Over the counter requests Flashcards
What is Constipation?
abnormal bowl movement –> hard or more difficult to pass stools
What are the symptoms of constipation?
Infrequent passing of stools
Straining to pass stools
Painful stools
Abdominal discomfort
Bloating
Feeling anorectal discomfort
Specks of blood in toilet
Using manual maneuvers to facilitate defecation
Constipation Pharmacological treatments
Bulk-forming laxatives (ispaghula, psyllium, sterculia)
Osmotic laxatives (glycerol, lactulose, macrogol, saline laxatives, sorbitol) –> possible interactions with lamivudine)
Stimulants (bisacodyl, frangula, senna, sodium Pico sulfate)
Stool softeners (docusate, liquid paraffin, poloxamer- only for children)
Constipation Non-pharmacological treatments
Adequate dietary fiber (adults: 25-30 g/day; children: age in years plus 5)
Adequate fluid intake (limit intake of fluids with a diuretic effect e.g. tea, coffee, alcohol)
Exercise for 30min a day
Respond immediately to the urge to defecate
Sit on toilet with knees higher than hips
Suggestions to prevent or limit symptoms
Ensure extra fluid intake
Increase fiber gradually
Encourage exercise
Sit with knees higher than hips
When to refer constipation?
Rectal bleeding; dark, tarry stools; or passing blood or mucus in stools
Anorectal pain
Unexplained weight loss
Fever
Tiredness
Anorexia
Vomiting
Severe abdominal pain
Management of constipation during pregnancy and breast-feeding
avoid in high dosage and prolonged use of:
Glycerol (in pregnancy)
Lactulose (in pregnancy and breastfeeding)
Macrogol (in breastfeeding)
Sorbiyol (in both)
Consider alternative:
Frangula (in both)
Sodium picosulfate (in pregnancy)
What is diarrhea?
an increase in stool volume and loose watery stools
Diarrhea symptoms
Nausea / vomiting
Abdominal pain
Fever
Flatulence
Weight loss
Diarrhea common causes
Anxiety or emotional stress
Endocrine disorders
ACUTE CAUSES:
Viral infection
Bacterial infection
Parasite infection
CHRONIC CAUSES:
Malabsorption
Fecal impaction (overflow diarrhea)
Inflammatory bowl disease (Crohn’s disease and ulcerative colitis)
Food intolerance (e.g. lactose)
Bowel cancer
Pharmacological treatments for diarrhea
Oral rehydration salts (ORS)
Antimotility medicines (e.g. Loperamide, diphenoxylate plus atropine)
Non-pharmacological treatments for Diarrhea
Resume normal diet as tolerated
Limit intake of fatty, sugary or spicy foods
Avoid caffeine, alcohol and drinks with high sugar content
Increase intake of starchy foods
use wipes or a soothing barrier cream containing zinc oxide
Prevention of Diarrhea
Good hand hygiene by thoroughly washing with warm water and soap
Regular clean high-traffic household surfaces to reduce risk of transmission
Follow recommendation of the food safety information council to avoid food poisoning
Exclude children with diarrhea from childcare and preschool
When to refer diarrhea?
Blood or mucus in stool
Severe abdominal or rectal pain
Fever
Severe vomiting
Dehydration
Severe or worsening of symptoms
Diarrhea lasting more than 14 days
Unintentional weight loss
Diarrhea alternating with constipation
Lasts more than 24 hours in infant less than 1
Lasts more than 2 days in a child less than 12 or an older person
Diarrhea in infant less than 6 months
Pregnancy
Chronic medical conditions
Immunocompromised
Recent travel to a tropical climate
Suspected malabsorption
Suspected adverse drug interactions
Laxative misuse
Management of diarrhea in pregnancy and breast feeding
Loperamide = safe after the first trimester during pregnancy/ short-term use in
Diphenoxylate with atropine = safe but avoid high dose in late term / short-term use in breast feeding
What is hay fever (allergic rhinitis)?
Triggered by allergens e.g. pollen, dust mites, smoke, mold spots, animal dander, workplace chemicals –> membranes of the eyes and nose are inflamed
Hay fever symptoms
Clear rhinorrhoea
Nasal congestion
Sneezing, especially paroxysmal
Itching of nose or throat
Ocular signs – watery, red, itchy eyes
Hay fever pharmacological treatments
Intranasal corticosteroids (INCSs) –> prevent and treat nasal congestion, sneezing, rhinorrhea (e.g. beclomethasone, budesonide, fluticasone propionate, mometasone)
Intranasal antihistamines –> relieve sneezing, rhinorrhea, nasal itch, nasal congestion (azelastine, levocabastine, olopatadine)
Oral sedating antihistamines (brompheniramine, chlorphenamine, cyproheptadine, dexchlorpheniramine, diphenhydramine, promethazine, triprolidine)
Intranasal decongestants –> relieve nasal congestion (oxymetazoline, phenylephrine, tramazoline, xylometazoline)
Oral decongestants –> relieve nasal congestion (phenylephrine, pseudoephedrine)
Adjunctive treatments (intranasal saline, intranasal ipratropium bromide)
Suggestions to prevent symptoms of Hay fever
Stay inside when pollen counts are high
Avoid outdoor activities know to lead to exposure of allergens
Shower after outdoor activity
Close car windows
Dry clothes and bedding inside
Keep the house well ventilated
Limit presence of dust-collecting items
Vacuum carpets frequently
Use dust mite-resistant covers
When to refer hay fever?
Symptoms are unresponsive to available treatments
Quality of life is seriously affected
Persistent unilateral nasal obstruction or discharge
Recurrent epistaxis (nosebleeds)
Anosmia (impaired sense of smell)
Signs of asthma - wheezing or shortness of breath
Signs of bacterial infection
Symptoms associated with medicine use
Orbital cellulitis
Medical conditions with similar symptoms to allergic rhinitis:
Acute rhinosinusitis (common cold)
Chronic rhinosinusitis –> persisting for 12+ weeks / purulent nasal discharge / pain, swelling, pressure around eyes, cheeks, forehead, nose / anosmia
Drug-induced rhinitis –> by aspirin, steroidal anti-inflammatory drugs, vasodilator medicines, estrogens
Rhinitis medicamentosa –> constant nasal congestion not relieved by intranasal decongestants
Non-allergic rhinitis –> absence of itching and ocular signs
Management of hay fever during pregnancy and breast feeding
Consider alternative of mometasone, desloratadine, fexofenadine in first trimester
Consider alternative azelastine, bilastine, phenylephrine, oral decongestants
Hayfever treatment Adverse effects
- Intranasal preparations can cause nasal irritation and nosebleeds
- oral sedating antihistamines can cause (sedation / paradoxical CNS stimulation / dizziness / dry mouth / constipation / blurred vision
- less sedating antihistamines can cause sedation
- oral decongestants (older people) at greater risk of: restlessness / insomnia / tremor / palpitations / increased blood pressure
What is tinea?
fungal infection caused by dermatophytes.
Types of Tinea
- Tinea pedis (athlete’s foot)
- Tinea corporis (ringworm)
- Tinea cruris (jock itch)
- tinea unguium (onychomycosis)
- Tinea capitis
- Tinea barbae
- Tinea manuum
- Tinea incognito
Skin conditions with similar symptoms to tinea:
- Dermatitis –> permanent areas of dry, itchy skin and intermittent acute flares
- Granuloma annulare –> skin colored or red annular papules or plaques / no scaling / can persist for months or years or may clear spontaneously
- Intertrigo –> inflamed, red, macerated skin of one or more skin folds / infectious or inflammatory origin
- Pityriasis versicolor –> patches of hyper- or hypopigmentation on the trunk, neck or arms
- Psoriasis –> well-defined, symmetrically distributed, red, scaly or macerated plaques / plaques appear shiny in skin folds / family history
Treatments for Tinea
- Azole antifungals (bifonazole, clotrimazole, econazole, ketoconazole, miconazole)
- Other antifungals (TERBINAFINE, tolnaftate)
- Antifungals for nail infection (amorolfine, ciclopirox)
Azole antifungals
Inhibit fungal growth
-bifonazole (cream)
- clotrimazole (cream, liquid)
- econazole (cream, liquid)
- ketoconazole (cream, shampoo)
- miconazole (cream, liquid, spray, gel)
other antifungals
-Terbinafine = inhibits fungal sterol synthesis (cream, gel, liquid, spray)
- Tolnaftate = inhibits fungal growth (powder)
antifungals for nail infection
- Amorolfine = inhibits fungal sterol synthesis (liquid)
- Ciclopirox = fungistatic and fungicidal activity; chelates iron to inhibit fungal growth (liquid)
When to refer tinea:
- extensive, severe or persistent infection
- infection of the scalp, beard or nail matrix
- lack of response to topical therapy
- prior treatment with a topical corticosteroid
- signs of secondary bacterial infection
- medical history of diabetes or immune deficiency
management of TINEA in children
- terbinafine and amorolfine are NOT recommended for treatment of children < 12
- ciclopirox is not recommended for children < 18
Management of TINEA in pregnancy and breastfeeding
- Bifonazole –> avoid use in pregnancy
- Ketoconazole –> topical use is safe in pregnancy
- Terbinafine –> topical use is safe in pregnancy
- Amorolfine –> consider alternative
- Ciclopirox –> consider alternative in first trimester
Tinea treatment adverse effects
- Azole antifungals, terbinafine, tolnaftate and amorolfine can cause local irritation
- ciclopirox can cause pain, burning and redness
Non-pharmacological treatment of Tinea
- dry affected skin thoroughly with a separate towel after washing
- avoid sharing bedding, towels, shoes, clothing
- wear sandals or things in public locker rooms, showers + swimming areas
- wear shoes made from leather or breathable material
- change socks frequently, esp. if wet
- wear clean, loose fitting cotton underwear and clothes
- check pets for ringworm and refer to a vet as necessary
- treat family members as necessary
- exclude children from school until the day after appropriate treatment has begun
