OTC+First Aid Flashcards
3 Categories
LEARN VIA L .R.D. METHOD
L – Legal requirements/ classifications
R- Responding to symptoms + Rx & referral points
D. Drug interactions/ effects
**beta blockers (less water soluble)=>sleep disturbances
**vaginal thrush treatment: 16-60, only treat if theyve had thrush twice in 6 months
**azoles and warfarin=>bleeding increases, INR increases
Responding to Symptoms
Stye
Ringworm
Molluscm
Conjunctivitis: 1st line self limiting w/warm flannel for 3 days, 2nd line chloramphenicol for 7 days (2yrs and above), pregnant/breastfeeding=>no, grey baby syndrome
Slapped Cheek: self-limiting
chickenpox (watery blisters): pops and scabs over
Scarlett fever (orange tongue/hard and red)
Changes/New In
> PHOCOLDEINE PRODUCTS HAVE BEEN RECALLED DUE TO ALLERGIC AND ANAPHYLACTIC REACTIONS. DO NOT RECOMMEND !!!
PSEUDOEPHIDRINE CONTAINING PRODUCTS ARE CLOSELY BEEN MONITORED BY THE MHRA . The MHRA is reviewing the evidence relating to the very rare risk of posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) associated with medicines containing pseudoephedrine.
FEXOFENADINE 120MG (Alevia) HAS BEEN RECLASSIFIED TO P MEDICINE.
TADALAFIL 10MG HAS BEEN RECLASSIFIED TO P MEDICINE CALLED
CIALIS TOGETHER.
DESOGESTREL-HANAORLOVIMACANBEBOUGHTOVERTHE COUNTER FOR REGULAR CONTRACEPTION.
Needle Stick Injury
encourage the wound to bleed, ideally by holding it under running water.
wash the wound using running water and plenty of soap
do not scrub the wound while you’re washing it=>could lead to infection, something could be stuck in the skin
do not suck the wound
dry the wound and cover it with a waterproof plaster or dressing
Refer for medical attention to reduce the risk of getting an infection.
FIRST AID INSTRUCTIONS FOR MEDICAL EMERGENCIES
1.If someone is unconscious but breathing and has no other injuries that would stop them being moved, place them in the recovery position (lay them on their side, upper leg over bottom leg, upper arm tucked under head, bottom arm to support head) until help arrives.
2. IF SOMEONE IS UNCONSCIOUS OR UNRESPONSIVE –
clear Airway if blocked. Breathing: If you have cleared a person’s airway but they’re still not breathing, provide rescue breathing (CPR: adults, 30 compressions 2 breaths; children: 15 compressions, 2 breaths). Circulation: As you are doing rescue breathing, perform chest compressions to keep the person’s blood circulating.
cardiopulmonary resuscitation (CPR)
HOW TO STOP A CHILD FROM CHOKING
Children, particularly those aged from 1 to 5, often put objects in their mouth. Advice patients.
>Back blows for babies under 1 year
Sit down and lay your baby face down along your thigh or forearm, supporting their back and head with your hand.
Give up to 5 sharp back blows with the heel of 1 hand in the middle of the back between the shoulder blades.=>call 999
>Back blows for children over 1 year
Lay a small child face down on your lap as you would a baby.
If this isn’t possible, support your child in a forward-leaning position and give 5 back
blows from behind.
If back blows don’t relieve the choking and your baby or child is still conscious, give chest thrusts to infants under 1 year or abdominal thrusts to children over 1 year.=>999
ANAPHYLAXIS
Anaphylaxis (or anaphylactic shock) is a severe allergic reaction that can occur after an insect sting or eating certain foods.
During anaphylactic shock, it may be difficult for the person to breathe, as their tongue and throat may swell, obstructing their airway.
Call 999 immediately if you think someone is experiencing anaphylactic shock.
Check if the person is carrying any medication. Some people who know they have severe allergies may carry an adrenaline self- injector, which is a type of pre-loaded syringe.
If they’re conscious, sitting upright is normally the best position for them.
**if they come to the pharmacy with anaphylaxis with expired pen, provide an emergency supply.
**if they call over the phone with anaphylaxis with an expired pen, use expired pen.
**brand new=>expired=>nothing
*dispense min 2 pens to pts that are at risk of anaphylaxis
**ACE and afro carribean=>angioedema
BLEEDING HEAVILY
If someone is bleeding heavily, the main aim is to prevent further blood loss and minimize the effects of shock.
First, dial 999 and ask for an ambulance as soon as possible. If you have disposable gloves, use them to reduce the risk of any infection being passed on.
Check that there’s nothing embedded in the wound. If there is, take care not to press down on the object.
>If nothing is embedded:
Apply and maintain pressure to the wound with your gloved hand, using a clean pad or dressing if possible. Continue to apply pressure until the bleeding stops.
Use a clean dressing or any clean, soft material to bandage the wound f irmly.
FIRST AID FOR BURNS
Stop the burning process as soon as possible. This may mean removing the person from the area, dousing flames with water, or smothering flames with a blanket. Do not put yourself at risk of getting burnt as well.
Remove any clothing or jewellery near the burnt area of skin, including babies’ nappies. But do not try to remove anything that’s stuck to the burnt skin, as this could cause more damage.
Cool the burn with cool or lukewarm running water for 20 minutes as soon as possible after the injury. Never use ice, iced water, or any creams or greasy substances like butter.
Keep yourself or the person warm. Use a blanket or layers of clothing, but avoid putting them on the injured area. Keeping warm will prevent hypothermia, where a person’s body temperature drops below 35C (95F). This is a risk if you’re cooling a large burnt area, particularly in young children and elderly people.
Cover the burn with cling film. Lay the cling film over the burn, rather than wrapping it around a limb. A clean, clear plastic bag can be used for burns on your hand.
Treat the pain from a burn with paracetamol or ibuprofen. Always check the manufacturer’s instructions when using over-the-counter medication. Children under 16 years of age should not be given aspirin.
Raise the affected area, if possible. This will help to reduce swelling.
FIRST AID FOR BURNS
Burns and scalds - Treatment - NHS (www.nhs.uk) click link
Go to a hospital accident and emergency (A&E) department for:
large burns bigger than the size of the affected person’s hand
deep burns of any size that cause white or charred skin
burns on the face, neck, hands, feet, any joints, or genitals
all chemical and electrical burns
any other injuries that need treating
any signs of shock – symptoms include cold, clammy skin, sweating, rapid, shallow breathing, and weakness or dizziness
HANA OR LOVIMA (OTC)
> FIRST-TIME SUPPLY – WOMEN WHO HAVE NEVER USED DESOGESTREL BEFORE OR WHO HAVE NOT USED IT FOR SEVERAL MONTHS .
If the woman is under 16 years of age, only supply Hana if she meets Fraser Guidelines
If the woman is under 18 years of age, do not supply more than 3 months of Hana (18+, 12 months)
Ask patient if pregnant ? And exclude pregnancy !
Do not supply Hana if vaginal bleeding has an unexplained cause; refer to doctor to exclude underlying pathology.
If allergic to desogestrel or one of the excipients (refer to SmPC or Pharmacy guide for a full list), do not supply Hana and refer to doctor.
Do not supply Hana if the woman has: * breast cancer or other known or suspected sex-steroid sensitive cancers (e.g. ovarian or uterine cancer) * unresolved severe liver disorders (blood tests show liver function values have not returned to normal, bilirubin/AST/ALT) * active venous thrombosis or pulmonary embolism, diabetic=>refer
HANA OR LOVIMA DRUG INTERACTIONS
> Listen out for: Enzyme Inducers (carbamazepine, phenytoin, phenobarbital, rifampicin, st. johns)
* medications that may interact with Hana (e.g. some treatments for epilepsy, tuberculosis, pulmonary arterial hypertension, high blood pressure, fungal infection, bacterial infection, HIV/HCV, depression and emergency contraception), refer to the SmPC or Pharmacy guide for a full list of medications
* intended treatment duration with medication which could interact.
Consult PI of concomitant medications. CYP enzyme-inducing medication: supply Hana but extra precautions required during and 28 days after medication use; other interacting medication: consult PI for recommendations. If interacting medications are used chronically or long- term, Hana may not be appropriate. Refer to doctor for further advice
HANA/LOVIMA
Questionnaire to fillout
Head Lice
HEAD LICE symptoms
Don’t treat unless you see lice or nits
*parents wants to take preventive treatment for lice bc spreading in school=>no lice, no treatment
Nits and lice are infectious. Get rid!!
Non -chemical treatment - Wet comb (nit comb)– comb through child’s hair, use tea tree shampoo after
Chemical treatment (more reliable), need to know age
hedrin (min age: 2 yrs, 8 hrs)
lyclear (min age: 6 months, 10 min)
Nitty gritty
Vamousse
Derbac-M
MEDICAL CONDITIONS: asthmatic=>do not sell vamousse as alcohol content can cause breathing difficulties, sensitive skin=>place towel around neck so it doesn’t get on skin as some ingredients can irritate skin
Vaginal Thrush
> L.R.Ds
Legal requirements- Age (16-60), number of episodes (2 in 6 month period), gender (can only treat males with cream if they have gotten thrush from their partner)
Thrush is a common yeast infection that affects men and women. It’s usually harmless but it can be uncomfortable and keep coming back. It is not classed as a sexually transmitted infection (STI).
Thrush symptoms in women - white vaginal discharge (like cottage cheese), which does not usually smell , itching and irritation around the vagina ,soreness and stinging during sex or when you pee
TREAT with clotrimazole or fluconazole (oral fluconazole cannot sell, must be referred if cream doesnt treat)
transgender pt: without surgerical/hormonal changes then they are still the original gender
DRUG INTERACTIONS/EFFECTS: dont sell clotrimazole cream if pt is on warfarin
CYSTITIS (uncomplicated lower UTI infection, only one that can be treated OTC)
AGE Requirements: 16-65, women only, refer men as not common in men
Symptoms include- frequent urination
pass out small amounts of urine
burning sensation
no discharge normally
urine may be cloudy
cystitis sachets (sodium citrate=>do not sell if pt has high BP, potassium citrate) otc for 2 days
>no evidence for cranberry juice/tablets
Refer after 2 days Rx
>refer if presence of blood, no sinister symptoms, renal impairment
>pharmacy 1st scheme: nitrofurantoin 100 MR BD for 3 days or 50mg QDS for 3 days, min eGFR in renal impairment: 45 mL/min=>if 32, alternative is trimethoprim 200mg BD for 3 days, if pt is on methotrexate (penicillins react) and cant have trimethoprim=>give cefalexin, if pregnant=>amox or cefalexin, if pt cant take ANY of the above=>fosfomycin
IMPETIGO (organsim: stapholacoccus aureaus (MRSA), blisters, bacterial infection)
Impetigo: refer due
to reduce risk of spreading.
RX – 2 types to consider
Bullous (yellow-brown, more likely to be widespread) and non-bullous (golden brown crust, most common, less likely to be widespread)=>either condition, REFER bc its contagious or treat under pharmacy 1st scheme (fluclox for QDS for 5 days, clarithro BD for 5 days)
Non-bullous: hydrogen peroxide 1% cream (crystacide, not to go around the mouth, should not be ingested), fusidic acid cream (safer for around the mouth) and Mupirocin (bactroban)=> if not suitable or tolerated, then prescribe oral fluxlocacillin=>if allergic give calrithromycin .
Widespread- only treatment for bullies Flucloxacillin
MEASLES
Glass Test: press it against the rashes, they will disappear for a few seconds and come back again
blanching (goes away and comes back)/non-blanching (if pressing on it and it stays, it doesnt go away, it is very serious)
Symptoms of measles: rashes, spots appear 3 – 5 days
After measles onset!
>Koplik spots: inside of mouth, white patch with red exterior/ring
what to do ?
Always REFER to A/E for immediate medical attention
*sepsis: dry nappy, havent urinated, high pitch crying
Viagra connect (VC) (must be 18 and male) is now available from pharmacies OTC. Sales of Viagra connect should be monitored by a responsible pharmacist who must check for drug interactions with any current medication being taken by the patient. Which one of the following medicines is the most likely to cause falls if taken with Viagra connect concomitantly? And as a result warrants you not supply the product and refer to a doctor.
a. Bisoprolol
b. Amlodipine
c. Doxasoxin
d. Rivaroxaban
e. Alteplase
**interact: alpha blockers. nitrates (nicorandil), erythromycin, tadalafil
c. Doxasoxin
VIAGRA CONNECT
VIAGRA CONNECT (VC)
Read reference source Viagra connect questionnaire –important for exam
Erectile dysfunction can be caused by diuretics, corticosteroids, anti-hypertensives and recreational drugs. VC can be sold OTC to men only over 18yrs
VC should not be supplied to patients who have had a stroke within last 6 months.=> over 6 months, fine.
VC can be sold over the counter even though the patient currently takes sildenafil
50mg daily which was prescribed by his GP but has ran out.=>cannot sell to take in addition to other medicine to increase dose, cannot sell
>directed not to engage in tedious physical activity, cannot sell
Learn drug interactions such as with tadalafil, ALPHA blockers, nitrates, erythromycin
>if pt has hypertension and taking amlodipine/ramipril, yes, does not interact.
Mr. Z is a 23 year old university student. He walks into a pharmacy and explains to the pre-reg student on duty that whilst revising for his exam he could feel the onset of a migraine. He took a tablet of sumatriptan prescribed by his GP. The migraine went away but came back a few hours later. He would like to know what to do next. What should the Pre-Reg student say?
a. The Pre-Reg student should advise the patient to contact his GP at this point
b. The Pre-Reg student should advise the patient to take Nurofen tablets and drink loads of water.
c. The Pre-Reg student should refer the patient to A&E.
d. The Pre-Reg student should advise the patient to rest in a dark room and the symptoms will eventually go away.
e. The Pre-Reg student should advise the patient to take another sumatriptan tablet.
e. The Pre-Reg student should advise the patient to take another sumatriptan tablet.
**can take another dose min 2 hrs later bc previous dose was effective, takes 2nd tablet and migraine returns for 3rd time=>see GP
**if previous dose had no effect, cannot take second tablet=>refer to GP
MIGRAINE (unilateral, affects one side)
See GP if first time experiencing a migraine and is over 50yrs
There are several types of migraine, including:
* migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights
* migraine without aura – the most common type, where the migraine happens without the specific warning signs
* migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop
>1st treatment: mirgraleve: (yellow: co-codamol), (pink: paracetamol, codeine, buclazine-antisickness), 2nd treatment: sumaptriptain
>only can sell sumatriptan OTC if they have been prescribed it before (migratan)/can check SCR with consent, if havent been prescribed must refer
SUMATRIPTAN KEY POINTS
>only take when needed
18 to 65 yrs. , how to take, drug interactions: serotonin syndrome (tramadol hates me), MAOI: increases hypertensive crisis, st. johns worts: increase serotonin and increase plasma conc as it is a enzyme inducer
CONJUNCTIVITIS
symptoms: redness, gritty, eyes stuck in the morning, discomfort, discharge, photosensitivity/blood/vision loss (refer)
>1st: self limiting advice for 72hrs/3days using a warm flannel
if self-limiting doesnt resolve infection, Chlorampheicol drops (age 2+, no pregnant/breastfeeding women)
OTC over 2yrs old
Don’t sell in pregnancy at all=>Grey baby syndrome=>Likely in 3rd trimester
Alternative rx is fusidic acid 1% eye drop if chloramphenicol hasnt worked
Administration of chloramphenicol: 1 drop in affected eye every 2 hrs for 2 days, then 1 drop every 4 hrs for 3 days, and carryon for 2 extra days=>7 day total
CHICKEN POX
Can occur at any age (myth: if youve had it once, you cant get it again).
Recommend piriton (OTC age: 1yr, every 4-6 hrs) and calamine cream.
>if they have fever, recommend paracetamol
Do not recommend ibuprofen!!!
Characterized by red spots all over body. Spots may burst and scab over.
Chicken pox is infectious two days before spots appear until they scab over
To prevent infecting others, reduce contact with people 2 days before if possible and 5 days after spots have appeared.
>chickenpox is contagious 2 days before spots appear and 5 days once they have appears=>if pt has chickenpox, they can go back to school from 5 days within the 1st day they observe the spots
COLD AND FLU SYMPTOMS
symptoms – *fever, headache, sore throat=>could be from medication: carbamazepine, sodium valproate, trimethoprim, aminosalicylates, vancomycin, mirtazipine=>cause blood disorders ie sore throat, mouth ulcer, bleeding, unexplained bruising, *cough, *aches, *blocked nose=>nasal spray (otrivine), no more than 7 days can have opposite affect/rebound congestion
Cough —-NICE guideline usually refer after 3 weeks. Coronavirus?
Give hygiene advice!
caused by viruses . Don’t treat with antibiotics
no evidence to support use of vitamin C, garlic. Caution in cardiac dysfunction=>no vitamin C as it is contraindicated, must be prescribed
TREATMENT (WHAM)– Age? chesty cough for 3 yr old: no specific cough medicine for under the age of 6, but if they are struggling to breathe, swallow, losing weight, coloured mucous=>refer, if clear phlegm, bronchostop, glycerin=>helps to sooth them, cocodamol: cannot sell for headaches/only used for short-term use of moderate pain, codeine linctus: P to POM bs abuse/addiction
decongestants: pseudoephidrine (concerned about MAOI=>causes hypertensive crisis), painkillers, antihistamines
Drug interactions.
**know paracetamol and ibuprofen doses for children
Maria is a 60-year-old patient who wants to buy Day &Nurse capsules to treat her cold and flu symptoms. Upon questioning, she tells you she is on a cocktail of medicines and hands you the list below.
Levothyroxine 50mcg , Mesalazine 400mg , Propylthiouracil 50mg
Phenelzine15mg and Ciclesonide80mcg
Which of her current medication can also cause ‘’cold and
flu’’ type symptoms.
A. Levothyroxine 50mcg
B. Mesalazine 400mg
C. Propylthiouracil 15mg
D. Phenelzine 15mg
E. Ciclesonide 80mcg
B. Mesalazine 400mg
**MR PITSR
“cold and flu” can be blood disorder symptoms
LEARN ANALGESICS DOSES
A mother whose son is suffering from fever would like to know the maximum dose of paracetamol she can give him per day .How much paracetamol 120mg/5ml should a 3 year old patient be given daily for fever MAX?
a. 5ml
b. 7.5ml
c. 15ml
d. 30ml
e. 40ml
d. 30ml
CONSTIPATION
Life style advice: increase fiber, reduce starchy foods, exercise
regular bowel motions – 3 times a day – 3 times a week=>spectrum of frequency
Red flag symptoms – blood (dark/brown) in stools , unexplained weight loss, clozapine: can lead to impaction
Causative drugs – opioids , TCAs, CCBs, Aluminum containing
LAXATIVES: BOSS G=>bulk forming, osmotic, softer, stimulants, glycerin suppository
Stay hydrated with magrocols!
Long term can cause hypokalaemia
**age is a problem when it comes to Dyspepsia
DIARRHOEA
Give lifestyle advice: plain foods
STAY HYDRATED: ORT
TRAVELLER’S DIARRHOEA: excempt=>USA, Canada, New Zealand, Australia, Western Europe
loperamide – over 12 yrs.
Pepto bismo – over 16 years
When to refer: blood, weightloss, persistant/systemic illness=>last 24 hrs+ and less than1 yr, then refer, 48hrs and less than 3, refer, 72hrs for everyone else, medication=>clindamycin (c. diff)
Causes – gastroenteritis, norovirus, food poisoning
TRAVEL SICKNESS
Symptoms–dizziness,nausea,vomiting,burping, sweating.
Treat mild cases and refer severe cases.
Over the counter Rx
**recommend: Travel (acupressure) bands (child that gets car sick)
Hyoscine hydrobromide tablets (least chance of drowsiness, KWELLS)
Promethazine tablets (Phenegan, long flight)
>promethazine teoclate=>severe morning sickness
Cinnarazine tablets (stugeron)
GORD
> A condition where acid from the stomach leaks up into the oesophagus.
Occurs when ring at the bottom of the oesophagus become weakened.
symptoms include – heartburn , acid reflux , bloating , bad breath , belching, nausea
1st line: Alginates=>raft forming (gaviscon), H2RA (famotidine, cimetidine=>interacts with many drugs), PPIs (OTC esomeprazole GSL 7, P 14, long-term must be prescribed, complications: GLGOH=>mask gastric cancer, lupus, gastric infections like c. diff, osteoporosis, hypomagnesaemia), eat early, small quantities but frequent, raise head of bed, avoid certain foods.
REFER – weight loss, constant vomiting, blood in vomit, on medication e.g. NSAIDs=>cause GI irritation/vomitting=>coffee grounds, DOACs
