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Pharmacy > OTC > Flashcards

OTC Flashcards

1
Q

what to recommend for white, clumpy, cottage cheese vaginal discharge with severe itching, no odour

A

vulvovaginal candidiasis (yeast infection)
vaginal antifungals are equally effective as oral, use QHS and can use during menses, safe in pregnancy/breastfeeding; short courses still take 7d for eradication.

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2
Q

vaginal discharge symptoms what red flags to refer?

A

diabetes, pregnancy, immunocompromise, HIV, STI risk (fever, pelvic pain), prepuberty (under 12yo) or history of 4 or more episodes a year (may need to tx partner if recurrent)

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3
Q

vaginal discharge symptoms what are signs of bacterial vaginosis?

A

thin grey milky discharge, no itch, fishy odour

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4
Q

what to recommend for rashes and sores around the mouth and mucous membranes?

A

orolabial herpes simplex virus infection
see dr for oral antiviral meds that are most effective at reducing severity and duration, used 1-5 days
OTC topical acyclovir cream used within 1h may reduce duration by half a day if used 5 times a day for 5 days

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5
Q

how to prevent transmission of cold sores?

A

orolabial herpes transmitted via saliva, avoid sharing utensils, toothbrushes etc.

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6
Q

how to prevent recurrences of cold sores?

A

avoid triggers like sun, stress, illness

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7
Q

when to refer for diarrhea?

A

red flags: >6BM/day for >48h, vomitting >4h, blood/mucus, chronic conditions, pregnancy, age<2yo

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8
Q

when and what to recommend for diarrhea?

A

if 3 or more loose BMs/day considered diarrhea
recommend loperamide (1st line, 2mg po after each BM max 16mg/day), diphenoxylate+atropine (avoid in pregnancy), bismuth (limited evidence)

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9
Q

bug spray recommendations for prevention of malaria, lyme disease etc

A

1st line:
DEET 25-35% Q4-6H for ages >2
Icaridin 20% Q8H less odor less grease

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10
Q

What are the OTC/NHP options for insomnia? When to take?

A

Diphenhydramine (for occasional use, if using more than 3 times a week, see the doctor)
Melatonin 1-5mg not recommended by CPGs but may help fall asleep faster, sleep longer and deeper
Valerian has weak evidence and can cause withdrawal, hepatotoxicity, and should avoid in pregnancy
Take 30-60min before bedtime

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11
Q

Offer smoking cessation tx for those who smoke more than __ cigarettes/day. 1 pack contains __ cigarettes.

A

10
20-25

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12
Q

The 1st line agent for smoking cessation is?
Contraindications?

A

Nicotine replacement therapy
(Combination therapy is more effective than patch alone)
Contraindications: recent stroke/MI, current severe arrhythmia/angina, TMJ, pregnancy, breastfeeding, age <18.

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13
Q

When must patients quit smoking if starting NRT/Varenicline/Bupropion

A

immediately for NRT
1-2 weeks for v/b

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14
Q

What’s the usual dose and duration of NRT patches? Where to apply? How long? What’s the max beneficial duration? Max safe total dose?

A

Usually 21mg x 6w then 14mg x2w then 7mg x2w
Apply in morning to clean non hairy areas of upper arm or hip for 16-24 hours. Rotate sites.
Not beneficial beyond 24 weeks ie. 6mths
Max 40mg/day is safe for those who smoked >40 cigarettes/day.

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15
Q

Counselling NRT gum/lozenges.

A

Gum: bite/chew twice, then park between teeth and gums for 1 min, and repeat for 30min.
Both: avoid acidic drinks (juice, coffee, soda, alcohol) 15min before (will reduce absorption)

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16
Q

Varenicline indication efficacy safety for smoking cessation

A

2nd line but equally effective as combo
nausea: take w food and drink more water
insomnia: take 2nd dose w supper
vivid dreams (may be bothersome)

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17
Q

Bupropion indication efficacy safety for smoking cessation

A

2nd line but associated w least weight gain
CI in eating disorders, seizures, recent MAOI use
insomnia, restlessness, dizziness, dry mouth

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18
Q

What to recommend for itching/burning, blistering, peeling, cracking, red and rarely bleeding or painful rash on the feet?

A

Athlete’s foot.
Topical antifungal BID x4wks: terbinafine most effective, others are ciclopirox, clotrimazole, ketokonazole, miconazole
Hydrocortisone if inflamed.
Adsorbent talc powder or antifungal (tolnaftate) powder on feet for prevention. Avoid walking barefoot and nylon socks.

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19
Q

What to recommend for areas of thickened skin on feet caused by pressure or friction?

A

non-contagious corn or calluses
non-pharm: soak 10m, use pumice stone, apply olive oil or moisturizer, use cusions.
tx: may use salicylic acid only to corn/callus for 10-14 days.

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20
Q

What to recommend for areas of thickened skin on feet that hurt when pinched, have pinpoint bleeding and black dots, and skin striations run around?

A

Plantar warts caused by HPV infection transmitted by contact.
1st line liquid nitrogen cryotherapy or salicylic acid 5-40% applied daily after showering/soaking for 8weeks and refer if persists >12 weeks.

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21
Q

when to refer patient looking for eye drops for red eyes?

A

red flags: trauma, contract lens wear, pain/tenderness, severe photophobia, significant vision changes, history of occular disease, white corneal opacity/haze

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22
Q

what to recommend for patient with red irritated eye if there is purulent discharge?

A

likely bacterial infection
children: refer
adults: topical antibiotic polymixin B/gramcidin, refer if no improvement in 48 hours, continue for 48h post sx improvement

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23
Q

what to recommend for patient with red irritated eye if there is watery discharge and no itching?

A

likely viral infection
refer, highl contagious for 2 weeks after

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24
Q

what to recommend for patient with red irritated eye if there is watery discharge and itching?

A

likely allergic
otc lubricants (refridgerated)
otc antihistamines for itching - pheniramine, ketotifen, olopatadine, antazoline (preferred over oral bc faster acting less drying, avail in combo w decongestants)
otc decongestants for redness - naphazoline, oxymetazoline, phenylephrine, tetrahydrazoline (CI glaucoma, rebound if used >10d)
mast cell stabilizers
otc mast cell stabilizer (cromolyn) slow onset 3-10d

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25
Q

what to recommend for bump on eyelid?

A

stye
apply warm compress for 5-10 min several times a day
refer if no improvement after 1 week

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26
Q

what to recommend for red itchy scaly eyelid?

A

maybe lice, blepharitis, rosacea, dermatitis
5-10 min compress, lid hygiene wipes or baby shampoo on Q-tip

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27
Q

what to recommend for acne

A

benzoyl peroxide (2.5% similarly effective to 5 and 10%)
salicylic acid 1-2%

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28
Q

what to recommend for chronically dry, red, itchy, scaly skin type worsened by certain triggers like?

A

atopic dermatitis
triggers like soaps, irritants, astringents, allergens, hot dry weather, sweat, stress, infections
non-pharms: moisturizer, oatmeal baths
tx: corticosteroids 1st line, others require rx

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29
Q

what to recommend for redness, itching, scaling in the scalp area aka dandruff?

A

use regular shampoo daily and antifungal shampoo 2-4 times weekly. Most effective are ketoconazole and ciclopirox. Less effective are antifungals selenium and zinc pyrithione or keratolytics salicylic acid, sulfur or coal tar (least effective).

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30
Q

what to recommend for hair loss and scale on baby’s scalp?

A

cradle cap
use nonmedicated shampoo, surfactant containing bath oil, moisturizer

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31
Q

what are red flags for diaper rash?

A

oozing, pus, vesicles, ulceration, frequent recurrences, fever, n/v, lesions outside diaper area, secondary infection of genitals, behavioural changes like nonstop crying, immunocompromise, failure to improve in 7d and resolve in 14d

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32
Q

what to recommend for diaper rash?

A

HYDROCORTISONE 0.5%-1% TID for 1-2wks apply 1st
ANTIFUNGALS BID applied 2nd
(miconazole 2%, clotrimazole 1%, ketoconazole 2% BID x1-2w most effective) (ciclopirox 1% BID x4w less effective) (nystatin BID X2w least effective)
ZINC OXIDE 20-40% applied last with each diaper change

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33
Q

what are red flags for burns?

A

> 10% BSA
blistering
thin skin (face, inner arm, perineum), hands or feet
under 5yo or over 60yo
chemical or electical

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34
Q

what to recommend for burns?

A

cool compress x20m
antibiotics/antiseptics NOT recommended
lidocaine or benzocaine may cause contact dermatitis
may use pramoxine (low sensitizing potential)

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35
Q

what to recommend to treat sunburn?

A

moisturizers, colloidal oatmeal, calamine lotion, pramoxine

36
Q

what to recommend for lice in someone with chrysanthemum allergy?

A

Dimethicone 50% (NYDA) apply to dry hair, leave 8h, rinse & repeat in 8-10 days - 97% cure
Isopropyl myristate/cyclomethicone (Resultz) apply to dry hair for 10m, rinse & repeat in 7 days -57-93% cure
AVOID permethrin and pyrethin + piperonyl butoxide

37
Q

what to recommend for pregnant/breastfeeding women with lice? or infants <2 yo?

A

Permethrin 1% (Nix, Kwellada) shampoo hair then apply f10m then rinse and repeat in 7 days - 96-100% cure
Pyrethin + piperonyl butoxide (R&C) apply to dry hair, leave on f10m then rinse and repeat in 7 days -94% cure

38
Q

when can kids with lice return to school?

A

the day after the 1st treatment

39
Q

after treatment for lice, what should patients expect?

A

no live lice in 24h
normal skin in 1w
itchiness lasts up to 2w (may use antihistamine)

40
Q

non pharms for lice?

A

nit comb to remove dead nits
wash clothes in hot water or store in plastic bag 2wks

41
Q

what is 1st line for itchiness worse at night, silvery linear raised papules? no other conditions or allergies

A

scabies 1st line: permethrin 5% lotion massage everywhere neck down and leave on 8-14h then rinse and repeat in 1wk, wash all clothes linens used during 3 days prior to tx, itch may persist 2wks post tx

42
Q

what to recommend for itchiness worse at night, silvery linear raised papules in pregnant/breastfeeding?

A

scabies 1st line: permethrin 5% lotion massage everywhere neck down and leave on 8-14h, repeat in 7days
safe in pregnancy/breastfeeding and >2mth old

43
Q

what to recommend for itchiness worse at night, silvery linear raised papules in someone with chrysanthemum allergy?

A

scabies 2nd line:
crotamition 10% creme apply once, then again in 24h, then wash off 48h after
sulfur 5-10% apply qhs x5-7d (compounded, limited data, smells and stains, irritation and dermatitis)

44
Q

after treatment for scabies, what should patients expect?

A

burrows clear up in 2w
itch persists for up to 4w

45
Q

what to recommend for nail thickening and discoloration?

A

fungal nail infection (onychomycosis)
topical antifungal Emtrix (propylene glycol, urea, lactic acid) applied once daily for 24 weeks (note rx topicals are much more effective)

46
Q

when to refer patients with discolored thickened nails?

A

if more than 2 nails affected, with >20% involvement, if there’s significant thickening or lifting of the nail, if the lanula is affected

47
Q

red flags for headaches?

A

child or middle aged-elderly
severe or abrupt
progressively worse, increasingly frequent
stiff neck, fever, reduced LOC

48
Q

what to recommend/discuss for pulsing headache on one side?

A

any light/sound sensitivity? any nausea/vomiting?
if yes, may be a migraine, refer for diagnosis
in the meantime can try OTC analgesics or NHP Mg citrate, riboflavin, CoQ10 and talk to Dr about rx triptans
can be triggered by too much or too little or irregular sleep, diet, exercise, stress

49
Q

what would you ask a patient with constipation to rule out red flags?

A

any blood, mucus in stool?
any fever? extreme thirst?
recent diarrhea?
does it wake you up at night?
any significant weight loss?
any eating disorders? chronic illness?
recent abdominal surgery?
any large abdominal mass?

50
Q

what would you recommend for children with constipation?

A

1st line: PEG (3350 better tolerated), lactulose, sorbitol
2nd line: mg hydroxide
other: glycerin suppository

51
Q

what to recommend for adult with acute constipation?

A

fiber plus stimulant (bisacodyl or senna)

52
Q

what to recommend for adult with chronic constipation?

A

chronic means >3mths
1st: fiber plus osmotic (PEG)
2nd: stimulants

53
Q

patient looking for mineral oil for constipation, what do you tell them?

A

not recommended, may reduce absorption of vitamins and may cause pneumonia if any gets into lungs, recommend fiber or other laxatives instead

54
Q

do laxatives need to be separated from other meds? foods?

A

separate fiber or PEG 2h from other meds
separate bisacodyl from milk, antacids, PPIs

55
Q

why should use of stimulant laxatives be minimized?

A

to minimize risk of side effects like liver toxicity, electrolyte imbalances (low sodium, potassium), stomach upset

56
Q

who should use caution when taking PEG?

A

Those with renal impairment since it can cause electrolyte disturbances. Otherwise safe in geriatrics, diabetes.

57
Q

do patients need to hold any of their meds before a colonoscopy?

A

most meds can be continued with some exceptions
iron should be stopped 5 days prior
diabetes meds may need to be adjusted for decreased oral intake
antithrombotic use should be discussed with prescriber and maybe adjusted based on risks vs benefits

58
Q

what are examples of clear liquids that patients can take pre-colonoscopy?

A

water, clear broth, coffee or tea (without milk), ices, gelatin, and fruit juices such as apple, grapefruit, and lemonade (no red dyes)

59
Q

what diet restrictions do patients usually have prior to colonoscopy?

A

no food 4-8hr prior (or longer if delayed emptying)
no liquids 2hr prior

60
Q

what are the different ways that bowel preparations are commonly dosed prior to colonoscopy?

A

morning colonoscopy - 1/2 dose QHS + 1/2 dose QAM
morning colonoscopy - 1 dose QHS
afternoon colonoscopy - 1 dose QAM

61
Q

how to make colonoscopy preps easier to consume

A

chill, drink through a straw, eat mints

62
Q

what are some PEG based colonoscopy prep meds?

A

CoLyte & PegLyte - high volume 4L
Bi-PegLyte - low volume 2L + bisacodyl tabs
all contain similar but not the same concentrations of PEG, sodium, chloride, potassium, sulfate, bicarbonate
MoviPrep is similar but also contains ascorbic acid

63
Q

what are some non-PEG based colonoscopy meds?

A

Pico-Salax (Generic Purg-Odan) - Sodium picosulfate/magnesium oxide/citric acid - sachets mixed with 150ml of cold water, must advise to also drink lots of clear fluids and electrolyte solutions like Gastrolyte, Pedialyte as well

64
Q

what to recommend for someone who is travelling and doesn’t want to get motion sickness?

A

for short duration: diphenhydramine or dimenhydrinate 1h prioir
for longer duration: scopolamine transdermal patch 4h prior; lasts 3 days
for refractory: promethazine (histanil, schedule 2)
counselling for all: sedation, anticholinergic s/e, don’t touch eye after handling patch

65
Q

red flags for nausea/vomiting?

A

dehydration
persistent vomiting
abdominal pain
blood in stool/vomit
difficulty swallowing
altered mental status
age over 55

66
Q

what to recommend for nausea/vomiting?

A

diphenhydramine (Benadryl)
dimenhydrinate (Gravol)
Ginger

67
Q

what would you ask a patient with heartburn to rule out red flags?

A

age >50
vomiting blood? chest pain?
difficulty or pain when swallowing?
abdominal mass?
weight loss? anemia?

68
Q

who should avoid antacids?

A

patients with heart failure, renal dysfunction, HTN, edema, cirrhosis, pregnancy, elderly (Mg and Al)

69
Q

counselling for antacids?

A

good for occassional use, works the most quickly and lasts 1-3 hours, Mg causes diarrhea, Ca and Al cause constipation, separate dosing of other meds by 2h

70
Q

options for heartburn?

A

antacids (fastest onset, lasts 1-3h)
alginates (maybe useful combined w antacid)
H2RA (less effective than PPI, efficacy may decrease overtime, good for nocturnal, many DDI with cimetidine)
PPI (most effective, give 30min before meals, long term use can contribute to CVD, dementia, hypoMg, osteoporosis, C Diff, pneumonia, CKD)

71
Q

what would you ask a patient with hemorrhoids to rule out red flags?

A

any protrusion that doesn’t go back in on its own?
any bright red bleeding?
is the stool dark tarry black? is there mucus?
any significant change in bowel habits or weight loss?

72
Q

what would you recommend for hemorrhoids?

A

for mild sx - Zinc (Anusol)
for pain - Pramoxine (Anusol Plus)
for itch - Hydrocortisone (Anusol HC, Proctosedyl) Rx max 1 wk use 2
for infection - framycetin (Proctosedyl) Rx

73
Q

patient inquiring about preparation H

A

contains vasoconstrictor phenylephrine, reduces inflammation and bleeding, use short term and avoid applying to open wounds esp if CVD, HTN

74
Q

patient inquiring about venixxa

A

po tablets contains citrus bioflavanoids, low quality evidence that it reduces itch, pain, bleeding, can cause nausea, some DDI

75
Q

Ringing of ears when to refer

A

Dizziness, hearing loss

76
Q

Recommendation for tinnitus

A

Lipoflavanoid supplement
Has vitamins, don’t take w dairy
May interact w NSAIDs, CV meds

77
Q

which probiotics recommended for preventing antibiotic associated diarrhea in children?

A

Lactobacillus rhamnosus GG and Saccharomyces boulardii 5–40 billion CFUs/day

78
Q

What are some unique characteristics of different antihistamines?

A

Allegra May have reduced absorption w fruit juice, antacids
Claritin and Aerius may have DDI that inc QT
Blexten CI in pts w Hx of QT and must take w full glass water 1h before or 2h after food
Blexten and Rupall are Rx - may cause more headache, drowsiness, interact w grapefruit

79
Q

Allergy eye drop brands

A

These contain antihistamine+decongestant (don’t use more than 3 days)
-refresh allergy relief
-visible advance allergy
-naphcon a

These have mast cell stabilizers (delayed effect but for chronic use)
-cromolyn
-opticrom

80
Q

Antiseptic lozenges

A

Amylmetacresol
2,4-diclorobenzylalcohol
Hexylresorcinal

Modest efficacy
Fairly safe

Cepacol sensations

81
Q

Hair loss

A

Minoxidil/Rogaine
Men and women’s both 5%
But men’s BID and women’s OD (+fragrance)

82
Q

AREDS products and counselling

A

Preservision
Vitalux
Take w food to reduce nausea

83
Q

What to recommend to help fall asleep faster

A

Benadryl (doesn’t help stay asleep though, would need something like zopiclone for that) use intermittently and see MD if using frequently

84
Q

Products for scarring

A

Vit E creams
Mederma
Scarfade

85
Q

Colonoscopy prep precautions

A

May cause BP changes, electrolyte, arrhythmia and seizures

Pharmacy (43 decks)

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