WART AND NAIL FUNGUS TREATMENT NAIL FOCUSED

WART AND NAIL FUNGUS TREATMENT NAIL FOCUSED
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Allergies:

NKDA (no known drug allergies)Aspirin/ NSAID’sCyclobenzaprineLidocaine / Local AnestheticTramadolOpioidGabapentinPenicillinAmitriptylineOther
WARTS
DISPENSE FLUOROURACIL 5% cream with CMPD capsule 20% Salicylic Acid and 40% Urea #60 capsules – Mix together and Apply 2gm to affected area every other day to thick skin with warts
NAIL FUNGUS
DICLOFENAC 1.5% in 45.5% DMSO #150ml – Mix Diclofenac (5ml) with other meds, apply to all nails being treated once daily *Cover with Bassa-Gel™* AND DISPENSE FLUCYTOSINE 500mg Cap #30 - Mix 1 cap and Diclofenac (5ml), apply to all nails being treated once daily *Cover with Bassa-Gel™* AND DISPENSE CMPD Clotrimazole 20mg Cap #30 - Mix 1 cap and Diclofenac (5ml), apply to all nails being treated once daily *Cover with Bassa-Gel™*
a. If checked, pharmacy is authorized to dispense the below in lieu of the medications
listed in #1 above if needed for any reason or if desired by patient
DICLOFENAC 1.5% in 45.5% DMSO #10ml – Apply to all nails being treated once daily *RPh: Cover with Bassa-Gel™ after all treatment done* AND DISPENSE TAVABOROLE 5% Solution (Generic KERYDIN®) #10ml – Apply to all nails being treated once daily *RPh: Cover with Bassa-Gel™ after all treatment done*DISPENSE DICLOFENAC 1.5%/DMSO soln #150ml with CMPD Ketoconazole and Urea 500mg Cap #60 – Mix 2 caps and 2ml of solution, apply twice daily to affected nail – Apply 2gm twice daily to thick nail with inflammation and infectionDISPENSE DICLOFENAC 1.5%/DMSO soln #150ml with CMPD Itraconazole and #120 – Mix 2 caps and 2ml of solution, apply twice daily to affected nail – Apply 2gm twice daily to nail with inflammation and infectionIf checked, also dispense Lamisil 250mg Generic Tab #84 – Take 1 tab by mouth once daily
FOOT PAIN
DISPENSE DICLOFENAC 1.5%/DMSO soln #150 ml with Lidocaine 4% solution 60ml – Mix together and 2ml of solution, apply twice daily to affected area of foot painCMPD Topical Cream – Gabapentin 6% Lidocaine 5% Diclofenac 3% Cyclobenzaprine 2%Baclofen 2% #120gms – Apply 1-2mls three to four times daily for treatment of painCMPD Topical Cream (NEEDS SEPARATE PRESCRIPTION) – Ketamine 10% Gabapentin 10% Lidocaine 5% Diclofenac 3% Cyclobenzaprine 2% Baclofen 2% #120gms – Apply 1-2 mls three times daily for treatment of pain
Physician Name:

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Address:

Street Address

Street Address Line 2

CityState

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Please enter a valid phone number.Format: (000) 000-0000.
Fax:
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WART AND NAIL FUNGUS TREATMENT NAIL FOCUSED

WARTS

NAIL FUNGUS

FOOT PAIN