Community Pharmacy (OTC) Flashcards
What organism causes RING WORM?
Tinea Corporis
Main symptom of ringworm is a rash. It may look red, silver or darker than surrounding skin
It’s fine for your child to go to school or nursery once they have started treatment.
It can be passed on through close contact with:
- an infected person or animal
- infected objects
- infected soil
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 kind of medication is Guaiphenesin?
Cough EXPECTORANT for productive chesty cough
These claim to make the coughing easier while enhancing production of mucus and phlegm.
− 6+ (guaifenesin, ipecacuanha – Covonia herbal mucus cough, ammonium chloride - Unicough, squill – Buttercup original cough mixure)
Do not give cough suppressants as they may lead to accumulation of mucus in lungs and ↑ risk of infection
What kind of medicine is Dextromethorphan?
Cough suppressant (antitussive)
Dry, irritating, non-productive cough – usually viral cause (self-limiting)
Cough suppressants/antitussives 6+ (pholcodine1st line, codeine 18+ , dextromethorphan1st line), SE = sedation and constipation
What antihistamine do we usually give to children?
Chlorphenamine maleate
Suitable for 1 year and over
drowsy (sedating) antihistamine
− Antihistamines: PRN and work within 1 hour
Older more sedating and anticholinergic (diphenhydramine, chlorphenamine – Piriton tab 6+ ; 1+ liquid, promethazine – Phenergan tab 5+; 2+ liquid). Avoid up to 14 days after stopping MAOI.
What age are steroid nasal sprays e.g. beconase, flixonase, not suitable in?
Under 18’s
Topical corticosteroids18+; max 3 months
mometasone – Nasonex,
fluticasone – Pirinase/Flixonase,
beclomethasone – Beconase
Take few days to work. SE: dryness, irritation of throat
What drugs can be given on instalment prescriptions (FP10MDA) other than Methadone?
Schedule 2 Controlled Drugs;
Buprenorphine;
Buprenorphine/naloxone (Suboxone); and
Diazepam
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 prescription each time the patient picks up an instalment
What formulations have more potential for abuse by addicts?
Sugar free
Syrup base less liable to abuse
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 each other
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.
Sedating antihistamines
diphenhydramine – Nytol1 6+
promethazine HCl – Sominex
promethazine HCl Phenergan16+
to take at bedtime
What is cinnarazine and what is it used in?
Can last 8 hours and need to take 2 hours before ____ ?
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
5+
Promethazine – Phenergan 2+ 25mg can last 6-8 hours and need to take night before or 2 hours before journey. (also cyclizine)
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 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
Treat MILD symptoms cystitis present for <48 hours for TWO days only. − Alkalinising agents neutralise the acidic urine to reduce irritation. Take 1 sachet (or solution) TDS for 2 days: Sodium citrate – Cymalon/CanesOasis: can cause fluid retention, ↑ BP.
Avoid in HTN, CVD, diabetes, pregnancy, impaired renal function, and patients taking lithium.
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
Children under __ should not be given cough and cold medication OTC containing
PSEUDOEPHEDRINE
PHENYLEPHRINE
DEXTROMETHORPHAN
PHOLCODINE
GUAIFENESIN
Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.
Children under 6 years old
Medicines containing:
ANTITUSSIVES (suppressants) dry cough (DEXTROMETHORPHAN
PHOLCODINE)
Expectorants (GUAIFENESIN, ipecacuanha)
Nasal decongestants (pseudo, phenylephrine, ephedrine, oxymetazoline, xylometazoline: otravine child)
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
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)
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
What is the organism causing athletes foot? How is athletes foot treated?
TINEA PEDIS
Options include terbinafine cream or an imidazole such as clotrimazole, miconazole, or econazole cream
Topical imidazole (Miconazole) can be used- Apply BD x 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
alt: undecenoic acid cream or topical preparations containing tolnaftate.
Main symptom of ringworm is a rash. It may look red, silver or darker than surrounding skin, depending on your skin tone.
The rash may be scaly, dry, swollen or itchy.
Ringworm can appear anywhere on the body, including the scalp (tinea capitis) and groin (jock itch).
Amorolfine 5% (Curanail, Loceryl) can be used for fungal nail infections. What is the directions for this?
Apply 1-2 times ONCE weekly 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
(only beneath tips or sides of nail affected). − Maximum of 2 infected nails at one time
Refer: Pregnancy and lactation ▪ Hypersensitivity ▪ Peripheral circulatory diseases ▪ Diabetes mellitus ▪ Immunosuppression ▪ Nail dystrophy or destroyed nail plate
Why has the safety of using medicines containing codeine to treat coughs and colds in children younger than 18 been reviewed?
Because of the potential for serious problems like slowed or difficult breathing.
Children, especially those who already have breathing 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.
What do we use to treat Oral thrush?
White patches on tongue and mucosal surfaces inside mouth that cannot be scraped off easily. It is raw and sore underneath the patches
Topical Miconazole gel- Daktarin oromucosal gel
4 months+
apply QDS after meals and continue for at least 1 week after symptoms disappear.
Do not apply gel to back of the throat – possible choking. − Prevent re-infection by using sterilize bottle teats.
If breastfeeding, apply miconazole cream to nipple and wipe away before a feed.
− Significant interaction: warfarin + miconazole = bleeding. −
Alternative is Nystatin oral suspension 1ml (100000 units) QDS for 7 days and continue 48 hours after lesion has resolved. − Severe cases give Fluconazole 50mg OD for 7 days.
Fluconazole 3rd line if topical preps can’t be used/ patient has a dry mouth
What is Lyme disease caused by? What does the rash present as?
Caused by bacterial infection from Tick 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 100mg BD x21 days
or
amoxicillin or azithromycin
Is sunlight a good cure for cold sores (herpes simplex virus 1)?
− It is highly contagious and will be no longer contagious after crusts form.
Sunlight can trigger cold sores so direct sunlight should be avoided and sun screen should be applied.
Prodromal phase (tingling, itchy, numb) → 6-24h → small fluid-filled blisters → break down to reveal raw area underneath → 4 days → crusting over. Most lesions heal within 7-10 days.
Trigger factors: sunlight, fever, local trauma, menstruation and stress
− Aciclovir cream (Zovirax) is available OTC (2g pack size). Apply 5 x DAILY for at least 4 days, max. 10 days starting at first sign of cold sore.
Penciclovir 12+ (Fenistil) is applied every 2h up to 8 times a day for at least 4 days. Wash hands after applying cream or touching lesion.
How many days of co-codamol 30/500mg tablets could you give maximum as an emergency supply?
5 days max
As co-codamol contains codeine 30mg which is a schedule 5 CD!
Orlistat impaires the absorption of Fat soluble vitamins. so patient is advised to take vitamin supplements at night or 2 hours after orlistat dose. Which are the Fat soluble vitamins?
A
D
E
K
Water soluble: B, C
ORLISTAT 60MG P MEDICINE
- Age > 18 years old
- − BMI >28mg/m2
- max 6 months
- Refer patient who has been unable to lose weight after 12 weeks
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.
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 6 months, or over 5 cubic meters
What does ‘Freshly prepared’ mean? What does ‘Recently prepared’ mean?
Freshly prepared: 24 HOUR EXPIRY
Recently prepared: 28 day expiry
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
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
Eye drops containing a lubricant only (e.g. propylene glycol) will expire in _____
6 months
Co-amoxiclav oral suspension will have an expiry of ____ once it is made up
7 days
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 but patients are still advised to discard the drops 5 days after opening (after finishing the course)
Oramorph 20 mg/mL solution
CD 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
Which emollient does not contain Urea?
hydromol
The mainstay of treatment OTC of travel sickness involves antihistamines:
Cinnarizine
Meclozine
Cyclizine
Promethazine: Promethazine Hydrochloride (Phenergan) and Promethazine Teoclate (avomine) OR Anticholinergics:
Hyoscine hydorobromide
Which 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
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
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
How does plaque psoriasis present?
Silvery white scales, when scraped away pinpoint bleeding occurs from the capillaries
− Coal tar solution12+ – Exorex, T/Gel Shampoo, Polytar. Polytar can stain clothes and has an unpleasant smell. Side effects: photosensitivity and skin irritation. − POM = topical vitamin D (Calcipotriol) BD, steroids, Dithranol.
What is the only contact lense solution that can be applied whilst contact lenses are still in the eye?
Re-wetting solution
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)
Where should Latanoprost eye drops be stored?
In the fridge
Where does the Fostair Nexthaler need to be stored?
What are its active ingredients?
At room temp
Steroid Beclometasone and LABA formoterol
Which eye drops used in glaucoma can cause a change in eye colour?
Prostaglandin analogues:
BIMATOPROST
LATANOPROST
TRAVOPROST
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 (anitemtic for migraine)
Yellow: Paracetamol, codeine
Max in 24 hours: 2 pink + 6 yellow
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!
Symptoms in infants: floppiness/unresponsive, dislike being handled, refuse feeds, difficult to wake, rapid breathing/grunting, unusual cry or moan and bulging fontanelle.
benzylpenicillin IM/IV should be given at the earliest opportunity
Symptoms of meningitis develop suddenly and can include:
- a high temperature (fever)
- being sick
- a headache
- a rash that does not fade when a glass is rolled over it (but a rash will not always develop)
- a stiff neck
- a dislike of bright lights
- drowsiness or unresponsiveness
- seizures (fits)
What are the signs and symptoms of Otitis externa?
Otitis externa (inflammation of ear canal) ‘swimmer’s ear
REFER: ▪ Deafness, tinnitus (ringing in the ears, vertigo, blocked ears, discharge (infected) ▪ Nausea and vomiting ▪ Bleeding ▪ Children < 12 years
itching
irritation
Some discharge
Oedematous (fluid build up) leading to conductive hearing loss
Ear canal/ external ear are red, swollen and eczema like
Acetic acid 2% spray – EarCalm spray12+ to treat mild superficial ear infections- stop and seek medical advice if no improvement within 2 days
Wear ear plugs when swimming and avoid shampoo, soap in ears.
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
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
N+V
Otitis media refer >72 hours
Children under 2 years with bilateral otitis media
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
How is allergic rhinitis differentiated from the common cold? What are the treatment options OTC for this?
Allergic rhinitis presents as: sneezing, rhinorrhoea 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 is minoxidil? Can you get it on an NHS prescription?
Used for pattern hair loss
Cannot be issued on NHS prescription
If patients are using several topical agents, when should the emollient 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.
We say that stimulant laxative are not first line constipation remedies, however when may we chose to recommend it?
bisacodyl 10+
senna6+/12+
sodium picosulfate10+
docusate,
glycero
If someone has been constipated for a while e.g. 10 days (refer if over 14 days) as these work quickly (8-12 hours) so may be appropriate for one-off use.
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
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
Who would you prefer to give codeine to? A 24 year old Ethiopian man or 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.
What condition presents with a rash, white coating of the tongue, plus headache and fever leading up to it?
Scarlet fever ‘sandpaper’ rash develops 12-48 hours after initial symptoms. First appears on the chest and stomach before spreading to other areas of the body. − Initial symptoms before rash include sore throat, headache, high temperature, flushed cheeks and swollen tongue. −Other symptoms include red and swollen tongue (strawberry tongue), swollen lymph glands, malaise, loss of appetite
Symptomatic relief: paracetamol to relief high fever; antihistamine or calamine lotion to relief itchiness.
POM Phenoxymethylpenicillin (Penicillin V) QDS for 10 days
Scarlet fever is very contagious. Keep children off for at least 24 hours after starting antibiotic. Without treatment, it can be infectious for 2-3 weeks after onset of symptoms
Cover mouth when sneezing or coughing as it can also spread through air droplets
Minimum age to buy Clamelle (azthromycin for chlamydia) OTC?
16 years: 1g for 1 dose, max pack size 1g
Can be sold for the epidemiological treatment of their sexual partners
Age restriction for
Hydrocortisone (hc45) 1 % cream?
Hc45 Hydrocortisone Cream is a treatment for dry skin conditions, such as eczema and dermatitis, that can also be used to ease reactions to insect bites, nickel allergies, plant allergies, and other irritants.
10 years
Max 15g tube
max. use 7 days.
Not for broken or infected skin. not for face or anogenital areas. Not for pregnancy. − Contraindicated in acne, rosacea, skin infections e.g. cold sore, athlete’s foot, impetigo and ringworm.
Age restriction for
Eurax HC (hydrocortisone 0.25%) cream?
10 years
Age restriction for
Clobetasone (eumovate) 0.05% cream?
(Moderate potency)
12 years
Age restriction for
Tamsulosin 400mcg tablets (FloMax)?
− Enhanced hypotensive effects if taken with antihypertensives. Advise patient to sit or lie down until the symptoms have gone. − Drowsiness or dizziness may affect performance of skilled tasks. − Stop treatment if symptoms have not improved after initial 2 weeks. − It does not increase the risk of prostate cancer.
45 years - 75 years
A 2-week supply can be given initially. If there has been an improvement in urinary symptoms within the initial 2 weeks, a further supply can be made for 4 weeks. After 6 weeks, a further supply can be made only where the patient confirms that the doctor has carried out a clinical assessment and agreed further supplies are appropriate.
Age restriction for
Naproxen 250mg tablets (Feminax Ultra)?
DYSMENORRHOEA
15 - 50 years
(9x250mg); 500mg STAT then 250mg every 6-8 hours PRN; max. 3 tablets each day; max. 3 days in one month.
refer if taking oral contraceptives
Age restriction for
Ibuprofen?
Suspension or suspension sachets- 3 months
Tablets: 12 years
Age restriction for
Mebendazole 100mg (OVEX) ?
THREADWORM -enterobius vermicularis
2 years +
−One dose taken orally; can repeat, if necessary, after 2 weeks to prevent reinfection. − Container must be labelled to show max. single dose of 100 mg (pack size max. 800 mg) − Treat all members of the household − Contraindicated in pregnancy – hygiene measures
refer <2 years
Pregnant and breast feeding
Pregnant and breastfeeding women and children under 2 years should follow strict hygiene measures for at least 6 weeks.
recent travel abroad
failed treatment
Age restriction for
Chloramphenicol 0.5% eye drops/ 1%eye ointment?
Acute bacterial conjunctivitis
>2 years
max duration of treatment = 5 days
Eye drops every 2h for first 2 days, then every 4h thereafter for up to 5 days (inc. 2 days after symptoms resolve) – store in fridge
Refer if not improving >48 hours
SE- grey baby syndrome, bone marrow depression
Brolene/golden eye can be used in all ages
Age restriction for
Loperamide 2mg?
12 years
2 caps STAT then 1 after each loose motion, max 16mg (8 tablets)/day.
(NOT in pregnant, breast-feeding, GIT infection) ORT ONLY!
Refer if medication ADR: magnesium antacid, NSAIDs, iron, laxatives, antibiotics, digoxin, PPIs, diuretics, SSRIs
Age restriction for
Aspirin?
16 years
Age restriction for
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)
Age restriction for
Tranexamic acid for menorrhagia?
18 years
Age restriction for
Paracetamol?
2 months
Age restriction for
Sumatriptan?
Imigran 50 mg - headache and migraine
18 years - 65 years
Previously tried simple analgesics
Established pattern of migraine (history of ≥5 attacks, with first occurring over 1 year ago)
Previously diagnosed by doctor or pharmacist
CI in HTN, MI, IHD, PVD, epilepsy
Take as soon as migraine onset (not prophylactically). Do not take a 2nd dose for the same attack. A 2nd dose can be taken after 2 hours if migraine recurs. Maximum 2 tablets in 24 hours.
Interacts with St John’s Wort, MAOIs, SSRIs, TCAs
Age restriction for
Cetirizine?
Loratidine?
2 years
Age restriction for
Levornorgestrel?
EMERGENCY HORMONAL CONTRACEPTION
Levonorgestrel 1500 microgram – Levonelle ONE Step
16 years
Unprotected sex/failure of a contraceptive method ≤72 hours (3d) − Patient who have taken CYP3A4 enzyme inducers within the last 4 weeks and for whom a copper IUD is not an option: 2 tablets of levonorgestrel 1500 micrograms should be taken.
− FSRH advise a ‘double dose’ in women >70kg or BMI >26kg/m2 , but is less effective.
If vomiting occurs within 3 hours another tablet should be taken STAT. − If appropriate, patients can take more than one dose of levonorgestrel within the same menstrual cycle, but may cause cycle disruption. − Breastfeeding: the small amount appears in breast milk should not be harmful.
− <13s: report to social services unless in exceptional circumstances. − 13-16s: can supply if consensual sexual activity.
Age restriction for
AMOROLFINE 5%?
18 years
ONCE WEEKLY for toenails = 9-12 months and fingernails = 6 months
Refer
▪ ≥2 infected nail ▪ Pregnancy and lactation ▪ Hypersensitivity ▪ Peripheral circulatory diseases ▪ Diabetes mellitus ▪ Immunosuppression ▪ Nail dystrophy or destroyed nail plate
Age restriction for
Cough- Simple linctus (pead)?
1 year
Refer
> 3 weeks of symptoms
▪ Not responding after 1 week of treatment
▪ Recurrent night-time cough if not associated with upper RTI in the past 2-4 weeks (may be asthma)
▪ Coloured sputum (green/yellow/brown = bacterial chest infection) ▪ Blood in sputum (pink-tinged and frothy = HF, rust = CAP, dark red = TB)
▪ Persistent fever, night sweats ▪ Persistent harsh barking cough
Age restriction for
Co-codamol?
12 years
But 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
Age restriction for
Steroid nasal sprays (beconase, flixonase)?
18 years
Age restriction for
Esomeprazole, Pantoprazole, Omeprazole?
18 years
Age restriction for
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)
Age restriction for
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)
Age restriction for
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)
Age restriction for
Ranitidine?
16 years
Age restriction for
Clotrimazole 2% cream?
16 - 60 years when used for thrush
Age restriction for
Chlorphenamine?
Liquid: over 1 years (safest choice for young children)
Chlorphenamine Tablets: 6 years
Age restriction for
Acrivastine?
12 - 65 years
Age restriction for
Senna?
12 years
Age restriction for
Ispaghula Husk (Fybogel)?
6 years
Age restriction for
Fluconazole capsule 150mg?
Used for thrush so16 - 60 years (refer outside of this range)
Age restriction for
Minoxidil 2% + 5%? (Regain)
18 years- 65 years
OTC Hair loss treatment
Age range for Thrush treatments?
Clotrimazole 2% creamClotrimazole 10% internal creamClotrimazole pessaryFluconazole 150mg capsuleAll 16- 60 years
Age restriction for
Clotrimazole 1% cream
For fungal skin infections (e.g. ring worm)Can be used in adults and children (no licensed age mentioned)
Age restriction for
Daktarin oral gel? (Miconazole)
licensed from 3 months
Age restriction for
Ulipristal Acetate?
Licensed for any girl of child bearing age
Minimum age Benzoyl Peroxide can be used in?
12 yearsAcne treatment
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
What is max dose of ranitidine OTC?
75 mg tabletsDo not take more than 2 in 24 hours
True or false:Being overweight can contribute to dyspepsia
True
True or false:Smoking can contribute to dyspepsia
True
In what group of patients is orlistat licensed for OTC?
> 18 yearsBMI > 28
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
What age can you sell OTC omeprazole to?
>18 years
What age can you sell esomeprazole to?
>18 years
What age can you sell OTC esomeprazole to?
>18 years
What is the dose of OTC esomeprazole, and what is the max time it can be used for?
20mg OD2 weeks maximum
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
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 are symptoms of colic?
High pitched cryingOften at same time of dayDrawing knees up to stomach
When would you refer with colic?
Failure to put on weightOTC treatment failure Danger symptomsOver anxious parentsSymptoms have not resolved past 4 months of age
What is 1st line for constipation?
Lifestyle measures
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
Why must bulk forming laxatives be taken with adequate fluids?
To avoid intestinal obstruction
Frequent use of stimulant laxatives can lead to what?
Fluid and electrolyte imbalance
How long does it take for glycerol suppositories to work?
Within 30 mins
What are the preferred type of laxative in children?
OsmoticBulk forming
What are the safest laxatives to use in pregnancy and breastfeeding?
Bulk forming and osmotic
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.
At what point is constipation classed as chronic?
Lasting 6 weeks or more
If a patient has constipation along with tiredness, what could be underlying causes?
HypothyroidismAnaemia
How long does it take for bulk forming laxatives to work?
12- 72 hours
What age can you sell Senna OTC to?
>12 years
What age can you sell Sodium picosulphate (Dulcolax pico liquid) OTC to?
> 10 years
What age can you sell ispaghula husk OTC to?
>6 years
Is Movicol is licensed for acute, chronic or both types of constipation?
Chronic
What are danger symptoms in a diarrhoea patient that prompts a referral?
Confusion DrowsinessPassing little urineDry mouthSunken eyesDuration of 3 days or longer in adults >24 hours in babies>48 hours in young chuldren
What is the difference between Diarolyte and Diarolyte Relief?
Relief contains rice power and normal diarolyte is glucose based
What age can you sell loperamide OTC to?
12 years and over
What is the maximum dose of GSL loperamide 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
Does rectal bleeding from haemorrhoids need to be referred?
No unless excessive bleeding occurs or has occurred for more than 3 weeks
A rash like this indicates what?
Chicken pox
A rash like this indicates what?
Scarlet fever - refer
What is this?
Blepharitis
What is this?
Bacterial conjuctivitis
What is this?
Allergic conjuctivitis
