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PHA333 > CNS/MSK OTC > Flashcards

CNS/MSK OTC Flashcards

1
Q

How is pain treated?

A

By OTC analgesias
- Paracetamol
- Ibuprofen
- Aspirin
- Codeine/dihydrocodeine
- Topical formulations

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2
Q

What is a migraine?

A

A complex neurological condition with a wide variety of symptoms such as nausea, vomiting, photophobia, phonophobia

Female to male 3:1 incidence ratio

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3
Q

What is a theory of migraines?

A

Vasodilation of blood vessels in brain

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4
Q

What is the classification of migraines?

A

Migraine without aura
Migraine with aura

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5
Q

What is a migraine without aura?

A

Recurrent headache disorder
Lasts 4-72 hours

Unilateral, pulsating, severe pain, aggravated by physical activity

Relief: lying in a dark room

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6
Q

List some migraine triggers

A
  • Diet: crash diet, red wines, cheese
  • Environmental: smoking, bright lights, screen, loud noise
  • Psychological: depression, anxiety, stress
    Medicines: COC and HRT
    Other: menstruation, menopause
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6
Q

What is a migraine with aura?

A

Transient, unilateral neurological symptoms of visual, sensory or other CNS

Aura occurs 5-60 minutes before headache

Visual aura: zigzag lines, flashing lights
Sensory: tingling in lips, fingers, difficulty speaking

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7
Q

What are the treatment options for migraines?

A
  • Simple analgesia (avoid recommending codeine/di)
  • Anti-emetics
    Migraleve pink
    Buccastem M Buccal (prochlorperazine 3mg) CI in epilepsy, liver, glaucoma
  • Migraine specific (5-HT1 agonists or ‘triptans’)
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8
Q

How do 5-Ht1 agonists work?

A

Imitation of the action of 5-HT which causes the dilated blood vessels to constrict

Sumatriptan OTC (imigran recovery) 18-65
History of 5/more in last year
30-60 minutes to work

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9
Q

When to be careful with sumatriptan?

A

Interactions MAOI, SSRI/SNRI, St John’s wort
Heart disease

Pregnant/breastfeeding
>50 first migraine
Failed treatment
COC
Migraine lasts over 24hr

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10
Q

How to take sumatriptan

A
  • One 50mg tablet asap
  • Start of headache and not aura unless they occur simultaneously
  • Second dose can be taken 2hr after if symptoms come back
  • No more than 2 tablets in 24hrs or for same attack
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11
Q

Benefit of prescribed treatment

A
  • Improved QOL
  • Reduce frequency, severity and duration of attacks
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12
Q

Counselling advice for migraines

A
  • Keep headache diary
  • Immediate use of simple analgesia
  • Dark and quiet environment
  • Good sleep hygiene
  • Diet and fluid intake
  • COCs
  • Cold compress
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13
Q

What is a TTH?

A

Tension type headache (most common type)
Bilateral

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14
Q

Differentiation of TTH

A

Not aggravated by physical activity
No nausea/vomiting
No photophobia/phonophobia
Relieved by simple analgesics

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15
Q

What are the causes of a TTH?

A

Anxiety, screen time, poor sleep, poor posture, stress

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16
Q

Treatment for TTH

A

Paracetamol/ibuprofen
Syndol
Avoid codeine where possible

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17
Q

Counselling advice for TTH

A
  • Alleviate stress
  • Check sleep hygiene
  • Advice on posture
  • Exercise
  • Regular breaks from screens
  • Acupuncture
18
Q

What is sinusitis?

A

Inflammation of the paranasal sinuses (swelling of the mucosal lining)
Triggered by URT infection

19
Q

Symptoms of sinusitis?

A
  • Unilateral
  • Facial pain/pressure/headache
  • Throbbing & tender to touch
  • Blocked nose (congestion), runny nose (nasal discharge)
  • Loss of smell
  • Fever
20
Q

Treatment of sinusitis

A
  • Analgesia: paracetamol/ibuprofen
  • Intranasal decongestant max 7 days use
  • Nasal irrigation w/saline
  • Refer if signs of infection (fever, severe pain, discoloured discharge)
21
Q

What is a cluster headache?

A

Severe unilateral pain which comes on suddenly

Localised in/around eye
15mins - 3 hours

22
Q

What are the associated symptoms of cluster headaches?

A
  • Nasal congestion
  • Facial flushing/sweating
  • Miosis

Refer to GP

23
Q

What are the red flags of a headache?

A
  • Migraine with COC
  • Headache with temp >38
  • Frequent treatment failure
  • Lasting over 4hrs
  • Children under 12
  • Neck stiffness
24
Q

What does MSK refer to?

A

musculature & skeleton

25
Q

Self-management for back pain?

A
  • Avoid bed rest
  • Increase physical activity over time
  • Local heat/ice packs
26
Q

OTC management for pain?

A
  • NSAID: ibuprofen 400mg TDS
  • Topical NSAIDs (ibuprofen gel/diclofenac gel)
  • Deep heat/deep freeze
  • Paracetamol/codeine combo not on its own
27
Q

What is a sprain?

A

Tear of a ligament

28
Q

Symptoms of a sprain

A

Tenderness, pain around joint, bruising, pain

29
Q

What is a strain?

A

Stretch of the muscle fibres and/or tendon
(Muscle stretched beyond limits)

30
Q

Symptoms of a strain

A

Muscle pain, cramping, spasm, weakness, bruising, inflammation

31
Q

Self management of strain/sprain

A

PRICE (Protect, Rest, Ice, Compression, Elevate)
HARM (Heat, Alcohol, Running, Massage) - avoid for 72hrs after

Heat encourages blood flow
Alcohol increases bleeding/swelling and reduces healing
Running causes further damage
Massage may increase bleeding & swelling

48-72hrs after
Ice should be applied for 15-20 mins every 2-3 hours for 2-3 days (cold reduces blood flow)
Elevation to reduce swelling
Compression to limit swelling

32
Q

OTC management for strain/sprain

A

Adjunctive to PRICE
Paracetamol/topical NSAID
Ibuprofen prn

33
Q

What are the red flags with MSK?

A
  • Severe arthritis
  • Back pain w/painful urination
  • Treatment failure
  • Drug reaction
34
Q

What is insomnia

A

A condition of unsatisfactory sleep

35
Q

Symptoms of insomnia

A

Fatigue, tiredness, lack of energy, irritability, reduced work performance, difficulty concentrating

36
Q

Causes of insomnia

A
  • Physical: pain, nasal congestion, cough, COPD, parkinsons
  • Physiological: poor sleep hygiene
  • Psychological: stress
  • Psychiatric: anxiety, depression, dementia
  • Pharmacological: steroids, decongestants, thyroxine, alcohol, caffeine, substance abuse
37
Q

What is the classification of insomnia?

A
  • Transient (days)
  • Short-term (up to 4 weeks)
  • Chronic (>4 weeks) > always REFER
38
Q

What is the treatment of insomnia?

A

Non-pharmacological
- Sleep hygiene
- CBT
- Relaxation techniques

Pharmacological
- Sedative antihistamines
- Complementary therapy

39
Q

Sleep hygiene advice?

A
  • Comfortable sleep environment
  • Regular sleep schedules
  • Limit caffeine
  • Exercise during day
  • Set regular waking times
40
Q

OTC management of insomnia?

A

Diphenhydramine
- Nytol original 25mg
- Nytol one a night 50mg
Half life 5-8hrs
No longer than 7 nights
Not for under 16

Promethazine
Half life 8-12hrs

SEs hangover effect, anticholinergic

41
Q

Complementary therapy

A
  • Herman sleep aids
    (kalms, valerian, Jamaica)
  • Aromatherapy
  • Nasal plaster
42
Q

Red flags of insomnia

A
  • Suspected depression
  • Chronic (>4 weeks)
  • Children (<16)
  • Suspected alcohol/drug dependence
43
Q
A

PHA333 (4 decks)

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