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OTC > referral > Flashcards

referral Flashcards

1
Q

Acne

A
  • children under 6
  • unclear diagnosis
  • lack of response to treatment
  • moderate to severe acne
  • signs of androgen excess
  • medicines that is causing/aggravating acne
  • experiencing significant negative emotional or social impacts
  • scarring or family history of severe scarring, from acne
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2
Q

Vaginal Thrush

A
  • 1st time symptoms
  • > 4 episodes a year
  • treatment failure
  • bleeding
  • pelvic or abdominal pain
  • discharge not of BV or VCC
  • sores
  • urinary symptoms
  • systemic symtpoms
  • history suggestive of STI
  • recent birth, miscarriage or abortions
  • IUD
  • <18yrs and >60yrs
  • immunosupression
  • diabetes
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3
Q

BV

A
  • 1st time symptoms
  • > 4 episodes a year
  • treatment failure
  • bleeding
  • pelvic or abdominal pain
  • discharge not of BV or VCC
  • sores
  • urinary symptoms
  • systemic symtpoms
  • history suggestive of STI
  • recent birth, miscarriage or abortions
  • IUD
  • <18yrs and >60yrs
  • sx recurr within 2 weeks of treatment
  • pregnancy
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4
Q

Epi-pen

A

refer
- Clinical need for adrenaline auto-injector not confirmed by a medical or nurse practitioner
- Child <7.5 kg where clinical need for adrenaline auto-injector not confirmed by a clinical immunology or allergy specialist
Supply and refer
- poor asthma control
- taking a beta blocker
- no action plan

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5
Q

Allergic Rhinitis

A
  • tx failure
  • quality of life seriously affected
  • persistent unilateral nasal obstruction or discharge
  • impaired sense of smell
  • infection
  • signs or sx of undiagnosed asthma
  • signs or sx associated with medicines use
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6
Q

common colds

A
  • fever above 39 degrees or chills
  • fever for >5 days or returning after a fever free period
  • dyspnoea
  • wheezing
  • chest pain
  • dehydration
  • vomiting
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7
Q

common colds - children

A
  • fever above 38 in infants
  • more than 2 days fever in children
  • symptoms that do not improve or get worse
  • ear pain
  • excessive irritability
  • lack of appetite or poor feeding
  • drowsiness or lack of energy
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8
Q

constipation

A
  • rectal bleeding, dark, tarry stool; or passing mucus in stools
  • rectal pain
  • unexplained weight loss
  • fever
  • anorexia, vomiting
  • severe abdominal pain
  • > 50yrs with new or worsening symptoms
  • constipation alternating with diarrhoea
  • sudden change in bowel habits lasting >2 weeks or recurring over >3 months
  • suspected laxative misuse
  • daily use of laxatives (excluding fibre based)
  • constipation persisting as a new symptom that is not attributed to changes in diet or lifestyle or medicines or medical condition
  • persisting after a week after 1 week of laxative or 2 weeks of dietary modification
  • change in, or persistent concern about, bowel habit in infants <3 months
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9
Q

Cough

A
  • cough persisting >2 weeks
  • Haemoptysis
  • Dyspnoea
  • Systemic symptoms ( weight loss and fever)
  • dicoloured or purulent sputum
  • wheeze
  • chest pain
  • Persistent hoarseness
  • feeding difficulties
  • recurrent, productive cough in a child (particularly at night)
  • nea/altered cough in a smoker ager >45 years
  • New/altered cough in a person who is immunosupressed
  • New/altered cough in a person who has visited a country where tuberculosis is endemic
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10
Q

dermatitis

A

-Unclear diagnosis
-Signs of secondary or systemic infection
-Respiratory, gastrointestinal (abdominal pain, vomiting) or cardiovascular (loss of consciousness, persistent dizziness, hypotension) signs or symptoms
-Drug reaction is suspected
-Signs or symptoms persist despite appropriate treatment
-Signs or symptoms are widespread
-Signs or symptoms are severe
-Sensitive areas (e.g. genital area) are affected

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11
Q

Diarrhoea

A

-Blood and/or mucus in the stools
- Severe abdominal or rectal pain
-Fever (≥39 °C)
-Severe vomiting
-Signs of severe dehydration (e.g. lethargy, loss of skin elasticity, sunken eyes, dry mouth, reduced urine output)
-Severe or worsening symptoms
-Diarrhoea lasting ≥14 days
-Unintentional weight loss
-Diarrhoea alternating with constipation
-Diarrhoea lasting >24 hours in an infant <1 year of age
-Diarrhoea lasting ≥2 days in a child
-Diarrhoea in an infant <6 months of age
-Pregnancy
-Chronic medical condition (e.g. heart failure, diabetes)
-Person is immunocompromised (e.g. chemotherapy, long-term corticosteroids, HIV infection)
-Suspected adverse drug reaction or laxative misuse

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12
Q

EC - refer

A

-the patient does not have a mature understanding of what is proposed
-oral EC is not supplied within the required time after unprotected sexual intercourse (UPSI)
-the patient has severe asthma treated with oral glucocorticoids and UPSI was >96 hours ago (ulipristal EC is indicated but may worsen their asthma)
->120 hours (5 days) after UPSI.

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13
Q

EC give and refer

A
  • BMI >30 kg/m2 or weight >85 kg
    -CYP3A4 enzyme inducer or griseofulvin used within the previous 4 weeks
    -malabsorption disorder (e.g. Crohn’s disease, acute vomiting, severe diarrhoea)
    -insufficient time interval between use of ulipristal EC and a progestogen
    -ulipristal EC is required more than once in the same menstrual cycle (possible risk of hepatotoxicity)
    -a victim or suspected victim of sexual assault
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14
Q

Gastroenteritis in children

A

-Severe abdominal pain
-High fever (≥39 °C)
-Minimal oral intake (e.g. due to persistent vomiting)
-Persistent diarrhoea
-Bloodstained vomit or stools
-Bilious (green) vomit
-Persistent vomiting (>2 days) or vomiting without diarrhoea
-Pre-existing disease/condition
-Immunocompromised
-Age <6 months
-Poor growth or nutrition
-Use of fortified feeds (concentrated feeds or caloric additives)
-Recent use of potentially hypertonic fluids (e.g. Lucozade)
-Signs of severe dehydration
-Recent overseas travel
-Recurring symptoms

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15
Q

GORD

A

-Dysphagia
-Painful swallowing
-Gastrointestinal bleeding—dark, tarry stools; haematemesis
-Recurrent vomiting
-Unexplained weight loss
-Severe chest pain or pressure, especially if accompanied by radiating pain in the shoulder/arm/neck/jaw, sweating or difficulty breathing; or exacerbated by exercise (requires immediate medical attention)
-New symptoms in person aged >55 years
-Changing, severe or frequent (>twice/week) symptoms
-Symptoms not adequately controlled or continuing after a 2-week trial of H2-antagonist or proton pump inhibitor (PPI)
-Prolonged or recurrent use of PPI without medical investigation
-Epigastric pain

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16
Q

headache and migraine

A

New or different type of headache
​Speech difficulties, confusion, memory problems, balance problems, drowsiness, seizures
Neurological symptoms (e.g. paraesthesia, hypoaesthesia)
Ocular symptoms (e.g. blurred/impaired vision, pain exacerbated by eye movement)
Neck stiffness, fever, vomiting
Recent head or neck trauma
Temporal artery tenderness
Sudden-onset, unprovoked, severe pain (‘thunderclap headache’)
Headache that wakes the patient
Headache triggered by reading or watching television for 20–30 minutes
Recent-onset headache triggered by coughing, sneezing, straining, bending over, exertion or sexual activity
Recent-onset headache in a person who:
has cancer or a history of cancer
is immunocompromised
is >50 years old
is <5 years old
is <18 years old and obese
Headaches with rapidly escalating frequency or severity
Suspected medication over-use headache
Suspected drug reaction
Headache not responding to treatment
Isolated aura (i.e. without headache)
Migraine symptoms increasing in frequency or occurring on >2 days a month
Symptoms of dehydration and/or electrolyte disturbance as a result of vomiting

17
Q

headlice

A

Diagnosis is unclear
Signs of secondary infection (e.g. weeping or crusting of skin, swollen glands, fever)
Insecticides and physical methods have failed, and systemic treatment may be required

18
Q

nappy rash

A

Severe or unusual rash
Lack of response to appropriate treatment
Other areas of the body affected
Signs of secondary infection (e.g. fever, pustules, erosions, ulcers

19
Q

Insomnia

A

Suspected chronic insomnia (insomnia disorder)
Comorbid conditions associated with insomnia (including other sleep disorders) that require treatment
No response to evidence-based management options
Melatonin needed for longer than 3 weeks and use is not being managed by a medical practitioner (i.e. last medical review >13 weeks ago)
Contraindications to non-prescription treatment options

20
Q

NRT - refer

A

Pregnancy
Nicotine replacement therapy contraindicated or unsuitable
Patient wishes to use a prescription medicine for smoking cessation (e.g. bupropion, varenicline, subsidised nicotine replacement therapy, nicotine vaping products)
A medicine the patient uses may require a dose change when they stop smoking (e.g. clozapine)

21
Q

NRT - supply and refer

A

Cardiovascular disease, diabetes, mental illness
Breastfeeding
Age <18 years

22
Q

mouth ulcers

A

Frequently recurring mouth ulcers
Large mouth ulcers (>1 cm in diameter)
Mouth ulcers lasting >2 weeks
Extremely painful mouth ulcers causing difficulty eating or drinking
Signs of infection or systemic illness (e.g. fever)
Suspected underlying cause (e.g. immunocompromise, medical condition

23
Q

threadworm

A
  • under 12 months old
  • signs of secondary infection
  • lack of response to treatment
  • unclear diagnosis
24
Q

Naloxone - refer

A
  • naloxone contraindicated (
25
Q

naloxone - overdose signs

A

choking, snoring or gurgling sounds
slow, shallow, erratic or no breathing
extreme drowsiness
being unresponsive
cold, clammy skin
pale face
bluish-purple skin (in lighter-skinned people), or greyish or ashen skin (in darker-skinned people)
blue or purple–black lips and fingernails
limp body
small or pinpoint pupils
slow, erratic or no pulse
vomiting.

26
Q

naloxone - supply and refer

A

Pre-existing cardiovascular disease
Using medicines that cause adverse cardiovascular effects
<18 years old
Pregnant or breastfeeding

27
Q

Tinea

A

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 (e.g. swelling, purulent drainage, fever)
Patient with diabetes or immune deficiency

28
Q

chlorsig

A

Severe eye pain or swelling
Reduced, blurred or loss of vision
Restricted eye movement
Cloudy cornea
Abnormal-looking pupils
Injury to the eye or suspected foreign body in the eye
A history of welding without adequate eye protection
Generally unwell
Experienced similar symptoms in recent weeks
Glaucoma
Dry eye syndrome
Use of other eye drops or eye ointments
Eye surgery or laser treatment in the past 6 months
History of bone marrow problems
Recently travelled overseas
Photophobia
Copious purulent (yellow–green) discharge
Contact lens user
age <2 yrs old

29
Q

cold sores (famciclovir)

A

Painful mouth ulceration with poor oral intake
Signs of bacterial skin infection
Systemic symptoms present
Lesions on other parts of the body
Outbreaks occur more than three times a year
Aged <18 years
Lesion present for >14 days
immunocompromised

30
Q

glucagon

A

Clinical need for glucagon not confirmed by a medical or nurse practitioner, or diabetes educator
If a patient with severe hypoglycaemia is taking beta-blockers, an ambulance should be called immediately, because they may not respond to glucagon and will require intravenous (IV) glucose

31
Q

hypoglycaemia sx

A

sweating
shaking
pallor
anxiety
palpitations
nausea.
hunger
confusion
blurred or double vision
impaired intellectual function
difficulty speaking
irritability
seizures
coma

32
Q

neutrafleur

A
  • Clinical need for high-concentration fluoride toothpaste not confirmed by a registered dental practitioner or medical practitioner
33
Q

orlistat

A

Aged <18 years
Previous or suspected eating disorder
cholestasis
major gastrointestinal (GI) surgery
chronic malabsorption syndrome
pancreatic enzyme deficiency
chronic pancreatitis
significant cardiac, renal, hepatic, GI, endocrine, chronic psychiatric and/or neurological disorders
bulimia or anorexia nervosa
laxative abuse
fat-soluble vitamin deficiency (vitamins A, D, E and K)
gallstones, renal stones
active peptic ulcer disease
postsurgical adhesions
pregnant

34
Q

SABA

A

Clinical need for a SABA not confirmed by a medical or nurse practitioner
Using a medicine that can interact with salbutamol and terbutaline∗
Three or more SABA inhalers used in previous 12 months∗
Using SABA >2 days per week (not including before exercise)∗
Asthma symptom control not good within the previous 4 weeks∗
Last medical review >6 months ago∗
Patient with asthma does not have a current personalised written asthma action plan

35
Q

Uticaria

A

Unclear diagnosis
Signs of secondary or systemic infection
Signs or symptoms persist despite appropriate treatment
Wheals are not transient, are painful, occur with bruise-like staining
Undiagnosed underlying condition is suspected
Food allergy or drug reaction is suspected

OTC (1 decks)

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