Year 3 OTC Notes Flashcards
Are Mouth Ulcers Self-Limiting?
Simple mouth ulcers are usually self-limiting and rarely present in general practice. However, severe, recurrent or persistent oral ulceration can be extremely painful and may result from an underlying systemic pathology.
Are mouth ulcers contagious?
No, they are not
What are the symptoms of mouth ulcers?
- A round sore or sores inside the mouth.
- Swollen skin around the sores.
- Tenderness.
- Problems with chewing or toothbrushing because of the tenderness.
- Irritation of the sores by salty, spicy or sour foods.
- Loss of appetite.
In severe mouth ulcer attacks, what may the patient also experience?
- Fever
- Physical sluggishness
- Swollen lymph nodes
What are the danger elimination/ red flag symptoms for mouth ulcers?
- ulcers last longer than 3 weeks
- ulcers keep coming back
- mouth ulcers become more painful or red - this could be a sign of bacterial infection, which may need treatment with antibiotics
- Symptoms linked to indigestion, heat burn, breathing problems
- ADRS - immunosuppressant
- Unexplained weight loss
- ulcers bigger than 1cm
- more than 5-10 ulcers present
What age are mouth ulcers more common in?
More common in women and those under the age of 40.
Can mouth ulcers run in families?
Mouth ulcers run in some families. So, a genetic factor may play a part in some cases.
What are aphthous ulcers?
Aphthous ulcers are recurring ulcers with no known cause that affect around 20 percent of the population
What lifestyle advice can be given to someone who presents with ulcers?
- use a soft-bristled toothbrush
- Drink cool drinks through a straw
- Eat softer foods
- Get regular dental check-ups
- Eat a healthy, balanced diet
- not chew gum
- using toothpaste that doesn’t contain sodium lauryl sulphate
- reducing stress and anxiety - which may be a trigger for some people
What is the treatment time scale for mouth ulcers?
If it lasts more than 3 weeks then refer to GP.
What colour can mouth ulcers be?
they can be white, red, yellow or grey in colour and swollen.
What is the difference between mouth ulcers and cold sores?
Mouth ulcers shouldn’t be confused with cold sores, which are small blisters that develop on the lips or around the mouth. Cold sores often begin with a tingling, itching or burning sensation around your mouth.
Which age is ulcers more common in?
Common in women between ages 10-40 years linked with menstrual cycle due to lack of iron
What lifestyle advice can be given to someone for ulcers and to prevent them?
- Use chlorhexadine mouth wash regularly
- Good oral hygeine - brush teeth twice daily for 3 mins, don’t brush harshly
- sharp food
- smoking
What is the treatment timescale for ulcers?
7 days - if no improvement then refer to GP
Name a few products that can be used for ulcers?
Iglu pastilles, Bonjela, benzocaine- oralgel, antibacterial mouthwash-chlorhexidine
Is oral thrush self-limiting in babies vs adults?
Yes, in babies oral thrush is harmless and is self-limiting within a month from their first appearance.
Where as in adults if left untreated the symptoms will persist and your mouth will continue to feel uncomfortable. If untreated can spread to body as an infection - serious.
What agent is oral thrush usually treated with?
Antifungals
What are the presenting symptoms of oral thrush in babies?
The main sign of oral thrush is a white coating on your baby’s tongue, although there may also be white patches elsewhere in the mouth. This coating may look like curd or cottage cheese and usually can’t be rubbed off easily. If it can be rubbed off easily it means its milk residues not thrush.
With babies with oral thrush what else may be associated at the same time that may need treatment too?
Associated nappy rash caused by the same infection that needs to be treated as well.
What are the presenting symptoms of oral thrush in adults?
- White patches (plaques) in the mouth that can often be wiped off, leaving behind red areas that may bleed slightly
- Loss of taste or an unpleasant taste in the mouth
- Redness inside the mouth and throat
- Cracks at the corners of the mouth
- A painful, burning sensation in the mouth
What are the red flag symptoms for oral thrush?
- Failed medication
- Diabetics
- Painless lesions
- Recurrent infection
- Persistent oral thrush can be linked to HIV
what lifestyle advice can be given to someone with oral thrush?
- rinse mouth after eating meals
-• Brushing your teeth twice a day with a toothpaste that contains fluoride, and interdental cleaning (flossing) regularly
• Visiting your dentist regularly for check-ups, even if you wear dentures or have no natural teeth
• stopping smoking if you smoke
• Rinsing your mouth with water and spitting it out after using a corticosteroid inhaler, and using a spacer (a plastic cylinder that attaches to the inhaler) when you take your medicine
• Ensuring that any underlying condition you have, such as diabetes, is well controlled
What is the treatment timescale for oral thrush?
Usually with treatment it should clear within 2 weeks. In some cases it can last for longer.
What OTC treatment can be given for oral thrush?
Daktarin oral gel (miconazole)
What is the dose and directions for daktarin gel?
Adults and Children over 2 years: 2.5 ml (half a 5ml spoonful) of gel
Applied four times a day after food.
Infants 4 months - 2 years: 1.25 ml (one quarter of a 5 ml spoonful) of gel applied four times a day after food. Each application should be divided into smaller portions.
Keep the gel in the mouth as long as possible
apply directly to the affected area with a clean finger
What is the warning that should be provided when using daktarin oral gel?
Its sticky; choking hazard by making sure you place the gel at the front of the mouth
What is the minimum age for oral daktarin gel OTC?
Minimum 4 months and over, should not be used for any babies younger than this.
A baby who has oral thrush can pass it on to mother and cause nipple thrush. What are the symptoms of nipple thrush?
• pain, cracked, flaky or sensitive nipples and areolas (the darker area around your nipple) and changed colour
What advice can be given to mother to prevent oral thrush in baby?
- sterilise dummies regularly, as well as any toys that your baby puts in their mouth
- sterilise bottles and other feeding equipment regularly, especially the teats
Where may patient say they have been to show indigestion?
Pain in the chest and upper abdomen to lower abdominal symptoms.
What is heartburn caused by?
When there is a reflux of gastric contents, particularly acid, into the esophagus, which irritates the sensitive mucosal surface.
Is heartburn self-limiting?
Yes, within 1 week.
What are the symptoms of heartburn?
Burning discomfort is experienced in the upper part of the stomach
The pain may be felt only in the lower retrosternal area or on occasion right up to the throat,
Causing an acid taste in the mouth.
Heart- burn is often brought on by bending or lying down. This causes discomfort which is relieved by belching but which in turn can be associated with acid reflux.
Difficult swallowing
Regurgitation- medicine sticks in oesophagus
What are the red flags (danger elimination) symptoms for heartburn/ indigestion?
- • Persistent symptoms (>5 days)
• ADRs
• Treatment has failed - Pregnancy
- Injury in the abdominal area
- Rigid abdomen but tender when touch
- Fever
- Difficulty to empty bowels
- > 45 years with symptoms for the first time
- Blood in the vomit or stools
- Pain worsens on effort
- Pain is severe
- Pain radiating to arms
- Difficulty swallowing
- Regurgitation
- Children
- Unintentional Weight Loss
What lifestyle advice can be given to reduce chances of heartburn?
- Obesity - if patient is overweight then weight reduction should be advised.
- Eat smaller meals more frequently than large meals, as reducing the amount of food in the stomach reduces gastric distention, which helps to prevent reflux.
- High fat meals delay gastric emptying,
- the evening meal is best taken several hours before going to bed
- Posture Bending, stooping and even slumping in an armchair can provoke symptoms and should be avoided where possible. It is better to squat rather than bend down
- raising the head of the bed can reduce both acid clearance and the number of reflux episodes.
- Tight, constricting clothing, especially waistbands and belts, can be an aggravating factor and should be avoided.
- Other aggravating factors Smoking, alcohol, caffeine and chocolate
What is the treatment timescale for heartburn/indigestion?
1 week
What is nausea?
Nausea is the queasy feeling a person gets before being sick or throwing up.
What are the presenting symptoms of nausea?
Feeling sick Being sick Pale in colour Headache Finding it hard to eat
What are the danger elimination questions/ red flag symptoms for nausea?
- Duration of more than 48 hours in adults
- Refer if child is under 2 years old
- dehydration
- blood in the vomit or stools
- migraine/ head injury
- Pregnant or breastfeeding
What can vomiting of milk in infants less than 1 years old may due to?
infection or feeding problems or, or an obstruction. An obstruction typically occurs in the first few weeks of life in a first-born male. The vomiting is frequently projectile in that the vomit is forcibly expelled a considerable distance. The condition can be cured by an operation under general anaesthetic lasting about half an hour called a pyloromyotomy. The pharmacist must distinguish, by questioning, between vomiting (the forced expulsion of gastric contents through the mouth) and regurgitation (where food is effortlessly brought up from the throat and stomach).
What lifestyle advice can be given to someone suffering from nausea?
- keep hydrated (rehydration sachets)
- Try eating small amounts of food, snack which are high in sugar
What is the treatment timescale for nausea?
48 hours for adults - — children under 2 should be referred to their GP
What is motion sickness thought to be caused by?
Thought to be caused by a conflict of messaged to the brain where the vomiting centre receives information from the eyes, the GI tract and the vestibular system in the ear.
Is motion sickness self-limiting?
Yes, within a couple of days
What are the presenting symptoms of motion sickness?
Nausea and sometimes vomiting, pale skin and cold sweats. Headache, rapid breathing, tired etc.
What are the danger elimination questions/ red flags symptoms?
- driver
- length of journey
- pregnant
- Migraine
- Symptoms continue after travelling
- Glaucoma
- Failed treatment
What lifestyle advice can be given to someone for motion sickness?
- Keep still – if possible, choose a cabin or seat in the middle of a boat or plane, because this is where you’ll experience the least movement. Use a pillow or headrest to help keep your head as still as possible.
- Look at a stable object – for example, the horizon. Reading or playing games may make your symptoms worse. Closing your eyes may help relieve symptoms.
- Fresh air – open windows or move to the top deck of a ship to avoid getting too hot and to get a good supply of fresh air.
- Relax – by listening to music while focusing on your breathing or carrying out a mental activity, such as counting backwards from 100.
- Stay calm – keep calm about the journey. You’re more likely to get motion sickness if you worry about it.
- Water bottle
What is the treatment time scale for motion sickness?
3 days
What options are there for motion sickness, which tablets?
Cinnaraine 15mg,
Hyoscine hydrobromide,
Promethazine (phenergan elixir),
Meclozine (sea legs)
What is the brand name for cinnarizine?
Cinnarizine 15mg = sturgeon
Boots version is the blue pack
What is the brand name for hyoscine hydrobromide?
Joyrides,
Kwells
What is the minimum age for cinnarizine vs hyoscine hydrobromide?
cinnarizine = 5 years and over
Hyoscine hydrobromide = 3 years and over
What are the side effects of motion sickness tablets?
Drowsiness, dry mouth, headache and stomach upset.
For cinnarizine how long before journey should tablet be taken for and how long does it last?
Should be taken 2 hours before and lasts 8 hours
For hyoscine hydrobromide how long before journey should tablet be taken for and how long does it last?
Should be taken 20 mins before travelling and lasts 6 hours
what is constipation?
- Content of large intestine move slowly & more water is absorbed from the faecal matter
- Stool becomes harder & more compacted which slows down their movement through the GI tract
What are possible causes of constipation?
- Not enough fibre in diet
- Not enough liquids
- lack of exercise
- medication (side effect)
- IBS
- Pregnancy
- Old age
- Laxative abuse
- Cancer
What are the symptoms of constipation?
Feeling nausea, loss of appetite, straining when passing,
- not passing stools as often as they normally would do - atleast for 3 days,
- bloating
- pain when passing
- can’t empty bowels completely,
- stomach cramps
- stool is dry, hard, abnormally large/ smal
What are the danger elimination questions/ red flags for constipation?
- Change in bowel habit of 2 weeks or longer
- Failure of OTC medication
- ADRs
- Blood in stools
- presence of abdominal pain, vomiting
- recurrent problem
- unintentional weight loss
- severe pain when passing stools
What lifestyle advice can be given to someone with constipation?
- Content of large intestine move slowly & more water is absorbed from the faecal matter
- Stool becomes harder & more compacted which slows down their movement through the GI tract
What is first line treatment for constipation?
Dietary changes - allow to settle for atleast 2-3 weeks
In pregnancy what type of laxatives should be avoided?
Avoid stimulant laxatives.
What is first choice of laxative for pregnant women?
Bulk-forming laxative - fybogel
What laxative is preferred in adults?
Bulk forming laxatives but should be advised to maintain fluid intake to prevent development of intestinal obstruction.
What is the treatment timescale for constipation?
If no improvements after a 1 week then refer to GP.
How do stimulant laxatives work?
Promotes movement of the faeces.
Gives examples of stimulant laxatives?
Dulcolax tablet (bisacodyl) Senokot tablet - senna
How are senna tablet usually taken?
2 tablets at night time
How do bulk-forming laxative work?
increases the mass of faeces
Give an example of bulk forming laxative?
Fybogel Hi-fibre - ispaghula husk
lemon/orange flavour/ plain
what advice to give when giving bulk-forming laxative?
Make sure you drink plenty of fluid when taking this medicine
don’t take shortly before bed
can be used in pregnancy
How do faecal softeners work?
Lubricates the faeces
Give an example of faecal softerners?
DulcoEase - docusate sodium
Glycerin suppositories in infants
Give examples of osmotic laxatives?
Lactulose
Macragol compound
What thing should be noted and checked when supplying lactulose?
Has sugar - not suitable for diabetics
Takes 2 days to be effective
What is the diarrhoea defined as?
Is defined as an increased frequency of bowel evacuation, with the passage of abnormally soft or watery faeces.
Is diarrhoea self-limiting?
Yes within a couple of days
What are the presenting symptoms of diarrhoea?
Abdominal cramps, flatulence, weakness or malaise, nausea and vomiting, fever
What are the danger elimination questions/ red flags symptoms for diarrhoea?
- Lasting ≥1 day in children <1yr
- Lasting ≥2 days in children <3yrs and the elderly
- Lasting ≥3 days in older children and adults
- History of change in bowel habit
- Suspected drug induced reaction
- Recent travel abroad
- Presence of blood or mucus in stools
- Pregnancy
- Change in diet
- Drugs
What lifestyle advice can be given to someone with diarrhoea?
Diarrhoea is often caused by an infection. You can reduce your risk by making sure you maintain high standards of hygiene.
For example, you should
• wash your hands thoroughly with soap and warm water after going to the toilet and before eating or preparing food
• clean the toilet, including the handle and the seat, with disinfectant after each bout of diarrhoea
• avoid sharing towels, flannels, cutlery or utensils with other household members
It’s also important to practise good food and water hygiene while travelling abroad, such as avoiding potentially unsafe tap water and undercooked food.
What is the treatment time scale for diarhhoea?
1 day in children, otherwise 2 days
What can be used to treat diarrhoea?
Loperamide
Dioralyte
What is the usual dose for loperamide?
Two capsules to start with. After that, take one capsule after each loose bowel movement. Don’t take more than 6 capsules in any 24 hours. Don’t take for more than 24 hours.
What is IBS?
Irritable bowel syndrome (IBS) is defined as a chronic, functional bowel disorder in which abdominal pain is associated with intermittent diarrhoea, sometimes alternating with constipation, and a feeling of abdominal distension.
Is IBS self-limiting?
Nope it isn’t, can go on for months or years.
What are the presenting symptoms of IBS?
Abdominal pain- anywhere in abdomen, relived by defecating
Bloating
Bowel habit change- can be either diarrhoea or constipation, incomplete emptying, semi formed stools, can have mucus in it NOT blood
Other symptoms- nausea, lethargic, urinary symptoms
What are the danger elimination questions/ red flags symptoms?
- Unexplained weight loss
- Child under 16 presenting symptoms
- Blood in stools
- Patient with no previous history of IBS and no precipitating factors
- Failed treatment
- Nausea and/or vomiting
What lifestyle advice can be given to someone with IBS?
Low fat, low sugar and high fiber diet
Fiber food oats, barely, rye, fruits, root vegetables, wholegrain bread, bran, cereal, nuts and seeds
If diarrhea- eat less fiber
If constipated - eat more fiber
Bloating- insoluble fiber e.g. bran
Exclude food that can exacerbate IBS like sweeteners (sorbitol and fructose), caffeine, and dairy products
What is the treatment timescale for IBS?
1 week
List some medicines that can be used OTC for IBS?
Mebeverine hydrochloride (Colofac) - not under 18 years old
- Peppermint Oil (Colpermin IBS Relief)
- Alverine Citrate 60mg (Spasmadol)
- Buscopan - Hyoscine butylbromide
What is threadworms?
• Threadworms are small, thin, white, thread-like worms between 2 and 13
mm long.
• They infect human guts (intestines).
• They are common in children, but anyone of any age can be affected
What are the symptoms of threadworms?
- Itchy around the anus (worse at night)
- white-cream threadlike objects in faeces/on anus
- Vaginal itch (girls)
- Diarrhoea may also be present in severe cases
- tiredness/ irritability during the day )due to loss of sleep)
What are the danger elimination questions/ red flags of threadworms?
- medication failure
- Signs of bacterial infection )perianal skin broken/ weeping (secondary infection)
- recent travel abroad (if the patient has travelled abroad they may have become infected with a different worm infection (e.g. tapeworm, roundowrm).
What advice should be given when providing threadworm treatment?
Treat ALL FAMILY members – even if they do not present the symptoms.
Reassure (parents in particular) that it is extremely COMMON
• Prevent transmission/reinfection by:
-CUT FINGERNAILS SHORT
-WASH HANDS and BRUSH FINGERNAILS after using the
bathroom/ preparing food
• This is to prevent the transmission of eggs (can remain viable for up to 1 week)
• Children – wear PYJAMAS to reduce itching of bare skin during the night.
Underpants can be worn under pyjama bottoms.
• Affected family members- have a BATH/SHOWER each MORNING to wash away eggs laid during previous night.
• Bed linen should be wash frequently
After how long should another dose be taken if first dose has failed?
After 2 weeks
Which active substance is used to treat threadworms OTC?
Mebendazole
Can mebendazole be given to pregnant women?
NO
What is the minimum age to use mebendazole?
2 years and over
What are haemorrhoids?
Commonly known as piles, this is when veins in the anal pop out from the anal canal (internal) or pop out of the anus (external)
What are the presenting symptoms of haemorrhoids?
- Pain
- irritation
- bleeding
- constipation
- change in bowel habits
What are the danger elimination/ red flag symptoms for haemorrhoids?
- Duration longer than 3 weeks
ADRs
presence of blood in the stools
persistent change in bowel habit
What lifestyle advice can you give to someone with haemorrhoids?
Hygiene with warm water no soap
Pat with tissue rather than rubbing
Increase dietary fibre
What is the treatment timescale for haemorrhoids?
1 week
Give examples of OTC treatments that can be used for haemorrhoids?
- Garmoloid cream (lidocaine and Zn)
- Anusol supositories (Zn, bismuth)
- Anusol HC ointment (with hydrocortisone)
What is the common cold?
A cold is a contagious viral disease which infects the soft lining (mucous membrane) of the nose (thus antibiotics don’t work against this)
- usually occurs anytime during the year
- symptoms gradually come on, not to severe
What is the flu virus?
- Flu virus affects the upper airways
- Usually occurs during the winter months
- Has a more sudden onset than cold, more severe, affect people’s daily activities
How can you catch cold or flu?
-you can catch a cold/flu by inhaling drops of mucus infected with a cold virus. Cold viruses can also survive on objects such as handles, keyboards etc. Spread by coughing, sneezing, talking
List some symptoms of a cold?
First signs: - scratch feeling in their throat -Tickling sensation in nose Runny/stuffy nose Sneezing Sore throat , coughs Sinus congestion Water eyes Mild muscular aches/ headache Symptoms can last for up to 2-14 day Mild fever temp 37-38.3ᴼC
List some symptoms of flu?
One respiratory symptom (cough, sore throat, nasal congestion, or rhinorrhoea)
Fever/high temperature (>38ᴼC)
One constitutional symptom (headache, sweat/chills, prostration)
Bedbound, unable to do daily activities
Loss of appetite
Weakness
Symptoms last for 1 week
What are the danger elimination questions/ red flags of cold/flu?
- Persistent high temperature
- Difficulty breathing/ wheezing
What should you look out for in phlegm?
If green (getting worse), yellow (getting better)/ blood may be secondary infection - refer
What are some lifestyle advice that can be given to someone with cold/flu?
o Wash hands frequently to prevent the spread of germs
o Get plenty of rest. Keep warm, but don’t let the room get to stuffy-a little fresh air may help you feel better
o Drink plenty of fluids –around 8-10 glasses a day. Hot drinks containing lemon juice or honey may help soothe the sore throat
o Inhale steam to help loosen & bring up phlegm
o Increase Vitamin C & zinc levels to boost the immune systems
o If possible, stay away from people with colds
o Avoid smoking – it irritates the mucus membrane of the nose
o Always sneeze and cough into tissues. Throw away used tissues immediately and then wash your hands,
o Don’t share cups or kitchen utensils with others. Use your own cup, plates and cutlery
What additional advice can be given to ensure patient receive this annually?
Flu vaccination
elderly and also those with certain medical conditions such as diabetes, asthma, heart conditions
What is the treatment timescale for cold/flu?
7-14 days
What does caffeine help with in cold/flu medicines?
Helps with absoprtion
What is coughing a result of?
Coughing is a reflex action caused when the airway is being irritated or obstructed
Can be due to an infection in the upper respiratory tract or just a common cold
Are coughs self-limiting?
Yes within a few days, if longer than 2 weeks then refer to GP
What are the presenting symptoms of cough?
Dry tickly cough
Chesty, loose cough with sputum
Sore throat
What are the danger elimination questions/ red flags of coughs?
- Long duration (2-3 weeks)
- • Difficulty breathing/shortness of breath
• Coloured sputum (yellow/green/rusty or blood stained)
• Persistent nocturnal cough in children
• Croup/whooping cough/ TB
• Bronchitis, asthma, CVD, gastro-osephagus
What lifestyle advice can be given to someone with cough?
- Maintain fluid intake
- catch it bin it and wash
- stop smoking
Drink plenty of fluids - thin mucous in throat help to cough it up.
Rest
Suck on hard candy – can ease dry, tickly cough
Cut down / try to quit smoking / stay away from second hand smoke.
If cough made worse by dry air then make air humid HUMIDIFIER
If cough made worse at night then use something that causes drowsiness
What is the treatment timescale for coughs?
2 weeks
What kind of cough is simple linctus used for?
Used for dry cough, go to GP if it doesn’t work within 5 days. It also contains high amounts of sucrose.
What is pholcodiene used for?
Dry tickly cough, not to be taken for under 12. contains alcohol. do not give id breastfeeding.
What is guaifenesin used for?
chesty coughs
What ingredient does robitussin dry cough contain?
Dextromethorphan
How do expectorants work and give a few examples?
promote sputum used for chesty coughs- guaifenesin and ipecucanhua
How do suppressants (antitussives) work and give a few examples?
codeine, pholcodiene, dextromethorphan
How do demulcents work and give a few examples of demulcents?
Contain soothing substances such as syrup or glycerol and some patients believe that such preparations relieve a dry irritating coughsimple linctus, glycerine, lemon, honey- sooth effect
What is acute cough?
lasting less than 3 weeks
What is chronic cough?
Lasting more than 3 weeks - may be related to smoking, asthma/ bronchitis
When supplying cough syrups what must be noted for diabetics?
FOR DIABETICS USE ROBOTUSSIN (SUGAR-FREE) -
tell patient to monitor blood glucose as control can get worse when ill
What can sore throat be caused by?
- Often mark the start of a cold/flu
- also be due to localised infection or irritation caused by coughing or mucus running down the back throat
- Can be caused by viruses / bacteria – infection
- Can also be brought on from following treatment with antibiotics or steroids
o Can be spread from one person to another by airborne droplets, hand contact / kissing
o If sever sore throat could be- Tonsillitis which is inflammation of the tonsils (found at the back of the throat)
What are the symptoms of sore throat?
Vary from localised, mild discomfort, to intense pain when swallowing, Pain may spread to ears
Dry throat, swollen tonsils
Difficulty swallowing
Hoarseness / croakiness
Redness & swelling of the back of the throat
Tenderness around the jaw & ear or around the front of the throat
Associated symptoms: headache, aching, temp, tiredness
What are the danger elimination questions/ re flag symptoms of sore throat?
- Long duration (2-3 weeks)
- ADRs (agranulocytosis)
- Unable to swallow
- White exudate on tonsils
- Recurrent infection
What is tonsillitis?
extremely painful sore throat, along with a fever, headache & general feeling of being unwell.
What lifestyle advice can be given to someone with sore thoat?
- Drink plenty of fluids. Warm drinks containing lemon juice & honey can be soothing
- Gargle with salty water / aspirin (adults only, not if you’re taking other aspirin medication/ <16 yrs)
- Don’t smoke or avoid smoky environment
- Don’t share cups, cutlery
- -Avoid food or drink that is too hot as this could irritate your throat – and sometimes triggers such as spicy food
- Can be contagious especially if it is glandular fever
What is the treatment timescale?
Should improve within 1 week then refer
What are some products that can be used for sore throats?
Pastilles and lozenges - strepsils, beechams lozenges
Antiseptic lozenges - Beecham lozenges
Local anaesthetics - Ultra chloraseptic anaesthetic throat spray (benzocaine)
Strepsil extra
Difflam Spray
Painkillers/ anti-inflammatory - ease the pain - covonia throat spray
Salt water - gargling with salty water - relieves sore throat - add teaspoon of salt to a glass of warm water
What microorganism causes vaginal thrush?
Fungal - Candida albicans
Is vaginal thrush self-limiting?
Yes - usually within 1-2 weeks.
What are the presenting symptoms of vaginal thrush?
- itching
- soreness
- Discharge (colourless/watery/white)
What are the danger elimination questions/ red flag of vaginal thrush?
OTC medication failure
Diabetics – high blood sugars favourable environment
Under 16ys – not usually fungus
Over 60 yrs – not usually fungus
• More than two attacks in the last 6 months - recurrent
• Pregnancy or suspected pregnancy
• Blood stained or strong smelling discharge – could be signs of STIs would need referral
What lifestyle advice can be given to someone with vaginal thrush?
- Avoid tight, close fitting clothes since these create a warm, moist environment which can be a trigger for thrush
- Avoid the use of soaps, bubble baths and douches which may affect the pH balance of the vagina and encourage infection
- The application of live yogurt not only has a soothing action but can restore the balance between bacterial and fungal cells, making fungal overgrowth less likely
What is the treatment timescale for vaginal thrush?
If symptoms do not improve within 1 week of treatment, refer to GP
What are some of the products available for vaginal thrush?
clotrimazole 2% cream - canestan - apply thinly 2-3 times a day until it has cleared
clotrimazole 500mg pessary
fluconazole oral capsule 150mg
What is cystitis?
A urinary tract infection where there is some inflammation of the urethra and the bladder (sometimes not through infection but also through bruising can be prevented through urinating after intercourse).
Most commonly occurs in women, rare in men.
Is cystitis self-limiting?
Mild cases will resolve themselves within a few days
What are the presenting symptoms of cystitis?
- Pain, burning or stinging when you pee (it’s a bit more acidic)
- Needing to pee more often and urgently than normal
- Urine that’s dark, cloudy or strong smelling
- Pain low down in your tummy
- Feeling generally unwell, achy, sick and tired
- Possible symptoms in young children include a high temperature (fever) of 38C (100.4F) or above, weakness, irritability, reduced appetite and vomiting.
What are the danger elimination/ red flag symptoms for cystitis?
Failed medication
Diabetics – sugar in the urine more risk at infection
Blood in urine
• All men (longer urinary tract) and children (not as common so needs referring)
• Fever, nausea/vomiting – systemic effects of infection
• Loin pain/tenderness – bacteria going from the bladder to the kidneys
• Haematuria
• Pregnancy – women who get cystitis while pregnant are more likely to have complications during birth
• Recurrent cystitis
• Discharge
What are some lifestyle advice that can be given to someone with cystitis?
- Staying well hydrated – drinking plenty of fluids may help to stop bacteria multiplying in your bladder
- Emptying your bladder as soon as possible after having sex
- Drinking cranberry juice has traditionally been recommended as a way of reducing your chances of getting cystitis.
- Wipe front to back
What is the treatment timescale for cystitis?
2 days - if symptoms are still persistent then see GP.
What can be used OTC?
Cystitis relief sachets - 1 TDS for 2 days
What is allergic rhinitis?
Allergic reaction to tree pollen, grass pollen, fungal spores.
What is perennial rhinitis?
Allergy to house dust mite, animal dander, feathers - symptoms are present all year round
What are the presenting symptoms of hayfever?
Itchy eyes Watery eyes Itchy nose Runny nose Blocked nose Sneezing
what are the danger elimination questions/ red flags of hayfever?
Wheezing/shortness of breath Tightness of chest Painful ear Painful sinuses Purulent conjunctivitis Failed medication
What are some lifestyle advice that can be given to someone suffering from hayfever?
Sleep with windows closed.
Avoid being outside when pollen count is high (mid morning/early evening)
Get someone else to cut the lawn.
Avoid stroking animals.
Drive the car with windows and vents closed.
Vacuum regularly
What is the treatment timescale for hay fever?
If no improvement of symptoms after 5 days of treatment, refer to GP.
What are headaches defined as?
Headache is defined as pain in the head that is located above the eyes or the ears, behind the head, or the back of the upper neck
What are tension headaches?
The most common type of headache.
Muscles in the head and neck tighten up to cause pain
Can be caused by tension or stress, not enough sleep, smoking, too much alcohol, eye strain, part of a cold or a side effect of some medication.
What is a sinus headache?
Caused by a build-up of pressure in the sinus, often during or after a cold
What are hangover headaches?
Pounding headache that occurs after drinking too much alcohol. Alcohol causes dehydration, which leads to swelling of the blood vessels in the brain.
What is a medication overuse headache?
Caused by the overuse of painkiller, any nitrate e.g. GTN can cause headaches. Someone who has just started a COC who has a headache needs to be referred as it can cause an embolism (stroke).
What are migraine headaches due to?
– Caused by the swollen blood vessels and the reduction of certain chemical substances in the brain.
What are the symptoms of tension headaches?
Tension headache – felt as dull, aching pain in the forehead, temples or at the back of the neck. Sometimes described as a tight bound around the head or a heavy weight pressing down on top of the head – BOTH SIDES OF THE HEAD – Last 30min – 7 days.
If migraine, will have sensitivity to light, numbness, loss of sensation
What are the symptoms of sinus headache?
Felt as deep, dull ache, on the sides of the nose and around the eyes, which is worse when the head is moved.
What are the symptoms of hangover headache?
feels like a dull pounding ache, often with nausea and vomiting
What are the symptoms of medication overuse headache?
Often described as oppressive and worse in the morning or after exercise.
What are the danger elimination questions/ red flags of headaches>
• Severe and >4 hrs duration • ADRs • Children <12 yrs • Associated with head injury/trauma • Location and type of pain (severe occipital and raised intracranial pressure) • Nausea and vomiting • Neck stiffness • Frequently recurring - sudden, severe headache - blurred vision - recent head injury - high fever with stiff neck - meningitis - numbness, tingling, weakness in arms and legs (stroke - symptoms)
What non-medical advice can be given for headaches?
- Get plenty of rest, take regular breaks when on a computer/concentrating for a long period
- Regular exercise or warm baths can help relieve tension
- Apply ice pack to painful areas
- If trigger is known, try to avoid
- Massage
- Drink plenty of water or non-alcoholic drinks in between alcohol
What is the treatment time scale for headaches?
1 day treatment timescale.
How long does it take for dispersible dosage forms to achieve peak compared to traditional drugs?
Dispersible dosage achieve peak in 30 minutes compared to traditional drugs which peak in 2 hours
Can aspirin be used first line for headaches?
NO
OTC age restriction for aspiring?
16 years and over
Can ibuprofen be used for someone on lithium and they come to buy ibuprofen for a headache?
No cannot be used - they will have a blue book (lithium and NSAIDs compete for the same site of action but NSAIDs are more ‘powerful’ so will displace lithium and therefore lithium plasma conc increases leading to toxicity)
What is a migraine?
- A severe throbbing, intense, recurring headache
- usually affects only one side of the head.
- accompanied by nausea, vomiting and visual disturbances.
- Caused by swollen blood vessels & the reduction of certain chemical substances in the brain
- There are also certain ‘trigger’ factors that can set off a migraine such as: certain foods (cheese, chocolate), bright lights, menstruation and some drugs.
- Not just pain – increase sensitivity to light and other sensations
- Certain foods and alcohol can cause It/ flashing lights/tiredness
What are the symptoms of migraine?
Headache - ON ONE SIDE Blurred vision Flashing/ coloured lights Nausea and/or vomiting tingling in the hands or arms Lasts 4min to 60mins
What are the red flag/ danger elimination questions for migraines?
• Severe and >4 hrs duration • ADRs • Children <12 yrs • Associated with head injury/trauma • Location and type of pain (severe occipital and raised intracranial pressure • Neck stiffness - medication not relieving symptoms - oral contraceptive/headache- if they start combined oral contraceptive there is a risk of stroke(any headaches)
What non-medical advice can be given for migraines?
- Keep a diary of everyday life so when a migraine occurs, can help pinpoint a trigger such as certain foods, smoking or certain drugs
- During the attack, lie down and rest (preferably sleep) in a dark, quiet room
- Try to lead a healthy lifestyle with good nutrition, plenty of water, sufficient sleep and exercise
What is the treatment timescale for migraines?
1 day - if no improvement then see GP
What is the active ingredient in imigran recovery?
Sumatriptan - only to be used with clear diagnosis of migraine.
Age 18 and over to 65
What is the age restriction for migraleve?
14 years and over
What is the dose for migraleve pink and yellow?
2P at onset, if needed, 2Y every 4hrs
MAX: 2P, 6Y
Is buclizine a sedating antihistamine?
Yes
Which formulation is better for migraines and why?
GUT motility slows down in migrane – so you recommend effervescent instead of oral tablets
What is dysmenorrhoea?
Painful periods or menstrual cramps
Is dysmenorrhoea self-limiting?
Yes - usually lasts less than 3 days
What are the presenting symptoms of dysmenorrhoea?
- Painful cramps
- Headache, backache
- Nausea, vomiting constipation
- Faintness, dizziness, fatigue
- Premenstrual syndrome (PMS)
What are the danger elimination questions/ red flags of dysmenorrhoea?
Abnormal discharge (of unusual colour) or (abnormal/heavy) bleeding (continuous bleeding)
• Severe intermenstrual pain – period pain when you are expecting your period
• Medication failure – don’t refer if one OTC didn’t work, if different combinations don’t work
• Presence of fever – signs of infection
What age does primary dysmenorrhoea occur in?
17-25 years old
What age does secondary dysmenorrhoea occur in?
25 years +
What is difference between primary and secondary dysmenorrhoea?
Secondary = underlying cause
What lifestyle advice can be given to someone with dysmenorrhoea?
- Exercise during menstruation is not harmful and may be beneficial - some evidence that moderate aerobic exercise can improve symptoms of PMS
- Some evidence that a low-fat, high-carbohydrate diet reduces breast pain and tenderness
- Some doctors suggest starting painkillers the day before the period is due – may prevent pain from building up
- Use hot water bottle
What is the treatment time scale for dysmenorrhoea?
If the pain of primary dysmenorrhea is not improved after two cycles of treatment, referral to the doctor would be advisable.
What ingredient is contained in feminax ultra?
Naproxen 250mg
Suitable for only women aged 15-50 years.
Should not be used for longer than 3 days treatment
What ingredient is contained in feminax express?
Ibuprofen lysine
What is the dose for feminax ultra (Naproxen)?
Two tablets taken initially, then a further tablet 6-8h later if needed. Max. 3 tablets in 24 hours. Max. treatment duration is 3 days.
What is insomina?
Difficulty sleeping or waking up and not being able to go back to sleep
What are the presenting symptoms of insomnia?
- Difficulty falling asleep at night.
- Awakening during the night.
- Awakening too early.
- Not feeling well rested after a night’s sleep.
- Daytime tiredness or sleepiness.
- Irritability, depression or anxiety.
- Difficulty paying attention, focusing on tasks or remembering.
- Increased errors or accidents.
What are the danger elimination questions/ red flags of insomnia?
- Suspected depression – can’t say are you feeling depressed/ so say is there anything you think might have caused this, How you feeling in yourself?/ How are you feeling in the moment?
- Insomnia lasting more than 3 weeks
- Children under 16
- Medication failure
What lifestyle advice can be given to someone for insonia?
- Set a specific time for getting up each day. Try to stick to this time, seven days a week, even if you feel you haven’t had enough sleep. This should help you sleep better at night.
- Don’t take a nap during the day.
- Take daily exercise, such as 30 minutes walking or cycling. But don’t exercise for at least four hours before going to bed, because this may make it more difficult to fall asleep.
- Stop drinking tea and coffee for a few hours before bedtime.
- Avoid drinking alcohol and smoking, particularly shortly before going to bed.
- Don’t eat a big meal just before bedtime.
- Only go to bed when you’re feeling tired. If necessary, go to bed later than usual if it means you might be able to fall asleep more quickly.
- Don’t use back-lit devices shortly before going to bed, including televisions, phones, tablets and computers.
- Try to create a relaxing bedtime routine, such as taking a bath, listening to soft music, and drinking a warm, milky drink every night. These activities will be associated with sleep and will cause drowsiness.
- Avoid regularly using over-the-counter sleeping tablets. It is not clear how effective these are, they don’t tackle the underlying problem, and have potential side effects. Read more abouttreatments for insomnia.
- Don’t lie in bed feeling anxious about lack of sleep. Instead, get up, go to another room for about 20 minutes and do something else, such as reading or listening to soft music, before trying again.
- Avoid watching the clock because it will only make you anxious about how long it’s taking you to fall asleep.
- Write a list of your worries and any ideas to solve them before going to bed. This may help you forget about them until the morning.
- Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright street lamps affect your sleep.
- Make sure your bedroom is at a comfortable temperature for sleeping.
- Wear ear plugs if noise is a problem.
- Don’t use your bedroom for anything other than sleeping or sex. Avoid watching television, making phone calls, eating or working while you’re in bed.
- Make sure your mattress is comfortable and that you have a pillow you like, as well as adequate bedding for the time of year.
What is the treatment timescale for insomnia?
1 week
Name some active ingredients that can be used to help with sleep?
Diphenhydramine (Nytol)
Promethazine (Phenargan)
Valerian (Nytol Herbal)
What types of drugs are diphenhydramine and promethazine?
Sedating antihistamines
What are the symptoms of irritant dermatitis?
- Mild-severe inflammation
- redness
- itching
- blistering, bleeding or cracking
- if becomes chronic, dry, inflamed, scaly and thickened
What are the symptoms of allergic dermatitis?
Starts as itchy, red rash at site of contact
- may be swelling or blistering
- if allergen persisits, skin becomes thicker, drier and scaly,
- reaction confined to site of contact but may spread
What are the danger elimination questions/ red flags for dermatitis and eczema?
• Infection – weeping, crusting, spreading
- broken skin
• Symptoms don’t subside after 1 week of treatment
• Severe condition – cracked skin, bleeding
• Duration of longer than 2 weeks
What lifestyle advice can be given for dermatitis/ eczema?
• Avoid known substances that cause irritation or wear protective clothing e.g. gloves
• Avoid itching or scratching or rubbing the skin
• If exposed to known allergen, wash skin immediately with cool water and soap (to remove allergen
• Moisturise hands to prevent dry, cracked skin
• Avoid skin contact with substances that may worsen the condition:
Hot water
Soaps
Chemicals
Acidic substances
Creams and lotions
What is the onset of action of the skin reaction for irritant contact dermatitis?
onset of the skin reaction is usually within 48 hours of coming into contact with the irritant
What is the onset of action of the skin reaction for allergic contact dermatitis?
often a delay of many hours to several days before symptoms develop following contact with the allergen
What is the treatment timescale for dermatitis/ eczema?
IF SYMPTOMS NOT IMPROVED IN 1 WEEK THEN REFER TO GP
What is acne?
Acne vulgaris – inflammation of hair follicles and sebaceous glands
Most common on face but also on arms and back
Triggered around puberty to due hormonal changes
Starts at the age of 10-13 yrs
What are the presenting symptoms of acne?
- Occur on face, chest and upper back
- Greasy skin
- Small, tender, red papules (=small, solid elevation of skin)
- Open and closed white heads and blackheads
- Deep inflamed lesions
What are the danger elimination questions/ red flags of acne?
Signs of infection – weeping, crusting, pus
- Moderate-Severe acne
- Failed medication
- Suspected drug-induced acne
- Not responded to treatment after 8 weeks
- If the suffer is an adult with spots for the first time
- Failed medication
- Severe case
What non-medicinal advice can be given for acne?
• Wash skin gently with a mild cleanser morning and night, plus after any heavy exercise.
Avoid very hot water, strong detergents, rough scrubbing pads or harsh astringents. Pat skin dry with a clean towel. Gentle toners or skin freshener can be used.
• Use acne treatment regularly and give them time to work.
• Wash hair regularly, especially if the person has a hair style with a fringe, or other hair which falls over the face
• Resist the temptation to squeeze, pinch or pick spots.
• Natural sunlight helps
• Choose cosmetics which are water-based rather than oil-based.
• A healthy, balanced diet with plenty of water, and regular exercise
• Water-based make up rather than oil based
• No evidence to say diet can make acne worse
• Takes at least two months for symptoms to clear – so need to be patient
• Skin may become dry
What is athletes foot?
Athlete’s foot is a very common, highly contagious fungal infection.
Occurs between the toes and on the soles of the feet.
Thrives in warm, damp environments so sweaty skin encourages infection.
Passed from person to person by direct contact or by contact with clothing and floors.
Itchy and flaky
What are the symptoms of athletes foot?
Itching between the toes and sometimes on the soles or sides of the feet
- Soggy white skin between the toes, smelly
- Flaking and Peeling or cracked skin
- Red and inflamed skin
- Small blisters between the toes
- Thickened, yellow toenails if the infection has spread to the nails
What are the danger elimination questions/ red flags of athlete’s foot?
- Signs of bacterial infection
- Diabetics – poor blood glucose management
- Affecting parts of the foot other than in-between toes
- No toenails affected
what lifestyle advice can be given for athletes foot?
o Wash feet every day and dry thoroughly especially between the toes using separate towel.
o Avoid sharing towels to reduce risk of passing the infection on.
o Wear socks made of cotton or wool (natural materials) and change them at least twice a day or when they have become damp.
o Avoid wearing shoes made of synthetic materials. Wear sandals or leather shoes instead.
o Powder the feet and inside of shoes with an antifungal powder
o Finish course of treatment, stopping early can lead to re-infection
o Wear plastic shoes or flip-flops in communal showers, changing rooms and around pools.
o Spend time bare foot allowing feet to breathe when possible.
o Antifungal powders to put in shoes – t
o Normal HbA1c should be around 48 – can also be about 53 if on different medications – for diabetics – risk of neuropathy
What is the treatment time scale for athletes foot?
2 weeks
What important information should be given when selling antifungal cream for athletes foot?
• Continue treatment for up to 2 weeks after the infection has cleared
What options are there for treatment of athletes foot?
Daktarin (miconazole) - cream or powder (Avoid in people who are on warfarin serious interaction).
Lamisil AT 1% cream
What are cold sores caused by?
Caused by a strain of the herpes simplex virus which is caught I childhood or early adulthood, probably from being kissed by someone with the virus.
What can trigger cold sores?
- Physical or emotional stress
- Illness such as cold or flu
- Strong sunlight or other sources of ultraviolet light such as sun beds
- Mouth Injuries
- Menstruation
- Fatigue or mental exhaustion
- Cold weather
What are the symptoms of cold sores?
- Discomfort, tingling or irritation in skin 6-24 hours before appearance
- Weeping and crusting about 4th day after appearance
- Extremely painful
- Total length of an episode is usually 1-2 weeks
- Length of an episode is 10-20 days
What are the danger elimination questions/ red flags of cold sores?
- Babies and young children
- Signs of bacterial infection
- History of frequent cold sores
- Painless sores
- Patients with atopic eczema
- Eye affected
- Immuno-compromised patient
What lifestyle advice can you give for cold sores?
- If the sore has developed, try to avoid touching it and if so, wash hands thoroughly to avoid spreading it to other parts of body – especially the EYE
- Don’t kiss someone when you have a sore
- Don’t share a towel, flannel, lipstick etc
- Never touch the eyes or genital area before washing your hands if you have touched the cold sore
What is the treatment timescale for cold sores?
2 weeks
What OTC options are there for cold sores?
Zovirax - acyclovir 5% antiviral cream
Blistex relief cream
What are the instructions for zovirax when used for cold sores?
Apply ever 4hrs/5 times a day for 5-10 days
Start treatment at first sign of cold sore-when skins tingles
Is there are cure for cold sores?
NO KNOWN CURE FOR COLD SORES
What are warts/ verrucas caused by?
Viral infection of the skin. high incidence in school children.
What do warts look like?
o Rough, scaly, pink or skin- coloured papules with roughened surface
o Normally Painless
What do verrucas look like?
o Areas of flat, thickened skin with a harder edge around a softer centre (warts grow inwards)
o Weight bearing areas (sole & heel), painful when pressure applied
o Often sore to touch and to stand or walk on
What are the danger elimination red flags for warts and verrucas?
- Cracked skin or weeping – may be secondary bacterial infection
- Change in appearance of lesions (size and colour)
- Bleeding or Itching
- Genital Warts
- Facial Warts
- Immuno-compromised patients - Diabetes
What lifestyle advice can be given for warts and verrucas?
- Avoid direct contact with another person’s wart
- Don’t share towels with a person who has warts or shoes or socks with someone who has a verucca
- Keeping feet dry and changing socks daily
- Don’t scratch or pick at a wart, this may encourage it to spread
- Wear flip-flops in communal showers
- Veruccas are covered with a plaster or special swimming socks (no bare feet)
- People with hand warts should wear gloves if they are using communal equipment (for example, in a gym).
What is the treatment timescale for warts and verrucas?
3 months
What active ingredient is used to treat warts and verrucas?
Bazuka Gel
What are the steps to using salicylic acid preparations (Bazuka gel) for warts and verrucas?
- Soak the affected area with warm water and towel dry
- Rub the surface of the verruca with a pumice stone or emery board to remove any hard skin
- Cover the surrounding healthy skin with Vaseline to protect it
- Carefully apply the salicylic acid making sure it does not cover any healthy skin around the verucca.
- Repeat the procedure daily, remember it can take up to 12 weeks – 3 months
What is scabies?
Scabies is an intensely itchy skin infestation caused a human
Mites burrow into skin on the abdomen, armpits, genital area, hands and feet. The neck and hands are not usually affected.
It is highly contagious and spread by close personal contact especially in overcrowded living conditions – schools, nursing homes. It can be passed on by sexual contact.
Itching is due to an allergic reaction to the itch mites and their body fluid
What are the symptoms of scabies?
- Small, thread like grey-line burrows can be seen
- Lines are raised, wavy and about 5-10mm long
- Intense itching which is worse at night
What are the danger elimination questions/ red flags for scabies?
- Babies and children
- Infected skin – weeping yellow discharge or yellow crusts (signs of bacterial infection)
- Treatment failure
- If diabetic or immunocompromised
How long does it take for symptoms of scabies to appear?
Symptoms of scabies begin to appear 2-6 weeks after infestation but after previous experience can appear a few hrs later
What lifestyle advice can be given for scabies?
- All bed linen, clothing and towels should be machine washed after the treatment has been applied to prevent re-infection
- Any items that can’t be washed e.g. cushions, sofa etc should be covered in plastic for 72 hrs to contain the mites until they die
- If you wash your hands during period of treatment then product will need to be re-applied
- Itching may continue after 3 weeks of successful treatment – eurax cream needed
- All household members should be treated on the same day as symptoms may take up to 8 weeks to develop therefore risk of reinfestation
Where is the treatment for scabies applied?
- Treatment is applied to entire body from neck down in adults
- Children under 2 and elderly the treatment should be applied thinly to entire body including ears unless contra-indicted (avoid eyes and mouth)
- Use malathion when permathrin is not suitable
What treatment options are available for scabies OTC?
Derbac M (malathion) Lyclear Dermal cream (Permethrin)
What can be used alongside to help with itching associated with scabies?
Eurax cream
Piriton
How long after treatment can itching last up until after successful treatment?
may continue up to 3 weeks
What must you check with the patient before supplying treatment for scabies?
Check if the patient is asthmatic and don’t give anything with alcohol
What are the instructions for scabies cream?
Apply head to toe leave it on over night and then shower the next day – then apply again in one week. Wash bed sheets and clothes – at 50oC
What is dandruff and what causes it?
Increased cell renewal leads to greater shedding of skin – build up of dead skin cells
Noticeable when brushing etc
Can occur either due to : - Not brushing the hair regularly
- An over growth of tiny fungal
- Nutritional deficiencies, such as lack of vitamin B or essential fatty acids
- A diet that is high in sugar & refined carbohydrates.
What are the symptoms of dandruff?
- Greyish white flakes of skin visible on the hair & shoulders
- Itching of the scalp
- Soreness of the scalp (can also feel tight)
- Hair loss
What are the danger elimination questions/ red flags of dandruff?
- OTC treatment failure
- Suspected psoriasis – will see more pink scales
- Signs of bacterial infection – is it weeping
What lifestyle advice can be given to prevent dandruff?
- Brushing hair on a regular daily basis
- Washing hair at least 3 times per week
- Rinsing hair thoroughly after washing
- Using specially medicated shampoo every 1-2 weeks to prevent reoccurrence
- Avoid using chemical hair dyes
- Ensuring a well balanced diet to include vitamins such as zinc, beta-carotene, B6, B12 and selenium.
- Avoid using hair products that may irritate the scalp, switch to a different product that may cause less irritation.
- Avoid scratching the scalp. When washing the hair use the tips of your fingers, NOT the nails.
- For mild dandruff use a shampoo used for dry hair, this will remove the flakes shed and the moisturiser in the shampoo will protect the scalp.
- Use an anti-dandruff shampoo & conditioner.
What is the treatment timescale for dandruff?
SYMTPOMS SHOULD IMPROVE WITHIN 12 WEEKS OF BEGINNING TREATMENT
Name a few medicated shampoos that can be used for dandruff?
Capasal therapeutic shampoo (salicylic acid)
selsun shampoo
meted anti-dandruff (salicyclic acid)
Nizoral anti-dandruff shampoo (ketoconazole)
What are the two types of hair loss?
Two types - localized patch hair loss (alopecia arieta) and common baldness (alopecia androgenetica)
What is the presenting symptoms of hair loss in women vs women?
Men – hair line decreases
Women- parting increases
Hair thinning
Gradual decrease
What are the danger elimination questions/ red flag symptoms of hair loss?
- Alopecia areata (sudden patchy hair loss)
- Suspected drug induced hair loss
- Suspected hypothyroidism
- Suspected anaemia
- Levodopa, warfarin, lithium, chemotherapy drugs, sodium valproate, carbamazepine – could be a side effects of these
What lifestyle advice for hair loss?
stress, smoking and reduce alcohol
What is the treatment timescale for hair loss?
6-12 month
Will take 4 months to see results – then 6 to 8 months later will see normal hair, however not meant to use it for longer than 12 months
What OTC treatment is available for hair loss>
Minoxidil (there is a 2% and 5% available) – don’t give to patients who are already on hypertensives or some cardiac issues – don’t give as it induces hypotension and increases risk of falls
What is psoriasis?
- Chronic recurring skin condition, where skin cells reproduce too quickly
- This is a skin condition in which skin cells reproduce too quickly causing red, flaky, crusty patches covered with silvery scales. These scales are then shed easily.
- Most commonly occur on elbows, knees, lower back and scalp. Can also cause intense itching and burning.
What are the symptoms of psoriasis?
- Red, scaly patches (silvery scales when scraped or scratched)
- Itchy patches (feel painful or sore)
- Thickening and reddening of patches of skin
- Usually on extensor surfaces of knees and elbows
- Can affect your scalp - where it can cause redness and flaking
- Can affect your fingernails - which can become pitted and discolored
What are the danger elimination questions/ red flags for psoriasis?
Evidence of infection – pus, weeping, crusting, cracked skin
No visible improvement after 1 week of treatment
No previous diagnosis
What lifestyle advice for psoriasis?
Keep the skin lubricated – oils, creams, Vaseline
• Mild soaps or soap-free cleaners are recommended such as Nivea and dove
• Exposure to the sun can help
• Bathing in hot water can help reduce scaling
• Avoid skin injuries and infections
• Try to drink at least 8 glasses of water a day
• Increase your fruit/veg intake
• Limit alcohol intake
What is nappy rash?
• An irritant dermatitis confined to the nappy area
Caused by prolonged contact of skin with urine and faeces, human waste produce turns into ammonia-which eats the baby’s skin & irritates the skin
What are the symptoms of nappy rash?
• Small, red dots present suggest fungal infection
What are the danger elimination questions/ red flags for nappy rash?
- OTC treatment failure
- Broken skin
- Signs of bacterial infection
- Other body areas affected
- Very severe rash
What lifestyle advice for nappy rash?
- Increase frequency of nappy changes
- Use warm water and cotton to clean the bottom thoroughly, rather than baby wipes. (contain alcohol that can irritate skin)
- Make sure the nappy area is dried thoroughly – pat rather than rub dry
- Leave the nappy off for as long as possible as air will encourage healing
- If cloth nappies are used, they should be machine washed using a non-biological washing powder, using an extra rinse if possible
- Avoid the use of talc this can cause irritation
- Apple a barrier cream (Vaseline) to protect the skin
- Avoid soaps as they dry out skin
- Find out how often the nappy is changed – ask how frequently it is being changed
What is the treatment timescale for nappy rash?
1 week
What are the danger elimination questions/ red flags for common childhood rashes?
- have a stiff neck
- are bothered by light
- seem confused
- are shaking uncontrollably
- have a fever you can’t control
- have unusually cold hands and feet
- have a rash that doesn’t fade when you press a glass against it
- unwell
- does not go with treatment
- long time
- spreading
- have an allergy
What is conjunctivitis?
• This is an inflammation of the conjunctiva, which is the thin membrane covering the white of the eye & inside of the eyelids.
What are the three main types of conjunctiviits?
• Infective Conjunctivitis (bacterial & viral)
-Caused by a virus (mainly in adults) or bacteria (mainly in children)
-Very contagious
• Allergic conjunctivitis
-Caused by an allergy (e.g. pollen, animal, fur, smoke, pollution, etc)
• Irritant conjunctivitis
-Caused by pollution, smoke, chlorine in swimming pool & low humidity
Glare & bright lights
Concentrating for long periods (eye strain), driving, using a computer
What are the symptoms of infective conjunctivitis?
- starts in one eye then quickly spreads to the other
- easily spreads from one person to another
- whites of the eye look pink
- eyelids- red and swollen
- sticky discharge - eyelash stick together (morning)
- eyes feel gritty/ irritated
What are the symptoms of allergic conjunctivitis?
- both eye develop symptoms at the same time
- accompanied with sneezing and runny nose
- watery eyes
- itchy eyes
- May occur at particular
What are the symptoms of irritant conjunctivitis?
- red eyes
- eyes feel tired
- eyes feel sore/irritated
- dry eyes
What are the danger elimination questions/ red flags of conjunctivitis?
younger than 2 years old pain recent eye surgery visual disturbances if patient has glaucoma pregnant or breastfeeding abnormal pupil
What lifestyle advice for infective conjunctivitis?
Good hygiene of hands & face (don’t share face towels)
Don’t rub eyes, as you may spread the condition
Pus & crust can be removed by using lukewarm salty water
Use disposable tissues when you dry your eyes
Dispose of antibiotic eye drops after the treatment is over
What lifestyle advice for irritant conjunctivitis?
Wear sunglasses to avoid glare
Place a bowl of water any a radiator to prevent the eye from drying out
Take regular breaks from the computer
Keep the eyes clean by continuing to bathe them with boiled and cooled water and using separate swabs for each eye to prevent re-infection.
Use separate face flannels and towels to the rest of the family to prevent passing on the infection.
Only use the treatments during waking hours.
Try not to rub your eyes.
If doing the gardening again in the wind try to protect the eyes with goggles or glasses.
What is the treatment timescale?
IF SYMPTOMS DON’T IMPROVE WITHIN 48 HOURS OF STARTING THEN REFER TO GP**
**USE TREATMENT FOR 5 DAYS EVEN IF SYMPTOMS DISAPPEAR
What general advice can you give for using eye drops and contact lenses?
- When using the eye drops or ointment you should take care to not touch the dropper or tube tip to any surface, or to your eye, in order to avoid contaminating the medicine.
- The eye drops and ointment may cause your vision to blur temporarily after you have applied them into your eye. Do not drive or operate machinery until this has worn off.
- Don’t wear contact lenses, as product can affect the contact lenses (may absorb preservatives) or it may aggravate the condition
- Must not be taken by mouth
List some common ear problems?
Ear wax - may be produce at a faster rate than normal–leads to a build up of excess
wax
-In extreme cases the wax may block the ear canal
Otitis Media -an infection amongst the middle ear
-Common amongst children (can affect adults)
Glue ear -type of chronic otitis media.
-Long term build up of thick/ stick fluid in the middle ear
Otitis externa -bacterial/fungal infection
-occurs when too much water in ear
What are the symptoms of excess ear wax?
Difficulty in hearing,
- pain in the ear,
- tinnitus (noise / ringing in the ear),
- blocked feeling in the ear,
- temporary deafness after swimming/ showers
What are the symptoms of otitis media?
Pus, fluid, inflammation inside middle ear
- Sever earache, hearing loss, fever & tinnitus
- Treatment – antibiotic
What are the symptoms of glue ear?
hearing loss
-commonly occurs in children
What are the symptoms of otitis externa?
common in children
- pain & itching, dulled hearing & ear discharge
- usually caused by a cold
What are the danger elimination questions/ red flags of ear problems?
Signs of infection (discharge)
• Perforated ear drum
• Pain
- under 12 years old
What lifestyle advice can be given for common ear problems?
Never insert anything into the ear
-Don’t use COTTON BUDS/FINGERS / SMALL OBJECTS to clean ear as this will simply push the ear wax deeper – increase the build up
-Swimming – the use of EAR PLUGS can help prevent water from getting into the ear.
-For ear glue – avoid SMOKY ENVIRONMENT
• Avoid doing anything before travelling that may cause your ears to get blocked e.g. swimming, diving.
• Have ears checked before travelling for infection.
• Have ears checked before travelling for excess wax.
What is the treatment timescale for common ear problems?
IF SYMPTOMS DON’T IMPROVE WITHIN 1 to 2 weeks THEN REFER TO
GP
What are natural methods without treatment to help with common ear problems?
- Suck sweets to relieve the pressure.
- Swallow regularly to relieve the pressure.
- Try Valsalva’s manoeuvre- hold the nose closed between the finger and thumb and with the mouth closed try and breathe out through the nose. This may relieve the pressure.
- Yawning
What treatment can be used for blocked ear?
- Use a decongestant spray just before descent. E.g. Sudafed decongestant nasal spray- one spray into each nostril three times a day when required, Otrivine nasal spray- one spray in each nostril 2-3 times a day.
- Use nasal drops e.g. otrivine drops- 2-3 drops in each nostril 2-3 times a day.
- Oral decongestant one hour before descent e.g. Sudafed one tablet 3-4 times a day
What is teething in babies?
A baby’s first teeth usually develop while the child is growing in the womb. These teeth then start to emerge through the gums when a child is 6-9 months old. This process is known as teething.
-A baby’s bottom front teeth usually come through first, followed by their top front teeth and then the top and bottom incisors either side
What are the symptoms of teething?
- Pain and discomfort
- Swollen gums
- Red, hot cheeks
- Nappy rash
- Increased tendency to chew objects
- Changes in sleep pattern and/or appetite
- Heavy drooling
What are the danger elimination questions/ red flags of teething?
- Failed medication
- Signs of lactose intolerance
- Infant failing to gain or is losing weight
- Excessive diarrhoea (leads to excessive fluid loss therefore dehydration)
- Temperature above 38 oC may suggest infection on top of teething
What non medicinal advice can be given for teething?
- It can be helpful to give the child something hard to chew on.
- Teething rings that can be cooled in the fridge can be particularly soothing.
- Teething gels containing local anaesthetics can provide some pain relief from sore gums.
- Brush the teeth as soon as they appear
- Do not rub whiskey on the gums
What is the treatment timescale for teething?
IF SYMPTOMS HAVE NOT IMPROVED IN 7 DAYS/ 1 week THEN REFER TO GP
What are some of the options for treatment gels?
Anbesol liquid/ teething gel
dentinox teething gel
bonjela teething gel
What are head lice?
Head lice are small, blood sucking insects that live and feed on the scalp.
After hatching the empty egg case turns white and is carried up to the surface by hair growth, where it becomes visible (‘nits’)
They take 6-14 days to become fully grown, and after this time they are capable of reproducing. They need to maintain contact with the host in order to survive.
More common in young children ( 4-11 years old are more susceptible due to prolonged head-to-head contact)
symptoms of headlice?
- Common in young children
- Small greyish-white or brown-coloured specks comb out of hair (Live and dead lice)
- Small blackish specks on pillows and collars (Insect faeces)
- Itching may occur after several weeks of infestation
- Nits are creamy-coloured empty egg cases that remain firmly attached to hair shafts as they grow outwards (if present is a sign of previous or current infection)
Danger elimination questions/ red flags of headlice?
- Bacterial infection from scratching - Weeping and pus from too much scratching– evidence of secondary infection
- Treatment failure (two applications of insecticide seven days apart – to kill any eggs not killed by first treatment
when using head lice treatment what must you be careful with for people with asthma?
avoid those that contain alcohol as this can trigger asthma attacks
Lifestyle advice for headlice?
- Avoid direct head to head contact.
- Minimise itching of scalp/behind ears.
- Carry out regular checks using the wet combing method. Every week, and also check behind the ears and neck
- Protect eyes and face when treating, with a towel
- Comb the hair every night
- Check hair clothes regularly for black specks
- Inform all close contacts if lice are found
OTC treatment advice for head lice?
- All members of the family should be treated at the same time to prevent re-infection
- Lotions allow for longer contact periods of insectides with hair than shampoos therefore several applications may be required or treatment failure may occur
- After treatment comb the hair wet with nit comb
- Use hand protection when applying
- Use fine tooth comb on wet hair to reduce pain and static electricity, over white paper. First brush the hair, then comb the hair and then use the fine tooth comb to prevent pain when the comb catches on knots in the hair
- Lice shells are yellowish colour.
- Live lice are grey/white or brown specs.
- Louse faeces are black specs on pillow or collar.
- Check hair at nape of neck and behind the ears.-warm and sheltered.
- Check weekly by wet combing to spot signs of infestation.
- Empty shells and no live lice probably means there is no current infestation.
- Only the comb and not the lotion removes the shells.
- Protect the eyes and face from the lotion.
- Residual effect of malathion reduced by chlorine in swimming pools and hair driers.
- AVOID ALCOHOL BASED TREATMENTs IN ASTHMATICS
What is the treatment timescale for head lice?
REFER TO GP IF SYMPTOMS HAVEN’T IMPROVED WITHIN ~ 14 DAYS
What active ingredient is good for head lice?
Dimeticone
What is a sprain?
A sprain involves an injury to a ligament that supports a joint, Knee and ankle joints are particularly vulnerable.
The pain will be considerable and instant when the damage occurs.
The area will look swollen and bruised, and little movement of the affected joint will be possible.
Grade I – Mild stretching of ligament
Grade II- Partial rupture of ligament
Grade III- Complete rupture with joint instability
What are strains?
A strain involves injury to the muscles and tendons that move the bones of a joint. There is a sharp and sudden pain on movement, although movement is possible. The area will be tender and swollen.
what is repetitive strain injury?
Some soreness – caused by a repeating movement
What are danger elimination questions/ red flags for sprain and strains?
- ADRs causing falls/bruising
- Medication failure
- Suspected fracture
What non medicinal advice for sprains and strains?
- Immediate treatment should lead to PRICE (in first 24-48hr period, avoid HARM (heat, alcohol, running and massage, can do HARM after 48hrs of the strain)
- Protection
- Rest – joint should be rested for 48 hrs after injury to avoid further damage
- Ice – apply ice asap after injury for 10-30mins max. e.g. bag of frozen peas
- Compression – gentle compression such as tubigrip can be used
- Elevation – by elevating the affected area, it helps reduce the swelling and bruising
- After the first 48hrs and inflammation has gone down, can apply heat for pain by using hot water bottle, warm bath or a counter-irritant (heat rub cream)
What are backaches?
- Backache is mild to severe pain or discomfort in the area of the lower back.
- The pain can be acute (sudden and severe) or chronic if it has lasted more than three months.
- It can be caused by awkward bending, pregnancy or sitting for a long period of time e.g. when driving.
What are the danger elimination questions/ red flags of backache?
- fever, nausea/ vomiting
- weight loss
- inflammation/ swelling
- pain that travels to chest, at high up the back
- pins and needles in the legs below the knee
- constant pain
- under 20 or over 55
Pain felt on either side of middle part of back
-just below ribcage associated with abnormality
in passing urine – KIDNEY PAIN
-SEVERE pain radiating down back onto both legs - SCIATICA
non-medicinal advice for backache?
- continuing with your normal activities wherever possible,
- the use of a muscle relaxant may be prescribed but only for a few days,
- if you are in severe pain, keep any bed rest as short as possible, as complete rest does not help recovery,
- doing exercises to strengthen your muscles and improve your posture,
- applying a cold compress (bag of frozen peas wrapped in a tea towel) to reduce the initial inflammation, applying heat (heating pad, hot water bottle or hot shower) after a few days to ease muscular pain
- Good posture, lifting correctly
What is the treatment timescale for backaches?
IF SYMPTOMS HAVE NOT IMPROVED IN 5 DAYS THEN REFER TO GP
What is tennis. golfer’s elbow?
Tennis, Golfer’s elbow: affects the elbow muscles, tendons and the bony knobble (epicondyle) on the inside of the elbow where the muscles that flex the forearm attach to the upper arm – it will be a strain
What are the symptoms of tennis elbow?
swelling around the outer edge of the elbow, tenderness around the elbow and pain during movement
What are the symptoms of golfer’s elbow?
swelling appears on the inside of the elbow, tenderness around the elbow and pain during movement & when quickly flexing the arm and hand
Picking things up may be difficult because of pain or weakness, and it is usually due to inflammation around the area due to repetitive movement
What non medicinal advice for tennis/ golfer’s elbow?
- PRICE to be used immediately
- Protection
- Rest – joint should be rested for 48 hrs after injury to avoid further damage
- Ice – apply ice asap after injury for 10-30mins max. e.g. bag of frozen peas
- Compression – gentle compression such as tubigrip can be used
- Elevation – by elevating the affected area, it helps reduce the swelling and bruising
- After the first 48hrs and inflammation has gone down, can apply heat for pain by using hot water bottle, warm bath or a counter-irritant (heat rub cream
What is a frozen shoulder?
It is a condition that affects your ability to move your shoulder around.
- There is stiffness and pain in the shoulder joint, which reduces normal movement in this area. –
- Recovery can be slow and symptoms usually last for two to three years, although for some people it is much faster than this.
What are the stages of frozen shoulder?
Stage 1: -the shoulder starts to ache and feel stiff, before becoming very painful.
- the pain is often worse at night and when you lie on the affected side.
- This stage lasts between 2-9 months.
Stage 2: -this is known as the adhesive stage.
-The shoulder typically becomes more and more stiff, although the pain does not
normally get worse.
-The muscles may start to waste slightly as they are not being used.
-This stage lasts between 4-12 months.
Stage 3: -this is the recovery stage in which you gradually regain movement of the shoulder.
-The pain also fades, although it may recur from time to time as the stiffness eases.
-Although you may not regain full movement of your shoulder, you will be able to do
many more tasks.
-This stage lasts five to twelve months.
What is rheumatism?
Rheumatoid arthritis is an autoimmune disease.
- Your immune system, which usually fights infection, attacks the lining of your joints, causing
them to become inflamed.
- Over time, your joints may become permanently damaged and stop working properly.
- pain, soreness or stiffness in the muscle, joints or tendons that is long-term
What are the symptoms of rheumatoid arthritis?
Joint pain and swelling - this is usually worst in the morning and tends to improve as you move around.
Joint stiffness - again this often improves once you start moving around.
Warmth and redness - the lining of the affected joint becomes inflamed, leaving the skin over the joint warm, red and swollen
Loss of appetite.
Generally feeling unwell.
Skin nodules - one in four people with rheumatoid arthritis develop lumps under their skin, known as rheumatoid nodules. These commonly occur on the skin over the elbows, and forearms, and are usually painless.
Anaemia -is a condition where the blood is unable to carry enough oxygen, due to a low number
What non-medicinal advice for rheumatoid arthritis?
You should try and get plenty of rest during a flare-up, as this is when your joints can be particularly painful and inflamed.
- Putting further strain on very swollen and painful joints can often make pain and inflammation worse.
- Exercise is very important for maintaining your general health and mobility. A gentle form of exercise that does not put too much strain on your joints is best. Swimming, for example
