GPhC Exam > OTC > Flashcards

OTC Flashcards

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1
Q

GI red flags

A
  • blood in stool/vomit
  • dysphagia
  • unexplained weight loss
  • vomiting with constipation
  • babies projectile vomiting
  • sustained alteration in bowel habit
  • medicines causing stomach pain: nitrates, CCBs, NSAIDs, alendrotnic acid, corticosteroids, opioids
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2
Q

Oral thrush symptoms

A
  • creamy white patches on oral mucosa
  • burning sensation in mouth
  • change in taste
  • refer a healthy adult presenting with oral thrush
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3
Q

Oral thrush OTC treatment

A
  • daktarin oral gel (miconazole)
    -licensed from 4 months old
  • apply after food
  • continue for 48 hours once lesions have healed
  • if CI, refer for nystatin
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4
Q

Causes of mouth ulcers

A
  • vitamin B/folic acid deficiency
  • stress
  • IBD
  • poor nutrition
  • trauma
  • carcinoma
  • smoking
  • ADR
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5
Q

Mouth ulcers symptoms

A
  • small lesions with a distinct outer edge
  • painful/ stinging
  • if irregular shape = due to trauma or something sinister
  • normally resolve within 7-14 days
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6
Q

When should you refer mouth ulcers

A
  • painless
  • > 3 weeks
  • clusters of 5 or more
  • pregnant/breastfeeding
  • diabetic
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7
Q

OTC treatment of mouth ulcers

A
  • paracetamol
  • anbesol (lidocaine) - one ulcer, infant age +
  • corsodyl (chlorhexidine) - 1 + ulcer, 12 years +, don’t swallow
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8
Q

Dyspepsia causes

A
  • hurried meals
  • spicy food
  • H. pylori
  • overweight
  • NSAIDs
  • Iron
  • Nitrates
  • CCBs
  • pregnancy
  • bisphosphonates
  • steroids
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9
Q

Dyspepsia lifestyle advice

A
  • decrease fat in diet
  • reduce alcohol intake
  • smoking cessation
  • weight loss
  • reduce caffeine intake
  • raise head of bed
  • eat 4 hours before going to bed
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10
Q

Dyspepsia OTC treatment

A
  • antacids e.g. gaviscon
  • 12 years +
  • magnesium = diarrhoea
  • aluminium = constipation
  • omeprazole/esomeprazole
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11
Q

OTC constipation summary

A
  • 1st = always lifestyle advice
  • bulk forming (ispaghula) - not in sedentary or not before bed
  • osmotic (lactulose/macrogol) - safe in preg/breasfeeding, lactulose in children = cavities
  • stimulant (senna/glyc/bisa) - avoid in preg, glycerol most effective in children moisten before use works in 30 mins, useful in opioid induced
  • stool softeners (docusate)
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12
Q

Diarrhoea

A
  • self-limiting
  • must stay off school/work for 48 hours
  • referral: babies > 24 hours, elderly and children > 48 hours, adults > 72 hours, traveller’s diarrhoea, chronic/recurrent, fatigue
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13
Q

Diarrhoea OTC treatment

A
  • oral rehydration therapy
  • immodium (loperamide)
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14
Q

Oral rehydration therapy details

A
  • used from 3 months old
  • sip little and often
  • sachets keep for 24 hours in fridge once made up
  • max 6 sachets daily
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15
Q

Immodium details

A
  • loperamide
  • used from 12 years
  • max 8 tabs daily
  • 2 tablets initially then one tablet after each loose stool for up to 5 days
  • MHRA: cardiac ADRs (QT prolongation) with high doses of loperamide associated with abuse and misuse
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16
Q

IBS symptoms

A
  • abdominal pain
  • bloating
  • alteration in defecation
  • must be diagnosed by Dr for OTC tx
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17
Q

IBS OTC treatment

A
  • buscopan IBS relief - GSL
  • buscopan cramps - P
  • both hyoscine butylbromide
  • avoid in pregnancy/breastfeeding
  • caution in glaucoma/BPH
  • peppermint oil = can cause heart burn, avoid in breastfeeding
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18
Q

Haemorrhoids symptoms

A
  • pain on defecation/sitting down
  • small amounts of bright red blood on toilet paper
  • itching
  • internal haemorrhoids = painless but will bleed
  • external = more painful and visible
  • referral: > 3 weeks, internal pain, large volumes of blood, blood mixed in stool, first time
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19
Q

Haemorrhoids OTC treatment

A
  • anusol
  • ointment = external, suppositories = internal
  • over 16s
  • hydrocortisone products = 18+, no more than 7 days, don’t use if skin broken/infected
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20
Q

Respiratory red flags

A
  • COPD
  • asthma
  • very old
  • very young
  • pleuritic chest pain
  • diabetes
  • diabetic = check blood sugars every 2-4 hours, may need to adjust insulin dose, drink plenty fluids, check ketone levels, aim for BG 6-10mmol/L
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21
Q

Cold and flu OTC treatment

A
  • paracetamol
  • sudafed (pseudoephedrine/ephedrine)
  • from 12 years
  • max: 720mg pseudo, 180mg ephedrine
  • don’t take at night - stimulant properties
  • don’t sell to diabetics (increase BG or HTN)
  • interacts with MAOIs
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22
Q

Cough summary

A
  • no evidence for cough products
  • referral: > 3 weeks, SOB, purulent sputum, haemoptysis, wheezing, drug induced, frothy sputum (HF)
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23
Q

Cough OTC treatment

A
  • simple linctus = paediatric and SF available, suitable for diabetics and preg
  • codeine linctus = MHRA: restricted under 12 (respiratory side effects), not for 12-18 years with respiratory problems, restricted in children - morphine toxicity
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24
Q

Sore throat referral

A
  • > 2 weeks
  • hoarsness > 3 weeks
  • immunosuppressants
  • exudate on tonsils
  • airway compromise
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25
Sore throat OTC treatment
- paracetamol - ibuprofen - topical preparations (little evidence)
26
Allergic rhinitis symptoms
- allergic conjunctivitis, runny nose, itchiness - referral: sinus/ear pain that doesn't resolve after 7 days, wheezing, purulent sputum - lifestyle: wear sunglasses, keep windows/ doors closed, avoid hanging out washing at midday
27
Allergic rhinitis OTC treatment
- oral antihistamines 1. chlorphenamine - 1 yrs (liquid), 6 yrs (tablet) 2. cetirizine, loratidine - 2 yrs (liquid), 6 yrs (tablet) - Beconase nasal spray (beclometasone) -- over 18s, start 2 wks before hay fever season, max: 3 months - sodium cromogylate eye drops -- over 6 yrs, see GP if needed > 14 days
28
Paediatric paracetamol doses
- 120mg/5mL - 2 months = stat 2.5mLat time of men B vaccine + 1 further dose if required OR one 60mg suppository - 3-5 months = 2.5mL QDS - 6-23 months = 5mL QDS - 2-4 yrs = 7.5mL QDS - 4-6 yrs = 10mL QDS - 250mg/5mL - 6-8 yrs = 5mL QDS - 8-10 yrs = 7.5mL QDS - 10-12 yrs = 10mL QDS - Tablet: 12-16 years 750mg QDS
29
Paediatric ibuprofen doses
- 100mg/5mL - 3-5 months = 2.5mL TDS - 6 - 11 months = 2.5mL TDS-QDS - 1-3 yrs = 5mL TDS - 4-6 yrs = 7.5mL TDS - 7-9 yrs = 10mL TDS - 10-11 yrs = 15mL TDS - 12-17 yrs = 200-400mg TDS
30
Teething symptoms
- temperature - swollen gums - excessive dribbling - nappy rash - reduced sleep
31
Teething OTC treatment
- paracetamol - anbesol (lidocaine) - topical tx - apply undiluted max 6x day
32
Cradle cap symptoms
- yellow, scaly skin on scalp and eyebrows - slight redness around area - referral: signs of infection
33
Cradle cap OTC treatment
- baby shampoo and a soft brush - apply oil at night and wash in morning with baby shampoo
34
Colic symptoms
- babies crying > 3 hours per day - worse on evening - pulling legs towards chest - referral: not gaining weight
35
Colic OTC treatment
- infacol (simeticone) - 0 yrs + - one drop before each feed - soothe baby - burping after meals - ensure correct teat size
36
Chicken pox symptoms
- varicella zoster - small, red, itchy spots on scalp, trunk, upper limbs that develop into vesicles, fever, general malaise - infectious 1-2 days before and 6 days after vesicles - not infectious once crust over - can return to school - referral: pregnant, immunocompromised, secondary infection, wheezing/rapid breathing - counselling: lukewarm baths, loose clothes, nails short, fluids
37
Chicken pox OTC treatment
- Paracetamol (fever) - calamine lotion and chlorphenamine (itch) - NEVER IBUPROFEN
38
Headlice details
- must see live louse to diagnose - only tx family if they have live lice - tx on same day
39
Headlice OTC treatment
- Hedrin (Dimeticone) - apply to dry hair from roots to tips - leave on for max 8 hours - repeat after 7 days - wash out with normal shampoo - wet combing essential to remove eggs - suitable for asthmatics and those aged 6 months + - MHRA: severe burns if in contact with flames
40
Threadworm details
- symptoms: nocturnal perianal itching, visible worms in stools - no need to keep children off school - referral: secondary infection, tx failure
41
Threadworm OTC treatment
- Ovex (mebendazole) - 1 x 100mg - repeat after 14 days - keep nails short and clean, wash bed linen daily
42
Measles symptoms
- white/grey spots on inside of cheeks (koplik spots) - flu like symptoms - sore eyes sensitive to light - red/brown rash starting on back of neck - lasts 7 days - stay off school
43
Measles OTC treatment
- paracetamol ** notifiable disease
44
Rubella (German measles) symptoms
- symptoms: rash starts behinds ear, flu-like symptoms - lasts 3 days - spotty rash that starts on the face or behind the ears and spreads to the neck and body - stay off school
45
Rubella OTC treatment
- paracetamol ** notifiable disease
46
Mumps symptoms
- painful swelling of parotid glands - avoid school/work for 5 days - highly contagious viral disease
47
Mumps OTC treatment
- paracetamol - ** notifiable disease
48
Scarlett fever symptoms
- flu-like - swollen neck glands - sore throat - sand paper rash - white coating on tongue - flushed cheeks - strawberry tongue
49
Scarlett fever OTC treatment
- refer for abx - return to school 24 hours post starting abx ** notifiable disease
50
Whooping cough symptoms
- cold-like initially - after 1 week cough begins - may bring up thick mucus - stay off for 48 hours from starting abx tx or 21 days from start of cough
51
Whooping cough treatment
- refer for abx ** notifiable disease
52
Eczema symptoms
- red, itchy, inflamed skin on internal flexures - referral: signs of secondary infection, severe/extensive
53
Eczema OTC treatment
- emollients e.g. hydromol - MHRA: risk of severe/fatal burns - apply in direction of hair growth to prevent folliculitis every 2-3 hours. Use to replace soap in bath - hydrocortisone 1% cream - wait 15-30 minutes after applying emollient and continue for 48 hours after eczema has cleared
54
Psoriasis symptoms
- pink/red rash with silver scale on external flexures - referral: new presentation, extensive or severe forms, pustular psoriasis, secondary infection
55
Psoriasis OTC treatment
- ovonex ointment (calcipotriol) - 18 yrs + - avoid sunlight exposure - max weekly dose is 100g of cream/oint
56
Irritant/contact dermatitis symptoms
- itchy/blistered/cracked/red skin which occurs hours - days after allergen/irritant - referral: infected skin, extensive/severe
57
Irritant/contact dermatitis OTC treatment
- hydrocortisone 1% cream - apply BD max of 7 days - not OTC for face or genitals - counselling: avoid irritant
58
Scabies symptoms
- itching in webs of fingers - itching worse at night - burrowing rash - grey lines on skin - referral: still itching after 3 weeks post OTC tx, those under 2 year
59
Scabies OTC treatment
- permethrin - tx all close contacts - using cotton wool, apply from neck down incl. head for 12 hours overnight - repeat in one week - can return to school/work after first tx - if hands washed during tx - reapply
60
Acne symptoms
- whiteheads - blackheads - painful pustules - cysts - oily skin - referral: no improvement after 8 wks OTC, drug-induced acne, anxiety/depression
61
Acne OTC treatment
- acnecide (benzoyl peroxide) - treat entire face - initially OD then increase to BD - may take 2-3 months to work - counselling: may bleach clothes/bed linen, don't squeeze spots, gentle face washing, apply a light moisturiser to reduce irritation
62
Shingles symptoms
- herpes simplex - symptoms: pain before rash appears, red papules, unilateral, follows nerve line - referral: over 50s, pregnant, eye involvement, immunocompromised
63
Shingles OTC treatment
- painkillers - if struggling to cope - refer - counselling: use cold compress 2-3 x daily - avoid preg women who have not had chicken pox, babies who are <1 month and immunosuppressed people
64
Ringworm symptoms
- dry/red/scaly/itchy rash - highly contagious and spread through objects (touch) - referral: on scalp, immunosuppressed
65
Athletes foot symptoms
- dry/flaky/red/soggy/itchy cracked skin between toes
66
Ringworm and athletes foot OTC treatment
- clotrimazole 1% cream - apply to affected area(s) and 2 inches surrounding - counselling: Don't share towels, wash clothes at high temperature, dry feet thoroughly, use talcum powder to help sweat, don't use moisturiser between toes
67
Fungal nail infection symptoms
- nail becomes thickened, distorted and crumbly - proximal = starts at base - distal = starts at tip - referral: < 18 years, diabetic/peripheral vascular disease, proximal, 2 + nails, fully destroyed nails
68
Fungal nail infection OTC treatment
- amorolfine nail lacquer - weekly application - file nail before applying - counselling: tx can take unto 12 months, keep nails short, use anti fungal powders in shoes
69
Warts and verrucas symptoms
- human papilloma virus - wart = irregular raised surface on skin - verruca = flat head, hard pads of skin, inward growth, black dots, pain - referral: signs of bleeding, wart adjacent to eczema, changed appearance, diabetes/PVD, wart not on hand or foot
70
Warts and veruccas OTC treatment
- Bazuka (salicylic acid with lactic acid) - 1 or 2 drops daily - can take up to 12 weeks to work - counselling: protect surrounding skin with vaseline, use an emery board (nail file) weekly
71
Impetigo symptoms
- lesions/sores around mouth and other areas of body - yellow/golden crust - referral: widespread, systemic symptoms
72
Angular chelitis symptoms
- red, swollen patches on corners of the mouth - referral: widespread, systemic symptoms
73
Impetigo OTC treatment
- mild = hydrogen peroxide 1% - use for 5 days - infected = refer
74
Angular chelitis OTC treatment
- decent lip balm (e.g. hemp from the body shop) - tx when it starts as it can develop into impetigo
75
sinus headache symptoms + treatment
- pain in cheekbones and behind brow bone - can treat with analgesics/decongestants
76
tension headache symptoms + treatment
- caused by stress, anxiety, fatigue, prolonged concentration - pain is described as band across the head - treat with analgesics
77
cluster headache symptoms + treatment
- severe pain around eye - unilateral - blocked nostril - hot/redenned cheek - REFER
78
temporal arteritis symptoms + treatment
- severe pain around temples, jaw pain, red prominent temporal artery, partial/complete vision loss - REFER
79
chronic daily headache symptoms + treatment
- dull headache associated with analgesic dependence - aim to reduce opioid use to 3 days - Refer: severe headache > 4 hours, migraine with COC, associated neck stiffness, injury, children < 12 yrs
80
OTC treatments for travel sickness
- Stugeron (cinnarazine) - hyoscine hydrobromide (kwells) - phenergan (promethazine)
81
OTC cinnarazine details
- from 5 years - 2 hours before travel then every 8 hours - sedating
82
OTC hyoscine hydrobromide details
- from 3 years - 30 mins before travel then every 6 hours
83
OTC promethazine details
- Elixr (from 2 years) - tablets (from 5 years) - take night before travel
84
Insomnia details
- refer: depression, <16 years, lasting > 3 wks - 1st line: sleep hygiene - exercise, no caffeine, no naps, wind down, no heavy meals at night, only to bed when tired, get up same time
85
Insomnia OTC treatment
- Nytol (diphenhydramine) - from 16 years - 20 mins before bed, not on consecutive nights
86
Thrush symptoms
- vulvar itching, pain, irritation, odourless white discharge, pain on passing urine, pain during sex - refer: first occurrence, discharge with strong smell, blood stained discharge, suspected STI, diabetes, pregnant, 2x occurrences in last 6 months, males that contracted it during sex, women aged < 16 and > 60
87
Thrush OTC treatment
- clotrimazole cream/pessary, fluconazole oral capsule - only in women aged >16 and <60 - counselling: no tight fitting clothes, no perfume products, if no improvement after 5 days - see GP ** clotrimazole can damage condoms - use alternative method of contraception for 5 days
88
Cystitis (E.coli) symptoms
- dysuria, urgency, cloudy/smelly urine, increased frequency/urgency - refer: men, children, pregnant, recurrent, diabetics, blood in urine, pain in loins, symptoms > 5 days, no improvement after 24 hours of OTC
89
Cystitis OTC treatment
- potassium/sodium citrate sachets - 1 TDS for 48 hours, if no improvement after 24 hours - see GP - counselling: plenty of fluids, no caffeine/alcohol, don't resist urge to urinate, paracetamol
90
Bacterial conjunctivitis symptoms
- gritty sensation, eye lids stuck together, yellow discharge - refer: extensive infection, copious amounts of discharge that accumulates after wiping, pain within eye
91
Bacterial conjunctivitis OTC treatment
- 2 years old - max 5 days - continue for 48 hours after eyes improve - counselling: not in 3rd trimester, no breastfeeding, see GP if no improvement in 48 hours. If under 2 = eye bathing (warm water on cotton pads, wipe from inner corner to outside of eye, use pad once only)
92
Stye symptoms
- painful localised swelling on either the lower eye or eyelid - refer: pain within the eye, vision changes, foreign body in eye
93
Stye OTC treatment
- self-limiting - counselling: apply warm compress 5-10 mins 2-4x daily
94
Blepharitis symptoms
- sore eyelids, dry eyes, blurred vision, sticky eyelashes, swollen eyelids, altered eyelash appearance, oily eyelid surface ** chronic condition - refer: extensive infection, copious amounts of discharge that accumulates after wiping, pain within eye, non-eye symptoms
95
Blepharitis OTC treatment
- eye hygiene - counselling: bathe eyes BD during infection, OD when normal, avoid mascara/eye liner
96
Subconjunctival haemorrhage symptoms
- blood shot eyes - refer: pain in eye, vision changes, foreign body in eye
97
Subconjunctival haemorrhage OTC treatment
- self-limiting condition
98
Dry eye symptoms
- sensations of a foreign body within the eye, photophobia, watery eyes (bilateral) - refer: pain in eye
99
Dry eye OTC treatment
- hypromellose 0.3% eye drops - 30 minute intervals when severe - decrease usage as symptoms improve
100
Ear wax symptoms
- temporary deafness/discomfort - refer: associated tinnitus/nausea, severe deafness, severe pain, failed OTC treatment
101
Ear wax OTC treatment
- oil based = cerumol olive oil ear drops or cerumol arachis oil ear drops - arachis oil not for nut allergy - peroxide = otex express ear drops - counselling: plug ears with cotton wool, make sure drops are at room temperature
102
Otitis externa symptoms
- inflammation of skin within ear canal, eczema present which can become infected, itchy/red/irritated skin - refer: foul smelling discharge, internal ear pain, foreign body present, mastoiditis, marked hearing loss, neoplasm, psoriasis, tinnitus, symptoms worse after 48 hours of OTC
103
Otitis externa OTC treatment
- EarCalm (acetic acid 2%) - 12 yrs + - max use 7 days - further 2 days once symptoms have cleared - counselling: use drops within 28 days of opening, prevent shampoo/soap from getting into ear, avoid cotton buds
104
Otitis media symptoms
- pain within eardrum and temporary deafness, cough/sore throat, perforated eardrum - refer: foreign body present, neoplasm, mastoiditis, systemic infection (fever present)
105
Otitis media OTC treatment
- paracetamol - GPs reluctant to treat within 48 hours as condition is self limiting
106
OTC clotrimazole 2% cream age
- 16 to 60
107
OTC naproxen 250mg tab age
- 15 to 50
108
OTC sildenafil 50mg tab age
- no max age, 18 +
109
OTC sumatriptan 50mg tab age
- 18 to 65
110
OTC tamsulosin 400mcg cap age
- 45 to 70
111
OTC esomeprazole and omeprazole age
- 18 + - OD
112
OTC atovaquone/proguanil (Maloff protect)
- 18 + - 40 kg - 1OD 1-2 days before, during and 7 days after
113
OTC proguanil
- daily - 1 week before, during and 4 weeks after
114
OTC Beclomethasone nasal spray age
- 18 + - 12 on prescription
115
OTC chloramphenicol age
- 2 + - 0 Rx
116
OTC clobetasone 0.05% cream age
- 12 + - 0 Rx
117
OTC hydrocortisone age
- 10 +
118
OTC mebendazole age
- 2 +
119
OTC cetirizine/loratidine age
- 2 + (liquid) - 12 + tablet
120
Paracetamol OTC age
- 2 months, post immunisation
121
OTC pseudoephedrine liquid age
- 6 + (liquid) - 12 + tablet
122
OTC Gina (estradiol vaginal tablet) age
- 50 + - no period for at least 1 year - can't take if history of clots, breast cancer
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