Booklet Exam Flashcards
What is GSL
General sales list. No pharmacy supervision
What are P
Pharmacy medicines. Only available at a pharmacy
What is POM
Prescription only
Common brands : what is in calpol
Paracetamol
Common brands : what is in Imodium
Loperamide hydrochloride
Common brands : what is in nexium
Esomeprazole
Common brands : what is in buscopan
Hycosine butylbromide
Common brands : what is in kwells
Hycosine hydrobromide
What is WWHAM
Who
What are symptoms
How long
Action taken
Medication taken
Products liable to abuse
Acetone
Aerosols
Laxatives
Paracetamol and codine
Antihistamines
Ephedrine and pseudoephedrine
What is the GI system
Involved in food intake, processing and excretion
Mouth
Salivary glands
Oesophagus
Stomach
LI and SI
Anus
What does the mouth do in GI
entrance to the digestive tract.
The teeth break down food.
Saliva begins carbohydrate digestion
Digestion in the mouth is minimal; no absorption of
nutrients occurs.
What does the oesophagus do in GI
During swallowing, food is prevented from entering the wrong passageways.
The pharyn-goe-sophageal sphincter prevents air from entering the digestive tract.
What does stomach do in GI
The stomach stores food and begins protein digestion.
What does the S.I do in GI
break down food, absorb nutrients needed for the body into blood, and get rid of the unnecessary components
What does the L.I do in GI
The large intestine is primarily a drying and storage organ.
Connected to small intestine at one end and anus at the other.
4 parts: cecum, colon, rectum and anal canal
What does the anus do in GI
Is the last part of the digestive system
consist of pelvic floor muscles and 2 anal sphincters.
Job is to detect rectal contents, gas, liquid or solid and control if a still should be excreted or not.
What is indigestion/heartbburn
Indigestion : Also called functional dyspepsia
Pain experienced in chest caused by overproduction of acid that the stomach produces when we eat. The over production leads to irritation and inflammation of stomach lining
Heartburn : also called GORD and reflux
Caused by food and stomach acid escaping the stomach and returning up the oesophagus. Can occur if there is weakness in the sphincter between the oesophagus and stomach.
What causes indigestion/heartburn
There may be several causes of these conditions, but it is not always possible to determine a direct link. Causes may include:
- Eating or drinking too much.
- Eating spicy or fatty foods.
- Drinking alcohol.
- Smoking.
- Certain medicines.
- Being overweight.
- Being pregnant.
- Stress.
Treatments for indigestion/heartburn . Mechanism and active ingredient :
Antacids : neutralise stomach acid - sodium bicarbonate or Mg salts
Alginates : create a mechanical barrier - sodium alginates
H2-antagonists : bind to histamine receptors interfere with gastric acid production and secretion - famotadine
Proton pump inhibitors : inhibit gastric acid secretion - pantoprazole
Formulations and points of interests for antacids
Liquids and chewable tablets
Fast acting but also short acting so might need repeat doses. Some have high sodium content and can cause diarrhoea
Formulations and points of interests for alginates
Liquids and tablets
1st line treatment for GERD. Safe for children and pregnancy. After meals. Can cause diarrhoea and nausea.
Formulations and points of interests for H2-antagonists
Tablets
Stop smoking whilst taking. Reduce alcohol intake. Often taken with 1st meal of the day.
Formulations and points of interests for proton pump inhibitors
Tablets and IV
Once a day in the morning. Can cause headaches and diarrhoea. Avoid spicy foods and cut down on caffeine and alcohol.
Lifestyle advice for heartburn and indigestion
Diet:
- Moving to a lower fat diet.
- Avoid trigger foods and drinks; such as chocolate, alcohol, caffeine, spicy or rich foods, fatty foods, citrus fruits, and onions.
- Eat smaller meals, more frequently
- eat more slowly.
- Avoid eating late at night.
Weight loss:
- In overweight patients, weight loss may help relieve symptoms and so advice on how to safely achieve this can be given.
Smoking Cessation:
- Stopping smoking may reduce symptoms.
Raising Head of the Bed:
- Raising the head of the bed may help to reduce symptoms in patients with
GORD as gravity may help prevent acid regurgitation.
What is constipation
is the infrequent passing of stools. It occurs when a patient
experiences a reduction in their normal bowel habit, and so may mean different things to different people. Therefore, constipation is when there is a change
from the usual for each specific patient. Constipation may or may not be painful and will often result in hard faeces.
What are the causes of constipation
Poor diet - Not including enough fibre in the diet, or
changing dietary habits suddenly.
Inadequate fluid intake - Not drinking enough or eating enough fibres
Pregnancy - Growing baby can put extra pressure on the intestines
Lack of exercise - Exercise is essential for regular bowl movements. Abdominal walls in diaphragm play a crucial role in defecation.
Medication - Medications can affect the muscles in the gut and the nervous system or can cause dehydration. Some can affect water absorption in stools.
Increasing age - More frequent with age. Decreased mobility, more medications, underlying diseases and rectal sensory-motor dysfunction. Lack of muscle tone in the bowel.
Cancer - Tumours in the abdomen can squeeze, squash or narrow the bowel and rectum making bowl movement difficult. A tumour in the lining of thw bowel can affect nerve supply to the muscles.
Alarm symptoms of constipation
- PAIN
- AGE: All children.
- BLEEDING: Bright red specks in the toilet, or on the tissue, can suggest haemorrhoids (piles).
- DURATION: Constipation which has lasted for over a week or is recurring.
- WEIGHT LOSS: If the patient has been losing weight unintentionally.
- MEDICATION: If the patient has already tried an over the counter (or prescription) product unsuccessfully.
- ONSET: Refer sudden onset of constipation with no cause
- OTHER SYMPTOMS: If constipation is accompanied with other symptoms, such as diarrhoea or vomiting
- Pregnancy/Breastfeeding
Treatment for constipation. Works and AI
1st is always dietary changes
Bulk form laxatives - Mimics increase in fibre consumption. Swells in bowel and increases faecal mass therefore encourages GI tract to move faster. Also tends to hold water which increases stool softness. - methylcellulose
Stimulant laxatives - Speed up the movement of Bowles by stimuting the nerves that control the muscles lignin the digestive tract - bisacodyl
Osmotic laxatives - Draw water from the rest of the body into the bowel - lactulose
Faecal softeners - Emollient laxative helps mix liquids into stools to revert dry masses forming - docusate calcium
Formulation and onset of action and points of interest for constipation medications
Bulk Forming Laxatives :
Tablets, sachets, granules - 24-36 hours - Take with plenty of water.
Stimulant Laxatives:
Tablets, suppositories,syrup - 8-12 hours - (Glycerin suppositories take 15 mins - 1 hour) - Recommended to take 1st dose at night due to onset of action (effect
then in morning). Can cause cramping. Only suitable for short-term use to treat occasional constipation.
Osmotic Laxatives:
Solutions, sachets 1-3 days Gentle option - can cause flatulence but usually settles after a couple of
days. Take with plenty of water.
Faecal Softeners:
Solutions, capsules - 1-2 days Often also has weak stimulant properties.
Lifestyle advice for constipation
Diet:
- Increase fibre
Fluids:
- Increase fluid intake
Exercise:
- Regular exercise is important to get things moving.
Other:
- Avoid ‘holding on’ as can make it worse.
- If you feel the urge to go, do not delay.
- Try to go somewhere quiet, and private, where you don’t feel rushed.
- Raising feet on a low stool while going to the toilet may make passing stools easier (keep knees above hips).
How to insert suppository
- Read the instructions on the label
- Wash and dry your hands
- Remove suppository from wrapper
- Lie on your side with your top leg bent upwards towards your stomach, or squat downs or stand with one leg raised on a sea (whichever is easiest)
- Use your finger to gently push the suppository, round end first, into your rectum (back passage) as high as it will comfortably go. A water based lubricant might make this process easier
- You may feel the urge to push it out straight away but lay or stand still, clenching your buttocks together for a few minuted and the feeling should go away.
- Wash your hands
What is diarrhoea
is the increased frequency of bowel movements, with soft or watery stools. As with constipation, it is relative to what is considered normal for the patient.
Acute: less than 7 days.
Persistent: more than 14 days.
Chronic: longer than a month.
What are the causes of diarrhoea
Diarrhoea is usually caused by a viral or bacterial infection.
Bacterial infections are normally a result of drinking contaminated water or
eating contaminated food.
Some medicines can cause diarrhoea and is a common side effect.
Other causes of diarrhoea could include:
- Faecal impaction.
- Stress, upset or anxiety.
- Increased intake of alcohol or caffeine.
- Colorectal cancer.
- Long-term conditions such as:
o Ulcerative Colitis.
o Crohn’s Disease.
o Malabsorption syndromes.
o Irritable bowel Syndrome (IBS).
Alarm symptoms of diarrhoea
- signs of dehydration - dark or smelly urine or urinating less than usual
- lasts more that 4 days for adults and 2 days for children with or without treatment
- Accompanied Edith’s every stomach pains
- Blood in stools
- Excessive thirst
- Rectal pain
- Change in bowl habit
- Suspected drug induced diarrhoea
Recent travel (last 3 months) to non-western countries, particularly
with tropical or subtropical climates.
- Accompanied with a fever.
Treatment options for diarrhoea
- can be offered Fluid Replacement. Oral rehydration
solutions (ORS) decrease the risk of dehydration and replace lost fluids and salts. They are usually a sachet of powder that is made up with safe, clean water.
Despite diarrhoea often being self-limiting with no alarm symptoms, patients often also ask for something to help stop the passing of frequent stools. Loperamide is the most common anti-diarrhoeal used.
Other options to help halt the diarrhoea include:
- Bismuth Subsalicylate
o Coats and sooths the stomach and intestines.
o Slows the growth of any bacteria present.
Lifestyle advice for diarrhoea
Sip water throughout the day to stay hydrated.
- Have plenty of rest to allow the body to recover.
- If OTC medication fails to work, it is important the patient sees the GP.
- There is no need for the patient to stop eating.
o Eat a light diet with easy to digest food i.e. soup, rice, pasta, bread.
o Babies should have their usual feeds.
o Avoid foods high in fat, fibre or sugar.
o Minimise dairy intake until feeling better.
o Fruit juices help increase glucose and potassium levels, while soups
help increase sodium. This is useful if patients do not wish to use
ORS.
Preventing travelers diarhoea
Preventing diarrhoea when abroad can be achieved by:
- Ensuring food is cooked through.
- Maintaining good food hygiene.
- Wash hands in hot, soapy water regularly.
- Use bottled water, or cooled boiled water.
- Avoid ice in drinks and ice creams.
- Avoid washing salads in tap water.
What is colic
condition which starts in infants when they are new born. It normally
stops around 4 months old.
Colic can be defined as excessive crying, in an otherwise healthy baby, for more than 3 hours a day, for more than 3 days a week, for more than 3 weeks.
However, new parents will rarely wait 3 weeks prior to seeking help and advice.
Therefore a diagnosis of colic may be suspected before this timescale is reached.
Causes and symptoms of colic
No one knows exactly what causes colic, but some
theories include:
- Trapped wind from feeding or crying.
- Lactose sensitivities
- Painful cramps due to an underdeveloped GI system.
Other signs the baby may have colic are:
- An inability to be soothed.
- Drawing up of legs or arching the back.
- Flushed face.
- Crying or fussing at similar times of day (very often morning or evening).
Treatment for colic
Referral to pharmacist is messesary. Treatments have no evidence base but are safe
Infacol, reduces surface tension of bubbles and allows elimination of gas
Lactase enzymes, e.g. Colief, help break down the lactase present in milk.
Other options to help ease colic are worth trying. You could suggest:
- Swaddling the baby
- Feeding as upright as possible to help prevent them swallowing excess air.
- Burping the baby well following a feed.
- Using white noise as a distraction.
- Rocking the baby
o Correct teat size if bottle fed – larger hole in the teat may be
needed.
o Correct latch if breast feeding.
What is a cough
Coughing is the body’s way of attempting to clear the airways via a forced, expulsive manoeuvre. It is an extremely common symptom of respiratory abnormalities. Although it is common, it can be extremely upsetting,
debilitating and irritating for the patient.
There are two types of common cough.
Productive
o ‘Chesty’: produces phlegm.
Non-productive
o ‘Dry’: not producing phlegm.
Why do we cough
coughing reflex to clear the airways. For example, this may be due to the presence of a foreign matter or mucus.
Long-term conditions, such as Asthma or COPD lead to a reduction of airflow in the lungs and this will initiate the coughing reflex too.
Multiple medications have a cough as a side effect of the drug.
Alarm symptoms of cough
- Mucus is not clear or white.
- Mucus is thin and frothy.
- There is blood in the mucus (including a red-tint).
- The patient has chest pain, shortness of breath, wheezing or any difficulty breathing.
- The cough has lasted for more than 3 weeks.
- There is a cough with no obvious cause
- High fever present.
- The patient is asthmatic or has COPD.
- The patient has a reoccurring cough.
Treatment options of coughs
three main types of cough mixture: 12+
- Expectorants - chesty coughs.
- Suppressants - dry coughs.
- Demulcents - any type of cough but particularly useful if tickly or irritating.
- Bronchostop, a traditional herbal product containing thyme and marshmallow root
How does a expectorant work and any examples
They reduce the stickiness of phlegm and makes it looser and easier for the body to cough up
Squill
How do suppressants work and nay examples
Block the natural coughing reflex
Menthol
How do demulcents work and any examples
Coat the pharynx and help reduce irritation ans soreness temporarily
Simple linctus
Lifestyle advice for cough
- Increase fluids.
- Rest as much as possible.
- Inhalation of steam may help to loosen and bring up phlegm.
- Good hygiene measures will help prevent the spread of germs.
o E.g. cover mouth when coughing. - stop smoking
What is a cold and symptoms
collection of mild symptoms which affect the Respiratory System.
-runny nose
-sore throat
- Sneeze
- headaches
- fever
Alarm symptoms of cold
- The patient has ear pain.
- Suspected influenza (Flu).
o Joint pain.
o Fever.
o Severe headache.
o Exhaustion
o Very unwell generally.
o Often a representative will present as the patient is too ill to
attend the Pharmacy.
- Weakened immune system, e.g. a patient with cancer.
- Any difficulty breathing or swallowing.
- Skin rash.
- Unintentional wright loss.
- The cold has lasted more than two weeks.
- There are spots on the tongue or throat.
- Children.
Treatment for cold
Only symptomatic relief
Medicines for aches and pains
Ibuprofen
Paracetamol
Aspirin
Naproxen
Medicines for congestion
Antihistamines
Pseudoephedrine
Acetaminophen
Medicines for sore throat
Benzocaine spray
Acetaminophen
Glycerin with glucose
Guidance on sale of ephedrine and pseudoephedrine
Illegal to sell or supply any product that contains more than 720mg Pseudoephedrine or 180mg ephedrine.
It is illegal to sell or supply a combination of products that between them add up to more than 720 mg pseudoephedrine or 180 mg ephedrine without a prescription
It was taken off the market because of abuse by manufacturers of methamphetamine
Can be bought in 12 pack tablets or 100ml liquid but any more will need to be prescribed.
Lifestyle advice for cold
- Use tissues instead of handkerchiefs as they can then be disposed.
- Wash hands often, particularly after you have blown your nose.
- “Catch” a sneeze in a tissue.
- Avoid sharing cutlery, drinks and towels.
Other advice could include:
- Rest.
- Drink plenty of water.
- Inhale steam to loosen mucus.
- Warm drinks with honey and lemon may be soothing.
- Reassure the patient that colds are self-limiting
What is croup and symptoms
commonly occurs in babies and young children due to a viral infection affects the larynx, trachea and bronchi
- Barking cough
- Hoarse voice
- Breathlessness/difficulty breathing.
- A rasping sound when breathing
symptoms are worse at night and can be further exacerbated by agitation and crying also have cold-like symptoms such as sore throat, cough, runny nose and fever
What causes croup
Strains of:
- parainfluenza virus
- influenza A and B
- rhinovirus
Less common:
- allergic reactions
- Inhalation of chemical irritants
Alarm symptoms of croup
- The patient is struggling to breath
- The patient’s skin or lips are looking pale or have a blue-ish ting.
- The patient is unusually quiet and still.
- The patient is unusually sleepy and drowsy.
- Sudden high temperature.
- Unable to take in and drink fluids.
Treatment of croup
In mild cases, croup can be a self-limiting condition – i.e. it will get better on its own.
- sitting the patient upright
- encourage them to drink plenty of fluids
- give paracetamol or Ibuprofen if temperature
In more severe cases, patients would be referred to GP surgery and/or hospital where they may be treated with oral corticosteroids.
What is hayfever and symptoms
also known as seasonal allergic rhinitis. It is often worse in the
mornings, when pollen rises into the air, and later in the evening, when the
pollen falls again.
- Sneezing
- Coughing
- Runny/blocked nose
- Itchy, red and watering eyes
- Itchy mouth, throat, nose and ears
- Loss of smell
- Pain around temple and forehead
- Headache
- Earache
What causes hayfever
When pollen is released into the air, it may be breathed in and can also lay on skin and get in the eyes.
The pollen in and around the body triggers the immune system to release
chemicals to fight this foreign matter and it is these chemicals which cause the
irritation and inflammation
Alarm symptoms of hayfever
- The patient is wheezing or has shortness of breath.
- The patient is taking medication or has other medical conditions.
How do antihistamines work and some AI’s and forms
Block effects of histamine
Ceterizine, loratidine,feoxfeidine, chlorophenamine
Tablets, liquids
How do mast cells stabilisers work and some AI’s and forms
Block calcium channels, preventing release of histamine
Olopatadine, ketotifen
Eye drops, inhalers, nasal sprays and oral
How do corticosteroids work and some AI’s and forms
Repression of genes encoding the multiple inflammatory cytokines
Prednisolone, dexamethsone
Tablets, inhalers, nasal sprays, njections, creams, lotions ans gels
How do allergen barriers work and AI and forms
Create a physical barrier, providing a extra layer of protection against allergens that are inhaled into the nasal cavity
Cellulose
Wipes, balm, spray
Lifestyle advice for hayfever
- Keeping windows and doors shut
- Checking the weather forecast for the pollen count is
- Avoid cutting grass.
- Wearing sunglasses,
- Avoid drying clothes on the washing line outside, if possible.
- Use Petroleum Jelly around the nostrils to trap pollen and prevent it
entering the body. - Vacuum regularly and dust using a damp cloth.
What is pain caused by
Signals sent from body to brain.
What is a tension headache
Episodic or Chronic.
Infrequent or frequent.
Generalised and non-throbbing.
Described as a tightening or weight pressing down. Gradual onset that gets progressively worse. Often due to posture, stress,tiredness etc.
Wh at is migraine with aura
Sensory symptoms, flashes of light, blind spots or tingling int he hands and face. aura is a warning sign of migraine
What is migraine without aura
Most common. No warning sign
What is a sinus headache
Pressure like pain in one specific area of face or head. Worsens with sudden movements. High temperature, toothache.
What is a cluster headache
Rare type of severe headache. Severe pain in one side of head often around eye. Triggered by alcohol, strong smells.
What is a hangover headache
Drinking lowers blood sugar levels so fatigue may be from brain working without enough of its main fuel.
What is a medication overuse headache
Develops and gets worse with frequent use of any medication treatment for pain. Rebound headache. Occurs for more than 15 days a month.
Alarm symptoms of pain
- Prescription or over the counter medication has not worked.
- The pain had lasted for more than a week.
- The patient is buying large quantities of analgesics regularly.
- The patient is on other medication or has other health conditions.
- Head injuries.
- Slurred speech.
- Any numbness.
- Any nausea/vomiting or fainting.
- prevents movement.
- The pain keeps reoccurring.
- Pain without an obvious cause.
How does paracetamol work and points of interest
Inhibit production of prostaglandins and reduce fever
8 tabs max in 24hrs
No other produts that may contain paracetamol
How do non-steroidal anti-inflamtories work ie ibuprofen and any points of interest
Block NSAIDs decrease the synthesis of prostaglandins which cause inflammation
400mg every 6-8 hours
How do combination opioids work and any points of interest
Opioids attatch to receptors on nerve cells in brain and blocks pain messages sent from body. Combining opioids with other mediations can improve pain management and so need a lower does of opioid.
What does caffeine do as a pain killer
Sometimes added to pain killers. Weak stimulant. Reduce chance of drowsiness and enhance effect of pain killer
Topical medication is
Applied to skin at site. Gets to source fast and works locally so reduce side effects
Types of topical meds
- NSAID creams/ointments/gels: work same as oral NSAID
- Counter Irritants: Adds a feeling of warmth to the skin which can distract the brain from the pain signals.
- Heat Patches: The heat dilates the blood vessels; increase circulation and reduced muscle spasms
- Cooling Therapies: Creates a cold sensation on the skin. Useful immediately after an injury. Helps to reduce the swelling.
- TENS: machines send small electrical pulses through the area to block pain signals.
Counselling for topical
Short term and low dose
Not for broken or irritated skin
Pain lifestyle advice
- Protect, Rest, Ice, Compress and Elevate (PRICE) the injury for 48hours after a sprain or strain.
- Compression for swelling.
- Weight loss will help ease pressure on joints and muscles.
- Good posture can help avoid back pain.
What is teething and symptoms
An infant’s first tooth can appear anytime from birth to their first birthday, and sadly, teething is often a painful process. Gums become sore as the tooth cuts through.
Symptoms that can indicate an infant is teething include:
- Dribbling (leading to a rash on the cheeks, or a sore chin).
- Disturbed sleep.
- Swollen, red and even bleeding gums.
- Hot cheeks (sometimes one sided).
- Infant chewing objects.
- Upset infant with no apparent, obvious cause.
Alarm symptoms of teething
- The infant has a rash on their body.
- The infant has a fever.
- The infant is vomiting.
- The infant is breathless or wheezing.
- The infant is refusing feeds/food (can be due to teeth but needs further
discussion and advice). - The infant is floppy or unresponsive.
- The parent/guardian seems overly concerned and worried for the infant.
Treatment for teething
Paracetamol and ibuprofen age dependant
Teething gel
Lifestyle advice for teething
- Teething rings that can be cooled can help soothe the infant’s gums as
they apply pressure and help reduce swelling. - If over 6 months old (weaning age), raw, chilled vegetables can be offered
to chew. - Similarly, frozen fruit (i.e. banana and melon) are other cooling options.
- The parent/guardian should comfort and try to distract the infant with
playing etc. - The child should be registered with a dentist once the first tooth appears.
- Clean teeth with a fluoride toothpaste once teeth start to come through.
- Petroleum Jelly around the mouth and chin may help prevent rashes from
dribbling.
What is travel sickness nad symptoms
Nauseous when travelling
- sweating
- excess saliva
- headaches
- pale
- fatigue
Why do people get travel sickness
Occurs due to repeated movements in Tavel. Brian recieve conflicting signals from eyes ans ears from movement and position and balance. Ear detect movement by eyes detect stillness
Alarm symptoms of travel sickness
- Pregnant/breastfeeding.
- Children under 3 years.
- Patient is on other medication.
- Patient has any medical conditions, including glaucoma.
- The patient is the driver (or other vehicle operator).
Treatment from travel sickness, how it works, effect time and duration
Antihistamines :
- block receptors and dull inner ears ability to sense motion. Block messages to part of brain that controls nausea
- 2hrs before journey and 8 hours alter if needed. After food
- gradual and can take up to 4 hours
Hycosine hydrobromide:
- work by affecting your inner ear and your brain to control vomiting. It also relaxes the muscles in the walls of your stomach.
- 30 mins to start and can be repeated every 6 hours,
- take 6 ours to work fully
Side effects of Hyoscine and counselling
- Dizzy
- Sleepy
- Dry mouth
- Constipation
- Fast heart rate
- Blurred vision
- Problems uritnating
- dont drive or use tools
- Avoid alcohol
- Sugar free gum or sweets
- Eat more high fibre foods and drink plenty of water
- Speak to Dr, may need to change meds
- Avoid during and using tools, more than a day speak to Dr
- Relax, dont force and try again later
Lifestyle advice for travel sickness
- Avoid rear facing seats, if possible.
- Avoid alcohol.
- Avoid large or fatty meals.
- Avoid reading or focussing on games.
- Ensure the vehicle is well ventilated (preferably with fresh air).
- Suck boiled sweets, or mints.
- Focus on distant objects (or on the horizon).
- If possible, make regular stops and walk around outside.
What are threadworms and symptoms
Threadworms are tiny parasites, 2-13mm long.
The female worms lay eggs in an irritant mucus, around the anus, at night.
Threadworms are very common in children and symptoms include:
- Itchiness around the anus, worse at night.
- Disturbed sleep, leading to irritability and tiredness.
- Visual confirmation of threadworms
If left untreated, ongoing cases of threadworms can lead to appetite loss, weight loss, and skin infections due to persistent scratching.
How to get threadwomrs
Threadworms are contracted by the patient swallowing the worm eggs. This may occur if the patient eats undercooked meat, plays with toys from an infected person, or shares bed linen and towels etc. with an infected person.
Children will often get stuck in a cycle of reinfection as they have less care over person hygiene. The threadworms lay the eggs around the anus, the child then itches and lodges the eggs under their fingernails. They then ingest the eggs
through finger sucking or eating and these then hatch in the gut again to restart the cycle.
Alarm symptoms of threadowmrs
- Pregnant/breastfeeding.
- Children under 2 years.
- Patient has previously tried over the counter medication,
unsuccessfully. - The skin around the anus is broken or weeping.
- Reoccurring cases.
- There is blood in the stools.
Treatment for threadworms
Mebendazole
Stops the worms using sugar, without glucose they lose their energy supply and die.
Doesn’t kill eggs so need another does 2 week later
- chewable or liquid
- If you have it then one dose and same if you live with anyone else. Repeat after 2 weeks
Lifestyle advise for threadworms
- rigorous hygiene measures
- wash hands and scrub under nails after visiting the toilet, carrying out nappy changes, before meals
- Wear underwear under pyjamas to help prevent night-time scratching.Ensure the underwear is changed in the morning.
- Shower and wash around the anus, upon waking, to rinse of the eggs.
What are head lice and symptoms
Head lice are small insects
They live on the hair of the patient, close to the warmth of the scalp.
Head lice eggs (also called nits) are also visible
Once they have hatched, they appear white.
They can be found attached to the hair near the follicle.
Head lice can be found by combing the hair with a fine-toothed comb.
Symptoms of head lice include:
- Visible lice and eggs in the hair, particularly in the nape of the neck and behind the ears.
- Itchy scalp.
Why do people get head lice
transmitted by head to head contact.
jump across from person to person as they need warmth to survive.
The lice can live for around one month and a female will lay several eggs per night.
The eggs hatch after 7-10 days.
The itching that patients sometimes experience is caused by the lice biting the scalp.
Over time, the patient becomes allergic to the saliva.
Alarm symptoms of head lice
- There is flaky skin, yellow scales, or crusts on the scalp.
- The patient has already tried a treatment but it has been unsuccessful.
- The patient has had regular, repeated infestations.
- Resistance to products is suspected.
Treatment options for head lice
Malathion - kills insects by preventing their nervous system from working properly. Paralyse and kills lice and eggs. 8-12 hours on hair
Permethrin - by overexciting the nervous system of insects, eventually causing the insect to die. 8-12 hours on hair
Dimeticone - It is not an insecticide, but eradicates adult and nymph lice via disruption of water homeostasis and suffocation. 8hours or overnight
- wet combing 2-3 days after treatment
- treat again after 7 days to catch unhached eggs
What is scabies and symptoms
condition that is caused by a parasitic mite. Female mites burrow into the surface of the skin where they lay their eggs. The eggs hatch and develop in 14 days, where the cycle begins again, therefore an infestation can take as little as 15-20 days to occur.
The main symptoms of scabies are intense itching (especially at night) and a rash.
Why do you get scabies
Passed through prolonged and skin thr skin contact because the mites cannot fly or jump between hosts
Alarm symptoms of scabies
- Children under 2years old
- Patient has and/or is receiving treatment for other skin conditions (i.e.
Eczema, psoriasis) - Patients that have a compromised immune system (i.e. cancer, HIV/AIDS)
- Severe itching with widespread rash
- Excessive scratching has broken the skin
- Patient has had regular repeated infestations
Scabies treatment
- Permethrin 5% cream can used to treat scabies as it contains a type of
insecticide that kills the mite. An alternative to permethrin is Malathion. - Do not apply the treatments after a hot bath or shower as it affects the
absorption of the cream/lotion on the skin.
How to apply permethrin and malathion
Permethrin
Child
Apply once weekly for 2 doses, apply over whole body including face, neck, scalp and ears then wash off after 8–12 hours.
Adult - same
Malathion
Child
Apply once weekly for 2 doses, apply preparation over whole body, and wash off after 24 hours.
Adult - same
What is herpes simplex and symptoms
highly contagious virus which causes cold sores, type 1 and genital herpes, type 2.
Patients may experience an itching or tingling sensation before HSV1 cold sores erupt. self-limiting and resolve in 7-10 days. Blisters scab over in 24hrs
Why do you get herpes
Spread via contact with saliva at sites of broken skin. Someone with cold sore kisses someone with a cracked lip
Alarm symptoms of herpes
- Pregnant/breastfeeding.
- The cold sores are present in another location (not lips).
- It is the patient’s first cold sore.
- The blisters are yellow and weeping (may indicate infection).
- The patient is on medication, or has other medical conditions.
- There are a large number of sores at once.
- The cold sores are inside the mouth.
- The blisters appear to be spreading.
- Infants and babies.
- The cold sores have been present for more than 14 days.
- The symptoms have suddenly worsened for no obvious reason.
- The patient has other symptoms (i.e. fever).
Treatment options for herpes
Treatment is not necessary as typical cold sores are self-limiting. However, due to discomfort and the physical appearance, patients will often seek relief.
Aciclovir and Penciclovir, oral pain killers
Lifestyle options for herpes
Avoid salty or acidic foods. Avoid contact with children. Cool soft foods, fluids. See GP if it hasn’t healed in 10 days
What is a fungal infection and symptoms
caused by two types of organisms;
dermatophytes (variety) or yeast (commonly Candida albicans).
The organisms thrive in warm, moist areas and are easily transmitted. The likelihood of contracting a fungal skin infection is increased with sweating,friction and skin moisture
Athletes foot and ringworm
Symptoms:
- Red and itchy, sore skin.
- Skin later becomes white, inflamed, and ‘soggy’ and may weep.
- Skin may crack and peel, possibly even bleed if severe.
- Typically it starts between the fourth and fifth toes in the toe webs.
- Skin may start to smell.
- It may spread to other toe webs, the sole and instep of the foot, and in time the nail.
Alarm symptoms of fugal infections
- Pregnant/breastfeeding.
- Children under 16 years old.
- It has spread beyond the toe webs.
- The patient has other skin conditions.
- The patient has another medical condition (especially Diabetes).
- The patient is taking medication.
- The patient is elderly (and unable to check bottom of own feet easily).
- The skin is cracked, bleeding, weeping or producing pus.
- The patient is in considerable pain.
- The patient has tried treatment already, unsuccessfully.
Treatment for fungal infections
Topical application - imidazoles - as the outer layer of the skin is shed so is the fungus
Lifestyle advice for fungal infections
- Avoid sharing towels to minimise spread of infection and wash them regularly.
- Dusting powders in socks and shoes can help prevent re-infection.
- Wash and dry feet (in particular, in between toes) daily.
- Wear open, breathable shoes.
- Change socks and hosiery daily.
- Cotton socks and leather shoes are the most breathable.
- Use flip-flops or plastic shoes in communal areas, like showers or changing rooms, to prevent re-infection and reduce spread to others.
- Wash shoes, if possible.
Fungal nail infection
Onychomycosis - toes nails more than fingers
Symptoms:
- Nail appears thickened or discoloured.
- May then become white or yellow as the nail lifts from the nail bed.
- Eventually, the whole nail may lift away.
- The nail may also become brittle, crumble, or become soft.
- Debris can accumulate under the nail.
- The nail may appear misshapen.
- Normally, the infection starts at the tip of the nail and spreads towards the base as it progresses.
- Untreated, the nail bed can become painful.
Alarm symptoms of onychomycosis
- Pregnant/breastfeeding.
- Children under 18 years old.
- The patient has other skin conditions.
- The patient has another medical condition (especially Diabetes).
- The patient is taking medication.
- The patient is elderly (and unable to check own feet easily).
- The patient has tried treatment already, unsuccessfully.
- More than two nails are affected.
- There has been trauma to the nail(s).
- It is affecting the finger nails.
- It is causing pain.
- It is affecting surrounding skin.
- More than 50% of the nail is affected, or if the nail bed is affected.
Treatment of onychomycosis
Amorolfine lacquer is a broad-spectrum antifungal used in fungal nail
infections. It is painted on to the affected nails once a week and this is applied
until the nail(s) have completely regrown and are clear of infection
What is ring worm and symptoms
Nothing to do with worms. Fungal skin infection. Ring like rash
Symptoms:
- Small circular patches with red, scaly, clearly defined edges.
- Less scaling and redness in the centre.
- May be itchy.
- Patches may multiply, grow and/or merge together.
- Rings may feel raised to the touch.
- Can occur anywhere on the body, depending on where contact with the
fungal spores was.
Treatment of ring worm
Imidazole creams tend to be the main choice of treatment, but Terbinafine
cream can also be used.
What is cystitis and symptoms
inflammation of the bladder. Commonly the urethra is also
involved.
Increased urination - desire and urgency
Pain and burning sensation
Why do you get cystitis
Caused by bacteria from rectum to urethra. UTI. Moe common in women
Alarm symptoms of cystitis
- Pregnant/breastfeeding.
- Children under 16 years old
- Patients over 70 years old.
- The patient is male.
- The patient has another medical condition.
- The patient is taking medication.
- The patient has tried some form of treatment already, unsuccessfully.
- It is the patient’s first time with Cystitis.
- Frequent, recurring Cystitis.
- The symptoms have persisted for more than 3 days.
- Any pain in the lower back or abdomen.
- There is blood in the urine.
- The patient has a fever or has been sick.
- There has been a change in vaginal discharge.
Treatment options for cystitis
Clear on its own 2-3 days
Painkillers for discomfort
Fluids to promote urination
Sachets
lifestyle advice for cystitis
- Increase fluids (water is best) to 8 glasses of water in 24 hours, minimum.
- Avoid tea, coffee or alcohol as these can aggravate symptoms.
- When visiting the toilet, wipe front to back to reduce bacterial spread.
- Avoid scented products (talc/soaps) around the vaginal area.
- The patient should ensure they visit the toilet if they feel the urge to urinate as this reduces the stress on the bladder.
- Practice double micturition. (Once finished urinating, try to urinate a little more to ensure an empty bladder.)
- Urinate after sexual intercourse.
- Wear cotton, breathable underwear.
- Avoid tight trousers or tights.
- Some foods may trigger Cystitis in some patients and so, if identified,
these should be avoided. (I.e. spicy food, caffeine, fruit juice.) - Avoid sexual intercourse until an attack of Cystitis has cleared up.
- A hot water bottle may help ease pain.
What is vaginal thrush and symptoms
caused by a yeast infection.
increased discharge (often thick, white, and ‘curd-like’ or cottage cheese like, with no abnormal odour) and itching around the vaginal area.
Scratching often leads to soreness and so there may also be stinging and pain during sex or when the patient urines.
Why do you get thrush
The yeast fungus is present on our bodies but grows excessively to cause thrush
Antibiotic use
Hormones changes
Tight clothing
Alarm symptoms of thrush
Pregnant/breastfeeding.
- Children under 16 years old.
- Patients over 60 years old.
- The patient is male.
- The patient has another medical condition.
- The patient is taking medication.
- The patient has tried some form of treatment already, unsuccessfully.
- It is the patient’s first time with thrush.
- Frequent, recurring thrush. (2 episodes in 6 months.)
- The symptoms have persisted for more than 5 days.
- Any pain in the lower back or abdomen.
- There is blood in the urine.
- There is spotting or bleeding after intercourse, or between periods.
- The patient has a fever, or has nausea or vomiting.
- Vaginal discharge is frothy, yellow, green or grey.
- Vaginal discharge has an odour.
Treatment options for thrush
treated with a topical antifungal (e.g. imidazoles, typically
Clotrimazole) and/or an oral antifungal (e.g. a triazole, specifically Fluconazole) which aims to eradicate the fugus
How to insert a pessary
- Hold your pessary firmly between your fingers and your thumb and fold it in half. The curved part should be facing the ceiling when you are ready to insert it. It will look like the shape of a taco
- Place a small amount of water-soluble lubricant on the pessary edge only that will be inserted first into your vagina. Do not cover the whole pessary with lubricant because it will be difficult to hold. You can purchase the lubricant at most pharmacies. Some examples are K-Y Jelly® or Astroglide® Do not use Vaseline or any other non-water soluble product.
- Holding the folded pessary in your dominant hand, spread the lips of your vagina apart with your other hand. It is important to spread the lips in a sideways motion, not in an upward motion, which will only stretch the lips and not help to open the vagina.
- Gently push the folded pessary, lubricated end first, into the vagina. The pessary should be inserted lengthwise into the vagina. The vagina is a closed area, so it cannot go anywhere else inside the body.
- Release the pessary once inside. It will unfold and return to its normalshape.
- If it does not feel comfortable, use your index finger to gently push it in a little farther. You can’t hurt yourself or the pessary doing this. The rim of your pessary should sit just under the pubic bone at the front of your vagina.
How to insert internal cream
- Remove the applicator from the packaging. Keeping the cap in place, insert the tip of plunger A into the applicator B (approximately 1cm).
- Twist and pull to remove the cap C. Be careful not to press the plunger in any further before you have inserted the applicator into the vagina. This will avoid wasting any cream.
- Carefully put the applicator as deep as is comfortable into the vagina (this is easiest when lying on your back with your knees bent up). Holding the applicator in place, slowly press the plunger until it stops so that the pre-measured dose of cream is deposited into the vagina.
- Remove the applicator. Dispose of the applicator in a safe place, out of the reach of children. The applicator cannot be flushed down the toilet.
What is dysmenorrhea
Period pain
Primary and secondary
Symptoms are the most severe on the day prior to
menstruation, or in the first 24 – 48 hours of menses. Secondary Dysmenorrhoea is when there is an identifiable cause, e.g. fibroids or endometriosis.
Why do you get dysmenorrhoea
Before menstruation starts, Progesterone hormones drop. This allows the
production of hormones called Prostaglandins to increase. The overproduction
of Prostaglandins in the uterus have a role in the uterine contracting and
therefore seem to be the main cause of the pain and cramping in Primary
Dysmenorrhoea.
Alarm symptoms of dysmenorhoea
- Pregnant/breastfeeding.
- Patients over 30 years old, presenting for the first time.
- The patient has another medical condition.
- The patient is taking medication.
- The patient has tried some form of treatment already, unsuccessfully.
- The patient is in severe or intense pain.
- The severity of the pain does not decrease as menses progress.
- The pain starts more than 24 hours before menses.
- The pain lasts for more than 3 days (per period).
- There is blood in the urine.
- The patient has irregular bleeding or irregular menstrual cycles.
- The patient’s periods have changed from the normal in any way.
Treatment of dysmenorrhoea
Pain killers are the mainstay of treatment in Primary Dysmenorrhoea. Non- Steroidal Anti-Inflammatory Drugs (NSAIDs) are the best choice as they work by reducing Prostaglandins and thereby may assist in treating the cause of the
pain, not just the pain itself.
Ibuprofen is the most sensible choice as it has the least side effects of the NSAIDs, however Naproxen is also licensed for Dysmenorrhoea over the counter
What is vaginal atrophy
when the walls lining the vagina become thinner, drier, and
inflamed. This as a result causes women to experience vaginal dryness,
itchiness and the area can become quite sore. It can also cause sex to be quite
painful
Why do you get vaginal atrophy
often caused by a reduction in oestrogen hormone levels
both during and after menopause, which result in changes to the vagina and
associated tissues. The tissues become inflamed, and less mucus is produced
resulting in associated dryness
Alarm symptoms of vaginal atrophy
- Patients less than 50 years old
- The patient has another medical condition.
- The patient is taking medication.
- The patient is on hormone replacement therapy
- The patient has tried some form of treatment already, unsuccessfully.
- The patient is in severe pain or discomfort in the vaginal area
- There is unusual vaginal discharge or bleeding
- The patient is experiencing bleeding after sex
- A history of breast, ovarian, uterine, or endometrial cancer
Treatment options for vaginal atrophy
There are water-based lubricants available that can be used around and inside
the vagina, e.g K-Y jelly©. There are also vaginal moisturisers that can be
inserted into the vagina that help reduce dryness – one example is Replens MD
vaginal gel©(22)
.
A new hormone replacement product has recently become available over the
counter licensed for the treatment of vaginal atrophy. It contains Estradiol in
10mcg vaginal tablets (pessaries), and its brand name is Gina©
What is ED
condition where a man is
unable to get or maintain an erection through sexual intercourse. It is more
common in men over 40 years of age but can happen at any age
Why do you get ED
various causes of erection problems, some of which are temporary
that include stress, tiredness, anxiety, and alcohol related. Other causes are
linked to high blood pressure, high cholesterol, hormone problems or
potentially as a side effect of a medicine
Treatment of ED
Sildenafil and tadalafil, both previously prescription only medicines are now
available as P medicines over the counter.
gel-based product available known as ‘Eroxon Stimgel©’stimulates nerve endings locally, which then increases blood flow to the region
to help maintain an erection
ED lifestyle advice
- Regular exercise – this will help patients keep physically fit
- Lose weight – weight can have an effect on erectile dysfunction
- Stop smoking as smoking can affect and be harmful to your blood vessels
- Having a health balanced diet
- Reducing stress and anxiety
Symptoms of blepharitis
- Feeling like there’s something in your eye.
- Burning or stinging eyes.
- Watery eyes.
- Itchy eyes.
- Sensitivity to light.
- Red and swollen eyes or eyelids.
- Tears that are foamy or have small bubbles in them.
- Dry eyes.
Treatment of blepharitis
- clean your eyelids twice a day to start with and then once a day as your symptoms improve
- continue to clean your eyes, even if your symptoms clear up
A GP might suggest using an antibiotic cream or ointment that you rub on your eyelid if your blepharitis does not clear up after cleaning your eyelids regularly.
If blepharitis has caused other problems, such as a lump of fluid under the skin (cyst), antibiotic eyedrops or tablets may be recommended.
Alarm symptoms of blepharitis
- Pain in the eye, as distinct from superficial soreness, grittiness or itchiness
- Redness localised to one area of the eye surface
- Disturbance of vision
- Pupils of abnormal shape or uneven pupils
- Pupils reacting unevenly to light
- Eye symptoms with headache and/ or nausea/ vomiting
- Recurrent subconjunctival haemorrhage
- Dry eyes
- Children and elderly
How to use eye drops
1 Tilt your head back and look up.
2 With 1 hand, pull your lower eyelid down and away from your eyeball — this makes a “pocket” for the drops.
3 With the other hand, hold the eye drop bottle upside down with the tip just above the pocket.
4 Squeeze the prescribed number of eye drops into the pocket.
What is otitis externa, symptoms and treatment
Externa = inflammation of outer ear Canal
Pin and discharge
Aluminium acetate
What is otitis media, symptoms and treatment
infection of middle ear compartment
Pain and temporary deafness. Perforated eardrum
Antibiotics
What is ear wax, symptoms and treatment
Wax blocking ear
Oily fluid or dry discharge, temporary deafness
Olive oil, hydrogen peroxide, syringe
What is glue ear, symptoms and treatment
Fluid in ear is stagnant
Pain radiating to jaw, swimming related children
Ear plus in water, swim hats
Why not to use earbuds to remove wax
When you use a cotton bud to try and remove ear wax, you are just pushing it further down the ear canal. This can cause the wax to build up and become impacted. When your eardrum is impacted with ear wax, it can cause pain and hearing loss. Cotton buds can also damage the delicate skin in the ear canal.
Allergic reactions to arachis oil
Risk of containing peanut protein
Mouth ulcers causes and treatment
Stress, dentures, poor hygiene, dehydration
Pastilles, with local anaesthetic , corticosteroids,
Oral thrush causes an treatment
Creamy white bumps
Low immunity, poor hygiene, yeast infection,
Miconazole - Daktarin
Fluconazole
Cold sore treatment
- Cold sore cream - lipsore
- Aciclovir tablets - antivirals
What Is eczema, why
Ski becomes itchy, inflamed, red, cracked. Can be small or widespread
Cause is unknown but can be allergies, family history or as a result of asthma and hayfever
Treatment of eczema
Treats the itching and dry skin
Emolients and topical hydrocortisone and antipruritic
When to see topical hydrocortisone
Mild hydrocortisone skin cream can be bought over the counter but stronger such as beclosetasone are POM
Creams for nappy rash and other skin problems for children under 10 are also POM
Over counter = hydrocortisone 1%
Prescription = hydrocortisone 2.5%
Mostly used for short periods of time and can wrk within days but for a bite or contact dermatitis it may need to be used for a week
Not recomended for children under 2yrs
What is contact dermatitis and treatment
Occurs within a few hours of skin exposure to irritant or allergen. Dry, blistered and cracked
Most common with soap and detergents
Emolients, topical hydrocortisone and antipruritics
What is seborrheicc dermatitis and treatment
Mainly affects scalp but also face. Occur in area of rich supply of sebaceous glands causing scaly patched, red skin and dandruff
Ketocnazole shampoo 1st line
Selenium sulphide 2nd line
What is psoriasis and treatment
Difficult to diagnose. Exact cause is unknown but can be genetically and environmentally influenced
Skin is inflamed, red scaly patches and sore over elbow or knee. Symmetrical patches
Emulsifying ointment for hydration
Calciptrol and topical steroids
What is urticaria
Hives
Itchy skin companied by swelling of the area
Skin is blistered and red but can disappear within 24 hours
Use antihistamines
Antihistamines, if they are drowsy or non doses
Certerizine - non - OD
Loratidine - non - OD
Fexofenadine - non - OD
Chlorophenamine - drowsy - one 4-6hours
What are warts and verucas
Cause by viral infection
Warts are raised lesion with rounded surface and flesh colours
Can disappear in 6m to a year
Wart alarms and treatments
Face
Diabetic
Pregnant
Change in appearance size and colour
Genital
Bleeding
Salicylic acid produces - soften and destroy
Cryotherapy - freezing
What is nappy rash and treatment
Rash
Contact with urine and faecies with skin
Emollient
Frequency nappy change
Castor oil
What is chicken pox
Common in children 10years under
Caused by a VZV virus . Contagious
What is impetigo
Confused with chicken pox and cold sore
More widespread without blisters but a honey crust
Doesn’t require topical or antibiotic treatment
Contagious
Measures and mumps
small white spots like
grains can be seen on the inner cheeks
and gums. The measles rash then
follows.
Measles is caused by infection
with the rubeola virus. The
virus lives in the mucus of the
nose and throat of an infected
child or adult.
Meningococcal disease
Meningococcal meningitis is a rare but
serious bacterial infection. It causes
the membranes that cover the brain
and spinal cord to become inflamed
Bacteria and viruses are the two main causes of meningitis.
The bacterium Neisseria meningitidis, also called
meningococcus, causes meningococcal meningitis.
Slapped cheek syndrome
first sign of slapped cheek
syndrome is usually feeling unwell for a
few days. Symptoms may include: a
high temperature of 38C or more, a
runny nose and sore throat and
headache.
Slapped cheek syndrome is caused by a virus called
parvovirus B19. This is found in the droplets in the coughs and sneezes of someone with the
infection.
Hand foot and mouth
Fever, Sore throat, Feeling of
being unwell (malaise), Painful, red,
blister-like lesions on the tongue, gums
and inside of the cheeks, A red rash,
without itching but sometimes with
blistering, on the palms, soles and
sometimes the buttocks, Irritability in
infants and toddlers, Loss of appetite
Hand, foot, and mouth disease
is a highly contagious infection. It’s caused by viruses from the Enterovirus genus,
most commonly the coxsackievirus. These viruses
can spread from person-to- person through direct contact with unwashed hands or surfaces contaminated
Whooping cough
Catarrhal symptoms, the whooping
sound is not initially present. The bout of coughing prevent normal breathing and the whoop represents the desperate attempt to get breathe in.
Caused by a bacteria called Bordetella pertussis. This is contagious and can be caught
by an infected person coughing and sneezing, and
tiny germs-droplets sprayed in to the air and breathed into the lungs of anyone nearby.
