OTC 2 Flashcards by Richard Armstrong

what are the symptoms of colic?

excessive high pitched crying
(Rule of 3s: at least 3 hours/ day, 3 days/ week for 3 weeks)
red in the face
clenched fists
knees drawn up to stomach
excessive gas/ trouble passing stool

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when should you refer colic?

inconsolable crying
failure to put on weight

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what OTC options are available for colic?

infacol (simethicone)
colief (lactase enzyme)

lack of clinical evidence but can trial for 1 week

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what other advice can you give regarding colic?

reassure parent
could trial removing cows milk for 1 week
massage the tummy in circular motions
hold baby during crying episodes, rock them, warm baths, burp them, hold upright during feed

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what age range is colic most prevalent in?

starts in infancy and can last until 6 months

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what are the symptoms of cradle cap?

greasy yellow scales on scalp

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what age range is cradle cap most prevalent in?

starts in infancy before 6 months

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is cradle cap self limiting?

yes,

clears up after a few weeks/ months
as scales flake off, skin underneath may appear red

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when should cradle cap be referred?

severe cradle cap on face/ body
swelling, scratching, bleeding
infected, inflammed

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what OTC products can be used for cradle cap?

baby shampoo (use soft brush and apply as daily routine)
olive oil BP (apply overnight to loosen scales, gently brush following morning)

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can you use capasal shampoo for cradle cap?

no, contains salicylic acid

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can you use nizoral dandruff shampoo for cradle cap?

no, contains ketoconazole

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what advice should be given to parents with a child with cradle cap?

don’t pick the scales - can cause infection

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what are the symptoms of meningitis?

non-blanching rash (pale, blotchy skin with widespread bruises which do not fade when pressed against a glass)
stiff neck
headache
cold hands and feet
confusion/ drowsiness
photophobia
seizures
flu-like symptoms
high fever
muscle ache
N&V

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what are the symptoms of meningitis in infants?

floppiness/ unresponsiveness
dislike being handled
refusing feeds
difficult to wake
rapid breathing/ grunting
unusual cry or moan
bugling fontanelle

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what should you do if an infant presents to the pharmacy with symptoms indicative of meningitis?

A&E

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how should you treat viral meningitis?

symptomatic relief (paracetamol, ibuprofen)

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what are the symptoms of measles?

koplik spots
conjunctivitis
cold-like symptoms
fever

rash starts behind ears, spreading to face, trunks, limbs
red-brown confluent and blotchy rash

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what are the symptoms of mumps?

fever
headache
malaise

swelling on one or both sides of face (inflammation of the parotid glands)

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what are the symptoms of rubella?

lymphadenopathy

rash starts on face, the spreads to trunk/ limbs
pink-red macular non-confluent rash

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when should you refer measles, mumps or rubella?

all cases

(notifiable diaseases)

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how could you manage MMR OTC?

symptomatic relief (paracetamol/ ibuprofen)

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what advice can you give for children suffering with MMR?

bed rest
hydration
contagious (off school)
avoid acidic drinks in mumps (irritates parotid gland)
children with rubella should avoid pregnant women

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how long is MMR contagious for?

measles - 4 days after rash
mumps - 5 days after swelling
rubella - 6 days after rash

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what complications can mumps cause in adults?

meningitis and sterility

what are the two types of nappy rash?

irritant and fungal

when should nappy rash be referred?

broken skin, severe nappy rash yellow crust/ weeping other body areas affected OTC failure > 1 week

what OTC options are available for irritant nappy rash?

barrier preparations: bepanthen, drapolene, sudocrem, metanium

what OTC options are available for fungal nappy rash?

clotrimazole miconazole apply for 7 days after clearing to prevent returning

should babies with oral thrush be referred or treated OTC?

treated OTC, common in babies

what OTC product can be used for oral thrush in infants?

daktarin SF oral gel (> 4 mnths)

how often should daktarin SF oral gel be applied and what is the duration?

QDS after meals continue for 1 week after symptoms disappear

what are the symptoms of slapped cheek?

bright red rash on cheeks light pink, lace like, itchy rash on trunk and limbs initial cold like symptoms (most contagious)

when should you refer slapped cheeK?

pregnant women (miscarriage/ still birth) blood disorders anaemia

what OTC products can be used for slapped cheek?

symptomatic relief (paracetamol or ibuprofen) antihistamines for itchy rash

what advice can be given for slapped cheek?

rest fluids once rash appears no longer contagious

what are the symptoms of whooping cough?

initial catarrhal symptoms (runny nose, watery eyes, fever) intense coughing bouts (between coughs there is a whoop)

when should you refer whooping cough?

all cases A&E if significant breathing difficulties

what OTC products can be given for whooping cough?

fever (paracetamol or ibuprofen)

what advice can be given for whooping cough?

very contagious (stay away from school 5 days after abx started or 3 weeks after coughing started) cover child's mouth/ nose when coughing/ sneezing

what are the symptoms of chicken pox?

small red spots, very itchy and infectious blisters leading to crusts

when should you refer chicken pox?

adults pregnant women weakened immune system infants under 4 weeks old shingles

what OTC products can be used for chicken pox?

calamine lotion crotamiton (eurax) >1 chlorphenamine (piriton) paracetamol AVOID ibuprofen (serious skin infection)

what advice can be given for chicken pox?

do not scratch lesions (infection) contagious until lesions crusted over

what is classed as a high temperature?

>38

what is classed as a high grade fever?

>39

what are the symptoms of scarlet fever?

pink-red itchy sandpaper rash (appears on chest/ stomach first) sore throat headache strawberry tongue flushed cheeks

how long should children stay off school with scarlet fever?

24 hours after starting abx

what are the symptoms of cluster headache?

occurs in clusters intense pain in/ behind one eye

what are the symptoms of sinus headache?

blocked/ congestion caused from blocked sinuses

what are the symptoms of tension headache?

constant ache that feels like a tight band around the head

what are the symptoms of migraine?

unilateral throbbing pain N&V photosensitivity/ sound sensitivity migraine with/ without aura acute triggers

when should you refer a headache?

unresponsive to analgesia within 1 day taking COC with migraine type headache recurring headache neck stiffness children < 12 severe headache lasting > 4 hours recent trauma injury increasing severity/ frequency sever deep pain (worse when lying down)

when are you unable to sell sumatriptan for migraine?

1st migraine attack in >50 4 attacks a month > 24 hours liver and renal impairment CVD epilepsy

what OTC products can be used for headaches?

simple analgesics analgesics with codeine and dihydrocodeine

what OTC products can be used for migraines?

sumatriptan antiemetics: prochlorperazine (buccastem) buclizine (migraleve pink)

what is the licensing for OTC sumatriptan?

18-65 yrs previously tried simple analgesia established pattern (5 attacks in past year needed) previously diagnosed

how do you take sumatriptan?

one 50mg tablet ASAP after onset do not take a second for the same attack second dose can be taken after 2 hours if migraine recurs only if response to first max 2 in 24 hours

when should insomnia be referred?

chronic insomnia (> 3 weeks) suspected depression < 16 years medication ADR

what OTC products can be used for insomnia?

diphenydramine (nytol) promethazine (sominex, phenergan)

what is age restriction for diphenydramine?

>16 years

what is the age restriction for promethazine?

>16 years

what OTC products are available for travel sickness?

hyoscine hydrobromide cinnarizine promethazine

what formulations of hyoscine hydrobromide are available OTC for travel sickness?

tablets (journeys lasting up to 4 hours) patches (journeys over 24 hours)

what is hyoscine hydrobromide contraindicated in?

glaucoma and prostatic enlargement

what brands of hyoscine hydrobromide are there for travel sickness?

kwells kwells kids joyride

what is the age restriction of kwells?

>10 years

what is the age restriction of kwells kids?

>4 years

what is the age restriction of joyride?

>3 years

what is the age restriction of scopaderm (hyoscine hydrobromide) patches?

>10 years

how long do hyoscine hydrobromide tablets last? and how long before the journey should they be taken?

for journeys lasting up to 4 hours take 30 mins before last 6 hours

how long do hyoscine hydrobromide patches last? and how long before the journey should they be taken?

for journeys lasting over 24 hours take night before last 72 hours

cinnarizine and promethazine can be used for travel sickness for journeys lasting how long?

4-8 hours

what is the age restriction for cinnarizine (sturgeron)?

>5 years

what is the age restriction for promethazine (phenergan)?

>2 years

what non-drug treatment options are there for travel sickness?

acupressure wristbands ginger herbal supplements limited evidence, only for patients unsuitable for medication

what OTC options are available for otitis externa?

earcalm spray

what is the age restriction for earcalm spray?

> 12 years

when should you refer BPH?

symptoms < 3 months dysuria, haematuria, cloudy urine past 3 months fever concomitant alpha blockers

what is the age licensing of tamsulosin for BPH?

45-75

how do you supply tamsulosin for BPH?

initially give 2 week supply give further 4 week supply if improvement

after 6 weeks of taking tamsulosin, what should be done?

see the dr - appropriate to continue

what is the age restriction of mebeverine?

>18 years

what is the age restriction of alverine?

>12 years

what is the age restriction of peppermint oil?

>18 years

what is the age restriction of buscopan?

>12 years

what is the age restriction of loperamide?

>18 years

what are the symptoms of scabies?

itching (worse at night) pimple like rash small thread like grey lines

what are the OTC options for scabies?

permethrin (lyclear) malathion (derbac-M)

how should you treat scabies?

apply treatment twice, 7 days apart apply to entire body treat all close contacts

what OTC options are there for threadworm?

mebendazole (ovex)

what is the age restriction of mebendazole?

>2 years

which patient group is mebendazole contraindicated in?

pregnant women

how should you treat threadworm?

mebendazole 100mg stat dose repeated after 2 weeks to prevent recurrence treat all family members

for pregnant and breastfeeding patients, who cannot use mebendazole, what advice can be given to manage threadworm?

strict hygiene measures for at least 6 weeks:

what are the different types of ulcer?

minor apthous (<5mm size and regular shaped) major apthous (>10mm size and regular shaped) trauma (irregular shape)

when should an ulcer be referred?

> 3 weeks painless >10mm > 5 ulcers

what OTC products can be used for ulcers?

chlorhexidine (prevents bacterial infection) local analgesics: benzydamine, choline salicylate local anaesthetics: lidocaine, benzocaine topical corticosteroids: hydrocortisone buccal pellets

what is the age restriction of corsodyl mouthwash (chlorhexidine)?

>12 years

what is the age restriction of difflam oral rinse (benzydamine)?

>12 years

what is the age restriction of bonjela adult (choline salicylate)?

>16 years

what are pseudoephedrine, phenylephrine, xylometazoline and oxymetazoline?

decongestants

why should you not use nasal spray decongestants for longer than 7 days?

risk of rebound congestion

what conditions are decongestants contraindicated in?

HTN hyperthyroidism diabetes CVD glaucoma prostatic enlargement

what should be used first line in patients with congestion who are < 3 months?

saline spray/ drops

what should be used first line in patients with nasal congestion who are over 3 months and 12 years?

steam inhalation

what is dextromethorphan?

anti-tussive

what are guaifenesin and ipecacuanha?

expectorants

what is the age restriction of dextromethorphan?

>6 years

what are the side effects of dextromethorphan?

sedation and constipation

cough medication containing what is best for children under 6 years?

glycerol simple linctus

what is the age restriction of cetirizine?

>6 years >2 years (liquid)

what is the age restriction of loratadine?

>2 years

what is the age restriction of acrivastine?

>12 years

what is the age restriction of chlorphenamine?

>6 years >1 year (liquid)

what is the age restriction of promethazine?

>5 years >2 years (liquid)

what is the age restriction of steroid nasal sprays?

>18 years

what steroids are available as nasal sprays?

fluticasone & beclometasone

what OTC eye drops are available for hay fever related watery, itchy eyes?

sodium cromoglicate (opticrom) xylometazoline/ antazoline (otrivine antistin)

what is the age restriction of covonia throat spray (lidocaine)?

>12 years

what is the age restriction of tyrozet lozenges (benzocaine)?

>3 years

when should you refer a fungal infection?

facial/ scalp involvement toenails also affected in athletes foot large area affected broken skin diabetic/ immunocompromised

clotrimazole (canesten) and miconazole (daktarin) are licensed in what age range?

all ages

what OTC option is there for acne vulgaris?

benzoyl peroxide

how should you treat acne with benzoyl peroxide?

start at a low strength, increase wash skin before applying takes 8 weeks for improvement, continue for 4-6 months

what age range is tranexamic acid licensed in?

18-45 years

what is the dose of tranexamic acid for menorrhagia?

two tablets TDS (QDS if severe) for max 4 days

what is the age restriction of naproxen for dysmenorrhoea?

18-50 years

what is the dose of naproxen for dysmenorrhoea?

two tablets initially, one further tablet 6-8 hours later if needed max 3 tablets/ per max 3 days/ month