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348 Cards in this Set

  • Front
  • Back

What are the danger symptoms of dyspepsia?

Dysphagia


GI bleeding


Progressive unintentional weight loss


Persistent vomiting

Which medications can cause dyspepsia?

Corticosteroids


NSAIDs


Iron


Bisphosphonates

Why should antacids be taken after meals and at bedtime?

Longer retention in stomach


Symptoms usually occur then

What side effect is associated with magnesium salts?

Diarrhoea

What side effect is associated with aluminium salts?

Constipation

What is the maximum licensed single dose of OTC ranitidine?

75mg

What lifestyle advice will help symptoms of dyspepsia?

Weight loss


Smoking cessation


Avoidance of trigger foods

Who is eligible for treatment with Orlistat?

Adults >18 with a BMI >28

What is the goal of treatment with Orlistat?

Weight loss of 5-10% initially

Side effects of Orlistat?

Flatulance


Steatorrhoea


Sudden bowel movements

Which PPIs can be sold OTC? At what dose and for how long?

Omeprazole 10mg tablets, Max 4 weeks.


Esomeprazole 20mg tablets, Max 14 days.


>18 years ONLY.

What are the symptoms of GORD in Children?

Failure to thrive


Difficulty feeding


Recurrent vomiting


Abdominal pain


Irritability

Colic danger symptoms?

Failure to thrive


Post-natal depression of parents

What should you advise as treatment for colic?

Avoid pharmacy products - limited evidence. Lifestyle:


Dummy


Hold baby upright


One breast at a time


Mothers diet


Size of teat on bottle


Baby massage


Take a break


Avoid over stimulation

What are the danger symptoms of constipation?

New/worsening in adults without explanation


Blood in stools


Weight loss


Nausea/vomiting

Treatment options for constipation

1. Lifestyle advice - increase fluids & fibre, move more


2. Drug Treatment

When do bulk-forming laxatives begin to work?

Delayed - 48-72 hours

Mechanism of action of bulk forming laxatives?

Retain water in the gut, increasing faecal mass and stimulating peristalsis

When do osmotic laxatives begin to work?

Up to 48 hours.

How do osmotic laxatives work?

Increase the amount of water absorbed into the large bowel

How long does it take stimulant laxatives to work?

8-12 hours

Mechanism of action of stimulant laxatives?

Stimulate colonic nerves to increase intestinal motility

Which laxatives are preferred in pregnancy and breast feeding?

Bulk forming and osmotic - no absorption

Danger symptoms of diarrhoea?

Drowsiness or confusion


Lack of urine output


Dry mouth/tongue


Sunken eyes


Weakness


Cool hands or feet


Sunken fontanelle of baby head

When is loperamide a suitable treatment for diarrhoea?

> 12 years old


Absolutely necessary e.g work


Not routinely

What is the OTC dose of loperamide?

2 x 2mg caps after each loose stool. Max 8 caps/day.

After how many days of persistent diarrhoea should a patient be referred to their GP?

3 days

When should children be referred to the GP re: diarrhoea?

Babies <1yr if >24 h


Children <3 years old, if >48h


Or if >1 day diarrhoea AND vomiting

Can you supply advance treatment for travellers diarrhoea under the Minor Ailments Scheme?

No.

Which medicines are covered by the sick day rules?

ACE inhibitors


ARBs


Diuretics


Metformin


NSAIDs

What treatment options are there for IBS?

Constipation dominant - bulk forming laxatives


Diarrhoea dominant - loperamide


Antispasmodics - for abdominal pain (mebeverine, alverine, peppermint oil, hyoscine)

What are some treatment options for haemorrhoids?

Zinc oxide - to soothe


Local anaesthetics (lidocaine/benzocaine) for 3-4 days max


Topical steroids ( hydrocortisone) Max 7 days


Astringents (bismuth subgallate) form protective layer


Bulk forming laxatives - to reduce straining

How long does acute cough usually last?

2 weeks

What are the danger symptoms associated with cough?

Fever


Shortness of breath


Chest pain (not when coughing)


Haemoptysis - urgent referral


>21 days (GP referral)

What can a persistent nighttime cough in children indicate?

Asthma

Which medication family is associated with cough?

ACE inhibitors can cause a dry cough


Can change to an ARB, but the cough may take a couple of months to settle down

Which medication family is associated with cough?

ACE inhibitors can cause a dry cough


Can change to an ARB, but the cough may take a couple of months to settle down

What are the treatment options for cough?

Demulcents e.g simple linctus


Expectorants e.g ipecacuanha


Cough suppressants e.g dextromethorphan


Antihistamines e.g diphenhydramine

Which medication family is associated with cough?

ACE inhibitors can cause a dry cough


Can change to an ARB, but the cough may take a couple of months to settle down

What are the treatment options for cough?

Demulcents e.g simple linctus


Expectorants e.g ipecacuanha


Cough suppressants e.g dextromethorphan


Antihistamines e.g diphenhydramine

How does simple linctus work?

Soothing ingredients suppress the voluntary cough mechanism, reducing frequency of cough

Which medication family is associated with cough?

ACE inhibitors can cause a dry cough


Can change to an ARB, but the cough may take a couple of months to settle down

What are the treatment options for cough?

Demulcents e.g simple linctus


Expectorants e.g ipecacuanha


Cough suppressants e.g dextromethorphan


Antihistamines e.g diphenhydramine

How does simple linctus work?

Soothing ingredients suppress the voluntary cough mechanism, reducing frequency of cough

Which patients are NOT suitable for treatment with anti-tussives?

Children under 6 years - Risk of respiratory side effects


Adolescents 12-18 years with problems breathing


Breastfeeding mothers

Which medication family is associated with cough?

ACE inhibitors can cause a dry cough


Can change to an ARB, but the cough may take a couple of months to settle down

What are the treatment options for cough?

Demulcents e.g simple linctus


Expectorants e.g ipecacuanha


Cough suppressants e.g dextromethorphan


Antihistamines e.g diphenhydramine

How does simple linctus work?

Soothing ingredients suppress the voluntary cough mechanism, reducing frequency of cough

Which patients are NOT suitable for treatment with anti-tussives?

Children under 6 years - Risk of respiratory side effects


Adolescents 12-18 years with problems breathing


Breastfeeding mothers

Which anti-tussives are preferred and which aren’t?

Menthol & dextromethorphan preferred


Codeine and pholcodeine less preferred due to side effects such as constipation and dependence

Which medication family is associated with cough?

ACE inhibitors can cause a dry cough


Can change to an ARB, but the cough may take a couple of months to settle down

What are the treatment options for cough?

Demulcents e.g simple linctus


Expectorants e.g ipecacuanha


Cough suppressants e.g dextromethorphan


Antihistamines e.g diphenhydramine

How does simple linctus work?

Soothing ingredients suppress the voluntary cough mechanism, reducing frequency of cough

Which patients are NOT suitable for treatment with anti-tussives?

Children under 6 years - Risk of respiratory side effects


Adolescents 12-18 years with problems breathing


Breastfeeding mothers

Which anti-tussives are preferred and which aren’t?

Menthol & dextromethorphan preferred


Codeine and pholcodeine less preferred due to side effects such as constipation and dependence

What is the rule when prescribing for children with a cough?

Give only ONE cough or cold preparation at once to avoid overdose (duplication of ingredients)

What is croup?


How long does it last?


How do you treat it?

Croup is caused by the parainfluenza virus and causes a barking cough and thick mucus production.


Lasts ~10 days, worst in the first 3 days.


No treatment as it is viral. Can give paracetamol if fever. Lifestyle advice - sit upright, fluid intake.

What is croup?


How long does it last?


How do you treat it?

Croup is caused by the parainfluenza virus and causes a barking cough and thick mucus production.


Lasts ~10 days, worst in the first 3 days.


No treatment as it is viral. Can give paracetamol if fever. Lifestyle advice - sit upright, fluid intake.

When should a child with croup be urgently referred to a GP?

Intercostal recession


Tachypnoea


Agitated/pale child


Stridor

How long do cold symptoms usually last?

7-10 days, sometimes up to 3 weeks

How long do cold symptoms usually last?

7-10 days, sometimes up to 3 weeks

Do oral decongestants cause rebound congestion?

No

How long do cold symptoms usually last?

7-10 days, sometimes up to 3 weeks

Do oral decongestants cause rebound congestion?

No

Can decongestants be given to children?

Avoid in under 6’s


Max 5 days treatment in 6-12 year olds

Decongestants should be used with caution in patients with which conditions?

Diabetes


Hypertension


Hyperthyroidism


Raised intraocular pressure


BPH


Hepatic or rental impairment


Ischaemic heart disease

Decongestants should be used with caution in patients with which conditions?

Diabetes


Hypertension


Hyperthyroidism


Raised intraocular pressure


BPH


Hepatic or rental impairment


Ischaemic heart disease

Decongestants are contraindicated in patients taking which drugs?

Monoamine oxidase inhibitors


Risk of hypertensive crisis

What are the symptoms of hay fever - include both ocular and nasal symptoms.

Ocular - red, itchy, watery eyes


Nasal - seasonal sneezing, nasal itching, nasal blockage, watery nasal discharge


Other - cough, wheeze, SOB, tiredness, fever, pressure sensation in head, itchiness

What is the cellular mechanism behind hayfever?

IgE mediated type 1 hypersensitivity reaction

Which OTC anti histamines are sedating? Which are not?

Sedating - chlorphenamine, promethazine, diphenhydramine


Non-sedating - acrivastine, loratadine, cetirizine

Which OTC anti histamines are sedating? Which are not?

Sedating - chlorphenamine, promethazine, diphenhydramine


Non-sedating - acrivastine, loratadine, cetirizine

What is the best choice treatment for a patient with rhinitis as a dominant symptom of hay fever?

Intranasal corticosteroids


Must be used regularly to be effective (efficacy begins at 12 hours and maximal at 3 days)

Which OTC anti histamines are sedating? Which are not?

Sedating - chlorphenamine, promethazine, diphenhydramine


Non-sedating - acrivastine, loratadine, cetirizine

What is the best choice treatment for a patient with rhinitis as a dominant symptom of hay fever?

Intranasal corticosteroids


Must be used regularly to be effective (efficacy begins at 12 hours and maximal at 3 days)

How long can intranasal corticosteroids be used?

3 months

What is the maximum amount of OTC oral decongestants that can be sold to one customer?

One pack equivalent to 720mg decongestant

Which patients should you refer in regards to requests for pain relief?

Abuse of analgesics


Young children who have not responded


Patients with increasingly severe pain

Which patients should you refer in regards to requests for pain relief?

Abuse of analgesics


Young children who have not responded


Patients with increasingly severe pain

Which OTC medication should be avoided by haemophiliacs?

Aspirin

Which medications would indicate that paracetamol is the best choice analgesic?

Methotrexate


Oral anticoagulants


Diuretics


ACE inhibitors

What are 4 non-pharma measures for pain relief? In which cases are these appropriate?

Heat - muscular aches or period pain


Cold compresses - headaches or sprains


Massage - headaches or muscular pains


Exercise - period pain or osteoarthritis

What are the treatment options for teething?

Paracetamol 1st line (>3 months old) - ibuprofen can be used if >6 months


Teething gels - e.g. calgel


Herbal options to do with chamomile

How long should a patient wait after a strain or sprain to resume exercise?

1-2 weeks

What are the danger symptoms associated with strains and sprains?

Unexplained deformity


Limited limb movement


Swelling


Appreciable weakness not due to pain or fever


Chills


Malaise

What duration of back pain would merit referral?

4-6 weeks or longer

What are the red flag symptoms associated with back pain?

Pain following major trauma


New back pain in <20s and >50s


Weight loss


Past hx of malignancy


Associated bowel/bladder symptoms


Widespread/progressive leg weakness


Fever

What is the difference between a tension headache and a migraine?

Tension - bilateral, full ache with a tightening sensation across the forehead


Migraine - pulsating/throbbing headache, may present with aura. Typically unilateral. Can be accompanied by n&v, photosensitivity, phonophobia.

What are the symptoms of sinusitis?

Headache unilaterally behind and around the eye. Typically worse on bending forward. Affected sinus usually feels tender to touch.

What symptoms indicate a medication overuse headache?

Present on >15 days in a month


Worst on waking


Increases after physical exertion


Worse on discontinuing causative medication

Which medication can cause medication overuse headache?

Paracetamol


Co-codamol


Triptans

What are the danger symptoms of headache?

Sudden onset


Different/more severe than previous headaches


Recent head trauma/neck stiffness/altered level of consciousness/focal neurological symptoms/ blackouts


Severe and associated with fever or rash


Age <12 years

Which patients are suitable for OTC treatment with triptans?

Clear diagnosis of migraine


If migraine is unresponsive


Previous triptan use


Patient is age 18-65

Which analgesic should be avoided in migraine?

Codeine - not proven to help pain, emetic actions, reduces gastric motility further

What is the mechanism of action of the triptans?

5-HT1 agonists - work by stimulation of 5-HT1B and 5-HT1D receptors

What is the dose of OTC sumatriptan?

50mg as soon as possible after onset.


Another 50mg can be taken after 2 hours if there is only a partial response or the migraine recurs.


Max 100mg in 24 hours

What are the OTC treatment options for travel sickness?

Hyoscine - take 30 mins pre-journey (last 6-8h)


Antihistamines e.g cinnarizine or promethazine - take 2 hours before journey (last 8h)

What are some contraindications to triptan use?

Hypersensitivity to sulphonamides


Hypertension


Previous MI


Angina


Peripheral vascular disease


Arrhythmia


Hepatic/rental impairment


Epilepsy


Atypical migraine


Hx of stroke


MAOI therapy


Ergotamine therapy

What are some contraindications to triptan use?

Hypersensitivity to sulphonamides


Hypertension


Previous MI


Angina


Peripheral vascular disease


Arrhythmia


Hepatic/rental impairment


Epilepsy


Atypical migraine


Hx of stroke


MAOI therapy


Ergotamine therapy

In which conditions is hyoscine contraindicated?

Urinary flow problems


Glaucoma

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

Which type of herpes causes which type of infection?

Type 1 - oral - cold sores


Type 2 - genital

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

Which type of herpes causes which type of infection?

Type 1 - oral - cold sores


Type 2 - genital

What are the triggers for herpes reactivation?

Menstruation


Sunlight


Stress


Colds

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How long do cold sores last?

10-14 days

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

Which type of herpes causes which type of infection?

Type 1 - oral - cold sores


Type 2 - genital

What are the triggers for herpes reactivation?

Menstruation


Sunlight


Stress


Colds

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How long do cold sores last?

10-14 days

When is Aciclovir an appropriate treatment for cold sores?


Dose/duration?

If started when tingling prodromal phase brings.


Five times a day for five days.

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

Which type of herpes causes which type of infection?

Type 1 - oral - cold sores


Type 2 - genital

What are the triggers for herpes reactivation?

Menstruation


Sunlight


Stress


Colds

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How long do cold sores last?

10-14 days

When is Aciclovir an appropriate treatment for cold sores?


Dose/duration?

If started when tingling prodromal phase brings.


Five times a day for five days.

What are the prodromal symptoms of shingles?

Headache


Flu like symptoms


Localised throbbing pain/tenderness


Paraesthesia

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

Which type of herpes causes which type of infection?

Type 1 - oral - cold sores


Type 2 - genital

What are the triggers for herpes reactivation?

Menstruation


Sunlight


Stress


Colds

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How long do cold sores last?

10-14 days

When is Aciclovir an appropriate treatment for cold sores?


Dose/duration?

If started when tingling prodromal phase brings.


Five times a day for five days.

What are the prodromal symptoms of shingles?

Headache


Flu like symptoms


Localised throbbing pain/tenderness


Paraesthesia

When should a shingles patient be referred?

Immunocompromised


Rash approaching the eye


If for antiviral treatment (within 1 week of rash appearance)

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

Which type of herpes causes which type of infection?

Type 1 - oral - cold sores


Type 2 - genital

What are the triggers for herpes reactivation?

Menstruation


Sunlight


Stress


Colds

What is threadworm infection?

Small worms infect the upper part of the colon.


Infection only in humans NOT animals


Eggs laid around anus/vagina promoting itching and transference eggs

How long do cold sores last?

10-14 days

When is Aciclovir an appropriate treatment for cold sores?


Dose/duration?

If started when tingling prodromal phase brings.


Five times a day for five days.

What are the prodromal symptoms of shingles?

Headache


Flu like symptoms


Localised throbbing pain/tenderness


Paraesthesia

When should a shingles patient be referred?

Immunocompromised


Rash approaching the eye


If for antiviral treatment (within 1 week of rash appearance)

What is the dose of aciclovir for shingles?

800mg 5x daily for 7-10 days

How can you diagnose threadworm infection?

See worms around anus (commonly at night) or on faeces

How can you treat threadworm infection?

Hygiene measures for 6 weeks (life cycle of worm)


Drug therapy e.g. mebendazole

What is the dose of mebendazole? Which groups of patients are unsuitable for this treatment?

Single one-off dose, often repeated after 2-3 weeks.


Unsuitable for <2 year olds

What is the mechanism of action of mebendazole?

Inhibits glucose uptake of worms causing immobilisation and death

What are the treatments for head lice?

Insecticide applied 7 days apart and left on overnight.


- malathion


- permethrin


- dimeticone


Wet combing every 4 days until no lice seen on 3 consecutive sessions


What are the symptoms of scabies?

Itch (especially at night)


Rash - between fingers and toes, wrists, ankles, nipples, buttocks, genitals

How should scabies be treated?

Treat anyone who has been in close contact even if asymptomatic


Permethrin


Malathion if pregnant/breastfeeding


Apply and wash off after 8-12 hours. Repeat after one week.

Which type of herpes causes which type of infection?

Type 1 - oral - cold sores


Type 2 - genital

What are the triggers for herpes reactivation?

Menstruation


Sunlight


Stress


Colds

What are the symptoms of athletes foot?

Itching and scaling, usually between the toes


Macerated/soggy skin


Hyperkeratosis of the feet (drying and scaling)

What are the symptoms of athletes foot?

Itching and scaling, usually between the toes


Macerated/soggy skin


Hyperkeratosis of the feet (drying and scaling)

How should athletes foot be treated?

Imidazoles


Terbinafine


For at least 1 week after disappearance of infection

What are the symptoms of athletes foot?

Itching and scaling, usually between the toes


Macerated/soggy skin


Hyperkeratosis of the feet (drying and scaling)

How should athletes foot be treated?

Imidazoles


Terbinafine


For at least 1 week after disappearance of infection

Which treatments are suitable for pregnant or breastfeeding patients with athletes foot?

Clotrimazole


Miconazole

What are the symptoms of athletes foot?

Itching and scaling, usually between the toes


Macerated/soggy skin


Hyperkeratosis of the feet (drying and scaling)

How should athletes foot be treated?

Imidazoles


Terbinafine


For at least 1 week after disappearance of infection

Which treatments are suitable for pregnant or breastfeeding patients with athletes foot?

Clotrimazole


Miconazole

Which patients with a nail infection should be referred?

Diabetics


Immunosuppressed


Peripheral circulatory disorders

In which patients is Amorolofine lacquer a suitable treatment?


What is the dose?

>18 years old and No more than two nails


Apply once a week after filing of nail for 6 months (fingers) or 9 months (toes)

What is ringworm?


How can it be treated?

Fungal infection presenting as red scaly patches with a clearly defined darker edge.


Topical anti-fungals - imidazoles or terbinafine

Where does sweat rash usually present?

Under breasts


Groin


Armpits


Webs of hands

How can sweat rash be treated?

Imidazoles

Describe impetigo

Weeping, golden, crusting eruption with a red base.

What are the common symptoms of UTI?

Frequency and urgency


Burning, stabbing pain in urethra and perineum


Burning pain on passing urine


Traces of blood in the urine


Cloudy or malodorous urine


A sensation of incomplete emptying

What are the common symptoms of UTI?

Frequency and urgency


Burning, stabbing pain in urethra and perineum


Burning pain on passing urine


Traces of blood in the urine


Cloudy or malodorous urine


A sensation of incomplete emptying

Which UTI symptoms are seen as “red flag” symptoms and require urgent referral to the GP?

Pregnancy


Male patients and children


Fever


Back pain (flank)


Vomiting


Visible haematuria

What are the appropriate antibiotics and doses for UTI?

Trimethoprim 200mg bd for 3 days


Nitrofurantoin 50mg QDS for 3 days

For which patients are alkalinising products such as potassium citrate unsuitable for?

Patients with hyperkalaemia


Renal impairment


Cardiac impairment


Patients taking K+ sparing diuretics, ACE-I or ARBs

In which patients are medications with a high sodium content contraindicated?

Pregnant women


Hypertensives

Which antibiotic can’t be used with alkalinising agents? Why?

Nitrofurantoin, alkalinising agents reduce the amount of nitrofurantoin excreted in the urine therefore reducing the efficacy

What lifestyle advice is available for women with UTI?

Drink water normally - avoiding alcohol and coffee


Double urination (strain to pee)


Wipe from front to back


Pee after sex


Cotton underwear, avoid constrictive clothes


Hot water bottle to relieve discomfort


Cranberry juice can be used for prevention but not treatment

Which antibiotic can’t be used with alkalinising agents? Why?

Nitrofurantoin, alkalinising agents reduce the amount of nitrofurantoin excreted in the urine therefore reducing the efficacy

What lifestyle advice is available for women with UTI?

Drink water normally - avoiding alcohol and coffee


Double urination (strain to pee)


Wipe from front to back


Pee after sex


Cotton underwear, avoid constrictive clothes


Hot water bottle to relieve discomfort


Cranberry juice can be used for prevention but not treatment

What are the symptoms of vaginal thrush?

Vulval itching


Local redness


Discharge that is white, curd-like and odourless


Pain on intercourse


Pain on urinating

Which antibiotic can’t be used with alkalinising agents? Why?

Nitrofurantoin, alkalinising agents reduce the amount of nitrofurantoin excreted in the urine therefore reducing the efficacy

What lifestyle advice is available for women with UTI?

Drink water normally - avoiding alcohol and coffee


Double urination (strain to pee)


Wipe from front to back


Pee after sex


Cotton underwear, avoid constrictive clothes


Hot water bottle to relieve discomfort


Cranberry juice can be used for prevention but not treatment

What are the symptoms of vaginal thrush?

Vulval itching


Local redness


Discharge that is white, curd-like and odourless


Pain on intercourse


Pain on urinating

Which patients with vaginal thrush should be referred to the GP?

First time


<16 yrs or >60 years


Pregnant

Which antibiotic can’t be used with alkalinising agents? Why?

Nitrofurantoin, alkalinising agents reduce the amount of nitrofurantoin excreted in the urine therefore reducing the efficacy

What lifestyle advice is available for women with UTI?

Drink water normally - avoiding alcohol and coffee


Double urination (strain to pee)


Wipe from front to back


Pee after sex


Cotton underwear, avoid constrictive clothes


Hot water bottle to relieve discomfort


Cranberry juice can be used for prevention but not treatment

What are the symptoms of vaginal thrush?

Vulval itching


Local redness


Discharge that is white, curd-like and odourless


Pain on intercourse


Pain on urinating

Which patients with vaginal thrush should be referred to the GP?

First time


<16 yrs or >60 years


Pregnant

How can vaginal thrush be treated?

Imidazoles e.g clotrimazole


Usually pessary + external cream


Fluconazole 150mg STAT

What lifestyle advice can you offer for vaginal thrush?

Avoid tight fitting clothes


Cotton underwear


Avoid irritant products e.g vaginal deodorant/soap


Spermicides can precipitate

What can cause atrophic vaginitis?

Menopause


Hormonal contraceptives


Smoking cigarettes


Radiation


Chemo

What can cause atrophic vaginitis?

Menopause


Hormonal contraceptives


Smoking cigarettes


Radiation


Chemo

What are the symptoms of atrophic vaginitis?

Pain during sex


Discomfort


Itch


Urinary problems

What can cause atrophic vaginitis?

Menopause


Hormonal contraceptives


Smoking cigarettes


Radiation


Chemo

What are the symptoms of atrophic vaginitis?

Pain during sex


Discomfort


Itch


Urinary problems

What are the danger symptoms for atrophic vaginitis? What can this suggest?

Dry eyes and dry mouth too.


Can suggest Sjögren’s syndrome (autoimmune)

What OTC treatment options are there for atrophic vaginitis?

Vaginal moisturisers (non-hormonal) e.g. Replens MD


Water based lubricants e.g. KY Jelly

What is the difference between primary and secondary dysmennorhoea?

Primary - young girls, symptoms present from menarche


Secondary - implies underlying pathology as pain starts after some years e.g 30s

What unconventional agents can be used for pain relief in dysmennorhoea?

Anticholinergics - hyoscine and alverine (Alverine is licensed)


TENS


Vitamin E


Fish oils


Pyridoxine


Thiamine


Magnesium


Heat


Reducing alcohol consumption

What symptoms differentiate between allergic conjunctivitis and bacterial conjunctivitis?

Discharge - watery vs purulent


Itching - only allergic

In which patients should conjunctivitis be urgently referred?

Newborns (under 28 days)

In which patients should conjunctivitis be urgently referred?

Newborns (under 28 days)

What is the dosing of chloramphenicol drops for conjunctivitis?

Apply every 2 hours for 2 days and then 4 hourly. Minimum duration 5 days.


(Ointment 3-4 times daily)

In which patients should conjunctivitis be urgently referred?

Newborns (under 28 days)

What is the dosing of chloramphenicol drops for conjunctivitis?

Apply every 2 hours for 2 days and then 4 hourly. Minimum duration 5 days.


(Ointment 3-4 times daily)

Which patients are unsuitable for chloramphenicol eye drops?

Pregnant


Breastfeeding


Under 2 years

How long does sodium cromoglicate need to be used for to be effective?

14 days.


Must be used regularly up to 4 times a day

What lifestyle advice should be given to patients with conjunctivitis?

Avoid wearing contact lenses until infection cleared up


Hygiene measures


Cold compresses


Avoid triggers if allergic conjunctivitis

What lifestyle advice should be given to patients with conjunctivitis?

Avoid wearing contact lenses until infection cleared up


Hygiene measures


Cold compresses


Avoid triggers if allergic conjunctivitis

Which ingredient in eye drops makes them unsuitable for contact lens wearers?

Benzalkonium chloride

What lifestyle advice should be given to patients with conjunctivitis?

Avoid wearing contact lenses until infection cleared up


Hygiene measures


Cold compresses


Avoid triggers if allergic conjunctivitis

Which ingredient in eye drops makes them unsuitable for contact lens wearers?

Benzalkonium chloride

What are the symptoms of dry eye?

Both eyes


Irritation/gritty ness


Transient blurring of vision


Excessive tearing

When should hypromellose be applied, and when should eye ointments be applied?

Hypromellose - prn throughout the day


Ointments - at night

How should blepharitis be treated?

Clean with boiled and cooked water and cotton wool. 2-3 minutes at a time. (Remove crusts)

What are the symptoms of otitis externa?

Itchy ears


Dullness of hearing


Ear discharge


Ear pain

What can cause otitis externa?

Irritants (e.g soap/water)


Infection


Allergy

What are the symptoms of otitis media?

Severe ear pain


Maybe Fever/nausea/vomiting


In children - tugging at ear, crying, irritability


May be preceded by URTI symptoms

What are the symptoms of otitis media?

Severe ear pain


Maybe Fever/nausea/vomiting


In children - tugging at ear, crying, irritability


May be preceded by URTI symptoms

What is the treatment for otitis media?

None - most (80%) clear up within 3 days

What are the symptoms of otitis media?

Severe ear pain


Maybe Fever/nausea/vomiting


In children - tugging at ear, crying, irritability


May be preceded by URTI symptoms

What is the treatment for otitis media?

None - most (80%) clear up within 3 days

When should you refer patients with otitis media?

Severe symptoms


Unresolved symptoms after 3 days

Which ear drops can be used to soften wax?

Urea-hydrogen peroxide


Warm water


NaCl 0.9%


Sodium bicarbonate


Olive oils

Which ear drops can be used to soften wax?

Urea-hydrogen peroxide


Warm water


NaCl 0.9%


Sodium bicarbonate


Olive oils

How should you advise patients to apply softening ear drops?

Apply generously


Lie on side with affected ear upwards for 5-10 mins

When should patients with mouth ulcers be referred?

Last > 3 weeks


Very painful/swollen/red

When should patients with mouth ulcers be referred?

Last > 3 weeks


Very painful/swollen/red

Which drugs can cause mouth ulcers?

NSAIDs


Nicorandil


Sodium laurel sulphate


Oral NRT

What are the treatment options for oral ulcers?

Topical steroids - hydrocortisone mucoadhesive QDS


Benzydamine mouthwash or spray (May sting)


Choline salicylate gel - apply 3 hourly max 6X day *ONLY >16*


Chlorhexidine mouthwash


Aloclair

Which drugs can cause dry mouth?

TCAs


Antihistamines


Antimuscarinics


Diuretics

Which drugs can cause oral thrush?

ICS


Cytotoxics


Broad spectrum antibacterials

What should a patient on warfarin receive for oral thrush?

Nystatin


AVOID MICONAZOLE

What can treat axial cheilitis?

Clotrimazole 1% cream

What are the danger symptoms of sore throat?

High temperature if systemically unwell


Breathing difficulties


Inability to swallow

What are the danger symptoms of sore throat?

High temperature


Breathing difficulties


Inability to swallow

Which drug carries a warning about sore throats in the BNF?

Carbimazole - refer urgently as may be neutropenic

Which drugs can reduce tear production?

Diuretics


Oestrogen


Beta blockers


Antimuscarinics

What are some eczema triggers?

Soap


Extremes of temperature


Stress


Hormonal changes


Inhaled allergens

What are some treatment options for eczema?

Emollients - frequently/daily


Mild steroid e.g. hydrocortisone 1% OD or BD max 1 week OR clobetasone butyrate 0.05% “

What are some treatment options for eczema?

Emollients - frequently/daily


Mild steroid e.g. hydrocortisone 1% OD or BD max 1 week OR clobetasone butyrate 0.05% “

Who is not suitable for treatment with OTC steroids for eczema?

Pregnant


Facial use


Anogenital use

What steroid use is associated with skin thinning?

Potent steroids for >4 weeks

What steroid use is associated with skin thinning?

Potent steroids for >4 weeks

Which conditions may be worsened by topical steroids?

Acne


Rosacea

What steroid use is associated with skin thinning?

Potent steroids for >4 weeks

Which conditions may be worsened by topical steroids?

Acne


Rosacea

How long should be left been applying steroids and emollients?

30 minutes

What type of allergy is contact dermatitis?

A type IV hypersensitivity

What type of allergy is contact dermatitis?

A type IV hypersensitivity

Over what age are patients with contact dermatitis suitable for treatment with steroids?

10 years

What are the treatment options for seborrhoeic dermatitis?

Ketoconazole shampoo (apply no more than once every 3 days)


Selenium sulphide


Pyrithione zinc shampoos (daily/every other day)


Tar shampoos (once or twice weekly)


For babies - olive oil to soften the plaques/dentinox

Which drugs are believed to trigger psoriasis?

Beta blockers


NSAIDs


Lithium salts


Chloroquine

Can psoriasis be treated under the minor ailments scheme?

Yes

Can psoriasis be treated under the minor ailments scheme?

Yes

What are the treatment options for psoriasis?

Emollients


Tar based preparations


Keratolytics e.g. salicylic acid


Dithranol - avoid contact with healthy skin


Calcipotriol - POM

Can psoriasis be treated under the minor ailments scheme?

Yes

What are the treatment options for psoriasis?

Emollients


Tar based preparations


Keratolytics e.g. salicylic acid


Dithranol - avoid contact with healthy skin


Calcipotriol - POM

How should topical treatments be used during flares/remission of psoriasis?

Flares - emollient


Stable - all other treatments aimed at inducing remission

What are the referral criteria for urticaria?

>6 weeks (routine)


Angioedema (999)

What are the referral criteria for urticaria?

>6 weeks (routine)


Angioedema (999)

What drugs can be used to treat urticaria?

Oral antihistamines


Calamine lotion



AVOID steroids

What are the referral criteria for urticaria?

>6 weeks (routine)


Angioedema (999)

What drugs can be used to treat urticaria?

Oral antihistamines


Calamine lotion



AVOID steroids

Which drugs may aggravate urticaria?

Codeine


Aspirin

Can genital warts be treated OTC?

No

What is hand foot and mouth disease?

Lesions on these sites - small blisters surrounded by a red ring


Caused by Coxsackie virus


Resolves within 1-2 weeks


Infectious

How long should Bazuka be used before an alternative treatment is sought?

3 months

Which patients are not suitable for treatment with salicylic acid?

Peripheral vascular disease


Diabetes

What are the treatment options for nappy rash?

Barrier creams e.g. conotrane/sudocrem


Imidazoles - 2-3X daily for 7-10 days after rash cleared

How can rosacea be differentiated from acne?

Butterfly pattern


Over 30 years old


No whiteheads/blackheads

What are the treatment options for acne?

Benzoyl peroxide (bleaching effect)


Nicotinamide gel (limited evidence)


Tea tree oil

What is the treatment for a burn?

Immerse in water for 20-30 mins


Dressings - alginate, paraffin gauze, clear film


Warm, moist environment

What is the treatment for a burn?

Immerse in water for 20-30 mins


Dressings - alginate, paraffin gauze, clear film


Warm, moist environment

Which burns should be urgently referred?

Bigger than patients hand


Face


Deep


Heavily blistered


Painful/painless(?)


Pale


Charred


SOB after chemical burn

What is the treatment for a burn?

Immerse in water for 20-30 mins


Dressings - alginate, paraffin gauze, clear film


Warm, moist environment

Which burns should be urgently referred?

Bigger than patients hand


Face


Deep


Heavily blistered


Painful/painless(?)


Pale


Charred


SOB after chemical burn

What are the referral criteria for sunburn?

Melanoma


Children/babies if severe

What symptoms can indicate cellulitis?

Reddened inflamed skin


Hot and painful


Spreading


Fever and vomiting


Usually on legs/arms

Treatment options for insect bites?

Antihistamines creams/tabs


Crotamiton cream


Topical steroids

In which situations is breastfeeding not advised?

Mothers using crack cocaine/high doses of benzos


HIV positive mothers


If taking drugs c/i in breastfeeding


Galactosemia

What age do you have to be to use OTC hydrocortisone?

Over 10 years