Number: 9201736
Walk in Centre
MEDICATION STANDING ORDER
CEFALEXIN 500mg capsules
Approved Treatment Protocols
CEFA
LEXI
N
For the treatment of:
1) Lactational mastitis 2) Uncomplicated cellulitis
*Cefalexin to be given if client has non-immediate hypersensitivity to penicillins
Included Clients
1) Lactating women > 16 years 2) Age ≥ 12 + weight ≥ 40kg with suspected uncomplicated cellulitis
Excluded Clients (refer to clinical protocol)
Exclusion Suggested Action(s) and Notes
History of allergy to cephalosporin’s or a severe immediate allergic reaction (including urticaria, anaphylaxis or interstitial nephritis) to a penicillin or carbapenems
Refer to NP/GP
Known renal impairment Dose may need to be reduced-> refer to GP
Pregnant Refer to NP/GP
Drug Interactions
Drug Suggested Action(s) and Notes
Probenicid Probenicid decreases the renal tubular secretion of cefalexin, dose will need adjusting -> refer to GP
Metformin Cefalexin may cause increased exposure to metformin due to reduced renal clearance -> refer to GP
Dosing and Administration Information
Age/Weight
Supply Dose
Strength Product
1) Lactating women >16 years 500mg capsules
1 x box of 20 capsules
500mg 6 hourly for 5 days
(GP to determine if a longer course is required) 2) ≥ 12 + weight ≥ 40kg
Adverse Drug Reactions/Side Effects
CEFA
LEXI
N
Reaction Advice for Clients and Notes
Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness.
Common side effects, if prolonged or worsening to seek medical advice
Skin rash, urticaria or anaphylaxis May indicate allergic reaction -> advise to seek medical advice immediately
Hepatic dysfunction, with or without jaundice Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)
Vaginal or oral fungal infection May occur following the use of antibiotics. Refer to a community pharmacy if they have symptoms.
Antibiotic associated Colitis
A severe form of diarrhoea caused by an overgrowth of Clostridium difficile bacteria. The bacteria release a strong toxin that causes the lining of the colon to become inflamed and bleed. Severity of symptoms may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
Points for both Lactational mastitis and uncomplicated cellulitis
• To be administered with or without food • Take antibiotic doses regularly and complete the full treatment course. • Advise that all cephalosporin’s are considered safe to use while breastfeeding – may cause loose
stools in the infant. • Paracetamol and/or ibuprofen for pain management • Follow up with GP on the 3rd day of antibiotic treatment • If deterioration in condition see GP • Drink adequate fluids to prevent dehydration
Specific points for uncomplicated cellulitis
• There may be an increase in redness in the first 24-48 hours of treatment • Elevate the limb for comfort (if applicable)
References
MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: amh.hcn.com.au/
Therapeutic Guidelines: online.tg.org.au/
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval number: 9201740
Walk in Centre
MEDICATION STANDING ORDER
CEFALEXIN (Lower UTI) 500mg capsules
Approved Treatment Protocols
CEFA
LEXI
N
For the treatment of lower UTI
Included Clients
Female clients age ≥ 16
Excluded Clients (refer to clinical protocol)
Exclusion Suggested Action(s) and Notes
History of allergy to cephalosporin’s or a severe immediate allergic reaction (including urticaria, anaphylaxis or interstitial nephritis) to a penicillin or carbapenems
Refer to GP
Known renal impairment Dose may need to be reduced-> refer to GP
Males Refer to GP
Drug Interactions
Drug Suggested Action(s) and Notes
Probenicid Probenicid decreases the renal tubular secretion of cefalexin, dose will need adjusting -> refer to GP
Metformin Cefalexin may cause increased exposure to metformin due to reduced renal clearance -> refer to GP
Pregnancy Refer to NP/GP
Dosing and Administration Information
Age Supply Dose
Strength Quantity
Age ≥ 16 500mg capsules 1 x box of 10 capsules 500mg 12 hourly for 5 days
Adverse Drug Reactions/Side Effects
Reaction Advice for Clients and Notes
CEFA
LEXI
N
Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness.
Common side effects, if prolonged or worsening to seek medical advice
Skin rash, urticaria, or anaphylaxis May indicate allergic reaction -> advise to seek medical advice immediately
Hepatic dysfunction, with or without jaundice Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)
Vaginal or oral fungal infection May occur following the use of antibiotics. Refer to a community pharmacy if they have symptoms.
Antibiotic associated Colitis
A severe form of diarrhoea caused by an overgrowth of Clostridium difficile bacteria. The bacteria release a strong toxin that causes the lining of the colon to become inflamed and bleed. Severity of symptoms may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
• To be administered with or without food • Take antibiotic doses regularly and complete the full treatment course. • Safe to use at recommended doses during breastfeeding. However observe the breastfed
infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush
References
MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: amh.hcn.com.au/
Therapeutic Guidelines: online.tg.org.au/
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval number: 9201739
WALK-IN CENTRES
MEDICATION STANDING ORDER CEFALEXIN (Tonsillitis/bacterial pharyngitis)
50mg in 1mL suspension
500mg capsules
Approved Treatment Protocols
CEFA
LEXI
N
Tonsillitis/bacterial pharyngitis
*Cefalexin to be given if client has non-immediate hypersensitivity to penicillins
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
History of allergy to cephalosporin’s or a severe immediate allergic reaction (including urticaria, anaphylaxis or interstitial nephritis) to a penicillin or carbapenems
Consider Roxithromycin medication standing order
Known renal impairment Dose may need to be reduced-> refer to GP
Pregnancy Refer to NP/GP
Drug Interactions
Drug Suggested Action(s) and Notes
Probenicid Probenicid decreases the renal tubular secretion of cefalexin, dose will need adjusting -> refer to GP
Metformin Cefalexin may cause increased exposure to metformin due to reduced renal clearance -> refer to GP
Dosing and Supply Information
CEFA
LEXI
N
Dosing Supply Label & Instructions
Weight / Age Dose Strength Quantity
< 10 kg Refer to GP
10-12kg 250mg (20.8 - 25mg/kg/dose)
50mg in 1mL suspension
1 x 100ml bottle
5ml every 12 hours for 10 days
12.1 - 14kg 300mg (21.4 –
24.8mg/kg/dose)
50mg in 1mL suspension
2 x 100ml bottle
6ml every 12 hours for 10 days
14.1 – 16kg 350mg (21.9 –
24.8mg/kg/dose)
50mg in 1mL suspension
2 x 100ml bottle
7ml every 12 hours for 10 days
16.1 – 18kg 400mg (22.2 –
24.8mg/kg/dose)
50mg in 1mL suspension
2 x 100ml bottle
8ml every 12 hours for 10 days
18.1 – 20kg 450mg (22.5 –
24.9mg/kg/dose)
50mg in 1mL suspension
2 x 100ml bottle
9ml every 12 hours for 10 days
20.1 – 22kg 500mg (22.7 – 25mg/kg/dose)
50mg in 1mL suspension
2 x 100ml bottle
10ml every 12 hours for 10 days
22.1 – 24kg 550mg
(22.9 – 24.9mg/kg/dose)
50mg in 1mL suspension
3 x 100ml bottle
11ml every 12 hours for 10 days
24.1 – 26kg 600mg
(23 – 24.9mg/kg/dose) 50mg in 1mL suspension
3 x 100ml bottle
12ml every 12 hours for 10 days
26.1 – 28kg 650mg
(23.2– 24.9mg/kg/dose)
50mg in 1mL suspension
3 x 100ml bottle
13ml every 12 hours for 10 days
28.1 – 30kg 700mg
(23.3– 24.9mg/kg/dose)
50mg in 1mL suspension
3 x 100ml bottle
14ml every 12 hours for 10 days
30.1 – 32kg 750mg
(23.4 – 24.9mg/kg/dose)
50mg in 1mL suspension
3 x 100ml bottle
15ml every 12 hours for 10 days
32.1 – 34kg 800mg
(23.5– 24.9mg/kg/dose)
50mg in 1mL suspension
4 x 100ml bottle
16ml every 12 hours for 10 days
34.1 – 36kg 850mg
(23.6– 24.9mg/kg/dose)
50mg in 1mL suspension
4 x 100ml bottle
17ml every 12 hours for 10 days
36.1 – 38kg 900mg
(23.7– 24.9mg/kg/dose)
50mg in 1mL suspension
4 x 100ml bottle
18ml every 12 hours for 10 days
38.1 – 40kg 950mg
(23.8– 24.9mg/kg/dose)
50mg in 1mL suspension
4 x 100ml bottle
19ml every 12 hours for 10 days
>40kg and adult 1000mg
50mg in 1mL suspension
OR
500mg capsules
4 x 100ml bottle OR
40 x 500mg capsules
20ml every 12 hours for 10 days
OR
2 x 500mg capsule every 12 hours for 10 days
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness.
Common side effects, if prolonged or worsening to seek medical advice
Skin rash, urticaria or anaphylaxis
May indicate allergic reaction -> advise to seek medical advice immediately
Hepatic dysfunction, with or without jaundice
Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)
Antibiotic associated colitis
A severe form of diarrhoea caused by an overgrowth of Clostridium difficile bacteria. The bacteria release a strong toxin that causes the lining of the colon to become inflamed and bleed. Severity of symptoms may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.
Vaginal or oral fungal infection
May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
CEFA
LEXI
N
• To be administered with or without food • Take antibiotic doses regularly and complete the full treatment course. • Advise that all cephalosporin’s are considered safe to use while breastfeeding – may cause
loose stools in the infant. • Paracetamol and/or ibuprofen for pain management • If deterioration in condition see GP • Drink adequate fluids to prevent dehydration
Suspension
• Store mixture in fridge (do not freeze) and shake well before use • Measure dose using a metric measure • Do not use any suspension that is left in the bottle after 14 days
If >1 bottle is supplied: • Bottles are the same and not intended to be taken together • Open one bottle first and finish this before moving on to second bottle
References MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: online.tg.org.au/ Australian Medicines Handbook http://amh.hcn.au
Approval Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201741
Walk-in Centres
MEDICATION STANDING ORDER
CEFTRIAXONE
1g IM injection
Approved Treatment Indications
CEFT
RIAX
ON
E
Clearance antibiotic for contacts of cases of meningococcal disease who have been referred to the Walk-in Centres (WiC) by a Health Directorate Communicable Disease Control officer.
A list of contacts for clearance antibiotics will be emailed or faxed to the WiC prior to their visit
Included Patients
• Women who are breastfeeding or pregnant (FIRST LINE) • Adults and children >2 years who are unable to take ciprofloxacin or rifampicin
Excluded Patients
Exclusion Suggested Action(s) and Notes
Children under 2 years old These children will not be referred to the WiC
Clients who have not been referred for clearance antibiotics by a Health Directorate Communicable Disease Control officer
Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.
Hypersensitivity to ceftriaxone, cephalosporin, penicillins, carbapenems, lidocaine (lignocaine)
Clients with renal impairment
Drug Interactions
Drug Suggested Action(s) and Notes
Calcium Calcium containing solutions cannot be used as a diluent.
Dosing and Administration Information
• Reconstitute with 3.5mls of lidocaine 1% (Do not administer with lidocaine if there is hypersensitivity to local anaesthetics).
• To remain a minimum of 15 minutes for observation following administration. Dosing Supply
Age Dose Strength (after reconstitution) Quantity
Child 2-12 years 125mg 250mg/ml 0.5ml
Adult 250mg 250mg/ml 1ml
Adverse Drug Reactions / Side Effects
Reaction Advice for Patients and Notes Anaphylaxis, Stevens-Johnson syndrome, angioedema
May indicate allergic reaction Redirect to ED via ACTAS
Rash, urticaria, allergy May indicate allergic reaction Advise client to seek medical advice immediately
Pain, induration, tender injection site Common side effects, if prolonged or worsening advise client to seek medical advice
Diarrhoea, nausea , vomiting Common side effects, if prolonged or worsening advise client to seek medical advice
CEFT
RIAX
ON
E
Headache, dizziness Refer to GP
Antibiotic associated colitis
A severe form of diarrhoea caused by an overgrowth of Clostridium difficile bacteria. The bacteria release a strong toxin that causes the lining of the colon to become inflamed and bleed. Severity of symptoms may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.
Vaginal fungal infection May occur following the use of antibiotics. Refer to a community pharmacy if they have symptoms.
Eosinophilia, thrombocytosis, leukopenia Refer to GP/ED Pancreatitis, cholecystitis, pseudolithiasis, nephroliasis Refer to GP/ED
Refer patient to printed CMI for a full list of adverse effects.
Specific Counselling Points
• Safe to use in pregnancy • Safe to use at recommended doses during breastfeeding. However observe the breastfed
infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush • Ceftriaxone has not been registered for use as a meningococcal disease clearance antibiotic
in Australia; however, it is recommended for this indication in many countries and its use for this purpose is endorsed by the Communicable Diseases Network Australia.
• Despite prophylaxis, disease can still occur. Parent education regarding frequent, careful observation and the need for examination by a medical practitioner at the first signs of any unexplained illness is essential.
References
Therapeutic Guidelines – Meningitis Chemoprophylaxis https://tgldcdp.tg.org.au MIMs online https://www.mimsonline.com.au Australian Medicines Handbook: amh.hcn.com.au/ The Royal Women’s Hospital, Pregnancy and Breastfeeding Medicine Guide: https://thewomenspbmg.org.au/
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date Order ends: 31 August 2019 CHO Approval Number: 9201737
WALK-IN CENTRES
MEDICATION STANDING ORDER
CEFUROXIME 250mg tablets
25mg/mL suspension
Approved Treatment Indications
CEFU
ROXI
ME
Patients with penicillin hypersensitivity (excluding immediate hypersensitivity) for the following indications:
- Acute otitis media - Acute bacterial sinusitis
Included Patients
All patients aged > 2 years
Excluded Patients
Exclusion Suggested Action(s) and
Notes
History of allergy to cephalosporin or a severe or immediate hypersensitivity (including urticaria, anaphylaxis or interstitial nephritis) to a penicillin or carbapenems.
Refer to NP/GP
Known renal and or hepatic impairment (CrCl < 10mL/min) Dose may need to be reduced refer to GP
Clients with phenylketonuria (oral liquids contain aspartame) Refer to NP/GP
Drug Interactions
Drug Suggested Action(s) and Notes
Probenecid Probenecid decreases the renal tubular secretion of cephalosporin dose will need to be adjusted Refer to GP
Dosing and Supply Information
Dosing Supply Label & Instructions Weight / Age Dose Strength Quantity
< 10 kg Refer to GP
10-13kg 150mg
(11.5 - 15mg/kg/dose)
125mg in 5mL suspension 1 x 70 mL
suspension
Take 6mL every 12 hours for 5 days
>13 - 17kg 200mg
(11.8 – 15.4mg/kg/dose)
125mg in 5mL suspension 2 x 70 mL
suspension
Take 8mL every 12 hours for 5 days
>17kg and up to 12
years
250mg
(14.6mg/kg/dose) 125mg in 5mL suspension
2 x 70 mL suspension
Take 10mL every 12 hours for 5 days
>12 years old to adult, and >33kg
500mg
125mg in 5mL suspension OR
250mg tablets
3 x 70 mL suspension
OR 20 x 250mg
tablets
Take 20ml every 12 hours for 5 days
OR Take TWO tablets
every 12 hours for 5 days
For age >12 but weight <33kg, dose as for >17kg and up to 12 years
Reconstitute suspension as per instructions on bottle
Adverse Drug Reactions / Side Effects
CEFU
ROXI
ME
Reaction Advice for Patients and Notes Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness
Common side effects, if prolonged or worsening see GP
Anaphylaxis, urticaria, blood dyscrasias, Stevens-Johnson syndrome, confusion
May indicate allergic reaction – present to GP/ED as appropriate
Antibiotic associated colitis
This is a severe form of diarrhoea which has been associated with many antibiotics including amoxicillin. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise patients to seek medical advice if they experience prolonged or severe diarrhoea.
Vaginal or oral fungal infection May occur following the use of antibiotics. Refer patient to community pharmacy if they have symptoms
Refer patient to printed CMI for a full list of adverse effects.
Specific Counselling Points
CEFU
ROXI
ME
Pregnancy and Breastfeeding • Maternal use of cefuroxime has not been associated with an increased risk of birth
defects or adverse pregnancy outcomes • Cefuroxime is safe to use at recommended doses during breastfeeding. However
observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush..
Capsules and Suspension: • Best taken with a light meal • Swallow tablets whole, mixture can be mixed with fruit juice or milk immediately
before dosing • Take antibiotic doses regularly and complete the full treatment course
Suspension:
• Store mixture in fridge and shake well before use • Measure dose using a metric measure
If >1 bottle is supplied: - Bottles are the same and not intended to be taken together - Open one bottle first and finish this before moving on to second bottle - Discard any unused suspension after 10 days
References
MIMs online https://www.mimsonline.com.au Therapeutic Guidelines Australian Medicines Handbook
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201738
Walk In Centre
MEDICATION TREATMENT PROTOCOL
CHLORAMPHENICOL Eye Drops 0.5% 10mL
Approved Treatment Indications
CHLO
RAM
PHEN
ICO
L
Bacterial conjunctivitis, defined as • Rapid onset of symptoms • Mucopurulent discharge
Corneal abrasion – superficial, uncomplicated
Included Patients
Bacterial conjunctivitis - Adults and children ≥ 2 years old
Corneal abrasion – Adults and children ≥ 6 years old
Excluded Patients
Exclusion Suggested Action(s) and Notes
History of hypersensitivity or allergy to chloramphenicol or any of the other ingredients in the eye drops
Refer to NP/GP
Complicated ocular trauma – see redirection list on Corneal Abrasion Clinical Protocol
Refer to Ophthalmology Reg/ED
Drug Interactions
Drug Suggested Action(s) and Notes
There are no clinically significant drug interactions when chloramphenicol is used topically
Dosing and Supply Information
Dosing Supply
Label & Instructions Strength Quantity
Bacterial Conjunctivitis Use 1 to 2 drops every 2 hours
initially, decreasing to 6-hourly as the infection improves
0.5 % 1 x 10mL
Instil 1-2 drops into the affected eye/s every 2 hours for the first 24 hours,
decreasing to 6-hourly until discharge resolves, for up to 7 days
Discard one month after opening
Corneal Abrasion Instil 1 drop four times per day for
four days 0.5% 1 x 10ml
Instil 1 drop into the affected eye four times per day until discomfort resolves
(rarely >4days) Discard one month after opening
Adverse Drug Reactions / Side Effects
Reaction Advice for Patients and Notes
Unpleasant taste post dose This is due to the eye drops travelling to the back of the throat and cannot be avoided
Local eye irritation with itching or burning
This may mean the patient is allergic to the eye drops Refer to NP/GP
Skin rashes and urticaria This may mean the patient is allergic to the eye drops Refer to NP/GP
Skin blisters or fever This may mean the patient is allergic to the eye drops Refer to NP/GP
Anaphylaxis Redirect to ED
Refer patient to printed CMI for a full list of adverse effects.
Specific Counselling Points
CHLO
RAM
PHEN
ICO
L
Safe to use in pregnancy and breast feeding Bacterial Conjunctivitis • If there is no improvement after 2 days with chloramphenicol drops, refer to GP • Never pad a discharging eye • Clear away debris and mucus with sterile sodium chloride 0.9% solution before using medication • Contact lenses should not be worn until 24 hours after the infection has completely resolved • Continue treatment for at least 48 hours after the eye appears normal (symptoms disappear) Corneal Abrasion • The eye will feel uncomfortable until the abrasion heals but should improve daily • Most corneal abrasions will heal in 24-72 hours • Contact lenses should not be worn until 24 hours after completion of treatment General Advice (applicable to both conjunctivitis and abrasion) • It is important to write the date you open on the bottle when you open it and to discard it 28 days
later (unless told otherwise). • Use a clean tissue to mop up any excess. • Some people find it easier to use eye medications properly if they have someone help them or if they
use a mirror.
References
MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: online.tg.org.au/ Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Order Number: 9201742
Walk-in Centres
MEDICATION STANDING ORDER
CIPROFLOXACIN 500 mg tablet
Approved Treatment Indications
CIPR
OFL
OXA
CIN
Clearance antibiotic for contacts of cases of meningococcal disease who have been referred to the Walk-in Centres (WiC) by a Health Directorate Communicable Disease Control officer.
A list of contacts for clearance antibiotics will be emailed or faxed to the WiC prior to their visit
Included Patients
• Children ≥ 12 years (FIRST LINE) • Adults (FIRST LINE)
Excluded Patients
Exclusion Suggested Action(s) and Notes
Children under 12 years old These children will not be referred to the WiC
Clients who have not been referred for clearance antibiotics by a Health Directorate Communicable Disease Control officer
Refer to Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 99624155 after hours via a paging service and leave a message in order to receive a returned call.
Women who are pregnant Consider ceftriaxone Notify Communicable Disease Control
Hypersensitivity to ciprofloxacin or other quinolones including nalidixic acid
Consider ceftriaxone Notify Communicable Disease Control
History of peripheral neuropathy, myasthenia gravis, epilepsy or CNS disorder
Consider ceftriaxone Notify Communicable Disease Control
History of renal impairment
Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 99624155 after hours via a paging service and leave a message in order to receive a returned call
Drug Interactions
Drug Suggested Action(s) and Notes
Ciprofloxacin is a strong inhibitor of CYP1A2 and may increase the concentration and risk of adverse effects of drugs metabolised by this enzyme. Examples are agomelatine, amitriptyline, asenapine, axitinib, bendamustine, clozapine, duloxetine, erlotinib, fluvoxamine, imipramine, lidocaine, olanzapine, ondansetron, paracetamol, pomalidomide, propranolol, rasagiline, ropinirole, ropivacaine, theophylline, warfarin, zolmitriptan
A number of medications interact with ciprofloxacin resulting in poor absorption or toxicity of one of the drugs. Contact Communicable Disease Control as per contact details above and consider ceftriaxone
Methotrexate, phenytoin, sildenafil, glibenclamide, glimepride, tizanidine
Ciprofloxacin may increase the concentrations of each of these drugs. Contact Communicable Disease Control as per contact details above and consider ceftriaxone
CIPR
OFL
OXA
CIN
Quinolones may cause seizures; administration with other drugs that also cause seizures may increase this risk.
Examples are
Alimemazine, amantadine, amisulpride, amitriptyline, aripiprazole, asenapine, baclofen, blinatumomab, bupropion, chlorambucil, chloroquine, chlorpromazine, cinacalcet, , clomipramine, clozapine, cycloserine, daclizumab, donepezil, dosulepin, doxepin, droperidol, enzalutamide, ertapenem, fampridine, foscarnet, flupentixol, fluphenazine, galantamine, ganciclovir, haloperidol, imipenem, imipramine, interferons, isoniazid, mefloquine, memantine, mianserin, moxifloxacin, neostigmine, norfloxacin, nortriptyline, NSAIDs, olanzapine, paliperidone, periciazine, phenelzine, pizotifen, promethazine, pyridostigmine, pyrimethamine, quetiapine, risperidone, rivastigmine, theophylline, tranylcypromine, trifluoperazine, valganciclovir, ziprasidone, zuclopenthixol
Quinolones may cause seizures; administration with other drugs that also cause seizures may increase this risk. Contact Communicable Disease Control as per contact details above and consider ceftriaxone
Lanthanum, sevelamer, thyroxine
These agents may reduce one another’s efficacy if given at the same time. Give ciprofloxacin at least 2 hours before, or 4–6 hours after these medications
Iron, sucralfate, antacids containing magnesium, aluminium or calcium
These agents interfere with the absorption of ciprofloxacin. Contact Communicable Disease Control as per contact details above and consider ceftriaxone
Drugs that may prolong QT interval: Disopyramide, amiodarone, sotalol, amisulpride, droperidol, haloperidol, ziprasidone, atazanavir, chloroquine, clarithromycin, clofazimine, erythromycin, fluconazole, mefloquine, moxifloxacin, pentamidine, quinine, voriconazole, anagrelide, arsenic trioxide, ceritinib, crizotinib, dasatinib, eribulin, lapatinib, lenvatinib, nilotinib, pazopanib, sorafenib, sunitinib, toremifene, vandetanib, vemurafenib, cisapride, citalopram, cocaine, dextropropoxyphene, domperidone, escitalopram, fluoxetine, methadone, pasireotide, solifenacin, tacrolimus, tricyclic antidepressants, tetrabenazine, vardenafil
Ciprofloxacin may have an additive effect on the QT interval (very rare). Contact Communicable Disease Control as per contact details above and consider ceftriaxone
CIPR
OFL
OXA
CIN
Cyclosporins Concomitant administration associated with transient elevations of serum creatinine. Contact Communicable Disease Control as per contact details above and consider ceftriaxone
Caffeine Ciprofloxacin may increase the effects of caffeine. Suggest limiting caffeine intake.
Dosing and Administration Information
To remain a minimum of 15 minutes post administration for observation
Age Dose Administration
≥ 12 years and Adult 500mg tablet once Oral 1 hour before or 2 hours after a meal
Adverse Drug Reactions / Side Effects
Reaction Advice for Patients and Notes Anaphylaxis Call ACTAS to transfer to ED Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, rash, itch
Common side effects, if prolonged or worsening advise patient to seek medical advice
Headache, dizziness, insomnia, restlessness
Avoid alcohol for 24 hours. If prolonged or worsening advise patient to seek medical advice
Arthralgia, myalgia, tendonitis, interstitial nephritis
Refer to GP
Hallucinations, seizure Refer to GP
Photo toxicity Wear protective clothing & use sunscreen
Refer patient to printed CMI for a full list of adverse effects.
Specific Counselling Points
CIPR
OFL
OXA
CIN
• This medicine may cause dizziness or faintness, which can affect your ability to drive and/or operate
machinery. Drinking alcohol may worsen these effects. • Ciprofloxacin is the preferred clearance antibiotic for women on the contraceptive pill. • Ciprofloxacin has not been registered for use as a meningococcal disease clearance antibiotic
in Australia however, it is recommended for this indication in many countries and its use for this purpose is endorsed by the Communicable Diseases Network Australia.
• Despite prophylaxis, disease can still occur. Parent education regarding frequent, careful observation and the need for examination by a medical practitioner at the first signs of any unexplained illness is essential.
• Safe to use at recommended doses during breastfeeding. However observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush
References
The Australian Immunisation Handbook 10th Edition 2017 Therapeutic Guidelines – Meningitis Chemoprophylaxis https://tgldcdp.tg.org.au MIMs online https://www.mimsonline.com.au
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval Number: 9201743
WALK-IN CENTRES
MEDICATION STANDING ORDER
DERMABOND Ampoule
Approved Treatment Protocols
DERM
ABO
ND
Simple, superficial, and linear lacerations on the skin surface
Included Clients
Clients aged > 2 years
Excluded Clients
Exclusion Suggested Action(s) and Notes
Known hypersensitivity to Dermabond
Consider alternative method of wound closure
Deep or long (>4cm) wounds
Wounds with jagged or abraded edges
Wounds that are in areas subject to excessive movement (e.g. involve flexures or joints)
Wounds close to areas likely to get wet (e.g. mouth)
Wounds that involve areas with significant hair growth (e.g. forearm, head)
Wounds >12 hours old
Wounds that cross the vermillion border Redirect to ED
Wounds close to or involving the eyes Refer to GP or ED
Contaminated or infected wounds Consider alternative method of wound closure or redirect to ED
Drug Interactions
Drug Suggested Action(s) and Notes
No significant drug interactions
Dosing and Administration Information
Dose Administration
1 ampoule as per wound closure guideline
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
DERM
ABO
ND
• Advise to keep wound clean and dry for the first 24 hours • Do not pick at the glue/scab • Let the glue/scab fall off naturally • Any bleeding or problems return to Walk-in Centres.
References
NPS Medicinewise https://www.nps.org.au/australian-prescriber/articles/skin-glues-for-wound-closure#b1
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201744
Walk in Centre
MEDICATION STANDING ORDER
Dexamethasone 1mg / 1 mL suspension
Approved Treatment Protocols
Dexa
met
haso
ne
For the treatment of croup
Included Clients
Child ≥ 2yrs old
Excluded Clients (refer to clinical protocol)
Exclusion Suggested Action(s) and Notes
History of allergy or hypersensitivity to dexamethasone or any corticosteroid
Refer to GP/ NP
Child with complex medical conditions or health issues (e.g. cystic fibrosis, Down syndrome)
Dose may need to be altered -> refer to GP/ NP
Concurrent Infection Refer to GP/ NP
Drug Interactions
Drug Suggested Action(s) and Notes
Antidiabetic agents (oral or insulin)
Glucose control maybe affected, advise to increase glucose monitoring and seek medical advice if extreme or prolonged.
Vaccines, live viruses or other immunisations
Advise no live vaccination to be administered within two weeks of corticosteroid dose – low risk, avoid if possible
Dosing and Administration Information
DEX
AMET
HAS
ON
E Age/Weight
Product/Strength Dose
Child age ≥2 years old Dexamethasone/ 1mg/mL
50 ml bottle Keep always in fridge,
opening does not shorten expiry date.
Oral dexamethasone 0.15mg/kg (max 10mg) single stat dose
Dosing Instructions
Weight (kg) Dose (mg) Strength
10 –12 kg 1.8mg 1mg/mL suspension Take 1.8mL by measure once only
13–14 kg 2.1mg Take 2.1 mL by measure once only
15 –16 kg 2.4mg Take 2.4mL by measure once only
17–18 kg 2.7mg Take 2.7mL by measure once only
19–20 kg 3 mg Take 3.0mL by measure once only
21–22 kg 3.3mg Take 3.3mL by measure once only
23 –24 kg 3.6mg Take 3.6mL by measure once only
25–26 kg 3.9mg Take 3.9mL by measure once only
27–28 kg 4.2mg Take 4.2mL by measure once only
29–30 kg 4.5mg Take 4.5mL by measure once only
31–32 kg 4.8 mg Take 4.8mL by measure once only
33–34 kg 5.1mg Take 5.1mL by measure once only
35–36 kg 5.4 mg Take 5.4mL by measure once only
37–38 kg 5.7 mg Take 5.7mL by measure once only
39-40kg 6 mg Take 6.0mL by measure once only
41-42kg 6.3mg Take 6.3mL by measure once only
43-44kg 6.6mg Take 6.6mL by measure once only
Adverse Drug Reactions/Side Effects
DEX
AMET
HAS
ON
E
Reaction Advice for Clients and Notes
Incidence of adverse effects is related to dose and duration of treatment. Single dose administration of Dexamethasone Oral Liquid, even in doses at the high end of the dose range is unlikely to produce harmful effects associated with chronic usage
General Retardation of growth can occur with long-term corticosteroid treatment in children.
Gastrointestinal (Nausea, vomiting, diarrhoea or constipation, abdominal distension, gastric irritation, increased/decreased appetite, indigestion)
Common side effects, if prolonged or worsening advise client to seek medical advice
Integumentary Skin rash and/or urticaria may indicate allergic reaction -> seek medical advice immediately. Impaired wound healing.
Nervousness or restlessness; insomnia. If prolonged, severe or worsening advise client to seek medical advice
Immune System
Infections may be masked since corticosteroids have marked anti-inflammatory and antipyretic properties and may produce a feeling of wellbeing.
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
. • Children with no stridor at rest or respiratory distress may be managed at home. Easy access
to further medical review should be available. • Children need to be encouraged to drink adequate fluids to prevent dehydration • Take oral liquid with food to help reduce stomach upset. Advise parents that dexamethasone
may cause mood or sleep disturbances and to seek medical advice if prolonged or worsening • Improvement should begin from 2 hours post administration. The anti-inflammatory effect of
dexamethasone lasts 2-4 days. • Paracetamol and/or ibuprofen for fever or pain management • Follow up with GP/ NP within 24 hours of treatment • If deterioration in condition see GP or the Emergency Department
References
45-46kg 6.9mg Take 6.9mL by measure once only
47-48kg 7.2mg Take 7.2mL by measure once only
49-50kg 7.5mg Take 7.5mL by measure once only
MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: amh.hcn.com.au/
Therapeutic Guidelines: online.tg.org.au/
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval number: 9201745
WALK-IN CENTRES
MEDICATION STANDING ORDER
DEXAMETHASONE, FRAMYCETIN & GRAMICIDIN
Ear drops
8mL solution
Approved Treatment Protocols
DEX
AMET
HAS
ON
E, F
RAM
YCET
IN &
GRA
MIC
IDIN
Otitis externa
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
Tympanic membrane trauma Refer to GP
Tympanostomy tube insitu Refer to NP/GP
Known hypersensitivity to dexamethasone, Framycetin or gramicidin
Refer to NP/GP
Viral or tubercular lesions Refer to GP
If fungal cause of infection is suspected Consider use of triamcinolone + neomycin + nystatin + gramicidin ear drops or refer to NP/GP if uncertain
Drug Interactions
Drug Suggested Action(s) and Notes
Nil known N/A
Dosing and Supply Information
Dose Strength Supply Label & Instructions
3 drops per ear canal
Dexamethasone 0.05%
Framycetin sulphate 0.5%
Gramicidin 0.005%
1 x 8mL bottle Instil THREE drops per ear canal 3 times a day for 3 to 7 days
Adverse Drug Reactions / Side Effects
DEX
AMET
HAS
ON
E, F
RAM
YCET
IN &
GRA
MIC
IDIN
Reaction Advice for Clients and Notes
Allergic dermatitis and fungal overgrowth
Both associated with prolonged use – use drops only for duration prescribed. See GP if these symptoms develop
Inner ear damage Rare side effect - see GP
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
Refer to CMI for instructions on instilling ear drops Consider use of tissue spears for absorbing discharge from ear canal Pregnancy – safe to use Breast feeding:
• Dexamethasone, Framycetin and Gramicidin is considered safe for use by breast feeding mothers
References
MIMs online https://www.mimsonline.com.au AMH https://amhonline.amh.net.au/ Therapeutic Guidelines
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201746
Walk in Centre
MEDICATION STANDING ORDER
DICLOXACILLIN 500mg capsules
Approved Treatment Protocols
DICL
OXA
CILL
IN
For the treatment of:
1) Lactational mastitis
2) Uncomplicated cellulitis
Included Clients
3) Lactating women > 16 years 4) Age ≥ 12 + weight ≥ 40kg with suspected uncomplicated cellulitis
Excluded Clients (refer to clinical protocol)
Exclusion Suggested Action(s) and Notes
History of mild to moderate penicillin allergy Consider cefalexin
History of severe or immediate hypersensitivity reaction to a penicillin
Refer to GP
Renal or hepatic impairment Refer to GP
History of cholestatic hepatitis with dicloxacillin or flucloxacillin
Refer to GP
Pregnant Refer to GP
Drug Interactions
Drug Suggested Action(s) and Notes
Probenicid Probenicid decreases penicillin excretion, prolonging its activity
-> refer to GP
Warfarin Dicloxacillin may decrease warfarin’s anticoagulant effect
-> refer to GP
Phenytoin Dicloxacillin may lead to a reduction in serum phenytoin levels
-> refer to GP
Methotrexate Penicillins may reduce the renal clearance of methotrexate resulting in toxicity -> refer to GP
Dosing and Administration Information
Age/Weight
Supply Dose
Strength Product
1) Lactating women >16 years 500mg
capsules 1 x box of 20
capsules
500mg 6 hourly for 5 days
(GP to determine if a longer course is required) 2) ≥ 12 + weight ≥ 40kg
Adverse Drug Reactions/Side Effects
Reaction Advice for Clients and Notes
Nausea, vomiting, epigastric discomfort, loose stools
Common side effects, if prolonged or worsening advise patient to seek medical advice
Rash, erythema, anaphylaxis, bronchospasm, fever, Stevens-Johnson syndrome
May indicate allergic reaction -> advise to seek medical advice immediately
Transient increases in LFTs and bilirubin
Monitor hepatic function in patients having > 2 weeks of therapy. Refer for monitoring if prolonged course and advise patient to seek medical advice if they have symptoms of jaundice (yellow skin and/or eyes).
Cholestatic hepatitis Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)
Vaginal or oral fungal infection May occur following the use of antibiotics. Refer to a community pharmacy if they have symptoms.
DICL
OXA
CILL
IN Antibiotic associated colitis
A severe form of diarrhoea caused by an overgrowth of Clostridium difficile bacteria. The bacteria release a strong toxin that causes the lining of the colon to become inflamed and bleed. Severity of symptoms may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
Points for both Lactational mastitis and uncomplicated cellulitis
• Dicloxacillin is absorbed best if the capsules are taken on an empty stomach at least half an hour before food or 2 hours after food.
• Take antibiotic doses regularly and complete the full treatment course. • Safe to use while breastfeeding – Dicloxacillin is safe to use at the recommended doses during
breastfeeding. However, observe the breastfed infant for potential adverse effects such as diarrhoea, vomiting, skin rash or thrush. Dicloxacillin is safe to use at the recommended doses during breastfeeding. However, observe the breastfed infant for potential adverse effects such as diarrhoea, vomiting, skin rash or thrush.
• Follow up with GP on the 3rd day of antibiotic treatment • If deterioration in condition see GP
• Drink adequate fluids to prevent dehydration • Paracetamol and/or ibuprofen for pain management
Specific points for uncomplicated cellulitis
• There may be an increase in redness in the first 24-48 hours of treatment • Elevate the limb for comfort (if applicable)
References
MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: amh.hcn.com.au/ Therapeutic Guidelines: online.tg.org.au/
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval number: 9201747
WALK-IN CENTRES
MEDICATION STANDING ORDER
GLUCAGON 1mg injection kit
Approved Treatment Protocols
GLU
CAG
ON
Hypoglycaemia
Included Clients
Clients with BGL readings < 4 mmol/L and have severely altered level of consciousness and/or when a client’s blood glucose level falls to values low enough to cause signs and symptoms of hypoglycaemia
If Glucagon is administered, an ACTAS “000” call must be made.
Dosing and Administration Information Dose Administration
Adult, child >25kg, SC or IM 1 mg. Child <25kg, SC or IM 0.5 mg. Call ACTAS “000” if glucagon is required
• The glucagon should be dissolved in the accompanying diluent.
• Inject the water for injections (1.1 mL) into the vial containing the freeze dried glucagon.
• Gently shake the vial until the glucagon is completely dissolved and the solution is clear.
• Withdraw the solution back into the syringe. The reconstituted solution appears clear and colourless, and forms an injection of 1 mg (1 IU) per mL to be administered subcutaneously or intramuscularly
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes
Nausea, vomiting,
Common side effects, if prolonged or worsening see GP
Hypokalaemia (large doses), allergic reactions Advise patient to seek medical advice
Specific Counselling Points
Pregnancy & Breastfeeding
• Glucagon is safe to use during pregnancy and breast feeding when indicated. Actions Post Dose
• Call ACTAS “000” if glucagon is required • The client should respond to glucagon within 10–15 minutes • Give complex carbohydrates orally when person has responded to prevent recurrent hypoglycaemia
References
MIMs online https://www.mimsonline.com.au The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide
Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201748
WALK-IN CENTRES
MEDICATION STANDING ORDER
IBUPROFEN 100mg in 5mL suspension
200mg tablets
Approved Treatment Protocols
IBU
PRO
FEN
For the treatment of mild to moderate pain or pyrexia in excess of 37.5° (that is either not relieved by Paracetamol, or where Paracetamol is contraindicated)
May be used for the following treatment protocols: Abrasions, Ankle Injury, Boils and Carbuncles, Bites, Burns, Common Cold, Contusions, Coxcackie Virus, Diarrhoea, Elbow Injury, Finger / Toe Injury, Foot Injury, Fractures, Hand Injury, Headache, Influenza, Knee Injury, Lacerations, Lactational Mastitis, Lower Urinary Tract Infection, Marine Stings, Migraine, Non-specific Viral Rash, Otitis Externa, Otitis Media, Paronychia, Primary Dysmenorrhoea, Rubella, Scaphoid Injury, Sinusitis, Spider Bites, Stings, Tonsillitis, Varicella, Wrist Injury
Included Clients
Adults and children aged > 2 years old
For clients who meet the inclusion criteria, a SINGLE dose of Ibuprofen may be administered in the WiC (a record of this dose must be documented in the clinical record)
Excluded Clients
Exclusion Suggested Action(s) and Notes
Pregnant or breast feeding mothers Use paracetamol or refer to GP
Ibuprofen dose within the last 8 hours (including any other Ibuprofen containing product)
Use paracetamol or refer to GP
Known hypersensitivity to Aspirin, Ibuprofen or other NSAID
Ibuprofen not appropriate Use paracetamol or refer to GP
Current or previous history of dyspepsia or peptic ulceration or GI bleeding
Ibuprofen not appropriate Use paracetamol or refer to GP
Asthmatics, who have never used NSAID before or have severe asthma or had worsening of asthma symptoms after previous use
NSAIDs may increase risk of bronchospasm. Ibuprofen is not appropriate Use paracetamol or refer to GP
Clients with known severe cardiac disease, heart failure, oedema or hypertension
These disease states can be exacerbated by sodium and fluid retention caused by NSAIDs. Ibuprofen is not appropriate Use paracetamol or refer to GP
Clients with known renal impairment Pre-existing renal impairment increases the risk of NSAID-induced impairment and risk of bleeding. Ibuprofen is not appropriate Use paracetamol or refer to GP
Dehydration NSAIDs may reduce renal function and cause acute renal failure Use paracetamol or refer to GP
Coagulation disorders Nonselective NSAIDs may increase risk of bleeding due to their antiplatelet effects Use paracetamol or refer to GP
Drug Interactions
IBU
PRO
FEN
Drug Suggested Action(s) and Notes
Fluconazole or Voriconazole May inhibit Ibuprofen’s metabolism, increasing its concentration and may increase risk of adverse effects. Use paracetamol or refer to GP
Alendronate May increase risk of gastric ulceration with NSAIDs; avoid combination or monitor carefully.
Tacrolimus, Cyclosporins Increased risk of nephrotoxicity with NSAIDs Use paracetamol or refer to GP
Oral Corticosteroids Increased risk of gastrointestinal bleeding Use paracetamol or refer to GP
Antiplatelet or Anticoagulants e.g. Aspirin, Clopidogrel, Phenindione, Warfarin
NSAIDs increase the risk of bleeding (antiplatelet effect) Use paracetamol or refer to GP
Other NSAIDs Avoid concomitant use of two or more NSAIDs Use paracetamol or refer to GP
Aspirin Increases risk of gastric ulceration with NSAIDs, however a single dose is safe.
Lithium, Methotrexate NSAIDs may reduce their elimination, increasing risk of toxicity Use paracetamol or refer to GP
Loop Diuretics e.g. frusemide, Bumetanide, Ethacrynic acid
Reduced diuretic effect and increased risk of nephrotoxicity Use paracetamol or refer to GP
ACE inhibitors, Angiotensin receptor blockers. E.g. Perindopril, Ramipril, Irebesartan, Telmisartan, Valsartan
May reduce antihypertensive effect of ACE inhibitor and may increase risk of renal impairment and hyperkalaemia Use paracetamol or refer to GP
Potassium, Aldosterone antagonists
E.g. Spironolactone, eplerenone
NSAIDs may increase the risk of hyperkalaemia (they can cause hyperkalaemia and also reduce renal function) Use paracetamol or refer to GP
Antihypertensive NSAIDs may impair antihypertensive effect of antihypertensive agents Use paracetamol or refer to GP
Dosing and Administration Information
NOTE: a SINGLE dose of Ibuprofen may be administered in the WiC
(a record of this dose must be documented in the clinical record)
Dosing Supply Instructions
Weight (kg) Dose (mg) Strength Quantity
10 – 14 80 100mg/5mL suspension
1 x 100mL bottle
Take 4mL by measure every 6 -8 hours when required
15 – 20 120 Take 6mL by measure every 6 -8 hours when required
21 – 25 160 Take 8mL by measure every 6 -8 hours when required
26 – 30 200 Take 10mL by measure every 6 -8 hours when required
31 – 35 240 Take 12mL by measure every 6 -8 hours when required
36 – 40 280 Take 14mL by measure every 6 -8 hours when required
41 – 45 320 Take 16mL by measure every 6 -8 hours when required
46 - 50 360 Take 18mL by measure every 6 -8 hours when required
> 50kg or Adults 400 100mg/5mL
suspension 1 x 100mL
bottle Take 20mL by measure every 6 -8 hours when
required
Adverse Drug Reactions / Side Effects
IBU
PRO
FEN
Reaction Advice for Clients and Notes
Nausea, vomiting, heartburn or pain in the upper part of the stomach
Common side effect which can be alleviated by taking dose with food. If prolonged or worsening see GP
Loss of appetite, cramps, wind, constipation or diarrhoea, headache, dizziness, sleepiness
These side effects are usually mild, if prolonged or worsening see GP
Vomiting blood or material that looks like coffee grounds or bleeding from the back passage, black sticky bowel motions (stools) or bloody diarrhoea
This may indicate gastric bleeding or ulceration refer to ED immediately
Rash, itch, face or lip swelling, wheezing or shortness of breath
This may indicate an allergic reaction to Ibuprofen refer to the ED immediately
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
• Maximum of 4 doses in 24 hours • Take medicine with or after food or milk • Ibuprofen may be taken with Paracetamol if necessary • Advise the client not to take other NSAID containing products at the same time e.g. over-the-
counter medicines containing Aspirin • Discontinue if indigestion or other gastro-intestinal symptoms develop e.g. haematemesis • If condition worsens or symptoms persist then seek further medical advice
See the community pharmacist for further supply
References
MIMs online https://www.mimsonline.com.au Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201749
Walk-in Centre
MEDICATION STANDING ORDER
Laceraine® Lidocaine (lignocaine) hydrochloride monohydrate 4%, Tetracaine (Amethocaine)
hydrochloride 0.5%, Adrenaline (epinephrine) 0.1% - 5mL vial
Approved Treatment Protocols
Lace
rain
e®
Lacerations
Included Clients
2-12 year olds with superficial dermal lacerations ≤7cm long
*Use with caution when client history of: epilepsy; hypovolaemia; diabetes mellitus; asthma
Excluded Clients
Exclusion Suggested Action(s) and Notes
Known allergy to any type of local anaesthetics or sensitivity to para-aminobenzoic acid and its derivatives
Redirect to ED
Not to be applied to digits, tip of nose, ears or genitalia
Laceraine® is contraindicated →Refer to Lidocaine (lignocaine) Protocol or Redirect to ED
Mucous membranes Laceraine® is contraindicated → Redirect to ED
Dental injuries Laceraine® is contraindicated → Redirect to Dentist or ED
Injuries involving a major vein/artery Laceraine® is contraindicated → Redirect to ED
Burns Laceraine® is contraindicated → Refer to Burns Protocol
Complex or contaminated wounds (bites)
Laceraine® is contraindicated → Redirect to GP or ED as appropriate
Drug Interactions
Drug Suggested Action(s) and Notes
Ingestion of MAO inhibitors in the last 14 days, tricyclics antidepressants, quinidine, non-selective beta-blockers (e.g. propranolol), cardiac glycosides (e.g. digoxin)
** If any of the above are noted client needs to be re-directed to ED for review **
Dosing Information
2-12 year olds
Wounds/lacerations ≤ 7cm
Laceraine® topical wound anaesthetic – NOT for injection lignocaine (lignocaine) hydrochloride 4% (40mg/mL) Tetracaine (Amethocaine) hydrochloride 0.5% (5mg/mL) adrenaline (epinephrine) 0.1% (1mg/mL) 5mL vial Max. Daily dose 0.1mL/kg (capped at a maximum of 3mL)
• 1-2mL for <5cm laceration • 3mL for ≥5cm laceration
Administration Information
• For topical use on broken skin e.g. laceration • Clean wound to remove debris and clotted blood • Wearing gloves, soak cotton wool balls with Laceraine® and apply to wound • Cover cotton wool balls and area around wound with an occlusive dressing • Leave dressing insitu for 20-30 mins (max. 60 minutes); test sensation prior to further
treatment • Care should be taken to ensure the product is not inadvertently transferred to the eyes,
mouth and other mucous membranes
Specific Counselling Points
• Blanching around the wound will occur and is a sign Laceraine® has taken effect • Stinging is normal on first application • Anaesthesia will be provided but pressure will still be felt during suturing • May not provide full anaesthetic cover – infiltration may still be required
Lace
rain
e®
Adverse Drug Reactions/Side Effects
Reaction Advice for Clients and Notes
Increased central nervous system excitability then depression (early sign tongue or perioral numbness)
Rarely occurs
Depression of cardiovascular system Vasovagal attack Rarely occurs
Local burning, itching, redness Most common reaction
Contact dermatitis, rash and hives Most common reaction
Redirect to ED if severe reaction occurs or if unable to achieve adequate anaesthesia
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
• Monitor child for adverse reactions
• Advise parents the topical anaesthetic takes 20-30 minutes to take effect
• Advise parents it is normal to see blanching of the skin
References
Laceraine® Topical Wound Anaesthetic Product Information; Phebra Pty Ltd, June 2013
Smith B.C and Wilson A.H. Topical Versus Injectable Analgesics in Simple Laceration Repair: An Integrative Review. The Journal for Nurse Practitioners. 2013; 9(6): 374-380.
Berant R. and Scolnik D. Topical lidocaine-epinephrine-Tetracaine is effective in reducing pain during laceration repair with tissue adhesive in children. Evid Based Nurs October 2014; 17(4): 118. Downloaded from http:ebn.bmj.com/ on September 20, 2015 – Published by group bmj.com.
Nurse Practitioner Clinical Protocol - Pain management and procedural sedation. Medication Standing Order: Lignocaine 4%, Tetracaine 0.5% and Adrenaline 0.1% (Laceraine). Emergency Department Princess Margaret Hospital for Children. July 2015.
Canberra Hospital and Health Services Laceraine Medication Standing Order. February 2016.
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval number: 9201750
WALK-IN CENTRES
MEDICATION STANDING ORDER
LEVONORGESTREL 1.5mg tablets
Approved Treatment Protocols
LEVO
NO
RGES
TREL
• Emergency Contraception (not to be supplied to a third party)
Included Clients
Female clients who have had unprotected intercourse <120 hours prior to arrival (As per the Gillick Principle). The dose is to be given under supervision in the Walk-in Centres.
If re-presenting due to vomiting ensure Vomiting Treatment Guideline followed.
Excluded Clients
Exclusion Suggested Action(s) and Notes
If time since unprotected sexual intercourse exceeds 72 hours
Refer to GP/NP, Sexual Health or ED
Breast cancer Refer to GP, Sexual Health or ED
Unexplained vaginal bleeding Refer to GP, Sexual Health or ED
Pregnancy Refer to GP
Drug Interactions
Drug Suggested Action(s) and Notes
Warfarin
Levonorgestrel for emergency contraception has been associated with a marked increase in INR within three days of administration, and warfarin dose my need to be altered Refer to GP
Hepatic CYP3A4 enzyme inducing drugs
e.g. Aprepitant, Asunaprevir, Bosentan,Dabrafenib, efavirenz enzalutamide, etravirine, griseofulvin, lumacaftor modafinil nevirapine phenobarbital, phenytoin rifabutin, rifampicin ritonavir St John’s wort
These medications can increase the metabolism (and therefore reduce the efficacy) of Levonorgestrel. Increased doses may be required Give dose but refer to GP or Canberra Sexual Health Clinic within 12 hours
Dosing and Administration Information
Dose Administration
1x1.5mg tablet Give 1x1.5mg tablet to be taken immediately in the Walk-in
Centres
Adverse Drug Reactions / Side Effects
LEVO
NO
RGES
TREL
Reaction Advice for Clients and Notes
Nausea, stomach upset or vomiting
Common side effects but should resolve within 12 hours. However if the client vomits within 2 hours of taking the tablets, the dose may not be effective and should be repeated Advise client to come back to the WiC or refer to GP or ED
Breast tenderness and headaches
Will disappear within 48 hours of dose and do not usually require treatment. Over the counter analgesia can be used if required. Refer client to GP if symptoms last longer than 48 hours.
Light vaginal bleeding
Can occur a few days after taking Levonorgestrel. This is NOT a normal period and client should see their GP if the bleeding is heavy or prolonged, or if menses is delayed by one week
Ectopic pregnancy (pregnancy in a fallopian tube) indicated by unusual pain in the low abdomen
This is a rare complication of Levonorgestrel, however if a client experiences these symptoms anytime within the month after taking the dose Immediate referral to ED is recommended
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
• Efficacy - Emergency contraception is not 100% effective, the time elapsed since intercourse is critical factor.
o <24 hours - 95% o 24-48 hours - 85% o 48-72 hours – 58% o 72-120 hours - <58% o >120 hours considered not effective
If a client is 70kg or more, or has Crohn’s disease, irritable bowel or acute diarrhoea or vomiting the efficacy may be reduced
• Possibility of Sexual Assault - where sexual assault is suspected, the client should be referred to a sexual assault referral centre as per Sexual Health Clinical Impression
• Ectopic Pregnancy - The client should be advised about the slight increase in the risk of ectopic pregnancy and advised what to do if they have symptoms (see adverse effects section)
• Contraceptive Advice - Emergency contraception will only cover the episode of unprotected sexual intercourse discussed and it is therefore important to use extra precautions at least until next menstrual period. Alternative contraceptive methods should be discussed and client referred to ACT Sexual Health & Family Planning as per Sexual Health Clinical Impression
• Sexually Transmitted Infections - Discuss with the client risk associated with unprotected sexual intercourse and the possibility of infection.
• Follow Up - After emergency contraception the client should be advised that their menstrual cycle should occur at the same anticipated time but could be a week early or a week late. If the client is a week or more late then pregnancy testing is advised. The emergency contraception does not provide any lasting contraception.
• Breast Feeding – Is considered safe for breast feeding mothers.
References
LEVO
NO
RGES
TREL
MIMs online https://www.mimsonline.com.au Australian Medicines Handbook http://amh.hcn.au
Direct product request guideline. Supply of Levonorgestrel as a Pharmacist Only medicine for emergency contraception. Pharmaceutical Society of Australia, October 2008.
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201751
WALK-IN CENTRES
MEDICATION STANDING ORDER
LIDOCAINE (lignocaine) 1% 5mL ampoule
Approved Treatment Protocols
LIDO
CAIN
E (li
gnoc
aine
) 1%
Abrasions, Boils and Carbuncles, Lacerations, Paronychia
Included Clients
Clients aged 2 or over
Clients aged 2-10 may need sedation and therefore referral to ED
Excluded Clients
Exclusion Suggested Action(s) and Notes
Known hypersensitivity to local anaesthetics
Lidocaine (lignocaine) is contraindicated Refer to ED or GP
Inflammation or sepsis at the proposed site of injection.
Lidocaine (lignocaine) is contraindicated Refer to ED or GP
Drug Interactions
Drug Suggested Action(s) and Notes
No significant drug interactions exist when lidocaine (lignocaine) is administered subcutaneously
Dosing and Administration Information Dose Administration
The maximum dose is 200mg (or 3mg/kg) which is 20mL of the 1% solution
• The lowest dosage that results in effective anaesthesia should be used to avoid high plasma levels and serious undesirable systemic side effects
• Injection should always be made slowly with frequent aspirations to avoid inadvertent intravascular injection, which can produce cerebral symptoms even at low doses.
• Most local anaesthetics have limited solubility if pH >6; adding alkaline solutions (e.g. sodium bicarbonate) to increase speed of onset is not recommended as it may result in precipitation.
• Injecting slowly through the wound rather than through intact skin helps reduce the pain from the injection
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes Localised oedema, urticaria, bronchospasm and anaphylaxis.
Client may be experiencing an allergic reaction Refer client to ED
Anxiety, pallor, tachycardia, hypertension, sweating or arrhythmias
May indicate a vasoconstrictor reaction which usually resolves on stopping administration Cease admininstration and refer client to ED
LIDO
CAIN
E (li
gnoc
aine
) 1%
Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness
May be early warning signs of CNS toxicity Refer client to ED
Specific Counselling Points
Pregnancy and breast feeding • Lidocaine (lignocaine) at recommended dosages is considered safe in pregnancy and
breastfeeding. Techniques that are less painful should be considered for wound repair, for example using narrow sterile adhesive strips for superficial wounds, and/or skin glues for small scalp lacerations.
References
MIMs online https://www.mimsonline.com.au Therapeutic Guidelines Analgesic The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201753
WALK-IN CENTRES
MEDICATION STANDING ORDER
LIDOCAINE (lignocaine) 1% with ADRENALINE (epinephrine)
1:100,000 5mL glass ampoule
Approved Treatment Protocols
Lido
cain
e (l
igno
cain
e) 1
% w
ith a
dren
alin
e (e
pine
phrin
e)
Boils and Carbuncles, Lacerations
Not for hand or face
Included Clients
Adults and children aged >2 years
Clients aged 2-10 may need sedation and therefore referral to ED
Excluded Clients
Exclusion Suggested Action(s) and Notes
Not for use on digits, face, ears or genitalia
Lidocaine without adrenaline (epinephrine) if appropriate, otherwise refer to ED
Known hypersensitivity to local anaesthetics
Lidocaine is contraindicated Refer to ED or GP
History of Raynaud’s disease or peripheral vascular disease
Lidocaine without adrenaline (epinephrine) if appropriate, otherwise refer to ED
Inflammation or sepsis at the proposed site of injection
Lidocaine with adrenaline (epinephrine) is contraindicated Refer to ED or GP
Hypertension in pregnant women Adrenaline (epinephrine) is contraindicated Refer to ED or GP
Known cardiac disease, arrhythmias Adrenaline (epinephrine) is contraindicated Refer to ED or GP
Drug Interactions
Drug Suggested Action(s) and Notes
Monoamine oxidase inhibitors or tricyclic antidepressants
The use of adrenaline (epinephrine) with these medications may lead to hypertension. Persons on these medication should be referred to the ED or
their GP for further management
Oxytocic drugs of the ergot type
The use of adrenaline (epinephrine) with these medications may lead to hypertension. Persons on these medication should be referred to the ED or
their GP for further management
Lido
cain
e (l
igno
cain
e) 1
% w
ith a
dren
alin
e (e
pine
phrin
e)
Adrenergic neuron blocking agents Persons on these medication should be referred to
the ED or their GP for further management
Cardiac glycosides, quinidine and beta blockers
The use of adrenaline (Epinephrine) with these medications may lead to arrhythmias. Persons on these medication should be referred to the ED or
their GP for further management
Hypoglycaemics
The use of adrenaline (epinephrine) with these medications may lead to a hypoglycaemic event.
Persons on these medication should be referred to the ED or their GP for further management
Dosing and Administration Information
Dose Administration
The maximum dose is 50mL (or 7mg/kg) of the 1% solution
• The lowest dosage that results in effective anaesthesia should be used to avoid high plasma levels and serious undesirable systemic side effects
• Injection should always be made slowly with frequent aspirations to avoid inadvertent intravascular injection, which can produce cerebral symptoms even at low doses.
• Most local anaesthetics have limited solubility if pH >6; adding alkaline solutions (e.g. sodium bicarbonate) to increase speed of onset is not recommended as it may result in precipitation.
• Injecting slowly through the wound rather than through intact skin helps reduce the pain from the injection
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes Localised oedema, urticaria, bronchospasm and anaphylaxis.
Client may be experiencing an allergic reaction Refer client to ED
Anxiety, pallor, tachycardia, hypertension, sweating or arrhythmias
May indicate a vasoconstrictor reaction which usually resolves on stopping administration Cease admininstration and refer client to ED
Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness
May be early warning signs of CNS toxicity Refer client to ED
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
Lido
cain
e 1
% w
ith a
dren
alin
e
Pregnancy and breast feeding • Lidocaine and adrenaline at recommended dosages are considered safe in pregnancy and
breastfeeding.
Techniques that are less painful should be considered for wound repair, for example using narrow sterile adhesive strips for superficial wounds, and/or skin glues for small scalp lacerations.
References
MIMs online https://www.mimsonline.com.au Therapeutic Guidelines Analgesic The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019 CHO Approval Number: 9201752
Walk in Centre
MEDICATION STANDING ORDER
LORATADINE 10mg tablets
1mg in 1ml suspension Approved Treatment Protocols
LORA
TADI
NE
Allergic conjunctivitis
Allergic rhinitis
Urticaria
Included Clients
Adults and children ≥ 2 years old – dose on site only, do not supply
Excluded Clients
Exclusion Suggested Action(s) and Notes
Pregnant women or breast feeding mothers Refer to Community Pharmacist or GP
Impaired hepatic function Refer to Community Pharmacist or GP
History of hypersensitivity or idiosyncrasy to Loratadine
Refer to Community Pharmacist or GP
Drug Interactions
Drug Suggested Action(s) and Notes
Nil Known N/A
Dosing and Administration Information
Age Dose Strength Quantity Instructions
2-12 years and <30kg
5mg 1mg/ml suspension
5ml suspension
Take 5ml daily
>30kg or Adults
10mg
1mg/ml suspension
10ml suspension
Take 10ml daily
10mg tablets 1 x tablet Take ONE tablet daily
For suspension, use a dose from the stock bottle
Adverse Drug Reactions/Side Effects
Reaction Advice for Clients and Notes
Difficulty breathing or syncope
May indicate allergic reaction – ED via ACTAS
Urticarial rash, drowsiness, nausea, headache, sedation, fatigue or dry mouth If prolonged or worsening see GP
Hepatic dysfunction, with or without jaundice. Weight gain Refer to GP
Nervousness, hyperkinesia, sedation Refer to GP
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
This medication is non-sedating for most but may make some people sleepy; don’t drive or operate machinery if drowsiness develops. Avoid use with pregnancy and breast feeding See the community pharmacist for further supply. If allergic rhinitis is chronic, then topical nasal sprays are also available and the client should be advised to discuss the problem with the pharmacist or GP
References
LORA
TADI
NE
MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: https://amhonline.amh.net.au/ Therapeutic Guidelines: online.tg.org.au/
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval number: 9201754
WALK-IN CENTRES
MEDICATION STANDING ORDER
METOCLOPRAMIDE 10mg tablets
10mg/2mL injections
Approved Treatment Protocols
MET
OCL
OPR
AMID
E
To control nausea and vomiting associated with the following treatment protocols: Migraine, Vomiting
Included Clients
Adults ≥ 20 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
Parkinson’s disease Refer to NP or GP
Nausea caused by medication changes or additions Refer to prescriber
Suspected bowel obstruction, haemorrhage, or perforation Refer to ED
Phaeochriomocytoma Refer to GP
Drug Interactions
Drug Suggested Action(s) and Notes
Anticholinergic drugs and narcotic analgesics
The effects of Metoclopramide on gastrointestinal motility are antagonised by Anticholinergic drugs and narcotic analgesics. refer to NP or GP
Alcohol, sedatives, hypnotics, narcotics or tranquillizers
Additive sedative effects can occur when Metoclopramide is given with alcohol, sedatives, hypnotics, narcotics or tranquillizers. Metoclopramide should not be administered to these clients, instead they should be referred to their GP/NP
All medications
Since Metoclopramide accelerates abnormally slow gastric and small bowel peristaltic activity, it may change absorption of orally administered drugs. The absorption of drugs from the small bowel may be accelerated (e.g. Paracetamol, Tetracycline, L-dopa), whereas absorption of drugs from the stomach may be diminished
Atovaquone Metoclopramide decreases atovaquone concentration and may decrease its efficacy refer to NP or GP
Dosing and Supply Information
NOTE: a SINGLE dose of metoclopramide may be administered in the WiC (a record of this dose must be documented in the clinical record)
Dose Supply Label & Instructions
Age / Weight Dose Strength Quantity
<20 years old Refer to GP
30 – 59 kg 5mg 10mg tablets 3 x 10mg tablets Take HALF a tablet 3 times a day
> 60 kg or Adults 10mg 10mg tablets 3 x 10mg tablets Take ONE tablet 3 times a day
> 60 kg or Adults 10mg 10mg ampoule 1 x ampoule IM 10mg administered in WiC
IM DOSE MAY ONLY BE ADMINISTERED ONSITE IN WiC
Adverse Drug Reactions / Side Effects
MET
OCL
OPR
AMID
E
Reaction Advice for Clients and Notes
Urticaria rash, difficulty breathing or syncope
May indicate allergic reaction Advise client to seek medical advice immediately
Restlessness, drowsiness, dizziness, headache
Common side effects, if prolonged or worsening advise client to seek medical advice
Depression, extra pyramidal side effects (these are more common in children or the elderly but can include parkinsonism, involuntary movements (tardive dyskinesia and dystonia’s), akathisia, hypertension, hypotension, hyperprolactinaemia leading to galactorrhoea, diarrhoea, constipation
Infrequent side effects, if prolonged or worsening advise client to seek medical advice
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
• Pregnancy and breast feeding – safe when taken at recommended doses • This medicine may make you feel drowsy or dizzy; do not drive or operate machinery until
you know how metoclopramide affects you • Acute dystonic reactions are best treated by IM / IV Benztropine in the ED and should be
referred immediately via ACTAS. • Drowsiness is common with metoclopramide. Clients should be advised not to consume
alcohol whilst taking Metoclopramide
References MIMs online https://www.mimsonline.com.au
The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide
Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201755
WALK-IN CENTRES
MEDICATION STANDING ORDER
MUPIROCIN 2% ointment
Approved Treatment Protocols
MU
PIRO
CIN
Impetigo
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
Extensive burns and wounds Systemic absorption of Mupirocin is possible and a theoretical risk of polyethylene glycol toxicity exists, especially in pre-existing renal impairment Refer to GP
Widespread or recurrent impetigo infections
Systemic treatment is required Refer to GP/NP
History of sensitivity reactions to any of the ointments components
Refer to GP
Skin lesions around the eyes, nose or any mucosal surface
Mupirocin is not for ophthalmic use, intranasal use or application to other mucosal surfaces Refer to GP/NP
Drug Interactions
No drug interactions have been demonstrated with Mupirocin. However Mupirocin should not be combined with other topical preparations as there is a risk of dilution, resulting in a reduction in the antibacterial activity and potential loss of stability of the Mupirocin.
Dosing and Supply Information
Clients Dose and Administration Supply Label & Instructions
All clients > 2 years
Apply a small amount of ointment to any crusted areas, 8-hourly for 7 days. The area treated may be covered with
gauze dressing if desired.
1 x 15g tube
Apply a small amount of ointment to affected
areas every 8 hours, for 7 days
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes Localised skin reactions, including itch, burning, erythema, stinging, dryness, pain and swelling
Advise client to discontinue treatment and refer to GP
Allergy (E.g. urticaria, anaphylaxis, angioedema)
May indicate an allergic reaction Advise client to discontinue treatment and seek medical advice
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
MU
PIRO
CIN
Avoid contact with eyes and mouth. Children with impetigo should be kept home until appropriate treatment is started. Sores on exposed surfaces must be covered with a watertight dressing when the child returns to school or child care. Treatment should not continue for more than 10 days Soap and water should be used topically, 8-hourly to soften crusts before Mupirocin ointment is administered. Topical Mupirocin at recommended dosages is safe in pregnancy and breastfeeding. However when topical applications of Mupirocin are used around the nipple area, any excess ointment should be removed before feeding.
References MIMs online https://www.mimsonline.com.au Antibiotic Therapeutic Guidelines The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide
Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201756
Walk-in Centres
MEDICATION STANDING ORDER
NORMAL HUMAN IMMUNOGLOBULIN (NHIG) MEASLES
Approved Treatment Indications
Nor
mal
Hum
an Im
mun
oglo
bulin
Susceptible contacts of infectious cases of measles within 144 hours after first exposure who have been referred to the WiC by a Health Directorate Communicable Disease Control officer.
A list of contacts for NHIG administration will be faxed to the Walk-in Centres prior to their visit
Included Clients
• A measles susceptible person who presents between 3 days – 144 hours post exposure to an infectious case of measles
• A measles susceptible pregnant woman up to 144 hours after first exposure • A measles susceptible person with impaired immunity up to 144 hours after first exposure • A measles susceptible person in whom MMR is contraindicated up to 144 hours after first
exposure • A person is considered susceptible to measles if they do not have acceptable presumptive
evidence of immunity. Acceptable evidence includes: o Persons born since 1966 who have documented evidence of receiving at least 2 doses
of a measles–containing vaccine ≥ 12 months of age (unless serologic evidence indicates otherwise)
o Persons born before 1966 (unless serological evidence indicates otherwise) o Documented evidence of immunity o Documented evidence of laboratory confirmed measles infection
Excluded Clients
Exclusion Suggested Action(s) and Notes
Children under 2 years old This is an exclusion criteria for the Walk-in Centres for all conditions. Refer to Centre for Disease Control ph. 02 6205 2155 during business hours or 02 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.
Clients who have not been referred for NHIG by a Health Directorate Communicable Disease Control officer
Refer to Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 99624155 after hours via a paging service and leave a message in order to receive a returned call.
Contacts will be counselled and screened prior to referral to Walk-in Centres – therefore clients would not be expected to present to the WiC with any of the following:
Nor
mal
Hum
an Im
mun
oglo
bulin
Persons first exposed to an infectious measles case more than 144 hours prior
Refer to Communicable Disease Control ph. 02 6205 2155 during business hours or 02 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.
Persons exposed to an infectious measles case less than 72 hours prior who do not have a contraindication to MMR
Consider MMR if not contraindicated
Refer to Communicable Disease Control ph. 02 6205 2155 during business hours or 02 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.
Persons who have received 1 dose of MMR ≥ 12 months of age
Allergy or anaphylaxis to any component of immunoglobulin
Refer to Communicable Disease Control ph. 02 6205 2155 during business hours or 02 9962
4155 after hours via a paging service and leave a message in order to receive a returned call.
Absolute IgA deficiency
People with severe thrombocytopenia or coagulation disorder - intramuscular injection is contraindicated
Those born before 1966 – unless they have serological evidence which indicates absence of immunity
Documented evidence of immunity
Documented evidence of laboratory confirmed measles infection
Drug Interactions
Drug Suggested Action(s) and Notes
Inactivated vaccines
May be administered concurrently with inactivated vaccines using separate syringes and separate injection sites
Live vaccines Delay the administration of some live vaccines (e.g. MMR, MMRV or varicella) for 5 months (6 months for those who are immunocompromised and receive a higher dose). Please refer to the Australian Immunisation Handbook
Dosing and Administration Information
NO
RMAL
HU
MAN
NO
RMAL
Nor
mal
Hum
an Im
mun
oglo
bulin
• Complete the pre-vaccination screening checklist prior to immunisation • To remain a minimum of 15 minutes for post-vaccination observation • Medication dose should be checked by two nurses prior to administration • Consider having two nurses present when administering NHIG to children • Ensure that there is an anaphylaxis response kit
Dose Administration Healthy children > than 2 years of age, adolescents and adults (including pregnant women)
0.2 ml / kg to a maximum of 15 ml (maximum of 5 mls per site)
Deep IMI using large (19 or 20) gauge needle
People with impaired immunity 0.5 ml / kg to a maximum of 15 ml (maximum of 5mls per site)
Deep IMI using large (19 or 20) gauge needle
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes Anaphylaxis (rare) Administer adrenaline and immediately refer to
Accident and Emergency or call MET
Local tenderness, erythema and muscle stiffness at injection site
Common side effects, if prolonged or worsening advise patient to seek medical advice
Mild pyrexia, malaise, drowsiness, urticaria, angioedema
Common side effects – see GP/ED
Refer client to printed CMI for a full list of adverse effects.
Specific Counselling Points
• Immunisation with live attenuated virus vaccines (including Measles, Mumps Rubella MMR) and varicella should be delayed 5 months following administration of IM NHIG
• NHIG will only provide transient protection against measles • Immunoglobulin is derived from pooled blood donation
References
Measles National Guidelines for Public Health Units http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-measles.htm The Australian Immunisation Handbook 10th ed 2015 http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home Australian Medicines Handbook: amh.hcn.com.au/
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order Ends: 31 August 2019
CHO approval number: 9201757
WALK-IN CENTRES
MEDICATION STANDING ORDER
OXYGEN
Approved Treatment Protocols
OXY
GEN
For use in medical emergencies
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
There are no absolute contraindications to oxygen in severe life threatening conditions
Drug Interactions
Drug Suggested Action(s) and Notes
There are no absolute contraindications to oxygen in severe life threatening conditions
Dosing and Administration Information
• Start oxygen if saturation using pulse oximetry is below 92% for adults and less than 95% for children.
• Face mask to be chosen to fit client i.e. child/adult. Use 5-10 litres/min administered via face mask and titrate to achieve levels 92-96% for adults and at least 95% for children.
• Patients with COPD in critical illness will have same saturation targets as Walk in Centre has no access to arterial blood gas analysis and period of stay and oxygen therapy is very short .
Specific Counselling Points
ACTAS “000: call is required for any client requiring Oxygen in the Walk in Centre.
References
Thoracic Society of Australia and New Zealand, 2016, Oxygen guidelines for acute oxygen use in adults. eTG Complete 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-in-children-acute-management#toc_d1e1228 eTG Complete 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=acute-oxygen-therapy
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201758
WALK-IN CENTRES
MEDICATION STANDING ORDER
PARACETAMOL 48mg in 1mL suspension
500mg tablets
Approved Treatment Protocols
PARA
CETA
MO
L
For the treatment of mild to moderate pain or pyrexia in excess of 37.5°
May be used for the following treatment protocols:
Abrasions, Ankle Injury, Bites, Boils and Carbuncles, Burns, Common Cold, Contusions, Coxsackie Virus, Diarrhoea, Elbow Injury, Fever, Finger / Toe Injury, Foot Injury, Fractures, Hand Injury, Headache, Influenza, Knee Injury, Lacerations, Lower Urinary Tract Infection, Marine Stings, Migraine, Otitis Externa, Otitis Media, Paronychia, Primary Dysmenorrhoea, Rubella, Scaphoid Injury, Sinusitis, Spider Bites, Stings, Tonsillitis, Viral Rash, Varicella, Vomiting, Wrist Injury
Included Clients
Adults and children > 2 years old
For clients who meet the inclusion criteria for a SINGLE dose of paracetamol, may be administered in the WiC (a record of this dose must be documented in the clinical record)
Excluded Clients
Exclusion Suggested Action(s) and Notes
Aged under 2 years Refer to GP or Community Pharmacy
Clients who have taken a Paracetamol containing product within the previous 4 hours or those who have taken 4 or more doses of Paracetamol within the previous 24 hours
Paracetamol has been given within the recommended dosing interval, another dose is unsafe Use Ibuprofen, wait specified time or refer to GP
Clients who have had a previous adverse reaction to Paracetamol
Paracetamol is not appropriate, use Ibuprofen or refer to GP or community pharmacy
Clients with liver disease Refer to GP
Drug Interactions
Para
ceta
mol
Drug Suggested Action(s) and Notes
Ethanol, Imatinib Concurrent use increases paracetamol toxicity- caution with use in alcoholics as may lead to liver damage
Cholestyramine Reduces the absorption of paracetamol if given within one hour of Paracetamol ensure client has not had Cholestyramine within one hour of Paracetamol dose
Rifampicin, Alcohol, Barbiturates, Phenytoin or Carbamazepine
These drugs induce CYP450 enzymes, and therefore increase the risk of Paracetamol toxicity. A single Paracetamol dose is safe, but clients requiring ongoing use of Paracetamol should be referred to their GP
Warfarin INR may increase in clients on a stable warfarin regimen who begin taking >3.5 g paracetamol each week. Refer to GP if client has been taking >3.5 g paracetamol each week
Zidovudine When used concurrently with Paracetamol, an increased tendency for neutropenia may develop. Combination should be avoided. Use Ibuprofen or refer to GP
Dosing and Administration Information
PARA
CETA
MO
L
Dosing Administer
Instructions Weight
(kg) Dose (mg) Strength Quantity
12 – 14 kg 192mg 48mg/mL suspension
1 x 200ml bottle Take 4mL by measure every 4 -6 hours when required
15 – 17 kg 216mg Take 4.5mL by measure every 4 -6 hours when required
18 – 20 kg 264mg Take 5.5mL by measure every 4 -6 hours when required
21 – 23 kg 312mg Take 6.5mL by measure every 4 -6 hours when required
24 – 26 kg 360mg Take 7.5mL by measure every 4 -6 hours when required
27 – 29 kg 408mg Take 8.5mL by measure every 4 -6 hours when required
30 – 32 kg 456mg Take 9.5mL by measure every 4 -6 hours when required
33 – 35 kg 504mg Take 10.5mL by measure every 4 -6 hours when required
36 – 38 kg 552mg Take 11.5mL by measure every 4 -6 hours when required
39 – 40 kg 576mg Take 12mL by measure every 4 -6 hours when required
41 – 45 kg 624 mg Take 13mL by measure every 4 -6 hours when required
46 – 50 kg 696mg Take 14.5mL by measure every 4 -6 hours when required
51 – 55 kg 768 mg Take 16mL by measure every 4 -6 hours when required
56 – 60 kg 840 mg Take 17.5mL by measure every 4 -6 hours when required
> 60 kg or Adults
960mg Take 20mL by measure every 4 -6 hours when required
1000mg 500mg tablets
2 x 500mg tablets Take TWO tablets every 4 -6 hours when required
Adverse Drug Reactions / Side Effects
PARA
CETA
MO
L
Reaction Advice for Clients and Notes Dyspepsia or Nausea
Rare adverse effects, advise client to seek medical advice if this worries them
Rash May indicate allergy to Paracetamol refer to GP
Jaundice, Liver dysfunction
Refer to GP if client experiences symptoms of jaundice (yellow skin and/or eyes)
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
• If pain and/or fever lasts for >48 hours, refer to GP. • No more than 4 doses of paracetamol or paracetamol containing products in 24 hours • There are many brands of paracetamol. It is also contained in many cough and cold products.
Prevent overdosing by checking carefully which strength product is being used, and the correct dose for that product. Avoid using more than one product containing paracetamol at the same time
• Too much paracetamol can cause liver damage. • Onset of pain relief is approximately 30 minutes after oral administration
See the community pharmacist for further supply
References
MIMs online 2017 https://www.mimsonline.com.au eTG Pain in Children 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=pain-children#MPS_d1e1148 Australian Medicines Handbook 2017 http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201759
WALK-IN CENTRES
MEDICATION STANDING ORDER
PHENOXYMETHYLPENICILLIN (Penicillin V)
150mg in 5mL suspension
500mg tablets
Approved Treatment Protocols
PHEN
OXY
MET
HYLP
ENIC
ILLI
N
Tonsillitis
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
History of immediate hypersensitivity reaction (i.e. anaphylaxis) to penicillins or other beta-lactams such as cephalosporin or carbapenems
Refer to Roxithromycin medication standing order
Known or suspected hypersensitivity reaction (not immediate) to penicillin or other beta-lactams such as cephalosporin or carbapenems
Refer to cefalexin medication standing order
A well client with red throat, no tonsil exudates and in the absence of fever and cervical lymphadenopathy
Antibiotics are not indicated
Client who is drooling, cannot swallow or child with stridor Refer to ED
Drug Interactions
Drug Suggested Action(s) and Notes
Food and Antacids Reduce absorption of Phenoximethylpenicillin administer Phenoximethylpenicillin on an empty stomach and away from any antacids
Methotrexate Penicillins reduce excretion of Methotrexate, causing increased risk of Methotrexate toxicity Refer clients on Methotrexate to their GP
Probenecid Probenecid decreases the renal tubular secretion of Penicillins, dose will need to be adjusted Refer to GP
Dosing and Supply Information
PHEN
OXY
MET
HYLP
ENIC
ILLI
N
Dosing Supply Label & Instructions
Weight / Age Dose Strength Quantity
< 10 kg Refer to GP
10-12.5kg
180mg
(14.4 - 18mg/kg/dose)
150mg in 5mL suspension
2 x 100ml bottle
6ml every 12 hours for 10 days
12.6 - 15kg
225mg
(15 – 17.9mg/kg/dose)
150mg in 5mL suspension
2 x 100ml bottle
7.5ml every 12 hours for 10 days
15.1 – 17.5kg
270mg
(15.4 – 17.9mg/kg/dose)
150mg in 5mL suspension
2 x 100ml bottle
9ml every 12 hours for 10 days
17.6 – 20kg 300mg
(15 – 17mg/kg/dose)
150mg in 5mL suspension
2 x 100ml bottle
10ml every 12 hours for 10 days
20.1 – 22.5kg
345mg
(15.3 – 17.2mg/kg/dose)
150mg in 5mL suspension
3 x 100ml bottle
11.5ml every 12 hours for 10 days
22.6 – 25kg
375mg
(15 – 16.6mg/kg/dose)
150mg in 5mL suspension
3 x 100ml bottle
12.5ml every 12 hours for 10 days
25.1 – 27.5kg
425mg
(15.3 – 16.7mg/kg/dose)
150mg in 5mL suspension
3 x 100ml bottle
14ml every 12 hours for 10 days
27.6 – 30kg
450mg
(15 – 16.3mg/kg/dose)
150mg in 5mL suspension
3 x 100ml bottle
15ml every 12 hours for 10 days
Child >30.1kg OR
Adults
500mg
(16.4mg/kg/dose at 30.1kg)
150mg in 5mL suspension
OR
500mg tablets
4 x 100ml bottle
OR
20 x 500mg tablets
16.5ml every 12 hours for 10 days
OR
1 x 500mg tablet every 12 hours for 10
days
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes
Nausea, Vomiting, Diarrhoea
Common side effects, if prolonged or worsening advise client to seek medical advice
Rashes May indicate allergic reaction, advise client to seek medical advice
Antibiotic associated colitis
This is a severe form of diarrhoea which has been associated with many antibiotics. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise clients to seek medical advice if they experience prolonged or severe diarrhoea.
Vaginal or oral fungal infection
May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
PHEN
OXY
MET
HYLP
ENIC
ILLI
N
Pregnancy and breast feeding: • Advise that phenoximethylpenicillin is considered safe to use in pregnancy • Safe to use at recommended doses during breastfeeding. However observe the
breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush
• Penicillin is in ADEC category A, this means it is a drug that has been taken by a large number of women and women of child bearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus being observed.
Capsules and Suspension • Take on an empty stomach to maximise drug absorption. This is best done 1 hour
before meals and before bed • Take antibiotic doses regularly and complete the full treatment course
Suspension • Store mixture in fridge and shake well before use • Measure dose using a metric measure
If >1 bottle is supplied: • Bottles are the same and not intended to be taken together • Open one bottle first and finish this before moving on to second bottle
References
MIMs online https://www.mimsonline.com.au Antibiotic Therapeutic Guidelines eTG Ear, nose and throat infections https://tgldcdp.tg.org.au/viewTopic?topicfile=ear-nose-throat-infections#MPS_d1e104 Australian Medicines Handbook http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201760
WALK-IN CENTRES
MEDICATION STANDING ORDER
PROMETHAZINE 10mg tablets
1mg/mL mixture
Approved Treatment Protocols
PRO
MET
HAZI
NE
Immediate treatment of allergic reactions May be used in the following treatment protocols: Allergic Rhinitis, Contact Dermatitis, Spider Bites, Stings, Urticaria, Varicella
Included Clients
Adults and children aged > 2 years
Excluded Clients
Exclusion Suggested Action(s) and Notes
Pregnancy and Breast feeding Consider use of an alternate antihistamine refer to GP or local pharmacy
Known allergy or hypersensitivity to Promethazine
Consider use of an alternate antihistaminerefer to NP, GP or local pharmacy
Epilepsy Promethazine lowers the seizure threshold Refer to pharmacy or GP for alternative
Children and adolescents with Reye's syndrome.
Promethazine should be avoided Refer to pharmacy or GP
Glaucoma, pyloroduodenal obstruction, bladder neck obstruction, symptomatic prostatic hypertrophy, hyperthyroidism, Parkinson’s disease
These conditions may be worsened by the anticholinergic effects of antihistamines refer to Pharmacy or GP for alternative
Drug Interactions
Drug Suggested Action(s) and Notes
Anticholinergics: aclidinium, amantadine, amitriptyline, atropine benzatropine, biperiden, chlorphenamine, chlorpromazine, clomipramine, clozapine, cyclizine, cyproheptadine, darifenacin, diphenhydramine, dosulepin, doxepin, glycopyrronium, hyoscine, imipramine, Ipratropium, mianserin, nortriptyline olanzapine, oxybutynin, periciazine, pheniramine, pizotifen, prochlorperazine, propantheline, solifenacin, tiotropium, tolterodine, umeclidinium
These medication may prolong and intensify the antimuscarinic, anticholinergic and CNS depressive effects of Promethazine Combination should be avoided, refer to local pharmacy or GP
CNS depressants (including alcohol, barbiturates, hypnotics, opioid analgesics, anxiolytic sedatives and neuroleptics)
Promethazine may cause drowsiness and may enhance the sedative effects of these medications. Use combination with caution
Dopamine Agonists: Apomorphine, Pramipexole, Rotigotine, Bromocriptine, Cabergoline, Pergolide, Levodopa with Benserazide or Carbidopa.
Promethazine is a dopamine antagonist will reduce the therapeutic effect of the dopamine agonist; avoid these combination refer to Pharmacy or GP for alternative
Medications that can increase the risk of seizures:
Amantadine, amisulpride, amitriptyline, aripiprazole, asenapine, baclofen, bupropion, chlorambucil, chlorpromazine, cinacalcet, ciprofloxacin, clomipramine, clozapine, daclizumab, donepezil, dosulepin, doxepin, droperidol, enzalutamide, ertapenem, foscarnet, flupentixol, fluphenazine, galantamine, ganciclovir, haloperidol, imipenem, imipramine, interferons, isoniazid, memantine, mianserin, moxifloxacin, neostigmine, norfloxacin, nortriptyline, NSAIDs, olanzapine, paliperidone, periciazine, phenelzine, pizotifen, promethazine, pyridostigmine, quetiapine, risperidone, rivastigmine, theophylline, valganciclovir, ziprasidone, zuclopenthixol
Promethazine lowers the seizure threshold; if used with other drugs that may increase the risk of seizures the risk
may further increase refer to Pharmacy or GP for alternative
PRO
MET
HAZI
NE
Dosing and Supply Information
Dosing Supply Label & Instructions
Age Dose (mg) Strength Quantity supplied
2-5 years 5mg every 8 hours when
required 1mg/mL
1 x 100mL mixture
Give 5mL by measure every 8 hours when required
6 – 12 years & Adults
10mg every 8 hours when
required
1mg/mL 1 x 100mL
mixture Give 10mL by measure every 8
hours when required
10mg tablets 3 x 10mg tablets Take 1 tablet every 8 hours when
required
The first dose may be administered on site in the WiC if required to give immediate relief. However please note that promethazine can cause drowsiness and clients should not drive a car once they have
had a dose
Adverse Drug Reactions / Side Effects
PRO
MET
HAZI
NE
Reaction Advice for Clients and Notes Promethazine may cause drowsiness and may increase the effects of alcohol. Drowsiness may continue the following day.
Those affected should not drive or operate machinery; alcohol should be avoided.
Sedation, impair alertness, dizziness, confusion, headache, blurred vision, mydriasis, dry eyes, constipation, dry mouth, urinary retention nausea, vomiting, diarrhoea, hypotension
Common side effects if prolonged or worsening see GP
Leukopenia, agranulocytosis, haemolytic anaemia, allergic reactions, arrhythmias, dyskinesia, hallucinations, elevated liver enzymes
Rare and infrequent side effects which are unlikely with a short course of treatment refer client to GP if they suspect any symptoms
CNS stimulation (excitation, hallucinations, ataxia, seizures) may occur rarely, especially in children and the elderly
Monitor client and refer to GP if symptoms occur
Refer client to printed Consumer Medicines Information for a full list of adverse effects
Specific Counselling Points
• This medication may make you sleepy; don’t drive or operate machinery if this happens. • Avoid alcohol and other medication which may cause sedation • Refer to GP if symptoms do not resolve in 24 hours
References
MIMs online https://www.mimsonline.com.au Australian Medicines Handbook http://amh.hcn.au
The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide
eTG Urticaria 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=urticaria-angioedema#MPS_d1e136
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201761
Walk-in Centres
MEDICATION STANDING ORDER
RIFAMPICIN
100mg/5mL syrup
Approved Treatment Indications
RIFA
MPI
CIN
Clearance antibiotic for contacts of cases of meningococcal disease who have been referred to the Walk-in Centres (WiC) by a Health Directorate Communicable Disease Control officer.
A list of contacts for clearance antibiotics will be emailed or faxed to the WiC prior to their visit.
Included Patients
• Children 2-12 years (FIRST LINE) • Adults in whom ciprofloxacin is contraindicated (SECOND LINE)
Excluded Patients
Exclusion Suggested Action(s) and Notes
Children under 2 years old This children will not be referred to WIC
Clients who have not been referred for clearance antibiotics by a Health Directorate Communicable Disease Control officer
Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.
Women who are pregnant or breastfeeding Consider ceftriaxone as preferred option
History of hypersensitivity to rifampicin Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.
Women who are taking the oral contraceptive pill
Consider ciprofloxacin (preferably) or ceftriaxone
Hepatic impairment, jaundice or alcoholism
Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.
Undernourishment or malnourishment
Drug Interactions
RIFA
MPI
CIN
Drug Suggested Action(s) and Notes
Oral contraceptives
Consider Ciprofloxacin or Ceftriaxone. If rifampicin required advise patient to take an active pill daily during course and for at least 7 days after last rifampicin dose and use extra contraceptive precautions, e.g. abstinence or a barrier method, continuing this for 4 weeks after the last Rifampicin dose.
A number of medications interact with Rifampicin If patient is taking any prescribed medication consider ceftriaxone or contact Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours
Antacids Antacids reduce the absorption of rifampicin therefore rifampicin should be taken a minimum of one hour prior to any antacid
Dosing and Administration Information
Dosing Supply Label & Instructions
Weight/age Dose Strength Quantity
10-12kg 120mg 100mg/5ml suspension 1 x 60ml bottle
6ml twice daily for two days
12.1-14kg 140mg 100mg/5ml suspension 1 x 60ml bottle
7ml twice daily for two days
14.1- 16kg 160mg 100mg/5ml suspension 1 x 60ml bottle
8ml twice daily for two days
16.1-18kg 180mg 100mg/5ml suspension 1 x 60ml bottle
9ml twice daily for two days
18.1-20kg 200mg 100mg/5ml suspension 1 x 60ml bottle
10ml twice daily for two days
20.1-22kg 220mg 100mg/5ml suspension 1 x 60ml bottle
11ml twice daily for two days
22.1-24kg 240mg 100mg/5ml suspension 1 x 60ml bottle
12ml twice daily for two days
24.1-26kg 260mg 100mg/5ml suspension 1 x 60ml bottle
13ml twice daily for two days
26.1-28kg 280mg 100mg/5ml suspension 1 x 60ml bottle
14ml twice daily for two days
28.1-30kg 300mg 100mg/5ml suspension 1 x 60ml bottle
15ml twice daily for two days
Dosing Supply Label & Instructions
RIFA
MPI
CIN
Weight/age Dose Strength Quantity
30.1-32kg 320mg 100mg/5ml suspension 2 x 60ml bottle
16ml twice daily for two days
32.1-34kg 340mg 100mg/5ml suspension 2 x 60ml bottle
17ml twice daily for two days
34.1-36kg 360mg 100mg/5ml suspension 2 x 60ml bottle
18ml twice daily for two days
36.1-38kg 380mg 100mg/5ml suspension 2 x 60ml bottle
19ml twice daily for two days
38.1-40kg 400mg 100mg/5ml suspension 2 x 60ml bottle
20ml twice daily for two days
40.1-42kg 420mg 100mg/5ml suspension 2 x 60ml bottle
21ml twice daily for two days
42.1-44kg 440mg 100mg/5ml suspension 2 x 60ml bottle
22ml twice daily for two days
44.1-46kg 460mg 100mg/5ml suspension 2 x 60ml bottle
23ml twice daily for two days
46.1-48kg 480mg 100mg/5ml suspension 2 x 60ml bottle
24ml twice daily for two days
48.1-50kg 500mg 100mg/5ml suspension 2 x 60ml bottle
25ml twice daily for two days
50.1-52kg 520mg 100mg/5ml suspension 2 x 60ml bottle
26ml twice daily for two days
52.1-54kg 540mg 100mg/5ml suspension 2 x 60ml bottle
27ml twice daily for two days
54.1-56kg 560mg 100mg/5ml suspension 2 x 60ml bottle
28ml twice daily for two days
56.1-58kg 580mg 100mg/5ml suspension 2 x 60ml bottle
29ml twice daily for two days
> 58.1 kg 600mg 100mg/5ml suspension 2 x 60ml bottle
30ml twice daily for two days
Adverse Drug Reactions / Side Effects
NO
RMAL
HU
MAN
NO
RMAL
Reaction Advice for Patients and Notes Anaphylaxis (rifampicin syrup contains sodium metabisulfite which may cause allergic reactions including anaphylaxis)
May indicate allergic reaction -> advise to seek medical advice immediately
Nausea, vomiting, diarrhoea Common side effects, encourage fluids, if prolonged or worsening to seek medical advice
Headache, dizziness, drowsiness, ataxia Common side effects, encourage fluids, if prolonged or worsening to seek medical advice
RIFA
MPI
CIN
Rash May indicate allergic reaction -> advise to seek medical advice immediately
Arthralgia, myalgia If prolonged or worsening, seek medical advice
Refer patient to printed CMI for a full list of adverse effects
Specific Counselling Points
• Rifampicin is absorbed best if you take it at least half an hour before food or two hours after food
• Urine, faeces, saliva, sputum, sweat and tears may be coloured red-orange by Rifampicin and its metabolites.
• Contact lenses may be permanently stained by Rifampicin so contact lens use during treatment should be avoided.
• A two day course of rifampicin eradicates nasopharyngeal carriage in 75-95% of carriers. • The product information for Rifampicin recommends a once-daily four-day regimen for
clearance of meningococcal disease. The two day regime described above is recommended by the Communicable Diseases Network Australia.
• Ceftriaxone is the preferred antibiotic for pregnancy
References
Invasive Meningococcal Disease CDNA National Guidelines for Public Health Units http://www.health.gov.au The Australian Immunisation Handbook 10th ed update 2017. http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home
MIMS online 2017 https://www.mimsonline.com.au
eTG Complete Meningitis chemoprophylaxis, 2017, https://tgldcdp.tg.org.au Australian Medicines Handbook 2017 , https://amhonline.amh.net.au
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval Number: 9201762
WALK-IN CENTRES
MEDICATION STANDING ORDER
ROXITHROMYCIN 50mg tablet for suspension
150mg tablet
Approved Treatment Protocols
ROXI
THRO
MYC
IN
An alternative antibiotic for clients with immediate penicillin hypersensitivity for the following indications:
• Otitis Media • Tonsillitis
Included Clients
Adults and children > 2 years old
Excluded Clients
Exclusion Suggested Action(s) and Notes
Known hypersensitivity to macrolides antibiotics, including Erythromycin, Clarithromycin or Azithromycin.
Use alternative antibiotic or refer to GP
Known impaired hepatic function Use alternative antibiotic or refer to GP
Macrolides, including Roxithromycin, have the potential to prolong the QT interval
Refer client to GP if they have : - Congenital prolongation of the QT interval - Ongoing proarrhythmic conditions including
uncorrected hypokalaemia or hypomagnesaemia, clinically significant bradycardia
- Clients receiving Class IA and III antiarrhythmic agents (e.g. Disopyramide, Quinidine and Amiodarone)
Clients with Myasthenia Gravis Refer to GP
Drug Interactions
Drug Suggested Action(s) and Notes
Theophylline Can increase the plasma concentration of theophylline. Use alternative antibiotic or refer to GP
Ergot alkaloids:
- Ergotamine - Dihydroergotamine
Severe reactions with possible peripheral necrosis have been reported. Use of Roxithromycin in clients taking ergot alkaloids is contraindicated Use alternative antibiotic or refer to GP
Disopyramide Roxithromycin can cause increased levels of Disopyramide Use alternative antibiotic or refer to GP
Terfenadine May increase serum levels of Terfenadine, resulting in severe cardiovascular adverse events Use alternative antibiotic or refer to GP
Astemizole, cisapride, pimozide
Are metabolised by CYP3A4 which is inhibited by macrolide antibiotics. QT interval prolongation and/or cardiac arrhythmias (typically torsades de pointes) have been reported when used in combination, therefore concomitant administration is not recommended Use alternative antibiotic or refer to GP
Drug Interactions (Continued)
ROXI
THRO
MYC
IN Drug Suggested Action(s) and Notes
Warfarin
Roxithromycin appears to interact with Warfarin. Increases in INR have been reported in clients treated concomitantly with Roxithromycin and Warfarin. Roxithromycin can be used in clients on Warfarin, however client should be referred to GP to monitor their INR
Digoxin
Roxithromycin may increase the absorption of Digoxin. This may very rarely result in Digoxin toxicity. Roxithromycin can be used in clients on Digoxin, however the client should be referred to their GP for ECG and Digoxin level monitoring.
Midazolam Roxithromycin can enhance and prolong the effects of Midazolam in clients treated with Roxithromycin Use alternative antibiotic or refer to GP
Roxithromycin Dosing and Supply Information
Dose Supply Label & Instructions
Weight Dose Strength Quantity
<2 years old Refer to GP
Treatment of Tonsillitis – 10 day course
12 – 23 kg 50mg twice daily for 10
days
50mg tablet for suspension
20 x 50mg tablets
Disperse ONE tablet in 1-2 spoonful’s of water and take TWICE
a day for 10 days
24 – 40kg 100mg twice daily for 10
days
50mg tablet for suspension
40 x 50mg tablets
Disperse TWO tablets in 1-2 spoonful’s of water and take TWICE
a day for 10 days
>40kg 300mg once a day for 10 days 150mg tablets 20 x 150mg
tablets Take TWO tablets ONCE a day for 10
days
Treatment of Otitis Media – 5 day course
12 – 23 kg 50mg twice
daily for 5 days 50mg tablet
for suspension 10 x 50mg
tablets
Disperse ONE tablet in 1-2 spoonful’s of water and take TWICE
a day for 5 days
24 – 40kg 100mg twice
daily for 5 days 50mg tablet
for suspension 20 x 50mg
tablets
Disperse TWO tablets in 1-2 spoonful’s of water and take TWICE
a day for 5 days
>40kg 300mg once a day for 5 days
150mg tablets 10 x 150mg
tablets Take TWO tablets ONCE a day for 5
days
Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes
Urticaria or rash May indicate allergic reaction Advise client to seek medical advice
Nausea, vomiting, epigastric pain (dyspepsia), diarrhoea, headache, cough, anorexia, flatulence
Common side effects, if prolonged or worsening advise client to seek medical advice
Hepatic dysfunction, with or without jaundice
Advise client to seek medical advice if they have symptoms of jaundice (yellow skin and/or eyes).
Vaginal or oral fungal infection May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
ROXI
THRO
MYC
IN
Roxithromycin is best absorbed on an empty stomach, so take dose at least 15 minutes before a meal. If it makes you feel sick then you can take it with food.
The 150mg tablets are designed to be swallowed whole and should not be dispersed in water.
Finish the course
Pregnancy and Breastfeeding: Safe to use in pregnancy. Safe to use at recommended doses during breastfeeding. However observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush
Tablets for Suspension
1. Remove the correct number of tablets from the foil.
2. Add one or two tablets, to water and mix well. At least a spoonful of water should be used.
3. Wait about 30 or 40 seconds for the tablet to break down into fine granules. (The tablets will not completely dissolve). Stir if necessary.
4. Ensure the water and granules are swallowed by your child straight away, otherwise the pleasant strawberry taste may disappear.
5. Have a glass of water ready and give your child a drink immediately after taking the medicine to ensure that all the dose is swallowed.
References
MIMs online 2017 https://www.mimsonline.com.au Australian Medicines Handbook 2017 http://amh.hcn.au
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201763
WALK-IN CENTRES
MEDICATION STANDING ORDER
SALBUTAMOL 100 microgram MDI
Approved Treatment Protocols
SALB
UTA
MO
L
Acute asthma (mild, moderate or severe episode)
Included Clients
Adults and children > 2 years old
Cautions
Pregnancy - may need referral to ED if client hypoxic or signs of PE
Excluded Clients
Exclusion Suggested Action(s) and Notes
Confirmed anaphylactic reaction to previous dose of salbutamol
Refer to ED immediately/ consider ACTAS call “000”
Angle-Closure Glaucoma Inhaled salbutamol may rarely precipitate acute angle-closure crisis, especially if used with Ipratropium Refer to ED immediately/ consider ACTAS call “000”
Drug Interactions
Drug Suggested Action(s) and Notes
Theophylline, diuretics, corticosteroids and antihypertensive
Increased risk of hypokalaemia when high doses of salbutamol are used Advise client monitoring of potassium will be required by GP or ED during periods of high salbutamol usage
Dosing and Supply Information
Dosing Administration Supply Label &
Instructions Age Dose*
Children < 6 years
2-6 puffs of 100mcg metered
dose inhaler (MDI) via Spacer
Give MDI via spacer with mask
attachment, if severe/moderate episode consider ACTAS “000” call
with application of O2 therapy if SpO2
<95%
Follow asthma protocol. Refer to ED immediately via
ACTAS “000”
Children > 6 years and adult
6-12 puffs of 100mcg MDI via
Spacer
Give MDI via spacer, if
severe/moderate episode consider ACTAS “000” call
with application of O2 therapy if SpO2
<92%
For mild symptoms
with resolution after initial salbutamol
treatment in WiC only:
1 x 100mcg Salbutamol
MDI
1 x Spacer. Follow asthma
protocol.
For asthma symptoms
Use 4 puffs via spacer
when required for shortness of
breath. Repeat as
necessary as per asthma action plan
SALB
UTA
MO
L Adverse Drug Reactions / Side Effects
Reaction Advice for Clients and Notes
Tremor, palpitations, headache
Common adverse effects. Advise client the effect is temporary and to seek medical advice if prolonged or worsening.
Urticaria, angioedema and anaphylaxis
May indicate allergic reaction advise client to seek medical advice ASAP if they experience these symptoms
Diabetic clients may experience hyperglycaemia with high doses
Advise client to monitor BGLs if using high doses
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
SALB
UTA
MO
L
• Client MUST be referred to the ED (or GP as indicated) for ongoing treatment ASAP as further assessment and treatment such as steroid therapy will be required
• Correct inhaler technique (in normal circumstances) with the spacer must be used to ensure adequate drug delivery, this is explained below: 1. Assemble spacer
2. Remove inhaler cap
3. Hold inhaler upright and shake well
4. Insert inhaler upright into spacer
5. Put mouthpiece between teeth without biting and close lips to form a good seal
6. Breathe out gently
7. Hold spacer level and press down firmly on canister once
8. Breathe in slowly and deeply then hold breath for about 10 seconds or as long as comfortable OR Breathe in and out normally for 4 breaths
9. Repeat the above step until the required number of puffs have been taken,
10. Remove spacer from mouth
11. Breathe out gently
12. Remove inhaler from spacer
13. If an extra dose is needed, wait 4 minutes and then repeat steps 3 to 11
14. Replace cap and disassemble spacer
References MIMs online 2017 https://www.mimsonline.com.au
National Asthma Guidelines 2017 http://www.nationalasthma.org.au Australian Medicines Handbook 2017 http://amh.hcn.au eTG Complete , First aid for acute asthma in children, 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-in-children-acute-management&guidelineName=Respiratory#toc_d1e1228 , First Aid for acute asthma in adults 2017, https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-acute-management#toc_d1e110
Approval
Date of approval: 15 March 2018
Date of effect: 15 March 2018
Date of review: August 2017
Date order ends: 31 August 2019
CHO Approval Number: 9201764
WALK-IN CENTRES MEDICATION STANDING ORDER
TRIMETHOPRIM 300 mg tablets
Approved Treatment Protocols
TRIM
ETHO
PRIM
Urinary Tract Infection (UTI)
Included Clients
Female clients > 16 years old with clinical symptoms of a UTI (see clinical impression)
Excluded Clients
Exclusion Suggested Action(s) and Notes
Pregnant women Refer to GP
History of allergy or adverse reaction to Trimethoprim
Use cefalexin treatment guideline or Refer to GP
Have known renal impairment If CrCl < 30mL/min Refer to GP, <10mL/min contraindicated
Known haematological disorders or documented megaloblastic anaemia due to folate deficiency
Use Cefalexin treatment guideline or Refer to GP
Porphyria Trimethoprim has been associated with acute attacks of porphyria and is considered unsafe in porphyria clients Refer to GP
Have urinary symptoms that are accompanied by fever (in excess of 38°C), nausea or vomiting and flank plain
Need to rule out pyelonephritis Refer to GP/ED if appropriate
Have a known folate deficiency Use cefalexin treatment guideline or Refer to GP
Male clients Refer to GP/ED
See drug interactions for further exclusions
Drug Interactions
TRIM
ETHO
PRIM
Drug Suggested Action(s) and Notes
Warfarin Trimethoprim may potentiate the anticoagulant activity of warfarin Refer to GP
Phenytoin, Digoxin, Procainamide.
Trimethoprim may increase serum concentrations and potentiate the effect of phenytoin, digoxin and procainamide Refer to GP
Zidovudine, Lamivudine Trimethoprim has been reported to reduce the renal excretion and increase blood concentrations of these medications Refer to GP
Dapsone Trimethoprim and dapsone increase each other's serum concentration when given concomitantly Refer to GP
Rifampicin Rifampicin may decrease the Trimethoprim concentration Refer to GP
Cyclosporins An increased risk of nephrotoxicity has been reported with use of trimethoprim and cyclosporin Refer to GP
Diuretics (Bumetanide, Chlorthalidone, Frusemide, Hydrochlorothiazide, Indapamide)
Hyponatremia has been reported when trimethoprim is used in combination with diuretics Refer to GP
Methotrexate or Pyrimethamine
Risk of megaloblastic anaemia if trimethoprim is given with other folate inhibitors use cefalexin
Rosiglitazone Trimethoprim inhibits rosiglitazone metabolism, increasing its concentration and the risk of adverse effects use cefalexin
ACE inhibitors (Captopril, Enalapril, Fosinopril, Lisinopril, Perindopril, Quinapril, Ramipril, Trandolapril)
Severe hyperkalaemia has been noted in clients given Trimethoprim together with an ACE inhibitor use Cefalexin
Dosing and Supply Information
Dosing Supply
Label & Instructions Strength Quantity
300mg at NIGHT for 3 days
300 mg tabs 3 Take ONE tablet at NIGHT for 3 days
NOTE: If client presents to the WiC before 1400Hrs, then a stat dose of Trimethoprim (300mg) PO, can be given to the client in the consult room, to initiate the treatment. The client is advised to wait as long as possible to take the night dose, minimum of 8 hours. They are then to continue with the 1 (300mg) tablet PO per night as per the directions above.
Adverse Drug Reactions / Side Effects
TRIM
ETHO
PRIM
Reaction Advice for Clients and Notes Fever, nausea or vomiting
Common side effects, if prolonged or worsening advise client to seek medical advice
Rash or itching May indicate allergic reaction, advise client to seek medical advice
Hyperkalaemia Trimethoprim causes potassium retention. Hyperkalaemia can occur with usual doses. Average onset is 4–5 days. Refer to GP for monitoring if the client has renal impairment
Refer client to printed Consumer Medicines Information for a full list of adverse effects.
Specific Counselling Points
Take with food to help minimise gastrointestinal disturbances
Take at bedtime to allow for maximum urine concentration
Breastfeeding: Trimethoprim is safe to use at recommended doses during breastfeeding. However observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush.
Episodes of recurrent cystitis despite treatment and client education can be treated, but must also be referred back to their own GP for investigation and ongoing management
References
MIMs online 2017 https://www.mimsonline.com.au Australian Medicines Handbook 2017 http://amh.hcn.au eTG Urinary tract infections 2017, https://tgldcdp.tg.org.au The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide 2017
Approval
Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019
CHO Approval Number: 9201765
Version Control Version Date Modifications
1.0 5 February 2010 First draft
2.0 15 March 2010 Metoclopramide Guideline
Cefalexin Guideline
3.0 17 March 2010 Amoxicillin Guideline
Antistine Privine (Albalon-A) Guideline
Cefaclor Guideline
Dexamethasone, Framycetin & Gramicidin Guideline
Loratadine Guideline
Minims Artificial Tears Guideline
Phenoximethylpenicillin Guideline
Promethazine Guideline
Roxithromycin Guideline
Salbutamol Guideline
Trimethoprim Guideline
4.0 23 March 2010 Cefalexin Guideline
Roxithromycin Guideline
5.0 29 March 2010 Adult Diphtheria & Tetanus (ADT) Booster Guideline
Amoxicillin Guideline
Amoxicillin + Clavulanate Guideline
Artificial Tears Guideline
Cefaclor Guideline
Dexamethasone, Framycetin & Gramicidin Guideline
Ibuprofen Guideline
Levonorgestrel Guideline
Lignocaine with Adrenaline Guideline
Lignocaine Guideline
Metoclopramide Guideline
Version Date Modifications
Mupirocin Guideline
Oxygen Guideline
Paracetamol Guideline
Phenoximethylpenicillin Guideline
Promethazine Guideline
Salbutamol Guideline
Trimethoprim Guideline
6.0 1 April 2010 Introduction added
Page numbering system changed
‘Medication Guideline’ renamed to ‘Medication Standing Order’ throughout document
‘Approved Treatment Indications’ renamed to ‘Approved Treatment Protocols’ on each Standing Order
‘Breastfeeding’ replaced with ‘Breast feeding’ throughout document
Amoxicillin + Clavulanate Standing Order
Antistine Privine Albalon-A Standing Order
Artificial Tears Standing Order
Cefalexin Standing Order
Dexamethasone, Framycetin & Gramicidin Standing Order
Gastrolyte-R Standing Order
Ibuprofen Standing Order
Lignocaine and Adrenaline Standing Order
Lignocaine Standing Order
Loratadine Standing Order
Metoclopramide Standing Order
Mupirocin Standing Order
Paracetamol Standing Order
Phenoximethylpenicillin Standing Order
Promethazine Standing Order
Roxithromycin Standing Order
Salbutamol Standing Order
Trimethoprim Standing Order
6.1
CHO approved
8 April 2010 • Standing Order date of review added • Chief Health Officer approval details added to each standing order
6.2 29 April 2010 • Abbreviations list added • Appendix added: medication management protocol • Grammatical and typographical errors corrected throughout document • ‘patient’ renamed to ‘client’ throughout document • ‘reconstitute suspension as per TCH policy before supply’ changed to
‘reconstitute as per WiC Medication Management Protocol before supply’
on pages 6,9 & 48 6.3 31 August 2010 • Change of name from Gastrolyte to Oral rehydration Salts
• Roxithromycin change treatment regime in line with best practice to a 10 day course for treatment of Tonsillitis.
6.4 30 November 2010
• ADT definition added of tetanus prone wounds and specific age range. • Amoxicillin increase does as per Antibiotic Therapeutic Guidelines 500mg
(child 15mg/kg up to 500mg) orally, 8 hourly for 5 – 7 days • Penicillin: change penicillin allergy suggested action to “refer to GP: as no
alternate antibiotic available • Cefaclor: In specific counselling points “Capsules and Suspension”
changed to “Tablets and Suspension.” Note: No third line available for sinusitis for severe penicillin allergy. Roxithromycin third line for otitis media.
• Levonorgestrel: Add “2” in front of “X750mcg tablet in the dose section • Glucagon Medication Standing Order added
6.5 August 2011 – February 2012
• Chloramphenicol – add to specific counselling points: Chloramphenicol eye drops are classed as an ADEC (Australian Drug Evaluation Committee pregnancy categories) category A. i.e. it is safe to be used in Pregnancy and breast feeding
• Chloramphenicol – Add: advise the client to press at the medial corner of the eye for about 3 minutes after administration of the eye drop to minimise systemic absorption
• Dexamethasone, Framycetin and Gramicidin (Sofradex) – change from administration for 5 – 7 days to 3 – 7 days as per TGs 2011.
• Dexamethasone, Framycetin and Gramicidin (Sofradex) Add – WiC clients to be advised to administer for 5 days and if no improvement advise client to see GP. Add accordingly to label instructions.
• Cefalexin – change dose to 500mg BD X 5 days (>40kgs) as per TGs and change label accordingly.
• Promethazine – remove exclusion criteria for newborn or premature infants as they are not within WiC scope of practice
• Glucagon – new MSO added • Antistine Privine replaced with Albalon-A as product no longer available • New guideline added – Normal Human Immunoglobulin
Note: There are no versions of this document between V 6.5 and V 13.1
13.1 June 2013 • Cefuroxime WIC protocol to replace Cefaclor due to the hospital Drugs & Therapeutics Committee removal of Cefaclor from the hospital formulary late 2012.
13.2 July 2014 • Levonorgestrel: addition under inclusions: Female clients who have had unprotected intercourse <120 hours prior to arrival. Age has decreased as per the Gillick Principle.
2014 version 1 July 2014 • Cefalexin: addition for treatment of mastitis • Dicloxacillin: addition for treatment of mastitis
2015 version1 May 2015 • Remove references to MET to reflect community Operations and insert Call ACTAS – “000”
• Remove requirement to document client MRN in drug register • ADT – updated introduction to 10th edition of Immunisation Handbook • Adrenaline – change from Epi-Pen to Ampoules 1:1000
• Amethocaine 0.5% eye drops – new MSO for CHO approval • Amoxicillin – Changed Paeds dosing to a narrower range. Also changed
from 7 day dose to 5 day dose as per Therapeutic Guidelines • Aspirin – new MSO for CHO approval • Cefuroxime – change to the Weight / Age in dosing to clarify Added “and
up to 12yrs” and “> 12 yrs old to...” • Cefuroxime suspension, changed discard date from 14 to 10 days as
per Pharmacy recommendation. • Cefalexin – Added in the “exclusion suggested actions” (Trimethoprim
for UTI) • Cefalexin – uncomplicated cellulitis new MSO for CHO approval • Ceftriaxone added for treatment of meningococcal contacts per Public
Health • Ciprofloxacin added for treatment of meningococcal contacts per Public
Health • Dexamethasone, Framycetin & Gramicidin – change dosing from 4
times per day to 3 times per day as per Therapeutic Guidelines • Dicloxacillin – uncomplicated cellulitis new MSO for CHO approval • Glucagon – removed references to IV Glucose to fit with Community
setting • Ibuprofen – added “Lactational mastitis” as per the protocol, and • Lignocaine 1% with adrenaline – removed Paronychia, as is outside
Medication scope • Metoclopramide – change Included clients from “age 12 yrs and over” to
Adults age 20 yrs and over” to reflect product info and NPS advice • Phenoximethylpenicillin – change supply from 250mg to 500mg to reflect
change in supply strength • Rifampicin added for treatment of meningococcal contacts per Public
Health • Trimethoprim – added a clause for a stat dosing if client presents in the
first part of the day • Trimethoprim – remove 1st Line as per Therapeutic Guidelines • Amethocaine - added under counselling "The eye must be protected
until normal sensation has returned. Protect eyes from dust or contamination - E.g. glasses. A patch is unnecessary."
• Aspirin - Added to excluded clients “Known history of duodenal ulcers discuss with paramedics" and "Give oxygen via Hudson mask whilst awaiting ambulance/ paramedic attendance."
• Dicloxacillin - Counselling points amended “To be administered on an empty stomach one to two hours before food or two hours after food and "Consider referral to Maternal and Child Health (MACH) services" added.
• Amethocaine - Added to counselling points “Not to drive or operate machinery if vision is affected.”
• Aspirin – Added under excluded clients “Known history of duodenal ulcers/peptic ulcer.”
• NHIG - “Centre for Disease Control” changed to “Communicable Disease Control”
2017 Version 1 September 2017 • Adrenaline / Epinephrine – Dual naming added. Dosage table changed • ADT – Now adults only (age ≥18). Children who are fully immunized
should be covered until adulthood • Albalon-A – Removed as no longer recommended • Amethocaine – Tetracaine dual naming added. Dose interval changed
from every 3 to every 5 minutes as per eTG • Amoxicillin - Name change from 'amoxicillin' to 'amoxicillin'. OCP
interaction removed. Reference to TB as exclusion removed. Addition of phenylketonuria as exclusion (oral liquid formulations contain aspartame). New dosing table added.
• Amoxicillin/clavulanate - Name change from 'amoxicillin' to 'amoxicillin'. OCP interaction removed. Addition of phenylketonuria as exclusion (oral liquid formulations contain aspartame). New dosing table added.
• Aspirin – Pregnancy and aspirin-sensitive asthma exclusions added • Artificial tears – Removed as this product replaced by Carmellose • Carmellose – Nil changes • Cefalexin (mastitis/cellulitis) - Name change from 'cefalexin' to
'cefalexin'. 'Cefalexin to be given if client has non-immediate hypersensitivity to penicillins' added to show it's not the 1st line AB. "GP to determine if a longer course is needed" added to cater for eTG 5-10 day recommendation.
• Cefalexin (UTI) - Name change from 'cefalexin' to 'cefalexin' • Cefalexin (tonsillitis) – new standing order • Ceftriaxone - References to contacting CHO were replaced with
contacting Communicable Disease Control. Dosing table amended based on dilution up to 4mls with lidocaine. Adverse reaction list extended.
• Cefuroxime - Addition of phenylketonuria as exclusion. Removal of Roxithromycin as possible alternate antibiotic. Removal of hepatic dysfunction adverse reaction warning. New dosing table added.
• Chloramphenicol - Instructions on how to administer eye drops removed (same is contained within CMI)
• Ciprofloxacin - Multiple additions to the drug interaction section. Wording around breast feeding changed.
• Dermabond – nil changes • Dexamethasone – new standing order • Dexamethasone, Framycetin, Gramicidin - Pregnancy removed as an
exclusion. A time limit provided for duration i.e. "3 to 7 days". Instillation of drops info deleted (contained in CMI)
• Dicloxacillin - Methotrexate drug interaction added. "GP to determine if a longer course is needed" added to cater for TG 5-10 day recommendation.
• Glucagon – Nil changes • Ibuprofen - 'Dehydration' and 'coagulation disorders' added as
exclusion factors. Addition of several more possible drug interactions. Tablets removed from dosing table as take home packets no longer provided
• Laceraine - Added "Use with caution when client history of: epilepsy; hypovolaemia; diabetes mellitus; asthma".
• Levonorgestrel - 'Pregnancy' added as exclusion factor. Several more possible drug interactions listed. Breast feeding comment added to counselling points. Dose now 1 x 1.5g tablet (not 2 x 750mg tablets)
• Lignocaine 1% - Safe to use in pregnancy and breast feeding comment added.
• Lignocaine 1% with adrenaline/epinephrine - Dual naming added. 'History of Raynaud’s disease or peripheral vascular disease' added to exclusion criteria.
• Loratadine - Use approved for allergic conjunctivitis and urticarial
• Metoclopramide – minor changes • Mupirocin - Allergy added as possible adverse effect. Pregnancy/breast
feeding comment added. • NHIG – minor formatting changes • Oral rehydration salts – Removed as no longer stocked • Oxygen - Criteria added for when to commence oxygen and range
provided to titrate to SpO2. COPD comment added. • Paracetamol - Ethanol, Imatinib added as potential drug interaction
agents. Corrections made to dosing table. • Phenoximethylpenicillin - cefalexin added as option for penicillin
hypersensitive patients. OCP removed as possible drug interaction. Dosing table changed from age-based to weight-based.
• Promethazine - Several new potential drug interactions added. • Rifampicin - All references to CHO removed. Dosing table changed from
age-based to weight-based • Roxithromycin - remove pregnancy exclusion, add breastfeeding advice • Salbutamol – minor changes • Trimethoprim - OCP removed from drug interaction list. Breastfeeding
comment added.