HM Medical Clinic

Cook Islands Essential Medicines List 2016
Updated January 2016
Medicine form strength
Notes, conditions of supply, guidance on use
Only medicines listed in the EML are recommended for use and are available in the Ministry of
Health pharmacies and hospitals.
For medicines not listed on the EML practitioners have the following options:
 changing to an EML-listed alternative  provide a prescription to enable the patient to purchasetheir supply from a community  completing the on the Ministry's www Where an EML-alternative medicine is not available practitioners may apply for a ‘named patient' supply by completing the Special Request for the Supply of a non-EML Medicine for an Individual Patientform on the Ministry's website. This should be forwarded to the Chief Pharmacist for consideration by a Standing Committee of the Pharmacy and Therapeutics Committee. Patients approved by the Standing Committee for a ‘named patient' supply can have prescriptions for their medicine filled at their nominated Ministry of Health Pharmacy. There are also some medicines listed in the EML for which a ‘named patient' application is required. Health practitioner can request the addition or removal of a medicine to the EML by using the form on the Ministry's website. This should be forwarded to the Chief Pharmacist for consideration at the next Pharmacy and Therapeutics Committee. Medicines listed in the Cook Islands EML have been approved by the Pharmacy and Therapeutics Committee for use in the Ministry of Health hospitals, clinics and pharmacies in the Cook Islands. INDEX
The indexing scheme of the WHO EML has been maintained for ease of updating and comparison.
Medicines listed under different headings are approved and recommended for use for that
condition. They can be located by scrolling to a particular section or by search using the ‘CTLR f'
function. Individual medicines may appear under more than one category
section Therapeutic Use and Medicine Classification
1.0 Anaesthetics 2.0 Medicines for Pain and Palliative Care 3.0 Anti-allergy Medicines and Medicines for Anaphylaxis 4.0 Antidotes and Medicines for Poisoning 5.0 Anticonvulsants and Antiepileptic Medicines 6.0 Anti-infective Medicines 7.0 Anti-migraine Medicines 8.0 Anti-neoplastics and Immunosuppressant Medicines 9.0 Anti-Parkinson's Medicines 10.0 Medicines affecting the Blood 11.0 Blood products and Plasma Substitutes 12.0 Cardiovascular Medicines 13.0 Dermatological Medicines (topical) 14.0 Diagnostic Agents 15.0 Disinfectants and Antiseptics 16.0 Diuretics 17.0 Gastrointestinal Medicines 18.0 Hormones and Contraception 19.0 Immunological Preparations (vaccines and antisera) 20.0 Muscle Relaxants for use in surgery 21.0 Ophthalmic Preparations 22.0 Oxytocic and Anti-oxytocic Medicines 23.0 Peritoneal Dialysis 24.0 Medicines for Psychiatric and Behavioural Disorders 25.0 Respiratory Tract Medicines 26.0 Electrolytes and Fluid Balance Preparations 27.0 Vitamins and Mineral Preparations 28.0 Ear, Nose and Throat Medicines 29.0 Neonatal Care Medicines 30.0 Rheumatology Medicines 31.0 Urinary Tract Medicines 32.0 Miscellaneous 1.10 General Anaesthetics and Oxygen
1.11 Inhalational Anaesthetics and Medicines
Isoflurane inhalationliq 250ml
Sevoflurane inhalation liq 250mL Nitrous oxide inhalation Oxygen inhalation(OXYGEN "G" SIZE Gas 1) Soda lime (sodium hydroxide) 1.12 Injectable Anaesthetics Ketamine inj500 mg/10mL Propofolinj200 mg/20 mL Emergency use only; minimum stock level 5 Thiopental inj 1g
1.2 Local Anaesthetics
Bupivacaine inj 0.5%, 20mL
Bupivacaine spinal (heavy) inj0.5%, 4 mL IDA, NZ Ethyl chloride 100mL Lidocaine inj2%, 20 mL for male catheterisation only on Lidocaine gel 2%, 30 mL recommendation of a doctor. Lidocainespray 10% 50mL For theatre only. Lidocaine HCl 2%+epinephrine (adrenaline) 1:80,000 dental cartridge Lignocaine + adrenaline inj 1% + 1:100,000, 5mL dental

1.3 Preoperative medication and sedation for short-term procedures

Midazolam inj15mg/3ml or 5mg/5mL Morphine inj10mg/mL Fentanyl inj 100mcg/2mL Theatre and HDU use only; Atropineinj1mg /1mL (1:1000) or
2.1 Non-opioids analgesics and Non-steroidal Anti-inflammatory medicines
Ibuprofen oral liq 100mg/5ml
Ibuprofen tabs 200mg, 400mg Diclofenac inj 75mg/3mL Use in hospital clinics and for renal colic only Diclofenac suppositories 25mg For use in Theatre only Mefenamic acid caps 250mg Use in women only Naproxen tabs 250mg Replacement for diclofenac, lower cardiac ris k Paracetamol oral liq120mg/5ml; 250mg/5ml Paracetamol suppos 125mg (or 120mg); 500mg Paracetamol tabs 500mg Amitriptyline tabs 25mg
2.2 Opioid Analgesics
Codeine phosphate tabs 30mg
Morphine inj 10mg/1ml Morphine sulphate oral liq 2mg/mL Morphine sulphate SR tabs 10mg, 30mg Morphine sulphate tabs immediate release 10mg Pethidine inj 50mg/1mL Restricted to obstetrics For use in post-operative and O&G pain management when other analgesics contraindicated or ineffective; available only Tramadol inj 100mg/2ml - in Theatre and Maternity ward For use in hospital in-patients and Ministry outpatients when other analgesics Tramadol caps 50mg contraindicated or proven as ineffective
2.3 Medicines for other common symptoms in Palliative Care
Amitriptyline tabs 25 mg
Dexamethasone inj4mg/mL or 5mg/mL Dexamethasone tabs 4mg Diazepam inj 10mg/2ml Diazepam rectal solution: use diazepam inj solution 10mg/2mL rectally Diazepam tabs 5 mg Docusate + sennosidesB tabs 50mg + 8mg Fluoxetine caps 20mg Haloperidol inj 5mg/1mL Haloperidol tabs 500mcg; 5mg Hyoscine butylbromideinj 20mg/mL Hyoscine hydrobromideinj 400mcg/mL Minimum stock level 5 amps Lactulose oral liq 10g/15ml Loperamide tabs 2mg Metoclopramideinj 10mg/2mL Metoclopramide tabs 10 mg Midazolam inj 15mg/3mL Ondansetron inj 4mg/2ml
Dexamethasone inj 4mg/mL or 5mg/mL 4mg/ml Adrenaline(epinephrine) inj 1:1000 = 1mg/1ml Hydrocortisone inj 100mg Ephedrine sulfateinj 30mg/1mL Promethazine tabs 10mg; 25mg; inj 50mg/2mL; oral liq 5mg/5mL Loratidine tabs 10mg For paediatric patients only; check for Prednisolone oral liq 5mg/1ml new policy development Prednisone tabs 5mg; 20mg
4.1 Non-specific Treatments
Charcoal, activated liq 200mg/1ml
Minimum stock 1 bottle
4.2 Specific Antidotes
For dosing recommendations see TOXINZ website
Acetylcysteine inj2g/10mL
Also use for organophosphate poisoning in Atropineinj600 mcg/1mL place of pralidoxime Calcium gluconateinj1g/10mL (10%) Naloxone inj400mcg/1mL Deferoxamine (desferrioxamine) inj500mg
Carbamazepine oral liq100mg/5mL
Carbamazepine tabs 200mg Carbamazepine CR tabs 200mg Diazepam rectal solution: use diazepam inj 10mg/2mL and administer rectally Midazolam inj 15mg/3mL or 5mg/5mL 15mg/3mL; IDA 5mg/5mL NZ For eclampsia and severe pre- Magnesium sulfateinj49.5% 5mL Phenobarbital tabs 30mg Phenobarbital sodium inj200mg/1mL Do not change suppliers; Phenytoin caps 100mg bioavailability issues Phenytoin oral liq 30mg/5mL Phenytoin sodium inj 250mg/5mL Minimum stock 5 amps Sodium valproate oral liq200mg/5mL Sodium valproate tabs EC 200mg, EC 500mg 6. ANTI-INFECTIVE MEDICINES

6.1 Anthelminthics
6.1.1 Intestinal anthelminthic
Albendazolechewable tab400mg
6.1.2 Antifilarial Albendazolechewable tabs 400mg Diethylcarbamazine tabs 50mg
6.2 Antibacterials
This section is under review
6.2.1 Beta Lactam medicines
Amoxicillin pwd for oral liq 125mg/5mL; 250mg/5mL Amoxicillin caps 250mg; 500mg Amoxicillin + clavulanic acid oral liq125mg/5mL Amoxicillin+clavulanic acid tabs 625mg Amoxicillin+clavulanic acid inj 600mg Ampicillin powder for inj 500mg, 1g 900mg/5ml vial(1.2 MIU) Benzylpenicillininj 600mg(1 MIU) Cefaclororal liq125mg/5mL Cefaclor caps 250mg See Antibiotic Guidelines; ordered on Cephalexin caps 500mg For surgical prophylaxis(minimum stock Cefazolin inj1g/10mL level 50) also seeAntibiotic Guidelines; Neonatal use only on recommendation of Cefotaxime sodium inj 500mg Starship specialist; stock 1 courseof 15 amps Ceftazidime inj1g RESTRICTED contact pharmacy; 1 course stocked Ceftriaxone inj250mg, 1g see Antibiotic Guidelines Cefuroxime inj 750mg see Antibiotic Guidelines Flucloxacillincaps 250mg, 500mg Flucloxacillininj500 mg Flucloxacillinoral liq 125mg/5mL Meropeneminj 1g RESTRICTED Stock 1 course 15 amps Phenoxymethylpenicillin(penicillin VK) oral liq125mg/5mL Phenoxymethylpenicillin(penicillin VK) Beta lactam adjunct Probenecid tabs 500mg See Antibiotics Guidelines 6.2.2 Other antibacterials Azithromycin tabs 500mg Chloramphenicol caps 250mg; oral See Antibiotics Guidelines; ordered on request; ordered on request Chloramphenicol oral liq 125mg/5mL See Antibiotics Guidelines Chloramphenicol inj 1g See Antibiotics Guidelines Ciprofloxacin tabs 500mg See Antibiotics Guidelines Doxycycline tabs 100mg For child 8 years and over Treat for maximum 48 hours recommended Gentamicin inj 20mg/mL; 80mg/2ml see Antibiotic Guidelines Metronidazole infus 500mg/100ml Metronidazole tabs 200mg, 400mg Metronidazole tabs oral liq 125mg/5mL Nitrofurantoin tabs 100mg Rifampicin caps 150mg, 300mg; See Antibiotic Guidelines Rifampicin oral liq 100mg/5mL Minimum stock level 1x100mL Roxithromycin tabs 150mg See Antibiotic Guidelines Sulfamethoxazole + trimethoprim (co- trimoxazole) oral liq(200 mg + 40 mg)/5 ml Sulfamethoxazole + trimethoprim (co- trimoxazole) tabs 400 mg + 80 mg NZ specialist recommendation only; Stock level for single course is 50 amps Clindamycin inj 600mg/4ml 600mg;see Antibiotics Guidelines Urinary tract infections – see Antibiotic Trimethoprim tabs 300mg Vancomycin inj500 mg See Antibiotic Guidelines 6.2.3 Antileprosy medicines (in combination) MDT –Combi packs available from WHO; ordered on Clofazimine caps 100mg Dapsone tabs 100mg ordered on request Rifampicin caps 150mg, 300mg 6.2.4 Anti-tuberculosis medicines For named patients only on recommendations of NZ specialist; use application form on Ministry website Ethambutol tabs 400mg Also give pyri doxime 25mg daily to prevent Isoniazid tabs 100mg Pyrazinamide tabs 500mg Rifampicin oral liq 100mg/5mL Minimum stock level 1x100mL Also for meningitis prophylaxis (minimum Rifampicin caps 150mg, 300mg stock level 100 caps)
6.3 Antifungal medicines
Clotrimazole vaginal cream: 1%
Clotrimazole vaginal tab 500mg Clotrimazole cream: 1% Resistant ringworm in outer islands; 150mg Fluconazole caps 50mg once weekly for 4 weeks Griseofulvin tabs 125mg, 500mg Use to be reviewed Terbinafine tabs 250mg See Antibiotic Guidelines Minimum amount 28; see Antibiotic Itraconazole caps 100 mg Guidelines; urgent order Nystatin oral liq 100 000IU/ml
6.4 Antiviral me dicines
6.4.1 Antiherpes medicines
For life-threatening infections only; see Antibiotics Guidelines. Minimum stock level 60 amps + urgent order through CITC Aciclovirinj 250mg/10mL Pharmacy of rest of course Aciclovirdispersible tab 200mg 6.4.2 Antiretrovirals For named patients only on recommendations of an overseas specialist; use application form on Ministry website Available through SPC, Suva Needle Stick injury kit: contact Dr May Aung 6.4.3 Other antivirals For moderate/severe disease or those at risk- see Antibiotic Guidelines; contact Oseltamivir tabs 75mg
6.5 Antiprotozoal me dicines
6.5.1 Antiamoebic and antigiardiasis medicines
Metronidazole infus 500mg/100ml
Metronidazole tab 200mg; 400mg
6.5.3 Antimalarial medicines For malaria curative treatment
Check NZ Formulary for country-specific recommendations;
Doxycycline tab 100mg
Child: 8 years and over Mefloquine tab 250mg Not to be used for treatment of skeletal Quinine tab 300mg muscle cramps (risks outweigh benefit) For malaria prophylaxis Check NZ Formulary for country-specific recommendations Available to government employees Doxycycline tab 100mg travelling on government business only Available to government employees Mefloquine tab 250mg travelling on government business only 6.5.4 Antipneumocystosis (PCP) and antitoxoplasmosis medicines Other medicines recommended by a NZ specialist can be obtained for named patients using the application form on Ministry website Sulfamethoxazole + trimethoprim (co- trimoxazole) oral liquid, (200 mg + 40 mg)/5 ml Sulfamethoxazole + trimethoprim (co- trimoxazole) tab 400mg+80mg 7. ANTI-MIGRAINE MEDICINES
7.1. For treatment of acute migraine attack
Aspirin (acetylsalicylic acid) tabs 300mg IDA; NZ
Ibuprofen tabs 200mg,400mg Paracetamol oral liq120mg/5ml; 250mg/5mL Paracetamol tabs 500mg Use by medical department doctors only;not to be usedfor patients with ischaemic Sumatriptan tabs 50mg cardiovascular disease
7.2. For migraine prophylaxis
Metoprolol tabs CR 47.5mg

8.1 Immunosuppressive medicines
Supply for named patients use application form available on the Ministry's website Azathioprine tabs 50mg application required for rheumatoid arthritis treatment by medicine department doctors or on recommendation of dermatologist only; supply for ‘named patients' use application Hydroxychloroquine tabs 200mg form available on the Ministry's website Prescribing in rheumatoid arthritis by medical doctors only; use with weekly folic acid 5mg Methotrexate tabs 2.5mg given on separate day; monthly FBC, LFTs
8.2 Cytotoxic and adjuvant medicines
For named patients only on recommendations of NZ specialist; use application form on Ministry website
8.3 Hormones and antihormones
For named patients only on recommendations of NZ specialist
Tamoxifen tabs 20mg

Benztropineinj 1mg/1ml
Benztropine tabs 2mg Levodopa+carbidopa tabs100mg+25mg; 10. MEDICINES AFFECTING THE BLOOD
10.1 Anti-anae mia me dicines
Ferrous sulfate oral liq 150mg/5mL
Ferrous sulfate tabs 200mg (65mg NZ SR 325mg is less effective elemental i ron) Ferrous sulfate+ folic acid tabs 200mg NZ has different strength (65mg elemental i ron)+ 400mcg Folic acid tabs 5mg Hydroxocobalamininj 1mg/ml Minimum stock level 25 amps; ordered on Iron (ferrous) polymaltose 100mg/2mL
10.2 Medicines affecting coagulation
For treatment of pulmonary embolism and Enoxaparin inj 100mg acute coronary syndrome only 5000iu/0.2mL for subcutaneous administration; 25,000iu/5mL (5mg/mL) for infusion preparation Heparin 5000iu/0.2mL, 25,000iu/5mL Phytomenadione (vitamin K) inj 10mg/1ml Phytomenadione tabs no longer available - use injection solution 10mg/1mL orally Phytomenadione (vitamin K) oral drops NZ Paediatric use only Emergence medicine, 1 patient may require up to 10 amps; minimum stock 10 Protamine sulfateinj 50mg/5ml Emergency use for O&G patients; minimum Tranexamic acid inj 1g/10ml stock l evel 12 amps For use in O&G and in surgery for patients Tranexamic acid tabs 500mg unable to have blood transfusion Warfarin tabs 1mg; 5mg INR monitoring required
10.3 Other medicines for haemoglobinopathies
For named patients only on recommendations of NZ specialist; use application form on Ministry website

Contact laboratory

11.3 Plasma substitute
Polygeline (succinylated gelatine)
12.1 Antianginal medicines
Glyceryl trinitrate sublingual spray
400mcg Isosorbide dinitrate 10mg Isosorbide mononitrate modified release NZ Metoprolol CR 47.5mg; CR 95mg Metoprolol inj 5mg/5mL Immediate release nifedipine only for Nifedipinemodified release 10mg, 20mg obstetric patients
12.2 Antiarrhythmic medicines and medicines for cardiac arrest
Adenosine inj 6mg/2mL
Adrenaline (epinephrine) 1:1000 1mL Use glass bottles or rigid PVC containers and giving set only- see NZ Formulary on Ministry Amiodarone inj 150mg/3mL Strength change; tablets scored for halving if Amiodarone tab 200mg Digoxin inj 500mcg/2mL Digoxin tab 62.5mcg, 250mcg Use NZ supplier only, bioavailability issue Diltiazem tabs immediate release 60mg; modified release 120mg; modified release 180mg For theatre and emergency trolley or tray in Emergency Department only; minimum stock level 5 amps. Check label carefully as possible Lidocaine 100mg/5mL inj confusion with local anaesthetic strengths Metoprolol CR 47.5mg; CR 95mg Metoprolol inj 5mg/5mL Supply for ‘named patients' use application Sotalolimmediate release tabs 80mg form available on the Ministry's website Verapamil inj 5mg/2mL Supply for ‘named patients' using application Verapamil tabs CR 240mg form available on the Ministry's website
12.3 Antihypertensive medicines

Atenolol tabs 50mg, 100mg
supply for ‘named patients' using application form available on the Ministry's website; for Candesartan tabs 8mg; 16mg patients unable to tolerate ACE inhibitors Doxazosin tabs 2mg Enalapriltabs 5mg; 10mg; 20mg Felodipine modified release 2.5mg; 5mg; 10mg Hydralazine inj 20mg Hydralazine tabs 25mg Labetololinj 25mg/5mL Labetolol tabs 50mg Approved for obstetric patients; for all other patients supplied for ‘named patients' using application form available on the Ministry's Methyldopa tab 250mg Metoprolol CR 47.5mg; CR 95mg Nifedipine modified release 10mg, Immediate release nifedipine only for modified release 20mg obstetric patients
12.4 Medicines used in heart failure

Metoprolol CR 47.5mg
for heart failure with atrial fibrillation Digoxin tab 62.5mcg, 250mcg Enalapril 5mg,10mg, supply for ‘named patients' using application form available on the Ministry's website; for Candesartan tabs 8mg; 16mg patients unable to tolerate ACE inhibitors Furosemide inj 20mg/2mL Furosemide tab 40mg tabs 2.5mg Spironolactone tab 25mg Dopamine inj 200mg/5mL
12.5 Medicines for acute coronary syndromes including unstable angina and myocardial

12.5.1 Antiplatelet agents
Aspirin tab 100mg, 300mg
Clopidogrel tab 75mg 12.5.2 Thrombolytics Streptokinase powder for inj 1.5MIU 12.5.3 Anticoagulants Heparin 25,000iu/5mL(5000iu/1mL) for infusion preparation Enoxaparin inj 100mg Adjust dose to ideal body weight
12.6 Lipid-lowe ring agents
Atorvastatin 20mg
Simvastatin 20mg Bezafibratetabs modified release 400mg Not for use in modera te to se vere renal impai rment
13.1 Topical Antifungal me dicines
Clotrimazole cream 1%
Terbinafine Cream 1% Whitfields Ointment (benzoic acid + salicylic acid, 6% + 3%) Selenium sulphide shampoo 2% For tinea versicolor- see Antibioti cs Guidelines 13.2 Topical Anti-infective medicines
Neomycin + bacitracin, oint0.5% +
(Soframycin equivalent) Dilute with boiled cooled water to pale pink Potassium permanganate crystals solution and use as a soak Silver sulfadiazinecream 1% For burns; for children 2 months and over
13.3 Topical Anti-inflammatory and antipruritic me dicines
Betamethasonecream 0.1%
Hydrocortisone base or acetate cream 1%
13.4 Medicines affecting skin diffe rentiation and proliferation
Not provided by Ministry of Health pharmacies and pharmacy store

13.5 Scabicides and pediculicides

Permethrin lotion 1%
Available on recommendation of NZ specialist Ivermetin tabs 3 mg only; cost $7/tablet; available on request
13.6 Psoriasis

Named patient supply on recommendation of Calcipotriol cream or ointment 0.005% a dermatologist; maximum 100g /week; available on request
14.1 Ophthalmic Preparations

Fluorescein eye drops 1% 0.5mL
Tetracaine(amethocaine) eye drops 0.5% NZ 0.5mL; 1%0.5mL
14.2 Radiocontrast media and diagnostics
contact Radiology
Ultrasound diagnostic gel 5L

15.1 Antiseptics for use on skin
Cetrimide + chlorhexidine solution, 15% + IDA
1.5% Ethanol solution 70% Hydrogen peroxide 1% cream See Antibiotic Guidelines Povidone iodine solution 10% (1% Also known as PVP iodine available iodine)
15.2 Disinfectants
Under revision
15.2.1 For instruments and disinfectants
Chlorine solution (0.1% available (Domestos contains 10% available chlorine, dilute 1 part to 100 parts) Glutaraldehyde + activator 2% 15.2.2 Skin preparations Isopropyl alcohol skin swipes Alcohol-based hand preparation e.g. 16. DIURETICS
tabs 2.5mg Furosemide inj 20 mg/2 ml Furosemide tab 40mg Mannitol infus 20% 17. GASTROINTESTINAL MEDICINES

17.1 Antiulcer medicines
Magnesium hydroxide+ aluminium
hydroxide + simethicone oral liq (Mylanta Plain) Magnesium hydroxide+ aluminium hydroxide + simethicone tabs (Mylanta Original) Omeprazole capsules 20mg Omeprazole inj 40mg Ranitidine Tab 150 mg Sodium alginate + magnesium alginate, For reflux in babies only; mix powder with 225mg + 87.5mg (Gaviscon Infant) boiled and cooled water Omeprazole capsules 20mg + amoxicillin H. pylori eradication – see Antibiotic capsules 500mg dose or metronidazole
17.2 Antie metic medicines

Dexamethasone inj 4 mg/1 ml or
Dexamethasone tabs 4mg Metoclopramideinj 10 mg/2 ml also recommended for migraine Metoclopramide tab 10 mg For use only in severe, intractable post-op vomiting by surgeon, obstetricianand in Ondansetron inj 4 mg/2ml Prochlorperazineinj 12.5mg Prochlorperazine tabs 5mg 17.3 Gastro-intestinal Anti-inflammatory me dicines
If required apply for named patients, use form on the Ministry website
17.4 Laxatives
Bisacodylsuppos 5mg; 10mg
Bisacodyl tabs 5mg Docusate sodium +sennoside B tabs Use for in-patients only when stool softener and stimulant required Lactulose oral liq10mg/15mL Macrogol 3350 + electrolytes 13.125g Klean-Prep available from radiology for bowel powder for dilution evacuation and for adult faecal compaction Sodium citrate (Microlax) enema 5mL
17.5 Medicines used in diarrhoea
17.5.1 Oral rehydration
Oral rehydration salts for dilution in 1L
17.5.2 Medicines for diarrhoea in children Zinc sulfate tabs dispersable 20 mg use with oral rehydration, recommend ed by WHO 17.5.3 Gastro-intestinal Anti- motility agents Not for use in child under 12 years; Maximum Loperamide tabs or caps 2mg treatment 2 days ( 16 tablets)
17.6 Treatment for Haemorrhoids
Cinchocaine + fluocortolone esters,
rectal oint 0.5% + 0.187% (Ultraproct) 30g Cinchocaine + fluocortolone esters, suppos 1mg + 1.24mg (Ultraproct)
17.7 Gastro-intestinal Anti-Spas modic Medicines
Hyoscine butylbromideinj 20mg/ml
Hyoscine butylbromide tab 10mg 18. HORMONES AND CONTRACEPTION

18.1 Adre nal hormones and synthetic substitutes
For named patients only on recommendations of NZ specialist; use application form on Ministry website
18.2 Androge ns
For named patients only on recommendations of NZ specialist; use application form on Ministry website
18.3 Contraceptives
18.3.1 Oral hormonal contraceptives
Levonorgestrel + ethinylestradiol +
ferrous fumerate tabs 150 mcg + 30 mcg + 75mg (Microgynon ED) Levonorgestrel tab 30 mcg (Microlut) Levonorgestrel tab 750 mcg (pack of two) UNFPA 18.3.2 Injectable hormonal contraceptives Medroxyprogesterone acetate depot inj 150 mg/1mL (Depo-Provera) 18.3.3 Intrauterine devices IUCD copper T 380A 18.3.4 Barrier methods Male condoms 18.3.5 Implantable contraceptives Levonorgestrel implant 75mg, 2 rods
18.4 Estrogens
Use by gynaecology doctors only; minimum Ethinylestradioltabs 10mcg stock 25 tablets Oestriolvaginal cream 0.1%
18.5 Insulins and othe r medicines used for diabetes
Gliclazide tabs 80 mg
Glucagon Inj 1 mg/ml Insulin neutral inj 100 IU/1ml x 10mL Insulin isophaneinj100 IU/1ml x 10mL Insulin neutral + insulin isophaneinj30/70 NZ x 10mL Metformin tab 500 mg
18.6 Ovulation inducers
Only for use by gynaecology docto rs as named patient supply: use application form on Ministry website

18.7 Progestogens
Norethisterone tabs 5mg

18.8 Thyroid hormones and antithyroid medicines
Levothyroxine tab 50mcg; 100mcg Named patient supply: use application form on Ministry website; requires regular full blood Carbimazole tab 5mg count; minimum stock level 200 tabs
19.1 Diagnostic agents

Tuberculin, purified protein derivative
Contact laboratory 19.2 Sera and immunoglobulin
Immunoglobulin RHO (anti-D) inj 250IU
Hepatitis B immunoglobulin 100IU/mL
19.3 Vaccines
BCG vaccine
Diphtheria, pertussis, tetanus (DPT) vaccine Diphtheria, pertussis, tetanus, Hepatitis B, haemophilus influenzaetype b (Pentavalent) vaccine Hepatitis B vaccine Human papillomavirus vaccine Influenza vaccine (current NZ recommended product) Mumps, measles, rubella (MMR) vaccine Poliomyelitis vaccine inj (IPV) Tetanus toxoid vaccine
Atracuriuminj 25mg/2.5mL
Neostigmine inj 2.5 mg/1mL Suxamethoniuminj 100 mg/2 mL Pancuroniuminj4mg/2mL Rocuroniuminj 10mg/1mL
21.1 Anti-infective agents for the Eye
Aciclovir eye oint 3%, 4.5g
AB guidelines only chloramphenicol check Framycetin eye/ear drops 0.5% Chloramphenicol eye drop 0.5% 10mL Chloramphenicol eye oint 1% 4g
21.2 Anti-inflammatory agents for the Eye

Dexamethasone 0.1% eye drops 5mL
Recommendation and use by eye specialist or eye doctor only; supply for ‘named patients', use application form available on the Ministry's website; minimum stock level 1 bottle
21.3 Local anaesthetics for the Eye

Tetracaine(amethocaine) 0.5% eye
drops 0.5mL

21.4 Miotics and antiglaucoma medicines

Acetazolamide tabs 250mg
For named patients only on recommendations of NZ specialist; use application form on Ministry Healthcare website Logistics Latanoprost eye drops 50 mcg/mL, For named patients only on recommendations of an eye doctor; use application form on Ministry website Pilocarpine 1% eye drops 15mL Timolol 0.25% eye drops 5mL
21.5 Mydriatics

Atropine 1% eye drops 15mL
Child use only if 3months and older Tropicamide 0.5% eye drops, 0.5mL OR Child under 3 months only homatropine = WHO CHECK ? add to14 Diagnostic agents
22.1 Oxytocics

Misoprostol tab 200mcg
Oxytocin inj 10 IU/1mL Minimum stock 30 amps Oxytocin + ergometrineinj 5IU + 0.5mg/1mL Carboprost trometamol 250mcg Minimum stock 5 amps
22.2 Antioxytocics (tocolytics)
Obstetric use only; capsules should be opened and swallowed for a rapid onset; Nifedipine immediate release caps 10 mg minimum stock level 20 tabs 23. PERITONEAL DIALYSIS SOLUTION
For named patients only on recommendations of NZ specialist; use application form on Ministry website

24.1 Medicines used in psychotic disorde rs
Haloperidol inj 5 mg/1mL
Also recommended for aggression Haloperidol depot inj 50 mg/5mL Haloperidol tabs 500 mcg; 5 mg Also recommended for aggression in Risperidone tabs1 mg; 2mg; 4mg Alzheimers patients Olanzapine tabs 10mg
24.2 Medicines used in mood disorders

24.2.1 Medicines used in depressive disorders
Amitriptyline tabs 25mg
Fluoxetine cap 20 mg Paroxetine tabs 20mg
24.2.2 Medicines used in bipolar disorders
Lithium carbonate tab 250 mg
Sodium valproate tab EC 200 mg; EC 500
24.3 Medicines for anxiety disorders

(Oral liquid no longer available, recommend Diazepam tab 5 mg give crushed tablets)
24.4 Medicines used for obsessive compulsive disorde rs

Fluoxetine cap 20 mg

24.5 Medicines for disorde rs due to psychoactive substance use

Nicotine replacement therapy (NRT)
chewing gum 2 mg; 4 mg Nicotine replacement therapy (NRT) transdermal patch 7 mg/24 hours; 14mg/24 hours; 21 mg/24 hours Nicotine replacement therapy (NRT) lozenges 1mg; 2 mg Methadone oral liq 2 mg/1 mL For named patients only; use application form on Ministry website
24.5 Medicines for ADHD

Methylphenidate tabs 10mg
For named patients only on recommendations of NZ specialist; use application form on Ministry website
24.6 Hypnotics

Not recommended
25.1 Antiasthmatic and medicines for chronic obstructive pulmonary disease
Beclometasonemetered dose aerosol50
mcg; 250mcg Adrenaline (epinephrine)inj 1:1000 (1mg/1ml) Salbutamol inj for infusion 5mg/5ml Salbutamol MDI (aerosol) 100 mcg Salbutamol nebuliser soln 2.5mg/2.5mL; 5 mg/2.5mL Ipratropium + salbutamol MDI 20mcg + ? add neb solution 100mcg Aminophylline inj250mg/10mL use in COPD only; check for interactions; supply for ‘named patients' only, use form on Theophylline modified release tab 250mg Ministry website Spacer for use in MDI
Oral rehydration salts for dilution to 1itre IDA; NZ
Potassium chloride modified release tabs NZ 600mg Polystyrene sulphate sodium powder 26.2 Parenteral Solutions
Compound sodium lactate (Hartmann's
solution) inj 1000mL Glucose (dextrose) 10% 500mL hypertonic injection Glucose (dextrose) 4.3% with sodium chloride 0.18% inj 1000mL Glucose (dextrose) 5% isotonic inj500mL; IDA; NZ 1000mL Glucose (dextrose) 50% hypertonic inj Potassium chloride 7.5% inj for infusion 10mL Sodium bicarbonate inj 8.4% 10mL Sodium chloride 0.9% isotonic inj 10mL, 500mL, 1000mL
26.3 Miscellaneous Solutions
Water for injection 10mL ampoule
Before using check to see if 0.9% sodium Water for irrigation 1000mL chloride injcould be used instead (cheaper)
Calcium carbonate tab 1250mg
(elemental calcium 500mg) Calcium gluconate 1000mg/10mL (10%) Pyridoxine 25mg tablet For use with isoniazid Thiamine (vitamin B6) 50 mg tablet Emergency medicine; minimal stock level Thiamine inj 200mg/2mL Multivitamins tab
Docusate 0.5% eardrops 10mL
Less irritant alternative to Cerumol Beclometasone nasal spray 100mcg Xylometazoline 0.05% nasal drops; 0.1% Child: use in 3 months and older nasal spray (Otrivine) Framycetin + gramicidin+ dexamethasone eye/ear drops 5mg/mL+ 50mcg/mL+ 500mcg/mL (Sofradex) Ciprofloxacin 2mg/mL + hydrocortisone See Antibiotics Guidelines, will be urgently 10 mg/mL eardrops ordered on request See Antibiotics Guidelines, will be urgently Tobramycin eye drops 0.3% for use in ear ordered on request
29.1 Medicines administered to the neonate (neonatal intensive care medicines)
Not used in the Cook Islands
29.2 Medicines administered to the mothe r
Dexamethasone inj 4mg/mL
Betamethasone acetate + betamethasone sodium phosphate inj 3/3.9 mg (Celestone) Salbutamol inj for infusion 5mg/5mL Bromocriptine tabs 2.5mg 30. RHEUMATOLOGY MEDICINES
Also see 8.1 Immunosuppressant Medicines for disease modifying treatments for rheumatoid arthritis
30.1 Medicines used to treat gout
30.1.1 Medicines for acute gout
Acute a tta ck: 2 table ts to s ta rt then 1 tab three time dail y for fi rs t day then one twi ce dail y for up to 7 days ; Chronic trea tment: 1 tab daily; see NZ Formulary for Colchicine tab 0.5mg dosing in renal impai rment Use in hospital clinics and for renal colic Diclofenac inj 75mg/3mL Diclofenac tab 50mg maximum treatment for 14 days Ibuprofen tab 400mg Naproxen tabs 250mg 20mg -40mg dail y for up to 5 days ; 5mg for ma xi mum Prednisone (or prednisolone) tabs 5mg
30.1.2 Medicine for gout prophylaxis
Allopurinol tab 100mg; 300mg
31.1 Urinary Alkalinisation
Sodium citrotartrate powder for oral liq
31.2 Benign Prostatic Hypertrophy
Doxazosin tabs 2mg
31.3 Urinary Incontinence
For use by gynaecology department only; ‘named patient' supply only, use application Oxybutynin tabs 5mg form available on the Ministry website
32.1 Lubricants
Lubricating jelly
ECG electrode jelly



A joint initiative from Norfolk County Council and Norfolk Health Services Schools in Norfolk asthma guidance Together we can make it happen! Introduction and key messages . . . . . . . 3 Asthma is the most common chronic childhood ❖ Training in asthma management. condition, affecting an estimated 16,500 Norfolk ❖ Identified asthma link staff.

Long-term neurological conditions

CONCISE GUIDANCE TO GOOD PRACTICE A series of evidence-based guidelines for clinical management Long-term neurological conditions:management at the interface betweenneurology, rehabilitation and palliative care NATIONAL GUIDELINES British Society of Rehabilitation Medicine Clinical Standards Department Guideline Development Group The purpose of the Clinical Standards