OTC flashcards
Chloroquine
Avoclor Any age 2 tablets weekly 1 week before 4 weeks after Side effects: GI, visual, seizures, psoriasis AVOID in: epilepsy, cyclosporin, digoxin, amiodarone, citalopram, mefloquine Fine in pregnancy
Give with proguanil
14 tablets for 2 weeks holiday
Proguanil
Paludrine Any age 1 week before 4 weeks after Side effect: diarrhoea Safe in pregnancy
Give with chloroquine
98 tablets for 2 weeks
Traveller’s diarrhoea
Caused by e.coli
Follow strict hygiene measures
NO LOPERAMIDE
GSL:
Dioralyte, all ages
Dioralyte relief: over 3 months
Prepare with 200ml of water, once reconstituted store in fridge. Use within 24 hours
Boil before use
Travel sickness
Antihistamines and anticholinergics are equally effective
Antihistamines for travel sickness
Cyclizine- POM
Cinnarizine- OTC, 5 and over
Promethazine- most sedative, phenergan, not for under 6s OTC
Anticholinergic for travel sickness
Hyoscine hydrobromide (Kwells)- not for under 10s Kwells kids- not for under 4
Hayfever
Allergic rhinitis
Loratadine first line
Nasal saline for runny nose
Don’t routinely recommend sedating antihistamines
If loratadine fails, sodium cromoglicate eye drops and nasal corticosteroid
Systemic antihistamines
Cetirizine- 6+ Loratidine- 2+- least sedative Acrivastine (benedryl)- 12+ Chloramphenamine tablets 6+ Piriton liquid 1+
Chloramphenamine
Inhibits phenytoin metabolism
MAOI enhances effect
Not for use in pregnancy
Ocular antihistamines
Antolazine 5+
AVOID in MAOIs and glaucoma
Nasal antihistamines
5+
Nasal corticosteroids
Beconase Flixonase 18+ Side effects: bitter taste, nasal irritation Avoid in pregnancy
Ocular and nasal mast cell stabilisers
sodium cromoglicate eye drops 6+
Fine in pregnancy
Insect bites and stings treatment
Local irritation: hydrocortisone 10+
Antihistamine
Analgesia
AVOID: calamine lotion
vinegar
Topical antihistamines- causes sensitisation
Systemic infection: refer
UVA
skin ageing and wrinkling
tanning ray
no damage to the epidermis
UVB
sunburn and redness
more damage to epidermal layers
skin cancer cause
Signs to look out for moles
asymmetry
border- jagged edges
colour- varying shade
diameter- 7mm or more
Suncreams
UVB only
Moles referral criteria
facial lesions over 40
itchy, irritated or bleeding
a mole that’s changed
Prickly heat
Milaria rubia Itchy rash, smalled raised spots Usually few days after sun exposure Develops when someone sweats more than normal sweat glands become blocked Use calamine lotion
Cystitis referral symptoms
soreness in child under 16 recurrent burning in men dark, cloudy urine more than 7 days generally unwell flank pain haematuria immunocompromised women over 70
recurring cystitis
three episodes in a year
2 in 6 months
Risk factors of cystitis
young women
diabetes
tampon use
pregnancy
Treatment of cystitis
potassium citrate- alkalise urine
sodium bicarb and citrate- cautioned in HTN
cranberry juice prophylaxis
Referral warts and verrucas
anogenital multiple or widespread diabetes lesions on face over 50 first time bleed or itch without provoking
Referral corns and calluses
impaired peripheral circulation
pain or difficulty walking
diabetes
treatment failure
Treatment for warts
salicyclic acid-2+
use vaseline around healthy skin
every day for 12 weeks or longer
Referral for chillblains
severe/recurring dont improve fever swollen glands swelling and pus forming
Compression stocking
Class 1: pregnancy and early vaccine class 2: medium varicose and prevention of ulceration class 3: severe varicose and treating ulcers
Headlice
only treat affected
2 applications 7 days apart
permethrin, malathion and dimeticone- 6 months+
Apply to dry hair
Treatment for crabs
malathion and permethrin
apply twice with 7 days apart
Jock itch
miconazole and clotrimazole
Referral threadworms
recent travel abroad
under 12 cannot be treated OTC
broken skin
pregnant
Threadworms
mebendazole 2+
side effects: abdo pain, rash
avoid with phenytoin, carbamazepine and cimetidine
avoid in pregnancy
piperazine- > 3months
Seasonal allergic conjunctivitis
same time each year
usually both eyes
perennial allergic conjunctivitis
daily symptoms of conjunctivitis throughout the year in both eyes, often on waking.
Contact dermatoconjunctivitis:
conjunctivitis with allergic dermatitis of the eyelids. Occurs in response to the use of eye drops.
Giant papillary conjunctivitis:
occurs in people using soft contact lenses- may occur with hard contact lenses and following eye surgery.
Chloramphenicol
drops 0.5%–> fridge
ointment 1%–> fridge
avoid unless essential
risk of neonatal baby syndrome
blepharitis referral criteria
inward/outward turning of eyelid
systemic
painless nodular lesion
Medications causing dry eyes
diuretics HRT Isotretinoin TCAs Beta blockers
Treatment for dry eyes
hypromellose 1%, 0.3%, 0.5%- hourly or half-hourly dosing
Polyvinyl alcohol
Carbomer- TDS prn
Lubricants- bedtime as blur vision
Alopecia referral
fungal infection of scalp
patients under 18
sudden onset
suspected iron deficiency
Alopecia treatment
Minoxidil
18-65
avoid in pregnancy and hypertension
Causes of dry mouth
sjogrens syndrome
radiotherapy
diabetes
diuretics
Medicines inducing dyspepsia
Antibiotics ACE inhibitors bisphosphonates iron metformin metronidazole nitrates potassium supplements steroids theophylline NSAIDs
Antacids
constipation with calcium
diarrhoea with magnesium
do not take for longer than 2 weeks
not for use under 12s
Alginates
can be used in pregnancy
First line in GORD
H2 antagonists
> 16 years
side effects diarrhoea, constipation, headache and rash
PPI
e.g omeprazole
18+
side effects headache, diarrhoea, nausea and vomiting and flatulence
Interactions: warfarin, digoxin, clopidogrel, phenytoin, antifungals
Dysphagia referral symptoms
Anaemia Loss of weight Persistent vomiting Pts over 55 years with unexplained recent onset Pain in arm
Cardiac or heartburn
Heartburn doesnt radiate to shoulders, neck or arm
Usually comes after meals
Usually respond to antacids
Rarely accompanied by cold, sweat, lightheadedness or dizziness
Drugs that cause constipation
Aluminium Antidepressants Antiepileptics Antipsychotics Calcium supplements Opioids diuretics iron
IBS referral
Blood in stool children under 16 Fever nausea and vomiting over 45 with recent bowel habit change severe abdo pain steatorrhoea
Treatment for IBS
Hyoscine 12+, avoid in pregnancy, caution in glaucoma
Mebeverine 10+, safe in pregnancy
Peppermint oil- colpermin 15+, mintec 18+, alverine 12+
Avoid colpermin and mintec in breastfeeding
Risk factors for haemorrhoids
being overweight
being over age 45
pregnant
fh
Treatment of haemorrhoids
Anusol/anusol HC- no longer than 7 days
Ear wax symptoms
Ear pain decreased hearing dizziness ringing in ear itching or drainage in ear
Immediate referral ear wax
Dizziness and tinnitus
Fever in children
Foreign body in ear canal
Pain in middle ear
Referral for ear wax
discharge of liquid or pus
no improvement after 4 days
pain on palpitation of mastoid bone
fever
Treatment for otitis externa
choline salicylate 1+
acetic acid 12+
Early signs of lymes
Bulls eye rash
edges of rash may feel slightly raised
rash usually about 15cm diameter
Late signs of lymes
pain around joints
numbness and paralysis
heart problems e.g. myocarditis
meningitis
3 days
3 weeks
3 months
URTI
Acute/chronic bronchitis
Chronic bronchitis, TB, carcinoma
Chronic productive cough
more than 8 weeks
Colours of sputum
Yellow, Brown, Green = Infection present
Thin, frothy, pink tingled = Left ventricular failure
Rust coloured = Pneumonia
Dark red = Carcinoma (occasional red sputum = force of coughing – not serious)
Thick, mucoid to yellow = Asthma
Offensive foul-smelling = Bronchiectasis or lung abscess
