OTC Flashcards
How are ulcers classified ?
As aphthous (minor or major ) or herpetiform ulcers.
What you need to know when diagnosing ulcers ?
- age
- child or adult
- nature of the ulcers
- size, appearance, location and number
- duration
- previous history
- other symtpoms
- medication
Minor aphthous ulcers are common in which patient group ?
more common in women and occur most often between the ages of 10 to 40 years
How long minor aphthous ulcers last ?
5 to 14 days
In which patient group major aphthous ulcers are more common?
in those who have ulcerative colitis, diameter may be up to 30mm can occur in crops of 10
when would mouth ulcers should referred ?
if persist for more than three weeks, if there is no pain
What drugs may cause mouth ulcers?
Nsaids, aspirin, nicorandil, sufasalazine, BB, cytotoxic drugs -refer
What is treatment timescale for mouth ulcers ?
if there is no improvement after one week see GP
How chlorhexidine (antiseptic) is useful in treating mouth ulcers?
help prevent secondary bacterial infection, there is some evidence that it reduces duration and severity of ulceration
What advice patients should be given when recommending chlorhexidine for mouth ulcers?
regular use can stain teeth brown, effect not usually permanent.
Advice patient to brush teeth before using the mouthwash to reduce risk of staining.
The mouthwash should be used twice a day, risking 10 ml in the mouth for one minute and continued 48 hours after symptoms have gone.
what topical corticosteroids are available for mouth ulcers?
hydrocortisone muco-adhesive 2.5 mg tablet for adults and children over 12.
How are hydrocortisone muco-adhesive tablets are used ?
a tablet is held in close proximity to the ulcer until its dissolved. ONE tablets QDS.
Tablet should not be sucked, but dissolved in contact with ulcer
What are local analgesic available for ulcers that are very painful ?
benzydamine mouthwash or spray and choline salicylate dental gel are short acting but can be useful.
How is benzydamine mouthwash used in ulcers and for what age group ?
over 12
Mouthwash is used by rinsing 15 ml in the mouth TDS
How is benzydamine spray used in mouth ulcers?
four sprays onto affected area TDS
In which age group choline salicylate gel is contraindicated and why ?
Under 16, can cause Reyes syndrome
What is age group for dioralyte relief/dioralyte sachets ?
> 3 months
Boots dehydration sachets suitable for what age group ?
1 year and over
What treatment can be offered for prickly heat ?
calamine lotion
Patient who has to be referred for cystitis ?
- under 16
- recurrent cystitis ( three episodes within one year or two episodes within 6 months )
- pain low down and duration of more than 7 days
- blood in urine
- flank pain
- vaginal discharge
- women over 70
- immunocompromised
Alkalasinig agents such as sodium citrate, sodium bicarbonate, potassium citrate should be avoided when ?
- sodium bicarbonate/citrate= avoid in hypertension
- potassium citrate= avoid with potassium sparing diuretics, ACE
what is perennial allergic rhinitis ?
symptoms present all year round
What do you need to know when patient present with hayfever symptoms ?
age duration,symtpoms runny nose nasal congestiom nasal itching watery eyes irritated eyes discharge from the eyes sneezing previous history associated conditions: eczema, asthma medication
when to refer hayfever?
- diagnosis unclear
- wheezing and SOB
- tightness of chest
- painful ear
- painful sinuses
- purulent conjuctivitis
- severe symptoms only partially relieved by OTC
- failed medication
- symptoms after OTC do not improve within 7 days
Difference between onset of action between antihistamines and cortisoteroid sprays ?
cortisoteroids may take several days to work
How are antihistamines helpful in hayfever?
effective in reducing sneezing and rhinorrhoea, less so in reducing nasal congestion
What is the minimum age for OTC loratadine, cetirizine, acrivastine ?
loratadine 2+
cetirizine 6+
acrivastine 12+
What side effects may cause chloprhenamine ?
have anticholinergic activity: dry mouth, blurred vision, constipation, urinary retention. These effects will increase if the patient is already taking another drug with anticholinergic effects: TCAs, prochlorperazine, metoclopramide, haloperidol
Antihistamines with anticholinergic effects are best avoided in which patients?
- narrow closed angle galucoma, since the anticholinergic effects produced can cause an increase in intraocular pressure
- use with caution in patients with liver disease or porstatic hyperthropy
Why decongestants should not be used more than one week ?
because of rebound congestion
In which patient groups vasoconstrictor eye drops should not be used ?
glaucoma or who wear soft contact lenses
when vasoconstrictor eye drops are first applied what symptoms patient may experience ?
painful stinging when first applied
What are steroid nasal sprays available OTC ?
beclometasone
fluticasone
mometasone
What are the side effects of nasal steroid sprays ?
dryness and irritation of the nose and throat as well as nosebleeds have occasionally been reported
For which patient groups nasal steroids should not be recommended ?
pregnant women
anyone with glaucoma
How quick sodium cromoglicate eye drops work ?
within one hour
How often cromoglicate drops be used?
four times a day
if the eye drops have benzalkonium chloride who shouldn’t use these eye drops ?
soft contact lenses
When should constipation be referred ?
- constipation accompanied by weight and appetite loss ( may indicate carcinoma)
- tarry-red, black or bloody stools
- constipation with weight gain, lethargy, coarse hair or dry skin ( hypothyroidism)
- drugs that cause constipation: opioid analgesics, hyoscine, SSRIs, TCAs, iron, chlorphenamine, bendro, propranolol, aliuminium antacids, verapamil
What are the side effects of laxatives?
- lactulose can cause flatulence, cramps and abdominal discomfort, particularly at the start of the treatment
- if bulk laxatives are not taken with sufficient water there is a risk of oesophageal and intestinal obstruction
When to refer diarrhoea?
- Less than 3 months refer immediately
- Children under 1 year: diarrhoea of duration for more than 1 day
- People with diabetes: duration of more than 1 day
- Children under 3: diarrhoea of duration for more than 2 days
- Adults and children: duration of more than three days
- nausea, vomiting and fever
- signs of dehydration: dry skin, sunken eyes, dry tongue, drowsiness, less urine
- alternating constipation and diarrhoea in elderly patients: may indicate faecal impaction
- weight loss and over 50
- drugs that cause diarrhoea: magnesium salts, antibiotics, digoxin, diuretics, iron, laxatives, NSAIDs, SSRIS
What is bismuth salicylate?
absobrs water as well as adsorbs toxins and bacteria onto its surface and then removes them from the gut
What drinks should not be used to reconstitue oral rehydration sachets ?
fruit, fizzy and sugary drinks and boiling water
-solution can be kept for 24 hours in the fridge
what drinks should patient avoid when they have diarrhoea ?
high in sugar as these can prolong diarrhoea and avoid milky drinks as a temporary lactose intolerance occurs due to damage to cells lining in the intestine
How to advise for babies who have diarrhoea ?
formula feeds for babies should be diluted to quarter strength and built back up to normal over three days
Who to refer for heartburn and indigestion ?
- children
- when pain radiates to the back and arms check for any underlying conditions ( symptoms can mimic a heart attack )
- difficulty swallowing
- regurgitation
- certain drugs can cause heartburn: TCAs, CCB, NSAIDs and caffeine
- persistent pain that originates from one point in the abdomen ( may indicate a duodenal or gastric ulcer )
- new or recently changed symptoms in a patient over 55 years
- patients over 55 years taking any OTC indigestion or heartburn remedy on daily basis
- previous gastric ulcer or gastrointestinal surgery
- patient has been taking symptomatic treatment of indigestion or heartburn for 4 or more weeks
- patient has jaundice or severe liver disease
How does antacids work ?
neutralise the excess acid produced by the body and can be taken during or immediately prior to symptoms developing.
preparations that are high in sodium should be avoided by HF patients, kidney or liver problems
how does alginates work ?
form a raft that sits on the surface of the stomach contents and prevents reflux. Some alginates contain bicarbonate which causes the release of carbon dioxide in the stomach meaning that the raft can float more easily on top of the stomach contents.
How does PPI work?
-work by inhibiting gastric acid secretion in the stomach by blocking the hydrogen potassium adenosine triphosphatase enzyme system. May take 1-3 days to provide full therapeutic effect during which antacids can be used.
PPIs interact with which medication ?
omeprazole can delay the elimination of warfarin, phenytoin and diazepam.
Interactions can also occur due to the change in gastric pH causing differences in the absorption if drugs, omeprazole reducing the absorption of itraconazole or ketoconazole and possibly increasing plasma concentration of digoxin
What are the most common side effects of PPIs?
headache, abdominal pain, constipation, diarrhoea, flatulence and nausea/vomiting
What to recommend for indigestion for pregnant women, elderly and hypertensive patient with heartburn ?
sodium free or low sodium antacid preparation containing alginate
