6.1 URTI: what are the red flags? If yes refer urgently to SMA.
-resp difficulty: >24breaths/min or O2 <94%
-high pitch wheeze, drooling, voice hoarseness
-confusion/lethargy
-SOB worsening in chronic conditions
-dehydration
6.1 URTI: presentations that mean refer to SMA.
-fever >40.5
-fever >38.5 for >72hr
-severe headache/neck pain/photophobia
-chronic resp disease
-nasal congestion >7days with purulent discharge
-facial/maxillary pain
-cough >3 weeks
-severe throat pain
-difficulty/pain swallowing
-Suspected viral URTI, or cant self care
6.1 URTI: tx for nasal? Tx for throat/fever/malaise?
Nasal:
Pseudoephedrine 60mg 1tab PO q6-8hr prn(max 4/24hr)
caution: high bp,asthma,heart disease,glaucoma,diabetes,thyroid,prostate,mao use in 2 weeks,other cold meds,acts stimulant
Desloratadine 5mg 1tab daily
caution: liver/ren, family hx seizures
Throat/Fever/Myalgias:
Ibuprofen (advil) 400mg 1tab PO 6-8hrs prn (max 3 tabs/24hours)
Caution: nsaid, bleeding, gi ulcer, liver/kidney, hyperkalemia, pregnancy
Acetaminophen (tylenol) 500mg 1-2 tabs PO q4-6hr prn (max 8/24hrs)
Caution: g6pd deficiency, liver
6.2 OTC Pain: what are the red flags?
-fracture
-cancer
-caude equina
-infection
6.2 OTC Pain: yellow flag?
-believes pain is harmful
-fever/avoidance of movement
-low mood/withdrawal
-expect passive tx rather than active participation will help
6.2 OTC Pain: tx?
Acetaminophen (tylenol) 500mg 1-2tabs PO q4-6hours prn max8/day
Ibuprofen (advil) 400mg 1tab PO q6-8hr prn max3/day
Diclofenac 2.23% (voltaren xst) q12hr prn
Consider RICE(rest,ice,compression,elevation)
6.3 OTC Headache: what do you first consider after assessment?
Other reasons to refer?
TBI
-first/worst
-thunderclap(sudden)
-balance/loc/sensation
-onesidedweakness
-chronic/progressive
-change of pattern
6.3 OTC Headache: tx?
Acetaminophen(tyleonol) 500mg 1-2 tabs PO q4-6hr prn max8/day
Ibuprofen(advil) 400mg 1tab PO q6-8hr prn max3/day
Nonpharm tx: rest,hydration,reducelight/noise/heat/cold
6.4 OTC GERD: what is dyspepsia?
GERD?
Odynophagia?
Dyspepsia: heartburn
Gastroesophageal reflux disease
Odynophagia: painful swallowing
6.4 OTC GERD: red flags?
-abdo mass
-anemia
-chest pain
-choking
-dysphagia/odynophagia
-gi bleed
-weight loss unintentionally
-vomit
6.4 OTC GERD: tx?
Gaviscon xst chew 2-4 tabs qid prn (after meals and at bedtime) (11tab/day)
Famotidine 20mg (pepcid) 1 tabs bid prn
6.5 OTC Dysmenorrhea: abnormal symptoms requiring sma?
-not mild-severe
-not beginning on menses onset
-not lasting 2-3days
Also refer sma if pt wants hormonal contraception
6.5 OTC Dysmenorrhea: tx?
Ibuprofen(advil) 400mg 1tab q6-8hr prn max 3/day
Nonpharm: low intensity exercise(yoga,stretching)
6.6 OTC Motion Sickness: red flags?
-dehydration
-bloody vomit(hematemisis)
-blood in stool (hematochezia)
-persistant vomiting
-abdo pain
-difficulty swallowing
-unintentional weight loss
6.6 OTC Motion Sickness: tx?
Dimenhydrinate 50mg (gravol) PO/IM q4hrs prn
Nonpharm tx: bland diet, rest, sit in front, look over horizon when driving
6.7 OTC Diarrhea: red flags?
-severe
->4-6poose bm/day for 2 days
-cramps,vomit,chills/fever
-blood/mucus in stool
-persistent
-recent antibiotic use
-severe dehydration
-weight loss
6.7 OTC Diarrhea: tx?
Loperamide 2mg 2tabs stat then 1tab every bm prn max 48hr, max8tabs/day
For dehydration: gastrolyte 1pack/200ml water stat and every loose bm
Nonpharm: bland diet, no dairy, decrease sugar, rest,fluids
6.8 OTC Constipation: red flags?
-no bm in >7days or constipated >2weeks
-blood/mucus in stool
-fever
-fam hx colon cancer
-abdo pain
-vomit
-defecation pain
-abdo surgery recently
6.8 OTC Constipation: tx?
PEG pack(restoralax) 1dose(17g) dissolved in liquid
1/day for 3-5days
Or
Bisacodyl 5mg (dulcolax) 1-2 tabs once daily at bedtime
Max 2 days supply
Nonpharm: water/fiber intake, increase exercise/movement
6.9 OTC Fungal: symptoms that are likely other diagnosis?
-skin erythema, pruritis
-slow spread, irregular/circumferential borders of plaques
-gets worse using cortisone cream
6.9 OTC Fungal: red flags?
-sudden onset, intense itch, slin redness (contact dermatitis)
-bright red, painful, not itchy (cellulitis)
-immunocompromised
-diabetic
6.9 OTC Fungal: tx?
Clotrimazole 1% (canesten) apply bid for 7-10days
6.10 Atopic Dermatitis/Dry Skin: red flags?
-mod/severe impact to wellbeing
-disturbed sleep
-widespread (>30%)
-incessant itching
-bleeding/oozing/blistering/pigment change
-systemic symptoms
-chemical exposure
6.10 Atopic dermatitis/dry skin: tx?
Moisturizing cream apply bid/qid prn
If Mild atopic dermatitis can give instead: hydrocortisone 1% cream apply bid prn for 7 days
