Resource Pharm- OTC Flashcards
When would you refer for a cold? Y/N
- ear ache
- coughing
- pregnant
- heart disease
- chest pain
- SOB after climbing a hill
Ear ache that is severe
Vulnerable patient groups e.g. very young, very elderly, heart disease, lung disease, severe asthma
Fever and cough that is persistent
Chest pain
Shortness of breath that can’t be explained
When would you refer for a cough? Y/ N
- recurring in daytime
- whooping cough
- drug side effect
- clear phlegm
- foul smelling sputum
Longer than 3 weeks + no improvement Chest pain Shortness of breath Wheezing Recurring cough present at NIGHT Whooping cough/croup Drug induced cough or wheezing e.g. ACEi/BB Yellow, green, brown or blood stained phlegm/sputum Offensive or foul smelling phlegm/sputum
When would you refer for a sore throat?
● Dysphagia (difficulty in swallowing)
● Longer than 7-10 days
● Hoarseness persisting for more than three weeks
● Sore throat with a skin rash
● White spots, exudate or pus on the tonsils with a high temperature and swollen glands
● Recurrent bouts of infection
● Suspected adverse drug reaction e.g. carbimazole
● Failed treatment
● Breathing difficulties
When would you refer for ear wax?
Foreign body in the ear Pain Dizziness Tinnitus Treatment failure
When would you refer for a headache?
Headache associated with recent head injury/trauma
Children under 12
Associated with stiff neck, fever and or rash
Sudden onset and or severe pain
Suspected ADR e.g. oral contraceptive pill
Associated with drowsiness, blackouts, unsteadiness, visual disturbances or vomiting
Recurring headaches
When would you refer for constipation?
Blood in the stools
Pain on defecation
Suspected drug induced constipation e.g. opiates, antidepressants
With abdominal pain, vomiting or bloating
Weight loss
Failed treatment
Change in bowel habit of more than 2 weeks
When would you refer for diarrhoea?
= Persistent change in bowel habit
= Recent travel which was abroad
= Presence of blood/mucus in the stools
= Diarrhoea with severe vomiting and fever
= Signs of dehydration e.g. dry mouth, drowsiness or confusion, passing little urine, sunken fontanelle and eyes
= Longer than 3 days in older children and adults (longer than 1 day in babies under 1 years and 2 days in children under 3 years and elderly)
Suspected drug induced diarrhoea e.g. antibiotics
Severe abdominal pain
When would you refer for dyspepsia?
# Unexplained weight loss # Suspected drug induced dyspepsia e.g. ferrous sulphate, NSAIDs #Persistent vomiting # Persistent symptoms (more than 5 days) or recurring, failed treatment # Black or tarry stools # Severe pain, Pain radiating to other areas of body e.g. arm # Symptoms developing for the first time in patients aged 45 years or over # Dysphagia (difficulty in swallowing)
When would you refer for haemorrhoids?
◇ Blood in the stools ◇ With abdominal pain or vomiting ◇ Weight loss ◇ Persistent change in bowel habit ◇ Longer than 3 weeks
When would you refer mouth ulcers?
¤ Lasting > 3 weeks ¤ Suspected ADR e.g. NSAIDS ¤Crops of 5-10 or more ulcers ¤Rash ¤Diarrhoea, weight loss ¤Involvement with other mucous membranes
When would you refer for cystitis?
~ Immunocompromised patient, DB, Preg, Man, Child, Elderly woman ~ Vaginal discharge ~ Haematuria ~ With fever, n+v ~ Pain or tenderness in the loin area ~ Recurrent cystitis, Failed treatment ~ Longer than 2 days
When would you refer for Primary dysmenorrhoea?
♤ Abnormal vaginal discharge
♤ Heavy or unexplained bleeding
♤ Signs of systematic infection e.g. fever
♤ Symptoms suggesting 2ndary dysmenorrhoea
When would you refer for vaginal thrush?
☆ >2 attacks in the last 6 months
☆Preg, DB, <16yo, >60yo, prev history or exposure of STD
☆Vulval or vaginal sores ulcers or blisters
☆Discharge green-yellow / blood / foul smelling
☆No improvement within 7 days, failed OTC
☆Abnormal vaginal bleeding
☆Any associated lower abdominal pain or dysuria
When would you refer for athlete’s foot?
▪︎Not responded to the appropriate treatment
▪︎Nail involvement
▪︎Spreading to other parts of the foot
▪︎Diabetics
▪︎Signs of bacterial inf e.g. weeping, pus, yellow crusts
When would you refer for cold sores?
- Longer than 2 weeks
- Lesions inside the mouth
- Eye is affected
- Immunocompromised patients, babies+children
- Signs of secondary bacterial infection e.g. weeping, pus, yellow crust
- Severe, widespread or worsening lesions
- Painless lesion
