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1
Q

Cold & Flu Referral

A

Asthma, Cough a lot, Earache, Chest Pain, Old people, Delirium, Illness, Fever, Young

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2
Q

Cold & Flu Referral

A

Asthma, Cough a lot, Earache, Chest Pain, Old people, Delirium, Illness, Fever, Young

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3
Q

Flu Symptoms

A

> 38degrees
Either cough/sore throat/nasal congestion/rhinorrhoea
AND either headach/malaise/myalgia/sweat/chills/prostration

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4
Q

Management of Cold Under 6

A

Non of the following: decongestant, antihistamine, expectorant, cough suppressant
Nasal drops

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5
Q

Management of Cold Over 6

A
  1. Decongestants
  2. Antihistamines
  3. Zinc (lozenges)
  4. Echinacea
  5. Vitamin C
  6. Cough remedies
  7. Analgesics
  8. Inhalants (eucalyptus,steam)
  9. Nasal Drops/Sprays
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6
Q

Management of Cold Over 6

A
  1. Decongestants
  2. Antihistamines
  3. Zinc (lozenges)
  4. Echinacea
  5. Vitamin C
  6. Cough remedies
  7. Analgesics
  8. Inhalants (eucalyptus,steam)
  9. Nasal Drops/Sprays
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7
Q

Cold Symptoms

A
  1. Rhinorrhea leading to congestion
  2. Sneeze
  3. Cough
  4. Headache (around eyes)
  5. Sore throat
  6. Earache
  7. Sinusitis (worse lying down)
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8
Q

Antihistamines Interact with

A

Alcohol, Hypnotics, Sedatives, Anxiolytics, Betahistine, Anticholinergics (eg tricyclics, trihexyphenidyl)

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9
Q

Antihistamine side effects

A

Drowsiness, Constipation, Blurred Vision, Dry mouth, Urinary Retention

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10
Q

Decongestants Cautioned in

A

Diabetes, Heart Disease, Hypertension, Hyperthyroidism

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11
Q

Antihistamines cautioned in

A

Closed-Angle Glaucoma (generally avoid), Prostatic Obstruction, Epilepsy, Liver disease

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12
Q

Sputum colour in chest infection

A

Green/Yellow/Rusty

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13
Q

Antihistamines Interact with

A

Alcohol, Hypnotics, Sedatives, Betahistine, Anticholinergics (eg tricyclics, trihexyphenidyl)

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14
Q

Antihistamine side effects

A

Drowsiness, Constipation, Blurred Vision

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15
Q

Decongestants side effects

A

Increased stimulation, Increased BP, Increase Blood Glucose, Heart stimulation problems in hyperthyroidism

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16
Q

Whooping cough symptoms

A

Begins with catarrh

Whoop on breathing in

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17
Q

Sputum colour in chesty cough

A

Green/Yellow/Rusty

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18
Q

Clear/White sputum indicates

A

Uninfected

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19
Q

TB symptoms

A

Chronic cough with blood
Chronic fever
Night sweats

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20
Q

Other symptoms with normal cough

A

Muscle ache, cold, sore throat, catarrh

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21
Q

Whooping cough symptoms

A

Whoop on breathing in

Catarrh

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22
Q

Hear Failure symptoms

A

Pink/Clear/Frothy sputum
SOB
Oedema
History

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23
Q

Refer cough in

A

SOB, Wheezing, Asthma, Blood, Sputum, Whoop, ADR, Two weeks not better, Chest pain, Croup

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24
Q

Cause of dry/tickly cough

A

viral

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25
Q

Normal cough other symptoms

A

Muscle ache, cold, sore throat, catarrh

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26
Q

Management of cough

A
  1. Suppressants: unproductive
  2. Expectorants: productive
  3. Antihistamines
  4. Sympathomimetics
  5. POM: Theophylline
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27
Q

Why ask about past medication in cough?

A

ACEI cause chronic dry cough. Dr can change to Angiotensin-2 receptors

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28
Q

Give examples of expectorants & their details

A

Guafenesin (Benilyn) 100-200mg

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29
Q

Give examples of antihistamines used to treat cough

A

Diphenyhydramine & Promethazine at night

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30
Q

Side effects of Theophylline

A

Palpitations, Headache, Insomnia, GI irritation, Nausea

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31
Q

Theophylline interactions

A

Increased by Cimetidine, Erythromycin

Decreased by Carbamazapine, Phenytoin, Rifampacin and smoking

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32
Q

Why ask about past medication in cough?

A

ACEI cause chronic dry cough. Dr can change to Angiotensin-2 receptors

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33
Q

Likely cause of sore throat in school child?

A

Streptococcal (bacterial) throat infection

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34
Q

Give examples of analgesics used in sore throat

A

Paracetamol, Aspirin, Ibuprofen

Flurbiprofen lozenges 8.75mg for over 12s: One every 3-6 hours. Max 5/day. Three days treatment

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35
Q

Medications causative of sore throat

A

Steroids (beclometasone/budesonide inhalers) leading to candidial infection due to poor technique

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36
Q

Refer sore throat if

A

Hoarseness for Three weeks, Children, Recurrent, ADR, Thrush, Dysphagia, One week not better, Glandular fever

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37
Q

Symptoms of glandular fever

A

mainly 14-21 year olds, malaise, sore throat, throat inflammation with creamy exudates, dysphagia (swollen glands)

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38
Q

Management of sore throat

A
  1. Analgesics
  2. Mouthwashes/Sprays
  3. Anaesthetics
  4. Lozenges/Pastilles
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39
Q

Give examples of analgesics used in sore throat

A

Paracetamol, Aspirin, Ibuprofen

Flurbiprofen lozenges 8.75mg for over 12s: One every 3-6 hours. Max 5/day. Three days treatment

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40
Q

Give examples of mouthwashes/sprays and anaesthetics used in sore throat

A
  1. Anti-inflammatory: Benzydamine (difflam)

2. Local anaesthetic: Benzocaine/Lidocaine sprays

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41
Q

Give examples of lozenges and pastilles used in sore throat

A

Antiseptic: Cetylpyridinium (merocets)
Antifungal: Dequalinium (dequadin)
Anaesthetic: Benzocaine (tyrozets)

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42
Q

Side effects and contraindications of Benzydamine

A

Numbess/stinging in mouth/throat

Spray >6, Mouthwash >12

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43
Q

Moderate allergic rhinitis is

A

Troublesome symptons: One or more of: disturbed sleep, daily activities, sports, leisure, work

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44
Q

Questions about lifestyle in sore throat

A

Smoking because it is causative

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45
Q

Intermittent allergic rhinitis is

A

less than 4 days a week or less than 4 weeks

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46
Q

Persistent allergic rhinitis is

A

more than 4 days a week or more than 4 weeks

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47
Q

Mild allergic rhinitis is

A

symptoms not troublesome: normal sleep, daily activities, sport, leisure, work

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48
Q

Moderate allergic rhinitis is

A

Troublesome symptons: One or more of: disturbed sleep, daily activities, sports, leisure, work

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49
Q

Symptoms of allergic rhinitis

A

Rhinnorhea, Nasal Congestion, Nasal itching, Teary eyes, Photophobia, Sneezing

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50
Q

Refer allergic rhinitis in

A

Wheeze, Asthma attacks, Tight Chest, SOB, ADR, Pain in face/ear, Purulent Conjuctivitis, 5 days no improvement

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51
Q

Management of allergic rhinitis

A
  1. Antihistamines
  2. Decongestants
  3. Steroid Nasal Sprays
  4. Sodium Cromoglicate
  5. Topical Antihistamines
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52
Q

Name non-sedating anti-histamines with ages

A

Acrivastine (>12)
Cetetizine (>6)
Loratidine (>2)

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53
Q

Name sedating anti-histamines with half lives

A

Promethazine (8-12h)

Diphenhydramine (5-8h)

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54
Q

Name less sedating anti-histamines

A

Chlorphenamine (tolerance to sedation)

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55
Q

What counselling is there for Azelastine

A

keep head upright

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56
Q

Give examples of steroid nasal spray used in allergic rhinitis

A

Beclometasone (beconase)

Fluticasone

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57
Q

Contraindications for steroid nasal spray

A

Glaucoma, Pregnancy, Under 18

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58
Q

Sodium Cromoglicate eye drops should not be used in

A

wearers of soft contact lenses

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59
Q

Give an example of a topical antihistamine used allergic rhinitis

A

Azelastine (Rhinolast) nasal spray

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60
Q

What counselling is there for Azelastine

A

keep head upright

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61
Q

Describe minor mouth ulcers

A
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62
Q

Describe major mouth ulcers

A

> 10mm

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63
Q

Management of mouth ulcers

A
  1. Chlorhexidine mouthwash
  2. Topical corticosteroids
  3. Local analgesic
  4. Local anaesthetic
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64
Q

Behcets syndrome recognised by

A

Involvement of other sites: vulva, vagina, eyes. With genital ulceration and iritis

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65
Q

Causes of Erythema multiforme

A

infection or drugs: sulphonamides/barbiturates

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66
Q

Mouth ulcers caused by

A

Asprin, NSAIDs, Cytotoxics, Sulphasazaline, radiotherapy, feverfew (herbal),
Iron/Folate/Zinc/Vitamin B12 deficiency

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67
Q

Refer mouth ulcers when

A

Mucous membrane involved, ADR, Illness Diarrhoea, Weight loss, One week of treatment failure, Rash, Three weeks not better

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68
Q

Symptoms associated with heartburn

A

Pain in back/arms, Dysphagia, Regurgitation

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69
Q

Counselling with Chlorhexidine gluconate mouth wash

A

side effect is teeth stain so brush teeth before but leave 10 minute gap before using mouthwash

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70
Q

Give examples of topical corticosteroids used in mouth ulcers

A

Hydrocortisone buccal tablets and Triamcinolone (kenocort) paste

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71
Q

Give examples of local analgesics used in mouth ulcers

A

Benzydamine mouthwash/spray

Choline Salicylate Dental Gel (Bonjela)

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72
Q

Give examples of local anaesthetics used in mouth ulcers

A

Lidocaine/Benzocaine (orajel)

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73
Q

Symptoms associated with heartburn

A

Pain in back/arms, Dysphagia, Regurgitation

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74
Q

Cause of heartburn

A

Too much fatty food, obesity, posture, clothing tight, pregnancy, smoking, caffeine, chocolate, alcohol

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75
Q

Which medicines can cause heartburn

A

Anticholinergics (eg TCA, CaCB)

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76
Q

Refer Heartburn if

A

Pain in arms, Severe heartburn, Children, One week not better or OTC failure, Regurgitation, Dysphagia

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77
Q

Name some alginates

A

sodium and potassium bicarbonate

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78
Q

Give names and duration of treatment of H2 antagonists

A

Famotidine (6 days)

Ranitidine (14 days)

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79
Q

Symptoms of IBS

A

Lower abdominal pain, increased frequency of poo, alternating constipation and diarrhoea
Rabbit/pencil like poo, mucous in stools, bloating, nausea, backache, lathargy

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80
Q

Name OTC Proton Pump Inhibitor and warning

A

Omeprazole 10mg od increase to 20mg if symptoms return

Don’t take with H2. Avoid in pregnancy. Can give false negative helicobacter breath test.

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81
Q

Refer Heartburn if

A

Pain in arms, Severe heartburn, Children, One week not better or OTC failure, Regurgitation, Dysphagia

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82
Q

Symptoms of gastric ulcer

A

Dull upper right hand side abdominal pain
Pointable
Even when stomach empty

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83
Q

Symptoms of gallstones

A

Pain in right rib margin or upper abdomen

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84
Q

Symptoms of IBS

A

Lower abdominal pain, alternating constipation and diarrhoea

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85
Q

Symptoms of atypical angina

A

mid chest pain

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86
Q

Antacids decrease the absorption of

A

Tetracyclines, Azithromycin, Itraconazole, Ketoconazole, Ciprofloxacin, Dipyridamole, Norfloxacin, Rifampacin, Zalcitabine, ACEI, Phenothiazines, Gabapentin, Phenytoin

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87
Q

Cause of indigestion

A

Excess food, alcohol, smoking

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88
Q

Drugs causative of indigestion

A

NSAID, Iron, Aspirin

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89
Q

When to refer indigestion

A

Blood, Recurring indigestion, Angina, Weight loss, ADR, Vomiting, IBS, Nausea, Gallstones, Children, Ulcer, Failed otc 5 days, First time >45yo

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90
Q

Management of indigestion

A
  1. Aluminium/Magnesium salts
  2. Sodium Bicarbonate
  3. Calcium Carbonate
  4. H2 antagonists
  5. Domperidone POM
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91
Q

Drugs which interact with antacids

A
  1. EC (so take 1hr before antacid)
  2. Antacids decrease absorption of: Tetracyclines, Azithromycin, Itraconazole, Ketoconazole, Ciprofloxacin, Dipyridamole, Norfloxacin, Rifampacin, Zalcitabine, ACEI, Phenothiazines, Gabapentin, Phenytoin
  3. Decrease in Iron absorption so take at different time
  4. Sodium Bicarbonate interacts with Lithium (decreased Li)
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92
Q

Milk alkali syndrome causes

A

Cause by Calcium Carbonate and Sodium Carbonate

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93
Q

Symptoms of milk alkali syndrome

A

Nausea, Vomiting, Anorexia, Headache, Confusion

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94
Q

Problems with milk alkali syndrome

A

Hypercalcaemia, Metabolic alkalosis, Renal insufficiency

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95
Q

Give 3 examples and details of Antihistamines for motion sickness

A
  1. Cinnarazine (>5)
  2. Promethazine (>5)
  3. Meclozine (>2yo)over 2yo. Take night before or 1 hr before, half life 24 hours. 25mg adult, 12.5mg in 2-12yo
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96
Q

Drugs causing Nausea and Vomiting

A

Aspirin, NSAIDS, Antibiotics (eg. doxycycline), Oestrogen, Steroids, Analgesics, Narcotics

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97
Q

Refer nausea and vomiting if

A

Smelly poo, History of chronic N&V, Elderly, Digoxin, 2 days or more, Under 2 years, Blood in vomit

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98
Q

Management of nausea and vomitting

A

Rehydration only

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99
Q

Dose and instructions for Promethazine

A

25mg in over 10
12.5 in 5 - 10 yo
Take night before or 1 hour before travel

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100
Q

Give 3 examples and details of Antihistamines

A
  1. Cinnarazine (>5)
  2. Promethazine (>5) Take night before or 1hr before, half life 24 hours. 25mg in over 10. 12.5mg in 5-10yo
  3. Meclozine: over 2yo. Take night before or 1 hr before, half life 24 hours. 25mg adult, 12.5mg in 2-12yo
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101
Q

Half life of cinnarazine

A

8 hours

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102
Q

Dose and instructions of cinnarazine

A

30mg adult, 15mg children. 2 hour before travel

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103
Q

Half life of Promethazine

A

24 hours

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104
Q

Dose and instructions for Promethazine

A

25mg in over 10
12.5 in 5 - 10 yo
Take night before or 1 hour before travel

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105
Q

Half life of Meclozine

A

24 hours

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106
Q

Dose and instructions of Meclozine

A

25mg adult
12.5mg in 2 - 12 yo
Take night before or 1 hour before travel

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107
Q

Anticholinergics contraindicated in

A

Prostatic hypertrophy, Glaucoma

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108
Q

Example of Anticholinergics for motion sickness

A

Hyoscine Hydrobromide (>3yo)

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109
Q

Dose and instructions for Hyoscine Hydrobromide

A

4-7 yo: 150micrograms
7-12 yo: 150-300micrograms
Adults: 300micrograms
Take 20min before travelling

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110
Q

Half life of Hyoscine Hydrobromide

A

6 hours

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111
Q

Side effects of Anticholinergics

A

Drowsiness, Blurred vision, Dry mouth, Constipation, Urinary retention

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112
Q

Drugs which cause constipation

A

Codeine, Aluminium, Hyoscine, Phenytoin, TCA, SSRI, Chlorphenamine, Promethazine, Clonidie, Methyldopa, Levodopa, Propanolol, Bendroflumethiazide, Chlorpromazine, MAOI

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113
Q

Symptoms of constipation

A

Abdominal discomfort, bloating, nausea, obstruction

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114
Q

Symptoms of piles

A

Discomfort while pooing, bleeding, constipation

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115
Q

Symptoms of anal fissure

A

Severe pain while pooing, less bleeding, constipation

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116
Q

Refer constipation when

A

Blood, One week otc failure, Bloating, Children, ADR, Pain severe, Two weeks of symptoms, Vomiting

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117
Q

Drugs which cause constipation

A

Codeine, Aluminium, Hyoscine, Phenytoin, TCA, SSRI, Chlorphenamine, Promethazine, Clonidie, Methyldopa, Levodopa, Propanolol, Bendroflumethiazide, Chlorpromazine, MAOI

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118
Q

Management of constipation

A
  1. Stimulant laxatives
  2. Bulk laxatives
  3. Osmotic laxatives
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119
Q

Give examples and counselling of stimulant laxatives

A

Bisacodyl EC - do not crush/chew
Docusate - works in 12 days
Can cause cramps/pain

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120
Q

Management of constipation in elderly

A

Bulk laxatives

Caution: Increase fluid otherwise obstruction

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121
Q

Give examples and counselling for osmotic laxatives

A 
Lactulose (2days for affect) can cause farting, cramps and discomfort
Epsom salts (2days for affect) overuse = dehydration
Glycerin suppositories (1hr for affect) can cause anal discomfort
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122
Q

Management of constipation in children

A

Increase fibre
Increase water
Then glycerin suppository

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123
Q

Management of constipation in pregnancy

A

Increase fibre
Increase water
Bulk laxatives

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124
Q

Stimulant laxatives contraindicated in

A

pregnancy

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125
Q

Management of constipation in elderly

A

Bulk laxatives

Caution: Increase fluid otherwise obstruction

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126
Q

When selling laxatives, watch out for

A

abuse for weight loss purpose

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127
Q

Symptoms of diarrhoea

A

Watery/rapid stool, cramp, flatulence, weakness, malaise, nausea, vomiting, fever

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128
Q

Cold, cough, vomiting and diarrhoea in babies could be

A

Rotavirus deactivating the stomach enzymes from digesting food

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129
Q

Name some bacteria causing diarrhoea

A 
Staphylococcus
Campylobacter (poultry)
Salmonella (eggs)
Shigella (bacillary dysentry)
Escherichia Coli (renal failure)
Bacillus Cereus
Listeria Monocytogenes (+flu leads to sepsis/meningitis)
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130
Q

Which antibiotic is effective against Shigella, Salmonella, Campylobacter?

A

Ciprofloxacin

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131
Q

Possible cause of chronic diarrhoea

A

IBS, Tumour, Inflammation (UC/Crohns)

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132
Q

General counselling with diarrhoea

A
  1. Increase water intake
  2. No milk
  3. Normal diet
  4. Children can continue milk and breast-feeding
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133
Q

Refer diarrhoea when

A

1 day - 1 year old
2 days - 2/3 year old
3 days - everyone else
Travel, Vomiting, Fever, ADR, Change in bowel habit, Blood/mucous in stool, pregnancy

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134
Q

Management of diarrhoea

A
  1. ORT
  2. Loperamide (>12)
  3. Diphenoxylate/Atropine (Co-phenotrope) (>12)
  4. Kaolin (rare)
  5. (not) Morphine because OTC conc not affective
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135
Q

What is the dose of ORT

A

Under 1: 50ml
1-5: 100ml
6-12: 200ml
Adult: 400ml

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136
Q

Management of IBS

A
  1. Antispasmodics
  2. Bulking agents
  3. Antidiarrhoeals (loperamide)
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137
Q

General counselling with diarrhoea

A
  1. Increase water intake
  2. No milk
  3. Normal diet
  4. Children can continue milk and breast-feeding
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138
Q

What to avoid in IBS

A

Caffeine, Milk, Chocolate, Onions, Garlic, Chives, Sorbitol, Fructose, Leeks

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139
Q

When to refer IBS

A

Children, Obstruction of bowel, Pregnancy, >45, Blood, Unexplained weight loss, First time, Failed medication

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140
Q

Non-drug management of IBS

A 
Relaxation techniques (may be a link to stress)
Increase fibre (oats)
Reduce sugar and fat
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141
Q

Peppermint Oil contraindicated in

A

Children, sufferers of heartburn

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142
Q

Antispasmodics contraindicated in

A

Paralytic ileus

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143
Q

Give examples and doses of antispasmodics

A

Alverine citrate 1-2 td with water
Peppermint Oil 2td, 15-30 min before food
Mebeverine 1td, 20 min before food

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144
Q

Counselling with Peppermint

A

Do not chew

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145
Q

Side effects of peppermint oil

A

rash, headache, tremor

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146
Q

Peppermint Oil contraindicated in

A

Children, sufferers of heartburn

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147
Q

Mebeverine contraindicated in

A
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148
Q

Counselling with Alverine citrate

A

Do not chew

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149
Q

Counselling with Peppermint

A

Do not chew

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150
Q

First degree haemorrhoids are

A

confined to the anal canal

can not be seen

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151
Q

Second degree haemorrhoids are

A

Prolapse while pooing

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152
Q

Third degree haemorrhoids are

A

persistently prolapsed

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153
Q

Symptoms of haemorrhoids

A

Pain, irritation, bleeding, constipation, change in bowel habit
Increased likelihood in pregnancy

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154
Q

Refer haemorrhoids when

A

3 weeks or more, ADR, Blood, Change in bowel habit, Pain, Vomiting, Warfarin (+blood)

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155
Q

Name astringents used in haemorrhoids

A

Zinc oxide
Witch hazel (hamamelis)
Bismuth salts

act by forming a layer

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156
Q

Name an antiseptic used in haemorrhoids

A

Resorcinol

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157
Q

Name skin protectants

A

Zinc

Kaolin

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158
Q

Name a counterirrittant used in haemorrhoids

A

Menthol

Phenol

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159
Q

Name steroids used for haemorrhoids and information

A

Hydrocortison (>18) for seven days use. Reduced inflammation = less pain and itching

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160
Q

Name astringents

A

Zinc oxide
Witch hazel (hamamelis)
Bismuth salts

act by forming a layer

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161
Q

Name an antiseptic used in haemorrhoids

A

Resorcinol

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162
Q

Cause of haemorrhoids

A

Diet, sedentary lifestyle, pregnancy, genetic, constipating drugs

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163
Q

Name a laxative used in haemorrhoids

A

Senna (stimulant) 1-2 days

Bulk laxative if patient can not adjust diet

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164
Q

Counselling in haemorrhoids

A

Increase hygiene and washing/bathing

Try not to itch

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165
Q

Counselling with suppositories/ointment/cream used in haemorrhoids

A

Use morning, night and at bowel movement

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166
Q

Cause of haemorrhoids

A

Diet, sedentary lifestyle, pregnancy, genetic, constipating drugs

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167
Q

Distribution of eczema in babies

A

Nappy, Neck, back of scalp, face, creases of limb

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168
Q

Distribution of eczema in white kids

A

Back of knee, inside elbow, wrist, hands, neck, ankles, around eyes

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169
Q

Distribution of eczema in black/Asian kids

A

Extensor surfaces and follicular appearance

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170
Q

Distribution of eczema in adults

A

Neck, groin, back of hands, anus, ankles

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171
Q

Management of Eczema

A
  1. Emollients
  2. Topical corticosteroids
  3. Antipruritics
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172
Q

Aggravating factors of eczema

A

Hayfever, dust, soap, stress, milk, food colouring, wool, antiseptic detergents

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173
Q

Associated conditions to eczema

A

Asthma
Hayfever
Family History

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174
Q

OTC hydrocortisone is contraindicated when

A

skin is infected (eg athelete’s foot, cold sore, acne)

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175
Q

Give examples of antipruritics

A

Calamine, Crotamiton (Eurax), Crotamiton+Hydrocortisone (Eurax HC)

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176
Q

Management of Eczema

A
  1. Emollients
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177
Q

Counselling for emollients used for eczema

A

Use as soap and moisturiser

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178
Q

Which topical corticosteroids can be used for eczema

A

Hydrocortisone (>10) for seven days

Clobetasone 0.05% (>12) for atopic eczema, primary irritant or allergic dermatitis and exclude seborrhoeic dermatitis

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179
Q

OTC hydrocortisone is contraindicated when

A

skin is infected (eg athelete’s foot, cold sore, acne)

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180
Q

Symptoms of Rosacea

A

Red, papules, pustules only on face

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181
Q

Drugs causing Acne

A

Lithium, Phenytoin, Progestogens, Levonogestrel, Norethisterone as COCs

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182
Q

Refer Acne when

A

Severe, ADR, Failure treatment after Eight weeks,

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183
Q

Acne often occurs in

A

Teenage years, Pregnancy

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184
Q

Which antibiotics are used for Acne

A 
Tetracycline: monocycline (Sumycin)
Topical erythromycin (akne-mycin)
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185
Q

Symptoms of Rosacea

A

Red, papules, pustules only on face

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186
Q

Counselling in Acne

A

No link to diet, hygiene, sunlight

Make up aggravates acne so used water based

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187
Q

What is contraindicated in Acne

A

Hydrocortisone

188
Q

Management of Acne

A
  1. Benzyl Peroxide (Aquagel, Panoxyl, Duac Quinoderm, Acnecide)
  2. Potassium hydroxyquinoline sulphate (Quinoderm) and salicylic acid (Occlusal)
  3. Nicotinamide (Freederm)
  4. Antibacterials (chlorhexidine: Quinoderm/Hibiclens wash)
  5. Antiobiotics
189
Q

Which antibiotics are used for Acne

A 
Tetracycline: monocycline (Sumycin)
Topical erythromycin (akne-mycin)
190
Q

What are the side effects of Benzyl Peroxide

A

red or sore skin

bleaching of clothes

191
Q

Ringworm of the scalp’s medical name is

A

tinea capitis

192
Q

Counselling for athlete’s foot

A

Wear leather or open shoes, cotton socks

Dry foot after washing

193
Q

What is the medical name for athlete’s foot

A

tinea pedis

194
Q

Dhobie itch/Jock itch medical name is

A

tinea cruris

195
Q

Ringworm of the body’s medical name is

A

tinea corporis

196
Q

Ringworm of the scalp’s medical name is

A

tinea capitis

197
Q

Treat fungal name with

A

Amorolfine 5% for 6 - 12 months

198
Q

Amorolfine is contraindicated in

A

Pregnancy

Breast feeding

199
Q

Treat ringworm infection with

A

Miconazole

200
Q

Refer athlete’s foot when

A

Severe, Toenails involved, Unresponsive two weeks, Pus/weeping, Infected, Diabetes

201
Q

Management of Athlete’s foot

A
  1. Azoles
  2. Terbinafine (Lamisil)
  3. Tolnaftate (mycil)
  4. Undecenoates
  5. NOT hydrocortisone unless intertrigo associated
202
Q

Which azoles can be used in athlete’s foot

A

Clotrimazole, Ketoconazole, Miconazole

203
Q

Symptoms of cold sore

A

Pain
Blister with inflamed red raised skin
Recurs in same place

204
Q

Side effect of terbinafine

A

Itch

Redness

205
Q

Warning with terbinafine

A

Avoid eyes

206
Q

Side effect of Tolnaftate

207
Q

Causative factors of cold sores

A

Sun, wind, stress, fever, menstruation

208
Q

Symptoms of cold sore

A

Pain
Blister with inflamed red raised skin
Recurs in same place

209
Q

Refer cold sore when

A

Frequent, Atopic eczema, Children, Eyes affected, Uncertain diagnosis, Painless sore, Severe, Worsening, Immunocompromised patient, Failed treatment, Two weeks or longer

210
Q

Counselling with cold sore

A 
Wash hands after application
Eye make up is a risk
Contagious so no sharing, no oral sex
Try to avoid if you have eczema
Sunscreen preventative
211
Q

Management of Warts/Verrucaue

A
  1. Salicylic Acid/Lactyic Acid gels/ointments/plasters
  2. Cryotherapy (>4) 10 days
  3. Duct tape for 5mins, 6 days, 8 weeks
  4. Formaldehyde gel bd for verrucae
  5. Glutaraldehyde 5%/10%
212
Q

Dose of Aciclovir/Penciclovir

A

Aciclovir: Every 4 hours, 5 times a day for 5 days
Penciclovir: Every 2 hours, 8 times a day for 4 days

213
Q

Refer if pigmented lesion

A 
increased in size
has irregular outline,
changes colour (especially to black)
itches or bleeds
has satellite lesions
214
Q

Describe a non-pigmented basal cell carcinoma

A

circular, raised, rolled edge, no healing, enlarges and crust fall off, not a lesion, elderly

215
Q

Refer warts/verrucae if

A

3 months no change, risk of cancer, chance in size/colour, bleed, itch, on genital/face, immunocompromised patients, multiple warts, diabetes

216
Q

Management of Warts/Verrucaue

A
  1. Salicylic Acid/Lactyic Acid gels/ointments/plasters
  2. Cryotherapy (>4) 10 days
  3. Duct tape for 5mins, 6 days, 8 weeks
  4. Formaldehyde gel bd for verrucae
  5. Glutaraldehyde 5%/10%
217
Q

Counselling with Salicylic Acid/Lactyic Acid

A

Avoid eyes

Use applicator

218
Q

Cryotherapy is contraindicated in

A

Diabetes

Pregnancy

219
Q

Glutaraldehyde side effect

A

Stains skin brown

220
Q

Symptoms of scabies

A

5-10mm grey threadlines
Inbetween fingers/toes/wrist/armpit/inner thigh/ass/balls
Itching at night

221
Q

Where does scabies occur mainly in babies and elderly?

A

Head and postauricular folds

222
Q

How does scabies look in immunocompromised and debilitated patients?

A

Skin becomes thick and crusted

223
Q

What should you look out for in scabies

A

Weeping yellow crusts/discharge shows secondary infection (impetigo)

224
Q

Refer scabies when

A

Failure treatment, Unclear disagnosis, Infected skin, Children, Yellow discharge/crust

225
Q

Management of scabies

A

Permethrin [Lyclear] (>2)

Malathion [Derbac] (>6)

226
Q

What is the dose of Permethrin in scabies

A

30-60g needed

Leave on for 8-12hours

227
Q

Who requires supervision with Permethrin use

228
Q

What are the side effects of Permethrin

A

Itching

Reddening of skin

229
Q

What is the dose of Malathion in scabies

A

100ml

Leave on for 24hours

230
Q

What is the counselling with Malathion in scabies

A

Apply with paintbrush/cotton wool on cool dry skin

If wash hands - reapply

231
Q

What are the side effects of Malathion

A

Skin irritation

232
Q

Who requires supervision with Malathion use

233
Q

Patient presents complaining of itching after use of scabies treatment

A

First few days it can be worse

Manage with Crotamiton cream or Promethazine tabs

234
Q

What non-medical counselling should be given in scabies after application

A

Wash bedding and all cloths at 80degrees

Get the whole family treated

235
Q

What can aggravate dandruff

A

Hair dye
Perms
Chlorquine causes psoriasis

236
Q

When should you refer dandruff

A

Psoriasis suspected, Unresponsive to treatment, Sore Scalp, Infection signs

237
Q

How is dandruff managed

A
  1. Ketoconazole 2% (Nizoral)
  2. Zinc Pyrithione (Denorex/Dermazinc)
  3. Selenium Sulphide 2.5% (SelSun)
  4. Coal Tar (T-Gel)
238
Q

Dose of Ketoconazole in dandruff

A

Use twice weekly for 2-4 weeks

239
Q

Dose of Zinc Pyrithione in dandruff

A

Use twice weekly for two weeks then once weekly thereafter

240
Q

Dose of Selenium Sulfide in dandruff

A

Use twice weekly for two weeks then once weekly for one week then as required

241
Q

Side effects of Selenium Sulfide

A

Discolouration of blonde, grey and dyed hair (therefore wash thoroughly)

242
Q

Counselling with dandruff treatment

A 
Continue treatment
Use of scalp not hair
Leave on for 5 mins
Use normal shampoo 3 times a week
Gel, mousse, hairspray is ok
243
Q

Possible causes of hair loss

A

Hypothyroidism
Pregnancy
Renal failure
Ringworm (tine capitis)

244
Q

Which medicines cause hair loss

A

Vitamin A (in overdose), Allopurinol, BB, Bromocriptine, Colchine, Coumarins, Clofibrate, Cytotoxics, Lithium, Sodium Valproate

245
Q

When to refer hair loss

A

Hypothyroidism suspected, Alopecia, ADR, Anaemia, Menstrual disorder

246
Q

What are the characteristics of hypothyroidism

A

Feeling tired, run down, weigtht gain, deepening of voice

247
Q

Management of hair loss

A

Minoxidil (Regaine)

248
Q

What is the mechanism of action of Minoxidil

249
Q

Counselling with Minoxidil

A

More likely to work if baldness is 10cm
Earlier use is better
Works better with thinning/loss at scalp top in men and generalised thinning in women
Reassure compliance is needed

250
Q

Minoxidil is contraindicated in

A

Pregnancy and Breast feeding

251
Q

Side effects of Minoxidil

A

Palpitation, Hypotension, Irritation, Tachycardia

252
Q

Dose of Minoxidil

A

Use twice daily on clean dry scalp. Do not wash for one hour.

253
Q

Symptoms of Psoriasis

A

Raised red scaly patch

Plaque at elbows/knee/lower back/sole/scalp

254
Q

Which medicines can cause Psoriasis

A

BB, Lithium, Antimalarials, NSAIDs

255
Q

Psoriasis should be referred when

A

there is an exacerbation

256
Q

Treatment of Psoriasis is caution in who and why

A

In pregnancy because some emollients are teratogenic

257
Q

Management of Psoriasis

A
  1. Calcipotriol (Dovonex) or Tacalcitol (curatoderm)
  2. Topical steroids: Betamethasone + Calciptriol (Dovobet)
  3. Dithranol (Micanol)
258
Q

What is second line management of Psoriasis

A

Phototherapy, Methotrexate, Etretinate, Ciclosporin

259
Q

Calcipotriol/Tacalcitol overuse can lead to

A

Hypercalcaemia

260
Q

How do you use with Betamethasone + Calciptriol in Psoriasis

A

Use in flexures (folds of skin) not the body, only up to 30% of the body for 4 weeks

261
Q

How do you use Dithranol

A

Leave on for 30 minutes then remove using emollient

262
Q

Counselling with Dithranol

A

Do not use on face, genitalia, flexures.

Wash hands after use

263
Q

Side effects of Betamethasone + Calciptriol

A

Adrenocortical suppresion, Skin atrophy, Striae (Stretch marks)

264
Q

Counselling with Betamethasone + Calciptriol

A

Stopping use can cause flare up of Psoriasis

265
Q

What is a tension headache

A

Dull pain at base of skull going up to upper neck
Feels like a band around head
No neck stiffness

266
Q

What is a classic migraine

A

with Aura. Visual alteration/flashing lights

Prodromal phase lasts 1 hour

267
Q

Characteristic signs of Prodromal phase of classic migraine

A

Tingling/numbness on one side of body/lips/fingers/face/hand

Nausea and Vomiting

268
Q

What is a common migraine

A 
No aura. Pulsating/Throbbing on one or both sides of head.
Photophobia.
Nausea and Vomiting.
Pain on movement
Lasts 72 hours
269
Q

What is a chronic daily headache

A

Present on more than 15 days a month over 6 months

Stiff neck

270
Q

What is a cluster headache

A

Half hour to 3 hours Headaches one after the other daily for 2-3months.
One side of head, in eye/cheek/temple.
Painful, watery eye and blocked/watery nostrol on same side

271
Q

What is Sinusitis

A

Build up of mucous with no drainage.
Causes pain behind and around eye.
Rhinnorhoea/congestion
Worse on bending or lying down

272
Q

What is temporal arteritis

A

Arteries in temple inflamed and appear red, are thick and painful

273
Q

Chronic daily headache may be caused by

A

ADR with codeine

274
Q

Temporal arteritis can lead to

275
Q

What can cause a headache

A

Stress, Chocolate, Cheese, Menstrual cycle, Eyes (need test), Work

276
Q

Which medicines can cause headaches

A

Nitrates in angina drugs, Codeine, overuse of meds, interaction of MAOI with tyramine

277
Q

Refer headaches when

A

Back of head, Unsteadiness, Breast feeding, Failure meds otc, Lying down worse, ADR, COCS (cerbravascular problems), CVD history, Injury, Drowsy, Severe, Children(65), Neck stiff, Eye disturbances, Mornings worse, Vomiting, Pregnant,

278
Q

Management of Migraine

A
  1. Paracetamol
  2. Ibuprofen
  3. Aspirin
  4. Codeine
  5. Doxylamine succinate
  6. Sumatriptan
  7. Cup of tea/coffee
  8. Buclizine
279
Q

Problems with paracetamol

A

at high dose can cause liver toxicity

280
Q

Dose of Ibupforen

A

200-400mg, 1200mg max OTC (analgesic).
After food.
Suspension

281
Q

Side effects of NSAIDs

A

Stomach irritation, idigestion, nausea, diarrhoea, gastric bleeding

282
Q

Cautions for NSAIDs

A

Asthma, Elderly

283
Q

NSAIDs contraindicated in

A

Peptic ulcer, Sensitivity to Aspirin, Congestive heart failure, renal impairment, pregnancy (especially third tri)

284
Q

NSAIDs interact with

A

Lithium (reduced Li clearance, increase in Lithium leading to Lithium toxicity)

285
Q

Symptoms of Lithium toxicity

A

GI symptoms, Polyuria (lots of pee), muscle weakness, lethargy, tremor

286
Q

Dose of Aspirin for analgesia

A

300-900mg every 4-6 hours, 4g max

287
Q

Side effects of Aspirin

A

GI irritation, GI bleeding, Ulceration, hypersensitivity

288
Q

Aspirin contraindicated in

A

Pregnancy,

289
Q

Aspirin interacts with

A

Alcohol, anticoagulants, SSRI, Venlafaxine, Methotrexate

290
Q

Dose of codeine for migraine

A

15mg with Aspirin/Paracetamol OTC

291
Q

Side effects of codeine

A

Constipation, Drowsiness, Respiratory Depression (unlikely OTC), headache (with overuse)

292
Q

Max number of OTC codeine/dihydrocodeine

A

32 unit dose including effervescent

293
Q

Doxylamine contraindicated in

294
Q

Sumatriptan max OT sale

A

2 tabs 50mg

295
Q

Age range for Sumatriptan

296
Q

Dose of Sumatriptan

A

50mg when headache starts. Second tablet 2hours after the first IF symptoms come back and IF response to first dose

297
Q

When selling OTC Sumatriptan refer

A

65, >50 first attack, first migraine in 12 months, 4 attacks a month, >24hour length of migraine, no response to Sumatriptan, >10days migraine a month, COC, Patients no recovery between attacks, Pregnant, BF, CVD risk

298
Q

Sumatriptan cautioned in

A

> 3 CVD risk factors

299
Q

What are CVD risks

A

> 40 man, Post-menopause women, hypercholesrerolaiemia, smoking >10, BMI >30, diabetes, FH angina/heart attack (father/brother MI/angina

300
Q

Sumatriptan contraindications

A

Prophylactic use, Hypertension, History MI, IHD, Angina, Arrythmias, Hepatic impairment, Renal impairment, epilepsy

301
Q

Side effects of Sumatriptan

A

nausea, vomiting, tingling, dizziness, drowsiness, flushing, warm sensation, weakness, fatigue, heaviness feeling, pain/pressure in any part of body

302
Q

Sumatriptan interacts with

A

MAOI, SJW, SSRI

303
Q

Side effects of Feverfew

A

Bitter taste, Skin rash, Heartburn, mouth ulcer, colic

304
Q

Feverfew contraindicated in

305
Q

Order of treating soft tissue injuries

A

Rest, Ice, Compression, Elevation

306
Q

When to refer musculoskeletal problems

A

Head injury, Arthiritis, Bruising unexplained, ADR, Back pain, Elderly, Bladder/Anal/Genital alteration, Fracture, Failure otc, Fibromyalgia, Frozen shoulder

307
Q

Management of musculoskeletal

A
  1. Topical analgesic
  2. Counterirritants/Rubefacients
  3. Topical anti-inflammatory/antifungals
  4. Heparinoid/Hyaluronidase
  5. Glucosamine/Chondroitin (poor evidence)
  6. Acupuncture
308
Q

Name some counterirritants and rubefacients

A

Methyl salicylate + Menthol (eg. Deep heat) + Capsicum/Capsaicin (eg. Radian B)
Nicotinates

309
Q

What counselling is given with Capsaicin

A

Wash hands

310
Q

Name a side effect of Nicotinates

A

dizziness/fainting

311
Q

Side effects of glucosamine

A

abdodiscomfort, tenderness, heartburn, diarrhoea, nausea

312
Q

Causes of back pain

A

posture, mattress, overweight, lifting things wrong

313
Q

When to apply heat in musculoskeletal pain

A

after 1-2 days

314
Q

Which bacteria cause Cystitis

A

Escherichia Coli
Staphylococcus saprophyticus
Proteus Mirabilis

315
Q

What are the symptoms of Cystitis

A 
Ithcing sensation
Frequency & urge urination increases,
Dysuria (pain on urination),
Bladder feels full but only drops come,
Urine clody/smelly
316
Q

What are the symptoms of Chlamydia in women

A

Symptoms of Cysitisis, vaginal discharge change, lower abdominal pain

317
Q

Management of Chlamydia

A

Azithromycin

318
Q

Symptoms of upper UTI in women

A

Fever, nausea, vomiting, loin pain, tenderness

319
Q

Possible causes of Cystitis

A

Diabetes, Honeymoon cystitis, toiletries (vaginal deodrant/bubble bath, chemicals (spermicides, disinfectant)

320
Q

Patient complains of itching, urination urge/frequency increase, dysuria, urine cloudy/smelly, thirst and weight loss

A

Diabetic with Cystitis - refer

321
Q

Drugs which can cause Cystitis

A

Cytotoxics: cyclophosphamide and methenamine hippurate (hexamine)
Possible the pill

322
Q

How do contraceptive pills link cause Cystitis

A

They don’t. Women on pill more likely to have more sex causing more chance Cystitis

323
Q

When to refer Cystitis

A

Children, Recurrent, ADR, Blood, Suprapubic pain, Fever, OTC failure, Loin pain or tenderness, Discharge changed, Diabetic symptoms, Upper UTI symptoms, Men, Pregnancy

324
Q

Management of Cystitis

A
  1. Ibuprofen or Paracetamol (2/7)
  2. Potassium and Sodium Citrate (2/7)
  3. Cranberry Juice
  4. Trimethoprim and Nitrofurantoin
325
Q

Potassium and Sodium Citrate mechanism of action in Cystitis

A

Alkalise urine as acidic causes dysuria

326
Q

Potassium Citrate contraindications

A

Potassium sparing diuretics, aldosterone antagonists, angiotensin-converting enzyme inhibitors
(In which hyperkalaemia can result)

327
Q

Potassium Citrate counselling

A

Unpleasant taste so dilute in cold water

DO NOT EXCEED STATED DOSE

328
Q

Sodium Citrate contraindications

A

Hypertension, Heart disease, Pregnancy

329
Q

How can cranberry juice help in Cystitis

A

In recurrent Cystitis 300ml a day has bacteriostatic effect

330
Q

Other counselling in Cystitis

A

After poo wipe tissue front back
Lean back when peeing & wait 20seconds
Drinking lots water helps in recurrent not acute Cystitis

331
Q

What is primary dysmenorrhoea

A

Lower abdominal cramping before bleeding starts
Eases at beginning period
Gone by end first day of period

332
Q

What is Mittelschmerz

A

Midcycle ovulation pain
Hours - days
Can have bleeding

333
Q

What is secondary dysmenorrhoea

A 
Pain other times of cycle ~ 1 wk before period
Relief or worsen beginning period
Dull aching pain
Pain during sex
More common in older women/had children
334
Q

What is endometriosis

A

35 - 45 yo
1 week before period or non-cyclical
Lower abdominal/back pain
Pain during sex

335
Q

What is Pelvic Inflammatory Disease

A

Severe lower abdominal pain, fever, vaginal discharge, not related to period

336
Q

What can cause Pelvic inflammatory disease

A

Intrauterine contraceptive device (coil)

337
Q

Dysmennorhoea associated symptoms

A

Nausea, vomiting, general GI discomfort, constipation, headache, backache, fatigue, feeling dizzy/faint

338
Q

What is Premenstrual Syndrome (PMS)

A

Bloated, increased weight, ankle/finger swelling, headache, breast tenderness all 2-14 days before period
Irritability, tension, depression, tiredness, difficulty concentrating
Better when period starts

339
Q

Management of PMS

A

Pyridoxine (Vitamin B6), Evening Primrose (breast tenderness)

340
Q

Management of Dysmenorrhoea

A
  1. NSAIDS: Ibuprofen, Naproxen
  2. Aspirin
  3. Paracetamol
  4. Hyoscine
  5. Caffeine
  6. TENS
  7. Acupuncture
341
Q

What does of Naproxen 250mg can be used in dysmenorrhoea

A

2 tabs initially the 1 every 6-8 hours pr. Max 3 tabs/day for maximum of 3 days

342
Q

When is Naproxen suitable for treatment of Dysmenorrhoea

A

In primary dysmenorrhoea 15-50year old

343
Q

When safe to take Aspirin but best avoided in dysmennorrhoea

A

Nausea and Vomiting

344
Q

Counselling with Aspirin & NSAIDs

A

After food, confirm no history GI problems, confirm no Aspirin sensitivity, confirm age/pregnancy

345
Q

Mechanism action of Aspirin & NSAIDs in Dysmenorrhoea

A

Inhibit prostaglandins

346
Q

Hyoscine contraindicated in

A

Closed-Angle Glaucoma, patient on other anticholinergics (eg TCA)

347
Q

When to refer Dysmenorrhoea

A

Abnormal discharge, Secondary dysmenorrhoea, Abnormal bleeding, PMS, Contraceptives, Late period pain, Intermittent pain (mittelschmerz), Failure otc, Fever

348
Q

Symptoms of Vaginal Thrush

A

Itching, Burning, Smelly cream curdy thick discharge, Pain on urination, pain on sex, partner rash on penis

349
Q

Cause of Vaginal Thrush

A

Toileteries, deodrants, douches, over-clearning

350
Q

Medicines that can cause Vaginal Thrush

A

Contraceptive pill, Antibiotics, Anaesthetics

351
Q

Refer Vaginal Thrush when

A

60, Dysuria, ADR, Discharge abnormal, Pregnancy, Abnormal bleed, Pain, First time, Ulcers, Sores, Blisters, OTC hypersensitivity (to imidazoles), Two attacks in 6 months, STD, seven days no improve

352
Q

Management of Vaginal Thrush

A
  1. Combination of the following
  2. Oral azole
  3. Pessary
  4. Topical (Clotrimazole/Miconazole)
353
Q

Dose of Azole cream used in Vaginal Thrush

A

Apply morning and evening

354
Q

Side effects of Azole creams in Vaginal Thrush

A

Burning on initial application

355
Q

Oral Fluconazole interacts with

A

Anticoagulants, oral sulphonylureas, ciclosporin, phenytoin, rifampacin, theophylline
Unlikely with single dose

356
Q

Side effects of Fluconazole

A

Nausea, Abdodiscomfort, farting, diarrhoea

357
Q

Fluconazole contraindicated in

A

Pregnancy

Breast feeding

358
Q

Management of Penile Thrush (rash on penis)

A
  1. Cream bd 6/7 under foreskin

2. Oral fluconazole

359
Q

Live Yoghurt is safe to use in Vaginal Thrush? T/F

A

True. However evidence lacking

360
Q

EHC recommended when

A
  1. COCS: >3 inactive, >2 active, >1 first week
  2. POP: >3hours. (Cerazette >12hours)
  3. Progestogen injectable: >14wk medroxyprogesterone and >10wk norethisterone
  4. Barrier failure
  5. UPSI
361
Q

Refer request of EHC when patient taking these meds

A 
Anticonvulsants (Carbamazepine, Phenytoin, Primidone, Phenobarbital)
Rifampacin
Griseofulvin
Ritonavir
SJW
362
Q

Refer EHC when

A

Possibly prergnant, Interacting meds, Future use, 72hours UPSI

363
Q

Drug in EHC is

A

Levonorgestrel 1.5mg

364
Q

Side effects of Levonorgestrel

A

Nausea, vomiting

365
Q

Levonorgestrel contraindication

A

Pregnancy, hepatic dysfunction, crohns

366
Q

Counselling with Levonorgestrel

A

Take ASAP = effectiveness decreases with time
Sickness common, if sick in 3h -> retake
Period disruption. Pregnancy/STD still possible
Missed COC - 7 days unprotected

367
Q

Pregnant lady wants Antacid - check what?

A

Sodium content

368
Q

Morning sickness management

A

with ginger

369
Q

Itching in pregnancy could be

A

obstetric cholestasis

370
Q

Symptoms of infective bacterial conjunctivitis

A

Pain, gritty, discharge which is sticky and purulent

371
Q

Management of bacterial conjunctivitis

A
  1. Chloramphenicol 0.5% eye drops every 2 hours for 24 hours then qd
  2. OTC: Chloramphenicol eye ointment 1%(>2)
372
Q

Counselling with conjunctivitis

A

Avoid contact lenses for 24 hours

Don’t share pillow/towel

373
Q

Symptoms of infective viral conjunctivitis

A

Pain, gritty and watery discharge

374
Q

Symptoms of allergic conjunctivitis

A

Irritation, discomfort and watery discharge

375
Q

Management of allergic conjunctivitis

A

Sodium Cromoglicate eye drops used before symptoms if possible
Decongestants
Antihistamine drops

376
Q

Symptoms of Corneal Ulcers

A

Pain from abrasion (possibly contact lenses)

377
Q

Iritis/Uveitis symptoms

A

Pain inside eye, eye is red, pupil small, no discharge

378
Q

Symptoms of Acute Closed-Angle Glaucoma

A

Severe pain in and around the eye, associated vomiting, impaired vision, halo around lights

379
Q

Symoptoms of Keratitis

A

Unilateral acutely painful red eye, photophobia,

380
Q

Blepharitis symptoms

A

Irritation, discomfort, watery discharge like allergic conjunctivitis but less itching, crusty matter between lashes

381
Q

Management of Blepharitis

A

Remove crusty matter from lashes uses cotton wool bud

382
Q

Refer eye problems when

A

Photophobia, lots of redness, vision affected

suspected: corneal ulcers, keratitis, Iritis, Glaucoma

383
Q

Management of Wax build up

A
  1. Olive oil (room temp, 1hour overnight)
  2. Sodium Bicarbonate drops (bd for 3-5days)
  3. Urea Hydrogen Peroxide [Otex] (5drops, bd, 4/7)
  4. Syringing
384
Q

Symptoms of Otitis Externa

A

Pain, discharge, also: itch, hearing loss,

385
Q

Symptoms of Otitis Media

A

Pain, deafness, eardrum perforates (discharge and pain goes down)

386
Q

Counselling in ear infections

A

Avoid soap/shampoo getting into ear canal, avoid cotton buds/towel corner/fingers

387
Q

Ear infections caused by which organism

A

Pseudomonas, Staphylococcal, Aspergillus

388
Q

Refer ear problems when

A

Infection suspected

389
Q

Symptoms of Chicken Pox

A

Small red lumps -> blisters -> crusts

On trunk and face (possibly mouth)

390
Q

Symptoms of Measles

A

First 2 days only a Cold, Cough, Conjunctivitis, Fever
After that: Koplik spots (small white) on inner cheek and gums
After that: Measles rash (small red patches) behind ears, face, trunk
Spots blanch on pressure

391
Q

Symptoms of Roseola Infantum

A

In v young children. Symptoms similar to Measles but on chest and abdomen

392
Q

Symptoms of Erythema Infectiosum (Fifth Disease)

A

Fever, headache, rash starting on face - slapped cheeks - spreading to trunk and limbs
Spots blanch on pressure

393
Q

Risks associated with Fifth disease

A

Risk in Preganacy of miscarriage and baby having anaemia

394
Q

Symptoms of German Measles (Rubella)

A

Initially catarrh & back of neck glands enlarge
Rash (fine red spots) starts on face then trunk and limbs
Spots blanch on pressure

395
Q

Symptoms of Meningitis

A

High temp, cold hands/feet, vomiting/diarrhoea, neck stiffness, joint pain, drowsiness, dislike of lights, confusion, fits, sometimes rash

396
Q

Symptoms of Meningitis in babies

A

High temp, cold hands/feet, vomiting/refuse feed, high pitch cry/whimpering, blank expression, blotchy pale complexion, floppy, lethargic, difficult to awake, head soft spot (Fontanelle) tense/bulging, sometimes rash

397
Q

Causative organism for Meningitis

A

Meningococcus, Haemophilus, Pneumococcus

398
Q

Refer childhood rash when

A

Meningitis suspected, flu symptoms, vomiting, headache, neck stiff, rash, no blanching on pressure, breathing difficulty, earache, severe cough

399
Q

Risk associated with Rubella (German measles)

A

Pregnancy - risk to foetus

400
Q

Management of Chicken Pox

A

Cut childs nails

  1. Crotamiton (Eurax)
  2. Calamine lotion
  3. Chlorphenamine
  4. Analgesics
401
Q

Symptoms of Colic

A

Late afternoon/evening crying, baby can not be comforted, red in face and draws up knees, passing wind, difficulty pooing

402
Q

Management of Colic

A

Simeticone (Infacol) for 1 week
BF babies mother exclude cows milk
Hypoallergenic formula (Nutramigen)

403
Q

Management of teething babies

A

Paracetamol, teething gel

404
Q

Things which cause Nappy rash

A

Urine, Poo, Soaps, Wetness, after diarrhoea, after Antibiotics,

405
Q

Baby with nappy rash also has rash on head

A

Seborrhoeic dermatitis

406
Q

Baby with nappy rash also has rash on other body areas

407
Q

Baby with nappy rash also has satellite papules (small red lesions)

A

Secondary fungal infection - refer for azole topical therapy

408
Q

Baby with nappy rash also has sore mouth/throat

A

Oral thrush - refer to doctor

409
Q

Baby with nappy rash which is weeping/yellow

A

Bacerial infection - refer for Antibiotics

410
Q

Management of nappy rash

A
  1. Emollients [Bepanthen] (zinc/lanolin/oils)
  2. Antibacterials [Savlon] (Chlorhexadine gluconate)
  3. Antifungals (azoles)
  4. Hydrocortisone cream/ointment
411
Q

Counselling with nappy rash

A

Let baby air on towel, change as early as possible, avoid waterproof pants, dry bum after cleaning, use emollient/cream

412
Q

Refer nappy rash if

A

Broken skin, severe, infected, other areas involved, 2 weeks no resolve, failure otc

413
Q

Symptoms of headlice

A

Visible on white paper/tissue after wet combing near nape/ears
Sometimes itch

414
Q

Management of headlice

A
  1. Dimeticone (Hedrin)
  2. Insecticide
  3. Isopropyl myristate & cyclomethicone solution (Full Marks)
  4. Coconut, anise and ylang ylang (CAY) spray
  5. Bug busting
415
Q

Give examples of insecticides used for headlice

A

Malathion (Derbac),
Permethrin (Lyclear),
Phenothrin

416
Q

Are tea tree oil and aromatherapy effective against head lice?

A

No evidence

417
Q

How does Dimeticone work

A

Coats lice and prevents them excreting water

418
Q

What is the dose of Dimeticone for head lice

A

Apply to dry hair and scalp
Leave 8hours then rinse
Apply again after 7 days and again if wet combing shows lice

419
Q

Isopropl myristate/cyclomethicone solution work by

A

having a physical effect on lice

420
Q

Dose of lotions used for head lice

A

Apply to dry hair/scalp
Leave on for 12 hours
rinse off
Repeat after 7 days

421
Q

Side effects of Dimeticone

A

Itching, flaky scalp, irritation

422
Q

Shampoos are better than Lotions for head lice. T/F

A

False. Lotions have a longer contact time. Shampoo/cream rinses/mousses not recommended

423
Q

Counselling for head lice

A

Treat whole family 50-100ml per person
Nits (empty shells) remain after treatment
Hair dryer inactivates lotion

424
Q

Considerations for alcohol based lotions

A

Keep away from flames
Stinging at broken skin or eczema
Avoid in asthmatics

425
Q

Symptoms of threadworms

A

Itching bottom at night
Seen in poo
Sometimes diarrhoea

426
Q

Parent asks about child who is scratching his bottom, what is causing this?

A

Could be either threadworms, allergic/irritant dermatitis (from soaps etc), scabies, fungal infection

427
Q

Refer Threadworms when

A

Infection, Weeping, Epilepsy, Broken skin, Failure otc, Abroad travel, Pregnant

428
Q

Management on threadworms

A
  1. Mebendazole (ovex/vermox)

2. Piperazine (pripsen)

429
Q

Mebendazole contraindicated

430
Q

Piperazine contraindicated

A

Pregnancy

Epilepsy

431
Q

Mebendazole is active against

A

Whipworm, roundworm, hookworm

432
Q

Piperazine is active against

A

threadworm, roundworm

433
Q

Side effect of Mebendazole

A

Diarrhoea (rarely)

434
Q

Mode of action of Piperazine

A

Paralysis of threadworm in gut

435
Q

Piperazine should be prescribed with

A

Senna. To ensure paralysed worms expelled

436
Q

Side effects of Piperazine

A

Nausea, vomiting, diarrhoea, colic, headaches, dizziness

437
Q

Mebendazole and Piperazine should be repeated when

A

Mebendazole after 7 days

Piperazine after 2 weeks

438
Q

Medicines which can cause oral thrush

A

Antibiotics, steroids

439
Q

Symptoms of oral thrush

A

White plaques tongue/innter cheek. Scrape - red/bleed

440
Q

Managament of oral thrush

A

Antifungal: Miconazole gel (Daktarin oral gel). After food.

>6years old: qd, Children: bd. 2/7

441
Q

Miconazole contraindicated in

A

Patients taking anticoagulants (increases bleeding time)

442
Q

Baby with nappy rash and oral thrush

A

Both areas Clotrimazole/Miconalzole

443
Q

Refer oral thrush when

A

Failed otc, Older kids, Recurrent infection

444
Q

Transient insomnia occurs for

A

a few days

445
Q

Short term insomnia occurs for

446
Q

Chronic insomnia occurs for

447
Q

Insomnia is caused by the following medicines

A

Decongestants, Fluoxetine, MAOI, Corticosteroids, Appetite suppressants, Phenytoin, Theophylline

448
Q

Which medical problems cause pain which can keep patient awake at night

A

Angina, Arthiritis,. Cancer, GORD, Parkinson’s disease, hyperthyroidism, Breathing difficulty in Heart Failure, COAD, Asthma

449
Q

Management of Insomnia

A
  1. Antihistamines
  2. Benzodiazapines
  3. Complementary therapy (lavander oil/aromatherapy)
  4. Melatonin (POM)
  5. SJW
  6. Nasal Plasters (for snorers)
450
Q

Which antihistamines are used for insomnia

A

Diphenyhydramine and Promethazine

451
Q

Half life of Diphenyhydramine and Promethazine

A

Diphenyhydramine: 5-8hours
Promethazine: 8-12hours

452
Q

When to take antihistamines for insomnia

A

20-30 mins before bed for >16 only

453
Q

Benzodiazapines used in insomnia should be used for

454
Q

What is melatonin

A

Produced by pineal gland during darkness

455
Q

Counselling regarding insomnia

A

Sleep hygiene, exercise, warm bath, electric blankey, caffeine avoidance

456
Q

Refer insomnia when

A

Depression, Under 16, ADR, Chronic

457
Q

Refer Chest problems when

A

Pain, SOB, Wheeze, Ankles swollen, Blood in sputum, Palpitations, Persistent cough, Whooping cough, Croup, Sputum mucoid/coloured

458
Q

Refer Gut problems when

A

Difficult swallowing, Blood in vomit, Blood in diarrhoea, Constipation AND vomiting, weight loss, alteration bowel habit

459
Q

Refer Eye problems when

A

Painful red, vision loss, double vision

460
Q

Refer ear problems when

A

Pain, discharge, deaf, irritation, tinnitus, vertigo

461
Q

Refer Urinary problems when

A

Difficult passing urine, Blood in urine, Cystitis with pain in abdomen/loin/back, Cystitis with temperature, Uretheral discharge, vaginal discharge, vaginal bleeding in pregnancy

462
Q

Neck stiffness/rigidity with temperature should be referred T/F

463
Q

Persistent vomiting can be treated OTC T/F

A

False, refer

464
Q

Child with non blanching rash (purpura)

465
Q

Medicines which cause hypertension/precipitate heart failure/have CV side effects

A

Sympathomimetics: Adrenaline, Noradrenaline, Dobutamine, Dopamine, Phenylephrine
Thyroxine, TCA, Triptans
Contraceptives

466
Q

Sudden Betablocker withdrawal can

A

Induce unstable angina, MI, sudden death

Pharmacy Pre-Registration (5 decks)

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