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OTC > Common conditions > Flashcards

Common conditions Flashcards

1
Q

Who to report any medical diseases from the notifiable officer?

A

Registered medical practitioners must notify the proper officer at their local council or local health protection team of any patient(s) suspected of suffering from any of the diseases listed below;

NHS ENGAND

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2
Q

What 20-30 diseases should be reported to the notifiable officer?

A

Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diarrhoea (infectious bloody)
Diphtheria
Encephalitis (acute)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Haemorrhagic fever (viral)
Hepatitis (acute infectious)
Legionnaires’ disease
Leprosy
Malaria
Measles
Meningitis (acute)
Meningococcal septicaemia
Mpox (monkeypox)
Mumps
Paratyphoid fever
Plague
Poliomyelitis (acute)
Rabies
Rubella
Severe acute respiratory syndrome (SARS)
Scarlet fever
Smallpox
Streptococcal disease (Group A, invasive)
Tetanus
Tuberculosis
Typhoid fever
Typhus
Whooping cough
Yellow fever

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3
Q

What to also give with IV aciclovir for shingles?

A

IV fluids - as the drug can crystalise

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4
Q

What are threadworms + symptoms?

A

Itching in bum due to to threadlike worm laying eggs in bowel.

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5
Q

What 3 cases to refer threadworm?

A

Recent travel abroad

secondary bacterial infection

If tx fails

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6
Q

What is threadworm treatment?

A

Mebendazole

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7
Q

What is OVEX (mebendazole) age limit?

A

Can be used in 2 and over

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8
Q

How is mebendazole taken?

A

100mg single dose

repeat in 2 weeks if reinfection risk

Treat all family members

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9
Q

Can mebendazole be used in pregnancy?

A

NO - instead follow hygiene measures for 6 weeks

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10
Q

What 5 non-pharmacological advice for threadworm prevention?

A

Wash hands often

shower morning to wash away eggs

regularly wash/iron bedding

DO NO share towels

cut nails short

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11
Q

What is mouth ulcer symptoms?

A

White centres with outer red ring

around tongue, cheecks and lips

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12
Q

When to refer mouth ulcers? (5)

A

If >3 weeks

Painless

> 10mm diameter

> 5 ulcers

Weight loss/ diarrhoea or medication SE - sulfazalazine

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13
Q

What age is bonjela used for mouth ulcers?

A

16 and over

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14
Q

What are 4 OTC products for mouth ulcers?

A

Chlorhexidine - 12+

Benzydamine - 12+ rinse/ 6+ spray

Bonjela - 16+

hydrocortisone Buccal tabs - 12+

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15
Q

What 3 advice to give about mouth ulcers?

A

Avoid spicy, salty hot food,

Increase iron, folate, b12

Brush teeth before chlorhexidine - prevent staining

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16
Q

What are 6 Symptoms of Cold + flu?

A

Blocked runny nose,

cough

sore throat

fever
pain, headache, ear ache

watery eyes

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17
Q

What 4 criteria to refer cold + flu?

A

No improvement in 2 weeks

middle ear pain not improving with mild analgesia

persistant productive cough + fever

vulnerable patients- DM, Asthma, young <3 months, elderly

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18
Q

What is given for cold + flu?

A

Paracetamol

ibuprofen

aspirin

Sudafed

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19
Q

What nasal congestants can be given?

A

Pseudoephedrine, phenylephrine

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20
Q

What is max amount of Pseudoephedrine, phenylephrine that can be bought OTC?

A

Max 720mg - so 12 tabs of 60mg each

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21
Q

How long to use nasal decongestant xylometazoline?

A

Max 7 days - can cause rebound congestions

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22
Q

What conditions to avoid decongestants?

A

HTN

DM

CVD

Glaucoma

Prostatic enlargement

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23
Q

What 3 drug classes interact with pseudoephridine ?

A

MAOI

TCA

BB

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24
Q

What can antihistamines do for cold + flu?

A

Dry up nasal secretions

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25
Q

What is non- pharma afvice for children under 6 for cold and flu?

A

steam inhalation

saline drops

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26
Q

What are 2 types of cough?

A

Productive - chesty, sputum

Non-productive- dry, tickly

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27
Q

What are 10 cough red flags that need referral?

A

More than 3 weeks

chest pain

SOB

wheeze

Pain when inspiration

Recurrent night time cough

Whooping cough

croup

coloured sputum

blood in sputum

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28
Q

What are some 1st line OTC medicines for dry cough for over 12+ (antitussives)

A

Dextromethorphan

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29
Q

Can codeine linctus be used in cough as OTC?

A

No now it is a POM

only for 18+

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30
Q

What 3 expectorants are used OTC for chesty cough in patients 6 and over?

A

Guaifenesin (most common)
Ipecacuanha - covonia
Squill

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31
Q

What is moa of expectorants?

A

Decrease sputum viscosity

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32
Q

What 4 antihistamines are used for chesty coughs as OTC in 6 and over years?

A

Diphenydramine- benylin

promethazine - night nurse

Brompheniramine

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33
Q

What 2 cough OTC medications are used in patients under 6 + safe in pregnant women, elderly?

A

Glycerol

Simple linctus

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34
Q

Can chesty coughs be treated with anti-tussive?

A

NO- mucus can build up, chest infection

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35
Q

Are dry coughs self limiting?

A

Yes- viral

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36
Q

What treatment should be given 1st line for cough in children 6-12?

A

Lifestyle advice first

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37
Q

What are 5 symptoms of BPH?

A

Chronic urinary retention

difficulty peeing

weak urine

difficulty fully emptying bladder

frequent need to pee

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38
Q

What are 4 criteria for referral of BPH?

A

Last less than 3 months

No peeing, blood in pee or cloudy urine in past 3 months

fever -UTI?

If on alpha blockers- hypotension

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39
Q

What 6 medical conditions mean that BPH needs to be referred?

A

Postural hypotension

Heart, liver, kidney issues

uncontrolled DM

Incontinence

previous prostate surgery

Undiagnosed cloudy vision

Surgery for cataract or glaucoma planned

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40
Q

What is OTC treatment for BPH?

A

Tamsulosin 400mcg

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41
Q

What age is tamsulosin licensed for?

A

45-75 years

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42
Q

What 3 criteria to supply tamsulosin?

A

Symptoms 3 months or more

Give 2 week supply first

Further 4 week supply if improvement after 1 4 days.

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43
Q

How to take tamsulosin?

A

Take a 400mcg capsule swallow whole after same meal each day

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44
Q

How many days tamsulosin initial supply?

A

14 days - 2 weeks

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45
Q

What are 2 SEs of tamsulosin?

A

Drowsiness, dizziness

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46
Q

What 3 advice to give patient with BPH?

A

Go to GP after 6 weeks to continue

Every year see doctor to review more OTC supply

DOES NOT increase risk of prostate cancer

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47
Q

When is orlistat given ?

A

If BMI 28 or more

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48
Q

What 5 drugs to not give orlistat with?

A

Levothyroxine - can increase hypo

Amiodarone + ciclosporin - reduce plasma levels

Warfarin

Acarbose

anti- epileptics

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49
Q

Orlistat and ADEK vitamins?

A

Reduced absorption of fat soluble vitamines- take vits night or 2 hours after orlistat

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50
Q

What drug is cautioned in orlistat?

A

Oral contraceptives- additional protection maybe needed if diarrhoea there.

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51
Q

What 6 cases to refer patients who want orlistat?

A

If DM, HTN, High cholesterol

Chronic malabsorption syndrome, cholestasis

pregnancy/breastfeeding

Kidney disease

Does not lose weight after 3 months

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52
Q

What is licensed age for orlistat (alli)?

A

18+

With BMI 30 or 28 and DM HTN or High cholesterol.

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53
Q

How long is orlistat used OTC?

A

6 months max

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54
Q

How to take orlistat?

A

1 60mg Capsule TDS before meals or after up to 1 hour.

Skip dose if meal missed or has no fat

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55
Q

What is lifestyle advice for patients on orlistat?

A

5 portion fruit/ veg

Alcohol 2-3 units day , 14 units max

2.5L fluids

18-30g fibre day

Not substitute for healthy diet/exercise

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56
Q

Why is patient referred to GP for orlistat if they have If DM, HTN, High cholesterol?

A

conditions help with Weight loss so lower prescribed doses may be given.

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57
Q

What are 4 symptoms of constipation?

A

Small hard stools passed less frequently

<3 times a week

straining
Nausea

Cramps/bloat

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58
Q

What is 5 referral criteria for constipation?

A

Bloody stools

unexplained weight/appetite loss

Patients over 40 with change in bowel habit.

Med SE- opioids, TCA, SSRI, aluminium antacids.

Constipation, lethargy, dry skin - hypothyroidism.

stimulant laxative use.

Obstruction

More than 2 weeks

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59
Q

What is 1st line for constipation?

A

Life style

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60
Q

What is 2nd Line for constipation?

A

BOS laxatives

Bulk, osmotic, stimulant

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61
Q

What age is bulk forming laxatives used in?

A

6+

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62
Q

Give 3 examples of bulk laxatives?

A

Isphagula husk
sterculia

methylcellulose

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63
Q

How do bulk laxatives work?

A

Increase fecal mass

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64
Q

How long does it take for bulk laxatives to work?

A

2-3 days full effect

24 hrs some change

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65
Q

What are 2 SE of laxatives?

A

Intestinal obstruction

flatulence

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66
Q

When to NOT take laxatives in the day?

A

Before bed

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67
Q

What age is lactulose allowed in?

A

3 month and older

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68
Q

What age is macrogol allowed in?

A

12+ years

Movicol - 2-11 years

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69
Q

MOA of osmotic laxatives?

A

Increase water in colon , draw fluid from body

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70
Q

How long does it take for osmotic laxatives to work?

A

2-3 days

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71
Q

How long does it take for lactulose to work?

A

48 hrs

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72
Q

What is SE of osmotic laxatives?

A

Discomfort, flatulence

cramps

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73
Q

List 4 stimulant laxatives?

A

senna

bisacodyl

sodium picosulfate

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74
Q

How long does it take for glycerol suppositories to work?

A

15-30 mins

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75
Q

What are doses for glycerol?

A

4g 12 + and adults

2g children under 12

1g infants

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76
Q

What are 3 SE of stimulant laxatives?

A

hypokalaemia

lazy bowel

diarrhoea

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77
Q

What is counselling for stimulant laxative?

A

Take at night to go in morning.

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78
Q

What age is liquid paraffin used as a stool softener in OTC?

A

3+

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79
Q

What to give pregnant woman with constipation?

A

BULK or lactulose

Avoid stimulant

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80
Q

What is cautioned to give elderly for constipation?

A

Bulk - increase risk of gut obstruction + hard to increase fluid.

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81
Q

what is given in children for constipation?

A

Lactulose

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82
Q

What is given in children for constipation?

A

life style first

Lactulose

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83
Q

What is advice for constipation?

A

Life style first line- takes 2 weeks

5 portion fruit/ veg

Alcohol 2-3 units day , 14 units max

2.5L fluids

18-30g fibre day

exercise 30 mins 5 x week

Toileting habit- squat, don’t hurry

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84
Q

What is dyspepsia?

A

Group of abdo symptoms

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85
Q

Causes of dyspepsia?

A

Indigestion

GORD- heartburn

gastritis

GI ulcers

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86
Q

6 Symptoms of dyspepsis?

A

Vague abdo pain above belly button

bloating, flatulence

feeling full early

N + V

Heart burn - GORD

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87
Q

What are 5 ALARM signs for dyspepsia?

A

Anaemia

Loss weight

anorexia

Recently changed/new unexplained dyspepsia in over 55 years

Malena, vomiting, blood in vomit

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88
Q

What else requires referall in dyspepsia?

A

If treatment for 4 weeks or more

Med SE- NSAID, CCB, warfarin, metformin

Refusing PPI, H2 antagonist if has C13 test in 14 days as test will not show

Children

Jaundice

Previous GI surgery

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89
Q

What symptom is linked to peptic ulcer?

A

Persistant boring poitn from 1 point of abdo

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90
Q

What symptom is linked to GASTRIC ulcer?

A

Pain linked to food- 30 mins after eating

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91
Q

What symptom is linked to duodenal ulcer?

A

Pain when stomach empty- 2-3 hrs after eating.

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92
Q

What is OTC product for dyspepsia?

A

Antacids- gaviscon

Alginates- raft on top of stomach contents

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93
Q

What is used in GORD heart burn?

A

Alginates

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94
Q

Is alginates ok in pregnancy?

A

Yes

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95
Q

What can antacids do with tetracyclines, bisphosphonates, quinolones?

A

Impair absorption

leave 2 hr gap

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96
Q

What does antacids do to fluid retention?

A

High Na content

avoid in HTN, HF, KIDNEY issues

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97
Q

Is pepto-bismal , ranitidine or bismuth salts safe in pregnancy for dyspepsia?

A

Nope

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98
Q

What PPI can be given OTC for dyspepsia?

A

Nexium- esomeprozole

Omeprazole+ pantoprozole too

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99
Q

What is max OTC supply of Esomeprozole?

A

14 days supply

Max 4 weeks use

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100
Q

Is PPI recommended in pregnancy for dyspepsia?

A

Not in preg/ breastfeeding.

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101
Q

When to refer to GP for dyspepsia after tx?

A

More than 2 weeks of tx failure

> 4 weeks use

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102
Q

What 2 long term PPI SE?

A

Low mg

Osteoporosis

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103
Q

Omeprazole and warfarin?

A

Increased bleeding

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104
Q

Omeprazole and Phenytoin?

A

Toxicity

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105
Q

Advice for dyspepsia?

A

Smoking cessation

avoid exceess alcohol, coffee , chocolate,

Raise head of bed

Eat 3 hrs before bed- small meals

Avoid spicy/fatty meals

Lose weight

Avoid tight clothing

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106
Q

What are haemorrhoids symptoms?

A

Dull pain when sitting/defacation

slight bleeding

swelling

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107
Q

When to refer haemmorhoids? (10)

A

Blood in stools- dark tarry stools (GI bleed)

Bright red stools

Abdo pian, vomiting, fever,

change in bowel habit

tenesmus - urge to poo when no stool

Sharp stabbing pain pooing - anal tear REFER

More than > 3 weeks

> 1 week otc failure

Constipating medicine

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108
Q

What are bright red stool meaning?

A

Anal fissue

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109
Q

What OTC products are there for haemorrhoids?

A

Soothing agents- anusol

Mild astringents- bismuth

Local anaesthetics -12+

Anusol + HC -18+

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110
Q

What age is anusol allowed?

A

18+

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111
Q

What is max duration of use for anusol with HC?

A

7 days - avoid pregnancy/breastfeeding

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112
Q

Age limit for (local anasthetics) lidocaine in haemorrhoids?

A

12+

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113
Q

advice to prevent haemorrhoids?

A

Increase fibre

treat constipation

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114
Q

What is diarrhoea?

A

Frequent loose stools

dehydration

N +flatulence

abdo cramps

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115
Q

When to refer to GP in diarrhoea?

A

Blood mucus

Change in bowel habit >50 years

weight loss

fecal impaction

sever vom + fever

recent travel abroad

Diarrhoea >3 weeks

Med SE - mg antacids, nsaids,

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116
Q

What is 1st line diarrhoea OTC in all ages?

A

Oral rehydration packets

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117
Q

For under 1 years old with diarrhoea how is oral rehydration sachet made up?

A

Use boiled + cooled water to make it

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118
Q

How long to store oral rehydration sachet mixture in fridge?

A

Make immediately before use + store for 24 hrs

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119
Q

What age is loperamide allowed otc?

A

12 +

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120
Q

What is max tabs of loperamide allowed per day?

A

8 tabs

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121
Q

Is loperamide allowed in preg/breastfeeding?

A

NO

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122
Q

What age is bismuth salicylate allowed in for diarrhoea?

A

16+ -

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123
Q

When to avoid bismuth salicylate?

A

If allergic to aspirin

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124
Q

What advice for babies with diarrhoea?

A

Dilute formula feeds to quarter strength + build up to normal over 3 days

feed more than normal + fluids.

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125
Q

What type of drinks to avoid in diarrhoea?

A

Sugary drinks + milk

drink bottled water when abroad

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126
Q

When to refer in acute diarrhoea? (3)

A

If babies <3 months have it ASAP

Under 1, diabetic or elderly - refer if more than 1 day

If under 3 years > 2 days

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127
Q

How many days diarrhoea before referring?

A

If 3 or more days

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128
Q

What are 4 signs of dehydration?

A

Dry skin/tongue

sunken eyes

less pee

depressed fontanelle in babies (head)

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129
Q

What is scabies symptoms?

A

Intense itching

worse at night

small grey lines, red ish.

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130
Q

What 4 cases to refer scabies?

A

Unclear diagnosis

babies and children

secondary infection

Tx failure

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131
Q

What is used as OTC for scabies?

A

Permetrin 5% cream

(lyclear)

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132
Q

What age is permethrin allowed OTC for scabies?

A

2 months and over

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133
Q

How to use permethrin?

A

Apply and leave for 8-12 hrs before washing off

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134
Q

What is 2nd OTC product for scabies?

A

Malathion - use in 6 months

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135
Q

How long to leave malathion before washing off?

A

12 hrs

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136
Q

How to treat scabies?

A

Apply to entire body.

2 treatments, 7 days apart

Treat all contacts at same time

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137
Q

When can adults + children return to work/school after scabies?

A

After 1st treatment

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138
Q

What is non- pharma advice for scabies?

A

Avoid close contact with others

itch will not stop immediately

Wash clothes + bed linen at >50 degrees

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139
Q

What is live lice?

A

Grey brown insects

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140
Q

What are nits?

A

Cream eggs- does not mean infestation

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141
Q

What is OTC for head lice?

A

Dimeticone 1st line

Malathion- alternative

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142
Q

What otc med for head lice has resistance to it?

A

Malathion

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143
Q

How to apply Dimeticone for headlice?

A

2 applications a week apart to get rid of hatched lice

Repeat after 7 days

Leave on for 8 hrs

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144
Q

What type of head lice prep to avoid in asthma/eczema?

A

Alcoholic prep- but more effective

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145
Q

What is a mechanical method of removing head lice?

A

fine tooth comb, every 4 days for 2 weeks until they gone.

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146
Q

Why are headlice shampoos not good?

A

Too diluted

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147
Q

How long to leave head lice liquids or lotions?

A

8–12 hours or overnight treatment is recommended.

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148
Q

Why to not use insecticides to prevent headlice?

A

Resistance

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149
Q

What are 2 Symptoms of hayfever?

A

Itchy watery eyes
Nasal symptoms

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150
Q

When to refer hayfever?

A

If chest tightness

Wheeze

SOB

Cough

Purulent conjunctivitis - eye infection

Painful ear/sinuses

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151
Q

What is otc use for hayfever?

A

non sedating Antihistamines e.g. cetitirizine, opticrom, beconaze.

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152
Q

What is a SE of older antihistamines?

A

More sedating

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153
Q

What 3 conditions should patients be cautioned when taking anti-histamines?

A

Epilepsy

Glaucoma

BPH

154
Q

What antidepressant class is CI with sedating antihistamine?

A

MAOI + up till 14 days of stopping MAOI.

155
Q

What age is benadryl (acrivastine) allowed in?

A

12-65 years

TDS

156
Q

What age can loratadine be used in?

A

2 and older - liquid
2+ for tab

157
Q

What age can cetirizine be used in?

A

licensed for 2 and over for liquid

158
Q

What is age limit for piriton tabs?

A

6+ years tabs

159
Q

What is age limit for steroid nasal sprays?

A

18+

160
Q

Examples of steroid nasal sprays?

A

Fluticasone

beclometasone

161
Q

How to reduce risk of hayfever?

A

Close windows, stay inside if pollen count high

Wrap around glasses

avoid grassy areas

162
Q

3 symptoms of sore throat?

A

Pain from back of throat, swallowing, swollen lymphW

163
Q

When to refer sore throat?

A

More than 1 week

dysphagia

horse voice for more than 3 weeks

extreme pain + no improvement within 24-48 hrs

MED SE- carbimazole, MTX

oral thrush- miconazole

High fever, red tonsils

164
Q

What 4 types of otc meds used for sore throat?

A

Pain releif - ibuprofen, paracetamol

Losenges

NSAIDs- anti-inflammatory e.g. benzdamine difflam spray

Lidocaine - numb pain

165
Q

What 4 ingrediates do antibac + antifunal lozenges have?

A

Chlorhexidine

thryothricin

benzalkonium chloride

cetylpyridinum chloride

166
Q

Advice for sore throat?

A

Gargle salt water, fluids, eat cool soft food,

diabetics- use sugar free

avoid smoking

167
Q

List 4 types of fungal infections? Slide

A

Tinea pedis

Tinea corporis - body

Tinea capatis

Tinea cruris - jock itch

168
Q

What age is lidocaine for in sore throat?

A

12+

169
Q

What is max use of flurbiprofen?

A

3 days max

Max 5 lozenges in 24 hrs

170
Q

What 6 criteria to refer fungal infection?

A

Face/scalp inolved

Toenails affected in athletes

Large area

Broken skin

Bacterial infection

Diabetes/immunocomp

OTC failed after 2 weeks

171
Q

What is 1st line OTC for fungal infections in all ages?

A

Clotrimazole or miconazole

172
Q

What is 1st line OTC for fungal infections in adults??

A

Ketokonazole - not anymore I think due to MHRA alert recall.

173
Q

What is terbinafine age (lamisil?)

A

16+

174
Q

What is terbinafine age (Lamisil once?)- solution

A

18+

175
Q

What is daktacort 15g licensing for use , age?

A

10 + years

7 day use only

Apply thinly BD

176
Q

What powder can be used prophylactically for athletes foot?

A

Mycota, mycil

177
Q

What 4 advice to give for fungal infection?

A

Contine at least 7 days after symptoms disappear

contagious

avoid towel sharing

Change socks often

178
Q

What is a corn/callus?

A

Yellow thick skin caused by friction on skin

179
Q

What 4 criteria to refer corn/callus?

A

Diabetic

treatment failed

impaired circulation

soft corns

180
Q

What otc product given for corns?

A

Corn plaster

181
Q

What is cradle cap?

A

Yellow scales on scalp - 6 months

182
Q

What to do for cradle cap?

A

Self limiting

goes away in weeks

183
Q

What 2 products for Cradle cap?

A

Olive oil

capasal shampoo

184
Q

When to refer cradle cap? (3)

A

Severe on face/body

Swelling, scratching, bleeding

infected/ inflamed - need abx?

185
Q

What is meningitis main symptom?

A

Non blanching rash

others - flu , fever, muscle ache, N + V

186
Q

What are 5 specific meningitis symptomd?

A

Stiff neck

severe headache

cold hand/feet

confusion, drowsiness

photophobia- hate bright lights.

187
Q

What are some meningitis symptoms in infants?

A

Floppiness

Dislike being handled

not eating, waking up

rapid breathing

unusual cry

bulging fontanelle

188
Q

What to do in meningitis?

A

REFER serious

189
Q

What type of meningitis does not need refering?

A

Viral - treated at home

paracetamol, ibu

190
Q

What are 4 measles symptoms?

A

Koplik spot - white in tongue

Cold like

fever

conjunctivitis

191
Q

What are 3 symptoms of mumps?

A

FEVER

headache

malaise

192
Q

What is rubella symptom?

A

lymphadenopathy

193
Q

How does measles rash start?

A

Red blotchy, confluent rash starts behind ears and moves

194
Q

Where does rubella rash start?

A

Start in face + spread to limbs

Pink, non confluent rash

195
Q

What to do if Measles, mumps, rubella?

A

Refer -notifiable disease

Only pain relief

196
Q

What 5 advice in MMR?

A

rest

hydrate

keep AWAY from school during contagious period

Avoid acidic drinks. - mumps

Rubella - away from pregnant women

197
Q

What drink to avoid in mumps?

A

Fizzy

198
Q

How long to keep children off school in measles?

A

4 DAYS AFTER RASH forms

most dangerous - otitis media, pneumonia

199
Q

How long to keep children off school in mumps?

A

5 days after swelling happens

200
Q

How long to keep children off school in rubella?

A

5 days after rash

201
Q

Why should rubella patients stay away from pregnant women?

A

Foetal damage

202
Q

What is 4 nappy rash referral criteria?

A

Broken skin

yellow crust- infection

Other parts affected

After otc tx fails> 1 week

203
Q

What to give as OTC for nappy rash?

A

Antifungal - clotrimazole, miconazole

Barrier preps- metanium

204
Q

What advice for nappy rash?

A

Change pampers asap

avoid waterproof nappies

Wash area well.

205
Q

What is fungal nappy rash symptom?

A

Satelite rash- small spots on outer area of rash.

206
Q

What 3 criteria to refer oral thrush?

A

Children/adults

Recurrent

OTC fails

207
Q

What is OTC for oral thrush?

A

Daktarin

208
Q

What is daktarin age limit?

A

4 months +

209
Q

How to apply daktarin?

A

Apply qds in oral thrush

Continue 1 week after symptoms go.

do not apply to back of throat - choking

210
Q

What virus causes slapped cheek ?

A

Parovirus

210
Q

What does miconazole interact with?

A

Warfarin

211
Q

What are slapped check symptoms?

A

Bright rash on cheeks

Light pink rash on limb

cold like symptoms - most contagious period

212
Q

When to refer slapped cheek?

A

If pregnant woman exposed

Blood disorder

severe anaemia symptoms

213
Q

What is OTC product for slapped cheek?

A

Paracetamol/ ibu

antihistamine - piriton

214
Q

When is slapped cheek condition contagious?

A

During cold symptoms phase

After rash = not contagious

215
Q

Do you need to keep child off school for slapped cheek?

A

No- rash appears so it is fine

216
Q

What are 3 fungal nail infection symptoms?

A

Dull yellow

Nail thickens

brittle

217
Q

When to refer fungal nail?

A

DM

Circulatory diseas

Immunocomp

Other nail infection or nail breaking away - need terbinafine

More than 2 nails affected

218
Q

What is OTC fungal nail infection tx?

A

Amorolfine nail lacquer (18+)

219
Q

What indication is Amorolfine used in?

A

DLSO - distal lateral subungal onchomycosis

220
Q

Can pregnant women use amorolfine?

A

NO CI in preg/breastfeeding

221
Q

How long does it take for nail fungal to go with amorolofine nail laquer?

A

Toe - 9-12 month

finger -6 months

222
Q

1 pack of amorolofine?

A

3 month supply

223
Q

How to use amorolofine?

A

Apply 1 weekly

file nail surface
clean well + apply lacquer

224
Q

CAN the amorolofine nail laquer treat whole nail?

A

No only the sides/and under nails

224
Q

What are 4 symptoms of psoriasis?

A

red plaques

silvery scales

225
Q

When to refer psorias?

A

If mod-sever

undiagnosed

226
Q

What otc products for psoriasis?

A

Emollient

12+ coal tar solution

227
Q

What are 2 SE of coal tar solution?

A

Photosensitive + skin irritation

228
Q

What virus is cold sore caused by?

A

HSV1

229
Q

What 2 symptoms of cold sore?

A

Tingling sensation

blister mouth, lips

230
Q

Wjen to refer cold sore?

A

painless
babies
Immunocomp
Eye affected

Cold sore> 2 weeks

Sore inside mouth

Pt with atopic eczema

231
Q

What otc is used for cold sores

A

Aciclovir- zovirax

Apply 5 times daily for 4 days

Max 10 days

232
Q

What age is penciclovir used?

A

12+

8 TIMES day for 4 days

2 hrly intervals

233
Q

What advice to prevent cold sores?

A

contagious

wash hands after applying cream

infection -can spread to eye so stop touching

avoid kissing, oral sex, sharing cutlery

reccurent- for life

234
Q

Is cold sore contagious?

A

YES - until crust forms

235
Q

How do warts look like?

A

Flesh coloured, raised surface

236
Q

How do verrucae look like?

A

Flat, occur on sole of feet

Black dots in middle

Can be painful

237
Q

When do warts disappear?

A

Naturally within 6 months to 2 years

238
Q

When to refer warts/verrucae?

A

Facial warts

Multiple warts
diabetic/ immunocomp

Itching/bleeding

change in size colour

OTC failed >3 months

239
Q

How long does it take for warts to go with OTC?

A

12 WEEKS ISH

240
Q

What otc product is used for warts/verruca?

A

Salicylic acid - bazuka

soften + destroy the wart

241
Q

How to use salicylic acid for wart/veruca?

A

Soak affected area in warm water for 5 mins

Apply daily, protect healthy skin

Remove dead skin every week

242
Q

When to refer patients who want EHC? (4)

A

> 5 days sinces UPS

Changes in period

Severe liver dysfunction

Enzyme inducers - phenytoin, carba, rifamp

243
Q

Levonorgestrel and ciclosporin?

A

Increase toxicity

244
Q

Can advanced supply of EHC be given?

A

Yes

245
Q

What are 4 symptoms of cystitis?

A

pain peeing

urinary freq + urgency

incomplete bladder emptying

dark, cloudy, strong smelling urine

246
Q

When 4 criteria to refer patients with cystitis?

A

Under 16 or over 70

men + children -rare

recurrent attacks -2 or more in 6 months or 3 in 1 year

duration >48

SEVERE symptoms

flank pain

systemic

Haematuria

Med SE

pregnant

Diabetic. immunocomp

247
Q

What to do if cystitis symptoms for >48 hours?

A

refer

248
Q

What to give OTC in cystitis?

A

Potassium citrate or sodium citratr

249
Q

How many days to use OTC for cystitis?

A

2 days only

250
Q

Advice for cystitis?

A

Cranberry juice

Water

pee after sex

wipe front to back

251
Q

What does recurrent attacks refer to in cystitis?

A

recurrent attacks -2 or more in 6 months or 3 in 1 year

252
Q

What is menorrhagia?

A

Heavy periods

253
Q

When to refer menorrhagia (heavy period)?

A

Under 18 or over 45 years

OTC failed - used 3 cycles and not working

intermenstrual bleed

renal fail

Med - warfarin

family endo cancer hx

VTE/preg/obesity/diabetes/

COC or PCOS

254
Q

What is otc used in menorrhagia?

A

Tranexamic acid

255
Q

What is otc licensing for tranexamic acid?

A

18-45 years

and regular 21 to 35 day cycles

No MORE THAN 3 DAYS variation

256
Q

What is dose of tranexamic acid?

A

2 x 500mg tabs TDS max 4 days

Heavy - take 4 times day

257
Q

What is SE of tranexamic acid?

A

N, V, D

Rare = visual or thromboembolic

258
Q

What are 3 contraindications of Tranexamic acid?

A

Hypersensitivity, haematuria, Renal failure

259
Q

How often to change tampoms?

A

2 hourly

260
Q

Symptoms of dysmenorrhea (period pain)?

A

Lower abdo pain

back pain , N,V, D + fatigue

261
Q

What criteria to refer period pain?

A

pain increases during pain

woman > 30 years

Vaginal bleeding post-menopause

Taking oral contraceptives

intermenstrual pain/bleed

Fever

262
Q

What is OTC product for dysmenorrhoea?

A

Feminax - NSAIDS

263
Q

Naproxen medicine type?

A

P med now

264
Q

What age to use ibuprofen for period pain?

A

12+

265
Q

What is OTC licensing age of naproxen for period pain?

A

15-50 years

266
Q

What is dose of naproxen for period pain?

A

500mg (2 tabs) and 1 further 250mg tab 6 to 8 hrs later PRN.

Max 3 tabs a day

Max 3 day use in 1 month

267
Q

What is 1 caution of using naproxen for period pain?

A

Asthma

268
Q

What are contraindications of feminax?

A

GI events

Severe HF, Kidney liver disease

stroke

anticoagulants

allergies

pregnant

269
Q

What are some symptoms of vulvovaginal thrush?

A

Itching sore, cottage cheese discharge, NO SMELL.

Pain during sex

stinging of skin when peeing due to scratching

270
Q

When to refer vaginal thrush? (7)

A

Abnormal vaginal discharge- smell and colour, fishy, yellow green (trichomoniasis)

Low abdo pain, vaginal spotting, bleeding

Vulval sores, ulcers, blisters

STI

Med SE - Abx, contraceptive, immunosuppressant.

271
Q

What 3 patient group predisposed to thrush and need referring?

A

Pregnancy

Diabetic

immunocomp

272
Q

What 2 otc products for vaginal thrush?

A

clotrimazole pessary + internal cream

Oral fluconazole - single dose

273
Q

What otc product better for immediate relief of thrush?

A

clotrimazole pessary

274
Q

What age is clotrimazole thrush cream for?

A

16-60 years

275
Q

TX for men with penile thrush whose female partner has thrush?

A

Men with symptoms caused by female partner’s thrush can use oral fluconazole

276
Q

Advice for vaginal thrush?

A

Cotton underwear loose clothing

avoid perfume soap

wipe front to back

change pads often

Yoghurt - apply to vag?

277
Q

What is whooping cough?

A

Pertussis

278
Q

What 2 symptoms of whooping cough?

A

Initial - runny nose, watery eyes, sore throat.

Intense cough bouts- thick mucus, vomiting

whoop - gasp air

279
Q

What to do if whooping cough?

A

Refer - all cases abx if <3 weeks

A + E if breathing difficulties

fever - paracetamol/ibu

280
Q

Is whooping cough contagious?

A

YES

stay away from school 5 days after starting abx

or 3 weeks after cough started.

281
Q

What is chicken pox symptoms?

A

Small red spots, itchy, infectious blister- crusts.

Prodromal symptoms

282
Q

What are prodromal symptoms of chicken pox?

A

Happens 3 days before chicken pox

Fever, sore throat, myalgia, malaise

283
Q

What 4 criteria to refer chicken pox?

A

Preg women

Weak immune system

Adults

Infants under 4 weeks - high risk

Shingles- over 50, pregnant, severe rash pregnant.

Re-infection with Varicella zoster virus

Blisters on one side of body

284
Q

What are 3 OTC option for chicken pox itching?

A

calamine lotion

Crotamiton/eurax

1+ chlorphenamine- piriton

285
Q

What is OTC option for chicken pox for fever?

A

Paracetamol only

286
Q

What drug to avoid during chicken pox for fever?

A

Ibuprofen - can cause serious skin reaction

287
Q

When are chicken pox lesions contagious?

A

Infectious until spots have crusted over

Direct contact with blister + air droplets – coughing

288
Q

What is eczema symptoms?

A

Sore inflammed rash

dry flaky

irritated, itchy skin

289
Q

What is contact dermatitis?

A

Caused by irritants or allergic reaction

290
Q

What 6 criteria to refer in eczema/dermatitis?

A

infected skin

severe rash

broken skin

on face/genital area

Symptoms > 2 weeks or otc failed> 7 days

291
Q

What are some otc treatments for eczema protection?

A

Emolients

Ointment -hydrating
Soap substitutes

Calamine/eurax for itching - GSL

292
Q

What is use of steroid in eczema?

A

Reduce inflammation

Mild to moderate

293
Q

What age is clobetasone used in for eczema?

A

12+

294
Q

What is steroid licensing for eczema?

A

Max 15g pack size

Max use 7 days - not in broken skin, no face, Not in pregnancy

295
Q

What 3 skin conditions are steroids CI in?

A

Acne

rosacea

skin infections -cold sore, impetigo

296
Q

What are 4 symptoms of acne?

A

White head -closed comedones

black head - open

Spots - red papules

Pustules - pus filled

297
Q

Who to refer with acne?

A

Otc failed > 8 weeks
children under 12

Adults over 25 - first time

Acne rosacea

Appears back chest NOT fac

Med SE- phenytoin, progestogen

Mod-severe

298
Q

What is otc product for acne?

A

Benzoyl peroxide

start low strength then increase to 10%

299
Q

How to apply benzoyl peroxide?

A

Wash skin before applying

8 weeks to improve- 4-6 month for full effect

Apply to whole area affected.

300
Q

What are Benzoyl peroxide SE?

A

Bleaches clothes, avoid direct sun, can cause stinging, red, peeling

301
Q

What is 3 symptoms of irritable bowel syndrome?

A

Lower abdo cramp

bloating

constipation + diarrhoea

302
Q

What factors can cause IBS?

A

Stress, depression, lack of fibre, anxiety

303
Q

What 6 criteria to refer ibs?

A

Children

over 45 - first time symptom

blood in stoot

Bowel obstruction

Unexplained weight loss

Pregnant

Fever, nausea, vomiting, Severe pain - IBD

depression - ssris

304
Q

What 3 anti-spasmodic drugs that help with IBS?

A

Mebeverine 18+

Alverine 12+

Peppermint oil 12+/15+

305
Q

What is a common SE of peppermint oil?

A

Heartburn

306
Q

What 2 antimuscarinics for IBS?

A

Hyoscine - 12+

dicycloverine 12+

307
Q

What interaction can happen with anti-muscarinics?

A

High ACB due to TCA, antihistamine effect

308
Q

What 2 condition to avoid anti-muscarinics?

A

Glaucoma

Prostatic enlargement

309
Q

What age limit for loperamide in Irritable bowel syndrome?

A

Has to be for tx of acute diarrhoea linked to IBS (after initial diagnosis by a doctor) in adults over 18 years.

310
Q

What is otitis media symptoms?

A

Throbbing ear ache

Discharge

311
Q

When does otitis media go away?

A

After 3 days self limiting

312
Q

What is otitis externa?

A

Swimmers ear

inflammation ear canal,
itchy

313
Q

When to refer otitis media?

A

when analgesia does not fix pain

systemic symptoms

no improvement after 3 days

high risk - immuno comp

children <2 years with both ears

314
Q

When to refer otitis externa?

A

Deafness

tinitis

blocker ear

N + V

children under 12

315
Q

When to refer ear wax build up?

A

OTC failed

tinnitis

persistant pain

316
Q

What is treatment for otitis media?

A

Self limiting

simple analgesia

317
Q

What is 1st line otc otitis externa?

A

Ear calm spray- acetic acid

318
Q

What is age limit for ear calm?

A

12+

319
Q

When to refer otitis externa?

A

after 2 days of no improvement with otc tx.

320
Q

What to give for ear wax build up?

A

Olive oil

arachis oil

321
Q

What are symptoms of fever?

A

High temp above 38 degrees

high grade is over 39.

322
Q

When to refer fever in children?

A

<3 months - fever 38 and over

3-6 months - fever 39 or over and lasts more than 24 hrs.

If > 6 months and lasts > 3 days.

Dehydrations, floppiness, drowsiness, vom, rash, convulsions.

323
Q

What to give for fever?

A

paracetamol ibu

324
Q

What is non bullous impetigo?

A

Small red sores around nose and mouth

can become blisters + burst

325
Q

What is bullous impetigo?

A

Common in neonates

start as fluid fill blister on arm legs

SPREADS more

Paun

fever + swollen lymph common

326
Q

What to do with impetigo?

A

REFER

topical fusidic in mild cases - which is pom

OTC- paracetamol

327
Q

Is impetigo contagious?

A

YES

328
Q

What are symptoms of scarlet fever?

A

Pink red itchy rash

develops 12-48 hrs after initial symptoms

329
Q

What are some initial symptoms of scarlet fever before the rash?

A

Sore throat, headache, high temp , flushed cheeks, swollen tongue

330
Q

What is needed for scarlet fever?

A

Abx phenoxymethylpen for 10 days

331
Q

What otc helps with itching and fever in scarlet fever?

A

Paracetamol

antihistamine

332
Q

How many days off school for scarlet fever

A

at least 24 hrs after starting abx

333
Q

What 6 diseases to stay off school?

A

MMR
Scarlet fever
Impetigo
Whooping cough
Chicken pox
scabies

334
Q

What is symptom of cluster headache?

A

intense pain in 1 eye

335
Q

What is tension headache?

A

Tight band , constant

336
Q

What is migraine?

A

Unilateral throbbing pain

N +V

Migraine with/without aura

photosensitivity

337
Q

When to refer in migraine?

A

1st migraine 50+

4 or more attacks a month

migraine symptoms have changed

more than 24 hr headache

renal/cvd/liver failure/epilepsy

338
Q

When is sumatriptan cautioned?

A

Epilepsy

339
Q

When is sumatriptan avoided?

A

Liver or renal impair

CVD disease, HTN

340
Q

When to refer headache?

A

Neck stiff

under 12

recent head injury

> 4 hrs

taking COC

Severe when lying down.

341
Q

What is used for otc migraine + headaches?

A

Analgesia- paracetamol, ibuprofen, aspirin.

Codeine

Antiemetics - prochlorperazine/ buclizine

sumatriptan

342
Q

What age is sumatriptan given as P?

A

18-65 years

343
Q

What is otc licensing for sumatriptan?

A

Migraine with or without aura

Previously tried analgesia

Established
diagnosed- by either doc or pharm

344
Q

How to take sumatriptan?

A

50mg asap after migraine

Second one can be taken 2hrs if migraine reoccurs

Max 2 tabs in 24 hrs

345
Q

What is insomnia referral?

A

Chronic >3 weeks

under 16

MED SE

suspected depression

346
Q

What otc drugs can be given for insomnia?

A

Diphenydramine

promethazine

both 16+

347
Q

What 2 crtieria to refer motion sickness?

A

Symptom after stopping tavel

Pt taking other anticholinergic drugs - TCA

348
Q

What OTC meds for journey under 4 hrs?

A

Hyoscine - take up to 30 mins before

Kwells, kwells kids, joy ride

349
Q

What age can kwells be used in?

A

10 +

350
Q

What age can kwells kids be used in?

A

4+

351
Q

What is given for motion sickness if journey longer than 24 hrs?

A

Hyoscine patch 10+ years

Lasts 72 hrs

352
Q

What 2 conditions are hyoscine contraindicated in?

A

Glaucoma

Prostatic enlargement

353
Q

What 2 antihistamines can be given for motion sickness for journeys 4-8 hrs?

A

Cinnarizine - 5+ (last 8 hrs)

Promethazine - 2+ (last 6-8 hrs)

354
Q

What alternative methods for motion sickness ?

A

Acupressure wristband

ginger

Good for preg/BF women

355
Q

What is symptom of bacterial conjunctivitis?

A

Both eyes

Sticky, purulent

redness
grity

356
Q

What is viral conjunctivitis symptoms?

A

Both eyes

watery discharge

redness

gritty

cold- flu syx

357
Q

What is allergic conjunctivitis symptoms?

A

Both eyes

clear watery discharge

red eyes

ITCHY

Hayfever, sneezing.

358
Q

When to refer conjunctivitis?

A

True eye pain

photophobia

vision affected

contacts

foreign body

eyes/head trauma

laser eye

glaucoma, keratitis, uveitis

359
Q

What is glaucoma symptom?

A

sudden sever eye pain

N + V

cloudy eye, blurred v + halos

360
Q

What symptoms in keratitis?

A

Loss of vision

photophobia

redness iris

361
Q

What are symptoms of uveitis?

A

Affect 1 eye

Irregular shaped pupil

photophobia

unreactive to light

362
Q

What is 1st line otc bacterial conjunct?

A

2+ years- chloramphenicol

363
Q

How to store chloramphenicol eye drops and apply it?

A

fridge

every 2 hrs for first 48 hrs then every 4 hours during waking hours for 5 days.

364
Q

How to apply eye ointment?

A

3-4 times daily for 5 days

365
Q

When to refer bacterial conjunctivits after tx?

A

after 48 hrs of not working

366
Q

What is a CI with chloramphenicol?

A

Family hx of blood disorders, hx of myelosupression

367
Q

What is piriton liquid age?

A

1+

368
Q

What is Diphenhydramine age?

A

16

369
Q

Who to not give sildenafil to? (3)

A

CVD- nitrates,

low BP

Those advised not to

370
Q

How to use miconazole?

A

use until 10 days after lesions clear for a minimum of 2 weeks

371
Q

How to use hydrocortisone cream?

A

Apply BD thin amount, not on face/ broken skin.

7 day max use

372
Q

Gap to leave between doxycycline and antacids.

A

oral Antacids greatly decrease the absorption of oral Doxycycline. Manufacturer advises separate administration by 2 to 3 hours.

373
Q

What criteria to not take coco-domol?

A

Head injury

sleep apnoea/ tonsillitis removed

Preg/breastfeeding

Adrenal gland/liver issues

breathing issues

374
Q

When can gina be used for HRT?

A

vaginal atrophy in postmenopausal women over 50 years and who have not had a period for at least 1 year.

Not allowed in past endo cancer

375
Q

What 2 vitamins not affected by orlistat?

A

B + C

376
Q

What is glandular fever caused by?

A

Epstein barr virus

377
Q

How long are you infectious with glandular fever for before symptoms?

A

You’re infectious for up to 7 weeks before you get symptoms, and you may be infectious for several months after being unwell.

378
Q

How to treat glandular fever?

A

self limiting,- paracetamol/ibu pain relief.

379
Q

Hows does glandular fever get passed?

A

Kissing, cutlery, spit

OTC (3 decks)

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