Extra OTC Notes Flashcards
1
Q
Who can’t take codeine?
A
odeine containing products are NOT suitable for:
Children under 12 years
Anyone under 18 years who has had a tonsillectomy/adenoidectomy
Children aged 12 to 18 years who have problems with breathing
Breastfeeding women (as it may be passed through breast milk)
Customers who are CYP2D6 ultra-rapid metabolisers (a genetic condition which increases the risk of codeine toxicity)
2
Q
What are the side effects of codeine?
A
Side effects of codeine can include drowsiness and blurred vision. If affected, customers should not drive or ride a bike. It is an offence to drive if your ability to drive safely is affected
3
Q
At which age ranges does 70% of growth occur in?
A
Ages 1-10
4
Q
As children go through different stages, what requirement changes?
A
Nutrition requirements
5
Q
What should the diet consist of for pre-school children?
A
5 portions of starchy foods each day to give energy,
wholegrain options shouldn’t be given too often as they are more filling,
Aim for five portions of fruit and vegetables each day,
Dairy foods are a good source of calcium, should be full fat versions for under 5s.
Protein rich foods can provide iron, zinc, vitamin D and vitamin B
High sugary foods should not be given for too long and watch salt intake.
6
Q
What should the diet consist of for children aged 5-11 year olds?
A
Advise on the following;
Healthy breakfast,
Healthy snacks,
Two portions of fish per week (one oily),
7
Q
What does oily fish provide and can too much be good or harmful?
A
Oily fish can provide essential fatty acids, but too much of it can be harmful due to the build up of low-level pollutants.
8
Q
What is the maximum amount of vitamin D a child aged 1-10 should not exceed?
A
Too much vitamin D supplementation can be harmful. Children aged one to 10 years should not have more than 50 mcg a day.
9
Q
What is peadisure drinks/ powder good for?
A
Perfect for fussy eaters: parents reported an improvement in appetite in four weeks*2
Less sick days: parents reported a reduction in sick days by 64 per cent in 16 weeks*2
Support to get back on track: provides essential nutrients to help kids bounce back to health after feeling poorly
Boost for active kids: provides essential macro and micro nutrients to help keep them fit and healthy
10
Q
What are some tips to give to parents of fussy eaters?
A
Gradually introduce a variety of different foods
Try small portions and praise them for eating
Give them the same food as the rest of the family to encourage them to try it
Present food in different ways
11
Q
What policy does boots operate for age-restricted products?
A
Challenge 25
12
Q
What does challenge 25 mean?
A
Anyone who looks under 25 should be asked for ID when purchasing age restricted items.
13
Q
Which products may have age restrictions?
A
Christmas crackers, energy drinks, razor blades, e-cigarettes and refills.
14
Q
What method should be used for challenge 25 situations?
A
STAR method
15
Q
What does STAR method stand for?
A
STOP - stop and consider appropriateness of the transaction
Think - consider the age of the person in front of you. Do they look under 25?
Ask - if you think the customer looks under 25 then ask for ID
Refuse - if the customer cannot provide ID.
16
Q
What are suitable forms of ID for challenge 25?
A
valid driving licence,
A valid passport,
a citizens card,
or any other photo identity card with the ‘PASS’ hologram and date of birth displayed.
17
Q
What shall you do if you refuse a sale due to no ID being shown>
A
Log it into the refusal log which is stored at the till. Recording refusals in the log will show that you and your store are complying with the legislation.
18
Q
What is the gut microbiota?
A
It is the name for the microorganisms living in a person’s digestive system.
19
Q
how many different species of microorganisms does each person have in their digestive tract?
A
Each person has about 300 to 500 different species of bacteria, yeasts and protozoa in their digestive tract
20
Q
Are all microorganisms harmful to our health?
A
whilst some microorganisms are harmful to our health, many are incredibly beneficial and even necessary for a healthy body
21
Q
Intestinal bacteria are known to produce which vitamins?
A
known to produce certain B vitamins which help release energy from food. It is also estimated that half of the daily vitamin K requirement, which is important for blood clotting, is provided by intestinal bacteria.
22
Q
Is there a link between weight and microbiota diversity?
A
Yes, there seems to be a link between long-term weight gain in humans and low microbiota diversity
23
Q
Which other people with certain diseases may have a less diverse microbiota?
A
A number of studies have shown a less diverse microbiota in people with a range of conditions such as inflammatory bowel disease, psoriatic arthritis, type 1 diabetes, atopic eczema, coeliac disease and type 2 diabetes.
24
Q
Is there more bacteria cells in your body than body cells?
A
There are more bacterial cells in your body than human cells. There are roughly 40 trillion bacterial cells in your body compared to around 30 trillion human cells.
25
What are probiotics?
Probiotics are live microorganisms that, when taken, may have certain health benefits.
26
What are the most commonly used probiotic species?
are lactobacillus and Bifidobacterium
27
What has research suggested about probiotics and what it can help with?
Some research has suggested that taking probiotics can support a healthy gut microbiota, and that it may prevent gut inflammation and other intestinal problems.
28
How can probiotics be taken?
Probiotics can be taken as a food supplement or may be found naturally in live yoghurt and fermented foods such as kefir, kimchi, and sauerkraut. However, the European Food Safety Authority (EFSA) has not approved any probiotic health claims.
29
What are prebiotics?
Prebiotics are typically the non-digestible carbohydrates that probiotics feed on. Increasing the amount of food for probiotics allows them to multiply and thrive in the gut.
30
What can prebiotics be found in?
Prebiotics can be found as a food supplement, often combined with a probiotic, or found naturally in foods such as asparagus, bananas, garlic and onions.
31
What is increased microbiota diversity an indicator of?
Increased diversity is a good indicator of gut health.
32
To encourage a diverse microbiota, customers could be advised to eat a diet that is high in what?
high in fibre-rich foods, e.g. fruits, vegetables and wholegrains.
33
What is guy dysbiosis and eating alot of what can cause this?
Gut dysbiosis is an imbalance of gut microbes, eating a lot of sugar or artificial sweeteners may cause gut dysbiosis.
34
What have studies linked the artificial sweetener aspartame to?
Artificial sweetener aspartame increases the number of some bacterial strains that are linked with metabolic disease, which may increase the risk of diabetes and heart disease.
35
Can exercise encourage the growth of a variety of gut bacteria?
Yes
36
What advice around antibiotics can increase microbiaota diversity?
Reduce unneccasary antibiotic usage, antibiotics should only be prescribed when they are really needed not only to reduce antibiotic resistance, but also because they can be damaging to the gut microbiota.
37
What can be given alongside antibiotics to reduce antibiotic acquired diarrhoea?
a probiotic could be considered alongside the antibiotic as there is evidence it may reduce antibiotic acquired diarrhoea.
38
What have studies suggested about psychological stress and gut microbiota?
Studies have suggested that psychological stressors can disrupt the microorganisms in the intestines, even if the stress is only short-lived.
39
In humans, a variety of stressors can negatively affect gut health, list a few of them?
Mental or emotional stress
* Environmental stress, such as extreme heat, cold, or noise
* Sleep deprivation
* Disruption of the circadian rhythm e.g. shift working
40
What is the link between sleep and gut microbiota?
A 2014 study indicated that irregular sleep habits and disturbed sleep can have negative outcomes for the gut microbiota, which may increase the risk of inflammatory conditions such as asthma and diabetes.
41
How much sleep per night should adults aim to get?
minimum 7 hours per night.
42
When we sleep the body moves between what cycles?
between REM (rapid eye movement) and non-REM sleep cycles.
43
How many stages of non-REM sleep are there?
three stages
44
When does REM sleep become increasingly deeper and longer?
towards the morning
45
Describe stage 1 of non-REM sleep?
The transition period from being awake to sleeping; a person’s eyes are closed but it is easy to wake them up. Brain activity, heart rate, breathing and eye movements start to slow down and the muscles start to relax.
46
Describe stage 2 of non-REM sleep?
Light sleep where the body temperature drops and eye movements stop. Brain activity, heart rate and breathing continue to slow down and muscles relax further.
47
Describe stage 3 of non-REM sleep?
When deepest sleep occurs; heart rate and breathing slow to their lowest levels during sleep and the muscles are completely relaxed. It is difficult to rouse someone from this stage of sleep; if they are woken up, they may feel disorientated for a few minutes. During this stage, the body repairs tissues, builds bone and muscle, strengthens the immune system and builds up energy for the next day
48
Describe REM sleep?
Occurs about 90 minutes after falling asleep. The eyes move rapidly from side to side while they are closed and brain activity increases. Breathing becomes faster and irregular, heart rate and blood pressure increase. Dreaming occurs mostly during REM sleep; the body becomes relaxed and immobilised, which prevents the person from acting out their dreams. REM sleep is important for learning and memory; this is when the brain processes information that has been taken in during the day and stores it in the long-term memory.
49
What may be some reasons why sleep may be affected?
```
Disruption of daily life
Anxiety and worry
Isolation and depression
Increased family and work stress
More screen time
Stress-related fatigue.
```
50
What are ways to relax to help with sleeo?
a warm bath to help the body reach an ideal temperature for sleep; relaxation exercises such as light yoga stretches to help relax the muscles; using relaxation CDs or podcasts; reading a book; or listening to the radio to help relax the mind
51
What has mindfulness shown to do?
Mindfulness has been shown to make it easier to fall asleep, improve sleep time and sleep quality. It is all about understanding ourselves better and enjoying the world around us by being more aware of the present moment. One technique is using mindfulness meditation before bedtime. This involves sitting quietly and paying attention to thoughts, sounds and sensations (commonly the sensations of breathing or parts of the body) to help clear the mind.
52
How can aromatherapy used to help with sleep?
Essential oils to help with improving relaxation include lavender, camomile, bergamot and marjoram.7-10 Aromatherapy can be used in different ways before bedtime, e.g. using essential oils for massage or products containing essential oils such as a pillow spray.
53
Can antihistamines that cause drowsiness be used to help fall sleep?
it may be appropriate to recommend a P medicine sleeping product containing an antihistamine that causes drowsiness, such as diphenhydramine.
54
What warning must be given for OTC sleeping tabs?
That they are only for short term use to reduce psychological dependence on sleeping tablets.
55
What else can be advised about antihistamines being used for sleeping?
ou should also advise customers that antihistamines may have side effects including residual drowsiness the following day
56
Which vitamins help with reduction in tiredness and fatigue?
iron and vitamin B12
57
In regards to sleeping (insomnia), when should patients be referred to the GP?
Self-care advice and changing their sleeping habits hasn’t worked
They have had difficulty sleeping for months
Their insomnia is affecting their daily life in a way that makes it difficult for them to cope.
58
What advice can be given to patients to help them get a good night's sleep?
Try to keep a regular sleep/wake pattern
Get out into natural light as soon as possible in the morning
Be more active – daytime exercise helps improve the quantity and quality of sleep (start with small amounts and build up gradually if you’re not accustomed to regular exercise)
Avoid stimulants containing caffeine (e.g. coffee, tea, cola, chocolate, energy drinks) for eight hours before bedtime
Don’t go to bed hungry, thirsty or just after eating a meal
Reduce screen time before bedtime
Don’t use alcohol to sleep and keep within the guideline not to regularly drink more than 14 units a week (both men and women)
Avoid nicotine before bedtime
Make sure the bedroom is cool, dark and quiet.
59
How many months are mothers recommended to exclusively breastfeed their baby?
for at least first 6 months of life
60
When a bay cries for more than 3 hours, on three days a week for at least a week, what can it be?
Colic
61
What other signs suggest colic?
Difficult to soothe,
Clench their fists and appear red in the face,
They may have a gurgling tummy,
may pull their knees to their stomach or arch their back,
62
What may HCPs recommend for long term treatment of colic?
Specially formulated milk like Aptamil Comfort - which can be used of the dietary management of colic and constipation.
63
What is reflux or posseting in babies?
when babies bring up a small amount of their milk. It's normal for babies and thought to be related to their immature digestive system.
64
For reflux in babies what kind of milk maybe suggested by HCPs?
thickened milk
such as Aptamil Anti-reflux
Thickened with carob bean gum, helps feeds stay down,
65
What further advice can be given to customers for colic in babies?
Hold or sit the baby upright when feeding to prevent them from swallowing too much air in their milk
Wind the baby after feeds
Holding, cuddling and gently rocking the baby may help
Try distractions such as gentle white noise, taking the baby out in the buggy, singing or a soothing warm bath
Reassure parents/carers that it should resolve by the time the baby is six months old.
66
When should a referral to GP be made for babies with reflux?
They have tried different things to help with reflux with no success after two weeks
The baby has reflux that starts after six months of age
The baby still has reflux when they are over one year of age
The baby is losing/has stopped gaining weight.
67
When selling products for eczema - before stepping up treatment what should be checked?
Check they know how much and how often to apply the different types of products and recommend smaller travel-sized emollients to apply when out and about
68
How long should patient self care before consulting GP for an acute sore throat?
Around one week.
69
What self management OTC can patient take for acute sore throat?
Use suitable pain relief, such as paracetamol, ibuprofen or medicated sprays and/or medicated lozenges. Symptoms that have come on suddenly, purulence, severe inflammation or fever should be referred to the pharmacist.
70
How long should patient self care before consulting GP for an acute otitis media (Inner ear infection)?
About three days (can be up to a week)
71
What self management OTC can patient take for acute otitis media?
Use suitable pain relief.
Refer the following to the pharmacist: Customers who are generally unwell, affected with discharge from the ear and children
72
How long should patient self care before consulting GP for Sinusitis?
If it’s viral, it can last up to 10 days. If it lasts more than 10 days it is likely to be bacterial.
73
What self management OTC can patient take for Sinusitis?
Use suitable pain relief, saline nasal drops/spray or decongestants. Remember to advise customers how long they should use them for. Refer customers with persistent symptoms to the pharmacist.
74
How long should patient self care before consulting GP for acute cough?
Can last for around three weeks. Refer customers with a cough that lasts more than three weeks to the pharmacist.
75
What self management OTC can patient take for acute cough?
Honey or a suitable cough relief medicine may offer some relief of symptoms. Refer customers with other medical conditions to the pharmacist.
Note: A new continuous cough may indicate a Covid-19 infection (coughing a lot in one hour or three or more coughing episodes in 24 hours).
76
Is vitamin-D fat soluble?
Vitamin D is a fat-soluble vitamin which is found in foods such as oily fish, red meat, liver and egg yolks. Some foods, such as bread and spreads, are also fortified with vitamin D.
77
What is the main source of vitamin D?
Sunlight
78
What happens when the skin is exposed to UVB rays?
7-dehydrocholesterol (a substance found in the skin) is converted in the liver and kidneys to an active form of vitamin D3 that can be used by the body.
79
What does vitamin D contribute to the normal absorption and utilisation of?
calcium and phosphorus in the body
80
What are the two types of vitamins D?
vitamin D2 (ergocalciferol), which is produced by plants, such as mushrooms, and vitamin D3 (cholecalciferol), which is produced by animals.
81
Which vitamin D2 or D3 is suitable for vegans?
it is important to understand whether they are vegetarian or vegan. Vitamin D2 is always suitable for vegans, but vitamin D3 can be derived from an animal source (such as sheep’s wool) or lichen (a vegan-friendly source).
82
How is vitamin D insufficiency diagnosed?
By a blood test
83
What can prolonged vitamin D deficiency result in children?
a condition called rickets in children and a similar condition called osteomalacia in adults - both which affect the bone strength
84
What is osteomalacia?
A condition as a result of prolonged vitamin d deficiency in adults
85
Can patients with symptoms of rickets or osteomalacia be treated OTC?
No they should be referred to their GP.
86
What are the signs and symptoms of rickets?
Pain – the bones affected by rickets can be sore and painful, so the child may be reluctant to walk or may tire easily; the child's walk may look different, e.g. waddling
Skeletal deformities – thickening of the ankles, wrists and knees, bowed legs, soft skull bones and, rarely, bending of the spine
Dental problems – including weak tooth enamel, delay
in teeth coming through and increased risk of cavities
Poor growth and development – if the skeleton doesn't grow and develop properly, the child will be shorter than average
Fragile bones – in severe cases, the bones become weaker and more prone to fractures.
87
What are the signs and symptoms of osteomalacia?
Pain felt in the bones – often in the legs, groin, upper thighs and knees
Muscle weakness – tends to affect the thighs and the muscles in the shoulders and main trunk of the body
Slight cracks in the bone (partial fractures).
88
What is the recommended maximum daily intake of vitamin D for adults, including pregnant and breastfeeding women?
100 mcgs. maximum per day. Most people can be recommended to take minimum 10mcgs per day.
89
What can too much vitamin cause?
Taking too much vitamin D can cause too much calcium to build up in the body, weakening the bones and damaging the kidneys and the heart.
90
What can cause constipation?
Not eating fibre
not drinking enough water
constipation
91
What are the symptoms of constipation?
Stomach cramps,
Difficulty passing stools
stools are dry or lumpy
92
What is first line treatment for constipation?
dietary changes, Eat plenty of fibre rich foods, e.g. fruits, veg, wholegrains cereals),
increase intake of fibre gradually to avoid bloating or wind.
Increase activity levels and drink fluids to soften the stools.
93
How long can it take for dietary changes to work for constipation?
It can take up to four weeks for changes to have an effect.
94
What is first line laxative?
A bulk forming laxative - unless they have opioid induced constipation.
95
What is the second line treatment?
An osmotic laxative
96
What are examples of osmotic laxatives?
Macrogol or lactulose
97
How do osmotic laxatives?
These work by drawing water into the stool or retaining fluid in the stool.
98
How does dulcoSoft work?
Main ingredient Macrogol - so is a osmotic laxative. it works with the body to provide gentle and effective relief of constipation. Provides gentle and effective relief in 24-72 hours.
99
What are the side effects of macrogol?
Diarrhoea – Advise customers to stop using any laxative and to drink plenty of water to avoid dehydration
Indigestion or nausea – Taking macrogol with or after food can help
Bloating or wind – Try taking it between meals
Stomach pain – May be relieved by placing a hot water bottle over the area, eating smaller meals and taking time to eat slowly
Side effects should improve if customers reduce the dose, and they may feel better after passing stools.
100
What is the suitability criteria for suitability?
Can be used in patients on medications that cause constipation, such as codeine. DulcoSoft is negligibly absorbed by the body and excreted unchanged
DulcoSoft is suitable for pregnant and breastfeeding women, but a consultation with a doctor is recommended
The liquid is suitable for children from two years (but a consultation with a doctor is recommended for children under eight years). The powder is suitable for children from eight years.
101
How many functions does the ear have and what are they?
The ear has two functions: hearing and balance.
102
What is the outer ear shaped to catch?
sound waves and funnel them through the ear canal to the ear drum
103
What does the middle ear do?
Amplifies the vibrations on the ear drum and transmits them to the oval window, a thin membrane that seals the inner ear.
104
How many parts does the inner ear consist of?
two parts: the cochlea, which performs the hearing function, and the vestibular system, which helps maintain balance.
105
What is the function of the eustachian tube?
The eustachian tube connects the middle ear to the airway in the back of the nose. It helps maintain equal air pressure on both sides of the eardrum and prevents fluid from accumulating in the middle ear
106
Upper respiratory infections, which inflame and block the eustachian tube can lead to what?
Can lead to middle ear infections or changes in middle ear pressure, resulting in pain
107
What are the nose and sinuses lined with?
The nose and sinuses (small empty spaces connected to the nose) are lined with mucous membranes, which produce mucus to trap dirt particles, keeping the inhaled air clean. If these become blocked then normal drainage into the throat cannot occur, resulting in swelling and pain.
108
What is the purpose of ear wax?
Earwax is produced to help keep the ears clean and free from dirt and germs.
109
What symptoms can build up of ear wax lead to?
symptoms such as earache, difficulty hearing, itchiness, dizziness, ear infections and tinnitus (sounds such as high-pitched tones coming from inside the ear).
110
Which people are more prone to build up of earwax?
Naturally have more wax in their ears
Have hairy or narrow canals (the tubes that link the eardrum and outer ear)
Wear hearing aids, earplugs and other things you put in your ear that can push the wax further in.
Age can also be a factor, as wax gets harder and does not fall out as easily as we get older.
111
What ingredients in oils soften the ear wax - dissolve the ear wax?
Chemicals, such as urea hydrogen peroxide, dissolve the earwax. Some drops contain a combination of the two.
112
When should patient be referred to ear wax removal?
If the ear doesn’t clear after five days of treatment or the ear is badly blocked and the customer is unable to hear.
113
What should patients with recurrent earwax be advised?
To use the drops on an ongoing basis to help keep the wax soft
114
What are the red flag symptoms for ear problems?
A very high temperature or feel hot and shivery
* Earache that does not improve after three days
* Swelling around the ear
* Fluid coming from the ear
* Hearing loss or a change in hearing
* A severe sore throat, dizziness or have been sick
* Regular ear infections
* A long-term medical condition, e.g diabetes or a heart, lung, kidney or neurological disease
* A weakened immune system
115
What are the three main symptoms of COVID-19?
- A high temperature
- A loss of, or change in, normal sense of smell or taste (anosmia)
- A new and continuous cough - even if it's mild
116
How does guaifenesin work - cough medicine?
Expectorants, for chesty coughs, contain ingredients such as guaifenesin and work by loosening secretions, making it easier to cough up the excessive mucus.
117
How do antitussives work in dry cough mixtures?
Dry cough mixtures (antitussives) contain ingredients such as dextromethorphan or pholcodine and work by reducing the cough reflex.
118
How does ipratropium bromide work?
Ipratropium bromide is an anticholinergic ingredient that, when used in a nasal spray, works by reducing the amount of mucus the nose produces, helping to relieve a runny nose.
119
Why shouldn't decongestant nasal sprays and drops not be used for more than a week at a time?
because using them for too long can cause rebound congestion, making the stuffiness worse.
120
What is the maximum days otrivine extra dual relief be used for?
maximum 7 days - there should at least 6 hours gap between each dose
121
How can we reduce spread of viruses - what advice can be given?
Drink plenty of water to avoid dehydration
Gargle salt water to soothe a sore throat (adults only)
Rest and sleep
Keep warm.
Using tissues to trap germs when they cough or sneeze
Binning used tissues as quickly as possible3
Washing hands frequently with warm water and soap, especially after coughing or sneezing.
122
What are 'quick fix' diets?
Where people try and lose weight as quick as they can;
- restricting food groups
- Detoxing
- Using products promising rapid weight loss (>2lbs of body fat per week).
123
What is healthy weight loss range defined as?
Losing 1-2 pounds per week.
124
Is no snacking - a myth?
Yes a myth - snacking in between meals may actually help to control appetite.
125
Can food help burn fat?
No foods will help burn fat. For weight loss it is more important to eat foods with fewer calories.
126
Is skipping meals a good way to lose weight?
No - skipping meals can make you hungry and more likely to reach for high calorie meals
127
What is heart burn described as?
A burning feeling in the chest and is caused by stomach acid travelling up towards the throat (acid Reflux).
128
If you keep getting heart burn what is this called?
Gastrooesophageal reflux disease (GORD)
129
What things can make heartburn worse?
Certain food and drink – such as coffee, alcohol, chocolate and fatty or spicy foods
* Being overweight
* Smoking
* Pregnancy
* Stress and anxiety
* Some medicines, such as anti-inflammatory painkillers (like ibuprofen)
* A hiatus hernia – when part of the stomach moves up into the chest.
130
What do antacids do?
work by neutralising the acid in the stomach to relieve symptoms. Some antacids also contain an alginate which coats the oesophagus with a protective layer
131
How does PPIs work>
These work by reducing the amount of acid the stomach produces and have a longer duration of action than antacids.
132
What if someone is on PPI but is getting breakthrough symptoms e.g. at night?
Some antacids are licensed to be used alongside a PPI for this purpose (co-dosing) and you could recommend these to customers.
133
What lifestyle measures that customers can try to help reduce heartburn?
Eating smaller meals more frequently; trying to lose weight if overweight; wearing clothes that are loose-fitting around the waist; and avoiding any known trigger foods. They could also try putting something under the head of the bed to keep their head and chest above waist level. This stops stomach acid travelling up the throat.
134
When someone is taking bulk-forming laxative what is important to advise on?
Drink plenty of water
135
If a patient is suffering from opioid-induced constipation what should the patient be offered?
They should not use bulk forming laxatives. As an alternative, you can recommend an osmotic laxative and a stimulant laxative (or docusate is an alternative which also has stool-softening properties).
136
What are the new stimulant laxative classifications?
GSL products are not licensed for use in patients under 18 years
* Only P medicines will be licensed for use in patients from 12 years
* GSL pack sizes will be restricted:
* Standard strength senna or bisacodyl tablets – maximum 20 tablets
* Max strength senna tablets – maximum 10 tablets
* Senna syrup – 100ml
* Larger packs will only be available as P medicines
* The wording on the pack will change to promote appropriate use of stimulant laxatives, so make sure you read it before discussing a product with a customer.
137
What are the red flag symptoms for constipation that require referral?
sudden, persistent change in their bowel pattern
* Rectal bleeding
* Black stools
* Worsening heartburn, indigestion or stomach pain
* Losing weight unexpectedly
* Difficulty swallowing
* Symptoms that don’t resolve after two weeks of taking an OTC medicine.
138
What is malaria?
Malaria is a serious tropical disease spread by infected female mosquitoes. It only takes a single mosquito bite for someone to become infected and, if it isn't diagnosed and treated promptly, it can be fatal.
139
What is the ABCD method to prevent malaria infection?
Awareness of risk – support customers to check the malaria risk of their travel destination. Ideally, they should do this at least a couple of weeks before travelling.
Bite prevention – encourage customers to avoid mosquito bites by using an appropriate insect repellent (such as one containing DEET) and reapplying as necessary, covering their arms and legs, and using an insecticide-treated mosquito net.
Chemoprophylaxis (malaria prevention tablets) – if chemoprophylaxis is required, you can support the customer to find a suitable antimalarial tablet for their destination. Atovaquone/proguanil is available as a Pharmacy medicine and may be suitable for the customer and their destination. Other products are available through the Malaria Prevention Service using the KnowMalaria App. It is important that antimalarial tablets are taken as per the instructions, including after returning from the trip to cover the incubation period of the disease.
Diagnosis – advise customers to seek immediate medical advice if they develop malaria symptoms and mention any countries they have been to, even up to a year after they return from travelling. Symptoms include a high temperature of 38°C or above, feeling hot and shivery, headaches, vomiting, muscle pains and diarrhoea.
140
What is mild traveller's diarrhoea defined as?
Mild travellers’ diarrhoea is passing three or more loose/watery bowel motions in 24 hours.
141
What is moderate traveller's diarrhoea accompanied with?
Moderate travellers’ diarrhoea is accompanied by fever, tummy cramps, urgent need to pass bowel motion, nausea or vomiting.
142
What is the priority in treatment of travellers diarrhoea?
Prevent dehydration, especially in young children.
143
What is incontinence?
It is when a person passes urine unintentionally
144
What is stress incontinence?
When urine is leaked due to exertion, for example when sneezing. This is most common type of incontinence with women.
145
What is urge incontinence?
When there is a sudden urge to urinate. It can be caused by a number of things, including drinking too many fluids or an enlarged prostate
146
What is post-micturition dribble?
when urine is leaked after going to the toilet which occurs when urine remains in the urethra. It more commonly affects men
147
What should customers do if they are experiencing any of these types of incontinence?
should speak to their GP
148
What happens if skin is in prolonged contact with the skin?
it can cause skin irritation or incontinence associated dermatitis
149
What should customers be advised against using for incontinence?
Should avoid using sanitary pads as these can stay damp and make the skin sore. They should only use products designed for incontinence as these protect from unwanted moisture as well as leaks and odours.
150
What products are available for incontinence?
pads, pants, penile sheaths and adapted clothing
151
What lifestyle changes can be advised to patients for incontinence?
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Lose weight (if appropriate) as excess weight can cause increased pressure on the bladder
Try pelvic floor exercises to strengthen muscles (instructions available on the NHS website)
Cut down on alcohol
Try strengthening exercises such as Pilates, rather than high-impact exercise such as jogging
Cut down on drinks containing caffeine and spicy or acidic foods, as these can irritate the bladder.
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Customers shouldn’t try reducing the amount of fluids they drink, as this may reduce the bladder’s capacity or result in constipation, which can make incontinence worse
152
What do b vitamins help to do?
Help to release energy from food
153
What does protein in the body help contribute to?
Contributes to the growth and maintenance of muscle mass and can be used s an energy source, particularly when food or drink intake is low
154
What are the symptoms of hydration?
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feeling thirsty.
dark yellow and strong-smelling pee.
feeling dizzy or lightheaded.
feeling tired.
a dry mouth, lips and eyes.
peeing little, and fewer than 4 times a day.
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155
When exercising how much should children aim for?
An hour of moderate aerobic activity every day, e.g. cycling or playground games. As a guide, when doing moderate aerobic activity, children should be able to talk but not sing
A variety of types and intensities of physical activity across the week to develop movement skills, muscles and bones, e.g. dancing, football, skipping or gymnastics.
156
When a child has chickenpox, do they need to stay away from school?
Yes they do, chicken pox is generally infectious from two days before the rash appears to five days after the onset of the rash. All lesions should be crusted over before children return to nursery or school (usually five days or more).
157
How can you manage symptoms of chickenpox?
Manage any fever with paracetamol (not ibuprofen). Use cooling gels and creams and/or antihistamine syrup for itchiness, if suitable.
158
When a child has bacterial conjunctivitis do they need to keep off school?
No need to keep off school
159
What is the management for bacterial conjunctivitis?
Bathe the eye with water that has been boiled then cooled. Chloramphenicol eye drops or ointment may be used, if suitable.
160
Should children with diarrhoea and vomiting stay away from school?
Yes should stay at home until 48 hours after symptoms have stopped and they are well enough to return.
161
If a child has had lice do they need to stay off school?
No need
162
What is the management for headlice?
Live lice can be removed by wet combing. If there are still live lice, products containing demeticone, isopropyl myristate or malathion can be used.
163
Does a child need to stay away from school if they have impetigo?
The child should stay home from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment.
164
Should a child stay away from school if they have fever?
Children with a high fever (38 degrees or more) should be kept home from school until the fever subsides.
165
What is conjunctivitis?
It is inflammation of the conjunctiva, which is the thin membrane protecting the eye.
166
What are the two possible causes of conjunctivitis?
Allergic reaction to pollen, or bacterial or viral infection.
167
What is bacterial conjunctivitis?
Infection which can affect one or both eyes
168
What are the main symptoms of conjunctivitis?
Burning, grittiness and/or itching in the eye,
red or blood shot eyes,
yellow/ green discharge from the eye - which may make the eyelashes stick together,
watery eyes
169
When should someone with bacterial conjunctivitis be referred to opticians or GP?
If customer has pain or their vision is affected
170
What are other conditions that can cause red eyes?
Dry eyes
Blepharitis
Burst blood vessel
171
To relieve conjunctivitis what can patients be advised?
- Cleans eyelashes with water
- separate piece of cotton wool for each eye
- symptoms usually clear within 2 weeks without treatment
- using antibiotic drops may speed this process up
172
What is chloramphenicol?
It is an antibiotic that is licensed for OTC treatment of acute bacterial conjunctivitis in adults and children 2 years and over.
173
With chloramphenicol what is the course of treatment?
5 days and customers should continue for the full five days even if symptoms improve
174
For conjunctivitis what requires referral?
Pregnant/breastfeeding women
Customers using contact lenses or other eye products
Children aged under two years
Customers who may have an eye injury/foreign body in the eye
The eye is inflamed and there is a rash on the scalp/face
The pupil of the eye looks unusual or cloudy
The eyes are sensitive to light
Customers who have had eye surgery/laser treatment
Customers with glaucoma or dry eye syndrome.
175
What is the largest organ in the body?
The skin and it has many functions. One of these is to provide a barrier, helping to keep harmful substances out and retain water.
176
What is the outer layer of the skin called?
It is known as the epidermis, is responsible for this barrier function.
177
What is the stratum corneum?
is part of the epidermis and is mostly made up of lipids (substances that repel water) and keratin (protein).
178
What does a serum barrier form?
Forms a layer over the stratum corneum.
179
What can changes in the sebum barrier over the stratum corneum affect?
The skin's ability to retain moisture, resulting in water loss from the body through the epidermis. This dryness can progress into deeper layers off the skin, resulting in skin that is tight, itchy, rough and/or scaly.
180
What do occlusive emollients (e.g. paraffin) do?
Form a layer on the surface of the skin, helping to reduce water loss through the epidermis.
181
What are humectants such as urea?
Humectants are substances that help retain and preserve moisture and attract water from the deeper layers of the skin to the epidermis.
182
What is urea (skin related)?
Urea is a naturally occurring substance found in the surface layer of the skin and is an active component of the skin's natural moisturising factor (NMF). Urea is highly hygroscopic (water-loving), so it attracts and retains water in the skin cells. It also works to soften the keratin layers.
183
What is keratin?
Keratin is a protein that holds the top layer of skin cells together. When the keratin layers are softened by urea, it encourages skin exfoliation, which helps the dead skin cells fall away from the skin. Exfoliation can prevent dry, flaky patches that can occur when dead skin cells don't shed from the skin completely.
184
TO maximise effect how should emollients be applied?
Regularly
Liberally
In the direction of hair growth
After washing their hands, showering or bathing
185
What are the three steps to the Online Doctor Service?
. Online consultation – customers should visit onlinedoctor.boots.com and complete their health history online. They can then select a delivery or pick up in store option and make payment; this takes five to 10 minutes.
2. Clinical assessment – a member of the clinical team will review everything within 24 hours and prescribe treatment if appropriate. They will message or call the customer if they have any follow-up questions.
3. Pick up in store or delivery – once they have received their treatment, customers will be provided with instructions and any other advice.
186
What is contact dermatitis?
Contact dermatitis is a type of eczema caused by contact with a particular substance that can cause the skin to become dry, irritated, itchy, blistered or cracked.
It can be caused by an irritant (a substance that damages the outer layer of skin) or an allergen (a substance that causes the immune system to respond in a way that affects the skin).
187
What is impetigo caused by?
Impetigo is a bacterial infection of the skin. It is the most common skin infection seen in young children in the UK, but can occur in people of any age.
188
What is the appearance of impetigo?
Impetigo usually affects exposed areas such as the hands and face and starts with red sores or blisters. Redness may be more difficult to see on darker skin. The sores or blisters quickly burst, leaving crusty, golden-brown patches. The crusty patches may be itchy and painful, can spread to other parts of the body and may get bigger.
189
What can be prescribed for impetigo?
The Boots Online Doctor Service can prescribe Fucidin (fusidic acid) or Bactroban (mupirocin) to help clear up the infection.
190
What are skin moles?
Moles are small, coloured spots on the skin. Most people have them and they are usually nothing to worry about unless they change shape, size or colour. The appearance of a new mole or a change to an existing mole is the most common sign of melanoma, the fifth most common skin cancer in the UK
191
What is melanoma?
the fifth most common skin cancer in the UK
192
Where can melanoma skin cancer occur?
Melanoma skin cancer can occur anywhere on the body; however, the most commonly affected areas are the back in men and the legs in women.
193
Which areas are melanomas uncommon in the body?
Melanomas are uncommon in areas that are protected from sun exposure.
194
What do melanomas look like?
n most cases, melanomas have an irregular shape and are more than one colour; they may also be larger than normal and sometimes may become itchy, bleed or have crusting. Customers should be advised to watch out for any new moles or a mole that gradually changes shape, size or colour
195
What is the boots mole scanning service?
eveloped to help detect suspicious moles that may indicate the presence of skin cancer and to raise awareness of the importance of regularly self-checking moles, which could lead to the early detection and treatment of skin cancer.
196
What is minimum ages for mole scanning service?
hose aged 18 years old and over.
197
Which moles or pigmented lesions cannot be scanned?
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Located in an intimate area of the body (e.g. genitals, areas of the breasts covered by a bra)
On the eyelid or the tip of an ear
Covered by an excessive amount of hair
Wet, open or bleeding
On a tattoo.
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198
What advice can you give to someone with impetigo?
Stay away from school or work
Keep the infected areas clean and dry
Try not to touch or scratch the infected areas
Wash hands frequently
Wash face cloths, towels and bedding at a high temperature
Don’t share face cloths and towels
Don’t prepare food for other people
Don’t play contact sports or go to the gym.
199
What are potential triggers for eczema?
Some skincare products, e.g. highly perfumed products. Customers can be advised to carefully check ingredient lists
Detergents, such as washing-up liquid
Everyday stress
Weather – very hot or dry weather can dry out the skin
Some types of clothing may irritate the skin
Some customers may have skin reactions to food triggers, but customers shouldn't adjust their diet significantly without seeking medical advice.
200
Who are free NHS Health checks offered to?
Adults aged 40-74 years to help spot early signs of stroke, kidney disease, type 2 diabetes and dementia
201
How often is Free NHS Health Check offered?
Every 5 years
202
Is osteoporosis more common in males or females?
More common in women as they have smaller bones and lower oestrogen during menopause.
203
At what age are free eye tests offered?
Everyone aged 60 years and over can get free eye test every couple of years (Customers over 40 with a close relative with glaucoma are also eligible).
204
What age does age-related macular degeneration (AMD) usually affect?
Affects people over 5- years old
205
What are the two types of AMD?
Dry AMD is when there is a gradual deterioration of the macula (a part of the retina at the back of the eye with a high concentration of the cells that detect light) as the retinal cells die and are not renewed
Wet AMD develops when abnormal blood vessels grow into the macula. These leak blood or fluid which leads to scarring of the macula and rapid loss of central vision.
206
Who can book a free 15 minute hearing check?
Adults aged 19 years and over can book a free 15-minute hearing check at boots hearingcare.
207
What are some of the symptoms of type 2 diabetes?
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Tiredness
Frequent urination
Unintentional weight loss
Repeated thrush infection
Cuts/wounds taking longer to heal
Blurred vision
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208
Which ethnicity is hypertension more common in?
It is also more common in people of black African or black Caribbean descent.
209
What does systolic pressure and diastolic pressure show?
Systolic pressure (the pressure in arteries during heart contraction) is the top reading and diastolic pressure (the pressure when the heart is between beats) is the bottom one. Generally, normal blood pressure is considered to be between 90/60mmHg and 120/80mmHg.
210
What is ambulatory blood pressure monitoring?
This is when someone has 24-hour testing, around once every 30 minutes, using a portable device. This helps to calculate the average blood pressure, as sometimes isolated readings can be misleading, and readings taken while people are carrying out their usual activities may be more accurate. This is useful for people who may have a high blood pressure reading due to the stress of being in the GP surgery – known as white coat syndrome.
211
Where are fat-soluble vitamins found?
Fat-soluble vitamins are found mainly in foods that are high in natural fat, such as oily fish, eggs and dairy products. The body can store these vitamins in the liver and fatty tissues until they are needed. This means they can build up in the body, so having too much of them can be harmful. Vitamins A, D, E and K are fat-soluble.
212
Why is vitamin A needed?
Vitamin A is needed for a healthy immune system and to keep skin healthy. It can also help vision in dim light. Good sources of vitamin A include dairy products, carrots, sweet potatoes, mangoes and green leafy vegetables.
213
Why is vitamin C important?
Vitamin C is important for a healthy immune system, to help the body absorb iron and for overall health. Foods that contain vitamin C include oranges, kiwi fruit, strawberries, broccoli, tomatoes and peppers.
214
What does vitamin D help to regulate?
Vitamin D helps to regulate the amount of calcium and phosphate in the body; these nutrients are needed to keep bones, teeth and muscles healthy.
215
What is the average of a woman to reach menopause in the UK?
51 years
216
What is premature menopause?
Menopause before the age of 40 - 1 in 100 women experience this also known as premature ovarian insufficiency
217
What else can menopause be caused by?
- Surgery to remove the ovaries (oophorectomy)
- Breast cancer treatments
- Chemotherapy
- Radiotherapy
218
How long does menopausal symptoms last?
Typically last for about four years after the last period but may continue for up to 12 years in about 10% of people.
219
What is perimenopause?
Women may experience symptoms as they approach the menopause (known as the perimenopause) as well as during the menopause.
220
What are most menopausal symptoms as a result of?
Due to declining oestrogen levels.
221
What is usually the first sign of menopause?
Usually a change in the normal pattern of a woman's periods.
They may start to have either unusually light or heavy periods.
- The frequency of the periods may also be affected.
- may have a period every couple of weeks or may not have a period for several months at a time.
- Eventually will stop and not have any periods.
222
What are the common symptoms of menopause?
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Hot flushes
Night sweats
Difficulty sleeping
Reduced sex drive (libido)
Problems with concentration and memory
Vaginal dryness
Pain or discomfort during sex
Headaches
Mood changes such as anxiety or low mood
Palpitations
Joint stiffness, aches and pains
Reduced muscle mass
Recurrent urinary tract infections (UTIs).
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223
Following menopause, which risks are increased?
- the risk of cardiovascular disease increases as oestrogen levels decline
- during first few years of menopause, women may lose bone density at a rapid rate increasing the risk of osteoporosis. this causes bones to become brittle and weak - leading to an increased risk of fractures especially in the spine, hips and wrist.
- women may also experience urinary incontinence due to the tissues of the vagina and urethra losing elasticity.
- Reducing hormone levels may also affect the balance of vaginal bacteria, increasing the prevalence of infections such as bacterial vaginosis (BV).
224
What is the main treatment for menopausal symptoms?
- Hormone replacement therapy
| - this replaces the oestrogen levels that are declining in the body
225
What do women who have an intact womb (who have not had hysterectomy) who choose HRT also need a combination of?
Will also need to use a combination product that also contains progestogen to protect the lining of their womb.
226
Is HRT available only as tablets?
- tablets
- patches
- implants
- gels to rub on the skin
227
What may some women be worried about when using HRT?
may be concerned that HRT increases their risk of developing breast cancer
228
What advice can you give to patients to relieve hot flushes and night sweats in menopausal women?
- Keeping the bedroom cool at night
- taking a cool shower or using a fan
- wearing light clothing
- Avoiding potential triggers such as spicy food, caffeine, smoking and alcohol
- doing regular exercise
- Maintaining a healthy weight
229
After the menopause, women are at an increased risk of developing osteoporosis. What advice can you give to customers to help reduce their risk of developing osteoporsosis?
Exercising regularly
Eating a healthy diet that includes plenty of fruit and vegetables
Stopping smoking
Reducing alcohol consumption
Getting some sunlight to help trigger the production of vitamin D, which supports bone health
Ensuring adequate dietary calcium intake to help protect and maintain bone density.
230
What should all women consider taking a daily supplement of?
10 micrograms of Vitamins D during the autumn and winter months because the sun is not strong enough for the body to make sufficient amounts of Vit D.
231
What emotional impact does menopause have on women?
- Many women experience emotional symptoms before and during the menopause including irritability, anxiety, mood changes and lack of motivation. Some women may say that they feel as though they have constant premenstrual syndrome (PMS).
232
What are the most common emotional symptoms of the menopause?
-Feeling sad and irritable
233
What is the menstrual cycle controlled by? and how many phases are there?
he menstrual cycle is controlled by hormones and consists of four main phases.
1) Menstruation/Period
2) Follicular Phase
3) Ovulation
4) Luteal Phase
234
Summarise the Menstruation/period?
The elimination of the thickened lining of the uterus (endometrium) from the body through the vagina.
235
What is the average length of a period?
Between 3 days and one week
236
Described the Follicular phase?
Starts on the first day of menstruation and ends with ovulation.
The pituitary gland releases follicle-stimulating hormone (FSH) which stimulates the ovary to produce follicles (tiny nodules or cysts).
Each follicle contains an immature egg.
Usually, only one follicle will mature into an egg, while the others die.
This can occur around day 10 of a 28-ay cycle.
The follicles release oestrogen, which stimulates the lining of the uterus to thicken in preparation for a possible pregnancy.
237
Describe Ovulation?
The release of a mature egg from the surface of the ovary.
This usually occurs mid-cycle, around two weeks or so before menstruation starts.
Ovulation is triggered by a surge of luteinising hormone (LH).
The egg travels down the fallopian tube towards the uterus and has a life span of around 24 hours.
Unless it meet a sperm during this time, it will disintegrate.
238
Finally describe the luteal phase?
During ovulation, the egg bursts from its follicle, but the ruptured follicle stays on the surface of the ovary.
- For the next two weeks or so the follicle transforms into a structure known as the corpus luteum.
239
What does the corpus luteum produce?
Releases progesterone, along with small amounts of oestrogen. This combination of hormones maintains the thickened lining of the uterus, waiting for a fertilised egg to stick (implant).
240
If a fertilised egg implants in the lining of the uterus, which hormone is produced?
Human chrionic gonadotrophin (hCG) which are necessary to maintain the corpus leutum. The corpus leutum keeps producing the raised levels of progesterone that are needed to maintain the thickened lining of the uterus.
241
If pregnancy does not occur, what happens to the corpus leutum?
- The corpus leutum withers and dies, usually around day 22 in a 28-day cycle.
242
What does the drop in progesterone levels cause?
Causes the lining of the uterus to fall away, beginning menstruation.
The cycle then repeats.
243
What advice can you give to increase chance of pregnancy to couples trying for a baby?
- have sex every two to three days without using contraception - make sure sperm enters the vagina
- Try to have sex around the time of ovulation - this is usually 12 to 16 days before the period starts. Some customers may want to use ovulation tests, which predict ovulation by measuring the surge of luteinising hormone in the urine.
- Try to maintain a healthy weight, cut down or stop drinking alcohol and do not smoke - this is important for both partners as these factors also affect sperm quality.
- Men should be advised that keeping their testicles cool can improve sperm quality. They can take steps such as wearing loose fitting underwear and taking breaks outside if they work in a hot environment.
244
How long can sperm live in the female reproductive system?
- up to five days
245
How do pregnancy tests work?
- by checking urine for the presence of a hormone called human chrionic gonadotrophin (hCG), which is released shortly after a fertilised egg attaches to the lining of the uterus.
246
When is hCG most concentrated?
-First thing in the morning so performing the pregnancy test at this time is most likely to give an accurate result, particularly if testing early.
247
What nutritional information advice should be given to patients trying for a baby?
- When trying to become pregnant and during the first 12 weeks of pregnancy, it is recommended that women take a daily supplement containing 400 micrograms (also written as μg or mcg) of folic acid to help prevent birth defects such as spina bifida
- It is also recommended that all pregnant women take a daily supplement containing 10 mcg of vitamin D between September and March. Some women may require a supplement year-round, e.g. if they have dark skin or keep themselves covered when outdoors
- Advise customers not to take cod liver oil or supplements containing vitamin A (retinol) during pregnancy as too much vitamin A could harm their developing baby
- Some women may experience low iron levels during pregnancy. Good sources of iron include lean meat, green leafy vegetables, beans, fortified breakfast cereals, dried fruit and nuts. Women should only take iron supplements during pregnancy on the advice of their GP or midwife
248
What advice can you give to help reduce drinking?
Gradually increase your number of drink free days
Swap to lower alcohol alternatives. The alcoholic strength of wines and beers can vary a lot, so keep an eye on the % ABV (alcohol by volume) and choose lower strengths where possible. Look out for 'reduced alcohol' or 'low alcohol' drinks too
Waiting until your evening meal before you have a drink is a simple way to help cut down
Mix up how you socialise so that drinking isn’t always involved, e.g. go out for breakfast, go for a walk or sign up for a new class with friends
Try setting an alcohol budget.
249
What are the 5 benefits of XSL-Medical Ultra 5?
Clinically proven to help customers lose up to five times more weight than dieting alone
Five benefits:1
```
Lowers body mass index (BMI)
Reduces existing body fat
Reduces centimeters around the hips and waist
Healthy weight loss
Can show results after one month.
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