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
