OTC treatment options

Question 1

Cold sores:

Aciclovir

Answer 1

Aciclovir may prevent cold sores from appearing if applied at first sign of attack. can speed up healing time if cold sore already formed.

Apply 5 times a day for 5 to 10 days, starting at first sign of attack

Safe in pregnancy and breastfeeding

Side effects - mild stinging or burning sensation

Question 2

Cold sores:

Famciclovir (PHARMACIST ONLY)

Answer 2

Used for recurrent cold sores

Take all 3 tablets as a single dose

Side effects: GI upset, headache, itch

Low risk in pregnancy, avoid in breastfeeding - aciclovir cream alternative

Question 3

Constipation:

Bulk forming laxatives (Konsyl-D, Metamucil)

Answer 3

Contains fibre that swells on contact with fluid to bulk up stool, encouraging stools to move through the bowel.

May take 2 or 3 days to start working. needs to be taken with lots of fluid.

Do not lie down straight after taking to prevent it getting stuck in your throat or bowel.

Safe in pregnancy and breastfeeding

Question 4

Constipation:

Faecal softeners (Docusate, glycerol suppositories)

Answer 4

Encourages mixture of dietary fat and water within the stool, making it easier to pass through bowels.

Most effective for recent mild constipation and may be useful for those with haemorrhoids.

Dose - 2 to 3 tablets bd (50mg); 2 tablets n (120mg)

Takes about 1 to 3 days to start working

Side effects - abdominal cramps, nausea

Safe in pregnancy and breastfeeding

Question 5

Constipation: Osmotic laxatives (lactulose, microlax enemas)

Answer 5

Work by drawing water into the bowels, softening the stool making it easier to pass. Needs to be taken with lots of water.

Takes up to 2 days to start working. microlax takes 30 mins

Safe in pregnancy and breastfeeding

Side effects: nausea, cramps, electrolyte disturbances

Question 6

Constipation: Iso-osmotic laxatives (molaxole)

Answer 6

Works by delivering liquid to the bowel rather than drawing it in from the body. softens the stool without loss of electrolytes.

Takes 1 to 2 days to start working

Safe in pregnancy and breastfeeding

Dose: 1 sachet daily, increased to 2 or 3 sachets daily if needed

Side effects: nausea, flatulence, abdominal pain

Question 7

Constipation: Stimulant laxatives (laxsol, bisacodyl)

Answer 7

Works by speeding up muscle movement to move the stool along by contraction. laxsol also contains a stool softener.

Takes about 8-10 hours to start working - take at night. Should not be for prolonged use.

Avoid in pregnancy unless prescribed by doctor. Safe in breastfeeding

Side effects: cramps, abdominal discomfort, diarrhoea

Question 8

Dandruff - Medicated shampoos (coal tar, salicylic acid)

Answer 8

reduce skin cell turnover, relieving scaling and itching. selenium and zinc pyrithione have mild antifungal properties.

coal tar can cause staining and smells bad. most shampoos will have a conditioner that should be used afterwards. coal tar can make scalp more sensitive to sunburn - sunscreen should be used.

stop using if scalp irritation or stinging occurs

Question 9

Dandruff - antifungal shampoos (ketoconazole)

Answer 9

useful when other treatments fail. These stop overgrowth of yeast.

may cause discolouration of blonde, grey or white hair. 2% strength is better.

How to use - lather the hair and leave for 3 to 5 mins before washing off. use twice weekly for up to 4 weeks, allowing a 4 week break in between courses. Can use mild cleansing shampoos in between applications

Question 10

Dermatitis - topical corticosteroids

Answer 10

reduce inflammation and itchiness. do not apply to broken skin or on face (without consulting doctor). Use for up to 1 week at a time (longer use should only be under medical supervision)

Dose - apply twice daily as needed for up to 1 week.

side effects - thinning of skin, stretch marks

Question 11

Dermatitis - soap free substitutes (aqueous cream)

Answer 11

soap can dry out the skin. soap substitutes should be used regularly to prevent this. aqueous cream should not be used as a moisturiser as it contains SLS (a detergent) which may aggravate dermatitis

Question 12

Diarrhoea and vomiting - ERT

Answer 12

replace lost electrolytes from diarrhoea and vomiting to prevent dehydration.

Only mix with water. for infants - boiled and cooled water should be used.

drink in small frequent sips, not big gulps as this can induce vomiting.

Once mixed, solution is good for 24 hours - discard after

safe in pregnancy and breastfeeding

Question 13

Eye conditions - Chloramphenicol (bacterial conjunctivitis)

Answer 13

Antibiotic eye drop. Helps reduce infection duration.

How to use - instil 1 or 2 drops into the affected eye every 2 to 6 hours for the first couple of days, and reduce frequency over time. continue for 48 hours after infection has cleared

Ointment - apply a thin ribbon of ointment every 3 hours. if using with drops, apply once at night.

Side effects - transient stinging, hypersensitivity. ointment may blur vision - avoid driving or operating heavy machinery until vision is clear.

advice - do not use decongestant eye drops as they can mask redness and therefore mask worsening infection; bathe eyelids with warm water and use warm compresses (wash after use)

Question 14

Eye conditions - allergic conjunctivitis (Livostin, Lomide)

Answer 14

Reduce histamine release, reducing allergic symptoms - itchy, puffy eyes.

Lomide is a preventative eye drop so needs to be used regularly (4 times a day). Side effects: burning, stinging, blurred vision

Combination decongestants should not be used for more than 3 days to prevent rebound congestion.

Advice - apply a cold flannel to soothe the eyes; wash hands frequently and after any contact with the eyes

Question 15

Eye conditions - dry eye (lubricating eye drops)

Answer 15

relieve dryness of the eye caused by imbalance in the tear film that lubricates the eye between blinks.

DO not cure dry eye but mimic the effect of natural tears to relieve symptoms.

Advice - protect eyes from wind and wear sunglasses outside; use eye wash to soothe eyes

Question 16

Fungal infections - athletes foot (miconazole, terbinafine

Answer 16

Terbinafine is fungicidal and resolves athletes foot with once daily application

Miconazole, clotrimazole etc are fungistatic. still effective but require more frequent application and need to be applied for 2 weeks after infection has cleared

Creams are good if area is moist as they are water soluble, absorbed into skin easier

Terbinafine dose - apply once or twice daily for up to 1 week

Question 17

Fungal nail infections - topical preparations

Answer 17

Products work better if most of the infected nail is removed before application. application needs to be consistent for best effect.

Myconail - Apply once or twice a week after filing nails. treat 6 months for fingernails, 9 to 12 months for toenails. contraindicated in pregnancy and breastfeeding.

Ciclopriox - apply every second day for 1 month, twice a week for 1 month, then once a week for up to 6 months. cleanse lacquer from nail once a week. safe in pregnancy and breastfeeding

Avoid nail varnish or artificial nails during treatment

Question 18

Haemorrhoids - Anusol

Answer 18

Contains zinc oxide which reduces secretion of fluids from damaged skin cells and provides a protective barrier

Dose - apply twice daily as needed

safe in pregnancy and breastfeeding

Question 19

Haemorrhoids - Proctosedyl

Answer 19

contains hydrocortisone, which reduces inflammation and swelling of the haemorrhoid, and cinchocaine, which numbs the area to relieve pain and itchiness

dose - apply 3 times daily for 1 week, then twice daily for 1 week, then once daily for 1 week

advice - best applied after a bowel motion (stays in contact with haemorrhoid longer). use applicator for haemorrhoids that are deeper

do not use in pregnancy, safe in breastfeeding

Question 20

Hay fever - oral antihistamines

Answer 20

Useful for symptoms that persist during the day. may be taken before hay fever occurs to prevent any delay in response. if hay fever is very mild, only needs to be taken when needed.

Drowsiness is uncommon with non-sedating, but can still happen in some people.

sedating antihistamines more useful when symptoms are problematic at night to help sleep

Side effects (non-sedating): uncommon; include headache, dry mouth, GI upset

Side effects (sedating): drowsiness, headache etc. makes skin more sensitive to sunlight - wear sunscreen

Question 21

Hay fever - nasal corticosteroids

Answer 21

Useful for treatment and prevention and as a first-line treatment for moderate to severe allergic rhinitis

Side effects: nasal dryness, smell and taste disturbances, headache.

Should not be used continuously for more than 6 months.

advice - shake bottle before use and blow nose.

Question 22

Indigestion/heartburn - antacids (Mylanta)

Answer 22

Neutralises stomach acid. suitable for mild and occasional symptoms.

avoid in pregnancy and breastfeeding (quick-eze appropriate).

Dose - 20ml three times daily after meals

Question 23

Indigestion/heartburn - alginates (gaviscon)

Answer 23

forms a protective raft on top of the stomach acid to protect lining of the oesophagus when the contents regurgitate upwards. many products contain calcium carbonate/sodium bicarbonate to neutralise stomach acid.

avoid in pregnancy and breastfeeding

dose - Acidex - 10 to 20ml after meals and before bed

Question 24

Indigestion/heartburn - PPIs (omeprazole)

Answer 24

used for short term symptomatic relief of reflux-like symptoms in people over 18.

Inhibits gastric acid secreting cells in the stomach.

refer to doctor if symptoms do not improve after 2 weeks.

Dose: 1 capsule once dail swallowed whole

side effects: GI upset (nausea, abdominal pain, diarrhoea), headache

avoid in pregnancy

Advice: capsules can be opened and granules can be sprinkled in some liquid (water, fruit juice). do not chew granules; take 30 mins before food for best effect

Question 25

Mouth ulcers - Topical analgesics

Answer 25

Contain a topical pain reliever or anaesthetic (lignocaine) to numb pain associated with ulcers

Dose - apply using index finger not more often than every 3 hours.

advice - wipe surface free of mucous before applying

do not use in children under 4 months. safe in pregnancy. small amount excreted in breastmilk - fine for short term use

Question 26

Mouth ulcers - Kenalog

Answer 26

forms a protective paste over the ulcer to speed healing. reduces inflammation and pain associated with ulcer. best applied after food and before bed.

avoid in pregnancy and breastfeeding (manufacturer advises to avoid). use bonjela instead.

avoid in untreated oral infection

Question 27

Oral thrush - miconazole and nystatin (PHARMACIST ONLY)

Answer 27

Antifungal to treat candida infection. hold dose in mouth as long as possible before swallowing. do not eat for half an hour or an hour after eating.

miconazole gel can be a choking hazard in babies under 6 months and people with swallowing issues - nystatin more appropriate.

Avoid miconazole in pregnancy. nystatin is safe.

Miconazole dose - 2.5ml four times daily after eating, continued for 1 week after infection clears. Side effects: nausea, vomiting, rash. has several medicines interactions - CYP3A4 inhibitor (most important is warfarin - can cause bleeding).

Nystatin dose - 1ml four times daily after eating, continued for 48 hours after infection clears

Question 28

Psoriasis - Coco-scalp

Answer 28

Contains coal tar, salicylic acid and sulphur which helps to remove skin scales on the scalp.

Apply for 1 hour, then wash off with a tar containing shampoo.

Question 29

Scabies - A-scabies, Lyderm

Answer 29

Pregnant women and those aged between 2 months to 2 years should be seen by doctor. Safe in breastfeeding.

Dose: Apply to the entire body from the top of the head to the soles of the feet, including the back and genitals. start from the top and work your way down to the limbs, hands and feet. finish by applying between the fingers/toes and under fingernails. retreat after 1 week. wash off after 8-12 hours.

Side effects: stinging, redness

Question 30

Shingles - Capsaicin (Zostrix)

Answer 30

Capsaicin reduces a chemical called substance P, which sends pain signals to the brain. Pain relief may take up to 4 weeks to take effect.

Burning or tingling may occur initially, but wears off as your body gets used to it. start with a small pea sized amount 3 to 4 times daily (every 4 hours).

Safe in pregnancy and breastfeeding.

Advice - avoid the eyes, mucous membranes, mouth when applying.

• wash hands immediately after use.
• do not have a hot shower before or after as this may make burning sensation worse.
• avoid applying heat to area where cream has been used.

Question 31

Travel Sickness: antihistamines (meclozine, promethazine)

Answer 31

Meclozine is generally less sedating than promethazine, however sedation may be an advantage for some. blocks the release of histamine in the CNS which is responsible for symptoms of nausea and vomiting.

Both are safe in pregnancy and breastfeeding. meclozine not for use in children under 6 years, promethazine children under 2 years.

Take the night before or 1 hour before travelling. avoid alcohol while taking. do not drive if taking this medicine

Meclozine dose: 2-4 tablets once daily, repeated after 24 hours if necessary

Promethazine dose: 25mg taken the night before travel. can be repeated after 8 hours if necessary.

Side effects: drowsiness, dry mouth, blurred vision, headache

Question 32

Vaginal thrush - Clotrimazole vaginal cream

Answer 32

Safe in pregnancy and breastfeeding. Fungistatic antifungal - stops bacteria from growing further

6 day cream more effective for pregnant women.

side effects: stinging, redness (side effects uncommon)

How to use:

• Wash hands before and after use
• pull out plunger from the applicator until it stops
• open tube of cream and attach it to applicator. squeeze cream until applicator is full
• remove tube and replace cap
• carefully insert the applicator as gently as deeply as is comfortable. this is best done on your back with your knees bent
• slowly push down on the plunger until it stops. this places the cream in the vagina. remove the applicator and dispose of it.

Important to finish the course to prevent infection from recurring or getting worse. make sure to use all 6 doses, even if you miss one dose.

If symptoms do not improve after 4 days (1%) or 3 days (2%), or if infection recurs within 2 months, see the doctor

if patient is under 18 or over 65, refer to doctor. If patient has recurring thrush infections (more than 3 in the last 6 months), refer

the cream may reduce effective of condoms/diaphragms

Question 33

Vaginal thrush - fluconazole

Answer 33

Fluconazole is fungistatic. taken as a single dose for thrush

avoid in pregnancy. safe in breastfeeding. be aware of medicines interactions (CYP3A4 inhibitor)

Side effects: rash (see doctor), GI upset, headache. most people do not experience any side effects with a single dose.

Question 34

Warts - Duofilm (salicylic acid + lactic acid)

Answer 34

remove dead surface skin cells. effectiveness may be improved by rubbing surface with pumice stone to remove hard skin after soaking in warm water.

dose: apply once daily. treatment may take up to 3 months

cover surrounding skin with vaseline before applying and apply only to the affected wart (can cause skin irritation). do not use on face or genitals

Question 35

Warts - cryotherapy

Answer 35

One-off application applied for about 20 seconds. may be repeated after 15 days.

can be uncomfortable and can cause blistering.

may take several attempts over several months to completely get rid of wart

Question 36

Worms - Mebendazole

Answer 36

Safe in 2nd and 3rd trimester, safe in breastfeeding

Dose: 100mg as a single dose, repeated in 2 weeks if reinfection occurs or symptoms are still present.

Vermox not approved for children under 2 years. de worm is fine.

Side effects: abdominal pain

Question 37

Worms - pyrantel

Answer 37

Low risk in pregnancy, safe in breastfeeding

dose: 10mg/kg as a single dose, repeated in 2 weeks if symptoms present

not approved for children under 1 year

side effects: nausea, vomiting, headache