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OTC Pre reg T23/24 > CNS > Flashcards

CNS Flashcards

1
Q

DANGER symptoms in PAIN

A

• pt appearing to abuse analgesics
•young children who havent responded to previous doses given
• increasing severity

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2
Q

Differential diagnosis in pain

A

• Dental pain due to inflammation

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3
Q

Treatment of PAIN main OTC

A

• Paracetamol
• Ibuprofen
• Aspirin

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4
Q

Assess analgesic effect?

A

• pain scale/intensity scale

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5
Q

When in paracetamol the only option

A

•History of hypersensitivity to:
• aspirin
•NSAIDs
• active peptic ulceration

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6
Q

Low dose of codeine in most OTC compounds

A

8mg

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7
Q

What is the therapeutic analgesic dose of codeine is?

A

30mg

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8
Q

A common opioid SE especially in elderly

A

constipation

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9
Q

SEs of caffeine

A

Nausea, headache, Insomnia, habit

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10
Q

Practical tips in pain relief

A

• Heat eg hot water bottle or bath
•cold compressess for headaches or sprains
• Massage
• exercise for period pain or osteoarthritis

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11
Q

Teething is usually around?

A

6 to 9 months

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12
Q

When can teething start, and until what age can it continue?

A

3 months til 3 years

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13
Q

Teething symptoms in infants

A

• discomfort
• pain
• disturbed sleep, swollen gums, hot cheeks, excessive salivation, nappy rash, and an increased tendency to chew objects.

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14
Q

What is the first-line treatment for teething discomfort in babies over three months old?

A

Paracetamol

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15
Q

For babies over six months old, what is the alternative analgesic option to paracetamol?

A

Ibuprofen if >6 months

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16
Q

Why are topical pain relief products containing salicylate salts contraindicated in children under 16 years old?

A

Risk of Reyes syndrome.

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17
Q

Give examples of topical pain relief products that are affected by the contraindication of choline salicylate.

A

Bonjela® and Bonjela Cool Mint®.

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18
Q

What precautionary measure should parents take before applying topical agents directly to the mucous membrane during teething?

A

Parents should be advised to wash their hands thoroughly.

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19
Q

What is the active ingredient in Ashton and Parsons Infant Powders, and what is its main indication during teething?

A

matricaria tincture (4 mg), a carminative related to chamomile. The main indication is to soothe the child during teething.

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20
Q

Are chamomile and related ingredients reported to have pain-relieving qualities?

A

No, they are not reported to have any pain-relieving qualities.

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21
Q

Is there clinical evidence supporting the use of homeopathic remedies for teething?
What is one example of a teething granule product mentioned, and what is its recommended dosage?

A

No.
• Teetha® Teething Granules, contains chamomilla at 6c potency.
•One sachet every two hours, up to a maximum of six doses in 24 hours.

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22
Q

What role can a chilled teething ring play in soothing sore gums?

A

A chilled teething ring may help to soothe sore gum by providing a cooling sensation.

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23
Q

Why is it important to take a chilled teething ring out of the freezer before it becomes solid?

A

To avoid bruising the gums.

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24
Q

Should teething rings be tied around a baby’s neck?

A

No

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25
Q

Besides teething rings, what are some other items that can be chewed on to help with teething discomfort?

A

• Chewing on hard biscuits,
frozen fruit (e.g., melon or banana), or
•chilled raw carrot can also help.

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26
Q

What precaution should be taken when giving items like hard biscuits or frozen fruit to a teething baby?

A

They should be given under careful supervision in case a large piece breaks off in the mouth.

27
Q

How can petroleum jelly be used to prevent rashes and soreness during teething?

A

Petroleum jelly applied around the mouth and chin may prevent rashes and soreness from excessive dribbling.

28
Q

What is the usual timeframe for resuming normal activities after a mild strain or sprain?

A

Normal activities can usually be resumed within one to two weeks after a mild strain or sprain.

29
Q

What causes bruises to appear after an injury, and how do they change in color over time?

A

Bruises appear where capillaries have broken or burst, initially as purple-red blotches fading through green and yellow.

30
Q

What symptoms accompanying an injury require immediate referral to an accident and emergency department?

A

•Unexplained deformity
•limited limb movement,
•swelling
•appreciable weakness not due to pain or fever, chills, malaise

31
Q

Which drugs can lead to bruising

A

•Steroids
•Carbimazole
• anticoagulants

32
Q

Why should unusual bruising be referred to a patient’s GP, especially if it occurs for no apparent reason?

A

Unusual bruising should be referred to the patient’s own GP to rule out more serious underlying disease, and it may result from drug SE.

33
Q

5 differential diagnoses for an inability to bear weight and bone tenderness after an injury?

A

•Fracture, tendon rupture, cartilage damage, nerve injury, and tendonitis.

34
Q

What is the purpose of short-term treatment with RICE (Rest, Ice, Compression, and Elevation) for strains and sprains?

A

Short-term treatment with RICE (Rest, Ice, Compression, and Elevation) helps avoid pain by reducing movement.

35
Q

How can ice be applied to reduce pain after an injury, and for how long is it recommended?

A

Immerse the affected part in ice water for up to 10 minutes or
•applying a malleable ice-pack covered with a wet cloth for up to 15 minutes.

36
Q

What caution should be taken when applying compression using an elasticated bandage after an injury?

A

An elasticated bandage can be applied for up to 48 hours after injury, taking care not to constrict blood flow, especially in patients with peripheral arterial disease/DM/elderly

37
Q

What analgesic is the first choice for mild strains and sprains, and why might NSAIDs be considered?

A

Paracetamol is the first choice for mild strains and sprains; NSAIDs may be considered but with caution due to potential adverse effects.

38
Q

What is Arnica gel used for, and what is the evidence supporting its effectiveness?

A

•Arnica gel is used for the symptomatic relief of muscular aches, pains, and stiffness. There is clinical evidence supporting its use.

•Homeopathic arnica lacks strong evidence.

39
Q

What is emphasized as important for preventing injury, especially during regular exercise and sport?

A

Prevention of injury is important, and recurrent sprains can contribute to the risk of new damage and long-term joint degeneration.

40
Q

Are methyl salicylate and rubefacients good for pain relief.

A

No good evidence. Placebo.

41
Q

What are the recommendations for warm-ups and stretching in the prevention of injury, and what evidence supports these strategies?

A

Warm-ups and stretching are felt to be beneficial, although there is little good evidence to support this strategy.

42
Q

What type of training, according to the extract, may be more useful in preventing injury?

A

Strength and endurance training may be more useful in preventing injury.

43
Q

How have external ankle supports been shown to impact the likelihood of ankle injury?

A

External ankle supports have been shown to reduce the likelihood of ankle injury.

44
Q

Why is early mobilization of the injured area considered important, and what should be the range of movement during this process?

A

Early mobilization is important to improve the range of movement within the discomfort range.

45
Q

How is low back pain defined in the extract, and what is its usual duration and recommended management?

A

Low back pain is defined as pain between the bottom of the ribs at the back and the top of the legs. It usually improves within one week and resolves within a month.

46
Q

According to the extract, what is recommended for patients with low back pain to facilitate improvement, especially if the pain persists for longer than four to six weeks?

A

Patients with low back pain should be advised to continue with gentle activity, especially walking, and aim for a return to normal activities as soon as possible. Referral for specialized advice is recommended if the pain persists for longer than four to six weeks.

47
Q

What are the “red flags” in back pain mentioned in the extract, and why should pharmacists be aware of them?

A

“Red flags” in back pain include pain following major trauma, new back pain in patients aged under 20 years or over 50 years, weight loss, past history of malignancy, associated bladder or bowel symptoms, widespread or progressive motor weakness in the legs, or gait disturbance, and fever. Pharmacists should be aware of these and refer if any are present.

48
Q

What common sleep problems may people report, and why might shift workers seek short-term solutions for sleep disturbances?

A

People may report poor quality sleep, difficulty initiating sleep, or maintaining sleep. Shift workers may seek short-term solutions for re-establishing a sleep routine. Insomnia is common, and prevalence increases with age.

49
Q

According to the extract, what factors could contribute to sleep problems, and what medical conditions should be investigated as possible underlying causes of insomnia?

A

Factors such as pain, movement disorders (e.g., restless legs), respiratory conditions (e.g., sleep apnea), daytime napping, and stress can contribute to sleep problems.

50
Q

When should a person experiencing insomnia be referred to a GP, especially in terms of its impact on their alertness the next day?

A

If insomnia affects how alert a person is the next day and puts them in danger, they should be referred to the GP for a routine appointment.

51
Q

What are some differential diagnoses for insomnia, and when might it be a presenting symptom in depression or drug misuse?

A

Differential diagnoses for insomnia include depression and drug misuse (e.g., amphetamines). Referral is advisable if these are suspected.

52
Q

What is rebound insomnia, and when might it occur during withdrawal from hypnotics or antidepressants?

A

Rebound insomnia may occur during withdrawal from hypnotics or antidepressants, and slow, gradual withdrawal is recommended.

53
Q

What antihistamines are mentioned as licensed for temporary relief of sleep disturbance, and what potential side effects are associated with their use?

A

Antihistamines such as promethazine (Sominex®) and diphenhydramine (Nytol®) are licensed for temporary sleep disturbance relief. However, there’s little evidence of their effectiveness, and they may cause residual drowsiness and tolerance.

54
Q

What alternative or complementary medicines are mentioned for improving sleep, and what is the evidence supporting their efficacy?

A

Alternative or complementary medicines like valerian, skullcap, passionflower, chamomile, and melatonin have been promoted for sleep improvement, but their efficacy is not established. Valerian may have a small benefit, but hepatotoxicity has been reported.

55
Q

What practical tips are provided in the extract for maintaining good sleep hygiene, and what elements are suggested to be removed from the bedroom?

A

Maintaining a regular bedtime routine (good sleep hygiene) is important. The bedroom should be comfortable, and stimulating elements like televisions should be removed.

56
Q

Why is alcohol not recommended as a sedative, according to the extract?

A

Alcohol is not recommended as a sedative because of its potential to cause rebound excitation leading to early morning wakening and its diuretic effects that can disturb sleep.

57
Q

According to the GP comment, when should advice be sought regarding dependence on benzodiazepines or Z drugs, and what action is recommended for such patients?

A

Advice should be sought on dependence with benzodiazepines or Z drugs (zopiclone, zolpidem). Patients with such concerns should be referred to their GP.

58
Q

What causes motion sickness, and what are the common symptoms associated with it?

A

Motion sickness is caused by repeated movements during travel, sending conflicting nerve signals to the brain from the eyes and the balance mechanism in the ear. Symptoms include nausea, vomiting, profuse sweating, excess saliva, headaches, or a pale, cold, clammy appearance.

59
Q

In what forms is hyoscine available for motion sickness, and what are the side effects of hyoscine tablets?

A

Hyoscine is available in tablet or patch form. The tablets (Kwells®, Joy-rides®) are taken 30 minutes before the journey with a duration of around six to eight hours. Side effects include dry mouth, drowsiness, and blurred vision. Hyoscine should not be used by anyone suffering from glaucoma or with urinary flow problems.

60
Q

Name two antihistamines mentioned for treating motion sickness, and when should they be taken before the journey?

A

Two antihistamines mentioned for treating motion sickness are cinnarizine (Stugeron®) and promethazine teoclate (Avomine®). They should be taken two hours before the journey and are effective for eight hours.

61
Q

What is acupressure, and how is it supposed to prevent travel sickness?

A

Acupressure involves applying pressure to a point on the wrist using a plastic stud in an elasticated wristband. It is supposed to prevent travel sickness, but there is very little evidence to support its use.

62
Q

What practical tips are provided in the extract to help prevent motion sickness during travel?

A

Practical tips to prevent motion sickness include looking out of the car or bus window frequently, focusing on distant objects, ensuring the vehicle is well-ventilated, trying to sleep, and avoiding large meals or alcohol before traveling.

63
Q

Are there any clinical evidence-supported options mentioned for preventing motion sickness, such as eating ginger or peppermint-based sweets?

A

No, there is no clinical evidence-supported option mentioned for preventing motion sickness, such as eating ginger or peppermint-based sweets.

OTC Pre reg T23/24 (7 decks)

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