Community Pharmacy (OTC) Flashcards
How long should daktarin gel be applied for?
During symptomatic period and for 7 days after symptoms have cleared up
What would be first line for period pains (primary dysmenorrhoea)?
NSAID
Can offer paracetamol as well or if NSAID contraindicated
What doesOtrivine Extra Dual Relief nasal spray contain and what is it used for?What is the age licensing for OTC?
Symptomatic treatment of nasal congestion and rhinorrhea in connection with common colds. Ipratropium bromide xylometazoline hydrochloride > 18 years
What would be first line for a sprain?What is second line?
Paracetamol or TOPICAL NSAIDIf no improvement after 48 hours of injury, use an oral NSAID
What should you recommend if a pregnant or breastfeeding lady comes in with oral thrush?
Refer
True or false:In oral thrush, white patches cannot be removed easily from the tongue
False- they can be removed easily leaving a red base
What are the symptoms of oral thrush?
Patches of curd-like, white or yellowish plaques that can occur anywhere in the mouth, especially the cheeks, gums,palate, and tongue. These are easily removed, revealing an underlying red base that is not usually painful.
What is this?
Angular stomatitis-
soreness, erythema and fissuring at the angles of the mouth
How does the afe licensing of OTC loperamide differ in the following indications:i) Acute diarrhoeaii) Acute diarrhoea associated with IBS
i) 12 years and older
ii) 18 years and older if associated with IBS, and need to have diagnosis by the doctor
What age should you refer someone with constipation?
<18 to rule out underlying causes
Constipation lasting how long with no identifiable cause prompts a referral?|
2 weeks adults
1 week children
When should you stop using EarCalm and what is the maximum number of days you can use it OTC?
Treatment should be continued until two days after symptoms have disappeared but no longer than 7 days
What age is acetic acid (EarCalm) licensed in?
12+
What are the main differences of presentation for viral and allergic conjuctivitis?
Viral can be bilateral or unilateralAllergic is bilateral, red and gritty
Is allergic conjuctivitis contagious?
No
What iare the different types of conjunctivitis?
ALLERGIC?
VIRAL?
BACTERIAL?
Allergic conjuctivitis
What is this?
Bacterial conjuctivitis
What is this?
Blepharitis
What is the advice for patients with blepharitis?
Maintain good eyelid hygiene (BD then OD)Remove debris from eyelids, can use baby shampoo to do thisWarm compressEye make up can make the condition worse
In patients with blepharitis, can their eyelids stick together?
Yes, can also be itchy and have a build up of debris
How long does acute otitismedia usually last?When would antibiotics be indicated?
3 days (can be up to a week) If symptoms do not improve by themself after 3 days or if patient is systemically unwell, consider antibiotics (amoxicillin)
A rash like this indicates what?
Scarlet fever - refer
A rash like this indicates what?
Chicken pox
What is the likely diagnosis and what would you do if a child presented with this in community pharmacy?
Scarlet FeverRefer as it is caused by Strep A and need antibiotics
What are the symptoms of scarlet fever?
Sore throat, fever, extensive red rash (sandpaper like as it is rough)The rash usually starts on the trunk before spreading. NO rash on the face but cheeks can be flushed Strawberry tongue - red papillae and white coating
Scarlet fever is caused by what?
Group A strep
Should Hedrin (dimeticone) be applied to wet or dry hair?
Dry
Apart from if the child is very young, after how many days should a child see their GP with a fever?
If it hasn’t reduced after 5 daysAny other warning signs e.g. if it isn’t reduced by paracetamol, if they have a rash etc
What are the symptoms of Reye’s Syndrome?
- Vomiting repeatedly- Tiredness and lack of interest or enthusiasm- Rapid breathing- SeizuresAs the condition progresses, the symptoms may get more severe and more wide-ranging, and can include:-Irritability, or irrational or aggressive behaviour-Severe anxiety and confusion that’s sometimes associated with hallucinations- Coma (loss of consciousness)
The difference between German measles and measles (morbilli) is what?
Measles manifests itself with white spots in the mouth.
Rubella is also known as what?
German measles
Which illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?
Measles
A patient has severe itchy hands, particularly at night. You notice silver lines with a dot at the end in the webs of her fingers.What is this?
Scabies
Discharge coming out the ear can indicate what?
Ear infection- refer
What is the dose of paracetamol for 12-15 years?
480-750mg QDS
What is the dose of paracetamol for 10-11 years?
500g QDS
What is the dose of paracetamol for 8-9 years?
375mg QDS
What is the dose of paracetamol for 6-7 years?
250mg QDS
What is the dose of paracetamol for 4-5 years?
240mg QDS
What is the dose of paracetamol for 2-3 years?
180mg QDS
What is the dose of paracetamol for 6 months-2 years?
120mg QDS
What is the dose of paracetamol for 3-5 months?
60mg QDS
What is the dose of paracetamol for a 2 month old?
30-60mg TDS
What does Level 1, 2 and 3 healthy living pharmacies entail?
Level 1- Promoting health, wellbeing and self-care (profession-led)Level 2 - Providing services (commissioner-led)Level 3 - Providing treatment (commissioner-led)
How many levels of healthy living pharmacy is there?
Level 1, 2 and 3Need to be on the HLP register
Miss W is a 19 year old patient who has developed several painful red lumps and patches (that measure 1-5 cm) on her lower legsWhat advice should you give?
These lumps are characteristic of erythema nodosum. Treatment is usually rest and painkillers such as NSAIDs.- The bumps and patches last about two weeks before fading like a bruise.
Psuedoephedrine is cautioned in what conditions?
DiabetesHypertensionHeart diseaseAngle-closure glaucoma
If a patient presents to the pharmacy with subconjuctival haemorrhage, what you recommend??What would warrant a referral?
There should be no pain and the patient should be reassured that symptoms will resolve in 10 to 14 days without treatment. However, a patient with a history of trauma should be referred to exclude ocular injury.
What is the dosing instruction for Viagra?
One 50 mg tablet taken with water approximately one hour before sexual activity - max of one tablet in 24 hoursIf Viagra Connect is taken with food, the onset of activity may be delayed compared to the fasted state
Viagra OTC is licensed from what age?
18 years
What is the max duration of days is licensed for OTC naproxen for painful periods?
3 days
What is the dosing instruction for naproxen OTC for painful periods?
Day 1- Take 2 tablets (500 mg) and then one tablet (250 mg) after 6 to 8 hours if needed.Max 3 tablets in a dayMax 3 days
Children under what age are legally too young to consent to sexual activity?
13 years
What is the advice regarding levonorgestrel EHC and breastfeeding?
Potential exposure of an infant to levonorgestrel can be reduced if the breast-feeding woman takes the tablet immediately after feeding and avoids nursing at least 8 hours following Levonelle
What is the advice regarding ulipristal EHC and breastfeeding?
After using ulipristal breast feeding is not recommended for a week because it is present in breast milk.During this time expressing and discarding the milk is advised to maintain lactation.
In what clinical conditions is the use of EHC levonorgestrel not recommended?
Severe malabsorption syndrome e.g. Crohn’s Severe hepatic impairment
In what clinical conditions is the use of EHC ulipristal not recommended?
Severe hepatic impairmentAsthma which is being treated by oral glucocorticoids
What is the advice surrounding EHC ulipristal and vomiting?
If vomiting occurs within 3 hours another tablet should be taken as soon as possible
If a patient has taken EHC, after how any days of an overdue period must they do a pregnancy test?
More than 5 days overdue
Can you take a second dose of levonorgestrel within the same cycle?
EMC does not advise it as it can disturb the woman’s period
What is the advice surrounding EHC levonorgestrel and vomiting?
If the patient vomits within 3 hours of taking levonorgestrel, she should repeat the same dose she took previously.
Levonorgestrel is less effective in women with a BMI over what?
26 - may need a double dose as per FSRH advice
If a patient has taken CYP3A4 enzyme inducing medicines or herbal products in the last 4 weeks, and an IUD is not suitable, what EHC and what dose should they have?
2 tablets of levonorgestrel 1500 micrograms should be taken within 72 hours of unprotected sex
True or false:Ulipristal EHC is not recommended for patients who have taken CYP3A4 enzyme inducing medicines or herbal products in the last 4 weeks
True
What is the dose of levonorgestrel for EHC?
1500 micrograms
What is the dose of ulipristal acetate for EHC?
30mg
What age is levonorgestrel licensed for OTC?
16 years and over
How may hours after unprotected sex is Levonorgestrel licensed for?
72 hours (3 days)
How may hours after unprotected sex is Ulipristal Acetate licensed for?
120 hours (5 days)
Can you catch chickenpox from someone with shingles?
Yes if you have not had chickenpox before
Can you catch shingles from someone with chickenpox?
No
How soon do you get symptoms after coming into contact with chickenpox?
1-3 weeks
How long before symptom onset is chickenpox contagious for?
Usually from 2 days before spots appearUntil the spots have crusted over- considered contagious until no new lesions have appeared for 24 hours
A non blanching rash can be a symptom of what?
MeningitisThe rash does not fade when pressed with a glass
What is the dosing instruction for amorolfine for fungal nail infections?What time scale for toenails and fingernails?
Apply to the nail once weeklyHas to be applied regularly until all the affected nail has grown out6 months for fingernails9-12 months for toenails
What is Onychomycosis?
Fungal nail infection
At what age would you refer a patient if they requested a PPI for first time dyspepsia symptoms?
55 years(Refer those over 45 years of age who suffer from long term recurrent symptoms of indigestion or heartburn)
Do PPIs provide immediate relief?
No- start to work after a day or soIf a patient needs immediate relief, an antacid or alginate is more appropriate
What is the dose for pantoprazole OTC?
20mg OD
What is the minimum age for pantoprazole OTC?
18 years
Is it recommended that a child with bacterial conjunctivitis does not go to school?
No - should still go to school
If a patient presents to the pharmacy with bacterial conjunctivitis, but wears contact lenses, what should you do?
Refer - needs to be advised chloramphenicol on the advice of a doctor / contact lens practitioner Hard contact lens users and disposable contact lens users can start using their lenses again after successfully completing a course of treatment.Soft contact lens wearers should wait 24 hours after completing a course of treatment before starting to use their lenses again.
What are the storage requirements for chloramphenicol i) Eye dropsii) Ointment
Store eye drops in the fridgeOintment does not need to be in the fridge but store at no more than 25°C
What are the dosing instructions for chloramphenicol ointment?What about if used with the eye drops?
Apply 3-4 times a day for 5 daysEye drops during the day, and the ointment just one application at night
What are the dosing instructions for chloramphenicol eye drops?
Total 5 days One drop into affected eye every 2 hours for the first 48 hours and every 4 hours after
If a male patient asks for tamsulosin OTC but mentions he suffers from postural hypotension, what should you do?
ReferCan cause postural hypotension
After how many weeks of tamsulosin OTC does the patient have to get assessed by a doctor?
6 weeks and they can agree whether further supplies are appropriate Then an annual review after this
How many weeks of tamsulosin is supplied initially?
2 weeks
What is the supply criteria for tamsulosin OTC?
Male patients 45-75 yearsHad symptoms for a minimum of 3 months2 weeks supplied initially and then if there is an improvement in symptoms, a further 4 weeks can be supplied (14 days after starting)
Can sumatriptan be used as a prophylactic for migraines?
No- it is for acute attacks
If a patient comes in asking for sumatriptan but is on an a MAOI, what should you do?
Refer
If a patient comes in asking for sumatriptan but is on an SSRI/TCA, what should you do?
ReferRisk of serotonin syndrome if used together
What is the supply criteria for sumatriptan OTC?
- > 18 years-
Needs to have a migraine diagnosis by doctor/pharmacist
-Established pattern of migraine - history of 5 or more attacks over a period of at least a year - Have tried simple analgesia and it hasn’t worked
If a patient comes in asking for tranexamic acid OTC for heavy periods, but is on warfarin/DOAC, what should you do?
Refer Heavy period may be due to anticoagulation
What is the max number of days you should use tranexamic acid OTC for?
4 days
What are the dosing instructions for tranexamic acid OTC?
Taken only once heavy bleeding has started 2 500mg tablets TDS until symptoms are alleviated (Can be increased to 8 tablets a day 4g for heavier periods)It will not work properly if taken before menstruationIt should not be taken for more than 4 consecutive days
What is tranexamic acid licensed for?
Heavy menstrual bleeding over several cycles with regular cycles
Is evaluation a stage in the transtheoretical model of change?
No
What are the 6 stages of transtheoretical model of change?
- Pre-contemplation2. Contemplation3. Preparation4. Active5. Maintenance6. Relapse
Sturgeon (cinnarizine) is licensed from what age?
5 years
Kwells OTC is licensed from what age?
4 years
Joy Rides OTC is licensed from what age?
3 years
What is the active ingredient in Joy Rides?
Hyoscine hydrobromide
Phenergan OTC is licensed from what age?
2 years
Loratadine OTC is licensed what from age?
2 years (as long as they weigh more than 30 kg)
Lyclear cream OTC is licensed for what age?
2 years (Under this age needs medical advice)
Mebendazole OTC is licensed for what age?
2 years
OTC choramphenicol is licensed for what age?
2 years
What age is Diarolyte relief OTC licensed for?
1 year(Under this age needs medical advice)
Piriton OTC (chlorphenamine) is licensed from what age?
1 year
Hedrin and Derbac liquid is licensed from what age OTC?
6 months
Daktarin 2% oral gel is licensed from what age otc?
4 months
Nurofen OTC is licensed from what age?
3 months
Calpol OTC is licensed from what age?
2 months
Woodwards Gripe water OTC is licensed for what age range?
1 month- 1 year
Gaviscon is licensed for what age OTC?
12 years
Rennie is licensed for what age OTC?
12 years
Voltarol gels OTC are licensed for what age?
14 years
Feminax ultra OTC is licensed for what age?
15-50 years
Nytol is licensed for what age OTC?
16 years
Azithromycin (OTC for chlamydia) is licensed for what age?
16 years
Canesten thrush cream is licensed for what age range OTC?
16-60 years
Tranexemic acid is licensed for what age OTC?
18-45 years
Corticosteroid nasal sprays are licensed for what age OTC?
18 years
Anusol Plus HC is licensed for what age OTC?
18 years
Buccastem is licensed for what age OTC?
18 years
What advice would you give to breastfeeding women being treated for scabies?
Breastfeeding women should remove the treatment from the nipples before feeding, and reapply afterwards.
What is the MHRA advice surrounding the sale of oral lidocaine for children?
- Gone from GSL to P medicine- Restriction of pack size of 10g- Moved to second line after non-pharmacological management
Is oral lidocaine for children (Anbesol, Bonjela):- P medicine- GSL - POM?
P medicineChanged from GSL in late 2018 Max pack size 10g
What is the patient advice surrounding sunlight and cold sores?
Sunlight can trigger cold sores so direct sunlight should be avoided and sun screen should be applied.
Tamsulosin 400mcg capsules can be sold to what group of patients over the counter?How long can they take this before assessment is needed by a doctor?
Treatment of functional symptoms of benign prostate hyperplasia inmen ages 45-75 yearsCan be taken for up to 6 weeks before clinical assessment by a doctor
Is Ella One recommended in a patient with severe uncontrolled asthma?
No, especially if being treated with an oral glucocorticoid
What age are Tyrozets (benzocaine) lozenges licensed in?
> 3 years
What age is otrivine child nasal drops licensed in?
6-12 years Contains xylometazoline
What age can you sell OTC diphenhydramine cough syrup?
> 6 years (Benylin children’s night cough)
What age can you sell OTC guaifenesin cough syrup?
> 6 years (Benylin chesty cough for children)
Coughing up thin and frothy mucous can suggest what?
Left ventricular failure
At what age are you eligible for the free flu vaccine?
65 years and older
What age range is OTC tranexamic acid licensed for in heavy periods?
18-45 year olds
Are OTC steroid creams licensed for psoriasis flare ups?
No
Can you give steroid creams OTC to pregnant women?
No
What areas can you not put OTC steroid cream?
Facial skin, broken skin, genitalsYou can put it on ears as this does not count as your face
What steroid creams are available OTC?
Hydrocortisone 1% and clobetasone butyrate 0.05%
What is the maximum number of days to use OTC steroid cream?
7 days
What is the minimum age to use hydrocortisone 1% cream OTC?
10 years
True or false:Diuretics can cause dry eyes
True
What can you offer OTC for angular stomatitis?
Clotrimazole 1% cream
What is angular stomatitis?
Cracked fissures in the corners of the mouth
If a patient has diabetes and presents to the pharmacy with oral thrush, what should you do?
Refer
What anticoagulation interacts with miconazole oral thrush gel and prompts a referral?
Warfarin
Should miconazole oral gel be applied before or after meals?
After and held in the mouth as long as possible
What is the minimum age to use miconazole 2% oral gel for oral thrush?
> 4 months
What is a common side effect on the teeth if a patient is having chlorhexidine mouthwash?
Stains teeth brown
What is the minimum age to use Difflam spray?
6 years
What is the minimum age to use Difflam mouthwash?
12 years
An ulcer lasting than more than how many weeks should be referred?
More than 3 weeks- exclude oral cancer
Can you treat bacterial conjunctivitis OTC for pregnancy and breastfeeding?
No- refer
What age would you refer for bacterial conjunctivitis?
<2 years
What age range is Feminax ultra licensed for?
15-50 years
What NSAID (stronger than ibuprofen) is available OTC for primary dysmenorrhoea?
Feminax ultra 250mg naproxen
Can you treat a pregnant person OTC for thrush?
No- refer
Women who have had more than how many episodes of thrush in 6 months- when should you refer to GP?
More than 2 episodes in last 6 months
True or false:Poorly controlled diabetes is linked with thrush
True
What age groups should be referred in vaginal thrush?
<16 years>60 years
What should you do if someone comes into the pharmacy with impetigo?
Usually needs a prescription to treat it so refer
How can sweat rashes be treated OTC?
Topical imidazoles e.g. Daktarin
How can ringworm (tinea corpis) and jock itch (tinea cruris) be treated OTC?
Most local infections can be treated adequately with topical antifungal preparations. Imidazoles (clotrimazole, econazole, miconazole) or terbinafine are suitable first-line treatments for groin infections and skin ringworm.
Amorolfine lacquer is licensed OTC for what condition and what is the age restriction?
Fungal nail infection18 years and over
What is the maximum number of nails you can treat OTC for fungal nail infection?
2 If more than this, need to refer
What is the minimum age for Lamisil OTC (terbinafine) for athelete’s foot (tinea pedis)?
> 16 years
What is 1st line for athlete’s foot in pregnancy and breastfeeding?
Topical imidazoles e.g. Daktarin Gold
Where should you apply scabies lotion?
All over the body
What is first line for scabies in pregnancy and BF?
Permethrin 5% w/w cream (Lyclear®)
What is first line for scabies?
Permethrin 5% w/w cream (Lyclear®)
How many times should you apply head lice treatment and how many days should you leave between each treatment course?
TwiceAt least 7 days between
What is recommended as first line for head lice treatment in asthma and eczema?
Wet combing If treatment needed, Dimeticone e.g. Hedrin
What is recommended as first line for head lice treatment in pregnancy and BF?
Wet combing If treatment needed, Dimeticone e.g. Hedrin
What age group is mebendazole not suitable for?
<2 years
What is the dosing instructions for mebendazole in threadworm?
Once only doseCan be repeated after 2 weeks if it has not cleared upEveryone in the house should be treated
What is 1st line for pregnancy in threadworm?
Strict hygiene measures Refer if this has not worked
What groups of patients is sumatriptan OTC unsuitable for?
- Previous myocardial infarction- Ischaemic heart disease, e.g. angina- Peripheral vascular disease- Cardiac arrhythmias (including Wolff-Parkinson-White syndrome)
What is the maximum dose of OTC sumatriptan?
Single 50mg dose stat
Can take another 50mg tablet but has to be at least 2 hours after taking the first tablet
Max 100mg in 24 hours for the same attack BUT symptoms have to have improved after taking the first tablet
If there is NO response to the first tablet, should not take a second tablet
What is the licensed age range for sumatriptan OTC?
18-65
Bonjela preparations containing choline salicylate is unsuitable for which age group?
Under 16 years
What is a purpuric rash?
One which does not blanch white on pressure
Systemic decongestants are contraindicated in patients taking what medicine class?
MAOIsRisk of hypotensive crisis
Systemic decongestants should be used with caution in what group of patients?
They should be used with caution in people with diabetes, hypertension, hyperthyroidism, raised intraocular pressure, prostatic hypertrophy, hepatic or renal impairment, or ischaemic heart disease.
How can you treat croup?
No medical treatment as it is viral but can offer antipyretic treatment if fever is present
What time of the day are symptoms of croup the worst?
At night
What is croup?
Croup in children is caused typically by the parainfluenza virus. It often starts with a cold and develops into a characteristic barking cough
A cough for how many weeks would prompt a referral?
Longer than 3 weeks
Can you use anusol HC plus ointment OTC in pregnancy and breastfeeding?
No
How many days max should you use Anusol HC plus ointment OTC?
7 days max(contains hydrocortisone)
What are the symptoms of haemorrhoids?
Bleeding, perianal itching, mucus discharge and pain
What age can you sell Colpermin IBS relief capsules OTC? (peppermint oil)
15 years and over
What age can you sell Buscopan OTC?
12 years and over
What age can you sell mebeverine OTC?
> 18 years
What kind of laxative should be used for IBS?
Bulk forming
Does rectal bleeding from haemorrhoids need to be referred?
No unless excessive bleeding occurs or has occurred for more than 3 weeks
What is the maximum dose of GSLloperamide a day?What is the maximum dose of P medicine loperamide a day?
12mg (6 caps a day) for GSL
16mg (8 caps a day) for P
What age can you sell loperamide OTC to?
12 years and over
What is the difference between Diarolyte and Diarolyte Relief?
Relief contains rice power and normal diarolyte is glucose based
What are danger symptoms in a diarrhoea patient that prompts a referral?
Confusion Drowsiness Passing little urine Dry mouth Sunken eyes Duration of 3 days or longer in adults >24 hours in babies >48 hours in young chuldren
Is Movicol is licensed for acute, chronic or both types of constipation?
Chronic
What age can you sell ispaghula husk OTC to?
> 6 years
What age can you sell Sodium picosulphate (Dulcolax pico liquid) OTC to?
> 10 years
What age can you sell Senna OTC to?
> 12 years
How long does it take for bulk forming laxatives to work?
12- 72 hours
If a patient has constipation along with tiredness, what could be underlying causes?
HypothyroidismAnaemia
At what point is constipation classed as chronic?
Lasting 6 weeks or more
Why are stimulant laxatives not really recommended in breastfeeding and pregnancy?
Not advisable in the third trimester as it may induce uterine contractions. Senna enters the breast milk, so may cause colic and diarrhoea in the infant.
What are the safest laxatives to use in pregnancy and breastfeeding?
Bulk forming and osmotic
What are the preferred type of laxative in children?
OsmoticBulk forming
How long does it take for glycerol suppositories to work?
Within 30 mins
Frequent use of stimulant laxatives can lead to what?
Fluid and electrolyte imbalance
Why must bulk forming laxatives be taken with adequate fluids?
To avoid intestinal obstruction
Generally, laxatives should be avoided in constipation as first line and lifestyle measures should be tried. What exemptions would you want to treat with laxatives?
If straining would exacerbate a condition e.g. angina Or increase bleeding risk e.g. haemorrhoids
What is 1st line for constipation?
Lifestyle measures
When would you refer with colic?
Failure to put on weight OTC treatment failure Danger symptoms Over anxious parents Symptoms have not resolved past 4 months of age
What are symptoms of colic?
High pitched cryingOften at same time of dayDrawing knees up to stomach
How can you treat colic OTC?
Anti-foaming agents e.g. simethicone (Dentinox, infacol)Gripe waterEffectiveness is lacking however and it should resolve by itself in time
What is colic?
When a baby cries with no obvious causeLinked to disorder of GI tract, post partum depression, anxious parentsAffects babies < 6 months old
What is the dose of OTC esomeprazole, and what is the max time it can be used for?
20mg OD2 weeks maximum
What age can you sell OTC esomeprazole to?
> 18 years
What age can you sell esomeprazole to?
> 18 years
What age can you sell OTC omeprazole to?
> 18 years
What is the OTC omeprazole dose and how long can they be used for and when would you refer?
10mg/20mg OD 4 weeks maximumHowever, if symptoms have not resolved in 2 weeks, referAny danger symptoms e.g. unexplained weight loss, refer
In what group of patients is orlistat licensed for OTC?
> 18 years
BMI >30
OR
BMI >28 with rf diabetes/hypertension/hypercholesterolaemia
True or false:Smoking can contribute to dyspepsia
True
True or false:Being overweight can contribute to dyspepsia
True
What is max dose of ranitidine OTC?
75 mg tabletsDo not take more than 2 in 24 hours
H2 antagonists e.g. ranitidine. What age can you sell them to OTC?Can you sell them to pregnant and breastfeeding women?
Over 16 yearsNo
Minimum age Benzoyl Peroxide can be used in?
12 yearsAcne treatment
Ulipristal Acetate
Licensed for any girl of child bearing age
Daktarin oral gel (Miconazole)
licensed from 3 months
Clotrimazole 1% cream
For fungal skin infections (e.g. ring worm)Can be used in adults and children (no licensed age mentioned)
Age range for Thrush treatments?
Clotrimazole 2% cream
Clotrimazole 10% internal cream
Clotrimazole pessary
Fluconazole 150mg capsuleAll 16- 60 years
Minoxidil 2% + 5%? (Regain)Age range
18 years- 65 yearsOTC Hair loss treatment
Fluconazole capsule 150mg?
Used for thrush so16 - 60 years (refer outside of this range)
Ispaghula Husk (Fybogel)?
6 years
Senna?
12 years
Acrivastine? (antihistamine) Age range
12 - 65 years
Antihistamines:Chlorphenamine liquid? (piriton syrup)
Liquid: over 1 years (safest choice for young children)Chlorphenamine Tablets: 6 years
Clotrimazole 2% cream? Age range?
16 - 60 years when used for thrush
Ranitidine?
16 years
Cough cold remedies containing chlorphenamine, promethazine, diphenylhydramine, tripolidine (antihistamines)?
6 years (Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)
Dexomethorphan?
6 years (Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)
Guafenesin?
6 years(Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)
Esomeprazole, Pantoprazole, Omeprazole?
18 years
Steroid nasal sprays (beconase, flixonase)?
18 years
Co-codamol?
12 yearsBut guidance states codeine containing products for pain relief should only be used in over 12’s when ibuprofen and paracetamol have failed. Codeine containing cough remedies should only be used in over 18 years as risks (of respiratory problems/ dependence) outweigh benefits
Simple linctus (pead)?
1 year
Amorolofine?
18 years
Levornorgestrel?
16 years
Cetirizine?Loratidine?
2 years
Sumatriptan?Age range
18 years - 65 years
Paracetamol?
2 months
Tranexamic acid? For menorrhagia (heavy bleeds)
18 years
Pseudoephedrine?
6 years(Any cough/ cold remedy containing actives like antihistamines, expectorants, suppressants and stimulants should not be used in under 6 years, and never first line in 6- 12 years, if used then maximum 5 days)
Aspirin?
16 years
Loperamide?
12 years
Chloramphenicol eye drops/ eye ointment?
2 years
Mebendazole?
2 years
Ibuprofen?
Suspension or suspension sachets- 3 monthsTablets: 12 years
Naproxen 250mg tablets (Feminax Ultra)?Age range
15 - 50 years
Tamsulosin 400mcg tablets (FloMax)?Age range
45 years - 75 years
Clobetasone (eumovate) 0.05% cream?
12 years
Eurax HC (hydrocortisone 0.25%) cream?
10 years
Hydrocortisone (hc45) 1 % cream?
10 yearsMax 15g tube
Minimum age to buy Clamelle (azthromycin for chlamydia) OTC?
16 years
What condition presents with a rash, white coating of the tongue, plus headache and fever leading up to it?
scarlett
measles, white koplik spots+conjunc ;)
We know codeine should be avoided for pain in children 12-18 years where possible. Who would you chose to give codeine to out of a 24 year old ethiopian man and a 31 year old Norweigan man?
The norweigan man
African/ ethiopian and middle eastern people are more likely to be ultra-rapid metabolisers of codeine so do not give to these patients.
If a patient using Benzoyl Peroxide experiences drying, burning or peeling of the face, should they stop using the product?
Just advise reducing the frequency of administration- stop using for a day or two then reduce to OD or use on alternate days
Can Gaviscon be used in pregnant women suffering from gastro-oesophagul reflux ?
Yes: remember your acronym APPLE: A= Antacids
Acid reflux is common in preganancy when the baby gets larger towards the end: they respond well to Alginate products like Gaviscon- can take through the day and night
We say that stimulant laxative are not first line constipation remedies, however when may we chose to recommend it?
If someone has been constipated for a while e.g. 10 days (refer if over 14 days) as these work quickly (6-12 hours) so may be appropriate for one-off use.
If patients are using several topical agents, when should the emolient be applied?How often can emollients be applied?
Before…. Leave at least 5 mins between applying to allow absorption.
emollients contain no active so can be applied as many times.. but general guidance is 2-3 times a day.
Can you get monoxidil on NHS prescription?
NO
How is allergic rhinitis differentiated from the common cold? What are reatment options OTC for this?
Allergic rhinitis presents as: sneezing, nasal discharge and nasal itching
Could use:
Loratidine- 1st line
2nd line:Sodium cromoglicate nasal drops (but take 1-2 weeks to work)- a mast cell stabiliser
Or steroid nasal spray (over 18’s)
Other options:
Azelastine- the only nasally administered antihistamine OTC
chlorphenamine (antihistamines)
What are simeticone drops indicated for?
Infant colic-excessive, frequent crying in a baby
One week trial of simeticone drops recommended:drops are designed to help release bubbles of trapped air in your baby’s digestive system.
Referral symptoms for ear conditions? (Considering Otitis Externa and Ear wax are the only ones that can be treated OTC!- Need to rule out otitis media- infection of inner ear)
Mucopurulent discharge (pus)- otitis media
Pain on palpitation of the mastoid area
Generalised inflammataion of the pinna
Impaired hearing in a CHILD
Slow-growing growths in elderly
Symptoms present over 4 days
OTITIS EXTERNA COMMONLY ASSOCIATED WITH A COLD./FLU!
What does treatment of Otitis externa involve?
ACETIC ACID (earcalm spray)- one spray to the affected ear TDS, max frequency 2-3 hours, continue for 2 days after symptoms gone
Choline salicylate drops- Earex Plus
What are the signs and symptoms of Otitis externa?
itching
irritation
Some discharge
Oedematous (fluid build up) leading to conductive hearing lossEar canal/ external ear are red, swollen and eczema like
What is a buldging spot on a babies forehead accompanied by vomiting, fever, cold hands likely to indicate?
early signs of meningitis- refer to A and E!
What do the yellow and what do the pink Migraleve tablets contain, and what is the max of each to be taken in 24 hours?
Pink: Paracetamol, codeiene, Buclizine
Yellow: Paracetamol, codeine
Max in 24 hours: 2 pink + 6 yellow
Which eye drops used in glaucoma can cause a change in eye colour?
Prostaglandin analogues:
BIMATOPROSTLATANOPROSTTRAVOPROST
Where does the new inhaler, Fostair Nexthaler, containing steroid Beclometasone and LABA formoterol, need to be stored?
At room temp
Its the old fostair (inhalation solution) that needs to be kept in a fridge
Where should Latanoprost eye drops be stored?
In the fridge
What presents as the following image accompanied by sore throat, headache, high temperature?
Scarlet fever
Antibiotics needed- refer
With treatment, most people recoverin about four tofive days and can return to school 24 hours after starting antibiotic treatment.Without treatment, you’ll be contagious for one to two weeks after symptoms appear.
If a patient has recently had their tonsills out (tonsillectomy) or adrenal glands out (adrenectomy) what OTC drug is cautioned?
If they have sleep apnoea (i.e. find it hard to breathe at night) then CODEINE is cautioned as can cause respiratory problems which can be fatal (Fatal ADRs reported)
What is the only contact lense solution that can be applied whilst contact lenses are still in the eye?
Re-wetting solution
How does plaque psoriasis present?
Silvery white scales, when scraped away pinpoint bleeding occurs from the capillaries
Which travel sickness medication would be most appropriate for a young child, 4 years old?
Hyoscine hydrobromide (licesned for over 3 years [joy rides]) or meclozine for over 2 years
What are the likely side effects of the antihistamines/ anticholinergics used in travel sickness?
Dry mouth!
Sedation
be careful with other medication that can cause sedation: alcohol, TCA’s, opioids
The mainstay of treatment OTC of travel sickness involves antihistamines:CinnarizineMeclozineCyclizinePromethazine: Promethazine Hydrochloride (Phenergan) and Promethazine Teoclate (avomine)OR Anticholinergics:HyoscineWhich one of these has a 24 hour duration of action?Which one causes most sedation?Which is the most effective for the prevention of motion sickness?
24 hour duration: Promethazine Teoclate
Most drowsiness: Promethazine Hydrochloride (Phenergan)
Most effective: Hyoscine hydrobromide
Which emollient does not contain Urea?
hydromol
Oramorph20 mg/mL solution- schedule? Expiry?
Schedule 2 CD
Anything over 2.6mg/ml (13mg/5ml) is schedule 2
4 month expiry
The lower strength (2mg/ml) has a 3 month expiry
Most eye drops will have an expiry of _____. What expiry do chloramphenicol eye drops have, considering they contain an antibiotic?
28 days
still 28 days for chloramphenicol- it it just reduced to 14 days on wards at slam. Patients are still advised to discard the drops 5 days after opening (after finishing the course)
Co-amoxiclav oral suspension will have an expiry of ____ once it is made up
7 days
Eye drops containing a lubricant only (e.g. propylene glycol) will expire in _____
6 months
Pseudoephidrine is contra-indicated in which condition?What about phenylephrine?
Pseudoephedrine: Hypertension, coronary artery disease, MAOI’s in the last two weeks
Phenylephrine: diabetes (as may increase glucose) and CV disease
What is information governance? How often do community pharmacies need to provide IG assurances to the NHS?Does the Information Governance lead need to be a pharmacist?
IG is all to do with confidentiality and how to handle patient sensitive data.
Pharmacies need to submit IG assurances annually.
The lead does not need to be pharmacist but needs enough authority to make changes in information handling
What does ‘Freshly prepared’ mean?What does ‘Recently prepared’ mean?
Freshly prepared: 24 HOUR EXPIRY
Recently prepared: 28 day expiry
Can nursing homes bring their waste medicines to your pharmacy to dispose of?Can the public: what will you do with the waste?
No- must use their own waste disposal
Only the public can bring it to the pharmacy: this is an essential service for the pharmacy to act as a collection point for waste medicines: sort it into solids, liquids and ampoules and arrange for waste contractor to pick it up.
Must not store waste for longer than 6months, or over 5 cubic meters
Can GTN be bought OTC?
YES
Both sub-lingual tablets and spray are P medicines
NB: Their effects last for 20-30 minutes, but in an emergency situation, repeat dose after 5 mins if no relief.
Orlistat impaires the absorption of Fat soluble vitamins. Which are the Fat soluble vitamins?
A (retinol)
D (D, colecalciferol/alfacalcidol)
E (tocopherol)
K (phytomenadione)
Water soluble: B1- thiamine B2- riboflavin B6- pyridoxine B12- folic acid
C- ascorbic acid (scurvy)
How many days of co-codamol30/500mg tablets could you give maximum as an emergency supply?
5 days max
As co-codamol contains codeine 30mg which is a schedule 5 CD!
Is sunlight a good cure for cold sores?
Sunlight can trigger cold sores so direct sunlight should be avoided and sun screen should be applied.
What is Lyme disease caused by? What does the rash present as?
Caused by bacterial infection fromTick bites
An early symptom of this condition is a characteristic “bulls eye on a dartboard” rash (called erythema migrans) that isn’t itchy
Usually treated with Doxycycline, amoxicillin or cefuroxime for 2-4 weeks
What do we use to treat Oral thrush?
Topical Miconazole gel- Daktarin oromucosal gel
(Nystatin 2nd line, Fluconazole 3rd line if topical preps can’t be used/ patient has a dry mouth)
Why hasthe safety of using medicines containing codeine to treatcoughsandcoldsin children younger than 18 been reviewed?
Because of the potential for serious problems like slowed or difficultbreathing.
Children, especially those who already havebreathing problems, may be more prone to these effects
Differences in metabolism of codeine: codeine is converted to Morphine in the body, this cause cause respiratory difficulties.
This use in under 18’s only applies to codeine linctus for colds/ cough; codeine containing products for pain relief can still be used in > 12 years, sold to > 16 years.
Amorolfine (Curanail, Loceryl) can be used for fungal nail infections. What is the directions for this?
Apply 1-2 times a week for: 6 months for finger nails 9- 12 months for toe nails Apply after filing and cleansing BNF age limit: 12, OTC age limit: 18. 3 ml pack is a P
What is the organism causing athletes foot? How is athletes foot treated?
TINEA PEDIS
Topical imidazole(Miconazole) can be used- Apply twice daily and continue for 10 days after the lesions have healed
Bnf states under topical antifungals: to prevent relapse these should be continued for 1-2 weeks after healing
Could also consider Griseofulvin
Nystatin, oral thrush- 7 days, then 48hours after lesions have healed
It is recommened people include oily fish in their diet to help reduce CV risk. Can you think of any examples of these?
Mackerel
Salmon
Sardines
A patient with a productive cough for the last week requests a product containing dextromethorphan because they have heard good things. What do you do?
They may have requested Benylin Dry Cough
Similar product: Benadril Tickly Cough containing Pholcodine
These are cough SUPPRESSANTS
Should NOT suppress a productive cough- need to get the mucous out- so recommend an expectorant (Guaiphenesin)
Children under __ should not be given cough and cold medication OTC containing PSEUDOEPHEDRINEPHENYLEPHRINEDEXTROMETHORPHANPHOLCODINEGUAIFENESINChlorphenamine, brompheniramine,diphenhydramine, doxylamine, promethazine and triprolidine.
Children under 6 years old
Medicines containing:
ANTITUSSIVES (suppressants) (DEXTROMETHORPHANPHOLCODINE)
Expectorants (GUAIFENESIN, ipecacuanha)
Nasal decongestants (pseudo, phenylephrine, ephedrine, oxymetazoline, xylometazoline)
Antihistamines:Chlorphenamine, brompheniramine,diphenhydramine, doxylamine, promethazine and triprolidine.
For use in 6-12 years they should be SECOND LINE and be used for no more than 5 DAYS
Can pseudoephidrine cause drowsniess?Can guaifenesin cause drowsiness?Can dextromethorphan?
No
Remember pseudoephidrine (SUDAFED) can be abused- stimulating- side effects include restlessness and insomnia, and hallucinations!
Guaifenesin does not cause drowsiness
Dextromethorphan can cause a little bit of drowsiness
What does sodium Citrate do to the pH of urine?
Cystitis sachets
It increases the pH- makes urine more alkaline
Acidic urine in cystits- hence the burning feeling
If a specific brand is stated on a prescription (e.g. Losec capsules- Omeprazole) can you give the generic if you run out of the branded?
No
Must legally prescribe that brand unless you ask the prescriber to change the Rx to generic
What is cinnarazine and what is it used in?
characterized as an antihistamine and a calcium channel blocker
Used for travel sickness and vertigo and tinnitus (problems with inner ear)
Very sedating
Found in Stugeron- 2 tablets 2 hours before travel
What is the medication causing drowsniess usually included in cough/ cough rememdies to help people sleep?
Diphenhydramine
A sedating antihistamine, found in things like Night nurse.
Also found in sleep aids such as sominex
Is it pharmacologically rational for a cough/cold remedy to contain dextromethorphan and guanefenesin? What about dextromethorphan and ammonium chloride?
No:Dextromethorphan is a cough suppressant so person coughing less
Guanefenesin and ammonium chloride both cough expectorants which means they make it easier to cough things up: work against eachother
What formulations have more potential for abuse by addicts?
Sugar free
Syrup base less liable to abuse
How is payment for Instalment precriptions worked out?
Payment is based on each occasion the pharmacist provides an instalment to the patient; i.e. each time the patient collects their drug from the pharmacy
Pharmacy needs to fill out back of prescriptioneach time the patient picks up an instalment
What drugs can be given on instalment prescriptions (FP10MDA) Other than Methadone?
Schedule 2 Controlled Drugs;
Buprenorphine;
Buprenorphine/naloxone (Suboxone);and
Diazepam
What age are steroid nasal sprays e.g. beconase, flixonase, not suitable in?
Under 18’s
What antihistamine do we usually give to children?
Chlorphenamine maleate
Suitable for 1 year and over
What kind of medicine is Dextromethorphan?
Cough suppressant (antitussive)
What kind of medication is Guaiphenesin?
Cough EXPECTORANT
These claim to make the coughing easier while enhancing production of mucus and phlegm.
Other example: Acetylcysteine, ammonium chloride
Not effective in children
A patient presents with the following at your pharmacy. They ask for some Brolene eye drops. What do you do?
This is a subcojunctival haemorrhage
Ask them if it is painful- any pain then refer
Ask them if they are on WARFARIN- if yes seek medical attention ASAP
Have you had any injury to the eye recently?
If no to the above- reassure the patient that it is self limiting, usually better within 2 weeks and no OTC products are recommended
What organism causes RING WORM?
Tinea Corporis
URINE COLOURS?SENNARIFAMPICINLEVODOPANEFOPAMNITROFURANTOINCO-DANTHRUMERCO-DANTHRUSATETRIAMTERENESULFASALAZINEENTACAOPONEPHENINDIONE
Fexfenadine OTC advice?
Avoid apple/orange juice, minimises exposure, ok
Unsightly big left toe, no pain, thickened?
Amorolfine 5% nail lacquer
Mr P
smoking 23 years
needs to consider stopping, recent titration asthma,
Stage of cycle?
Preparation stage at present; if engages in smoking cessation regime he will move to Action
OTC smoking cessation options?
Nicotine- patches/lozenges/gums/inhalors
Varenicline/Bupropion POM meds, OTC under PGD only
smoking cessation follow up monitoring?
2 weeks after NRT start
4 weeks after stopping smoking, CO levels monitor, aim for <10 parts per million
Otitis externa symptoms?
dry skin
muffled hearing
itchy canal
history eczema/hayfever swimming
OTITIS EXTERNA TREATMENT?
OTC ACETIC ACID (if >12 years+no history of perforated ear drum).
1 spray at least TDS after each activity, max. dose 1 spray every 2-3 hrs.
Up to 2 weeks use
Fluticasone 0.05% nasal spray OTC requirements?
18 years+
Alternative is ES, patient request
Or just get a prescription
Nappy rash symptoms?
Red blotches on bottom
Hot, sore-looking skin
Irritable baby
Pimples/spots
NAPPY RASH TREATMENT?
1st line- change nappies frequently+use tightly fitting water-proof pants
Expose to air, barrier application, each nappy change (barrier after steroid)
Discomfort? Hydrocortisone 0.5/1%, AVOID IN NEONATES, MAX. 1 week treatment
Candidal infection? Clotrimazole cream, avoid barrier till fungal clear
Nappy rash, fungal, 7 days after clear
NAPPY RASH REFERRALS?
> 2 weeks
Yellow Crusts
Broken skin
MEBENDAZOLE
AGE?
REINFECTION AFTER 2 WEEKS?
AGE? 2 years+
REINFECTION AFTER 2 WEEKS? Take another dose
Levonelle
Take within?
Vomit within X hours, take second dose?
Take within? 72 hours
Vomit within X hours, take second dose? 2 hours
Use higher dose for patients >70kg, BMI > 26kg/m^2
ellaOne
Take within?
Vomit within X hours, take second dose?
AVOID?
Take within? 120 hours
Vomit within X hours, take second dose? 3 hours
AVOID? for 1 week after administration/during!
A drug that induce hepatic
enzyme activity and considerably reduce the
emergency hormonal contraceptive effect?
Topiramate (antiepileptic)
CLOTRIMAZOLE
CAUTION/REFERRAL?
UNDER 16/OVER 60
First occurence
2 episodes past 2 months/>2 in past 6 months
SAFE? female, diabetic history, last used pessary 1 year ago
SICK DAY RULES
Dehydration (vomiting, diarrhoea & fever)
CAN TEMPORARILY STOP WHAT DRUGS?
DIURETICS
ACE INHIBITORS
METFORMIN
NSAIDs
OTC SUMATRIPTAN?
It is indicated for the acute treatment of migraine attacks, with or without aura, in adults aged 18 to 65 years
at least 5 in past year
Reasons for
depot antipsychotic?
Improved patient compliance
Reduced peaks/troughs in efficacy
Treatment for a patient with a potassium level of 6.6mmol/L?
Calcium gluconate 10% plus insulin and glucose 50%
Treatment for a patient with a sodium level of 152mmol/L?
Hydration and stop possible offending drugs
raised TSH and low T4 levels=?
treatment?
HYPOTHYROIDISM
LEVOTHYROXINE
Prolongation of the QT-interval?
DOMPERIDONE
CITALOPRAM
CLARITHROMYCIN
ERYTHROMCYIN
LEVONELLE/ULI SIDE-EFFECTS
BOTH ABDOMINAL PAIN, N&V, HEADACHE
LEVO VS ULI
HYDROCORTISONE 1% LICENSING?
10+
TERBINAFINE 16+
LEVO AVOID BREASTFEEDING JUST 8 HOURS
12+ steroid?
clobetasone
bacterial infection?
not hydrocortisone
Give oral antifungal if topical an L
CARDIAC SYMPTOMS
REFER TO GP?
REFER TO A&E?
REFER TO GP? 55+ new symptoms
REFER TO A&E?
heart attack, jaw/arm pain
slurred speech
HEADACHE
UREGNT REFERRAL TO A&E?
SUDDEN
HEADACHE
NON-URGENT REFERRAL TO GP?
MIGRAINE, few days
STOMACH PAIN
URGENT REFERRAL TO A&E?
SUDDEN SEVERE, abdominal pain
STOMACH PAIN
NON-URGENT REFERRAL TO GP?
dyspepsia period pain injury food poisoning weight loss
FEVER URGENT REFERRAL TO A&E?
UNDER 3 MONTHS
RASH DOES NOT GO AWAY
SEPSIS URGENT REFERRAL TO A&E?
slurred speech, confusion, shivering, cold, muscle pain
CARDIAC SYMPTOMS
URGENT REFERRAL TO A&E?
breathlessness, chest pain, left arm pain, coughing up blood
CARDIAC SYMPTOMS
NON-URGENT REFERRAL TO A&E?
HEARTBURN
RESPIRATORY SYMPTOMS
URGENT REFERRAL TO A&E?
SOB, wheezing, radiating pain,
RESPIRATORY SYMPTOMS
NON- URGENT REFERRAL TO GP?
COPD, asthma, symptoms, lifestyle
NEUROLOGICAL SYMPTOMS URGENT REFERRAL TO A&E?
numbness, spine movement, stroke
NEUROLOGICAL SYMPTOMS NON-URGENT REFERRAL TO GP?
muscle weakness,
SIGNS OF CANCER URGENT REFERRAL TO A&E?
mouth ulcers, unexplained weight loss, radiating oedema
OTC DO WWHAM WHO WHAT HOW LONG ACTION SYMPTOMS
WHAT IS THIS?
STYE
RINGWORM?
ROSACEA?
butterfly like
SCABIES
SHINGLES
VERRUCA FEET
WARTS HAND COMMON
VERRUCCA
WARTS?
CONTACT DERMATITIS
PSORIASIS FACT?
Psoriasis often occurs on extensor surfaces (elbows and knees), trunk, flexures, sacral
and natal cleft, scalp and behind the ears, and umbilicus. This is an image of plaque
psoriasis, which generally presents as large plaques. There is usually a clear
delineation between normal and affected skin. May be pink or red, but in people with
pigmented skin this may not be obvious. Scale is typically silvery in colour.
Psoriasis may be caused by infection, drugs (including corticosteroid withdrawal),
ultraviolet light exposure, trauma, hormonal changes, stress, smoking, and alcohol.
What is this?
A cattle farmer visits the pharmacy for advice. He noticed a strange patch of skin on his arm after work yesterday, which is itchy. He
hasnʼt put anything on it yet as he is unsure what it is. Upon examination, it is almost a perfect circle 2 cm in diameter and appears red
and scaly around the edges and silvery in the middle
Tinea corporis
What is indoramin?
Alpha-blocker, careful with tamsulosin!
What are the symptoms of hay fever? (4)
- Rhinorrhoea
- Nasal congestion
- Itching
- Allergic conjunctivitis
What are the referal criteria for hay fever? (5)
- Pregnancy
- Suspected infection
- Drug induced
- Structural or mechanical reasons
- Systemic conditions associated with mucus (e.g. CF)
Which drugs can induce symptoms of hay fever? (7)
- ACE inhibitors
- Beta blockers
- Chlopromazine
- Aspirin
- NSAIDs
- Cocaine
- Diverse effect of nasal decongestants
What is the first line treatment for someone presenting with general symptoms of hay fever?
Non-sedating antihistamine
At which age are Cetirizine and Loratadine both licensed from?
2 years
At which age is Acrivastine licensed?
Over 12
How often should a non-sedating antihistamine be taken?
Once daily
If a patient taking a non-sedating antihistamine experiences “breakthrough” symptoms, which drug can you recommended instead?
Sedating antihistamine taken at shorter intervals
At what age is chlorphenamine syrup licensed?
Over 1
At what age are chlorphenamine tablets licensed?
Over 6
At what age is promethazine licensed? (syrup and 10mg tablets)
Over 2
Can promethazine 25mg tablets be sold OTC for hay fever?
No, licensed for insominas in patients over 16
If patient is experiencing nasal congestion due to hay fever, what is the recommended OTC treatment?
Nasal corticosteroid
At what age are beconase and nasonex both licensed for?
Over 18
When should nasal corticosteroids be taken for maximal effect?
A week before hay fever begins
Is sudafed nasal decongestant spray recommended for hay fever?
Not recommended but can be used as an adjunct
What is the maximum recommended duration of use for sudafed nasal spray and why?
7 days - risk of rebound congestion
At what age is sudafed blocked nose spray?
Over 12
Which 2 drugs can be applied topically if the patient is experiencing allergic conjunctivitis?
- Mast cell stabilisers
2. Occular antihisatmines
How long does it usually take for a common old to resolve?
7 days
How long does it usually take for a common old to resolve in children?
14 days
What is used for symptomatic relief of a cold?
Paracetamol and ibuprofen
What advice do you give patients with colds?
Keep hydrated and rest
As well as paracetamol and ibuprofen, what else can be used to treat symptoms of a cold?
Intranasal decongestants
Is there a place for oral decongestants when treating a cold?
They can be used in the short term but the benefit is small
As well as lifestyle measures, what must patients be counselled on when buying cough and cold medicines?
The risk of paracetamol overdose
Which cough and cold medicines should be avoided in those under 6? (4)
- Anti-tussives
- Expectorants
- Topical and oral decongestants
- Antihistamines
In patients under 6, what can be used for symptomatic relief of cough and cold?
- Paracetamol and ibupofen
2. Simple cough remedies
If a patient is over 1, what can be recommended for symptomatic relief of cough and cold?
Warm drink of honey and lemon
What are 5 self care measures for cough and cold that can be purchased OTC?
- Steam inhalation
- Vapour rubs
- Gargling salt water
- Menthol sweets
- Nasal saline drops
What are the 2 types of cough?
- Productive (chesty)
2. Non-productive (dry)
How long does an acute cough last?
Less than 3 weeks
What should you do if a patient presents with a cough lasting longer than 3 weeks?
Refer for further investigation
How long must a cough last to become chronic?
Over 8 weeks
What is the most likely cause of a cough?
Viral upper respiratory tract infection
What is a trigger for croup?
Recent viral infection
At what age does croup normally occur?
Between 3 months and 6 years
How long does croup usually resolve?
48hours
When should you refer someone with croup for medical intervention? (2)
- Over 48 hours
2. Severe
A patient presenting with which symptoms is likely to have pneumonia? Requires urgent referral to GP (5)
- High fever
- Malaise
- Headache
- Breathlessness
- Pleuritic pain
Give an active ingredient of expectorants
Guafenasin
Give 4 active ingredients of anti-tussives
- Codeine
- Pholcodeine
- Dextromorphan
- Antihistamines (diphenyldramine)
At which age is codeine linctus licensed for OTC?
Over 18
Does the MHRA advise the use of cough and cold medicines in children 6-12?
No, only supplementary to best principles of care
Who should not have codeine at all?
Under 18s with sleep apnoea who have had tonsil and adenoid surgery
In which patients should codeine be used with caution?
12-18 difficulty breathing
symptoms of hemorrhoids
referral symtoms
itching feeling like the bowel is not empty bleeding on toilet paper or in bowl pain REFER after 1 week of OTC treatment recurrent episodes sharp stabbing pain on deification large vol of blood or blood mixed in stool (black and tarry) accompanying systemic symptoms (N&V, loss of appetite)
Hemorrhoids treated OTC for ………… should be referred
1 week
what does sharp stabbing pain on deification indicate?
anal fistula
advice for hemorrhoids
avoiding constipation (fluids, fiber and exercise) don't strain
three types of things used in hemorrhoid preparations
local anaesthetics
astringent
anti-inflamatory
where should local anesthetics be used on hemorrhoids?
only externally and not on broken skin (the anesthetic can be absorbed into systemic circulation and is toxic)
how long can you use a local anesthetic for haemerrhoids
5-7 day
what is the action of this ingredient of hemorrhoid preparations:
bismuth oxside
astringent
what is the action of this ingredient of hemorrhoid preparations: cinchocaine
local anesthetic
what is the action of this ingredient of hemorrhoid preparations:
muccopolysacharide polysulfate
fribrinolytic
what is the action of this ingredient of hemorrhoid preparations:
shark oil
skin protectant
what is the action of this ingredient of hemorrhoid preparations: yeast extract
wound healing angent
sumitriptan is licensed for a max of how many attacks per month
4
Should levothyroxine or liothyroxine be maintained on the same brand?
liothyronine
alternative to carbimazole that may cause Liver tox
propylthyuricil
When would you refer for a cold?
Ear ache that is severe
Vulnerable patient groups e.g. very young, very elderly, heart disease, lung disease, severe asthma
Fever and cough that is persistent
Chest pain
Shortness of breath that can’t be explained
When would you refer for a cough?
Longer than 3 weeks and not improving
Chest pain
Shortness of breath
Wheezing
Recurring cough present at night
Whooping cough/croup
Cough or wheezing that may be drug induced e.g. ace inhibitors and beta blockers
Yellow, green, brown or blood stained phlegm/sputum
Offensive or foul smelling phlegm/sputum
When would you refer for a sore throat?
Dysphagia (difficulty in swallowing)
Longer than 7-10 days
Hoarseness persisting for more than three weeks
Sore throat with a skin rash
White spots, exudate or pus on the tonsils with a high temperature and swollen glands
Recurrent bouts of infection
Suspected adverse drug reaction e.g. carbimazole
Failed treatment
Breathing difficulties
When would you refer for ear wax?
Foreign body in the ear
Pain
Dizziness
Tinnitus
Treatment failure
When would you refer for a headache?
Headache associated with recent head injury/trauma
Children under 12
Associated with stiff neck, fever and or rash
Sudden onset and or severe pain
Suspected adverse drug reaction e.g. oral contraceptive pill
Associated with drowsiness, blackouts, unsteadiness, visual disturbances or vomiting
Recurring headaches
When would you refer for constipation?
Blood in the stools
Pain on defecation
Suspected drug induced constipation e.g. opiates, antidepressants
With abdominal pain, vomiting or bloating
Weight loss
Failed treatment
Change in bowel habit of more than 2 weeks
When would you refer for diarrhoea?
Persistent change in bowel habit
Recent travel which was abroad
Presence of blood/mucus in the stools
Diarrhoea with severe vomiting and fever
Signs of dehydration e.g. dry mouth, drowsiness or confusion, passing little urine, sunken fontanelle and eyes
Longer than 3 days in older children and adults (longer than 1 day in babies under 1 years and 2 days in children under 3 years and elderly)
Suspected drug induced diarrhoea e.g. antibiotics
Severe abdominal pain
When would you refer for dyspepsia?
Unexplained weight loss
Suspected drug induced dyspepsia e.g. ferrous sulphate, NSAIDs
Persistent vomiting
Persistent symptoms (more than 5 days) or recurring
Black or tarry stools
Severe pain
Pain radiating to other areas of body e.g. arm
Symptoms developing for the first time in patients aged 45 years or over
Dysphagia (difficulty in swallowing)
Failed treatment
When would you refer for haemorrhoids?
Blood in the stools
With abdominal pain or vomiting
Weight loss
Persistent change in bowel habit
Longer than 3 weeks
When would you refer mouth ulcers?
Lasting longer than 3 weeks
Suspected adverse drug reaction e.g. NSAIDS
Crops of 5-10 or more ulcers
Rash
Diarrhoea
With weight loss
Involvement with other mucous membranes
When would you refer for cystitis?
Diabetics
Immunocompromised patient
Pregnant
Men
Children
Elderly women
Vaginal discharge
Haematuria (presence of blood in the urine)
With fever, nausea and or vomiting
Pain or tenderness in the loin area
Recurrent cystitis
Failed treatment
Longer than 2 days
When would you refer for Primary dysmenorrhoea?
Abnormal vaginal discharge
Heavy or unexplained bleeding
Showing signs of systematic infection e.g. fever
Symptoms suggesting secondary dysmenorrhoea
When would you refer for vaginal thrush?
Diabetics
More than two attacks in the last six months
Failed OTC treatment
Pregnant
Vulval or vaginal sores ulcers or blisters
Vaginal discharge that is green-yellow or blood stained
Vaginal discharge that is foul smelling
Under 16 or over 60 years of age
No improvement within 7 days of treatment
Previous history of STD (sexually transmitted infection) or exposure to partner with STD
Abnormal or irregular vaginal bleeding
Any associated lower abdominal pain or dysuria
When would you refer for athlete’s foot?
Not responded to the appropriate treatment
Nail involvement
Spreading to other parts of the foot
Diabetics
Signs of bacterial infection e.g. weeping, pus or yellow crusts
When would you refer for cold sores?
Longer than 2 weeks
Lesions inside the mouth
Eye is affected
Immunocompromised patients
Signs of secondary bacterial infection e.g. weeping, pus, yellow crust
Babies and children
Severe, widespread or worsening lesions
Painless lesion
When would you refer for warts and verrucas?
Anogenital warts
Facial warts
Diabetics
Immunocompromised patient
Bleeding or itching
Changed in size or colour
OTC treatment that has been unsuccessful following 3 months of treatment
What OTC meds should be avoided or used with caution in asthma?
Aspirin and NSAId
Cough suppressants e.g. codeine, pholcodine and dextromorphan
Head lice preparations containing alcohol
What OTC meds should be avoided or used with caution in those with prostate enlargement?
Those that may precipitate urinary retention:
Anticholinergics e.g. sedating antihistamines, Kwells and Buscopan
Decongestants e.g. phenylephrine
What OTC meds should be avoided or used with caution in glaucoma?
Anticholinergics e.g. sedating antihistamines, Kwells and Buscopan
Corticosteroids e.g. Beconase nasal spray
Name some OTC medicines that are prone to abuse
Opioid analgesics Laxatives Stimulants Antihistamines Cough/cold preparations e.g. Sudafed
Sodium hyaluronate 0.2% eye drops?
Once opened the bottle can be used for up to 90 days
condition blocked sweat ducts?
miliar/heat rashkeep skin coolloose clothingplenty fluidsCalm
MHRA WARNINGS1. PPI’s- c diff, osteo, gastric cancer masked, hypomagnesaemia, b12 L long-term2. Hydrochlorothiazide- non-melanoma skin cancer3. Domperidone- qt prolongfation4. Ondansteron- oral cleft5. Clozapine- intestinal obstruction, constipation, report6. Erythromycin- qt prolongation7. Ciprofloxacin- tendons, ruputured, avoid in kids, seizure threshold L8. Loperamide- qt prolongation9. Bisphosphonates- atypic necrosis, jaw, hearing10. Finasteride- teratogenic, female, handling
naproxen+steorids no good, bleed
URINE COLOURS
perfect circle, central clearing, defined edges?
tinea corporis, ringwor
Chloramphenicol
eye drop vs ointment?
Drops:
ONE drop into the affected eye(s) every two hours for the first 48 hours, then decrease the dose to every four hours
During waking hours only.
Ointment:
If using alone - Apply approximately one cm of ointment between the lower eyelid and the eye three to four times daily
If using with eye drops - One cm of ointment between the lower eyelid at night
5 days MAX
DROPS DURING THE DAY, OINTMENTS DURING THE NIGHT
Optrex storage?
fridge!
Mometasone directions?
Two sprays into each nostril once a day until symptoms are controlled, then one spray into each nostril daily.
MOMETASONE CRAZY ADMINISTRATION
Shake container well before each use
Before first administration the spray should be primed, this is achieved by actuating the pump ten times until a fine mist is obtained; re-prime with two sprays if the pump has not been used for 14 days
Advise person to blow their nose gently
Hold bottle upright
Bend head slightly forward
Close one nostril as spray is administered in the other nostril, breathe in slowly through your nose. Breathe out through your mouth. Use second spray if appropriate
Repeat with the other nostril
Wipe the nozzle with a clean tissue or handkerchief
Discard once all sprays have been used or after two months of first opening
MOMETASONE STORAGE?
Do not use after expiry date.
Use within two months of first opening.
CHLORPHENAMINE IS SEDATING! LORADATINE IS PREFERRED, AWAKENESS, NON-SEDATING
PREGABALIN, MHRA, TERATOGENIC!
wet combing regimen?
The recommended regimen for wet combing treatment is four sessions spaced over 2
weeks (on days 1, 5, 9, and 13).
It takes about 10 minutes to complete the process on short hair, and 20–30 minutes for long, frizzy, or curly hair. Two combing procedures are recommended at each treatment session.
permethrin?
mebendazole?
1 week
2 week
permthetrin
Scabies?
Head lice?
2 month+
6 month+
A 25-year-old woman asks for something to treat her eyes. Both of her eyelids are sore and her eyes feel gritty. She reports no pain or change in vision and she has no medical conditions.
Blepharitis is a condition where the eyelids look inflamed and the eyes may feel gritty, itchy or as though they are burning.
LIDOCAINE?st
Apply a pea sized blob of gel (see circle shown in the patient information leaflet) to a clean fingertip
and spread gently onto the sore area of the gum. If necessary, repeat the dose after 3 hours. Do
not use more than 6 times in one day (24 hour period).
HAND FOOT MOUTH?
PARACETAMOL ETC WILL DO!
QUICKEST FOR CONSTIPATION?
GLYCEROL SUPPOSITORY!
SILDENAFIL AGE?
IBUPROFEN?T
18+
ibuprofen calm, it’s the tamsulosin n watnot
alpha blockers, b blockers, etc
35+, SMOKING?
VTE RISK FACTOR!
ALELRGIC RHINITIS, FLUTICASONE PREFERRED?
ALLERGIC RHINITIS ORDER?
MILD- azelastine
MODERATE- fluticasone
tinea corporis
SEPSIS, NO FLUIDS, GP ASAP!
FEXOFENADINE AGE?
12+
Apple juice and orange juice decrease the exposure to fexofenadine.120mg in adults and children!
LACTULOSE-LACTOSE INTOLERANT, GUESS
SCARLETT FEVER, HIGH TEMP, GP ASAP!!
RINGWORM, CLOTRIMAZOL 1%, CALM
A
itchy scalp does not mean?
Head lice, u gotta detect comb etc and confirm!
impetigo, kid otc?
hydrogen peroxide is cool
Itchy scalp X= head lice, no need to wash high temp either, scabies/mebendazole?
MICONAZOLE DIRECTIONS, FUNGAL?
APPLY BD+10 DAYS AFTER LESIONS HAVE HEALED
SUBARROHCNOI?
KICKED IN THE HEAD, stress
4 year old, cough?
glycerin honey and lemon linctus
bacterial conjunctivitis, treatment?
pick one
drop or ointment :/
chloramphenicol drop?
ONE drop into the affected eye(s) every two hours for the first 48 hours, then decrease the dose to every four hours
CLOTRIMAZOLE 2%?
CLOTRIMAZOLE 1%?
CLOTRIMAZOLE 2%?
CLOTRIMAZOLE 1%?
CLOTRIMAZOLE 2%? vaginal thrush
CLOTRIMAZOLE 1%? skin, nappy rash
Canesten HC
fungal
itching
Treat
heavy cold
Abdomen
elderly
itchy?
VARICELLA ZOSTER!
post-herpetic neuralgia?
amitriptyline!
A- Desosest rel 712W missed pile tall ASAP useprotection forfurther 2days In this case only 4hourspassed noneedfor Erk
ANALF ISSURE
haemorrhoids?
lumps, out of anus
itching/burning/pain/swelling
rectal bleeding
straining/incomplete
anal fissure?
sharp pain
cold sores treatment?
aciclovir!
SLEEPY TIME ANTIHISTAMINE?
DIPENHYDRAMINE
1ST LINE IMPETIGO OTC?
BENZOYL PEROXIDE
ORAL CANDIDIASIS?
FUNGAL?
ORAL CANDIDIASIS? 7 days after lesions have healed
FUNGAL? BD+10 days after lesions have healed
SCABIES, PERMETHRIN?
THREADWORM, MEBENDAZOLE?
SCABIES, PERMETHRIN? 1 WEEK
THREADWORM, MEBENDAZOLE? 2 WEEKS
BACK PAIN?
1st line- NSAID
2nd line- Codeine with/without paracetamol
3rd line- spasm, short course benzo, diazepam
baby, paracetamol post-immunisation dose?
up to 6months
60mg right after vaccination
60mg 4-6hrs after first dose
60mg 4-6hrs after second dose
MODAFINIL?
Contraception during+2 months after
FLUOROQUINOLONE?
heart valve regurgitation
taking desogestrel?
day 1 of cycle then continous
levonorgestrel+desogestrel?
you can take same day str8 away
groin, sore/wet/itchy/smelly?
clotrimazole/miconazole? str8
meningitis?A
notifiable!
SHINGLES?
GO A&E ASAP
A 26-year-old asks to purchase the morning after pill. She had intercourse
last night and the condom split. She takes carbamazepine for epilepsy. Which
action would be most appropriate for the pharmacist to take?
double up levonelle!
An 8-year-old has had a cold and very sore throat for 2 days and has a
temp of 39.2C. Her throat appears very red, her tongue is red with tiny white
spots, and she has a widespread red rash that feels rough but blanches when
pressure is applied. What is the likely cause of her symptoms?
SCARLETT FEVER, WHITE SPOTS!
scarlett?
go GP quick ting!
Orlistat dose?
1 tds!
orlistat no weight loss within 12 weeks?r
stop treatmetn!
gastroenteritis?
diarrhoea!
tranexamic acid+pill?
UNSUITABLE!
TRANEXAMIC ACID?
no effect on period
max 4 days
n&v DIARRHOEA COMMON
x pill
MAX. SILDENAFIL DOSE?
50MG
Trichomoniasis is?
Parastici1
MENINGITIS, CAPILLARY REFILL?
5 SECONDS? REFER
meningitis CRT>X REFER?
3 SECONDS!
temp> x?
39 referral
REYE’S SNDROME?
HELLA VOMITING
metformind oesn’t cause dysuria!
tranexamic acid irrregular cycle?
avoid
sumatriptan+smoking?
no problem
TAKEN ULIPRISTAL?
TAKE BARRIER TILL NEXT PERIOD
fexofenadine+juice?
don’t mix bruh
derbac lotion
24hours!
permethrin cream?
2+, scabies, 12hrs
