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GPhC Exam > OTC > Flashcards

OTC Flashcards

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
Q

Sore throat OTC treatment

A
  • paracetamol
  • ibuprofen
  • topical preparations (little evidence)
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26
Q

Allergic rhinitis symptoms

A
  • 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
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27
Q

Allergic rhinitis OTC treatment

A
  • 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
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28
Q

Paediatric paracetamol doses

A
  • 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
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29
Q

Paediatric ibuprofen doses

A
  • 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
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30
Q

Teething symptoms

A
  • temperature
  • swollen gums
  • excessive dribbling
  • nappy rash
  • reduced sleep
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31
Q

Teething OTC treatment

A
  • paracetamol
  • anbesol (lidocaine) - topical tx - apply undiluted max 6x day
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32
Q

Cradle cap symptoms

A
  • yellow, scaly skin on scalp and eyebrows
  • slight redness around area
  • referral: signs of infection
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33
Q

Cradle cap OTC treatment

A
  • baby shampoo and a soft brush
  • apply oil at night and wash in morning with baby shampoo
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34
Q

Colic symptoms

A
  • babies crying > 3 hours per day
  • worse on evening
  • pulling legs towards chest
  • referral: not gaining weight
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35
Q

Colic OTC treatment

A
  • infacol (simeticone) - 0 yrs +
  • one drop before each feed
  • soothe baby
  • burping after meals
  • ensure correct teat size
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36
Q

Chicken pox symptoms

A
  • 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
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37
Q

Chicken pox OTC treatment

A
  • Paracetamol (fever)
  • calamine lotion and chlorphenamine (itch)
  • NEVER IBUPROFEN
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38
Q

Headlice details

A
  • must see live louse to diagnose
  • only tx family if they have live lice - tx on same day
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39
Q

Headlice OTC treatment

A
  • 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
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40
Q

Threadworm details

A
  • symptoms: nocturnal perianal itching, visible worms in stools
  • no need to keep children off school
  • referral: secondary infection, tx failure
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41
Q

Threadworm OTC treatment

A
  • Ovex (mebendazole)
  • 1 x 100mg - repeat after 14 days
  • keep nails short and clean, wash bed linen daily
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42
Q

Measles symptoms

A
  • 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
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43
Q

Measles OTC treatment

A
  • paracetamol
    ** notifiable disease
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44
Q

Rubella (German measles) symptoms

A
  • 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
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45
Q

Rubella OTC treatment

A
  • paracetamol
    ** notifiable disease
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46
Q

Mumps symptoms

A
  • painful swelling of parotid glands
  • avoid school/work for 5 days
  • highly contagious viral disease
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47
Q

Mumps OTC treatment

A
  • paracetamol
  • ** notifiable disease
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48
Q

Scarlett fever symptoms

A
  • flu-like
  • swollen neck glands
  • sore throat
  • sand paper rash
  • white coating on tongue
  • flushed cheeks
  • strawberry tongue
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49
Q

Scarlett fever OTC treatment

A
  • refer for abx
  • return to school 24 hours post starting abx
    ** notifiable disease
50
Q

Whooping cough symptoms

A
  • 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
Q

Whooping cough treatment

A
  • refer for abx
    ** notifiable disease
52
Q

Eczema symptoms

A
  • red, itchy, inflamed skin on internal flexures
  • referral: signs of secondary infection, severe/extensive
53
Q

Eczema OTC treatment

A
  • 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
Q

Psoriasis symptoms

A
  • pink/red rash with silver scale on external flexures
  • referral: new presentation, extensive or severe forms, pustular psoriasis, secondary infection
55
Q

Psoriasis OTC treatment

A
  • ovonex ointment (calcipotriol)
  • 18 yrs +
  • avoid sunlight exposure
  • max weekly dose is 100g of cream/oint
56
Q

Irritant/contact dermatitis symptoms

A
  • itchy/blistered/cracked/red skin which occurs hours - days after allergen/irritant
  • referral: infected skin, extensive/severe
57
Q

Irritant/contact dermatitis OTC treatment

A
  • hydrocortisone 1% cream
  • apply BD max of 7 days
  • not OTC for face or genitals
  • counselling: avoid irritant
58
Q

Scabies symptoms

A
  • 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
Q

Scabies OTC treatment

A
  • 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
Q

Acne symptoms

A
  • whiteheads
  • blackheads
  • painful pustules
  • cysts
  • oily skin
  • referral: no improvement after 8 wks OTC, drug-induced acne, anxiety/depression
61
Q

Acne OTC treatment

A
  • 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
Q

Shingles symptoms

A
  • herpes simplex
  • symptoms: pain before rash appears, red papules, unilateral, follows nerve line
  • referral: over 50s, pregnant, eye involvement, immunocompromised
63
Q

Shingles OTC treatment

A
  • 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
Q

Ringworm symptoms

A
  • dry/red/scaly/itchy rash
  • highly contagious and spread through objects (touch)
  • referral: on scalp, immunosuppressed
65
Q

Athletes foot symptoms

A
  • dry/flaky/red/soggy/itchy cracked skin between toes
66
Q

Ringworm and athletes foot OTC treatment

A
  • 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
Q

Fungal nail infection symptoms

A
  • 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
Q

Fungal nail infection OTC treatment

A
  • 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
Q

Warts and verrucas symptoms

A
  • 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
Q

Warts and veruccas OTC treatment

A
  • 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
Q

Impetigo symptoms

A
  • lesions/sores around mouth and other areas of body
  • yellow/golden crust
  • referral: widespread, systemic symptoms
72
Q

Angular chelitis symptoms

A
  • red, swollen patches on corners of the mouth
  • referral: widespread, systemic symptoms
73
Q

Impetigo OTC treatment

A
  • mild = hydrogen peroxide 1%
  • use for 5 days
  • infected = refer
74
Q

Angular chelitis OTC treatment

A
  • decent lip balm (e.g. hemp from the body shop)
  • tx when it starts as it can develop into impetigo
75
Q

sinus headache symptoms + treatment

A
  • pain in cheekbones and behind brow bone
  • can treat with analgesics/decongestants
76
Q

tension headache symptoms + treatment

A
  • caused by stress, anxiety, fatigue, prolonged concentration
  • pain is described as band across the head
  • treat with analgesics
77
Q

cluster headache symptoms + treatment

A
  • severe pain around eye
  • unilateral
  • blocked nostril
  • hot/redenned cheek
  • REFER
78
Q

temporal arteritis symptoms + treatment

A
  • severe pain around temples, jaw pain, red prominent temporal artery, partial/complete vision loss
  • REFER
79
Q

chronic daily headache symptoms + treatment

A
  • 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
Q

OTC treatments for travel sickness

A
  • Stugeron (cinnarazine)
  • hyoscine hydrobromide (kwells)
  • phenergan (promethazine)
81
Q

OTC cinnarazine details

A
  • from 5 years
  • 2 hours before travel then every 8 hours
  • sedating
82
Q

OTC hyoscine hydrobromide details

A
  • from 3 years
  • 30 mins before travel then every 6 hours
83
Q

OTC promethazine details

A
  • Elixr (from 2 years)
  • tablets (from 5 years)
  • take night before travel
84
Q

Insomnia details

A
  • 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
Q

Insomnia OTC treatment

A
  • Nytol (diphenhydramine)
  • from 16 years
  • 20 mins before bed, not on consecutive nights
86
Q

Thrush symptoms

A
  • 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
Q

Thrush OTC treatment

A
  • 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
Q

Cystitis (E.coli) symptoms

A
  • 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
Q

Cystitis OTC treatment

A
  • 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
Q

Bacterial conjunctivitis symptoms

A
  • gritty sensation, eye lids stuck together, yellow discharge
  • refer: extensive infection, copious amounts of discharge that accumulates after wiping, pain within eye
91
Q

Bacterial conjunctivitis OTC treatment

A
  • 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
Q

Stye symptoms

A
  • painful localised swelling on either the lower eye or eyelid
  • refer: pain within the eye, vision changes, foreign body in eye
93
Q

Stye OTC treatment

A
  • self-limiting
  • counselling: apply warm compress 5-10 mins 2-4x daily
94
Q

Blepharitis symptoms

A
  • 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
Q

Blepharitis OTC treatment

A
  • eye hygiene
  • counselling: bathe eyes BD during infection, OD when normal, avoid mascara/eye liner
96
Q

Subconjunctival haemorrhage symptoms

A
  • blood shot eyes
  • refer: pain in eye, vision changes, foreign body in eye
97
Q

Subconjunctival haemorrhage OTC treatment

A
  • self-limiting condition
98
Q

Dry eye symptoms

A
  • sensations of a foreign body within the eye, photophobia, watery eyes (bilateral)
  • refer: pain in eye
99
Q

Dry eye OTC treatment

A
  • hypromellose 0.3% eye drops
  • 30 minute intervals when severe
  • decrease usage as symptoms improve
100
Q

Ear wax symptoms

A
  • temporary deafness/discomfort
  • refer: associated tinnitus/nausea, severe deafness, severe pain, failed OTC treatment
101
Q

Ear wax OTC treatment

A
  • 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
Q

Otitis externa symptoms

A
  • 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
Q

Otitis externa OTC treatment

A
  • 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
Q

Otitis media symptoms

A
  • pain within eardrum and temporary deafness, cough/sore throat, perforated eardrum
  • refer: foreign body present, neoplasm, mastoiditis, systemic infection (fever present)
105
Q

Otitis media OTC treatment

A
  • paracetamol
  • GPs reluctant to treat within 48 hours as condition is self limiting
106
Q

OTC clotrimazole 2% cream age

A
  • 16 to 60
107
Q

OTC naproxen 250mg tab age

A
  • 15 to 50
108
Q

OTC sildenafil 50mg tab age

A
  • no max age, 18 +
109
Q

OTC sumatriptan 50mg tab age

A
  • 18 to 65
110
Q

OTC tamsulosin 400mcg cap age

A
  • 45 to 70
111
Q

OTC esomeprazole and omeprazole age

A
  • 18 +
  • OD
112
Q

OTC atovaquone/proguanil (Maloff protect)

A
  • 18 +
  • 40 kg
  • 1OD 1-2 days before, during and 7 days after
113
Q

OTC proguanil

A
  • daily
  • 1 week before, during and 4 weeks after
114
Q

OTC Beclomethasone nasal spray age

A
  • 18 +
  • 12 on prescription
115
Q

OTC chloramphenicol age

A
  • 2 +
  • 0 Rx
116
Q

OTC clobetasone 0.05% cream age

A
  • 12 +
  • 0 Rx
117
Q

OTC hydrocortisone age

A
  • 10 +
118
Q

OTC mebendazole age

A
  • 2 +
119
Q

OTC cetirizine/loratidine age

A
  • 2 + (liquid)
  • 12 + tablet
120
Q

Paracetamol OTC age

A
  • 2 months, post immunisation
121
Q

OTC pseudoephedrine liquid age

A
  • 6 + (liquid)
  • 12 + tablet
122
Q

OTC Gina (estradiol vaginal tablet) age

A
  • 50 +
  • no period for at least 1 year
  • can’t take if history of clots, breast cancer

GPhC Exam (22 decks)

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