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The Pharmacist Year 3 > Minor Ailments COPY > Flashcards

Minor Ailments COPY Flashcards

OSCE

1
Q

Give 5 potential causes of mouth ulcers

A
  • Stress
  • Trauma
  • Sensitivity to certain foods (“Have you noticed the ulcers appearing after eating certain food?”)
  • GI diseases (Ulcerative colitis or Crohn’s disease flare up)
  • Smoking
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2
Q

What are the age parameters for mouth ulcers?

A

Most common aged 20-40

Refer any children under 10

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3
Q

How long do mouth ulcers normally last? When should you refer?

A

Last 1-2 weeks

Refer if they have not resolved after 3 weeks or if there is no improvement after 1 week of treatment

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4
Q

Give 5 disease states that may make mouth ulcers more common.

A 
Coeliac disease
Crohn's
Reiter's syndrome
Immunodeficiency
B12 or iron deficient anaemia
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5
Q

Give 3 medicines that may make mouth ulcers more common.

A

NSAIDs
Nicorandil
Beta-blockers

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6
Q

What are the danger eliminations for mouth ulcers?

A
  • Duration >3 weeks
  • ADRs (NSAIDs)
  • Failed treatment
  • Ulcers bigger than 1cm (10p coin)
  • More than 5 ulcers
  • Painless ulcer
  • Recurrent ulcer
  • Unexplained weight loss
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7
Q

Give 3 treatment options for mouth ulcers.

A

Reduce inflammation and pain

Mouthwash:
- Difflam (Benzyldamine) mouthwash

Oral gels:
- Lidocaine (Anbesol/Iglu)
- Cetalkonium chloride 
(bonjela)
- Apply using clean fingers

Children:

  • Bonjela junior gel or soothing teething gel
  • Difflam spray (6+)

Counselling:

  • Ask if have had it before (establish current knowledge)
  • Ask opinion of which they would prefer
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8
Q

What lifestyle advice could you give to someone with a mouth ulcer?

A
  • Use a soft-bristled toothbrush
  • Drink cool drinks with a straw
  • Avoid eating hard foods e.g. toast and crisps
  • Avoid very hot or acidic drinks such as cola and fruit juice
  • Reduce stress (try exercise)
  • Limit smoking until ulcers have disappeared
  • Regular dentist visits
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9
Q

Give 3 potential causes of oral thrush?

A

Broad spectrum antibiotics
Immunosuppression (HIV, deficiency)
Inhaled steroids

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10
Q

What are the presenting symptoms of oral thrush?

A
  • White/Cream patches that can be wiped off
  • Bleed when wiped off
  • Discomfort but not painful
  • Cracks inside the mouth
  • Unpleasant taste/Loss of taste

Resolves in less than 3 weeks

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11
Q

How long does oral thrush normally last? When should you refer?

A

Refer if:

  • Over 3 weeks or infection is recurrent
  • If no improvement after one week of treatment
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12
Q

What are the danger eliminations for oral thrush?

A 
Diabetes
Recurrent infection
Failed meds
Painless lesions (cuts or sores should not be present)
Duration > 3 weeks
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13
Q

Give 2 treatment options for oral thrush.

A

Miconazole oral gel 2% (Daktarin)

  • Can be used in children over 4 months
  • Not to be used with warfarin or in pregnancy

Pregnancy:

  • Chlorhexidine mouthwash
  • May cause brown staining of teeth which can be minimised by brushing teeth before applying it and rinsing mouth after
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14
Q

What lifestyle advice could you give to someone with oral thrush?

A
  • Use a soft toothbrush
  • If asthmatic – rinse mouth after using inhaler or talk to GP about using a spacer device
  • Limit/stop smoking
  • Ensure good blood glucose control
  • Regular check-ups with dentist
  • Remove dentures overnight and clean them
  • Regularly sterilise/disinfect dentures, dummies, mouth toys
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15
Q

What are the differences between indigestion and heartburn?

A

Heartburn - burning sensation in centre of chest worsens when lying down
Indigestion - pain in stomach, bloated, full sensation

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16
Q

Give 7 potential causes of heartburn and indigestion?

A 
Pregnancy
Obesity
Tight clothing
Not chewing properly
Smoking
Skipping meals
Bending or lifting
Certain food/drink
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17
Q

How long does indigestion/heartburn normally last? When should you refer?

A

Refer if lasted over 2 weeks, or 1 week with treatment

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18
Q

What are the danger symptoms of heartburn/indigestion?

A
  • Persistent symptoms (>5 days)
  • ADRs (NSAIDs)
  • Pain worsens on effort
  • Pain is severe
  • Regurgitation
  • Children
  • Blood in vomit or stools (“Have you seen anything like coffee grounds/pink or read streaks in your vomit?”“Are your stools black or tar-like?”)
  • Difficulty swallowing
  • Unintentional weight loss
  • Failed treatment
  • First time sufferers who are >45 years
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19
Q

Give 4 treatment options for indigestion and heartburn.

A

Antacids (neutralise stomach acid - fast relief but short acting):

  • Aluminium hydroxide (asilone
  • Calcium and magnesium carbonate (Rennies): safe in pregnancy
  • Sodium alginate (Gaviscon) reduce acid reflux
  • Zanprol tablets (Omeprazole) reduce acid secretion
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20
Q

What lifestyle advice could you give to someone with indigestion or heartburn?

A
  • Eat small, regular meals
  • Avoid eating late at night
  • Avoid trigger foods (spicy food, alcohol, caffeine, fatty food)
  • Eat sitting down
  • Chew food properly
  • Exercise regularly but not immediately before or after a meal
  • Cut down smoking
  • Alleviate position in bed using pillows
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21
Q

Give potential causes of nausea and vomiting

A

Gastroenteritis
Pregnancy
Alcohol

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22
Q

What are the age parameters for nausea/vomiting?

A

Refer children under 2 and elderly due to dehydration risk

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23
Q

How long does nausea and vomiting normally last? When should you refer?

A

Refer adults with symptoms over 2 days, may give them rehydration therapy in the meantime

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24
Q

Give 3 medicines that may make nausea and vomiting more common.

A

NSAIDs
Chemotherapy
Antibiotics

Reduce symptoms by taking with food

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25
Q

What are the danger symptoms of nausea and vomiting?

A
  • Duration of more than 48 hours in adults
  • Refer if child is under 2 years old
  • Blood in the vomit or stools
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26
Q

Give 3 treatment options for nausea and vomiting.

A
  • Hyoscine Hydrobromide (JoyRides) - N&V caused by motion sickness
  • Dioralyte ORT
  • Domperidone liquid
  • Prochlorperazine buccal
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27
Q

What lifestyle advice could you give to someone with nausea and vomiting?

A
  • Replace lost fluid with regular sips of water
  • Ginger biscuits can help alleviate nausea

Motion sickness:

  • Take first dose before the journey in order to be effective
  • Take regular breaks to stretch legs
  • Breathe slowly and deeply
  • Focus on objects in the distance

Pregnancy:

  • Drink and eat little and often
  • Avoid food/smells which trigger nausea
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28
Q

What are the danger eliminations for motion sickness?

A
  • Glaucoma
  • Failed treatment
  • Seek advice if symptoms continue after you stop travelling
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29
Q

What is the most common treatment for motion sickness?

A

APPLY BEFORE TRAVELLING

Hyoscine (Joy rides, Kwells)

  • Take 20-30 minutes before travelling
  • Can be given from age 3 onwards
  • Can cause dry mouth - alleviate by sucking on something like a lolly to simulate saliva
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30
Q

What lifestyle advice could you give to someone with motion sickness?

A
  • Minimise motion by sitting at the front or middle of a boat
  • Look straight ahead at a fixed point
  • Close eyes and breath slowly
  • Fresh air and regular breaks
  • Ginger can help with nausea
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31
Q

Give potential causes of constipation

A
  • Not enough fibre or fluids in the diet
  • Pregnancy
  • Old age
  • Laxative abuse
  • Change in diet or routine
    ADRs (Iron, antihypertensives, codeine)
  • Stress/Depression
  • Sedentary lifestyle
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32
Q

What are the age parameters for treatment of constipation?

A

Children may be given a single glycerin suppository
Avoid stimulant laxatives in pregnancy
Elderly should be given bulk forming laxatives but maintain fluid intake

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33
Q

Timescale for referral

A

Refer if no change in symptoms after:

  • 1 week if OTC treatment provided
  • 2 weeks with dietary advice only
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34
Q

What are the danger symptoms of constipation?

A
  • Change in bowel habit of 2 weeks or longer
  • Failed medication
  • ADRs (Opioids - Codeine)
  • Blood in the stools
  • Presence of abdominal pain, vomiting
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35
Q

Name 2 stimulant laxatives

A

Bisacodyl
Senna
Glycerin suppositories

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36
Q

Name 2 faecal softeners.

A

Lactulose solution

Docusate sodium

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37
Q

Name a bulk forming laxative.

A

Ispaghula husk

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38
Q

What lifestyle advice could you give to someone with constipation?

A
  • Increase fibre and fluid intake (fruit, veg, wholegrain, cereal)
  • Regular exercise
  • Avoid holding back when you have the urge to go to the toilet
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39
Q

What are the age parameters for diarrhoea?

A

Refer infants and babies due to dehydration risk

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40
Q

How long does diarrhoea normally last? When should you refer?

A

Refer if symptoms have lasted one week

If no improvement after 2 days of treatment (1 in infants) refer

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41
Q

Give 2 medicines that may make diarrhoea more common.

A

Antibiotics

Antacids containing magnesium

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42
Q

What are the danger symptoms of diarrhoea?

A

Signs of dehydration
Bloody/dark stools
Severe abdominal/rectal pain
Returning from holiday with a fever

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43
Q

Give 3 treatment options for diarrhoea.

A

Dioralyte ORT
Loperamide
Bismuth (bacterial diarrhoea)

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44
Q

What lifestyle advice could you give to someone with diarrhoea?

A 
Drink plenty of water
Follow good toilet hygiene
Avoid foods that aggravate diarrhoea
Tackle stress/anxiety
Drink bottled water on holiday
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45
Q

What key symptom is indicative of IBS?

A

Pain in the lower left quadrant of abdomen

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46
Q

What are the age parameters for IBS?

A

Refer children, the elderly or pregnant women

Usually affects people under 40

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47
Q

How long does IBS normally last?

A

Tends to be episodic

Symptoms may occur in a pattern over months or years

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48
Q

What are the danger symptoms of IBS?

A 
Over 45s with change in bowel habits
Blood in stools or rectum
Unexplained weight loss
Unresponsive to treatment
Family history of IBD or cancer
Previous bowel surgery
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49
Q

What are the two most common treatments for symptomatic relief of IBS?

A

Fybogel- constipation relief

Immodium- diarrhoea relief

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50
Q

Give 3 treatment options for IBS.

A

Hyoscine
Mebeverine
Peppermint oil

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51
Q

What lifestyle advice could you give to someone with IBS?

A 
Have regular meals
Drink plenty of water
Reduce tea/coffee intake
Reduce alcohol and fizzy drink intake
Avoid aggravating factors
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52
Q

What is the key to treating threadworms?

A

The entire family should be treated even without symptoms

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53
Q

What are the danger symptoms of threadworms?

A

Travel abroad
Medication failure
Perianal skin broken/weeping

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54
Q

Give the most common treatment option for threadworms.

A

Mebendazole

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55
Q

What lifestyle advice could you give to someone with threadworms?

A

Treat all family members
Reassure that it is very common
Cut fingernails short
Wash hands and brush nails after using the bathroom
Wear pyjamas to reducing itching at night
Have bath/shower each morning

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56
Q

How long should symptoms of threadworms last before referring?

A

If no improvement after 7-14 days with treatment, refer.

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57
Q

What are the age parameters for haemorrhoids?

A

Refer children

Incidence increases with age

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58
Q

How long do haemorrhoids normally last? When should you refer?

A

Refer if present longer than 3 weeks

Refer if no improvement with treatment after 1 week

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59
Q

Give 5 potential causes of haemorrhoids?

A 
Pregnancy
Irregular eating patterns
Poor toilet habits
Obesity
Regular straining/heavy lifting in work or sport
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60
Q

What are the danger symptoms of haemorrhoids?

A 
Presence of blood in stool
Change in bowel habits
Abdominal pain
Severe, sharp pain when defecating
Persistent/recurrent inflammation
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61
Q

Give 3 treatment options for haemorrhoids.

A 
Anusol
Anusol HC (hydrocortisone)
Lidocaine
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62
Q

What lifestyle advice could you give to someone with haemorrhoids?

A 
Promote soft stools
Try not to strain
Avoid excessive caffeine intake
Avoid opioid analgesics
Topical treatments will provide relief but cannot cure
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63
Q

How long does a cold/flu normally last? When should you refer?

A

Cold symptoms can last 2-14 days
Flu symptoms last around 1 week
Refer if symptoms persist for 2-3 weeks
Refer if no improvement with treatment after 1-2 weeks

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64
Q

What are the danger symptoms of cold and flu?

A 
Shortness of breath
Difficulty breathing
Blood in phlegm
Phlegm is green/yellow
Chest pain on coughing
Rash/stiffness
Earache not settling with analgesia
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65
Q

Give 2 examples of decongestants.

A

Xylometazoline

Pseudoephedrine

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66
Q

What lifestyle advice could you give to someone with cold/flu?

A 
Get plenty of rest
Keep hydrated
Inhale steam to loosen and help bring up phlegm
Increase vitamin C and zinc
Avoid smoking
See if you are eligible for flu vaccine
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67
Q

What is the difference between a chesty cough and a dry/tickly cough?

A

Chesty coughs tend to be productive, bring up sputum

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68
Q

What is the key identifier of chronic bronchitis?

A

Tends to be worse in the morning

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69
Q

How long does a cough normally last? When should you refer?

A

Refer if over 3 weeks or no improvement with treatment after 2 weeks

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70
Q

What medicines or conditions may cause cough?

A

ACE inhibitors
Emphysema
Bronchitis
Lung disease

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71
Q

What is the key identifier of congestive heart failure with a cough?

A

Worse when lying down, may be swelling in legs

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72
Q

What are the danger symptoms of a cough?

A 
Green/yellow phlegm
Blood in phlegm
Shortness of breath
Noisy/difficult breathing
Chest pain
Rash/stiff neck
Ear pain
Unintentional weight loss- TB
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73
Q

Give an example of a demulcent formulation for a cough.

A

Beechams honey and lemon

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74
Q

Give examples of expectorants.

A

Guaifenesin
Pseudoephedrine
Diphenhydramine
Levomenthol

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75
Q

Give the main example of a cough suppressant.

A

Dextromethorphan

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76
Q

What lifestyle advice could you give to someone with a cough?

A 
Keep hydrated
Rest
Suck on a hard candy
Cut down smoking
If worsened by dry air, get a humidifier
If worse at night take something that will make you drowsy
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77
Q

How long does a sore throat normally last? When should you refer?

A

Refer if lasted over 2 weeks or if no improvement with treatment after 1 week

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78
Q

What are the danger symptoms of a sore throat?

A 
Extreme pain
Skin rash
Fever
Spots on throat or tongue
Neck stiffness
Difficulty swallowing
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79
Q

What is the key differential diagnosis of a sore throat?

A

Glandular fever

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80
Q

Give 3 treatment options for a sore throat.

A

Dichlorobenzyl alcohol (strepsils)
Benzalkonium antiseptic
Benzocaine spray

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81
Q

What lifestyle advice could you give to someone with a sore throat?

A

Drink plenty of fluids
Gargle with salty water
Avoid smoking
Avoid food or drink that is too hot

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82
Q

What is the main difference between hay fever and perennial rhinitis?

A

Hayfever is seasonal from April to September

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83
Q

What are the age parameters for allergic rhinitis?

A

Common in children

Symptoms often become milder as you get older

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84
Q

What are the danger symptoms of allergic rhinitis?

A 
Wheezing, shortness of breath
Chest pain
Earache/facial pain
Redder eyes, coloured and sticky discharge
One sided nasal discharge
Failed treatment
Pregnancy
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85
Q

What timescale should you refer allergic rhinitis?

A

If symptoms do not improve within 5 days of commencing treatment

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86
Q

Give an example of a mast cell stabiliser.

A

Sodium cromoglicate

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87
Q

Give 5 treatment options for allergic rhinitis.

A 
Loratidine
Chlorphenamine
Sodium cromoglicate
Xylometazoline
Beclometasone spray
88
Q

What lifestyle advice could you give to someone with allergic rhinitis?

A 
Avoid triggers
Sleep with windows closed
Avoid being outside when pollen count is high
Wear dark glasses
Limit pets to certain areas of the house
89
Q

Name 4 types of headache.

A

Tension
Sinus
Hangover
Medication overuse

90
Q

How might someone describe a tension headache?

A

Dull ache in forehead, temples or back of the neck

Tight band around head or heavy weight on top of head

91
Q

What often accompanies a hangover headache?

A

Nausea and vomiting

92
Q

What are the key symptoms of a medication overuse headache?

A

Oppressive

Worse in the morning or after exercise

93
Q

What are the age parameters for a headache?

A

Refer children, especially with trauma

94
Q

Give 2 likely causes of headaches.

A

Alcohol

Straining eyes/using a computer

95
Q

What are the danger symptoms of headaches?

A 
Sudden, severe headache
Nausea and vomiting
Persistent and recurring
Fever, stiff neck
Blurred vision
Trauma
Increasing severity or frequency
Numbness, tingling of limbs
96
Q

What are the benefits of dispersible as opposed to traditional tablets in headache?

A

Achieve peak effect in 30 minutes rather than 2 hours

97
Q

Why may levomenthol be useful in headache?

A

Available as cooling strips to apply topically

98
Q

What lifestyle advice could you give to someone with a headache?

A 
Plenty of rest
Regular breaks when concentrating for long periods
Try to avoid known triggers
Regular eye tests
Apply ice pack to painful areas
Well hydrated
99
Q

What are the key symptoms of a migraine?

A 
Headache on one side
Blurred
Vision
Flashing/coloured lights
Nausea and vomiting
Tingling in hands or arms
100
Q

How long can a migraine last?

A

Lasts 4-60 minutes

Complete recovery in 4-72 hours

101
Q

With what medication should a migraine be referred?

A

COCP

102
Q

What are the danger symptoms of migraines?

A

First time

Vision/hearing/sensory loss

103
Q

When can sumatriptan be sold in migraine?

A

With previous GP diagnosis

104
Q

Give 3 treatment options for migraines.

A

Sumitriptan
Migraleve pink and yellow
Midrid capsules

105
Q

What lifestyle advice could you give to someone with migraines?

A

Keep a diary in order to try and identify triggers
During attack, lie down, try to sleep, in dark and quiet room
Maintain good nutrition

106
Q

Define a sprain.

A

Injury to ligament supporting a joint

107
Q

Define a strain.

A

Injury to muscles and tendons that move the bones of a joint.

108
Q

What are the danger symptoms of muscoskeletal injuries?

A

Unable to bare weight
Severe pain or swelling
Numbness and severe deformity
Popping sound upon injury

109
Q

What are the age parameters for muscoskeletal injury?

A

Refer children and elderly due to fracture risk

110
Q

How long do sprains/strains normally last? When should you refer?

A

Refer if over 4 days or treatment does not improve symptoms within 4 days

111
Q

What are the potential causes of backache?

A

Pregnancy
Awkward bending
Sitting for long periods

112
Q

How long does backache normally last? When should you refer?

A

Refer if constant or no improvement after 10-14 days

113
Q

What are the danger symptoms of backache?

A 
Fever, nausea and vomiting
Weight loss
Inflammation/swelling
Pain that travels to chest
Loss of bowel control
Kidney pain
Severe pain radiating into legs
114
Q

Define tennis elbow.

A

Swelling around outer edge of the elbow, pain during movement.

115
Q

Define golfer’s elbow.

A

Swelling on the inside of the elbow

Pain during movement and when quickly flexing arm/hand

116
Q

How long does tennis/golfer elbow normally last? When should you refer?

A

Usually around 2 days, after this refer

If no improvement with treatment after 4 days refer

117
Q

What lifestyle advice could you give to someone with muscoskeletal injury?

A 
Protect
Rest
Ice
Compression
Elevate

After first 48 hours, inflammation reduced, may apply heat for pain

118
Q

What is frozen shoulder?

A

Stiffness and pain

Reduced movement

119
Q

How long does frozen shoulder normally last? When should you refer?

A

Aching/stiffness can last 2-9 months
Adhesive stage- stiffness and muscle wasting many last 4-12 months
Recovery stage can take 5-12 months

120
Q

What lifestyle advice could you give to someone with frozen shoulder?

A

Shoulder exercise to maintain movement

Saving the shoulder can increase stiffness and cause muscle wasting

121
Q

How long does rheumatism normally last? When should you refer?

A

Refer if over 6 weeks
If they haven’t seen their doctor in 6 months, refer back
If no improvement with treatment after 7 days, refer

122
Q

What lifestyle advice could you give to someone with rheumatoid arthritis?

A

Plenty of rest during flare ups
Exercise is important to maintain mobility
Non-weight bearing exercise such as swimming

123
Q

Presenting symptoms of vaginal thrush

A
  • Itching
  • Soreness
  • Discharge (colourless/watery/white) distinguishing symptom from cystitis
124
Q

How long does vaginal thrush normally last? When should you refer?

A

Lasts 1-2 weeks

Refer if > 2 weeks or if symptoms do not improve within 1 week of treatment

125
Q

What are the danger symptoms of vaginal thrush?

A
  • Diabetes
  • Duration > 2 weeks
  • Treatment failure
  • Pregnancy or suspected pregnancy
  • Under 16 or over 60
  • First occurrence (“Have you experienced this before? Is it the same?”)
  • Blood stained or strong smelling discharge (“Are you sexually active”)
  • More than 2 attacks in 6 months
126
Q

What lifestyle advice could you give to someone with vaginal thrush?

A
  • Avoid tight fitting clothing as they create a warm, moist environment which can trigger thrush
  • Avoid strong soaps and douches
  • Application of live yoghurt can soothe and restore bacterial/fungal cell balance
  • Male partners can use clotrimazole cream to stop spreading
127
Q

What treatment options are there for vaginal thrush?

A

ASK WHERE THE ITCH IS - Internal or External

Clotrimazole (topical - Canesten):

  • External cream (2%)
  • Internal cream (10%)
  • Pessary (500mg)
  • Canesten combi (Pessary + external cream)

Fluconazole (oral tablet):
- 24 hours to act

128
Q

What are the presenting symptoms of cystitis? Potential causes?

A
  • Pain, burning or stinging when you pee
  • Needing to pee more often and urgently than normal
  • Urine that’s dark, cloudy or strong smelling
  • Pain low down in your tummy
  • Feeling generally unwell, achy, sick and tired

Causes:

  • Bacterial infection (50%)
  • Physical activity
  • Dehydration
129
Q

How long does cystitis normally last? When should you refer?

A

Refer if treatment for 2 days gives no improvement

130
Q

What are the danger symptoms of cystitis?

A
  • Failed medication
  • Diabetics (sign of uncontrolled blood glucose)
  • All men and children
  • Fever, nausea and vomiting
  • Blood in urine
  • Pregnancy (increased likelihood of complications)
  • Back pain
  • Recurrent cystitis
131
Q

What is the mainstay treatment for cystitis?

A

Potassium citrate

  • Alkanalise urine
  • Oral solution, sachets (cystopurin) and tablets (Effercitrate)

Pain relief: Nitrofurantoin (can give to relieve pain whilst they wait for referral)

132
Q

What are the presenting symptoms of dysmenorrhea?

A
  • Painful cramps
  • Headache, backache
  • Nausea, vomiting constipation
  • Faintness, dizziness, fatigue
  • Premenstrual syndrome (PMS)
133
Q

How long does dysmenorrhoea normally last? When should you refer?

A

Around 3 days

Refer if no improvement with treatment over 2 cycles

134
Q

What are the danger symptoms of dysmenorrhoea?

A
  • Abnormal discharge (colour) or heavy bleeding
  • Fever
  • Severe pain between periods
  • Repeated medication failure
135
Q

Give 3 treatment options for dysmenorrhoea.

A

Ibuprofen (Anadin period, feminax express, nurofen)
- Add Paracetamol if not effective enough)

Naproxen (Feminax ultra)

Tranexamic or Mefenamic Acid

136
Q

What are the guidelines for giving tranexamic acid in dysmenorrhoea?

A

Over 18
Regular cycle
Commence treatment when period starts
Treat for no more than 4 days

137
Q

What is lifestyle advice for dysmenorrhea?

A
  • Exercise during menstruation may be beneficial - some evidence that moderate aerobic exercise can improve symptoms of PMS.
    “There are a couple things that have been shown to help but you may not feel up
  • Start painkillers before period is due – may prevent pain from building up
  • Hot water bottle/heat packs
138
Q

What are the danger symptoms of insomnia?

A

Suspected depression/anxiety

  • ASK “Can you think of anything that has triggered this?”/“How are you feeling at the moment?” THEN “You might want to go to the GP about the things you’ve said to me”
  • Insomnia lasting more than 3 weeks
  • Children under 16
  • Medication failure
139
Q

What are the treatment options for insomnia?

A

Diphenhydramine (nytol)

Promethazine Hydrochloride (Phenergan, Day&Nurse) 
- Longer lasting than Diphenhydramine

All available as tablets or oral solution

140
Q

What lifestyle advice could you give to someone with insomnia?

A
  • Avoid daytime naps
  • Avoid caffeine, nicotine, alcohol and heavy meals 6 hours before bed
  • Regular exercise can help but avoid 4 hours before bed
  • Try having warm bath or milky drink before bed
  • Try relaxation techniques such as deep breathing
141
Q

How long does insomnia normally last? When should you refer?

A

Refer if over 3 weeks or 1 week if no improvement with treatment

142
Q

What are the differences between irritant and allergic contact dermatitis?

A

Irritant can become chronic and occurs within 48 hours of contact
Allergic can have a delay of hours or days before symptoms seen

143
Q

How long does contact dermatitis normally last? When should you refer?

A

If over 2 weeks or no improvement after 1 week with treatment refer

144
Q

Give potential causes of contact dermatitis.

A 
Nickel in jewellery
Soaps
Detergents
Hair dye
Chromates (cement)
Plasters
145
Q

What are the danger symptoms of contact dermatitis?

A

Infection
Severe condition
Cracked or bleeding skin

146
Q

What are the danger symptoms of acne?

A

Signs of infection
Pregnancy
Adult suffering for the first time

147
Q

Give potential causes of acne.

A 
Stress
Make up
Contraceptive pill
Exfoliation
Before period
148
Q

How long does acne normally last? When should you refer?

A

Refer if no improvement with 8 week treatment

149
Q

What is the treatment for acne?

A

Benzyl peroxide

150
Q

What lifestyle advice could you give to someone with acne?

A

Wash skin gently twice daily
Avoid very hot water and strong detergents
Wash hair regularly, especially with fringe
Resist temptation to squeeze sports
Natural sunlight helps
Choose water based cosmetics

151
Q

What are the danger symptoms of athlete’s foot?

A 
Base of nail discoloured, brittle
Weeping, yellow crusts
Swollen foot
Large blisters/ulcers
Diabetes
152
Q

What should be suggested in treatment failure of athlete’s foot?

A

Consider adherence
If tried daktarin, recommend lamisil
Give lamisil once if compliance issues
Continue treatment for 2 weeks after infection has cleared

153
Q

Give 4 treatment options for athlete’s foot.

A

Miconazole (daktarin)
Terbinafine (lamisil)
Miconazole and hydrocortisone (daktarin HC)
Amorolfine (curanail)

154
Q

What lifestyle advice could you give to someone with athlete’s foot?

A 
Wash and dry feet thoroughly
Wear socks made of cotton or wool
Avoid shoes made of synthetic material
Powder feet and inside of shoes with anti fungal
Spend time bare foot when possible
155
Q

How long does athlete’s foot normally last? When should you refer?

A

Refer if present for over 2 weeks or no improvement with 7 days of treatment

156
Q

How do cold sores present?

A

Tingling in skin for 6-24 hours before appearance
Weeping/crusting at 4th day after appearance
Total episode usually lasts 1-2 weeks

157
Q

What can cause cold sores?

A 
Stress
Illness
Strong sunlight
Menstruation
Fatigue
Cold weather
158
Q

What are the danger symptoms of cold sores?

A 
Failure to resolve
Severe or worsening
History of frequent occurrence
Painless
Eye affected
159
Q

Give 2 treatment options for cold sores.

A

Acyclovir 5% (Zovirax)

Lidocaine 2% gel

160
Q

What are the key differences between warts and verrucae?

A

Warts- rough, scaly papules that are normally painless
Occur on hands, elbows and knees
Verrucae- flat, thickened skin with black centre, painful when pressure applied
Occur on weight bearing ares, soles of feet

161
Q

What are the danger symptoms of warts/verrucae?

A 
Cracked skin
Weeping
Itching
Bleeding
Genital or facial
162
Q

What is the treatment of verrucae?

A

Salicylic acid

163
Q

What lifestyle advice could you give to someone with a wart or verruca?

A

Treatment takes up to 3 months, refer if no improvement after 12 weeks
Keep feet dry
Do not scratch or pick
Cover with swimming socks or plaster

164
Q

How long does scabies normally last? When should you refer?

A

Symptoms appear 2-6 weeks after infestation

Refer if treatment does not show improvement in 7-14 days

165
Q

What are the danger symptoms of scabies?

A 
Babies and children
Pregnancy
Diabetes
Asthma
Infected or broken skin
166
Q

How is scabies treatment applied?

A

To entire body from the neck down and left for at least 8 hours before washing off.

167
Q

Give 2 treatment options for scabies.

A

Permethrin

Malathion

168
Q

What are the symptomatic treatment options in scabies?

A

Chlorphenamine and Eurax cream to stop itching

169
Q

What lifestyle advice could you give to someone with scabies?

A

Very contagious
Bed linen, towels should be machine washing on hot wash after treatment
Any linen that cannot be washed should be contained in plastic bag for 3 days until mites die
Itching may continue for 3 weeks after successful treatment
All household members should be treatment on the same day

170
Q

Give 3 potential causes of dandruff.

A

Not brushing hair regularly
Nutritional deficiencies
High sugar diet

171
Q

What are the danger symptoms of dandruff?

A 
Pregnancy
Yellow, greasy looking skin
Inflammation
Red and crusty skin
Knees or elbows- psoriasis
172
Q

Give 3 treatment options for dandruff.

A

Salicylic acid shampoo
Selenium sulphide shampoo
Ketoconazole 2% shampoo

173
Q

What lifestyle advice could you give to someone with dandruff?

A

Brush hair daily, wash at least 3 times per week
Use medicated shampoo every 1-2 weeks to prevent recurrence
Avoid chemical dyes
Avoid scratching

174
Q

When should symptoms of dandruff improve?

A

Within 12 weeks of starting treatment

175
Q

What are the features of psoriasis?

A

Occurs on scalp, knees, elbows and can affect finger nails

Thickened red patches of skin, look scaly

176
Q

How long does psoriasis last?

A

Usually occurs in cycles of weeks to months

Refer if no visible improvement after 1 week of treatment

177
Q

What are the danger symptoms of psoriasis?

A

Weeping
Crusting
Crack skin
Infection

178
Q

What are the 2 main treatment options for psoriasis?

A

Coal tar

Hydrocortisone 1% cream

179
Q

What lifestyle advice could you give to someone with psoriasis?

A

Keep skin lubricated
Use soap free cleansers if possible
Exposure to sun can help
Bathing in hot water can reduce scaling

180
Q

How long does nappy rash normally last? When should you refer?

A

Refer if present for over 2 weeks or with treatment if symptoms do not improve in 1 week

181
Q

What are the danger symptoms of nappy rash?

A

Signs of infection
Small, red dots or extension beyond nappy area suggestive of fungal infection
Darker, purple spots (meningitis)

182
Q

What are the mainstays for treatment of nappy rash?

A

Canesten or daktarin followed by barrier cream

183
Q

What lifestyle advice could you give for nappy rash?

A

Increase frequency of nappy changes
Use warm water and cotton to clean bottom
Pat nappy area dry
Leave nappy off for as long as possible
Talc and baby wipes can be irritant
Barrier creams can help to protect the skin

184
Q

What are the 3 types of conjunctivitis.

A

Infective
Allergic
Irritant

185
Q

Describe the difference in symptoms of infective and allergic conjunctivitis.

A

Infective- starts in one eye and spreads, sticky discharge, whites of the eyes look pink, eyes feel gritty and irritated
Allergic- both eyes develop symptoms at the same time, watery and itchy eyes

186
Q

How long does conjunctivitis normally last? When should you refer?

A

Usually resolves itself but refer if over one week

Refer if no improvement within 48 hours of treatment

187
Q

What could be the cause of conjunctivitis?

A 
Contact lenses
Allergy
Pollution
Smoke
Chlorine
Bright lights
188
Q

What are the danger symptoms of conjunctivitis?

A 
Worsening symptoms
Vision disturbance
Glaucoma
Recurrence
Pregnancy
Abnormal pupil
189
Q

What are the 2 treatment options for infective conjunctivitis?

A

Propamidine

Chloramphenicol

190
Q

What are the 2 treatment options for allergic conjunctivitis?

A

Sodium cromoglicate

Xylometazoline

191
Q

What are the 2 treatment options for irritant conjunctivitis?

A

Witch hazel

Naphazoline

192
Q

What lifestyle advice could you give for conjunctivitis?

A

Do not rub eyes
Infective is highly contagious
Pus/crustiness may be removed with warm slaty water

193
Q

Describe the presenting features of excess earwax.

A 
Difficulty hearing
Pain
Tinnitus
Blocked feeling
Temporary deafness after swimming or showers
194
Q

Describe the presenting features of otitis media.

A 
Pus
Fluid
Inflammation
Severe earache
Hearing loss
Fever
Tinnitus
195
Q

Describe the presenting features of otitis externa.

A

Pain and itching
Dulled hearing
Ear discharge

196
Q

What are the age parameters for ear problems?

A

Refer children under 12 with wax problems

197
Q

How long do ear problems normally last? When should you refer?

A

Refer if no improvement of excess wax in 3 days, persistent otitis external for 7 days
Refer if no improvement with treatment after 7 days

198
Q

What are the danger symptoms of ear problems?

A 
Severe pain
Complete deafness
Fever in glue ear
Otitis media
Otitis externa accompanied by foul smelling discharge or fever
199
Q

What is key to point out with treatments for ear problems?

A

Some products contain peanuts or soya

Drops should be used at room temperature

200
Q

Give 3 treatment options for softening ear wax.

A

Arachis oil and chlorobutanol
Almond oil, archis and camphor oil
Urea hydrogen peroxide

201
Q

What may be given for treatment of otitis external?

A

Acetic acid spray

Isopropyl alcohol

202
Q

What lifestyle advice could you give for ear problems?

A

Cotton buds can compact ear wax
Avoid smoky environments with glue ear
Use ear plugs when swimming

203
Q

When does teething generally occur?

A

Around 6-9 months

204
Q

What are the danger symptoms of teething?

A

Excessive diarrhoea

Temperature over 38

205
Q

What are the 4 treatment options for teething?

A

Paracetamol
Ibuprofen
Bonjela
Lidocaine and cetalkonium (abnesol)

206
Q

What lifestyle advice could you give for teething?

A

Plenty of fluids
Teething rings- can also be cooled in fridge to soothe
Brush teeth as soon as they appear

207
Q

When does head lice generally occur?

A

Common aged 4-11, symptoms occur a long time after initial infection
Refer if no improvement with treatment after 1-2 weeks

208
Q

What is the best method for treating head lice?

A

Wet combing method

Every 4 days for at least 2 weeks

209
Q

Give the 3 treatment options for headline.

A

Phenothrin
Malathion
Dimeticone

210
Q

What lifestyle advice could you give for head lice?

A

Avoid direct head to head contact
Minimise itching
Protect eyes and face when treating
Treat all members of the family

211
Q

What are the danger symptoms of hair loss?

A

Patchy hair loss
Hypothyroidism
Anaemia

212
Q

What is the main treatment option for hair loss? Who can receive it?

A

Minoxidil 2% for women

Minoxidil 5% for men

213
Q

Where does eczema most commonly present?

A

Babies- nappy area, neck, belly, back of scalp, limb creases
Children- skin creases, ankles, around the eyes
Adults- neck, back of hands, ankles, groin

214
Q

What are the danger symptoms of eczema?

A

Infection

Pain

215
Q

What lifestyle advice could you give for eczema?

A 
Aggravating factors
Stress can worsen eczema
Avoid itching
Use non-biological washing powders
Keep skin moist and supple to avoid cracking
216
Q

Give lifestyle advice for cystitis

A

Would you like some advice on how to prevent this happening again? What have you already tried? Can you think of anything that you think that has triggered it?

  • Staying well hydrated – drinking plenty of fluids may help to stop bacteria multiplying in your bladder
  • Avoid tea, coffee and alcohol as they cause dehydration
  • Empty your bladder as soon as possible after having sex
  • Drinking cranberry juice has traditionally been recommended as a way of reducing your chances of getting cystitis.
  • Wipe front to back

The Pharmacist Year 3 (5 decks)

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