Common conditions and counter prescribing Flashcards
What are the symptoms of scabies?
- Lesions predominantly on hands/wrists or other sweaty/ folds
- Burrows up to 1cm sometimes visible
- Itching that worsens at night time
What are the symptoms of atopic eczema?
- lesions- red, sore, itchy
- predominantly on hands or joints
- flares up usually in cycles
What are the symptoms of contact dermatitis?
- Lesions - red, itchy, and then will go dry and scaly
- location correlating to something that has contacted the body e.g. jewellery, clothing, chemicals
What are the symptoms of ring worm?
- Lesions- that are red/silver, circular and have a clear advancing edge and cleared centre area
- itching
What treatments can be used for scabies?
- First line treatment is permethrin 5% cream applied once a week for 2 doses all over the body and wash off after 8-12 hours. (over 2 months old)
- Malathion 0.05% lotion- apply once a week for 2 weeks and wash off after 24 hours ( over 2 years)
- Benzyl benzoate cream
- crotamiton cream cream can be used for persistent itching after killing scabies. This is not appropriate in pregnancy though!
General advice for scabies?
- Treat everyone in the household and repeat after a week
- Wash all bedding and clothing at at least 50 degrees and anything that cant be washed, seal in a bag for 3 days
- Don’t share bedding, clothes, towels
- If wash hands during treatment, reapply!
How is scabies spread?
Prolonged skin to skin contact
What treatments can be used for atopic eczema and contact dermatitis?
- Emollient creams
- Steroid creams ( not allowed for children under 10)
General advice for atopic eczema and contact dermatitis?
- Use emollient creams regularly to avoid flare ups
- Try to avoid scratching
- Not contagious
- look out for signs of infection
What is the treatment for ringworm>
Topical imidazole cream
General advice for ringworm?
- Maintaining good hygiene measure to avoid spread
- Avoid scratching
- Once treatment has been started, children can go back to school but should cover the area
- wash towels and sheets regularly
Can children go to school with scabies?
Yes, 24 hours after the first treatment has been applied
How is ringworm spread?
Through close contact or shared infected objects
What are the symptoms of cold sores?
- Prodrome- fever, malaise
- Tingling, itching or
burning sensation - Lesions around the lips and mouth that start as fluid-filled vesicles and then crust over and scab
Treatment for cold sores?
- Topical antivirals e.g. Aciclovir- use in the prodrome stage when tingling or burning symptoms first appear
- paracetamol or ibuprofen for pain or fever
- Amonia e.g. blistex
What are the symptoms of impetigo?
- red sores or blisters/ lesions that have a golden-brown crust
- itching
What is the difference between bullous and non-bulbous impetigo?
- Non-bullous- Usually red lesions that develop into golden crusts like cornflakes and are most commonly around the mouth and nose area
- Bullous- Usually fluid-filled blisters that appear on the centre of the body between waist and neck or arms and legs
What are the treatment for impetigo?
- Hygiene measures- wash with soap and water
- Refer to GP for topical or oral antibiotics:
e.g. topical antiseptic- Hydrogen peroxide 1% cream for non-bulbous or fusidic acid 2% cream for bullous - Oral antibiotic flucloxacillin 500mg tablets
General advice for impetigo
- wash with soap and water
- keep children off school until lesions have crusted over
- wash hands frequently
- wash sheets and towels
- ## don’t touch or scratch sores
What are the symptoms of vaginal candidasis (thrush)?
- White and curd-like (cottage cheese)
- No odour to the discharge
- itchiness
What are the treatments for vaginal candidiasis (thrush)?
- Topical imidazole creams or pessary e.g. clotrimazole or miconazole. Brands can include canastan
- Second like treatment - oral fluconazole capsule- single dose of a 150mg capsule.
General advice for thrush?
- If given fluconazole- inform can reduce effect of latex condoms
- wipe front to back
- wear light, cotton clothes and not those that are tight or humid
- ## avoid deodorants or bubble baths etc
When would you refer a patient with vaginal candidiasis?
- If they are under 16 or over 60 as unlikely to present for first time in these ages and antibiotics are not licensed for it.
- If pregnant- products not licensed
- if diabetic- can be harder to treat so should be referred
What are the symptoms of bacterial vaginosis?
- Grey or white discharge with a fishy odour
- not likely to be itchy
- can be increased with extensive cleaning and use of local irritants
Treatments of bacterial vaginosis?
Reduce use of local irritants
refer to gp for antibiotics
What are the symptoms,ptoms of trichomoniasis?
- Foul- smelling, green-yellow discharge
- Lower abdominal pain, dysuria (pain or burning on urination) and dyspareunia (genital pain during sex)
What are the treatment for trichomoniasis?
- refer to GP for antibiotics and will have a full STI screen
What are the symptoms of cystitis?
- Dysuria- pain and discomfort on urination
- increased urination frequency
- dark, cloudy or strong smelling urine
- abdominal pain
What are the treatments for cystitis?
- Paracetamol or ibuprofen
- lots of fluid to avoid dehydration
- possible referral to GP for antibiotics
What causes cystitis?
Bacteria from the bowel or skin getting into the urethra.
How can you reduce chances of getting cystitis?
- Wipe from front to back
- pee after sex
- drink lots of fluids
- wash around vagina after sex
- avoid scented soaps of bubble baths
- Avoid lots of sugary foods or drinks- can give good environment for bacteria growth
- avoid lots of caffeine or alcohol as can irritate the bladder
What are the symptoms of threadworm?
- Itching around anus or vagina that worsens at night and at bath-time
- Visible worms in poo that are white and about 1 cm
- Lack of sleep, irritability and tiredness
What are the treatment for threadworms?
- Mebendazole tablets- given to everyone in the house and then again 2-3 weeks later (not for children under 2)
- Piperazine- again 2 weeks later (not for under 1)
further doses prevent reinfection
General advice for threadowrms?
- It is not a sign of poor hygiene!
- Maintain good hygiene
- wash all bedding, clothes, towels
- clean house and hoover thoroughly
- wear underwear or clothes to bed too prevent itching
- wash hands thoroughly before handling food, eating and using the loo
- bath or shower every morning to wash away eggs
- keep fingernails short
What are the symptoms of tapeworms?
- Prescence of worm or parts of in faeces. Worms are white, flat and the size of rice.
- intestinal discomfort, diarrhoea, vomitting
- change in appetite
- recent foreign travel likely to be a sign
Treatment for a tapeworm?
Refer to a GP who will likely require a stool sample
What are the symptoms of roundworms?
- Whole worm seen in faeces
- may have a high temperature to dry cough, not usually many symptoms
- recent foreign travel
Treatment for roundworm?
refer to gp
General advice for tapeworm and roundworm?
- Thoroughly cook food especially pork or fish
- Wash fruit and veg in clean bottled water
- Wash hands before handling food, eating and after toileting
- wear pjs to bed
What are the symptoms of hemorrhoids?
- itching or burning around the anus
- dull aching pain on pooing
- fresh blood on stools or toilet paper
- lumps on external anus
- constipation
What is the treatment for haemorrhoids?
- Local anaesthetic e.g. benzocaine, lidocaine
- Skin protectors e.g. zinc oxide
- topical steroid cream e.g. hydrocortisone
- if a child refer to a gp
General advice for a haemorrhoid?
- If symptoms not improved in one week see GP
- Apply creams or ointments in the morning, night and after bowel movements
- good anal hygiene, can use moist toilet paper
- eat lots of fibre, water and exercise to keep poo soft
When would you give antibiotics for impetigo?
- If it has become widespread e.g. presenting a high fever or lethargy
- would give flucloxacillin 250-500mg BD
if allergy to penicillin would give clarithromycin
