Week 14 / OTC Minor Ailments 1 Flashcards

Question

Q: What are the signs and symptoms of dyspepsia?

Answer 1

A: Upper abdominal discomfort and pain Heartburn Acid reflux Nausea and vomiting related to eating Burning discomfort felt in the stomach, radiating behind the breastbone Unpleasant acid taste in the mouth Fullness in the upper abdomen Belching

Answer 2

A: Eat smaller, more frequent meals to reduce strain on the stomach Raise the head end of your bed to prevent stomach acid from traveling upwards Smoking cessation: Consider referring the patient to a stop smoking service Weight loss to reduce pressure on the stomach Avoid trigger foods such as: Chocolate Alcohol Caffeine Rich, spicy, or fatty foods

Answer 3

A: Antacids (e.g. calcium carbonate, magnesium/aluminium salts, Rennie) Effectiveness: Limited evidence, but symptomatic relief often reported Usage: Best taken after meals or at bedtime Considerations: Avoid taking with other medications as they can impair absorption; magnesium salts may cause diarrhea, aluminium salts may cause constipation. Alginates (e.g. sodium alginate, potassium alginate, Gaviscon) Effectiveness: Forms a ‘raft’ on the stomach contents, providing relief from reflux Considerations: Potassium-based alginates for those on a restricted sodium diet. Proton Pump Inhibitors (PPIs) (e.g. omeprazole, esomeprazole) Effectiveness: Most effective for heartburn, takes up to 24 hours to work Usage: Short-term use for reflux (max. 14 days for esomeprazole, max. 4 weeks for omeprazole) Considerations: Licensed for 18+ years old.

Answer 4

A: Causes: Poor fibre intake Poor fluid intake Sedentary lifestyle Other medications Signs and Symptoms: Reduced frequency of defecation Straining with small, hard stools Abdominal discomfort and cramps Feeling of incomplete emptying Referral Symptoms: Blood in stools Pain during defecation Abdominal pain, vomiting, or bloating Unexplained weight loss Failed treatment Change in bowel habit for more than 2 weeks OTC Treatment: Bulk Forming Laxatives Osmotic Laxatives Stimulant Laxatives Stool Softeners Special Considerations: Children: Usually resolves without treatment. Fruit juice can help. Referral if not resolved. Pregnancy/Breastfeeding: Bulk-forming and osmotic laxatives are the safest as they are not absorbed. Avoid Senna due to potential effects on the infant.

Answer 5

A: Drink eight glasses of fluid a day (about 2 litres). Avoid too much caffeine, as it can worsen constipation. Eat high-fibre foods. Remain physically active.

Answer 6

A: Bulk forming (e.g., ispaghula) Retain water in the gut, increasing faecal mass and stimulating peristalsis. Delayed onset, not for acute relief. Must be taken with adequate fluids. Side effects: bloating, distension, and flatulence. Licensed for 6yrs+. Osmotic (e.g., lactulose, macrogol) Increase water absorption into the large bowel. Effects in up to 48 hours. Lactulose is liquid and licensed for babies. Macrogol: available in sachets, paediatric sachets, and liquid. Licensed from 2yrs+. Stimulant (e.g., senna, bisacodyl) Stimulate colonic nerves to increase intestinal motility. Effects within 8–12 hours, taken at night. Can lead to fluid and electrolyte imbalance with frequent use. Senna: Licensed for 18yrs+. Bisacodyl: Licensed for 12yrs+. Stool Softener (e.g., docusate, glycerol) Reduce surface tension, increasing fluid penetration into faeces. Docusate: given orally as liquid or capsules. Glycerol: given rectally, licensed for use in children. Works within approximately 30 minutes.

Answer 7

A: Causes: Viral or bacterial infections (e.g., E. coli, Salmonella, Cryptosporidium). GI diseases (e.g., IBS). Signs and Symptoms: Increased frequency of bowel evacuation with abnormally soft or watery faeces. Usually acute and self-limiting. Associated symptoms: abdominal cramps, flatulence, weakness/malaise. Referral Symptoms: Drowsiness or confusion. Signs of dehydration (e.g., passing little urine, dry mouth and tongue). Cool hands or feet. Sunken fontanelle in babies/young infants. Blood or mucus in stools. Persistent vomiting. Lasting longer than 3 days in adults. Recent travel abroad. OTC Treatment: Electrolyte and fluid replacement. Anti-diarrhoeals (a.k.a. anti-motility drugs) for adults and older children.

Answer 8

A: Hydration: Drink plenty of normal drinks (fruit juices and soups can help provide sugar and salt). Diet: Eat as normally as possible, ideally foods high in carbohydrates. Solid food: No need to avoid solid food for 24 hours. Hygiene: Always wash hands after using the toilet or changing nappies. Regularly clean the toilet, including the flush handle and toilet seat. Special Considerations: Seek specialist advice for those handling food as part of their job.

Answer 9

A: Oral Rehydration Sachets (e.g., Dioralyte): Standard treatment for acute diarrhoea in babies and young children. Dissolve sachets or tablets in water, and take with each loose stool in addition to regular fluid intake. Licensing varies based on the preparation. Anti-motility Drugs (e.g., Loperamide, Imodium): Reduces the duration of diarrhoea and improves symptoms. Increases stool consistency. Only used when symptom control is needed, not routinely. Ensure plenty of fluids are consumed during treatment.

Answer 10

A: Causes: Inflammatory response due to histamine release when allergens (e.g., pollen, dust mites, animal dander) are deposited on the nasal and respiratory mucosa. Seasonal allergic rhinitis (due to grass/tree pollens) or perennial (due to dust mites, animal dander). Often associated with asthma and eczema. Symptoms: Rhinorrhoea (runny nose) Nasal congestion Nasal itching Watery and irritated eyes Sneezing Discharge from the eyes

Answer 11

A: Antihistamines: Block histamine action to reduce symptoms like sneezing, itching, and runny nose. Nasal Corticosteroids: Help reduce inflammation and alleviate nasal congestion and other symptoms. Sodium Cromoglicate: Prevents the release of histamine and other inflammatory substances. Decongestants (short term): Provide temporary relief of nasal congestion.

Answer 12

A: Allergen avoidance: While it's not always possible, it's important to minimize exposure. For seasonal allergic rhinitis (hay-fever): Keep car windows and air vents closed to prevent pollen/allergens from entering. Close house windows when the pollen count is high. For perennial allergic rhinitis: Regularly clean the house to minimize dust and allergen build-up.

Answer 13

A: Antihistamines Non-sedating: Acrivastine, Cetirizine, Loratadine, Fexofenadine Sedating: Chlorphenamine First-line treatment for mild-to-moderate symptoms. Effective in reducing sneezing and rhinorrhoea. Intranasal Corticosteroids Beclometasone, Fluticasone, Mometasone Treatment of choice for moderate-to-severe continuous nasal symptoms. Reduces inflammation due to allergens. Requires regular use for full benefit. Sodium Cromoglicate Eye Drops Effective for eye symptoms. Works within an hour. Should be used continuously for full benefit. Decongestants Short-term use to reduce nasal congestion, sometimes combined with antihistamines. Useful when starting a preventer like nasal corticosteroids.

Answer 14

A: Causes: Stress/tension Migraine triggers (bright light, certain foods, missed meals, extreme weather, etc.) Long-distance travel Loud noises Altered sleep patterns Increased pressure in sinuses Signs and Symptoms: Tension Headache: Bilateral, dull ache with a pressing or tightening sensation across the forehead or base of the skull. Migraine: Pulsating/throbbing headache with or without aura/visual disturbances. Sinusitis: Unilateral headache behind and around the eye, worsened by bending forward, and sensitive to touch. Red flag/referral symptoms: Headache associated with injury/trauma Headache with fever or rash Severe headache lasting over 4 hours Headache in children under 12 years Associated drowsiness, unsteadiness, or visual disturbances Neck stiffness Frequent and persistent headaches Sudden onset More severe than previous headaches

Answer 15

A: Eye Strain: Has the patient had a recent eye test? Eye strain can cause headaches. Tension Headaches: Reassurance and stress-relieving techniques can be helpful. Physical exercise is recommended, especially for those with a sedentary lifestyle. Migraines: Avoid known triggers. Keeping a diary can help identify triggers. Meningitis Consideration: Always consider and rule out meningitis if the patient presents with headache, particularly with red flag symptoms like fever or neck stiffness. Referral: Refer the patient if there’s any doubt about the diagnosis or if red flag symptoms are present.

Answer 16

A: Simple Analgesics: Paracetamol: Analgesic and antipyretic effects. Ibuprofen: Analgesic, anti-inflammatory, and antipyretic effects. Opioid Containing Analgesics: Available in combination with paracetamol or ibuprofen (e.g., codeine, dihydrocodeine). Short-term use (max. 3 days) due to addiction risk. Not proven effective for migraine pain. Sumatriptan: Used for acute relief of migraine with or without aura. Should be taken as soon as possible after migraine onset. Doxylamine: Antihistamine with sedative effects, useful for tension headaches. Found in Syndol for short-term treatment of moderate pain.

Answer 17

A: Causes: Fungal infection caused by candida yeast. Predisposing factors: antibiotic use, pregnancy, and diabetes. Common in women of childbearing age. Signs and Symptoms: Vulval itching and erythema. White, curd-like, and odourless vaginal discharge. Dyspareunia (pain during intercourse) and dysuria (pain during urination). Red Flag/Referral Symptoms: First-time occurrence. Pregnancy or suspected pregnancy. More than two attacks in 6 months. History of STD or exposure to a partner with STD. Age under 16 or over 60. Abnormal bleeding or bloodstained vaginal discharge. Vulval or vaginal sores/ulcers/blisters. Failed treatment. OTC Treatment: Oral: Fluconazole 150mg capsule. Topical: Clotrimazole cream. Intravaginal: Clotrimazole 500mg pessary. Clotrimazole 10% internal cream.

Answer 18

A: Privacy: Patients may feel embarrassed about discussing vaginal symptoms. Ensure privacy during the conversation. Product Selection: Consider the patient's preference when recommending products. Patients may need counseling on the correct use of certain treatments (e.g. pessaries). Prevention Tips: Avoid synthetic underwear; opt for cotton underwear instead. Wash only the external area with unperfumed, mild soaps. Wipe from front to back after bowel movements. Treatment for Male Partners: Asymptomatic partners do not require treatment. Symptomatic partners (e.g. rash on the penis or glands) can use clotrimazole cream for 7 days or a single fluconazole 150mg capsule.

Answer 19

A: Fluconazole 150mg Capsule Indication: Treatment of vaginal thrush only. Convenience: One-time oral dose, usually more convenient and better adherence. Action: Takes 12-24 hours for symptoms to improve. Age Range: 16-60 years. Dosage: One single capsule as a one-off dose. Contraindications: Not suitable for pregnancy or breastfeeding. Combination Packs: Available with capsule and cream. Intravaginal Treatments (e.g. clotrimazole pessary or internal cream) Indication: For treatment of vaginal thrush only. Effectiveness: Single-dose products, as effective as oral treatments. Symptom Relief: May provide more immediate relief for itching and soreness. Combination Packs: Available with external cream. Topical External Cream (e.g. clotrimazole) Indication: Only antifungal cream licensed for vaginal thrush. Strength: 1% and 2% strengths available (licensing may vary). Usage: For external use to reduce itching. Safety: Safe for use during pregnancy and breastfeeding.

Answer 20

A: Causes A superficial fungal skin infection of the feet and toes. Most common dermatophyte infection. Signs and Symptoms Begins with scaling and itching on one foot (usually between the 4th and 5th toes). Symptoms include itching, flaking, and fissuring of the skin. Skin may appear white and “soggy” due to maceration. Feet often have an unpleasant odor. Red Flag/Referral Symptoms Signs of secondary infection (weeping, pus, yellow crusts). Patients with diabetes. Treatment failure. Involvement of toenails. OTC Treatment Antifungals: Available as creams, powders, solutions, sprays, and paints. Creams are the most common treatment option. Powders and sprays may be used on shoes to prevent re-infection.

Answer 21

A: Antifungal Creams Available options: Clotrimazole, Miconazole, Terbinafine. Treatment Duration Continue treatment for at least one week after all signs and symptoms have disappeared. Some creams may require a different treatment duration, so always read the Patient Information Leaflet (PIL) for specific instructions.

Answer 22

A: Miconazole 2% oral gel is the OTC treatment for oral thrush. It is commonly used to treat the fungal infection of the mucous membranes of the mouth, often caused by medications like inhaled corticosteroids.

Answer 23

A: Denture hygiene: Ensure dentures are removed before using miconazole gel to prevent re-infection. Diabetic patients: They may need a review of their treatment to better control blood glucose levels, as poor control can contribute to oral candidiasis. Inhaled corticosteroids users: Advise rinsing the mouth or drinking water after using the inhaler to prevent oral thrush.

Answer 24

A: Miconazole 2% oral gel For adults/children 6+ years: Apply four times daily after eating using a clean finger. For children 4 months – 6 years: Apply twice daily after eating. Ensure the gel stays in contact with the oral mucosa for as long as possible. Continue treatment for 2 days after symptoms disappear to ensure complete eradication. Contraindicated in children under 4 months due to choking risks—refer to GP for nystatin solution.

Week 14 / OTC Minor Ailments 1 Flashcards

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