OTC Flashcards
What are the symptoms of a bee sting? 🐝
Instant sharp burning pain, red welt in the area, slight swelling around the sting
What are the main referral points/questions for a bee sting? 🐝
Anaphylaxis, abdominal pain/vomiting
What are the 2 main treatment options for a bee sting? 🐝
- Corticosteroid cream 1% (apply to affected area 1-2 times daily) or 0.5% (2-3 times daily)
- Non-sedating antihistamine
What are some counselling points/advice for a bee sting? 🐝
- provide advice on how to remove the sting
- clean the area and ice to help relieve discomfort (no more than 15 mins)
- use an effective insect repellent when outdoors (containing DEET)
What are the symptoms for chicken pox? 🤒
Malaise, low grade fever, headache, runny nose, cold
Rash with small blisters
What is the progression of a chicken pox rash?
Starts on body and progresses to head and limbs
What are the 4 main referral points for chicken pox?
- Suspected measles (rash appears around ears and face then progresses to trunk and limbs; fever)
- Suspected rubella (rash starts on the face and quickly progresses to the trunk; swollen glands; cold like Sx)
- Meningitis (rash on trunk and limbs; fever; lethargy; stiff neck) - non blanching rash
- Pregnant women (need a blood test to determine levels of antibodies - can cause miscarriage or foetal varicella syndrome)
What is the treatment for chicken pox?
No required treatment options for healthy individuals
- Solugel for blisters to prevent scarring
- Antihistamines to help with itch
- Paracetamol for temperature 🤒
For which common OTC condition do you need to ask about vaccination status?
Chicken pox
What are some common counselling points for chicken pox?
- gloves when sleeping
- keep hydrated
- loose clothing
What is the exclusion period for chicken pox?
Until blisters have dried and at least 5 days after the onset of symptoms
(No need to exclude contacts - except pregnant women - unless they are displaying symptoms)
Opioids, diets, trauma and pregnancy are some of the causes for which commonly encountered diagnosis?
Constipation
What are some of the questions to ask when confirming a diagnosis of constipaton?
Change of diet/routine, pain on defection, presence of blood, duration, lifestyle changes
When to refer for a constipation diagnosis?
- black tarry stools
- systemic symptoms
- alternating constipation/diarrhoea
- lasting over 2 weeks with no identifiable cause
What are black tarry stools indicative of?
Upper GI bleed
What is an appropriate treatment option for constipation for a child 1-5 years old?
Movicol Jr.
(1 sachet per day dissolved in 60mls of water)
What is an appropriate treatment option for constipation for a child 6 years old or over?
Movicol Jr. (2 sachet in 120mls water daily)
What is the MOA of movicol?
Macrogol 3350 exerts an osmotic action in the gut which induces a laxative effect.
What are some counselling points for child constipation?
- increase dietary fibre
- hydration
- avoid caffeine
- encourage good toilet hygiene
What are some of the symptoms/diagnostics that you would consider for headlice?
- itching at the scalp, back of neck or behind ears
- diagnosis should be made on the presence of live lice
- note that patients may be asymptomatic (no itch)
When to refer for headlice
- if diagnosis unclear
- signs of secondary infection
- treatment failure
What are some products you could recommend for the treatment of headlice?
- KP24 (medicated and natural)
- Moov range (natural)
- ban lice (medicated)
What is the wet combing technique for removal of headlice?
Using conditioner, comb through hair thoroughly every 2 days until no lice are found for 10 consecutive days (physical removal method). Can do in addition to using treatment
What are some counselling points for headlice?
- hot wash pillow cases and hair brushes/bands
- avoid contact with others hair (particularly for school aged children)
- check other family members for head lice
- tie back long hair
- reassure parents that it is not a hygiene issue
What is the exclusion period for headlice?
None required, just ensure that patient is treated
What are the symptoms or differentiating features of nappy rash?
- rash confined to the areas with direct contact (skin folds generally unaffected)
- burn like rash around the nappy area
- may itch/sting/burn and be generally sore
- redness
When to refer for nappy rash?
- severe rash
- signs of secondary infection
- frequent recurrence
- involvement of other body areas
- no treatment response
- skin is broken
- baby is generally unwell
What is a treatment option for nappy rash and how is it used?
Sudocream (ZnO) - apply a thin coat evenly after each nappy change or as often as required
What is a good adjunctive therapy you may recommend for nappy rash?
Soap free washes (QV baby as an example)
What are some counselling points for nappy rash?
- regular nappy changes (if they have a dirty nappy, don’t wait to change it)
- avoid wipes that are scented or contain alcohols
- nappy free time
- reassure patient that this will likely resolve quickly and refer if it doesn’t
Which OTC condition is caused by a mite?
Scabies
Intense itching of the skin which is typically worse at night and after showering is associated with condition?
Scabies
What are some of the symptoms of scabies?
- intense itching of the skin
- visible burrows on the skin between the fingers and in skin creases
- bumpy/pimply rash
- clear fluid filled lesions
What are some of the differentiating features of scabies?
- location (finger webs, wrists, side of fingers)
- worse at night
- no history of allergies reduces the likelihood of it being contact dermatitis
Referral points for scabies
- signs of bacterial infection
- treatment failure
- infants (<6 months) and elderly
- extensive broken skin due to itching
- if itch persists for more than 1 month
What is the first line treatment option for scabies and what directions would you give?
Lyclear (permethrin - paralyses and kills mites and their eggs)
Directions
- 1 tube per person (maybe 2 for a larger person)
- apply after showering and drying
- apply to the whole body paying careful attention to creases and crevices (including under the nails)
- wash treatment off after 8 hours
- do not apply after a hot bath as this increases absorption and removes drug from treatment site
- all household members and close contacts should be treated
If a patient is allergic to permethrin, what could you suggest as an alternative treatment for scabies?
Benzyl benzoate (Ascabiol)
Eurax (for infants under 6 months)
What are some counselling points for scabies?
- itch may continue for several weeks (offer an antihistamine to help with the itch, maybe even sedating to help with sleep)
- soap free moisturiser
- secondary infection is common (try not to itch)
- wash all bedding/soft toys/clothes in a hot wash or store in a sealed bag for 3 days
What is the exclusion period for scabies?
Until the day after treatment has commenced
What are the symptoms of haemorrhoids?
- pain on defecation
- pain when sitting
- dull ache
- localised itching
- bright red blood
What are some differential diagnoses to be aware of for haemmharoids?
- anal fissures (intense pain on defecation)
- dermatitis (itching)
- threadworm (itching)
- ulcerative colitis and chrons
- upper GI bleed
- cancer
When to refer for haemmhaorids?
- worsening or no improvements after 1 week on tx
- increased bleeding
- been more than 3 weeks
- abdominal pain
- blood in stools (not bright red)
- systemic Sx
- cancer Sx (over 40 with changes in bowel habit and bleeding or family Hx)
What is an appropriate treatment option for haemorrhoids and what are the directions?
Anusol ointment
- clean area before application
- use twice daily (morning and night after a bowel motion)
- use externally for external haemorrhoids and use applicator and apply internally for internal haemorrhoids
Which OTC product is inappropriate for haemorrhoids but commonly used for anal fissures?
Rectogesic
What is an alternative treatment for haemorrhoids to Anusol ointment?
Proctosedyl ointment
List some counselling points for haemorrhoids.
- avoid straining when having a bowel motion
- use baby wipes rather than toilet paper
- ensure good toilet hygiene
- warm baths/cold compresses may help relieve
- use a doughnut shaped cushion when sitting
- good diet/hydration
This condition is common in the third trimester of pregnancy
Haemorrhoids (note - treatment options are safe)
Which condition is not a disease within itself but rather a symptom of an underlying problem?
Diarrhoea
What is the common viral cause of diarrhoea?
Rotavirus
What is the common cause of bacterial diarrhoea?
Contaminated food or drink
What is a common medication resulting in diarrhoea?
Laxatives
What bug do you suspect if a patient returns from overseas with diarrhoea?
Giardias
When should you refer a patient with diarrhoea?
- over 50 years
- alternating with constipation
- blood or musous in stools
- severe sx (8-10 in 24 hours)
- longer than 2-3 days in elderly or children
- infants
- pregnancy
- recent overseas travel
- signs of dehydration
What is a an appropriate treatment option for diarrhoea?
Loperamide (Gastro stop)
- 2 capsules with water and 1 after each loose bowel motion (max 8 per day)
Note: anti cholinergic and opioid agonist - consider ADRs
What are counselling points for diarrhoea?
- MUST maintain hydration (give hydrolyte)
- eat a balanced diet (avoid sweet/spicy/fatty foods)
- increase fibre and starch foods
- ensure good hand hygiene
What conversation might you have with a patient when they present with diarrhoea?
Recommend to let diarrhoea run its course, however can give drugs if the patient needs to work/go out etc.
What are the symptoms of dyspepsia?
- vague abdominal discomfort above the umbilicus associated with belching
- bloating
- flatulence
- full feeling
- nausea and vomiting
- heartburn
What are some of the questions you may ask to determine the diagnosis of dyspepsia?
- age of patient
- location and nature of pain
- radiation
- severity
- associated symptoms
- aggravating or relieving factors
- social/medication history
When would you refer a patient presenting with dyspepsia?
- suspected CVD event
- ALARM Sx
- Medication induced
- waking at night from pain
- pain worse on an empty stomach
- Tx failure
- Frequent Sx
What is an appropriate short term treatment option for dyspepsia?
Nexium
- 1 tablet daily for 7 days
Note: give one week of supply and reassess before you give a second week then REFER
What is an alternative treatment for dyspepsia (other than PPIs)?
Gaviscon - 20mls up to 4 times per day
What are some counselling points for dyspepsia?
- low fat diet
- reduce alcohol intake
- stop smoking
- decrease weight
- reduce caffeine
- avoid trigger foods
- stay upright after eating
- eat smaller meals
- elevate head in bed
- avoid eating or drinking before exercise
What is the typical definition of colic?
Cries for more than three house a day for more than three days a week for more than 3 weeks (this is generally reduced in practice however)
What are some of the symptoms of colic?
- excessive and inconsolable crying
- facial flushing and drawing up of the legs
- may be more common in the evening
- infant will generally be healthy
- on/off pattern
What are some of the DDx questions you can ask about colic?
- age and weight of patient
- are they generally healthy (eating well, gaining weight, wet nappies)
- ask about symptoms
- consider: acute infection, intolerance to cows milk, GORD
When to refer for colic?
- projectile vomiting
- blood/green tinge in vomit
- diarrhoea
- fever
- loss of appetite or weight
- decreased alertness
- distressed parent or child
What is an appropriate treatment option for colic?
Infacol wind drops (simethicone)
- 1 dropper full in the back of the babies tongue up to 12 times per day after feeding
Note: limited evidence for benefit but doesn’t hurt to try
What are some counselling points for colic?
- MUST reassure that the baby will be OK, symptoms will subside over time (generally by 3-5 months)
- If bottle fed, reduce teat size to prevent swallowing air
- warm baths
- gentle tummy massage
- support the mother
- refer if necessary
What symptoms would you expect for a mouth ulcer?
- roundish grey/white in colour
- small with a raised rim
- clearly defined margin
- pain is the key presenting symptom
- consider trauma ulcers
When to refer for mouth ulcers?
- young children (herpes)
- more than 2 weeks
- painless ulcer
- systemic Sx
- large and multiple ulcers in back of mouth
- eye involvement
- ulcer causing great difficulty eating or drinking
What is the first line treatment for mouth ulcers?
Kenalog in orabase (help with pain and inflammation) - S3!!!!!!!!!!
- Apply a small quantity to the affected area before bed (do not rub in)
- can be used 2-3 times per day
What is an alternative treatment option for mouth ulcers?
SM33 gel
Apply to the affected area every 3 hours
What are some counselling points for mouth ulcers?
- Avoid touching the area or wash hands well if you do
- soft toothbrush
- salt water
- avoid hard/sweet/salty/fatty/acidic foods
- avoid hot foods or drinks
- use anaesthetic lozenges
- give preventative advice
Cold sore symptoms
- burning/tingling/itching/pain 3-6 hours before the development of the cold sore
- begins as a small group of pamphlets that progress to create a small, thin walled vesicle
- most common site in the boarder of the lip
DDx for cold sores
- impetigo
- angular chelates (corners of mouth become cracked)
When to refer a cold sore?
- Suspected eye infection
- recurrent infections
- immunocompromised patients
- systemic Sx
- signs of bacterial infection
- lesions present in other areas
- treatment failure
What is a first line treatment option for cold sores?
Zovirax (Aciclovir)
- apply at first sign of a tingle or blister
- apply a small amount to the affected area 5 times per day for 4 days
What are some counselling points for cold sores?
- avoid sharing items (towels/razors/utensils)
- avoid triggers
- clean cold sores with warm water and keep dry
- use lip balm or moisturisers to keep lips moist
- avoid chocolate during outbreak
What are some of the symptoms associated with having water in the ears?
- pain
- itch
- reduced hearing
- noises in the ear such as buzzing or humming
Referral/DDx questions for water in the ear?
- systemic symptoms
- clear/watery discharge (normal)
- need to ask about grommets or recurring pain/infections
What is an appropriate treatment option for water in the ear?
Ear clear for swimmers ear - instill 4-6 drops one ear and keep head tilted for 1 minutes. Repeat in other ear
What are some counselling points for water in the ear?
- need to provide advice regarding the instillation of drops
- Wear ear plugs when swimming
- dry ears thoroughly after swimming
- avoid putting fingers into the ears - prevent infection
- can use the ear drops after swimming in a prophylactic manner
Thick white discharge, odourless, intense itching/burning and painful irritation are symptoms of which condition?
Vaginal thrush
When to refer for vaginal thrush?
- If under 16 or over 60 years old
- Recurrent episodes
- Pregnancy
- Abdominal or pelvic pain
- Urinary symptoms
- Diabetes, Cushing’s HIV, iron deficiency
What is an appropriate treatment option for vaginal thrush for a PREGNANT woman?
Canesten Thrush (Pessary and Cream 6 day treatment pack)
- Insert pessary deeply into the vagina gently before bed (DO NOT USE APPLICATOR)
- Use in conjunction with cream which may be applied 2-3 times daily around the area to help with the itch (partner may also use this cream)
What are some counselling points for vaginal thrush?
- Vagisil have itch relief wipes and creams
- Avoid tight fitting, non-absorbent clothing
- Not an STI
- Wipe from front to back
- Avoid using soap in the genital area
- Avoid perfumed toilet papers and menstural products
- Sometimes partners may also develop an itch however this is NOT an infection and should resolve when the female is treated
Symptoms of bacterial vaginosis?
- thin, white or grey discharge which has a fishy odour
- odour is worse during sex and periods
- absence of itching and soreness
What is a treatment option for bacterial vaginosis?
Fleurstat BV Gel (S3!!!!!)
- use 1 applicator full at bedtime for 7 nights (complete the course)
Counselling points for bacterial vaginosis
- can take a women’s health multivitamin
- wipe front to back
- avoid using soap in genital region
- avoid perfumes TP and period products
What are the symptoms of bacterial conjunctivitis?
- present in both eyes but often one eye affected first by 24-48 hours
- purulent discharge
- gritty feeling
- generalised and diffuse redness
Questions to ask for bacterial conjunctivitis
- discharge present?
- vision disturbances?
- pain/discomfort/itch?
- location of redness?
- duration?
- photophobia?
First line Tx for conjunctivitis
Chlorsig eye drops (S3!!!!!!!!)
1-2 drops in each eye every 2-6 hours for up to 5 days
Chlorsig eye ointment (S3!!!!!!!!!!)
1.5cm ointment every 3 hours for up to 5 days
NOTE - weird directions, most resources say different things
What are the counselling points for eye drops?
- instillation of eye drops
- ensure good hand hygiene
- bathe eyes in Luke warm water to remove nay discharge
- avoid wearing contact lenses until the infection has cleared
- highly contagious
What is the exclusion period for bacterial conjunctivitis?
Until discharge from eyes has ceased
What are the symptoms of allergic conjunctivitis?
- present in both eyes
- thin watery discharge
- generalised redness (inside eyelid)
- itchy
- rhinitis
What is an appropriate treatment option for allergic conjunctivitis?
Zaditen eye drops
1 drop in each eye twice daily (morning and night)
Counselling points for allergic conjunctivitis
- counsel on eye drop use
- avoid triggers where possible
- consider an oral antihistamine?
