Rozex, Hycor, Ventolin MDI with spacer, Symbicort turbuhaler, Seretide

Accuhaler, Airomir autohaler, Spiriva, Nasonex, Nitrolingual Pumpspray,

Transiderm Nitro patches, Vagifem pessaries, Epipen junior, Salofalk enema,
Aldara, Stemetil suppositories

Medication
Rozex

Hycor

Indication/contrain
Rosacea
Accepted: Malodrous
fungating wounds

Allergic and selected

inflammatory
conditions of lids,
conjunctiva, corenea,
iris
Including post
operative
inflammation
Contraindicated:

Counselling /Dosage
Wash and dry your hands and wash the area
before applying the gel -> can apply makeup
after if need to.
Apply morning and evening to a dry clean face
Squeeze a small quantity of rozex gel onto
figure tips
Apply thin film of gel (less than a fingertip) or
cream onto affected areas twice a day. Ensure
skin is clean and dry before application. Avoid
eye area.
Should improve within 3 weeks, continue
treatment for 8-12 weeks.
SEs: Local redness, dryness, skin irritation and
eye watering.
L8 - sun protection
Slow reacting,
Also think about the extra things that you can
mention using mild cleanser (cetaphil). Avoid
using things that trigger the rosacea like cold,
alcohol.
Apply eye ointment 2-4 times daily.
Contraindicated in people with ocular infection
(especially herpes simplex)
Gently pull out the lower eyelid to form a sac.
Run the ointment into the sac, then allow the
eyes to close. Apply gentle pressure on the
closed eye for about one minute.
Try not to let the nozzle of the tube contact the
eye when applying. If handled incorrectly eye
ointment can become contaminated by bacteria
which can cause, when applied to the eye,
further infections.
-

add pressure and move your eye around.

1cm
blurring, stinging and redness
do not use more than three weeks
contact lenses and discard for 28 days

Side effects: Occular hypertension, retarded

corneal healing, rebound inflammation.

The most common side effect is temporary
blurred vision, especially after application of the
eye ointment.
Other uncommon side effect to watch out for
include: burning stinging, redness or watering of
the eye
Ventolin

MDI not inhalation,

but the ability to use
the device
Breathe out so its nice
and comfortable.
Place mouth around
and form the seal.
Start breathing in, as
you breathe in press
down the device and
breathe in
And hold your breathe

corneal thinning (resulting in decreased

vision, watering of the eye
cataracts
glaucoma

Shake well and inhale 1-2 puffs as required, or

5-15 minutes before exercise; repeat 3-4 times
a day as necessary. SHAKE BEFORE EVERY
DOSE.
1. remove cap and shake MDI
2. exhale
3. place mouthpiece in mouth and tilt head
back slightly
4. start to breathe in slowly and deeply
5. at the same time as breathing in, press
down on canister to actuate 1 puff
6. continue to breathe in
7. hold breath for at least 10 seconds
8. breathe out slowly
9. if second dose is required repeat above

Check how much is in

there by priming.

if spacer

Children MDI with

spacer and mask
<4yold

Assemble spacer

4 with mouth piece

5> dried powder
device, breathe
activated device
>8 large volume
spacers.
Large volume spacers
should make a sound
unless its clogged. ->

Remove inhaler cap

Hold inhaler upright and shake well
Insert inhaler upright into spacer
Put mouthpiece between teeth without biting and
close lips to form good seal
Breathe out gently
Hold spacer level and press down firmly on canister
once
Breathe in slowly and deeply then hold breath for
about 10 seconds or as long as comfortableOR

better air flow.

Breathe in and out normally for 4 breaths*

Remove spacer from mouth
Breathe out gently
Remove inhaler from spacer
If an extra dose is needed, wait 1 minute and then
repeat steps 3 to 11
Replace cap and disassemble spacer
Cleaning
Warm soapy water.
Which device to use?
The bigger the device is better.
The smaller one has the ability to put on the mask.
Nice seal, no biting down on the spacer.

Symbicort
turbuhaler

Breath activated
So need long steady
breathe (not
necessary fast)
- hold your
breathe.
Exhale away from the
device.
Max dose: 6 inhalation
a day.
Twist it all the way left
and twist it all the way
right until you hear
the click.
Talk about the meter.
Sore throat, hoarse
voice.
Holding upright
Dont breathe back

Howtouseit
1. Unscrewandliftoffthecap
2. HoldtheTurbuhalerupright
3. Twistthecolouredbasetotherightthentheleft,
untilitclicks
4. BreatheoutgentlyawayfromtheTurbuhaler.Donot
blowintoit
5. Putthemouthpieceinthemouthensuringagoodseal
isformedwiththelips
6. Breatheinthroughyourmouthforcefullyanddeeply
forapproximately5seconds
7. RemovetheTurbuhalerfromyourmouthbefore
breathingout
8. Replacethecap
9. Totakemoremedicationrepeatsteps28
Howtocleanit
Wipemouthpiecewithacleandrytissue

into device if you want

to inhale again.
Seretide
accuhaler

Nned to keep using

even if your asthma is
under control.
Dont bite down
Sorethroat,
If you dont feel
anything, dont think
that you dont have a
dose.

Howtouseaccuhaler
1. HoldtheAccuhalerbyitsbaseinonehand
2. Placethethumboftheotherhandinthethumbgrip
3. OpentheAccuhalerbypushingthethumbgrip
arounduntilitclicks
4. Slidetheleveruntilitclicks
5. BreatheoutawayfromtheAccuhaler
6. Putthemouthpieceinthemouthensuringagoodseal
isformedwiththelips
7. Breatheinsteadilythroughyourmouthfor
approximately5seconds
8. RemovetheAccuhalerfromyourmouthandholdfor
approximately10seconds
9. Breatheoutslowly
10. CloseAccuhaler
11. Totakemoremedicationrepeatsteps29

Airomir autohaler
Salbutamol like
ventolin.
Reliever

Easier to use, dont

have to time your
breathing.
Dont stop breathing
even if you hear the
click.
Asthma management
plan. More than three
times a week.
For second dose, need
to flick down again.
Still needs to be
primed.

How to use autohaler

1. RemovethecoverfromtheAutohalermouthpiece
2. HoldtheAutohalerinanuprightpositionwithout
blockingtheventsatthebase
3. Liftthegreyleverupatthetopandshakethedevice
vigorously
4. Breatheout,awayformautohaler
5. Tiltthechinup
6. Putthemouthpieceinyourmouth,closingyourlips
firmlyaroundit(formtightseal)
7. Breatheinthroughyourmouthsteadilyanddeeply
forapproximately5seconds.TheAutohalerwillfire

Always shake.

adoseofmedicationautomatically
8. RemovetheAutohalerandholdyourbreathfor10
seconds
9. Breatheoutslowlythroughyournose
10. Returnthegreylevertoitsoriginalposition
11. Totakemoremedicationrepeatsteps29
Howtocleanit
Wipemouthpiecewithacleandrytissue.Takethecanister
andletitrunthroughwarmwater.

Spiriva
(tiotropium)
Anti cholinergic
agent

Maintanence therapy
in COAD (does not
relieve immediate
symptoms)

- inhaled once daily via a HandiHaler device

(capsule inserted into device that pierces it and
releases powder)(inhale for ten seconds)

Wash it once a month.

Leave it for 24 hours
to dry.

-ensure that patients do not swallow the capsule

and are able to use the device

Mention that its not a

reliever
Pierce and release the
trigger, dont hold it.
Dont swallow the
capsule

-common side effect is a dry mouth or throat

irritation
-avoid powder contact with eye
-strip in use has an expiry of 5 days once first
capsule is removed

When peeling, only

open up one capsule a
at a time.
Need to change the
handihaler every 6
months

Nasonex

Washing it/ rinse it

with warm water
(open it up (three
pieces) and leave it in
water
Prime it if its sitting

How to use a nasal spray

there
Aim it into the nose,
use opposite hand to
aim at the walls or itll
go to the back.
Dont shove it all the
way up the nose.
Leak out, wipe bottom
of nose.
Breathe in gently.
Shouldnt use it for
more than six months
at a time.

1. clear the nose by gently blowing, or using

a saline spray
2. Shake the bottle before use and follow the
manufacturers advice about priming if
needed (spraying two to three times into
the air until even spray is produced)
3. Head should be tilted slightly forward
when administering the spray to prevent
dripping down back of throat.
4. Put the nozzle just inside the nose, aiming
towards the outside wall
5. Block the other nostril, and while sniffing
gently, sqirt once or twice (in two different
directions along the outside wall)
6. Avoid sniffing too hard or the contents are
likely to go straight down the throat
7. Repeat for the other nostril

How long will it take to

take affect: few days
to work for few effect.
This dose is
approximately for two
weeks, if symptom is
better, reduce dose (2
d)
Use before symptoms
(seasonal, a week
before symptoms)
Blood nose

Nitrolingual Pump
spray

Transiderm Nitro
patches

Cleaning the device:

clean the nasal cap
(can be pulled off)
Prime away
Whatever activity
precipitate the attack,
dont do it. Or use it
before activity.
Remember nitrate
free period.
Dispose properly
Side effects:

headache, which

Follow these steps to apply a patch to your skin.

1

Choose an area of skin:

The best place is your chest but you may use any area

usually goes away

after taking a mild pain
reliever such as
paracetamol

except below your knees or elbows.

Choose an area of skin that has no sores, cuts or rashes.

If the skin is very hairy, you can clip the hair (do not shave
it) so that the patch sticks well and won't be hard to
remove.

Use a different area of skin each day. Wait several days

before using the same area again.

Make sure the skin is clean, cool, dry and free from
creams, lotions or oils:

You may need to wash the area with soap and water and
dry it completely.

If your skin is very oily, you can use methylated spirits to

clean it, then dry it completely.

After a shower or bath, wait a few minutes before applying

the patch to make sure your skin is completely cool and
dry.

You may use body lotion or bath oil after the patch has
been applied.

Cover patch with medication,

no heat supply to the patch,
water bottles - > increase

Open the sachet that contains the patch:

Tear open the sachet at the notch and remove the patch.

Cut with clippers do not shave.

Moisturise when you move the
patch

Do not use scissors because you may accidentally cut the

patch and the medicine may leak out.

Any air bubbles on the patch are not important.

Remove the protective liner from the sticky side of the

patch:

Pick up the patch with the tab upwards and the white liner
facing you.

Firmly bend the tab forward with your thumb.

Use both thumbs to peel off the protective liner, starting at

the tab. Do not touch the sticky surface of the patch.

Throw the liner away.

Apply the patch to the skin as soon as you have

removed the liner:

Press the sticky side of the patch to the area of skin you

dizziness or
lightheadedness,
sometimes
accompanied by a fast
heart beat, especially
when getting up
suddenly
itching or burning
under the patch
reddening of the skin
after the patch has
been taken off

flushing of the face

nausea (feeling sick)

or vomiting

palpitations: abnormal
feeling of heart beat.

Usually upper body

Water proof. Pool doesnt
affect patch.
Anywhere except Below the
knees or elbow

Nitrate free period

when their angina is, if
its at night then use it
at night.
Your body might be
tolerable to it.
What side of the bed
you sleep on.

have chosen so that the tan coloured side is showing.

Press the patch firmly in place with the palm of your hand
for 10 to 20 seconds. The patch needs the pressure and
heat of your hand to stick well.

Check that the patch has stuck by running your finger

around the edge. Do not try to lift the edge of the patch to
see if it has stuck.

How to remove the patch

Vagifem pessaries Can use finger instead

of applicator.

Use the little tab to pull the patch away from your skin.

Fold the old patch in half with the sticky side inwards.

Throw the old patch away safely out of the reach of

children. The patch still contains some leftover medicine
that could harm a child.

Remove any stickiness from the skin with soap and water
or methylated spirits.

Wash hands well. Tear off one single blister pack. Open
the end as shown in the picture

Insert the applicator carefully into the vagina. Stop when

you can feel some resistance (8-10 cm).

To release the pessary, gently press the push button until

you feel a click. The pessary will stick to the wall of the
vagina straight away. It will not fall out if you stand up or
walk.

Take out the applicator and throw it away.

Vaginal dryness.
After sexual
intercourse.
Put it in as far as
comfortable.

Epipen Junior

To hold it without your

thumb or finger ontop
of any of the ends
(orange pen)

General

Grip only the mid-section of the EpiPen AutoInjector. Avoid touching either end, except when you

USE IT whenever you

suspect
Take blue cap off. But
thats not the end
Best in the thigh, can
go through ONE layer
of clothing
Jab
Ten seconds
Rub area for ten
seconds.
If its discoloured ->
usually off but still use
it if theres nthing else
Still call ambulance.
12 month expiry. Shelf
life.

remove the blue safety release. The blue safety

release stops the EpiPen from firing or working.

Never place thumb, fingers or hand over the orange

end as this contains the needle.

Always point the orange end (which holds the needle)

away from any part of any body, except the planned
injection site. This is usually the thigh of the person
who has the severe allergic reaction.

Keep EpiPen away from the face and eyes.

Carefully follow the step-by-step directions to make the

EpiPen work properly.
Step 1
Flip open the yellow cap on the protective carry tube. Carefully tip
and slide the EpiPen Auto-Injector out of the carry tube. Never
place thumb, fingers or hand over the orange end as this contains
the needle. Check the contents of the EpiPen Auto-Injector
through the viewing window. Make sure the solution is clear,
colourless and sediment-free. If the viewing window is obscured,
the EpiPen has already fired and cannot be used again.
Step 2
Make a fist around the EpiPen Auto-Injector, with your thumb
nearest to the blue safety release (see FIGURE 1).

Step 3
Activate the EpiPen Auto-Injector by removing the blue
safety release with your other hand (also shown in FIGURE
1). This triggers the EpiPen. It is now ready to

fire the needle and

inject the medicine through the needle into the thigh

muscle.

After you remove the blue safety release do not touch or

place thumb, fingers or hand over the orange end as this
contains the needle.
Step 4
Hold the EpiPen Auto-Injector at a 90 angle (right angle) to
the outer part of the thigh. Hold the orange end about 5cm
away from the thigh (see FIGURE 2).

Step 5
Push the orange end FIRMLY into the outer mid-thigh until a
click is heard or felt. Keep pressing the EpiPen AutoInjector firmly against the thigh for approximately 10 seconds
(see FIGURE 3).

NOTE: EpiPen may be used either

through clothing, as shown in FIGURE 3, or

directly on to skin.

When you press the orange end of the EpiPen Auto-Injector

firmly against the thigh, the hidden needle fires. It injects the
measured dose of adrenaline (epinephrine) into the thigh muscle.
Step 6
Carefully take the EpiPen Auto-Injector away from the thigh.
The orange needle cover will extend to cover the needle (see
FIGURE 4).

Gently rub the thigh in the area of the injection for about 10
seconds.
Check the viewing window - it should now be obscured. If it
isnt, the EpiPen has not fired or worked. If the viewing
window is not obscured, repeat steps 2-6 above.
Step 7
Record the time EpiPen was given.
Step 8
Seek further medical attention for yourself immediately.
Although you have received adrenaline (epinephrine) from
EpiPen, you may need more medical treatment.
Either

Contact your doctor or

Call an ambulance (telephone 000 in Australia or 111

in New Zealand). State that adrenaline (epinephrine)
treatment may be needed.

NOTE: EpiPen is only for immediate emergency treatment

of a severe allergic reaction. Further treatment is usually
needed.
Step 9
Explain to the doctor that you have had EpiPen (intramuscular
adrenaline (epinephrine)).
Take your used EpiPen Auto-Injector with you.
Counselling
-

Make sure anyone who may need to give you adrenaline

is taught how to recgonise when you need it and how to
give it
Call an ambulance as soon as possible after using

Salofalk enema

Hold it in for as long

as possible (thirty
minutes)
Will have an urge to
go due to
inflammation but will
get better

How to use it
If possible, go to the toilet and empty your bowels before
using your enema.
1

Wash your hands thoroughly with soap and water.

Using a pair of scissors carefully cut along the dotted line

of the pack containing the enema bottle. Take care not to
cut or damage the bottle.

Shake the enema bottle for 30 seconds.

Remove the protective cap from the applicator and hold

the bottle by its upper end.

Lie down on your left side with the left leg outstretched
and the right leg bent

Disposable, non
reusuable.
Wash hands

adrenaline because further doses may be required

Keep two adrenaline autoinjectors with you at all times.
They need to be stored in the dark, between 15C

Laying down flat

Guide the applicator deep into the rectum and whilst holding the
bottle obliquely, squeeze slowly.

Remove the applicator from the rectum when the bottle is

empty.

Remain lying down for at least 30 minutes to allow the

enema to spread throughout the lower part of the large
intestine.

Wash your hands thoroughly and try not to empty your

bowels again until the next morning.

You may experience a little discomfort and a feeling of urgency to

empty your bowels immediately after enema insertion. This is
normal and expected due to the inflammation present within the
bowel. Try to resist this urge to empty your bowels for as long as
possible. This feeling will subside as treatment continues and the
inflammation decreases.

Aldara

Warts
1

Before applying Aldara, wash your hands and treatment

area with mild soap and water and allow it to dry
thoroughly. If you are using Aldara pump remove the
protective cap and prime several times until cream
appears at the nozzle. Alternatively, open a sachet of
Aldara and squeeze some cream onto your fingertip.

Apply a thin layer of Aldara cream onto the treatment area

and rub it gently into the skin until the cream vanishes.
For sBCC lesions enough cream should be applied to
cover the lesion and about 1cm of surrounding skin.
If using the pump, four actuations of the pump is
equivalent to the content of one 250 mg sachet of Aldara
cream.
One sachet contains enough cream to cover a treatment
area of 20 square centimetres (approximately 3 square
inches).

If using the pump, replace the protective cap back on the

pump after application of the cream. Carefully store where
children cannot reach it. Wash your hands with mild soap
and water. If using the sachet after application of the
cream, carefully dispose of the unused Aldara cream in
the sachet where children cannot reach it.
Once opened, the contents of the pump are to be used
within 4 weeks.

Leave Aldara cream on the affected area for 6 to 10

hours. Do not shower or bathe during this time.

After 6-10 hours, the area where Aldara cream was

applied should be washed with mild soap and water.

Application site reactions including redness, wearing

away of the skin, flakiness, swelling,

Most of these skin reactions are mild to moderate, and

are signs that the product is working.

If your skin reacts badly or the skin reaction becomes too

uncomfortable when using Aldara cream, wash the cream
off with mild soap and water and contact your doctor. Your
doctor may recommend that you stop treatment for a few
days.

Stemetil may be given as a suppository. First wash your

hands well with soap and water, then follow these
instructions: Go to the toilet and empty your bowels if
possible. Do not strain.

Feel the suppository through its plastic shell. If it feels

very soft, chill it in the fridge or cool it by holding it under

Sachet cream. Dont

need to use all cream,
only enough to coat
the area.
Transfer of STD.
Put vasaline around
the area to prevent
the burns of
surrounding days
Dont use it for more
than 16 weeks

Stemetil
Suppository

Wash hands
Moistoine it before
putting it in so its
lubricated.
Take the silver foil up.

SE same as tablets
Drowsiness
Do use oil lubricant
cause it can
disintegrate the
medication.

cold water for several minutes

1

Remove the suppository from its shell

Moisten the suppository by dipping it briefly in cool water

Put one foot up on the side of the bath or toilet, raising the
knee to the chest

Insert the suppository, pointed end first, gently into the

rectum (back passage)

Try not to go to the toilet for at least one hour to allow the
suppository to work.