OTC Flashcards
Warts/verrucas: when to refer?
Anogenital or facial warts
Diabetics
Immunocompromised patient
Bleeding or itching
Changed in size or colour
OTC treatment that has been unsuccessful following 3 months of treatment
Warts/verrucas: How to treat?
Salicylic acid based products (Bazuka)
Glutaraldehyde based products (can stain skin brown) - not common
Cryotherapy (OTC example: Wartner)
Use emery board or pumice stone to get rid of dead skin, so treatment reaches ‘root’ of wart/verruca
Cold sores - when to refer?
Over 2 weeks Eye is infected (HSV in the eyes can cause herpes simplex keratitis, a) potentially sight-threatening infection Painless lesion (could be lip cancer) Lesions in mouth Severe/widespread Immunocompromised patient Children/babies Signs of secondary bacterial infection - yellow crust/weeping/pus
Cold sore - treatment?
Can be self-limiting (leave alone)
Aciclovir (Zorivax)
Penciclovir (Fenistil)
Athlete’s Foot (Tinea pedis) - when to refer
Diabetes Involves nails Spreading to other parts of foot Signs of bacterial infection e.g. weeping, pus or yellow crusts No response to treatment
Athlete’s foot (tinea pedis) - how to treat?
Imidazoles (clotrimazole (Canesten®))
Ketoconazole (Daktarin Gold®)
Miconazole (Daktarin Aktiv®)
Terbinafine (Lamisil®)
Vaginal thrush (CANDIDIASIS) - symptoms?
Vulval itching Local erythema (redness) White, curd-like and odourless discharge Dyspareunia (pain on intercourse) Dysuria (pain during urination)
Vaginal thrush (CANDIDIASIS) - when to refer?
Pregnant Under 16s Over 60s Diabetes More than two attacks in the last 6 months Failed OTC treatment Sores/ulcers/blisters Foul smelling discharge Green-yellow or blood stained discharge No improvement after 7 days Previous history of STD Exposure to partner with STD Abnormal vaginal bleeding Any associated lower abdominal pain or dysuria
Vaginal thrush (CANDIDIASIS) - treatment?
The imidazoles; clotrimazole, econazole and miconazole are equally effective.
Pessaries/intravaginal cream more effective than external treatment (but this helps soothe symptoms)
Primary dysmenorrhoea (period pain) - when to refer
Abnormal vaginal discharge
Heavy or unexplained bleeding
Signs of systematic infection e.g. fever
Symptoms suggesting secondary dysmenorrhoea (caused by an underlying condition)
Primary dysmenorrhoea (period pain) treatment?
NSAIDs (ibuprofen first choice)
Codeine could work.
Anticholinergic antispasmodics, such as hyoscine butylbromide (Buscopan®) and
alverine citrate (Spasmonal®), relax the uterine smooth muscle - option
Cystitis - when to refer?
Pregnant Men Children Elderly women Vaginal discharge Haematuria (presence of blood in the urine) With fever, nausea and or vomiting Pain or tenderness in the loin area Recurrent cystitis Failed treatment Longer than 2 days Diabetes immunocompromised
Cystitis - treatment?
Can be self-limiting
Cystitis sachets which contain potassium or sodium citrate
Cranberry juice (no real evidence) - avoid if on warfarin
Mouth ulcers when to refer?
Lasting longer than 3 weeks Suspected adverse drug reaction e.g. NSAIDS Crops of 5-10 or more ulcers Rash Diarrhoea With weight loss Involvement with other mucous membranes
Cough - when to refer
onger than 2 weeks and not improving
Chest pain
Shortness of breath
Wheezing
Recurring cough present at night
Whooping cough/croup
Cough or wheezing that may be drug induced e.g. ace inhibitors and beta blockers
Yellow, green, brown or blood stained phlegm/sputum
Offensive or foul smelling phlegm/sputum
