Week 15 / OTC Minor Ailments 2 Flashcards
(20 cards)
Q: What are the causes, signs and symptoms, and OTC treatments for Ear Wax?
A:
Causes:
Earwax (cerumen) is a normal substance that cleans, lubricates, and protects the ear canal and has antibacterial properties.
Excessive build-up can occur if the wax hardens, often due to cotton wool buds pushing wax deeper into the ear.
Signs & Symptoms:
Temporary deafness
Discomfort or blockage sensation
Symptoms usually develop gradually.
Referral Symptoms:
Dizziness, tinnitus, fever, or general malaise
Foreign body in the ear
Pain
OTC medication failure
OTC Treatment:
Cerumenolytics (to soften earwax)
Oil-based
Peroxide-based
Water-based
Q: What general advice should be given for Ear Wax Removal?
A:
Possible Side Effects:
Ear drops may cause transient hearing loss, discomfort, dizziness, and irritation of the skin.
Check for Allergies:
Some earwax treatments contain arachis (peanut) oil or almond oil—check for nut allergies before selling.
When to Refer:
If earwax issues are recurrent, patients should see their GP for an inner ear examination.
Other Treatment Options:
Ear irrigation, syringing, or suctioning by a healthcare professional may be needed.
Q: What are OTC treatments for ear wax and how should they be used?
A:
Cerumenolytics:
Agents like Cerumol, hydrogen peroxide, urea, sodium bicarbonate, and olive oil help soften earwax for easier removal.
Usage:
Prescribe ear drops for 3–5 days initially.
Pour a few drops into the affected ear, lying with the affected ear uppermost.
Stay for 2–3 minutes to allow the drops to soak in and soften the wax.
Q: What are the causes and OTC treatments for mouth ulcers?
A:
Causes:
Trauma (e.g., biting the inside of the cheek, ill-fitting dentures).
Stress and emotional factors.
Food allergies.
May precede menstruation or remain unexplained.
OTC Treatments:
Chlorhexidine mouthwash for cleaning and reducing bacteria.
Anaesthetic/analgesic gels to relieve pain.
Orabase protective paste to protect and soothe the ulcer.
Hydrocortisone muco-adhesive buccal tablet to reduce inflammation.
Q: What are the OTC treatments for mouth ulcers and their uses?
A:
Anaesthetic/Analgesic Gels:
Lidocaine (e.g., Anbesol, Calgel) - Provides short-term pain relief with limited side effects and no known interactions.
Choline Salicylate (e.g., Bonjela) - Licensed for use from 16 years old. (Bonjela teething and Jnr have different licensing)
Chlorhexidine Mouthwash:
Reduces ulcer duration and severity, prevents secondary bacterial infection.
Can stain teeth brown if used regularly.
Use twice a day for 1 minute, continue for 48 hours after symptoms disappear.
Orabase Protective Gel:
Protects the ulcer from further abrasion by sticking to mucosal surfaces.
Does not provide pain relief.
Hydrocortisone Muco-adhesive Buccal Tablet (e.g., Corlan Pellets):
Reduces inflammation and pain locally on the ulcer.
Can help shorten healing time (evidence is weak).
Used by adults and children over 12. One tablet four times a day, dissolve on the ulcer, don’t suck.
Q: What are the causes, signs, symptoms, and treatment options for warts and verrucas?
A:
Causes:
Warts: Small, rough growths caused by the infection of skin cells with certain strains of the human papillomavirus (HPV).
Verrucas (Plantar Warts): Warts on the sole of the foot caused by HPV.
Signs and Symptoms:
Warts: Can appear anywhere, most common on hands and feet, and are more frequent in children (12-16 years old).
Appear as raised, fleshy lesions with a rough surface, often resembling a cauliflower.
Verrucas: Found on weight-bearing areas like the sole and heel, may cause pain when walking due to pressure.
Referral Symptoms:
Changed appearance (size, color)
Bleeding, itching
Genital warts, facial warts
Immunocompromised patients
OTC Treatments:
Active treatment: Lesions typically disappear with sufficient immunity (6 months to 2 years).
Acids (e.g., salicylic acid)
Cryotherapy (freezing treatments)
Q: What general advice should be given to patients regarding the treatment of warts and verrucas?
A:
Correct Use: Many OTC treatments are available, but it’s crucial to apply them correctly to break down hard skin and prevent damage to healthy surrounding skin.
Consistency: Continuous application of the treatment for several weeks or months is often needed for any significant benefit, so it’s important to explain this to the patient.
Contraindications: OTC wart treatments cannot be used on:
The face or skinfolds (e.g., groin, axillae).
Moles, birthmarks, lesions with red edges, or unusual colors.
Open wounds, irritated, reddened skin, or areas that seem infected.
Q: What are the OTC treatment options for warts and verrucas, and how do they work?
A:
Acid Treatments (e.g., salicylic acid, lactic acid):
Mechanism: Softens and destroys the lesion by chemically burning, which helps in mechanically removing the affected tissue.
Forms: Gels, paints, plasters.
Application: Apply once a day, usually at night, after soaking the affected area in warm water for 5–10 minutes.
Risks: Can cause chemical burns and irritation to healthy skin. Use petroleum jelly around the lesion to protect healthy skin.
Cryotherapy (e.g., Dimethyl ether propane):
Mechanism: Freezes the wart, effectively killing the infected tissue.
Application: Available for home use for adults and children over 4.
Risks: Less effective at home compared to doctor-administered liquid nitrogen, and not recommended for people with diabetes or pregnant women.
Q: What are the causes, signs, symptoms, and treatment options for conjunctivitis?
A:
Causes:
Viral Conjunctivitis: The most common cause, often linked to viral respiratory infections.
Bacterial Conjunctivitis: Causes sticky and purulent discharge.
Allergic Conjunctivitis: Seasonal, associated with allergic rhinitis.
Signs and Symptoms:
Redness or ‘pinkness’ of the eye.
Gritty sensation in the eye.
Discharge:
Sticky (purulent) = bacterial infection.
Watery = viral infection.
Initial symptoms in one eye, which may spread to the other.
Referral Symptoms:
Clouding of the cornea.
Associated vomiting.
Possible foreign body in the eye.
Irregular pupil shape.
Photophobia (light sensitivity).
Eye pain.
Changes in vision.
For bacterial conjunctivitis: No improvement within 48 hours of treatment.
OTC Treatment:
Viral Conjunctivitis: No specific OTC treatment, but symptoms can be eased by bathing eyelids to remove discharge and using lubricant eye drops.
Bacterial Conjunctivitis: Chloramphenicol eye drops.
Allergic Conjunctivitis: Antihistamines, sodium cromoglicate.
Q: What are the general hygiene measures and advice for managing infective conjunctivitis?
A:
General Advice for Infective Conjunctivitis:
Highly Contagious: Both viral and bacterial conjunctivitis are contagious.
Infectious Period: A patient remains infectious until redness and weeping resolve, usually within 10-12 days.
Self-help and Hygiene Measures:
Bathe the eyelids with lukewarm water to remove any discharge.
Use tissues to wipe eyes, and discard them immediately.
Wash hands regularly and avoid sharing towels and pillows.
Avoid wearing contact lenses until the infection clears up.
Discard old lenses and use new ones after the infection has resolved.
Q: How should chloramphenicol be used for treating bacterial conjunctivitis?
A:
Chloramphenicol (available as drops or ointment):
Licensed for use: Children older than 2 years.
Drops:
First 48 hours: 1 drop every 2 hours.
After 48 hours: Reduce to 4 times a day for up to 5 days of treatment.
Ointment: Apply 3-4 times a day.
Suitability: Suitable for most patient groups, but always check the license.
Pregnancy: Not recommended; hygiene measures should be followed.
Breastfeeding: Only if absolutely necessary.
Q: What are the main causes, symptoms, and OTC treatments for head lice?
A:
Causes:
Most prevalent in children aged 4-11 years, especially girls and those with long hair.
Transmitted only through head-to-head contact.
Lice reproduce by laying eggs (nits) at the base of hair shafts, which hatch after 7-10 days.
Symptoms:
Live lice observed (diagnostic).
Wet combing to detect lice.
Scalp itching.
Eggshells (cream/white-colored) attached to hair, though these alone do not indicate active infection.
Referral Symptoms:
Psoriasis or secondary infections.
Symptoms without live lice.
OTC Treatments:
Wet combing.
Insecticides:
Physical: Mechanical methods like combing.
Chemical: Insecticide treatments to kill lice.
Q: What are the general guidelines for detecting and treating head lice?
A:
Detection:
Detection combing is the most reliable method to confirm live lice presence.
Use a fine-toothed comb (0.2-0.3 mm apart) on wet or dry hair to detect lice.
Only treat if live lice are found. Treat all affected household members on the same day.
Treatment:
Treatments are most effective when done correctly and on the same day.
Children can still attend school while being treated.
Additional Advice:
No need to treat clothing or bedding that has come into contact with lice, as lice live only 1-2 days once detached.
Essential oil and herbal treatments are not recommended due to lack of evidence.
It’s not possible to prevent lice infestations, but primary school children should be examined regularly at home with a detection comb.
Q: What is the general advice for managing colic in infants?
A:
Feeding Technique Review:
Underfeeding can lead to excessive sucking and air swallowing, which may cause colic-like symptoms.
If bottle feeding, ensure the teat size is appropriate.
Reassure Parents:
Colic is not their fault and the baby will grow out of it eventually.
Parental Wellbeing:
Check on the wellbeing of parents and ensure they have a good support network.
Signposting for Support:
Refer to a health visitor or Cry-sis (Support for Crying and Sleepless Babies) for further guidance and support.
Q: What are the OTC treatments for head lice?
A:
Wet Combing:
Inexpensive, reusable kits.
Time-consuming and less effective than other treatments.
Use a fine-toothed detection comb.
Apply conditioner, comb the hair from roots to ends.
Comb the hair again after finishing.
Perform wet combing on days 1, 5, 9, and 13 to catch newly hatched lice.
Physical Insecticides:
Dimeticone (Hedrin) and Isopropyl myristate & cyclomethicone (Full Marks).
First-line treatment due to few adverse effects and no resistance.
Dimeticone disrupts lice by causing their gut to rupture.
Hedrin (6 months+), Full Marks (2 years+).
Chemical Insecticides:
Malathion is second-line, available as alcoholic or aqueous lotions.
Permethrin is less recommended due to high resistance rates in the UK and short contact time.
Alcohol-based malathion should be avoided for asthma or eczema patients.
Q: What are the causes, signs, and symptoms of colic, and what are the OTC treatments?
A:
Causes:
Repeated episodes of excessive crying in an infant who is otherwise healthy.
The exact cause is unknown, but it is believed to be multifactorial.
Linked to GI disorders like spasmodic muscle contractions, potentially due to cow’s milk allergy, lactose intolerance, or insufficient lactobacilli.
Affects between 1 in 20 and 1 in 5 babies.
Signs & Symptoms:
Begins in the first weeks of life and usually resolves by 3-4 months.
Symptoms include excessive crying, facial flushing, drawing up of legs, clenching of fists, and arching of the back.
May experience difficulty passing wind or stools.
Attacks are more frequent in the early evening.
Referral Symptoms:
Baby not thriving.
Symptoms persist or worsen after 4 months.
Parents may need additional support.
OTC Treatment:
Simeticone: may help reduce gas and bloating.
Lactase: can help with lactose intolerance.
No strong evidence supports OTC treatments, but they may still be tried.
Q: What are the OTC treatments for colic and their considerations?
A:
Simeticone (e.g. Infacol):
Commonly used to treat infantile colic, but evidence of benefit is uncertain.
A 1-week trial of simeticone drops can be suggested if other strategies fail and the parents want to try treatment.
Pharmacologically inert with no side effects, drug interactions, or precautions. Safe for all infants.
Lactase Enzyme (e.g. Colief):
Some babies may struggle to digest lactose in milk, which could be a contributing factor to colic.
Colief Infant Drops break down lactose in the milk, making it easier to digest.
Evidence of benefit is uncertain, but it is pharmacologically inert with no side effects or drug interactions. Safe for all infants.
Q: What are the causes, symptoms, and OTC treatments for teething?
A:
Causes of Teething:
Teething occurs when deciduous teeth (milk teeth) emerge through the gums.
Typically begins around 6 months of age, though it can start earlier (before 4 months) or later (after 12 months).
A full set of milk teeth usually emerges by 2–3 years old.
Symptoms of Teething:
Pain, increased biting and chewing, drooling, gum-rubbing, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite, disturbed sleep, and mild fever (pyrexia).
Gum swelling, redness, and tenderness are often observed just before tooth eruption.
Referral Symptoms:
If the child becomes systemically unwell, is severely distressed, or has prolonged symptoms, seek urgent medical review.
OTC Treatment:
Teething Rings (non-pharmaceutical).
Ibuprofen/Paracetamol (for pain relief).
Lidocaine-containing products (for localized numbing).
NOT Recommended:
Oral salicylate gels (due to the risk of Reye’s syndrome).
Homeopathic gels/powders (lacking sufficient evidence).
Q: What general advice is recommended for teething infants?
A:
Teething and Oral Care:
Baby’s teeth should be brushed using a baby toothbrush once they appear.
The first dentist appointment should be at around 6 months of age.
Self-Care Measures for Symptom Relief:
Gentle gum rubbing with a clean finger.
Allow the infant to bite on a clean, cool object (such as a teething ring).
Cuddling and reassuring the child.
Wipe away excess saliva regularly to prevent facial rash.
OTC Medications (if self-care fails):
Paracetamol and/or ibuprofen can be used for symptom relief in infants three months or older, if other measures haven’t helped.
Q: What are the OTC treatments for teething?
A:
Analgesics (Paracetamol and Ibuprofen):
For infants 3 months or older if needed.
Give either paracetamol or ibuprofen alone.
If the child does not respond, check for adherence and appropriate dosing.
If appropriate doses still don’t work, consider alternating paracetamol and ibuprofen.
Be careful not to exceed the maximum doses of either drug in 24 hours.
Use sugar-free versions.
Lidocaine Gels (e.g., Anbesol, Calgel, Detinox Gel, Bonjela):
Third-line treatment option.
Apply a pea-sized amount to a clean fingertip and spread it gently on the sore gum area.
Repeat every 3 hours if necessary, but don’t exceed 6 doses in 24 hours.
No longer available as GSL; will now be P medicines.
