OTC: General Flashcards
1
Q
3 types of conjunctivitis?
A
Bacterial: OE then BE, Sticky purulent discharge, gritty feeling
Viral: BE due to cold/flu, Watery eyes with redness and gritty feeling - self limiting or aciclovir POM
Allergic: BE, watery, red, itchy- due to hayfever/pollen
2
Q
Referral criteria for conjunctivitis?
A
- Closed angle closure glaucoma symptoms (n/v, blurred/hazy vision, rainbow rings, photophobia, intense eye pain and headache): can cause blindness
- Previous laser /surgery within 6 months
- Eye inflammation with rash on face
- Foreign body in the eye
- Eye/head trauma
- Keratitis (esp with contact lens)
3
Q
Immediate referral in those with conjunctivitis (3)?
A
Glaucoma symptoms
- Sudden severe eye pain
- N/V
- Cloudy eye
- blurred/halo vision
- headache
Keratitis (corneal ulcers)
- severe eye pain, loss of vision, photophobia, redness around eyes
Uveitis
- irregular pupil shape with no response to light and photophobia
4
Q
OTC treatment for conjunctivits
A
1) Chloramphenicol eye drops or oint: 2yrs +
2) Brolene: propamidine isoetionate
Refer if no improvement in 48hrs
5
Q
Chloramphenicol eye drops dosage OTC?
A
1-2 drops every 2 hrs for 1st two days whilst awake
then every 4hrs next 3 days ( 5 day course)
Fridge
6
Q
Chloramphenicol eye ointment dosage OTC?
A
TDS/QDS
7
Q
Contraindications for chloramphenicol?
A
Myelosuppression
Blood dyscrasia
8
Q
Conjunctitivits lifestyle advice?
A
Wash hands before and after use Dispose tissue after use Avoid sharing pillows Bathe eyelids No lens before or 24hrs after use
9
Q
What causes vaginal thrush?
A
Candida albicans
10
Q
Symptoms of vaginal thrush?
A
Itching and sore
Cottage-cheese like discharge (cream and curd like)
No smell
Pain during sex
Stinging skin when urinating due to scratching
11
Q
OTC referral ages for thrush?
A
<16yrs
>60yrs
OTC failure >7days
Recurrent attacks (>2 episodes within 6 months - underlying cause)
12
Q
OTC referral criteria for thrush?
A
<16yrs
>60yrs
OTC failure >7days
- Recurrent attacks (>2 episodes within 6 months - underlying cause)
- Smell and colour: grey, watery, fishy - BV
- Yellow/green, frothy, foul - vaginal trichomoniasis
- Vag spotting, abd. pain, dysuria - gonnorrhoea/chlamydia
- sores ulcers blisters - herpes
- STI (inform partner)
- Vaginal bleeding - cancer?
- Med ADR? antibiotics, SGLT2 inhibitors (gliflozins)
- Pregnant/diabetic/immunocompromised
13
Q
Treatment options OTC for thrush?
A
Fluconazole 150mg STAT PO: 12-24hrs for symptom relief - treat systemically
Clotrimazole pessary/cream - internal/external (pessary at night, immediate relief)
14
Q
Which OTC formulation would not be suitable for pregnant women?
A
Antifungal cream with applicator
15
Q
Lifestyle advice for vulvovaginal thrush?
A
Cotton underwear Wipe front to back Avoid soap/douching Change clothes and wash after physical activity Refrain from sex due to spread moisturise with emollient
16
Q
How would you treat severe infection of candidiasis?
A
Either two doses of oral fluconazole 150 mg (taken 3 days apart) or, if oral treatment is contraindicated, two doses of clotrimazole 500 mg vaginal pessary (used 3 days apart).
17
Q
How would you treat candidiasis in pregnancy?
A
Intravaginal clotrimazole or miconazole should be prescribed for at least 7 days.
Oral antifungals should not be used.
18
Q
What drugs can antifungals used for candidiasis interact with?
A
Anticoagulants like warfarin as antifungals are enzyme inhibitors CYP 3A4, CYP 2CP
Statins, CCBs, Phenytoin
Tacrolimus/Sarolimus: increased levels
19
Q
What can EHC be used for?
A
Unprotected sex
Contraceptive failure
Advance supply e.g. going on holiday
20
Q
Referral criteria for EHC?
A
- Severe liver impairment
- unprotected sex >5days: needs copper IUD
- Period changes: late/light/heavy
- Interacting medicines: enzyme inducers (carbamazepine, phenytoin, rifampicin, st johns wart, griseofulvin) - needs double dose but unlicensed OTC
21
Q
What are the two EHC options?
A
Levonorgestrel - 3 days, 72hrs (16+)
Ulipristal - 5 days, 120hrs (No age)
22
Q
Which EHC can you take more than once in the same cycle?
A
Levonorgestrel - can
Ulipristal - contra indicated
23
Q
EHC should be avoided in?
A
Severe liver impairment
Ectopic pregnancy risk
Chrons disease
Asthma treated with steroids
24
Q
Which EHC has to be stopped in breastfeeding?
A
Levonorgestrel OK avoid nurding 8hrs
Ulipristal - Not recommended for 1 week
25
Regular contraception with EHC?
Levonorgestrel - OK, start stat and barrier for 7 days
Ulipristal - use condom until next period (5days after and barrier for 2 days)
Barrier for prog - 2 days
Barrier for combined - 7 days
26
Advice for EHC?
Take asap.
If vomit within 3 hrs, take a double dose
Barrier method until next period
ulipristal reduced effectiveness of current contraception so use barrier methods
Abnormal bleeding at period - see gp
delayed period - see gp: levo >5days, uli >7days
Severe abdominal pain: ectopic pregnancy
27
Significant interactions with EHC?
Rifampicin, ciclosporin
28
How many missed pills of regular contraception would prompt to get EHC?
Combined: 2pills (week 1 day 1-7 EHC/week2 day 8 -14 but barriers or 3 day 15-21 no need ehc but precautions for 7 days)
29
Legal age of consent for sex in the UK?
16yrs, IF <16YRS: Use fraser
30
Offences are considered statutory rape in those under
13yrs
31
What is cystitis?
Infection caused by e.coli
32
Symptoms of cystitis?
Dysuria, haematuria, foul smell, polyuria, dark/cloudy urine
33
Referral criteria for cystitis?
<16, >70
Men and children
Recurrent: >2 episodes in 6 months or 3 in a year
Duration: >48hrs
Severe symptoms
Lower back/flank pain
Systemic symptoms e.g. fever, n/v (pyelo?)
Haematuria - inflammation/stones, if not painful it can be cancer
Abnormal discharge
Medication ADR: allopurinol/cyclophosphamide
34
Which patient groups are predisposed to UTI?
Immunocompromised
pregnant
diabetic
35
Treat UTI OTC?
Sodium/potassium sachets - 1 sachet TDS for 2 days - neutralises urine and provides symptomatic relief
36
Interaction for sodium/potassium sachets?
Contraind in hyperkalaemia/hypertension/heart disease/pregnancy/kidney disease/salt restricted diet (eg on lithium)
Interact with: ACEi, spironolactone, potassium sparing, lithium
37
Lifestyle advice for UTI?
```
lots of water
pee after sex
wipe front to back
cranberry juice
avoid douching
cotton underwear
```
38
What are the OTC supply criteria for sumatriptan?
1) Must first be diagnosed by a dr or pharmacist
2) Established pattern: 5 attacks per year (approx)
3) Simple analgesia ineffective
39
Describe the different types of headaches
1) intense eye pain: cluster headache
2) Sinus headache: runny nose
3) aura/no aura/ n/v / unilateraly throbbing / photosensitivity / triggers- migraine
4) tight band pulsating around head - tension headache
40
When would you refer headache?
- OTC analgesia failure >1 day
- Oral contraceptive
- Recurring
- <12
- Severe headache >4hrs
- Trauma/injury
- inc severity and frequency
- severe deep pain when lying down
- stiff neck (meningitis)
41
When would you refer after that pt has been on sumatriptan?
- 1st time migraine and >50yrs
- >4 attacks/month
- >24hr headache
- Migraine symtpoms have changed
42
What conditions should sumatriptan be avoided in?
```
severe renal/liver impairment
CVS disease (recent tia/stroke/mi) and epilepsy
```
43
Give some oTC remedies for migraine.
1) Co-codamol: max 3 days and can cause rebound headaches
2) Migraleve pink (with anti emetic buclizine)
3) Syndol: para codeine caffeine
4) n/v with migraine: buccal buccastem prochloprerazine
5) nurofen: ibuprofen
44
How to counsel a patient on the use of sumatriptan?
OTC: max 2 doses of 50mg and POM is max 6 x 50mg.
Take one dose stat on onset of symptoms. Then do not take another unless its for another attack. (Leave 2 hrs gap) should work within 30mins.
45
What is insomnia?
Inability to maintain sleep.
Inability to go to sleep.
Poor quality and duration of sleep.
Early awakening from sleep.
46
OTC products for insomnia are suitable for those over the age of ____
16yrs
47
What OTC treatments are available OTC for insomnia?
1) Sleep hygiene
2) Nytol: diphenhydramine
3) Sominex/phenergen: promethazine
48
The maximum duration you can use phenergen/sominex (promethazine) OTC for insomnia?
1 week
49
The maximum duration you can use nytol (diphenhydramine) OTC for insomnia?
2 weeks
| 20mins before bedtime
50
OTC insomnia preparations are contra-indicated/cautioned in _______
Epilepsy
| Myasthenia gravis
51
Give examples of sleep hygiene advice.
Avoid blue light
Have a consistent routine
Read before bed/meditation/bath
Avoid drugs/alcohol/exercise before bed (stimulant)
52
What are the symptoms of motion sickness?
Pale skin
Dizzy
N/V
Cold sweats
Triggers: sea, car, air
53
Three point criteria when recommending products for motion sickness?
1) Age
2) Journey duration
3) Drowsiness
54
Hyoscine hydrobromide is an antimuscuranic which can be used for motion sickness. What are the contra indications?
Glaucoma
Prostate enlargement
60yrs+
55
Referral criteria for motion sickness?
If symptoms last after travel and if on TCA/phenothiazines.
56
What non-drug options are available for motion sickness?
Sea band/garlic herbal capsules: ok for pregnancy and in those that have contraindications
57
OTC options for motion sickness?
```
Hyoscine hydrobromide:
1) kwells kids 150mcg 4yrs+
joyride 3yrs+
2) kwells 300mcg 10yrs+
3) Scopoderm 1.5mg patch (72hrs)
```
4) Cinnarizine - Stugeron 15mg:
5) Phenergen (promethazine) 5mg/5ml or 10mg/25mg tablets
58
For journeys <4hrs what are the treatment options and doses?
Hyoscine hydrobromide (150mcg kids or 300mcg adults) - 30mins before travel then, 1 tab q6hrs max TDS
59
For journeys >4hrs what are the treatment options and doses?
Scopoderm - hyoscine hydrobromide 1.5mg patch: to apply behind the ear on the evening before or 5/6hrs before - lasts 72hrs
60
For journeys 4-8hrs what are the treatment options and doses?
Stugeron cinnarizine 15mg - 5yrs+: 1 tab 2 hrs before then TDS (half in 5-12yrs)
phenergen (promethazine) 2yrs+: take the night before (6-8hr duration)
61
Age for kwells kids and joy ride (hyoscine hydro bromide)?
Kwells kids: 4yrs+
| Joy ride: 3yrs+
62
Age for Kwells adult?
10+
63
Age for scopoderm patch?
10+
64
Age for stugeron?
5+
65
Age for phenergen?
2+
66
Lifestyle advice for motion sickness?
Stare at a still object
Relax with music
Open windows - fresh air
Stay still
67
Symptoms of BPH?
Chronic urinary retention
Urgency
Weak stream
Difficulty passing urine/fully completing bladder
68
Symptoms of BPH that require referral?
- <3months (new)
- cloudy urine / haematuria / dysuria
- fever - undiagnosed UTI
(UTI symptoms - refer stat)
69
Interactions with BPH?
a-blockers or any other hypotensive drugs
70
Conditions with BPH that require referral?
- prostate surgery
- uncontrolled diabetes
- urinary incontinence
- blurred/cloudy vision
- scheduled surgery for glaucoma/cataract
71
What is BPH?
prostate gland enlargement = pressure on the urethra = symptoms
72
BPH complications?
Can cause a UTI - refer to GP
| Inability to urinate - Urgent A+E: may need catheter to drain (severe pain + bladder swelling)
73
Tamsulosin 400mcg supply criteria OTC?
- Symptoms present for min3 months
- 45-75yrs
- 2 week supply initially then a further 4 weeks if improvement in those two weeks - after that must be diagnosed by a dr for further supplies
74
Tamsulosin dose?
400mcg ON or evening with meals (initially postural hypotension so take while sitting down and rarely SJS)
75
Tamsulosin is cautioned in
those taking CYP inhibitors e.g. antifungals
76
how long after tamsulosin use should a patient see a dr?
6 weeks
77
How often should tamsulosin be reviewed?
annually
78
Tamsulosin counselling?
```
Swallow whole do not chew or crush
With meals
6weeks - gp
12 months - review
SE: drowsy/dizzy - driving, postural hypotension
```
79
Tamsulosin has an enhanced hypotensive effect with the following drugs:
other a-blockers
- indoramin
- doxazosin
80
Tamsulosin interacts with the following drugs:
```
Enzyme inhibitors e.g. antifungals
warfarin
verapamil
diclofenac
PDE5 inhibitors e.g. sildenafil: excessive hypotension
```
81
What is orlistat used for?
To help weight loss in conjunction with a low fat diet
Inhibits dietary absorption of fats
BMI >28kg/m2
82
Requirements for the use of orlistat?
BMI >28kg/m2
| Age 18yrs+
83
When would you need to refer those on orlistat?
1) Conditions: hypertension, hyperlipidaemia, diabetes: may require dose changes, kidney disease, malabsorption, rectal bleeds
2) Drugs: levothyroxin, amiodarone and ciclosprin (reduces levels), warfarin (vit k and inr), contraindicated with acarbose, antiepileptic drugs (increases seizure risk)
3) no weight loss in 3 months
4) max 6 months use
5) preg/bf
84
orlistat should be cautioned in:
those with vitamin deficency especially fat soluble vitamins ADEK - recommend supplements at night or 2hrs after orlistat
+ contraception as severe diarrhoea can reduce the effectiveness: use additional precautions
85
Talk about orlistat OTC.
- Alli - 60mg capsules - max 180mg per day
- 60mg TDS before with or upto an hour after main meals
- omit doses if missed meals or no fat in meals
- SE: oily stools and faecal incontinence
86
Lifestyle advice with orlistat/constipation?
```
5 x fruit/veg per day
2.5L fluid
18-30g fibre
30mins/day exercise for 5 days
alcohol 2-3units a day max 14 units and alc free days in between
```
87
What is constipation?
small, hard stools passes less frequently than normal (NICE: < 3x a week)
- straining
- incomplete defeacation
- abd pain/bloating
- nausea
88
When to refer constipation?
- blood in stools
- unexplained weight loss
- >40yrs and sudden
- hypothyroid symptoms: weight gain, cold intolerance, thin hair, fatigue
- obstruction
- laxative abuse
- constipation > 2 weeks
89
Drugs that can cause constipation?
opioids/iron/TCA/ aluminium/ CCB - verapamil /diuretics/antimuscuranics/antihistamines
90
1st line for constipation?
Lifestyle. Fibre intake around 30g, increase fluid intake, fruit and veg x5, alcohol within limit (14 units weekly), do not hold in faeces, exercise 30mins/5days
91
2nd line for constipation?
Bulk forming - methylcellulose, isphagula husk 6+, sterculia 6+: 2-3days to work, SE oesophageal and intestinal obstruction, swallow whole and not just before bed
Osmotic - movicol 2-11yrs paeds or 12+ adults, lactulose 3months +, magnesium sulphate 12+: increases water in colon, works in 2-3days, se: discomfort flatulence cramps
Stimulant - senna 6+ POM/12+ GSL, docusate (also a stool softener) 18+, bisacodyl 10+, sodium picosulfate 10+ - increases GI motility and works in 6-12hrs so take ON
^ glycerin suppositories: work in 15-30mins 4g adults, 2g children <12 and 1g infants
Stool softeners - liquid paraffin 3yrs+: not recommended as causes anal seepage, lipoid pneumonia and malabsorption of ADEK
92
Laxatives suitable for pregnancy?
1) Bulk forming - isphagula husk but few days to work
2) Osmotic: lactulose
3) Stimulant senna but not at term or birth - induces contractions
93
Laxatives unsuitable for elderly
bulk forming as can cause obstruction
94
LAXATIVES SUITABLE FOR CHILDREN
1ST LINE = LACTULOSE (OSMOTIC)
95
Laxatives suitable for opioid-induced constipation?
1) Osmotic - lactulose/movicol
2) Stimulant - senna
NO BULK FORMING: RISK OF OBSTRUCTION
96
Age category for bulk forming laxatives - isphagula and sterculia?
6yrs +
97
Age category for osmotic laxatives?
Movicol paeds 2yrs+
Movicol adult 12yrs+
Magnesium sulphate 12yrs+
Lactulose 3months +
98
Age category for stimulant laxatives?
Bisacodyl - 10+
Sodium picosulfate - 10+
Senna - 12+
Docusate - 18+
99
if a patient makes lifestyle changes for their constipation, how long will it take to work?
atleast 2 weeks
100
What is dyspepsia?
heartburn, reflux, GORD, indigestion, ulcers - upper abdominal symptoms
101
Symptoms of dyspepsia?
```
Reflux
GORD
heartburn
burning sensation/pain above stomach
n/v/abd pain/bloating
feeling 'full'
```
102
Referal criteria for dyspepsia?
- New onset in >55yrs
- ALARM symptoms: anorexia, loss of weight, anaemia, recurrent n/v, malaise/blood in stool
- used >4weeks
- no relief >2weeks
- Ulcer risk e.g. pain after eating food (gastric) or pain on empty stomach around 2-3hrs after food and interferes with sleep (duodenal)
- CVS: if HF, liver/kidney failure, risk of MI (radiating) or angina (worse on exertion)
- endoscopy within 14 days - false negative
- ADR
103
OTC treatment for dyspepsia?
1) Antacids/alginates: gaviscon
2) H2 rec antagonists - cimetidine
3) PPI - omeprazole/esomeprazole, pantoprazole
104
Lifestyle advice for dyspepsia?
```
smaller meals
fluid intake
fruit and veg
weight loss
smoking cessation
```
105
What drugs can cause dyspepsia?
```
NSAIDS
Warfarin
Aspirin
Theophylline
Steroids
Bisphosphonates
Iron
Abx
SSRI
Nitrates
```
106
Cautions with OTC dyspepsia treatment?
anyone with heart failure, hypertension, kidney/liver failure
volume depletion states
high potassium and sodium content
malabsorption of other drugs so 2hrs gap
107
Which antacids have low NA?
mucogel
| maalox
108
Age range for OTC dyspepsia tx?
18+
109
Which h2 receptor antagonist is available for dyspepsia?
cimetidine but POM (enzyme inhibitor)
| ranitidine - cancerogenic
110
PPis can be used for dyspepsia, what is the criteria?
omeprazole 10mg available OTC and pantop 20mg available otc and esomeprazole 20mg available
1-3 days to work
enzyme inhibitor
max 2 week supply
can cause hypomag/hyponat/fractures/osteoporosis
interactions:
warfarin - inc bleeding
clopidogrel - reduced antiplatelet effect use lansop
phenytoin - inc toxicity
