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
When would you refer for warts and verrucas?
□ Anogenital warts □Facial warts □Diabetics □Immunocompromised patient □Bleeding or itching □Changed in size or colour □OTC treatment that has been unsuccessful following 3 months of treatment
What OTC meds should be avoided or used with caution in asthma?
Aspirin and NSAID
Cough suppressants e.g. codeine, pholcodine and dextromorphan
Head lice preparations containing alcohol
What OTC meds should be avoided or used with caution in those with prostate enlargement?
Those that may precipitate urinary retention:
Anticholinergics e.g. sedating antihistamines, Kwells and Buscopan
Decongestants e.g. phenylephrine
What OTC meds should be avoided or used with caution in glaucoma?
Anticholinergics e.g. sedating antihistamines, Kwells and Buscopan
Corticosteroids e.g. Beconase nasal spray
Name some OTC medicines that are prone to abuse
Opioid analgesics Laxatives Stimulants Antihistamines Cough/cold preparations e.g. Sudafed
Which of the following is a 'notifiable disease' A. food poisoning B. glandular fever (mononucleosis) C. slapped cheek (fifth disease) D. varicella zoster
food poisoning
A young preg woman asks for threadworm tx for her 2yo son
Which statement is correct?
A. Adult threadworms can live for up to 6 weeks
B. Mebendazole 100mg can be given to a 2yo
C. Tx should be repeated after 1 week
D. Only good hygiene measures can be recommended
D. Only good hygiene measures can be recommended
MAx daily intake of sugar for adults? A. 6g B. 19g C. 24g D. 30g
30g
Carbimazole is rapidly and almost completely metabolised to
thiamazole
Fosphenytoin is a water-soluble prodrug that was developed to overcome the problems that were associated with giving phenytoin parenterally.
Fosphenytoin is rapidly metabolised to phenytoin by endogenous phosphatases in the body.
NHS Improvement Patient Safety Alert:
Risk of death and severe harm from error with injectable phenytoin
- Use of injectable phenytoin is error-prone throughout the prescribing, preparation, administration and monitoring processes; all relevant staff should be made aware of appropriate guidance on the safe use of injectable phenytoin to reduce the risk of error.
latanoprost patient advice
- Can turn irides brown esp coloured and tx in one eye
- Advise pt to avoid repeated contact with skin as it can also be pigmented and hari growth
- Eyelash growth and vellus hair changes
MHRA/CHM advice: Latanoprost (Xalatan®): increased reporting of eye irritation since reformulation
- Following reformulation of Xalatan®, to allow for long-term storage at room temperature, there has been an increase in the number of reports of eye irritation from across the EU.
- Pts to tell HCP within a week if they experience eye irritation (e.g. excessive watering) severe enough to make them consider stopping treatment. Review tx and prescribe a different formulation if necessary.
MHRA advises consider vitamin D supplementation in patients who are immobilised for long periods or who have inadequate sun exposure or dietary intake of calcium.
A. Methotrexate B. Digoxin C. Lithium D. Phenytoin E. Phenobarbital F. Cyclophosphamide
Phenytoin
What to do in case of phenytoin SE
- rash
- bradycardia & hypotension
Rash
- Discontinue; if mild re-introduce cautiously but discontinue immediately if recurrence.
Bradycardia and hypotension
- With intravenous use; reduce rate of administration if bradycardia or hypotension occur
