Counter Prescribing WS W9 Flashcards
Signs and symptoms of shingles
Skin tingling, headache, bloched rash that become itchy blisters, only on one side of the body
Response, which makes you refer shingles
The rash gets infected, pain after the rash is gone, muscle weakness, pregnancy, had more than once, if the eye is involved, if they are immunosuppressed
Main management options of shingles
Oral anti-viral, painkiller, aciclovir
Other general advice for shingles
Keep the area clean and dry, wear loose clothing, be careful around other people that have not previously had chickenpox or are pregnant
Signs and symptoms of insect bite
Pain in the bite area, did they see an insect, small swollen lump, allergic reaction if it is itchy and raised, swollen if infected, they did any activities for example camp camping
Response which makes you refer for insect bite
Stung in the mouth or eyes, have cellulitis, have stomach pain or nausea, feel dizzy or lightheaded, have temperature or an allergic reaction, have travelled to somewhere foreign i.e. Australia
Main management options of an insect bite
Antihistamine, steroid cream, pain painkillers, flucloxacillin
Other general advice for an insect bite
Don’t scratch, insect repellent, cool compress
Signs and symptoms of ringworm
Ring shaped rash, it can grow and spread, slightly raise and scaly, seen in faces
Response, which makes you refer for ringworm
If it is on the scalp, if they have weak immunity, have already used an antifungal
Main management options for ringworm
Topical antifungal such as clotrimazole or miconazole
Oral antifungal may be prescribed such as terbinafine
Other general advice for ringworm
Maintain good personal hygiene, avoid scratching, wash clothing and bedding, avoid sharing personal items, disinfect surfaces
Signs and symptoms of contact dermatitis
Redness, burning or stinging sensation, dry cracked skin, swelling, blisters, peeling or scaling, itching, there may be pain or tenderness and a distribution where the substance came into contact with the skin
Response which makes you refer for contact dermatitis
Intense itching or pain, wide breast rash, oozing lesions, severe swelling, suspected infection, persistent/chronic dermatitis, difficulty identifying the trigger, eyes or genitalia, diabetes, symptoms do not improve with OTC medication
Main management options for contact dermatitis
Topical corticosteroids - hydrocortisone cream or more potent corticosteroids - betamethasone
To avoid corticosteroids use calamine lotion
Oral antihistamine and or oral corticosteroid - predisolone
Cool compress, oatmeal bath, wet dressing, antibiotic - cephalexin
Other general advice for contact dermatitis
Identify and avoid the irritant/allergen, proper skin care and hygiene, moisturise regularly, wear protective clothing, avoid heat and sweat, managed stress
Signs and symptoms of thrush
White vaginal discharge, cottage cheese consistency, no abnormal odour, itching and irritation around the Volver and vagina, soreness and singing during sexual intercourse or when urinating
Response, which makes you refer thrush
Antifungal not working, more than four times in a year, first time having thrush, symptoms are severe and not improving, pregnant, breastfeeding, under 16 or over 60, we immunity
Main management options of thrush
Antifungal such as clotrimazole of fluconazole
Other general advice for thrush
Use water and an emollient to wash the area rather than soap and dry properly after washing, wear cotton underwear, avoid sex, pee after sex
Signs and symptoms of UTI
Difficulty going to the toilet, burning sensation and increased frequency, itchiness, cloudy urine with an odour, cramping in lower abdomen/back, low-grade fever, blood and urine sometimes
Response, which makes you refer UTI
Very high/very low temperature, confusion or drowsiness, lower tummy pain, blood in urine, pregnancy, diabetes
Main management options for UTI
Sometimes can go away on own, paracetamol for fever, antibiotics for three days i.e. nitro fear towing, can treat from 16 to 65 on pharmacy first
General advice for UTI
Keep the area clean and dry, don’t wipe front to back, drink fluids, urinate after sex
Signs and symptoms of bacterial vaginosis
Smelly thin discharge with no itching or soreness, burning sensation, painful sex, fishy odour
Response, which makes you refer BV
Candidiasis = white, odorless curdy discharge
Yellow green frothy discharge = trichomoniasis
Ulceration, acute pain = genital herpes
pH greater than 4.5 after test
systemic symptoms = fever and chills (PID)/endometritis
Severe lower abdominal pain/bleeding unnaturally
Pregnancy equals pre-term labour and postpartum infections
Immunocompromised patients
Main management options for bacterial vaginosis
Oral metronidazole or topical intravaginal metronidazole
General advice for bacterial vaginosis
Reduce exposure to contributing factors such as bubble baths and shampoo in bath
Signs and symptoms of trichomoniasis
50% asymptomatic in women, thick and scant to profuse and thick vaginal discharge, Volver itching, odour, ulceration, lower abdominal pain, painful to you go to the bathroom
For men, urethral discharge and dysuria
Response, which makes you refer trichom
Severe abdominal pain, coloured discharge, blood and urine, genital sores/blisters, failure of treatment, pregnant women equals pre-term delivery, if they have HPV increased risk of cervical cancer, infertility
Main management options of trichomoniasis
Oral metronidazole
General advice for trichomoniasis
Screening for other STI’s, screen partners, advise sexual abstinence for at least a week, good hygiene
Signs and symptoms of viral sore throat
Painful throat, dry scratchy throat, redness at the back of the throat, bad breath, mild cough, swollen neck glands, fever, runny nose
Response, which makes you want to refer viral sore throat
Difficulty breathing, unable to swallow, drooling, immunocompromised, diabetes, or chemotherapy, being over a week
Main management options of viral sore throat
Paracetamol, ibuprofen, anaesthetic spray, lozenges, gargle salt water
Signs and symptoms of tonsillitis
Fever over 38, red swollen tonsils, nausea, bad breath, headache, earache, swallowing problems
Response, which makes you want to refer for tonsillitis
Seven or more episodes in a year, white pus filled spots on the tonsils, symptoms don’t go away after four days, very young children, pregnant women, elderly
Main management for tonsillitis
Cool drinks to soothe the throat, paracetamol, ibuprofen, gargle salt water, lozenges, throat sprays, antiseptic solutions, amoxicillin
Signs and symptoms of scarlet fever
Sore throat, fever, headache, fatigue, nausea and vomiting, blanching rash with a sandpaper texture, strawberry tongue, swollen lymph nodes, flushed face
Response which makes you want to refer for Scarlet fever
Lesions equals hand foot and mouth disease, long lasting fever, a rash that differs from scarlet fever, confusion/agitation/consciousness equals TSS, severe abdominal pain, severe dehydration, immunosuppressed, under five years old, pregnant, heart disease, elderly, chronic conditions
Main management options for Scarlet fever
10 day course of phenoxymethyl penicillin or clarithromycin for penicillin allergy
Pregnant women equals erythromycin
Are the general advice for Scarlett fever?
Advice, pain relief medication’s, drink fluids, clean and cover any skin breaks, no school for 24 hours after antibiotic started, handwashing and hygiene, follow-up with no change after seven days, avoid sharing cutlery, et cetera
Signs and symptoms of glandular fever
Fever, sore throat, lymph nodes swollen, fatigue, malaise, rash
Response which makes you want to refer for glandular fever
Severe and prolonged symptoms, unusual age group (not 15 to 24), respiratory distress, stridor, can swallow fluids, elderly, immuno compromised, chronic medical conditions
Main management for glandular fever
Paracetamol and ibuprofen to relieve pain
General advice for glandular fever
Symptoms usually asked 2 to 4 weeks, common tiredness, return to normal activities ASAP, avoid heavy lifting and contact/collision sports
Signs and symptoms of bacterial conjunctivitis
Red eyes, burning/itchy, produces a yellow/green puff that sticks to the lashes, watery eyes
Response which makes you want to refer bacterial conjunctivitis
Baby is less than 30 days old, wear contacts and have spots on your eyelids, sensitivity to light, change in vision like wavy lines or flashing
Signs and symptoms of allergic conjunctivitis
Red water eyes, a burning/itchy/gritty feeling, sensitivity to light, swollen eyelids, puffy eyes in the morning
Response, which makes you refer allergic conjunctivitis
Baby is less than 30 days old, changes in vision that wavy lines are flashing
Signs and symptoms of a sty
Painful lump on the inside of the eyelid or around the eye, swollen and red eyelids, filled with yellow pus
Response, which makes you refer a stye
Does not clear up in a few weeks, affects vision, eye is producing pus
Signs and symptoms of a subconjunctival haemorrhage
Small red spot of blood on the white of your eye
Response, which makes you refer subconjunctival haemorrhage
Unexplained bleeding, you have a blood condition, chemotherapy, does not clear up in two weeks
Main management option for bacterial conjunctivitis
Eyedrops - chloramphenamine, or antihistamines
General advice for bacterial conjunctivitis
Cover your mouth and nose when sneezing and put used tissues in the bin, wash hands regularly, wash pillow cases
Main management options for allergic conjunctivitis
Eyedrops or antihistamines, steroid eyedrops
General advice for a allergic conjunctivitis
Use only sent free soaps and detergent, install an air purifier, vacuum/dust regularly,
Main management options for a stye
Antibiotic cream, oral antibiotics cephalexin
General advice for a sty
Rinsing the eyelids daily with warm water, disinfecting contact lenses and changing them regularly, removing all eye makeup before going to bed
Main management options for subconjunctival haemorrhage
Will resolve on its own within 7 to 14 days
General advice for subconjunctival haemorrhages
Avoid taking medication increase risk of bleeding and avoid rubbing your eyes
Signs and symptoms of impetigo
Red sauce or blisters that burst and leave golden crusty patches, itchiness
When To refer impetigo
Not improving after 2 to 3 days of antibiotics and rapidly deteriorating/fever
Signs and symptoms of cold sores
Tingling/itching or burning feeling around the mouth, a fluid filled blister will form and eventually burn to form across
When to refer a cold sore
Blisters on the inside of the lip or mouth, if it hasn’t started to heal within 10 days, swollen or painful gums, weak immune system
Signs and symptoms of angular Cheilitis
Red, swollen or cracked skin in the corners of the mouth, itching or burning, crusty blisters
When to refer angular Cheilitis
B12 deficiency, younger immunocompromised people, diabetes
Signs and symptoms of aphthous ulcers
Painful, round/oval ulcers with a yellow/grey base and a red border, found in the cheeks and tongue
When to refer aphthous ulcers
Lost more than three weeks, bigger than usual or in the back of the throat, bleeds or becomes more painful
Main management options of impetigo
Hydrogen peroxide/antibiotic cream if there is one lesion
Antibiotic cream, if widespread
Main management options for cold sores
Anti-viral creams/tablets - aciclovir
General advice for cold sores
Use sunblock lip balm SPF 15+, ibuprofen/paracetamol for swelling, fluids to avoid dehydration
Main management options for angular cheilitis
Miconazole gel or nystatin suspension
General advice for angular cheilitis
Vitamins, avoid smoking, good dental hygiene
Main management options aphthous ulcers
Antimicrobial mouthwash, painkiller, corticosteroid lozenge, salt saline mouthwash
General advice for aphthous ulcers
Encourage regular dental checkups
Signs and symptoms of otitis media
Severe and sudden ear pain, temporary reduction in hearing, fever, irritability, fluid drainage, redness of air canal, balancing issues
Referring otitis media
Been infected already recently, hearing loss, severe vertigo, facial weakness or paralysis, under six months, immuno compromised
Signs and symptoms of otitis externa
Ear pain, itching and irritation in the canal, redness and swelling of the outer ear and the canal, feeling of pressure and fullness inside the ear, scaly skin in and around the canal, discharge from the ear which can be watery or thick
Referring otitis externa
Severe headache and earache, fever over 39, cellulitis spreading the face, diabetes, immunocompromised
Signs and symptoms of glue ear
Middle part of the ear fills up with fluid, temporary hearing loss, earache, tinnitus, problems balancing
Referring glue ear
Last more than three months, affects learning and development, severe hearing loss before glue, down syndrome or cleft lip
Signs and symptoms of wax
Earache, fullness in the ear, partial hearing loss, itchiness, discomfort and odour/discharge, tinnitus, vertigo
Referring wax
Cannot hear anything at all, pain in the ear, visible/suspected perforation, failed attempts at removing, more than five days, history of ear surgery or deafness
Main management of otitis media
Pain relief, eardrops, only antibiotics if the eardrum has been perforated
General advice for otitis media
Pneumonia and flu vaccines can reduce the risk and breastfeeding for six months also reduce the risk
Main management for glue ear
Usually wait to see if it gets better on its own for three months, blowing up a special balloon using one nostril at a time and swallowing us holding the nostril to drain the fluid
If causes an infection, use antibiotics
Main management options for otitis externa
Antibiotic and steroid eardrops
General advice otitis external
I’ve avoid getting the ear wet, warm compress and general OTC pain relief
Main management options for wax
Olive oil drops to soften, sodium bicarbonate drops to dissolve, some GP surgeries syringe
General advice for wax
If prone can regularly use softening drops and do not use cotton buds
What is fever pain and when is it used?
Fever pain in last 24 hours - 38 or more
Purulence - puss on the tonsils
Attend rapidly – symptoms started less than three days ago
Inflamed tonsils – red and widespread
No cough or coiler – bacterial versus viral tonsillitis (viral a cough)
0-1 equals 13 to 18% streptococci = no antibiotic
2–3 equals 34 to 40% streptococci = 3 day backup of antibiotic
More than four equals 62 to 65% streptococci = intermediate antibiotic if severe
