Community Pharmacy (OTC) Flashcards
1
Q
How long should daktarin gel be applied for? (i.e. treatment duration)
A
During symptomatic period + 7 days after symptoms cleared up
2
Q
What would be first line for period pains (primary dysmenorrhoea)?
A
NSAID
Can offer paracetamol as well or if NSAID contraindicated
3
Q
What doesOtrivine Extra Dual Relief nasal spray contain and what is it used for?What is the age licensing for OTC?
A
Symptomatic treatment of nasal congestion and rhinorrhea in connection with common colds. Ipratropium bromide xylometazoline hydrochloride > 18 years
4
Q
What would be first line for a sprain?What is second line?
A
Paracetamol or TOPICAL NSAIDIf no improvement after 48 hours of injury, use an oral NSAID
5
Q
What should you recommend if a pregnant or breastfeeding lady comes in with oral thrush?
A
Refer
6
Q
True or false:In oral thrush, white patches cannot be removed easily from the tongue
A
False- they can be removed easily leaving a red base
7
Q
What are the symptoms of oral thrush?
A
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.
8
Q
What is this?
A
Angular stomatitis-
soreness, erythema and fissuring at the angles of the mouth
9
Q
How does the licensing of OTC loperamide differ in following indications: i) Acute diarrhoea
ii) Acute diarrhoea associated with IBS
A
i) 12 years and older
ii) 18 years and older if associated with IBS, and need to have diagnosis by the doctor
10
Q
What age should you refer someone with constipation?
A
<18 to rule out underlying causes
11
Q
Constipation lasting how long with no identifiable cause prompts a referral?|
A
2 weeks adults
1 week children
12
Q
When should you stop using EarCalm and what is the maximum number of days you can use it OTC?
A
Treatment should be continued until two days after symptoms have disappeared but no longer than 7 days
13
Q
What age is acetic acid (EarCalm) licensed in?
A
12+
14
Q
What are the main differences of presentation for viral and allergic conjuctivitis?
A
Viral = bilateral or unilateral
Allergic = bilateral, red and gritty
15
Q
Is allergic conjuctivitis contagious?
A
No
16
Q
What iare the different types of conjunctivitis?
ALLERGIC?
VIRAL?
BACTERIAL?
A
Allergic conjuctivitis
17
Q
What is this?
A
Bacterial conjuctivitis
18
Q
What is this?
A
Blepharitis
19
Q
What is the advice for patients with blepharitis?
A
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
20
Q
In patients with blepharitis, can their eyelids stick together?
A
Yes, can also be itchy and have a build up of debris
21
Q
How long does acute otitismedia usually last?When would antibiotics be indicated?
A
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)
22
Q
A rash like this indicates what?
A
Scarlet fever - refer
23
Q
A rash like this indicates what?
A
Chicken pox
24
Q
What is the likely diagnosis and what would you do if a child presented with this in community pharmacy?
A
Scarlet FeverRefer as it is caused by Strep A and need antibiotics
25
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
26
Scarlet fever is caused by what?
Group A strep
27
Should Hedrin (dimeticone) be applied to wet or dry hair?
Dry
28
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
29
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)
30
The difference between German measles and measles (morbilli) is what?
Measles manifests itself with white spots in the mouth.
31
Rubella is also known as what?
German measles
32
Which illness is characterised by white spots surrounded by a red ring on the inner cheek and gums?
Measles
33
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
34
Discharge coming out the ear can indicate what?
Ear infection- refer
35
What is the dose of paracetamol for 12-15 years?
480-750mg QDS
36
What is the dose of paracetamol for 10-11 years?
500g QDS
37
What is the dose of paracetamol for 8-9 years?
375mg QDS
38
What is the dose of paracetamol for 6-7 years?
250mg QDS
39
What is the dose of paracetamol for 4-5 years?
240mg QDS
40
What is the dose of paracetamol for 2-3 years?
180mg QDS
41
What is the dose of paracetamol for 6 months-2 years?
120mg QDS
42
What is the dose of paracetamol for 3-5 months?
60mg QDS
43
What is the dose of paracetamol for a 2 month old?
30-60mg TDS
44
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)
45
How many levels of healthy living pharmacy is there?
Level 1, 2 and 3Need to be on the HLP register
46
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.
47
Psuedoephedrine is cautioned in what conditions?
DiabetesHypertensionHeart diseaseAngle-closure glaucoma
48
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.
49
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
50
Viagra OTC is licensed from what age?
18 years
51
What is the max duration of days is licensed for OTC naproxen for painful periods?
3 days
52
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
53
Children under what age are legally too young to consent to sexual activity?
13 years
54
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
55
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.
56
In what clinical conditions is the use of EHC levonorgestrel not recommended?
Severe malabsorption syndrome e.g. Crohn's Severe hepatic impairment
57
In what clinical conditions is the use of EHC ulipristal not recommended?
Severe hepatic impairmentAsthma which is being treated by oral glucocorticoids
58
What is the advice surrounding EHC ulipristal and vomiting?
If vomiting occurs within 3 hours another tablet should be taken as soon as possible
59
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
60
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
61
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.
62
Levonorgestrel is less effective in women with a BMI over what?
26 - may need a double dose as per FSRH advice
63
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
64
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
65
What is the dose of levonorgestrel for EHC?
1500 micrograms
66
What is the dose of ulipristal acetate for EHC?
30mg
67
What age is levonorgestrel licensed for OTC?
16 years and over
68
How may hours after unprotected sex is Levonorgestrel licensed for?
72 hours (3 days)
69
How may hours after unprotected sex is Ulipristal Acetate licensed for?
120 hours (5 days)
70
Can you catch chickenpox from someone with shingles?
Yes if you have not had chickenpox before
71
Can you catch shingles from someone with chickenpox?
No
72
How soon do you get symptoms after coming into contact with chickenpox?
1-3 weeks
73
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
74
A non blanching rash can be a symptom of what?
MeningitisThe rash does not fade when pressed with a glass
75
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
76
What is Onychomycosis?
Fungal nail infection
77
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)
78
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
79
What is the dose for pantoprazole OTC?
20mg OD
80
What is the minimum age for pantoprazole OTC?
18 years
81
Is it recommended that a child with bacterial conjunctivitis does not go to school?
No - should still go to school
82
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.
83
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
84
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
85
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
86
If a male patient asks for tamsulosin OTC but mentions he suffers from postural hypotension, what should you do?
ReferCan cause postural hypotension
87
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
88
How many weeks of tamsulosin is supplied initially?
2 weeks
89
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)
90
Can sumatriptan be used as a prophylactic for migraines?
No- it is for acute attacks
91
If a patient comes in asking for sumatriptan but is on an a MAOI, what should you do?
Refer
92
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
93
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
94
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
95
What is the max number of days you should use tranexamic acid OTC for?
4 days
96
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
97
What is tranexamic acid licensed for?
Heavy menstrual bleeding over several cycles with regular cycles
98
Is evaluation a stage in the transtheoretical model of change?
No
99
What are the 6 stages of transtheoretical model of change?
1. Pre-contemplation2. Contemplation3. Preparation4. Active5. Maintenance6. Relapse
100
Sturgeon (cinnarizine) is licensed from what age?
5 years
101
Kwells OTC is licensed from what age?
4 years
102
Joy Rides OTC is licensed from what age?
3 years
103
What is the active ingredient in Joy Rides?
Hyoscine hydrobromide
104
Phenergan OTC is licensed from what age?
2 years
105
Loratadine OTC is licensed what from age?
2 years (as long as they weigh more than 30 kg)
106
Lyclear cream OTC is licensed for what age?
2 years (Under this age needs medical advice)
107
Mebendazole OTC is licensed for what age?
2 years
108
OTC choramphenicol is licensed for what age?
2 years
109
What age is Diarolyte relief OTC licensed for?
1 year(Under this age needs medical advice)
110
Piriton OTC (chlorphenamine) is licensed from what age?
1 year
111
Hedrin and Derbac liquid is licensed from what age OTC?
6 months
112
Daktarin 2% oral gel is licensed from what age otc?
4 months
113
Nurofen OTC is licensed from what age?
3 months
114
Calpol OTC is licensed from what age?
2 months
115
Woodwards Gripe water OTC is licensed for what age range?
1 month- 1 year
116
Gaviscon is licensed for what age OTC?
12 years
117
Rennie is licensed for what age OTC?
12 years
118
Voltarol gels OTC are licensed for what age?
14 years
119
Feminax ultra OTC is licensed for what age?
15-50 years
120
Nytol is licensed for what age OTC?
16 years
121
Azithromycin (OTC for chlamydia) is licensed for what age?
16 years
122
Canesten thrush cream is licensed for what age range OTC?
16-60 years
123
Tranexemic acid is licensed for what age OTC?
18-45 years
124
Corticosteroid nasal sprays are licensed for what age OTC?
18 years
125
Anusol Plus HC is licensed for what age OTC?
18 years
126
Buccastem is licensed for what age OTC?
18 years
127
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.
128
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
129
Is oral lidocaine for children (Anbesol, Bonjela):- P medicine- GSL - POM?
P medicineChanged from GSL in late 2018 Max pack size 10g
130
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.
131
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
132
Is Ella One recommended in a patient with severe uncontrolled asthma?
No, especially if being treated with an oral glucocorticoid
133
What age are Tyrozets (benzocaine) lozenges licensed in?
> 3 years
134
What age is otrivine child nasal drops licensed in?
6-12 years Contains xylometazoline
135
What age can you sell OTC diphenhydramine cough syrup?
> 6 years (Benylin children's night cough)
136
What age can you sell OTC guaifenesin cough syrup?
>6 years (Benylin chesty cough for children)
137
Coughing up thin and frothy mucous can suggest what?
Left ventricular failure
138
At what age are you eligible for the free flu vaccine?
65 years and older
139
What age range is OTC tranexamic acid licensed for in heavy periods?
18-45 year olds
140
Are OTC steroid creams licensed for psoriasis flare ups?
No
141
Can you give steroid creams OTC to pregnant women?
No
142
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
143
What steroid creams are available OTC?
Hydrocortisone 1% and clobetasone butyrate 0.05%
144
What is the maximum number of days to use OTC steroid cream?
7 days
145
What is the minimum age to use hydrocortisone 1% cream OTC?
10 years
146
True or false:Diuretics can cause dry eyes
True
147
What can you offer OTC for angular stomatitis?
Clotrimazole 1% cream
148
What is angular stomatitis?
Cracked fissures in the corners of the mouth
149
If a patient has diabetes and presents to the pharmacy with oral thrush, what should you do?
Refer
150
What anticoagulation interacts with miconazole oral thrush gel and prompts a referral?
Warfarin
151
Should miconazole oral gel be applied before or after meals?
After and held in the mouth as long as possible
152
What is the minimum age to use miconazole 2% oral gel for oral thrush?
>4 months
153
What is a common side effect on the teeth if a patient is having chlorhexidine mouthwash?
Stains teeth brown
154
What is the minimum age to use Difflam spray?
6 years
155
What is the minimum age to use Difflam mouthwash?
12 years
156
An ulcer lasting than more than how many weeks should be referred?
More than 3 weeks- exclude oral cancer
157
Can you treat bacterial conjunctivitis OTC for pregnancy and breastfeeding?
No- refer
158
What age would you refer for bacterial conjunctivitis?
<2 years
159
What age range is Feminax ultra licensed for?
15-50 years
160
What NSAID (stronger than ibuprofen) is available OTC for primary dysmenorrhoea?
Feminax ultra 250mg naproxen
161
Can you treat a pregnant person OTC for thrush?
No- refer
162
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
163
True or false:Poorly controlled diabetes is linked with thrush
True
164
What age groups should be referred in vaginal thrush?
<16 years>60 years
165
What should you do if someone comes into the pharmacy with impetigo?
Usually needs a prescription to treat it so refer
166
How can sweat rashes be treated OTC?
Topical imidazoles e.g. Daktarin
167
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.
168
Amorolfine lacquer is licensed OTC for what condition and what is the age restriction?
Fungal nail infection18 years and over
169
What is the maximum number of nails you can treat OTC for fungal nail infection?
2 If more than this, need to refer
170
What is the minimum age for Lamisil OTC (terbinafine) for athelete's foot (tinea pedis)?
> 16 years
171
What is 1st line for athlete's foot in pregnancy and breastfeeding?
Topical imidazoles e.g. Daktarin Gold
172
Where should you apply scabies lotion?
All over the body
173
What is first line for scabies in pregnancy and BF?
Permethrin 5% w/w cream (Lyclear®)
174
What is first line for scabies?
Permethrin 5% w/w cream (Lyclear®)
175
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
176
What is recommended as first line for head lice treatment in asthma and eczema?
Wet combing If treatment needed, Dimeticone e.g. Hedrin
177
What is recommended as first line for head lice treatment in pregnancy and BF?
Wet combing If treatment needed, Dimeticone e.g. Hedrin
178
What age group is mebendazole not suitable for?
<2 years
179
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
180
What is 1st line for pregnancy in threadworm?
Strict hygiene measures Refer if this has not worked
181
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)
182
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
183
What is the licensed age range for sumatriptan OTC?
18-65
184
Bonjela preparations containing choline salicylate is unsuitable for which age group?
Under 16 years
185
What is a purpuric rash?
One which does not blanch white on pressure
186
Systemic decongestants are contraindicated in patients taking what medicine class?
MAOIsRisk of hypotensive crisis
187
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.
188
How can you treat croup?
No medical treatment as it is viral but can offer antipyretic treatment if fever is present
189
What time of the day are symptoms of croup the worst?
At night
190
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
191
A cough for how many weeks would prompt a referral?
Longer than 3 weeks
192
Can you use anusol HC plus ointment OTC in pregnancy and breastfeeding?
No
193
How many days max should you use Anusol HC plus ointment OTC?
7 days max(contains hydrocortisone)
194
What are the symptoms of haemorrhoids?
Bleeding, perianal itching, mucus discharge and pain
195
What age can you sell Colpermin IBS relief capsules OTC? (peppermint oil)
15 years and over
196
What age can you sell Buscopan OTC?
12 years and over
197
What age can you sell mebeverine OTC?
> 18 years
198
What kind of laxative should be used for IBS?
Bulk forming
199
Does rectal bleeding from haemorrhoids need to be referred?
No unless excessive bleeding occurs or has occurred for more than 3 weeks
200
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
201
What age can you sell loperamide OTC to?
12 years and over
202
What is the difference between Diarolyte and Diarolyte Relief?
Relief contains rice power and normal diarolyte is glucose based
203
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
```
204
Is Movicol is licensed for acute, chronic or both types of constipation?
Chronic
205
What age can you sell ispaghula husk OTC to?
>6 years
206
What age can you sell Sodium picosulphate (Dulcolax pico liquid) OTC to?
> 10 years
207
What age can you sell Senna OTC to?
>12 years
208
How long does it take for bulk forming laxatives to work?
12- 72 hours
209
If a patient has constipation along with tiredness, what could be underlying causes?
HypothyroidismAnaemia
210
At what point is constipation classed as chronic?
Lasting 6 weeks or more
211
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.
212
What are the safest laxatives to use in pregnancy and breastfeeding?
Bulk forming and osmotic
213
What are the preferred type of laxative in children?
OsmoticBulk forming
214
How long does it take for glycerol suppositories to work?
Within 30 mins
215
Frequent use of stimulant laxatives can lead to what?
Fluid and electrolyte imbalance
216
Why must bulk forming laxatives be taken with adequate fluids?
To avoid intestinal obstruction
217
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
218
What is 1st line for constipation?
Lifestyle measures
219
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
```
220
What are symptoms of colic?
High pitched cryingOften at same time of dayDrawing knees up to stomach
221
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
222
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
223
What is the dose of OTC esomeprazole, and what is the max time it can be used for?
20mg OD2 weeks maximum
224
What age can you sell OTC esomeprazole to?
>18 years
225
What age can you sell esomeprazole to?
>18 years
226
What age can you sell OTC omeprazole to?
>18 years
227
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
228
In what group of patients is orlistat licensed for OTC?
> 18 years
BMI >30
OR
BMI >28 with rf diabetes/hypertension/hypercholesterolaemia
229
True or false:Smoking can contribute to dyspepsia
True
230
True or false:Being overweight can contribute to dyspepsia
True
231
What is max dose of ranitidine OTC?
75 mg tabletsDo not take more than 2 in 24 hours
232
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
233
Minimum age Benzoyl Peroxide can be used in?
12 yearsAcne treatment
234
Ulipristal Acetate
Licensed for any girl of child bearing age
235
Daktarin oral gel (Miconazole)
licensed from 3 months
236
Clotrimazole 1% cream
For fungal skin infections (e.g. ring worm)Can be used in adults and children (no licensed age mentioned)
237
Age range for Thrush treatments?
Clotrimazole 2% cream
Clotrimazole 10% internal cream
Clotrimazole pessary
Fluconazole 150mg capsuleAll 16- 60 years
238
Minoxidil 2% + 5%? (Regain)Age range
18 years- 65 yearsOTC Hair loss treatment
239
Fluconazole capsule 150mg?
Used for thrush so16 - 60 years (refer outside of this range)
240
Ispaghula Husk (Fybogel)?
6 years
241
Senna?
12 years
242
Acrivastine? (antihistamine) Age range
12 - 65 years
243
Antihistamines:Chlorphenamine liquid? (piriton syrup)
Liquid: over 1 years (safest choice for young children)Chlorphenamine Tablets: 6 years
244
Clotrimazole 2% cream? Age range?
16 - 60 years when used for thrush
245
Ranitidine?
16 years
246
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)
247
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)
248
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)
249
Esomeprazole, Pantoprazole, Omeprazole?
18 years
250
Steroid nasal sprays (beconase, flixonase)?
18 years
251
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
252
Simple linctus (pead)?
1 year
253
Amorolofine?
18 years
254
Levornorgestrel?
16 years
255
Cetirizine?Loratidine?
2 years
256
Sumatriptan?Age range
18 years - 65 years
257
Paracetamol?
2 months
258
Tranexamic acid? For menorrhagia (heavy bleeds)
18 years
259
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)
260
Aspirin?
16 years
261
Loperamide?
12 years
262
Chloramphenicol eye drops/ eye ointment?
2 years
263
Mebendazole?
2 years
264
Ibuprofen?
Suspension or suspension sachets- 3 monthsTablets: 12 years
265
Naproxen 250mg tablets (Feminax Ultra)?Age range
15 - 50 years
266
Tamsulosin 400mcg tablets (FloMax)?Age range
45 years - 75 years
267
Clobetasone (eumovate) 0.05% cream?
12 years
268
Eurax HC (hydrocortisone 0.25%) cream?
10 years
269
Hydrocortisone (hc45) 1 % cream?
10 yearsMax 15g tube
270
Minimum age to buy Clamelle (azthromycin for chlamydia) OTC?
16 years
271
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 ;)
272
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.
273
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
274
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
275
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.
276
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.
277
Can you get monoxidil on NHS prescription?
NO
278
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)
279
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.
280
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!
281
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
282
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
283
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!
284
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
285
Which eye drops used in glaucoma can cause a change in eye colour?
Prostaglandin analogues:
| BIMATOPROSTLATANOPROSTTRAVOPROST
286
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
287
Where should Latanoprost eye drops be stored?
In the fridge
288
What presents as the following image accompanied by sore throat, headache, high temperature?
Scarlet fever
Antibiotics needed- refer
With treatment, most people recover in about four to five 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.
289
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)
290
What is the only contact lense solution that can be applied whilst contact lenses are still in the eye?
Re-wetting solution
291
How does plaque psoriasis present?
Silvery white scales, when scraped away pinpoint bleeding occurs from the capillaries
292
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
293
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
294
The mainstay of treatment OTC of travel sickness involves antihistamines:CinnarizineMeclozineCyclizinePromethazine: Promethazine Hydrochloride (Phenergan) and Promethazine Teoclate (avomine)OR Anticholinergics:Hyoscine 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
295
Which emollient does not contain Urea?
hydromol
296
Oramorph 20 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
297
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)
298
Co-amoxiclav oral suspension will have an expiry of ____ once it is made up
7 days
299
Eye drops containing a lubricant only (e.g. propylene glycol) will expire in _____
6 months
300
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
301
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
302
What does 'Freshly prepared' mean? What does 'Recently prepared' mean?
Freshly prepared: 24 HOUR EXPIRY
Recently prepared: 28 day expiry
303
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
304
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.
305
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)
306
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!
307
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.
308
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, amoxicillin or cefuroxime for 2-4 weeks
309
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)
310
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.
311
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
```
312
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
313
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
314
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)
315
Children under __ should not be given cough and cold medication OTC containing PSEUDOEPHEDRINE PHENYLEPHRINEDEXTROMETHORPHANPHOLCODINEGUAIFENESINChlorphenamine, 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
316
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
317
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
318
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
319
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
320
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
321
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
322
What formulations have more potential for abuse by addicts?
Sugar free
Syrup base less liable to abuse
323
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
324
What drugs can be given on instalment prescriptions (FP10MDA) Other than Methadone?
Schedule 2 Controlled Drugs;
Buprenorphine;
Buprenorphine/naloxone (Suboxone); and
Diazepam
325
What age are steroid nasal sprays e.g. beconase, flixonase, not suitable in?
Under 18's
326
What antihistamine do we usually give to children?
Chlorphenamine maleate
| Suitable for 1 year and over
327
What kind of medicine is Dextromethorphan?
Cough suppressant (antitussive)
328
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
329
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
330
What organism causes RING WORM?
Tinea Corporis
331
URINE COLOURS?SENNARIFAMPICINLEVODOPANEFOPAMNITROFURANTOINCO-DANTHRUMERCO-DANTHRUSATETRIAMTERENESULFASALAZINEENTACAOPONEPHENINDIONE
332
Fexfenadine OTC advice?
Avoid apple/orange juice, minimises exposure, ok
333
Unsightly big left toe, no pain, thickened?
Amorolfine 5% nail lacquer
334
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
335
OTC smoking cessation options?
Nicotine- patches/lozenges/gums/inhalors
| Varenicline/Bupropion POM meds, OTC under PGD only
336
smoking cessation follow up monitoring?
2 weeks after NRT start
| 4 weeks after stopping smoking, CO levels monitor, aim for <10 parts per million
337
Otitis externa symptoms?
dry skin
muffled hearing
itchy canal
history eczema/hayfever swimming
338
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
339
Fluticasone 0.05% nasal spray OTC requirements?
18 years+
Alternative is ES, patient request
Or just get a prescription
340
Nappy rash symptoms?
Red blotches on bottom
Hot, sore-looking skin
Irritable baby
Pimples/spots
341
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
342
NAPPY RASH REFERRALS?
>2 weeks
Yellow Crusts
Broken skin
343
MEBENDAZOLE
AGE?
REINFECTION AFTER 2 WEEKS?
AGE? 2 years+
| REINFECTION AFTER 2 WEEKS? Take another dose
344
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
345
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!
346
A drug that induce hepatic
enzyme activity and considerably reduce the
emergency hormonal contraceptive effect?
Topiramate (antiepileptic)
347
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
348
SICK DAY RULES
Dehydration (vomiting, diarrhoea & fever)
CAN TEMPORARILY STOP WHAT DRUGS?
DIURETICS
ACE INHIBITORS
METFORMIN
NSAIDs
349
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
350
Reasons for
| depot antipsychotic?
Improved patient compliance
| Reduced peaks/troughs in efficacy
351
Treatment for a patient with a potassium level of 6.6mmol/L?
Calcium gluconate 10% plus insulin and glucose 50%
352
Treatment for a patient with a sodium level of 152mmol/L?
Hydration and stop possible offending drugs
353
raised TSH and low T4 levels=?
| treatment?
HYPOTHYROIDISM
| LEVOTHYROXINE
354
Prolongation of the QT-interval?
DOMPERIDONE
CITALOPRAM
CLARITHROMYCIN
ERYTHROMCYIN
355
LEVONELLE/ULI SIDE-EFFECTS
BOTH ABDOMINAL PAIN, N&V, HEADACHE
356
LEVO VS ULI
357
HYDROCORTISONE 1% LICENSING?
10+
358
TERBINAFINE 16+
359
LEVO AVOID BREASTFEEDING JUST 8 HOURS
360
12+ steroid?
clobetasone
361
bacterial infection?
not hydrocortisone
362
Give oral antifungal if topical an L
363
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
364
HEADACHE
| UREGNT REFERRAL TO A&E?
SUDDEN
365
HEADACHE
| NON-URGENT REFERRAL TO GP?
MIGRAINE, few days
366
STOMACH PAIN
| URGENT REFERRAL TO A&E?
SUDDEN SEVERE, abdominal pain
367
STOMACH PAIN
| NON-URGENT REFERRAL TO GP?
```
dyspepsia
period
pain
injury
food poisoning
weight loss
```
368
FEVER URGENT REFERRAL TO A&E?
UNDER 3 MONTHS
| RASH DOES NOT GO AWAY
369
SEPSIS URGENT REFERRAL TO A&E?
slurred speech, confusion, shivering, cold, muscle pain
370
CARDIAC SYMPTOMS
| URGENT REFERRAL TO A&E?
breathlessness, chest pain, left arm pain, coughing up blood
371
CARDIAC SYMPTOMS
| NON-URGENT REFERRAL TO A&E?
HEARTBURN
372
RESPIRATORY SYMPTOMS
| URGENT REFERRAL TO A&E?
SOB, wheezing, radiating pain,
373
RESPIRATORY SYMPTOMS
| NON- URGENT REFERRAL TO GP?
COPD, asthma, symptoms, lifestyle
374
NEUROLOGICAL SYMPTOMS URGENT REFERRAL TO A&E?
numbness, spine movement, stroke
375
NEUROLOGICAL SYMPTOMS NON-URGENT REFERRAL TO GP?
muscle weakness,
376
SIGNS OF CANCER URGENT REFERRAL TO A&E?
mouth ulcers, unexplained weight loss, radiating oedema
377
```
OTC DO WWHAM
WHO
WHAT
HOW LONG
ACTION
SYMPTOMS
```
378
WHAT IS THIS?
STYE
379
RINGWORM?
380
ROSACEA?
butterfly like
381
SCABIES
382
383
SHINGLES
384
VERRUCA FEET
| WARTS HAND COMMON
385
VERRUCCA
386
WARTS?
387
CONTACT DERMATITIS
388
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.
389
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
390
What is indoramin?
Alpha-blocker, careful with tamsulosin!
391
What are the symptoms of hay fever? (4)
1. Rhinorrhoea
2. Nasal congestion
3. Itching
5. Allergic conjunctivitis
392
What are the referal criteria for hay fever? (5)
1. Pregnancy
2. Suspected infection
3. Drug induced
4. Structural or mechanical reasons
5. Systemic conditions associated with mucus (e.g. CF)
393
Which drugs can induce symptoms of hay fever? (7)
1. ACE inhibitors
2. Beta blockers
3. Chlopromazine
4. Aspirin
5. NSAIDs
6. Cocaine
7. Diverse effect of nasal decongestants
394
What is the first line treatment for someone presenting with general symptoms of hay fever?
Non-sedating antihistamine
395
At which age are Cetirizine and Loratadine both licensed from?
2 years
396
At which age is Acrivastine licensed?
Over 12
397
How often should a non-sedating antihistamine be taken?
Once daily
398
If a patient taking a non-sedating antihistamine experiences "breakthrough" symptoms, which drug can you recommended instead?
Sedating antihistamine taken at shorter intervals
399
At what age is chlorphenamine syrup licensed?
Over 1
400
At what age are chlorphenamine tablets licensed?
Over 6
401
At what age is promethazine licensed? (syrup and 10mg tablets)
Over 2
402
Can promethazine 25mg tablets be sold OTC for hay fever?
No, licensed for insominas in patients over 16
403
If patient is experiencing nasal congestion due to hay fever, what is the recommended OTC treatment?
Nasal corticosteroid
404
At what age are beconase and nasonex both licensed for?
Over 18
405
When should nasal corticosteroids be taken for maximal effect?
A week before hay fever begins
406
Is sudafed nasal decongestant spray recommended for hay fever?
Not recommended but can be used as an adjunct
407
What is the maximum recommended duration of use for sudafed nasal spray and why?
7 days - risk of rebound congestion
408
At what age is sudafed blocked nose spray?
Over 12
409
Which 2 drugs can be applied topically if the patient is experiencing allergic conjunctivitis?
1. Mast cell stabilisers
| 2. Occular antihisatmines
410
How long does it usually take for a common old to resolve?
7 days
411
How long does it usually take for a common old to resolve in children?
14 days
412
What is used for symptomatic relief of a cold?
Paracetamol and ibuprofen
413
What advice do you give patients with colds?
Keep hydrated and rest
414
As well as paracetamol and ibuprofen, what else can be used to treat symptoms of a cold?
Intranasal decongestants
415
Is there a place for oral decongestants when treating a cold?
They can be used in the short term but the benefit is small
416
As well as lifestyle measures, what must patients be counselled on when buying cough and cold medicines?
The risk of paracetamol overdose
417
Which cough and cold medicines should be avoided in those under 6? (4)
1. Anti-tussives
2. Expectorants
3. Topical and oral decongestants
4. Antihistamines
418
In patients under 6, what can be used for symptomatic relief of cough and cold?
1. Paracetamol and ibupofen
| 2. Simple cough remedies
419
If a patient is over 1, what can be recommended for symptomatic relief of cough and cold?
Warm drink of honey and lemon
420
What are 5 self care measures for cough and cold that can be purchased OTC?
1. Steam inhalation
2. Vapour rubs
3. Gargling salt water
4. Menthol sweets
5. Nasal saline drops
421
What are the 2 types of cough?
1. Productive (chesty)
| 2. Non-productive (dry)
422
How long does an acute cough last?
Less than 3 weeks
423
What should you do if a patient presents with a cough lasting longer than 3 weeks?
Refer for further investigation
424
How long must a cough last to become chronic?
Over 8 weeks
425
What is the most likely cause of a cough?
Viral upper respiratory tract infection
426
What is a trigger for croup?
Recent viral infection
427
At what age does croup normally occur?
Between 3 months and 6 years
428
How long does croup usually resolve?
48hours
429
When should you refer someone with croup for medical intervention? (2)
1. Over 48 hours
| 2. Severe
430
A patient presenting with which symptoms is likely to have pneumonia? Requires urgent referral to GP (5)
1. High fever
2. Malaise
3. Headache
4. Breathlessness
5. Pleuritic pain
431
Give an active ingredient of expectorants
Guafenasin
432
Give 4 active ingredients of anti-tussives
1. Codeine
2. Pholcodeine
3. Dextromorphan
4. Antihistamines (diphenyldramine)
433
At which age is codeine linctus licensed for OTC?
Over 18
434
Does the MHRA advise the use of cough and cold medicines in children 6-12?
No, only supplementary to best principles of care
435
Who should not have codeine at all?
Under 18s with sleep apnoea who have had tonsil and adenoid surgery
436
In which patients should codeine be used with caution?
12-18 difficulty breathing
437
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)
```
438
Hemorrhoids treated OTC for ............ should be referred
1 week
439
what does sharp stabbing pain on deification indicate?
anal fistula
440
advice for hemorrhoids
```
avoiding constipation (fluids, fiber and exercise)
don't strain
```
441
three types of things used in hemorrhoid preparations
local anaesthetics
astringent
anti-inflamatory
442
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)
443
how long can you use a local anesthetic for haemerrhoids
5-7 day
444
what is the action of this ingredient of hemorrhoid preparations:
bismuth oxside
astringent
445
what is the action of this ingredient of hemorrhoid preparations: cinchocaine
local anesthetic
446
what is the action of this ingredient of hemorrhoid preparations:
muccopolysacharide polysulfate
fribrinolytic
447
what is the action of this ingredient of hemorrhoid preparations:
shark oil
skin protectant
448
what is the action of this ingredient of hemorrhoid preparations: yeast extract
wound healing angent
449
sumitriptan is licensed for a max of how many attacks per month
4
450
Should levothyroxine or liothyroxine be maintained on the same brand?
liothyronine
451
alternative to carbimazole that may cause Liver tox
propylthyuricil
452
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
453
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
454
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
455
When would you refer for ear wax?
Foreign body in the ear
Pain
Dizziness
Tinnitus
Treatment failure
456
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
457
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
458
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
459
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
460
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
461
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
462
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
463
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
464
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
465
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
466
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
467
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
468
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
469
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
470
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
471
Name some OTC medicines that are prone to abuse
```
Opioid analgesics
Laxatives
Stimulants
Antihistamines
Cough/cold preparations e.g. Sudafed
```
472
Sodium hyaluronate 0.2% eye drops?
Once opened the bottle can be used for up to 90 days
473
condition blocked sweat ducts?
miliar/heat rashkeep skin coolloose clothingplenty fluids Calm
474
475
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
476
naproxen+steorids no good, bleed
477
URINE COLOURS
478
perfect circle, central clearing, defined edges?
tinea corporis, ringwor
479
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
480
DROPS DURING THE DAY, OINTMENTS DURING THE NIGHT
481
Optrex storage?
fridge!
482
Mometasone directions?
Two sprays into each nostril once a day until symptoms are controlled, then one spray into each nostril daily.
483
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
484
MOMETASONE STORAGE?
Do not use after expiry date.
| Use within two months of first opening.
485
CHLORPHENAMINE IS SEDATING! LORADATINE IS PREFERRED, AWAKENESS, NON-SEDATING
486
PREGABALIN, MHRA, TERATOGENIC!
487
488
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.
489
permethrin?
mebendazole?
1 week
2 week
490
permthetrin
Scabies?
Head lice?
2 month+
6 month+
491
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.
492
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).
493
HAND FOOT MOUTH?
PARACETAMOL ETC WILL DO!
494
QUICKEST FOR CONSTIPATION?
GLYCEROL SUPPOSITORY!
495
SILDENAFIL AGE?
| IBUPROFEN?T
18+
ibuprofen calm, it's the tamsulosin n watnot
alpha blockers, b blockers, etc
496
35+, SMOKING?
VTE RISK FACTOR!
497
ALELRGIC RHINITIS, FLUTICASONE PREFERRED?
498
ALLERGIC RHINITIS ORDER?
MILD- azelastine
| MODERATE- fluticasone
499
tinea corporis
500
SEPSIS, NO FLUIDS, GP ASAP!
501
FEXOFENADINE AGE?
12+
Apple juice and orange juice decrease the exposure to fexofenadine.120mg in adults and children!
502
LACTULOSE-LACTOSE INTOLERANT, GUESS
503
SCARLETT FEVER, HIGH TEMP, GP ASAP!!
504
RINGWORM, CLOTRIMAZOL 1%, CALM
505
A
506
itchy scalp does not mean?
Head lice, u gotta detect comb etc and confirm!
507
impetigo, kid otc?
hydrogen peroxide is cool
508
Itchy scalp X= head lice, no need to wash high temp either, scabies/mebendazole?
509
MICONAZOLE DIRECTIONS, FUNGAL?
APPLY BD+10 DAYS AFTER LESIONS HAVE HEALED
510
SUBARROHCNOI?
KICKED IN THE HEAD, stress
511
4 year old, cough?
glycerin honey and lemon linctus
512
bacterial conjunctivitis, treatment?
pick one
| drop or ointment :/
513
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
514
CLOTRIMAZOLE 2%?
CLOTRIMAZOLE 1%?
CLOTRIMAZOLE 2%? vaginal thrush
CLOTRIMAZOLE 1%? skin, nappy rash
515
Canesten HC
fungal
itching
Treat
516
heavy cold
Abdomen
elderly
itchy?
VARICELLA ZOSTER!
517
post-herpetic neuralgia?
amitriptyline!
518
```
A- Desosest rel 712W
missed pile tall
ASAP useprotection
forfurther 2days
In this case only
4hourspassed
noneedfor Erk
```
519
ANALF ISSURE
520
haemorrhoids?
lumps, out of anus
itching/burning/pain/swelling
rectal bleeding
straining/incomplete
521
anal fissure?
sharp pain
522
cold sores treatment?
aciclovir!
523
SLEEPY TIME ANTIHISTAMINE?
DIPENHYDRAMINE
524
1ST LINE IMPETIGO OTC?
BENZOYL PEROXIDE
525
ORAL CANDIDIASIS?
FUNGAL?
ORAL CANDIDIASIS? 7 days after lesions have healed
FUNGAL? BD+10 days after lesions have healed
526
SCABIES, PERMETHRIN?
THREADWORM, MEBENDAZOLE?
SCABIES, PERMETHRIN? 1 WEEK
THREADWORM, MEBENDAZOLE? 2 WEEKS
527
BACK PAIN?
1st line- NSAID
2nd line- Codeine with/without paracetamol
3rd line- spasm, short course benzo, diazepam
528
baby, paracetamol post-immunisation dose?
up to 6months
60mg right after vaccination
60mg 4-6hrs after first dose
60mg 4-6hrs after second dose
529
MODAFINIL?
Contraception during+2 months after
530
FLUOROQUINOLONE?
heart valve regurgitation
531
taking desogestrel?
day 1 of cycle then continous
532
levonorgestrel+desogestrel?
you can take same day str8 away
533
groin, sore/wet/itchy/smelly?
clotrimazole/miconazole? str8
534
meningitis?A
notifiable!
535
SHINGLES?
GO A&E ASAP
536
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!
537
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!
538
scarlett?
go GP quick ting!
539
Orlistat dose?
1 tds!
540
orlistat no weight loss within 12 weeks?r
stop treatmetn!
541
gastroenteritis?
diarrhoea!
542
tranexamic acid+pill?
UNSUITABLE!
543
TRANEXAMIC ACID?
no effect on period
max 4 days
n&v DIARRHOEA COMMON
x pill
544
MAX. SILDENAFIL DOSE?
50MG
545
Trichomoniasis is?
Parastici1
546
MENINGITIS, CAPILLARY REFILL?
5 SECONDS? REFER
547
meningitis CRT>X REFER?
3 SECONDS!
548
temp> x?
39 referral
549
REYE'S SNDROME?
HELLA VOMITING
550
metformind oesn't cause dysuria!
551
tranexamic acid irrregular cycle?
avoid
552
sumatriptan+smoking?
no problem
553
TAKEN ULIPRISTAL?
TAKE BARRIER TILL NEXT PERIOD
554
fexofenadine+juice?
don't mix bruh
555
derbac lotion
24hours!
556
permethrin cream?
2+, scabies, 12hrs
557
CLOTRIMAZOLE 2%?
CLOTRIMAZOLE 1%?
