OTC medication practice points

Question 1

Oral rehydration salt (adults, children 12+)

Answer 1

Solution
200mL every 30 min
Max. 4L/day

Effervescent
2 tabs in 200mL water every hour for 1st SIX HOURS
(12-20 tabs in 1st 6 hours)
Max. 40 tabs/day

Question 2

Oral rehydration salt (children) - mild-moderate dehydration

Answer 2

1-3 yrs
100mL every 90 min
Max 1.4L/day

3-6 yrs
100mL every 60 min
Max 2L/day

6-12
100mL every 30 min
Max 2.6L/day

Question 3

Loperamide (adults/children 12+)

Answer 3

1. Initial dose 4mg (2 tabs)
2. 2mg (1 tab) after each loose bowel movement
3. Stop dosing when loose stools no longer occur for 12 hours

Max 16mg/day (8 tabs)

NOT FOR CHILDREN <12

Capsule, tab or ODT

Question 4

Loperamide (PBF)

Answer 4

Pregnancy
- 1-2 doses AFTER 1st TRIMESTER

BF
- short term use only
- monitor infant for drowsiness

Question 5

Intranasal dosage forms

Answer 5

Shake well before use

Prime before use

Clear nose before use

Question 6

INCs (adult, children 12+)

Answer 6

2 sprays into each nostril ONCE DAILY
Can decrease to 1 spray if symptoms controlled (excl. ciclesonide)

Budesonide - 32mcg (4 sprays d)
Xtra strength - 64mcg (2 sprays d)
Max. 256mcg/day

PBF: budesonide (rhinocort)

Question 7

INCs (children)

Answer 7

Mometasone (2-12)
1 spray (50mcg) into each nostril ONCE DAILY

Budesonide (6-18)
128mcg into each nostril ONCE daily

Ciclesonide (6-18)
2 sprays (100mcg) into each nostril ONCE daily

Question 8

Intranasal antihistamines (adults)

Answer 8

Levocabastine 2 sprays each nostril TWICE daily
Max. 4x/day
Max. 8 weeks

Azelastine 1 spray into each nostril TWICE daily
Also: comb’d w/ fluticasone (same)

PBF: Levocabastine

Question 9

Intranasal antihistamines (children)

Answer 9

Levocabastine (6+)
2 sprays each nostril bd

Azelastine (5+)
1 spray each nostril bd

Question 10

Oral less sedating antihistamines

Answer 10

All: 1 tablet a day prn until symptoms are controlled

Fexofenadine
120mg - 1 to 2 (patient dependent)
180mg - 1 tab 1 daily

PBF: Loratadine
Fexofenadine, Desloratadine (T2,3 ONLY)

Question 11

Oral less sedating antihistamines (children)

Answer 11

Loratadine
Chewable tablets –> 5mg tab
2-9y = 1 tab D
9+ = 2 tab D
Syrup –> 1mg/mL
1-2y = 2.5mL D
2-12y <30kg (incl) = 5mL D
2-12 y 30kg+ = 10mL D

Fexofenadine
Suspension
2-11y = 5mL (30mg) bd prn

prn until symptoms gone/controlled

Question 12

Oral sedating antihistamines (adults)

Answer 12

Dexchlorpheniramine
1 tab (2mg) q6h prn
OR
5mL (2mg) q6h prn

Promethazine
10mg tab OR 25mg tab
25-75mg nocte
OR
10-20mg 2-3x daily

PBF: Dexchlorpheniramine
Promethazine safe, AVOID USE CLOSE TO TERM
monitor infant sedation

Question 13

Oral sedating antihistamines (children)

Answer 13

Dexchlorpheniramine
Syrup 2mg/5mL (q6h, prn)
2-4y = 1.25-1.75 mL
4-6y = 1.75-2 mL
6-12y = 2-4 mL (0.8-1.6mg)

Promethazine
Elixir (5mg/mL)
2-5y = 5-15mL nocte OR 5mL 2-3x/day
6-12y = 10-25mL nocte OR 10mL 2-3 days

nocte: 0.5mg/kg MAX 25mg

2-3x/day: 01.25mg/kg MAX 12.5mg

STICK TO LOWEST DOSE POSSIBLE

Question 14

Intranasal decongestants (6+)

Answer 14

Oxymetazoline (0.05%)
- 2 sprays into each nostril twice daily
Max. bd

Xylometazoline
- 2 sprays into each nostril twice daily (can incr. to 4x/day)

3 days only

Question 15

Oral decongestant (adult, children 12+ excl.)

Answer 15

Phenylephrine (10mg)
- 1 tab q4h prn
Max. 6 tabs/day

Pseudoephedrine (60mg)
- 1 tab q6h prn
Max. 4 tabs/day (240mg/day)

DO NOT REC IN CHILDREN

Question 16

Saline solution (all)

Answer 16

Prime pump + clear nose

Keep head upright
Fully depress pump and inhale

2 sprays each nostril q2-3h prn

BABY (use 5-10min before feeding)
<1y = 1 spray/nostril of Baby Saline Spray prn
>1y = 1-2 spray/nostril of Baby Saline Spray prn

Let doctor know

Question 17

Pyrantel (adult, children 1+ incl) PBF

Answer 17

10mg/kg = 1 square/10kg

10-25kg (1-5y) = 1-2 sq
26-45kg (6-10y) = 3-4 sq
46-56kg (11-13y) = 5 sq
57-70kg (14-18y) = 6 sq
Adults (> 70kg) = y sq

Retreat after 2 weeks if reinfestation occurs

Question 18

Mebendazole (adults, 2+) NON PBF

Answer 18

Tablets/Choc chews (100mg)
1 tab

Suspension
5mL

Repeat after 2 weeks

Question 19

Tinea cream

Answer 19

Terbinafine (feet) (1%)
Clean + dry affected area
Apply to affected area DAILY
Incl. surrounding skin

Use for 1 week
Max 2-4 wk for soles of feet

Miconazole (2%) or Clotrimazole (1%)
Apply thin layer TWICE daily
Use until symptoms disappear + 2 weeks post-symptoms

Question 20

Tinea spray

Answer 20

General:
Shake well before use
Hold 15cm from affected area

Terbinafine (1%)
Once daily for 1 week
Max 2 wk, monitor effectiveness

Miconazole (2%)
Apply thin layer TWICE daily
~ 4 weeks, monitor effectiveness

Question 21

Tinea powder

Answer 21

Miconazole (2%)
Apply to lesion + inside clothes where the affected area is
TWICE daily

Continue treatment uninterrupted until lesion is completely healed (~4 weeks)
- Monitor effectiveness

Question 22

Tinea tincture (nail)

Answer 22

Miconazole (2%)
- Clean and cut nail short as possible
- Apply thin layer to affected nail + surrounding area TWICE daily
- Clean product build up using polish remover (acetone based) BEFORE REAPPLICATION

Continue uninterrupted treatment (more than 2 mo) until new nail grown/lesion completely cured

DON’T PUT OVER BROKEN SKIN/LESIONS

Question 23

Tinea liquid

Answer 23

Terbinafine (1%)
Apply once to feet

• Clean and dry both feet thoroughly
• Treat both feet (even if no symptoms)
• Let dry to a film 1-2 min
• Wash off 24 hours later

Wash hands
Do not massage into skin
See dr if no improvement after 1 week

Question 24

Severe skin inflammation (w/ hydrocortisone)

Answer 24

Clotrimazole 1% + hydrocortisone 1% (Hydrozole)
Use TWICE daily for 1 week
Continue with Clotrimazole 1% cream for 2 weeks after infection + inflammation clears
Apply to thinly clean/dry skin
Wash hands after use (exc. tinea manuum)

Question 25

Bulk forming (adults)

Answer 25

Psyllium Husk
5g level spoonful in 250+ mL
15g 1-3x/day

2 caps 3x/day
Max. 6 caps

not before bed
drink more water

1-3 days onset
Use for 1 week

Question 26

Bulk forming (children)

Answer 26

Psyllium Husk
5g level spoonful in 250+ mL
6-11y = 7.5g 1-3x/day

Better to stick with powder only

Question 27

Osmotic (adults, children 12+)

Answer 27

macrogol
1 sachet in 125mL water DAILY
Max 3 sachets daily

Take on empty stomach for faster effect

0.5-3h onset
Use for 1 week

Question 28

Osmotic (children)

Answer 28

Macrogol
2-5y = 1 sachet a day in 60mL water
6-11y = 2 sachets a day

Question 29

Sumatriptan (50mg) = imigran

Answer 29

Take 1 tab at onset of migraine
- If symptoms improve, do not take anymore
- If symptoms continue after taking, see dr.
After 2 hours +, if experiences a new migraine, take 1 more tab
- after that, if still no improvement (ie new migraine), see dr.

Question 30

Metoclopramide + paracetamol (5mg/500mg) = anagraine

Answer 30

1-2 tab an onset
1 q4h prn

Max 6 tabs/24h
No improvement after 1 day, see dr.

Question 31

Docusate + senna

Answer 31

Take 1-2 tablets before bed
Max 4 tablets/night

Take with water
Not for long term use –> fluid and electrolyte imbalance

Senna = 6-12h onset
Docusate = 24-72h onset

Question 32

Poloxamer (children 0-3)

Answer 32

Coloxyl infant drops
Use 3 times daily –> can put in water/juice
0-6m = 0.3mL
6-18m = 0.5mL
18-36m = 0.8mL

2-3 days onset

Question 33

paracetamol (adults)

Answer 33

tab/cap (500mg)
1-2 q4-6h prn
Max 4g/day = 8 tabs/day

Rapid Soluble tab
dissolve 1-2 tabds in room temp water, q4-6h prn
Max 8 tabs/day

Question 34

paracetamol (children)

Answer 34

15mg/kg every 4-6 hours

Max 30mg/kg (do not exceed 4g) per day

After 2 days, fever does not subside = see dr

Question 35

ibuprofen (children)

Answer 35

5-10mg/kg (max 400mg) 3-4x/day

Stay hydrated while taking this
If it is low-grade fever, may not require medication

Question 36

Gaviscon dual action (more Ca, to neutralise excess stomach acid)

Answer 36

Take after meals + before bedtime

CHEW TABLETS, FOLLOW WITH WATER
Adults:
4 tabs, up to 4x/day
6-12y:
2 tabs, up to 4x/day

LIQUID SACHETS (portable)
Adults: 2 sachets (20mL)
6-12y: 1 sachet (10mL)

Use for 1 week at most, see if there’s improvement

Question 37

Esomeprazole 20mg
Pantoprazole 20mg

Answer 37

18+
1 tab a day for 1-2 weeks (depends on which box bought

PBF: Not safe in 1st trimester

Useful/not useful –> need more/alternative –> see Dr after 1-2 weeks