OTC 2 Flashcards
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
when should you refer colic?
inconsolable crying
failure to put on weight
what OTC options are available for colic?
infacol (simethicone)
colief (lactase enzyme)
lack of clinical evidence but can trial for 1 week
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
what age range is colic most prevalent in?
starts in infancy and can last until 6 months
what are the symptoms of cradle cap?
greasy yellow scales on scalp
what age range is cradle cap most prevalent in?
starts in infancy before 6 months
is cradle cap self limiting?
yes,
clears up after a few weeks/ months
as scales flake off, skin underneath may appear red
when should cradle cap be referred?
severe cradle cap on face/ body
swelling, scratching, bleeding
infected, inflammed
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)
can you use capasal shampoo for cradle cap?
no, contains salicylic acid
can you use nizoral dandruff shampoo for cradle cap?
no, contains ketoconazole
what advice should be given to parents with a child with cradle cap?
don’t pick the scales - can cause infection
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
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
what should you do if an infant presents to the pharmacy with symptoms indicative of meningitis?
A&E
how should you treat viral meningitis?
symptomatic relief (paracetamol, ibuprofen)
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
what are the symptoms of mumps?
fever
headache
malaise
swelling on one or both sides of face (inflammation of the parotid glands)
what are the symptoms of rubella?
lymphadenopathy
rash starts on face, the spreads to trunk/ limbs
pink-red macular non-confluent rash
when should you refer measles, mumps or rubella?
all cases
(notifiable diaseases)
how could you manage MMR OTC?
symptomatic relief (paracetamol/ ibuprofen)
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
how long is MMR contagious for?
measles - 4 days after rash
mumps - 5 days after swelling
rubella - 6 days after rash
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
