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Better access to mental health of gains following experiential therapies for depression discount super p-force oral jelly 160mg online. Journal of Consulting and initiative: Orientation manual for clinical psychologists cheap super p-force oral jelly 160mg amex, psychologists purchase super p-force oral jelly 160 mg free shipping, social Clinical Psychology cheap super p-force oral jelly 160 mg amex, 77, 103-112. For low > bibliographic information prevalence disorders, where little formal research has been conducted and published, there may be > design of the study (e. The frst section presents the evidence for adults (including older adults) > methodology (including randomisation procedure) and the second presents the evidence for adolescents and children. In these sections, studies focusing on > treatment outcomes individual therapy appear before those focusing on group therapy. In some meta-analyses and systematic reviews, interpreting the evidence client type was not differentiated. In these instances, the study is labelled ‘Combined’ and is repeated in When interpreting the information presented in this each section at the end of the relevant intervention. These In addition, some of the disorders included in this review limitations include small sample size; inconsistent or comprise multiple diagnostic categories. For example, unclear descriptions of comparison groups; and limited ‘Eating disorders’ is made up of anorexia nervosa, reporting on the methodology used, including limited bulimia nervosa and binge eating disorder. In addition, it treatments for these subcategories differ, fndings have is important to note that the review provides only a been reported under the relevant diagnostic label. Further information about individual studies should Finally, a ‘Summary of evidence’ appears at the be sought from the original research papers. Where studies found no support for the intervention, the term ‘Insuffcient evidence’ is used. This strategy has the advantage of generating transparent rankings, but does not equate to a comprehensive systematic review, or critical appraisal of the relevant scientifc literature. The following tables are a summary of the level of evidence for the interventions reviewed for mental disorders affecting adults (table 1) and adolescents and children (table 2). Treatment gains were maintained at the 12-month follow up, but the differences between the groups were no longer signifcant. Procedure Two separate analyses were conducted – one on studies with control groups and one on those without (effect sizes were calculated on pre- to post-treatment changes). Results on the secondary outcome (the Beck Depression Inventory) were contradictory. Due to insuffcient referral numbers at study commencement, randomisation was not possible. This program was then offered a second time so that each topic was covered twice (28 weeks). Psychodynamic PsychotheraPy title of PaPer The effcacy of short-term psychodynamic psychotherapy for depression: A meta-analysis authors and journal Driessen, E. Meta-analyses were conducted assessing pre- to post-treatment change, posttreatment to follow-up change in the short-term psychodynamic psychotherapy conditions and comparison of short-term psychodynamic psychotherapy with control conditions or alternative treatments at posttreatment and follow up. Pretreatment to posttreatment changes in depression in the intervention group were large, and changes were maintained until 1-year follow up. When short-term psychodynamic psychotherapy was compared to other psychotherapies, a small but signifcant effect size was found in favour of the other therapies; however these differences disappeared at the 3-month follow up, but a non-signifcant trend indicated possible superiority of the other psychotherapies at 1-year follow up. Effect sizes were smaller for group short-term psychodynamic psychotherapy than for individual therapy. Problems with unextractable data and multiple different comparators limited the analyses possible for the review and a number of fndings were contradictory or diffcult to interpret. In the frst year of follow-ups, the short-term therapies were signifcantly more effective than the long-term therapy; however, these differences were not signifcant after 2 years. After 3 years, long-term psychodynamic psychotherapy was signifcantly more effective than either of the short-term therapies. There is some evidence that guided self- help has a benefcial effect in those with largely subclinical depression. This evidence is derived mainly from studies comparing guided self-help to a waitlist control. It consists of fve interactive modules, available sequentially on a week-by-week basis, with revision in the sixth week. The Sadness program consisted of four components: six online lessons, homework assignments, participation in an online forum, and regular email contact with a clinician. There were no differences between the groups on the measures assessing level of psychosocial disability. An additional weekly telephone contact of up to 30 minutes was included in the intervention. Participants were randomly assigned to either assisted self-help, minimal contact, or to a waitlist control. Those in the assisted self-help group received more intensive assistance in completing the workbook than those in the minimal contact group. The guided self- help group received a maximum of 4 brief (15-30 minute) sessions with a therapist in addition to the purposely written psychoeducation self-help manual. Those in the waitlist control received routine care from primary-care professionals (e. The individualised self-help package was designed to improve treatment adherence, decrease treatment drop-out, and teach simple self-help strategies. Psychoeducation group title of PaPer Patient education and group counselling to improve the treatment of depression in primary care: A randomized control trial authors and journal Hansson, M. The group psychoeducation program, Contactus, comprised 6 weekly lectures on topics such as diagnosing and treating depression and non-pharmacological alternatives to treatment, followed by post-lecture group discussions (8-10 patients per group). The intervention aimed to promote positive thinking, pleasant activities, social skills and social support. Treatment gains were maintained at 12-months, but the difference was no longer signifcant. Psychosocial interventions appear to have the greatest beneft in reducing risk of relapse and improving functioning during the maintenance phase. Psychoeducation group title of PaPer Clinical practice recommendations for bipolar disorder authors and journal Mahli, G. Group participants also had fewer recurrences of any type, spent less time acutely ill, and spent less time in hospital. When standardised recovery criteria to pathological worry were applied, the rate of recovery at posttreatment was very small, although it improved at follow up. Each session followed an agenda and focused on specifc formal and informal mindfulness-based stress reduction techniques (e. Furthermore, those whose baseline symptoms were in the clinical range experienced a reduction in their symptoms comparable to those of a non-clinical population. Psychodynamic PsychotheraPy title of PaPer Short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalised anxiety disorder: A randomised, controlled trial authors and journal Leichsenring, F. Participants in both groups received up to 30 weekly 50-minute sessions carried out according to treatment manuals. The main elements of the brief Adlerian treatment were encouraging relationships, identifying the focus, and determining areas of possible change within the focus therapy. The participants were granted access to the website and instructed to complete each of the 11 modules on a weekly basis. They were also asked to fll out three self-report questionnaires each week to monitor their progress. Each treatment was combined with either imipramine or placebo, resulting in 8 treatment conditions. All treatments were conducted in small groups, that met for 14 three hour sessions over 18 weeks. There were no signifcant differences between the imipramine and placebo conditions. The self-help group received a relapse prevention treatment manual and brief phone calls aimed at bolstering program compliance. In the current review, there was insuffcient evidence to indicate that any of the remaining interventions were effective. Exposure treatments involving physical contact with the phobic target were more effective than other forms of exposure (e. At posttreatment and at the 12-month follow up there was no signifcant difference between the two groups with the exception of the proportion showing clinically signifcant improvement on the primary measure, the behavioural approach test. The live exposure treatment was delivered in a single, 3-hour session following a brief orientation session. At posttreatment and at the 12-month follow up there was no signifcant difference between the two groups. However, the results also showed that the live exposure treatment is more effective posttreatment for those who showed clinically signifcant improvement on the primary measure, the behavioural approach test. No signifcant differences were found between combined treatment (exposure with cognitive therapy) and exposure or cognitive interventions alone. While not signifcantly different, exposure produced the largest controlled effect size relative to cognitive or combined therapy. Earlier changes in experiential avoidance predicted later changes in symptom severity. Psychodynamic PsychotheraPy group title of PaPer A pilot study of clonazepam versus psychodynamic group therapy plus clonazepam in the treatment of generalized social anxiety disorder authors and journal Knijnik, D. The group therapy consisted of 12 weekly 90-minute sessions using a focused, short-term, psychodynamic approach. There were no signifcant differences between the groups on secondary measures of broader psychosocial functioning. At weeks 1, 2, 3, 6 and 8, a brief meeting with the therapist (about 30 minutes) was held to review the chapters assigned that week. Across the entire sample, reductions in social anxiety, global severity, general anxiety, and depression were observed at posttest and at 3-month follow up. Treatment group participants received feedback on their homework assignments and brief weekly phone calls (about 10 minutes) from the therapists. All showed large reductions in compulsions during treatment and retention of most or all the gains at treatment completion. Psychoeducation, when delivered as a ‘stand alone’ intervention, was found to be inferior to trauma-focused exposure interventions. The two treatment conditions comprised 5 weekly 90-minute sessions with structured homework activities. However, cognitive restructuring was still effcacious at posttreatment and at follow up, but not to the same degree as prolonged exposure. In sessions 5-9, those in the combined treatment group were asked to imagine reacting as they wished they had done while being exposed to the most diffcult moments of the traumatic event. However, there was no signifcant difference in effectiveness between the two treatment conditions, although there was signifcantly lower dropout in the imaginal exposure with imagery rescripting group.
For each aspect purchase 160 mg super p-force oral jelly otc, you have to check whether the proposed treatment is effective and safe order super p-force oral jelly 160mg overnight delivery. A check on effectiveness includes a review of the drug indication and the convenience of the dosage form buy super p-force oral jelly 160mg without a prescription. Verify the suitability of your P-drug A Active substance and dosage form B Standard dosage schedule C Standard duration of treatment 51 Guide to Good Prescribing For each of these generic 160mg super p-force oral jelly fast delivery, check:Effectiveness (indication, convenience) Safety (contraindications, interactions, high risk groups) 52 Chapter 8 Step 3: Verify the suitability of your P-drug Step 3A: Are the active substance and dosage form suitable for this patient? Effectiveness We assume that all your P-drugs have already been selected on the basis of efficacy. However, you should now verify that the drug will also be effective in this individual patient. For this purpose you have to review whether the active substance is likely to achieve the therapeutic objective, and whether the dosage form is convenient for the patient. Convenience contributes to patient adherence to the treatment, and therefore to effectiveness. Complicated dosage forms or packages and special storage requirements can be major obstacles for some patients. Safety The safety of a drug for the individual patient depends on Table 5: contraindications and interactions; these may occur more High risk factors/ frequently in certain high risk groups. Contraindications are groups determined by the mechanism of action of the drug and the characteristics of the individual patient. Some Lactation patients will fall into certain high risk groups (see Table 5) Children and any other illnesses should also be considered. Some side Elderly effects are serious for categories of patients only, such as Renal failure drowsiness for drivers. Interactions can occur between the Hepatic failure drug and nearly every other substance taken by the patient. History of drug Best known are interactions with other prescribed drugs, but allergy you must also think of over-the-counter drugs the patient Other diseases might be taking. Interactions may also occur with food or Other medication drinks (especially alcohol). Exercise: patients 13-16 Verify in each of these cases whether the active substance and dosage form of your P-drug is suitable (effective, safe) for this patient. A few weeks ago you diagnosed essential hypertension (145/100 on various occasions). Your P-drug for hypertension in patients under 50 is atenolol tablets, 50 mg a day. Brought in with a severe acute asthmatic attack, probably precipitated by a viral infection. She has great difficulty in breathing (expiratory wheeze, no viscid sputum), little coughing and o a slight temperature (38. Apart from minor childhood infections she has never been ill before and she takes no drugs. You conclude that she will need surgery fast, but in the meantime you want to relieve the pain. Patient 13 (hypertension) Atenolol is a good P-drug for the treatment of essential hypertension in patients below 50 years of age, and it is very convenient. Despite the fact that it is a selective beta-blocker, it can induce asthmatic problems, especially in higher doses because selectivity then diminishes. In severe asthma you should probably switch to diuretics; almost any thiazide is a good choice. Patient 14 (child with acute asthma) In this child a fast effect is needed, and tablets work too slowly for that. Inhalers only work when the patient knows how to use them and can still breathe enough to inhale. In the case of a severe asthma attack this is usually not possible; moreover, some children below the age of five may experience difficulties with an inhaler. If an inhaler cannot be used, the best alternative is to give salbutamol by subcutaneous or intramuscular injection, which is easy and only briefly painful. In this case acetylsalicylic acid is contraindicated as it affects the blood clotting mechanism and also passes the placenta. Paracetamol is a good choice and there is no evidence that it has any effect on the fetus when it is given for a short time. Patient 16 (pneumonia) Tetracycline is not a good drug for children below 12 years of age, because it can cause discolouration of the teeth. The drug may interact with milk and the child may have problems swallowing the large tablets. Good alternatives are 54 Chapter 8 Step 3: Verify the suitability of your P-drug cotrimoxazole and amoxicillin. Tablets or parts of tablets could be crushed and dissolved in water, which is cost-effective if you can clearly explain the 3 procedure to the parents. You could also prescribe a more convenient dosage form, such as a syrup, although this is more expensive. In all these patients your P-drug was not suitable, and in each case you had to change either the active substance or the dosage form, or both. Atenolol was contraindicated because of another disease (asthma); an inhaler was not suitable because the child was too young to handle it; acetylsalicylic acid was contraindicated because it affects the blood clotting mechanism and because the patient is pregnant; and tetracycline tablets were contraindicated because of serious side effects in young children, possible interactions with milk, and inconvenience as a dosage form. The aim of a dosage schedule is to maintain the plasma level of the drug within the therapeutic window. As in the previous step, the dosage schedule should be effective and safe for the individual patient. The window and/or plasma curve may have changed, or the dosage schedule is inconvenient to the patient. If you are not familiar with the concept of the therapeutic window and the plasma concentration-time curve, read Annex 1. Exercise: patients 17-20 Review for each of the following cases whether the dosage schedule is suitable (effective, safe) for the patient. Recently mild hypertension was diagnosed, and diet and general advice have not been sufficiently effective. You have been treating his pain successfully with your P-drug, oral morphine solution, 10 mg twice daily. Chronic rheumatic disease, treated with your P-drug, indometacin, 3 times 50 mg daily plus a 50 mg suppository at night. However, it should not be done with capsules nor with special tablets such as sugarcoated or slow-release preparations. He was on oral morphine solution, 15 mg twice daily, to which he had responded well. Your P-drug is amitriptyline, 25 mg daily initially, followed by a slowly rising dose till the drug is effective (with a maximum of 150 mg per day). These differences may influence the pharmaco- dynamics or pharmacokinetics of your P-drug. A change in pharmacodynamics may affect the level (position) or width of the therapeutic window (Figure 1; see also Annex 1). The therapeutic window reflects the sensitivity of the patient to the action of the drug. Changes in the therapeutic window are sometimes expressed as the patient being ‘resistant’ or ‘hyper-sensitive’. The only way to determine the therapeutic window in the individual patient is by trial, careful monitoring and logical thinking. In Patient 17 (diabetes) it is important to note that β-blockers counteract the effect of insulin. This means that higher concentrations of insulin are needed for the same effect: the therapeutic window for insulin shifts upwards. The plasma curve no longer matches the window, and the daily dose of insulin must be raised. For these two reasons you may decide to change to another drug group that does not affect glucose tolerance, e. Patient 18 (lung cancer) has probably become tolerant to morphine, as he responded well to the drug before. The therapeutic window is shifted upwards and the dose has to be raised, for example to 15 mg twice daily. In terminal patients drug absorption and metabolism may be so disturbed that even larger dosages (e. Changes in plasma concentration-time curve The plasma concentration-time curve may be lowered or raised, or the concentration may fluctuate outside the therapeutic window. In Patient 19 (pain at night) the plasma concentration of Figure 2: Slow fall in plasma concentration late at night indometacin probably falls below the therapeutic window in patient 19 early in the morning (see Figure 2). Any change in medication should therefore aim at increasing the plasma level in that period. You could advise her to take the evening dose later, or to set the alarm in the night to take an extra tablet. You could also increase the strength of the evening suppository to 100 mg, while decreasing her first morning tablet to 25 mg. He has probably been overdosed, patient 18 because his metabolism is impaired by the terminal cancer, decreasing the elimination of the drug and therefore lengthening its half-life. In addition, the distribution volume of his body is reduced because of emaciation. The curve therefore probably lies above the window, implying that the daily dose should be reduced. Remember that it takes about four half-lives to lower the plasma concentration to a new steady state. If you want to speed up this process you can stop the morphine for one day, after which you can start with the new dose. Metabolism is high Excretion is high How can you define the position of the plasma curve in an individual patient? The plasma concentration can be Plasma concentration curve measured by laboratory investigations, but in many will rise if: settings this is not possible and it may be expensive. More Absorption is high Distribution is low important, each measurement represents only one point Metabolism is low of the curve and is difficult to interpret without special Excretion is low training and experience. More measurements are expensive and may be stressful to the patient, especially in an outpatient setting. Figure 4: Downward shifted window and upward shifted curve Changes in window and curve in patient 20 Changes in both window and curve are also possible, as illustrated in Patient 20 (depression) (see Figure 4). Dosage schedules for antidepressant drugs in the elderly usually recommend that the dose be reduced to half the adult dose, for two reasons. First, in the elderly the therapeutic window of antidepressant drugs shifts downwards (a lower plasma concentration will suffice).
Whether a random level can be usefully used to ascertain compliance remains to be determined – although this is probably useful where major non-compliance is possible buy super p-force oral jelly 160 mg without a prescription. Unfortunately discount super p-force oral jelly 160 mg, a large number of patients developed aplastic anaemia generic super p-force oral jelly 160 mg with amex, some with a fatal outcome cheap 160mg super p-force oral jelly. This re-emergence of felbamate has not been reported to be accompanied by a corresponding increase in additional cases of aplastic anaemia or hepatitis. Its mechanism of action, and therefore its reported adverse side effects, appears to be similar, but less severe, to that of topiramate. A randomised double-blind placebo-controlled trial of 139 participants aged 430 years showed significant benefit in most seizure types, particularly atonic (‘drop’) and absence 46 seizures. Many other drugs have been used in paediatric epilepsy, usually in an attempt to control multiple and refractory seizure types. Acetazolamide, a diuretic and carbonic anhydrase inhibitor, is considered by many to be a useful add-on drug (usually in combination with 47 carbamazepine) in treating focal seizures. Pyridoxine (vitamin B ) is clearly the treatment of6 48 choice in the rare inherited disorder of pyridoxine-dependent seizures , but it has also been 49 used in West syndrome (infantile spasms). If there has been no obvious or sustained response to pyridoxine, and there remains a high suspicion of pyridoxine-dependent epilepsy, the child should then receive a three- or four-week course of pyridoxal phosphate. Biotin should also be used in infants and young children with refractory seizures pending the result of a serum biotinidase level. Folinic acid should also be used for any infant with neonatal-onset seizures that have been resistant to both conventional antiepileptic medication and pyridoxine and where no cause has been found for the epilepsy. The high-fat, low-carbohydrate ketogenic diet is a historical treatment that has gained more 50 credibility as an effective management of children with drug resistant epilepsy. A randomised controlled trial has demonstrated definitive efficacy over no change in treatment. More relaxed forms of the diet have raised the possibility of it being available to use over a wide age range. Intravenous immunoglobulins have been used with varying (usually very limited), success in ,52,53 intractable epilepsies including children with both the West and Lennox-Gastaut 54,55 syndromes. There are marked variations in the frequency of courses, duration of treatment and doses of this particular therapy and there is as yet no established or universally accepted mechanism of action. Drug choice in childhood epilepsy should, wherever possible, be evidence based as in older individuals. However, there are few randomised controlled trials on which to base drug choice within the epilepsy syndromes. This in part reflects the logistical and ethical difficulties as well as the expense in conducting paediatric trials. Nevertheless, the principal should still be to try and base treatment strategies on robust evidence. They state that focal epilepsies in children older than four years of age have a similar clinical expression to focal epilepsies in adolescents and adults. In refractory focal epilepsies, the results of efficacy trials performed in adults could to some extent be extrapolated to children, provided the appropriate dose and safety data are established. For syndromes limited to childhood, sufficient experience needs to be gained in this 56 population before a new medicinal product may be registered for these indications in children ; predictably such experience is likely to be largely anecdotal unless data can be obtained from well-conducted national or international randomised controlled trials. Many studies are conducted on the basis of seizure type rather than syndrome, are limited in duration and reveal little in the way of long-term effects. Further, a recent randomised double-blind trial in the treatment of childhood absence epilepsy comparing ethosuxuimide, sodium valproate and lamotrigine showed superior efficacy of sodium valproate and 59 ethosuximide over lamotrigine, but some neuropsychological advantage to ethosuximide. There has been increasing concern about the effect of sodium valproate on the unborn child of mothers taking the medication – both an increased risk of malformations, as well as cognitive delay in later childhood. For this reason the medication is not recommended as first line in girls of child-bearing age, and when considered, the risks of taking the medication need to be weighed against the risk of the epilepsy itself in each individual. Epilepsies associated with focal seizures are slightly less common in children in contrast to adults and for these individuals carbamazepine is the usual preferred treatment. Vigabatrin is particularly effective in 12 treating infantile spasms caused by tuberous sclerosis but appears to be slightly less effective 61,62 than tetracosactide or prednisolone in treating spasms due to other aetiologies. However there are currently differences of opinion regarding the treatment of infantile spasms, in part reflecting clinicians’ concerns over drug safety and in part availability of medication. Which is used will depend on family and physician choice, weighing up the risk:benefit of the treatment involved. Although use of vigabatrin in adults and older children has been associated with 21 visual field constriction, this appears to be related to dose and duration of treatment and does not necessarily prevent or reduce the use of this drug in treating infantile spasms when weighed up against the risk of short-term high-dose steroids. In Dravet syndrome, previously called severe myoclonic epilepsy of infancy, medications of choice are sodium valproate, clobazam and topiramate. Furthermore a well-constructed randomised crossover study demonstrated stiripentol, a cytochrome P450 inhibitor, to be 63 significantly more effective than placebo when added to sodium valproate and clobazam ; however, this drug may be associated with significant somnolence as well as loss of appetite. Several studies have been conducted evaluating treatments against placebo in Lennox-Gastaut syndrome as add-on therapy. Overall the authors concluded that no study to date had shown any one drug to be effective over and above another but lamotrigine, rufinamide, clobazam, topiramate and felbamate may be helpful as add-on 66 therapy. Therefore until further research has been undertaken clinicians will need to continue to consider each patient individually, taking into account the potential benefit of each therapy weighed against the risk of adverse effects. These must be effective (preferably with a broad spectrum of action against a wide range of seizure types), safe and be available in child-friendly formulation. In this regard, it is common for a child to be falsely described as being refractory to treatment because they have been prescribed the wrong drug for their epilepsy syndrome. The classic example is the use of carbamazepine or oxcarbazepine for juvenile-onset absence or juvenile myoclonic epilepsy, when it is known to exacerbate both the myoclonic and absence seizures which characterise these syndromes. Consequently the prescribing mantra must be ‘if I add, what can I take away’ to avoid dangerous polypharmacy. In individual cases of torsades de pointes there are often multiple risk factors present. The 8,9,10,11 main risk factors which should be considered are: Potentially Modifiable A list of medicines Electrolyte Disturbances (in particular hypokalaemia, hypomagnesaemia and more known to prolong the rarely hypocalcaemia). It is recommended that you check the lists for drugs commonly used in your area of practice to familiarise yourself with the risks. Antimicrobials Antipsychotics (all have some risk) Erythromycin Risperidone Clarithromycin Fluphenazine Moxifloxacin Haloperidol Fluconazole Pimozide Ketoconazole Chlorpromazine Antiarrhythmics Quetiapine Dronedarone Clozapine Sotalol Antidepressants Quinidine Citalopram/escitalopram Amiodarone Amitriptyline Flecainide Clomipramine Dosulepin Others Doxepin Methadone Imipramine Protein kinase inhibitors e. The risk of torsades de pointes depends on patient factors and medication history. The decision should be made on a case by case basis taking into account any additional risk factors the patient has. Domperidone: small risk of serious ventricular arrhythmia and sudden cardiac death. Changes to the contents are published in Hormone Preparations – Systemic 90 monthly updates. Alternatively there is a nominal charge for an annual subscription Respiratory System & Allergies 211 to the printed Schedule publications. To Sensory Organs 219 access either of these subscriptions visit our subscription website www. This includes community pharmaceuticals, hospital pharmaceuticals, vaccines and increasingly, hospital medical devices. The processes we generally use are outlined in our Operating Policies and Procedures. This medicine is an unapproved medication supplied under Section 29 of the Medicines Act 1981. Community Pharmaceutical costs met by the Government Most of the cost of a subsidised prescription for a Community Pharmaceutical is met by the Government through the Combined Pharmaceutical Budget. The Government pays a subsidy for the Community Pharmaceutical to pharmacies, and a fee covering distribution and pharmacy dispensing services. 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The criteria the patient must meet are that they: a) have limited physical mobility; b) live and work more than 30 minutes from the nearest pharmacy by their normal form of transport; c) are relocating to another area; d) are travelling extensively and will be out of town when the repeat prescriptions are due. The Annotation must include the details specified in the Schedule, including the date the prescriber was contacted (if applicable) and be initialled by the dispensing pharmacist. An authority to substitute letter, which may be used by Practitioners, is available on the final page of the Schedule. Alternatively a copy of the invoice for the purchase of the Pharmaceutical may be attached to the prescription, in the place of an annotation, in order to be eligible for Subsidy. The endorsement can be written as “certified condition”, or state the condition of the patient, where that condition is specified for the Community Pharmaceutical in Section B of the Pharmaceutical Schedule. 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