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
What kind of laxative should be used for IBS?
Bulk forming
What age can you sell mebeverine OTC?
> 18 years
What age can you sell Buscopan OTC?
12 years and over
What age can you sell Colpermin IBS relief capsules OTC? (peppermint oil)
15 years and over
What are the symptoms of haemorrhoids?
Bleeding, perianal itching, mucus discharge and pain
How many days max should you use Anusol HC plus ointment OTC?
7 days max(contains hydrocortisone)
Can you use anusol HC plus ointment OTC in pregnancy and breastfeeding?
No
A cough for how many weeks would prompt a referral?
Longer than 3 weeks
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
What time of the day are symptoms of croup the worst?
At night
How can you treat croup?
No medical treatment as it is viral but can offer antipyretic treatment if fever is present
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.
Systemic decongestants are contraindicated in patients taking what medicine class?
MAOIsRisk of hypotensive crisis
What is a purpuric rash?
One which does not blanch white on pressure
Bonjela preparations containing choline salicylate is unsuitable for which age group?
Under 16 years
What is the licensed age range for sumatriptan OTC?
18-65
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 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 1st line for pregnancy in threadworm?
Strict hygiene measures Refer if this has not worked
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 age group is mebendazole not suitable for?
<2 years
What is recommended as first line for head lice treatment in pregnancy and BF?
Wet combing If treatment needed, Dimeticone e.g. Hedrin
What is recommended as first line for head lice treatment in asthma and eczema?
Wet combing If treatment needed, Dimeticone e.g. Hedrin
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 first line for scabies?
Permethrin 5% w/w cream (Lyclear®)
What is first line for scabies in pregnancy and BF?
Permethrin 5% w/w cream (Lyclear®)
Where should you apply scabies lotion?
All over the body
What is 1st line for athlete’s foot in pregnancy and breastfeeding?
Topical imidazoles e.g. Daktarin Gold
What is the minimum age for Lamisil OTC (terbinafine) for athelete’s foot (tinea pedis)?
> 16 years
What is the maximum number of nails you can treat OTC for fungal nail infection?
2 If more than this, need to refer
Amorolfine lacquer is licensed OTC for what condition and what is the age restriction?
Fungal nail infection18 years and over
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.
How can sweat rashes be treated OTC?
Topical imidazoles e.g. Daktarin
What should you do if someone comes into the pharmacy with impetigo?
Usually needs a prescription to treat it so refer
What age groups should be referred in vaginal thrush?
<16 years>60 years
True or false:Poorly controlled diabetes is linked with thrush
True
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
Can you treat a pregnant person OTC for thrush?
No- refer
What NSAID (stronger than ibuprofen) is available OTC for primary dysmenorrhoea?
Feminax ultra 250mg naproxen
What age range is Feminax ultra licensed for?
15-50 years
What age would you refer for bacterial conjunctivitis?
<2 years
Can you treat bacterial conjunctivitis OTC for pregnancy and breastfeeding?
No- refer
An ulcer lasting than more than how many weeks should be referred?
More than 3 weeks- exclude oral cancer
What is the minimum age to use Difflam mouthwash?
12 years
What is the minimum age to use Difflam spray?
6 years
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 miconazole 2% oral gel for oral thrush?
>4 months
Should miconazole oral gel be applied before or after meals?
After and held in the mouth as long as possible
What anticoagulation interacts with miconazole oral thrush gel and prompts a referral?
Warfarin
If a patient has diabetes and presents to the pharmacy with oral thrush, what should you do?
Refer
What is angular stomatitis?
Cracked fissures in the corners of the mouth
What can you offer OTC for angular stomatitis?
Clotrimazole 1% cream
True or false:Diuretics can cause dry eyes
True
What is the minimum age to use hydrocortisone 1% cream OTC?
10 years
What is the maximum number of days to use OTC steroid cream?
7 days
What steroid creams are available OTC?
Hydrocortisone 1% and clobetasone butyrate 0.05%
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
Can you give steroid creams OTC to pregnant women?
No
Are OTC steroid creams licensed for psoriasis flare ups?
No
What age range is OTC tranexamic acid licensed for in heavy periods?
18-45 year olds
At what age are you eligible for the free flu vaccine?
65 years and older
Coughing up thin and frothy mucous can suggest what?
Left ventricular failure
What age can you sell OTC guaifenesin cough syrup?
>6 years (Benylin chesty cough for children)
What age can you sell OTC diphenhydramine cough syrup?
> 6 years (Benylin children’s night cough)
What age is otrivine child nasal drops licensed in?
6-12 years Contains xylometazoline
What age are Tyrozets (benzocaine) lozenges licensed in?
> 3 years
Is Ella One recommended in a patient with severe uncontrolled asthma?
No, especially if being treated with an oral glucocorticoid
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 in men ages 45-75 yearsCan be taken for up to 6 weeks before clinical assessment by a doctor
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.
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 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
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.
Buccastem is licensed for what age OTC?
18 years
Anusol Plus HC is licensed for what age OTC?
18 years
Corticosteroid nasal sprays are licensed for what age OTC?
18 years
Tranexemic acid is licensed for what age OTC?
18 years
Canesten thrush cream is licensed for what age range OTC?
16-60 years
Azithromycin (OTC for chlamydia) is licensed for what age?
16 years
Nytol is licensed for what age OTC?
16 years
Feminax ultra OTC is licensed for what age?
15-50 years
Voltarol gels OTC are licensed for what age?
14 years
Rennie is licensed for what age OTC?
12 years
Gaviscon is licensed for what age OTC?
12 years
Woodwards Gripe water OTC is licensed for what age range?
1 month- 1 year
Calpol OTC is licensed from what age?
2 months
Nurofen OTC is licensed from what age?
3 months
Daktarin 2% oral gel is licensed from what age otc?
4 months
Hedrin and Derbac liquid is licensed from what age OTC?
6 months
Piriton OTC (chlorphenamine) is licensed from what age?
1 year
What age is Diarolyte relief OTC licensed for?
1 year(Under this age needs medical advice)
OTC choramphenicol is licensed for what age?
2 years
Mebendazole OTC is licensed for what age?
2 years
Lyclear cream OTC is licensed for what age?
2 years (Under this age needs medical advice)
Loratadine OTC is licensed what from age?
2 years (as long as they weigh more than 30 kg)
Phenergan OTC is licensed from what age?
2 years
What is the active ingredient in Joy Rides?
Hyoscine hydrobromide
Joy Rides OTC is licensed from what age?
3 years
Kwells OTC is licensed from what age?
4 years
Sturgeon (cinnarizine) is licensed from what age?
5 years
What are the 6 stages of transtheoretical model of change?
- Pre-contemplation2. Contemplation3. Preparation4. Active5. Maintenance6. Relapse
Is evaluation a stage in the transtheoretical model of change?
No
What is tranexamic acid licensed for?
Heavy menstrual bleeding over several cycles with regular cycles
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 the max number of days you should use tranexamic acid OTC for?
4 days
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 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 sumatriptan but is on an SSRI/TCA, what should you do?
ReferRisk of serotonin syndrome if used together
If a patient comes in asking for sumatriptan but is on an a MAOI, what should you do?
Refer
Can sumatriptan be used as a prophylactic for migraines?
No- it is for acute attacks
What is the supply criteria for tamsulosin OTC?
Male patients 45-75 years- Had symptoms for a minimum of 3 months- 2 weeks supplied initially and then if there is an improvement in symptoms, a further 4 weeks can be supplied
How many weeks of tamsulosin is supplied initially?
2 weeks
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
If a male patient asks for tamsulosin OTC but mentions he suffers from postural hypotension, what should you do?
ReferCan cause postural hypotension
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
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 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
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.
Is it recommended that a child with bacterial conjunctivitis does not go to school?
No - should still go to school
What is the minimum age for pantoprazole OTC?
18 years
What is the dose for pantoprazole OTC?
20mg OD
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
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)
What is Onychomycosis?
Fungal nail infection
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
A non blanching rash can be a symptom of what?
MeningitisThe rash does not fade when pressed with a glass
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
How soon do you get symptoms after coming into contact with chickenpox?
1-3 weeks
Can you catch shingles from someone with chickenpox?
No
Can you catch chickenpox from someone with shingles?
Yes if you have not had chickenpox before
How may hours after unprotected sex is Ulipristal Acetate licensed for?
120 hours (5 days)
How may hours after unprotected sex is Levonorgestrel licensed for?
72 hours (3 days)
What age is levonorgestrel licensed for OTC?
16 years and over
What is the dose of ulipristal acetate for EHC?
30mg
What is the dose of levonorgestrel for EHC?
1500 micrograms
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
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
Levonorgestrel is less effective in women with a BMI over what?
26 - may need a double dose as per FSRH advice
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.
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
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
What is the advice surrounding EHC ulipristal and vomiting?
If vomiting occurs within 3 hours another tablet should be taken as soon as possible
In what clinical conditions is the use of EHC ulipristal not recommended?
Severe hepatic impairmentAsthma which is being treated by oral glucocorticoids
In what clinical conditions is the use of EHC levonorgestrel not recommended?
Severe malabsorption syndrome e.g. Crohn’s Severe hepatic impairment
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.
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
Children under what age are legally too young to consent to sexual activity?
13 years
What is the dosing instruction for naproxen OTC for painful periods?
On the first day 2 tablets (500 mg) should be taken initially and then one tablet (250 mg) after 6 to 8 hours if needed.Max 3 tablets in a dayMax number of days for treatment is 3 days
What is the max duration of days is licensed for OTC naproxen for painful periods?
3 days
Viagra OTC is licensed from what age?
18 years
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
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.
Psuedoephedrine is cautioned in what conditions?
DiabetesHypertensionHeart diseaseAngle-closure glaucoma
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.
How many levels of healthy living pharmacy is there?
Level 1, 2 and 3
Need to be on the HLP register
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)
What is the dose of paracetamol for a 2 month old?
30-60mg TDS
What is the dose of paracetamol for 3-5 months?
60mg QDS
What is the dose of paracetamol for 6 months-2 years?
120mg QDS
What is the dose of paracetamol for 2-3 years?
180mg QDS
What is the dose of paracetamol for 4-5 years?
240mg QDS
What is the dose of paracetamol for 6-7 years?
250mg QDS
What is the dose of paracetamol for 8-9 years?
375mg QDS
What is the dose of paracetamol for 10-11 years?
500g QDS
What is the dose of paracetamol for 12-15 years?
480-750mg QDS
Discharge coming from the ear can indicate what?
Ear infection- refer
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
Which illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?
Measles
Rubella is also known as what?
German measles
The difference between German measles and measles (morbilli) is what?
Measles manifests itself with white spots in the mouth.
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)
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
Should Hedrin (dimeticone) be applied to wet or dry hair?
Dry
Scarlet fever is caused by what?
Group A strep
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
A rash like this indicates what?
Chicken pox
A rash like this indicates what?
Scarlet fever - refer
How long does acute otitis media 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)
In patients with blepharitis, can their eyelids stick together?
Yes, can also be itchy and have a build up of debris
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 this
Warm compress
Eye make up can make the condition worse
What is this?
Blepharitis
What is this?
Bacterial conjuctivitis
What is this?
Allergic conjuctivitis
Is allergic conjuctivitis contagious?
No
What are the main differences of presentation for viral and allergic conjuctivitis?
Viral can be bilateral or unilateral
Allergic is bilateral, red and gritty
What age is acetic acid (EarCalm) licensed in?
12+
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
Constipation lasting how long with no identifiable cause prompts a referral?|
2 weeks
What age should you refer someone with constipation?
<18 to rule out underlying causes
How does the afe licensing of OTC loperamide differ in the following indications:
i) Acute diarrhoea
ii) 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 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.
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 should you recommend if a pregnant or breastfeeding lady comes in with oral thrush?
Refer
What would be first line for a sprain? What is second line?
Paracetamol or TOPICAL NSAID
If no improvement after 48 hours of injury, use an oral NSAID
What does Otrivine 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 period pains (primary dysmenorrhoea)?
NSAID
Can offer paracetamol as well or if NSAID contraindicated
How long should daktarin gel be applied for?
During symptomatic period and for 7 days after symptoms have cleared up
Why should Bismuth salicylate for diarrhoea not be given to aspirin hypersensitive patients?
Bismuth salicylate16+: avoids in those hypersensitive to aspirin, causes black stools and tongue. e.g. Pepto-bismo
