OTC babies Flashcards
1
Q
What is colic?
A
Excessive crying with no obvious cause.
2
Q
Colic symptoms?
A
Rule of 3:
- > 3hrs a day crying
- > 3 days a week for a minimum of one week
Red face Clenched fist Hard to settle Gas and rumbling Knees upto chest
3
Q
When would you refer colic?
A
Inconsolable crying or inability to put on weight with age
4
Q
Otc products for colic?
A
Infacol - simeticone (from birth)
Colief - lactase
Gripe water (1month+)
5
Q
Typical age of babies with colic?
A
Birth to 6months old
6
Q
Advice for parents for colic?
A
- tummy rub circular motions
- refrain from cow milk/dairy
- rock baby over shoulder
- warm bath
- burps after feeds
- hold baby
- grows out by 6months
7
Q
What is cradle cap?
A
Infantile seborrhaeic dermatitis. Primarily affects oily skin and scalp.
Common in babies <6months old
8
Q
Symptoms of cradle cap?
A
Yellow, greasy scales
Flaking of skin
Could affect eyebrows, nose and nappy areas
9
Q
Referral of cradle cap;
A
If widespread face/body
If infected/inflammed - needs flucloxacillin
If scratchy, swollen or bleeding - atopic eczema
10
Q
OTC cradle cap treatment;
A
1) baby shampoo and hair brush to loosen scales
2) olive oil bp to soften and remove scales
3) capasal shampoo: salicylic acid and coal tar
4) nizoral shampoo: ketoconazole
11
Q
Cradle cap advice for parents:
A
- common, harmless and self limiting
- do not peel scales as can expose to infection
- not contagious
12
Q
What is meningitis?
A
Inflammation of the meninges (lining around brain and spinal cord)
13
Q
Meningitis causative organisms?
A
Neisseria meningitides
Streptococcus pneumoniae
14
Q
Meningitis non-specific symptoms?
A
Flu like
High fever
Muscle ache - severe
Nausea/vomiting
15
Q
Meningitis specific symptoms?
A
Stiff neck Non-blanching rash Cold extremities Photophobia Confused/drowsy
16
Q
Why do you need to refer meningitis immediately?
A
Refer STAT
Viral - treat with ibu/para and self limiting
Bacterial - can cause life threatening/blood poisons and limb amputations
17
Q
Meningitis treatment for NO non blanching rash and query sepsis?
A
Benzylpenicillin
If allergy:
Cefotaxime
If allergic to both:
Chloramphenicol
18
Q
Measles, mumps and rubella what is it? - vaccine at 1yr and 3yr 4months
A
Viral diseases that can spread and affect the lungs and become more serious
19
Q
Measles symptoms?
A
koplik spots (3days before) - white spots on buccal mucosa
Conjunctivitis
Flu-like symptoms
Fever
Characteristic: rash behind ears and spreads to limb trunks and face
Red - brown confluent and blotchy rash
20
Q
Mumps symptoms and characteristics?
A
Symptoms - fever, headache, malaise
Characteristics - swelling on both sides of face
21
Q
Rubella symptoms and characteristics?
A
Lymphadenopathy (swollen lymph glands)
Rash on face then spreads to trunks and limbs
Pink-red confluent rash
22
Q
Is MMR a notifiable disease?
A
Yes must report
23
Q
How long after is mmr contagious?
A
Measles - four days after rash
Mumps - five days after rash
Rubella - six days after rash
24
Q
Key warnings with MMR?
A
Measles - can cause complications otitis media, pneumonia, encephalitis
Mumps - risk of meningitis and sterility
Rubella - stay away from pregnant women and foetal damage
25
Mmr advise?
Otc - paracetamol/ibuprofen
Advice - bed rest, hydrated, contagious so no school, no acidic drinks
26
MMR vaccines schedule?
Dose 1 - 1st birthday/1 year old
Dose 2 - 3yrs and 4months
27
What is a fungal nappy rash?
Erythamateous rash characterised by redness, pimples around edges. Occurs if nappies arent changed regularly and there is frequent contact with faeces and urine. Affects the buttocks
28
What two indicators would prompt you to suspect a FUNGAL nappy rash over a normal nappy rash?
Pimples around edges
| Rash between buttock folds
29
What is the referral criteria for nappy rash?
- signs of weeping/infection
- >7day OTC failure
- broken skin/severe
- widespread
30
How do barrier preps help in nappy rash, give some examples.
they hydrate, soothe and form a protective layer over the skin
e.g. sudocrem, metanium, bepanthen
31
What antifungals are available OTC for nappy rash?
Canesten - Clotrimazole
| Miconazole - use for 7 days after infection cleared too to prevent recurrence
32
Advice for parents who have children with fungal nappy rash?
- Change nappies regularly straight after soiled/wet
- Avoid powder ( can further irritate)
- Clean area thoroughly with water/wipes
- Let bottom air dry after shower
33
What kind of lesions on nappy rash would make you suspect that it is infected?
crusty lesions
34
Age limit on clotrimazole OTC?
Nil.
| if pregnant - seek advise from midwife (can use clotrimazole OTC but not with applicator)
35
What is the causative organism for oral thrush?
candia albicans
36
Symptoms of oral thrush?
White, sore spots in and around the mucosa of the mouth
37
Oral thrush referral criteria?
Everyone except babies as less common in adults.
Recurrent
OTC failure >7 weeks
38
OTC products available and age limit:
Daktarin: miconazole 2% oral gel sugar free, 4 months+
| Apply QDS after meals and for 1 week after symptoms disapppear to prevent recurrence
39
If a woman is breast feeding and on topical miconazole, how would you advise them to administer it?
Apply to nipple and wash off before feed
40
What could happen if daktarin oral gel (miconazole) was applied to the back of the throat?
Risk of choking and aspiration
41
What is a key interaction with miconazole otc?
Warfarin.
Miconazole is a potent inhibitor that increases warfarin levels in the blood and increases INR. This increases the risk of bleeding. Always refer to GP for nystatin.
42
How would you advise a patient on high dose inhaled corticosteroids to avoid oral thrush?
Use spacer
Rinse mouth after use
Dental hygiene
Wash and airdry once a month
43
Advice for parents of babies that get oral thrush?
sterilise bottles
| if BF: apply miconazole and wash before feeds
44
What virus causes slapped cheek syndrome?
Parvovirus
45
What are the characteristic features of slapped cheek syndrome?
Bright red rash on cheeks
Light pink, lace-like, itchy rash on trunk and limbs
Cold/flu-like symptoms before rash appears: e.g. fever, sore throat, headache, runny nose, malaise
46
Is slapped cheek syndrome contagious?
Yes - mainly before rash appears so during cold/flu-like symptoms
47
What category of people must be vary and cautious of being in contact with slapped cheek syndrome and why?
Pregnant women because there is an increased risk of stillbirth/miscarriage
Blood disorders
Severe anaemia
48
What treatment options are available for those with slapped cheek syndrome?
Pain relief: Paracetamol/Ibuprofen
itch relief: chlorphenamine (v.drowsy, 1yr+)/calamine
Rest, fluids
49
What age range is chlorphenamine suitable for?
1yr+ but v.drowsy
50
When is slapped cheek syndrome no longer contagious?
Once the rash appears.
51
Moses, 5, presents with a bright red rash on his cheeks and a light pink itchy rash on his chest, thighs and arms. The mother thinks it could be an allergic reaction from a recent visit at a friend's baby shower. She mentions that he has a fever and feels poorly.
What is the best course of action?
1) Sell hydrocortisone
2) Sell paracetamol and tell mum to inform pregnant friend to see GP urgently
3) Sell chlorphanemine + paracetamol and tell mum to inform pregnant friend to see GP urgently
4) Refer child to GP as he is contagious
5) Sell chlorphanemine
3: Sell paracetamol (dose: <6yrs 120mg/5ml, so dose 10ml every 4-6hrs max 4 doses) and chlorphenamine (1yr+)
Tell friend because of risk of miscarriage and still birth
no hydrocortisone as 10yrs+
No need to refer, rash needs to appear then non-contagious and resolves with antipyretics, fluid, rest
52
What is whooping cough caused by?
Pertussis (often viral) - due to underdeveloped immune system
53
Characteristic symptoms of whooping cough?
- initial (upto10days): runny nose - persistent, watery eyes, sore throat, fever
- coughing bouts (bacteria moved into lungs): thick mucus followed by vomiting
- 'whoop' between coughs when gasping for air as cough is constant
- occurs at night
54
Is whooping cough contagious?
Yes
55
When do you refer whooping cough?
All cases: GP
A+E: If breathing difficulties - cyanosis, SOB, choking, breathlessness, rapid/shallow breathing: may require additional support for lungs
56
Treatment for pertussis/whooping cough?
1) vaccine - for mother at 16 weeks pregnant
2) antibiotics
3) Fever: paracetamol/ibuprofen
Cover mouth and nose
57
How long should a child be off school if diagnosed with whooping cough?
5 days after initiation of antibiotics
| 3 weeks after initiation of cough
58
How long can a whooping cough last for?
2-3 months
59
What is the age limit on guaifenesin cough syrup?
6yrs+
60
1st line antibiotics for whooping cough?
macrolides: clarithriomycin, azithromycin
61
For those <1month old with whooping cough what is the ab choice based on NICE?
Clarithromycin
62
For those >1month old with whooping cough what is the ab choice based on NICE?
Clarithromycin/Azithromycin
63
For those PREGNANT with whooping cough what is the ab choice based on NICE?
Erythromycin
64
What is the choice of AB in those allergic to macrolides and who have whooping cough?
Co-trimoxazole
65
What age range is co-trimoxazole indicated in and what patient category is it contra-indicated it?
>6 weeks old
| Contra indicated in pregnancy
66
What virus causes chicken pox?
Varicella Zoster
67
Symptoms of chicken pox?
Red spots that then blister in 12hrs and then scab over.
Prodromal symptoms occur around 3days before: fatigue, malaise, fever
68
Chicken pox commonly affects...
Children <10yrs but can also re-infect those who have had it before
69
Referral criterial for chicken pox and why?
Pregnant
Adult esp >50yrs
Immunocompromised
Infants <4weeks
Risk of severe infection and in adults risk of shingles - require treatment with aciclovir 800mg 5x a day for SEVEN days (NICE)
70
What is shingles?
Caused by herpes zoster, infection of a nerve.
Presents with a tingly pain and rash on one side of body which then forms blisters and crusts over (could take upto 4 weeks)
71
Till when is shingles contagious?
Only until there is fluid oozing: spread via direct contact
72
Counselling points for Aciclovir and CALS:
Antiviral, complete the course, can cause photosensitivity and hepatic damage - use SPF and protect skin, report any dark urine, abd pain, pale stools, itchy skin + ensure adequate fluid intake
73
How would you treat chicken pox for a child OTC?
```
If itchy:
Crotamiton - eurax (if <3yrs only OD application)
Calamine lotion
Chlorphenamine (antihistamine) - 1yrs +
Cooling gel mousse
aloe vera gel
```
If Fever:
Only paracetamol, NO IBUPROFEN as can cause severe skin reactions
74
Contagious period for chicken pox in kids?
Avoid school or nursery.
Most contagious 1-2days after rash (when blisters present)
Go back to school/nursery only when blisters have crusted over. (normally up till 5 days after)
75
Lifestyle advise for chicken pox?
Cut nails short and avoid itching as can scar
| Loose clothing
76
Paracetamol comes in what suspension strength?
120mg/5ml
>2months
>4kg
77
Paracetamol child doses:
```
3-5months: 60mg QDS
6-23months: 120mg QDS
2-3yrs: 180mg QDS
4-5yrs: 240mg QDS
6-7yrs: 240-250mg QDS
8-9yrs: 360 - 375mg QDS
10-11yrs: 480 - 500mg QDS
12-15yrs: 480 - 750mg QDS
16yrs+: 500mg -1G QDS
```
78
When should you refer children with fever?
< 6 months and no improvement in 24hrs.
>6 months and no improvement in 72hrs.
<3months: >38deg
3-6months: >39deg
Signs of meningitis:
Stiff neck, non blanching rash, systemically unwell, photophobia, excessive crying
Febrile convulsions
Dehydration
79
Suitability of ibuprofen in children.
>3 months
>5kg
100mg/5ml
80
Ibuprofen child doses:
```
1-2months: 5mg/kg TDS QDS
3-5months: 2.5ml TDS
6-11months: 2.5ml TDS/QDS
1-3yrs: 5ml TDS
4-6yrs: 7.5ml TDS
7-9yrs: 10ml TDS
10-11yrs: 15ml TDS
12yrs+: 15-20ml TDS/QDS
```
81
What is impetigo?
bacterial infection
82
Two types of impetigo that would depict diagnosis and treatment?
Non-bullous: staph aureus, step pyogenes affects localities like mouth nose face and extremities: no pain and sometimes itches
Bullous: staph aureus (fluid filled) affects flexures face trunk limbs: pain and itch
83
What does bullous mean?
Blisters on skin
84
Symptoms of impetigo?
yellow, golden, brown and crusty lesions
85
Referral for impetigo?
All cases
86
Treatment for localised, non-bullous impetigo?
Topical treatment - can give up to 7 days dep on judgement
1) hydrogen peroxide 1% cream BD/TDS 5 days
2) Fusidic acid 2% TDS 5 days
3) Mupirocin 2% TDS 5 days
87
Treatment for non-bullous widespread impetigo?
Topical
| fuscidic acid 2%/mupirocin 2% TDS for 5 days
88
Treatment for bullous widespread systemic impetigo?
1) Fluclox 500mg QDS for 5 days
| 2) Pen allergy: macrolide clari 250mg bd 5 days, erythro 250-500mg QDS 5 days
89
Lifestyle advice for impetigo?
Hygiene measures - wash hands
avoid sharing towels and clothes
cut nails
no school till rash disappears as its contagious
90
Key interactions with medication for impetigo?
Fusidic acid + statins - risk of severe rhabdomyolyisis so hold statin during and 7 days after
Flucloxacillin and anticoagulants
Flucloxacillin and methotrexate - increased risk of mtx toxicity
Macrolides (cyp3a4 inhibitors)
- QT prolonging drugs - amiodarone, sotalol, quinine, SSRIs
- Enzyme inducers - CRAP GPS
- warfarin and doacs - increase anticoagulant effect so increased risk of bleeding
- CCB: hypotension
- ciclosporin - increased levels
- colchicine - increased risk of colch toxicity (n/v/diarr/myopathy)
- digoxin - increased levels
- insulin/sulfonylurea - hypoglycaemia
- statin - statin holiday
91
What is scarlett fever?
Infection that is caused by Streptococcus pyogenes which results in a fever and scarlet rash
92
Most common age of scarlett fever?
2-8yrs and spreads via droplets/aerosol transmission
93
Non-specific/prodromal symptoms of scarlett fever?
```
Sore throat
Fever
Headache
Fatigue
N/V
```
12-48hrs after, the rash develops
94
Specific symptoms of scarlett fever?
Strawberry tongue
| Sandpaper like rash on back/trunk
95
How long should children with scarlett fever stay off school for?
Minimum 24 hrs after starting antibiotic as it is contagious
96
Lifestyle advice for scarlett fever?
Avoid sharing clothes, towels, linen, cups
Cover mouth when sneezing, coughing
Very contagious
Increase handwashing
97
1st line treatment for scarlett fever?
Phenoxymethylpenicillin QDS for 10 days, dose based on weight of the child
98
Three treatment options for scarlett fever?
Phenoxymethypenicillin
Amoxicillin
Azithromycin
99
What are the contraindications for phenoxymethylpenicillin?
Penicillin/cephalasporin allergy
100
What are the main adverse effects for phenoxymethylpenicillin?
N/V/D
Signs of c.diff: fever, severe diarrhoea, blood/pus in stools
Leuocpenia/neutropenia/thrombocytopenia/coagulation disorders
Convulsions in renally impaired or high doses
101
Interactions with phenoxymethylpenicillin?
- anticoagulants/warfarin: INR may need adjusting
- Methotrexate - increased risk of toxicity so monitor FBC twice a week for 2 weeks
- contraception: concerning if patient vomit/nausea/diarrhoea
102
What class of antibiotics used in scarlett fever are safe in pregnancy and breastfeeding?
Penicillins
103
What drug used in gout has a particular interaction with amoxicillin?
Allopurinol: increased risk of rash
104
Azithromycin is used for scarlett fever in those that are penicillin allergic. What are the SE and interactions?
SE: hepatotoxicity, anaphylaxis, n/v/d, QT prolongation
Int:
Warfarin
DOACS
Digoxin - inc toxicity
Hypokalaemia drugs: loops, b2 agonists, corticosteroids
QT prolonging drugs: amiodarone, sotalol, terfenadine, quinine, amisulpiride
Colchicine - increased risk of toxicity: n/v/d/myopathy
