Pharmacy OTC Red Flags and Treatment

Acne - RED Flags <12 or first onset when 25> Inflammatory or nodular (>5 mm) OHS causation No/worse improvement after 6-12 weeks Psyche affected Rosacea (rosy cheeks) Acne TREAT - Non pharma Keep area clean BD & after exercise Use non-oily products AVOID picking on it Keep hair clean Healthy Diet Acne TREAT - Pharma Benzoyl Peroxide or Azoleic acid - OD @ night bc could redden skin - apply to the whole area - Full efect after few weeks Cold Sores - RED flags P ainful red eyes I nfant N ot healed in 14 days G enital sores U sing immunosuppressant meds rapid or widespread w/ fever and/or other ill Cold sores TREAT non pharma SELF LIMITING Cold sores TREAT pharma NO CURE Aciclovir - 5D @ first indication - reduces symptoms Famciclovir - 1500 mg tab @ FI Hydrocolloid patches - 24H per day Scabies RED flags <2, preggo or >65 or immunosuppressed Yellow weeping discharges itching >4 weeks after treatment Scabies TREAT non pharma USE SELF CARE CARD - treat all members whom you have had close physical contact & in the same household 1 / 10 -Wash everything & keeps items on airtight containers to suffocate the mites Scabies TREAT pharma USE SPECIAL LOTION accordance to the self care card - leave on for as long as indicated - cover the entire body - reapply to body if washed off e.g. hands Thrush RED flags 1st time Returns after 2 months or 3 x a year Vaginal discharge is frothy preggo or <16 or > 60 pain fever and/or unwell diabetes and/or immunosuppressed STI OTC failure Thrush TREAT non pharma Clean mouth if oral Wear loose clothing and keep skin clean Miconazole - 4 x Daily (QID) - After food - Hold gel in mouth for as long as possible b4 swallow - Continue for 7-14 days AFTER symptoms have cleared Thrush TREAT Pharma Nystatin - 1 ml QID - After food - can use in infants <6 months - can cause GI upset if excessive swallow - continue for 48 hours AFTER symptoms have disappeared <2 or Pregnant Live Lice after OTC Signs of infection Head Lice RED flags Wet combing Method - Wet hair & apply conditioner 2 / 10 Head Lice TREAT - non pharma - Comb w/ fine comb 3cm portions - wipe after eachstroke Head Lice TREAT pharma Shampoos Psoriasis RED flags Feel stressed about it Affects daily life Symptoms for the first time OTC failure Painful red rassh w/ fever Psoriasis TREAT non pharma Moisturise Soap free Be healthy Psoriasis TREAT pharma Strong strength corticosteriods - hydrocortisone - clobetasone - Dithranol - Coal tar - Salicyclic Acid Tinea RED flags Includes athletes foot. Rash starts to ooze weep rash does not get better w/ treatment losing hair yellow thick or crumbly nails other conditions Tinea TREAT non pharma Wash & dry well BD Wear loose fitting cotton & and change BD DONT SHARE Wash all clothing & bedding Use seperate towel for infested area Barefoot in bed Dry out shoes Tinea TREAT pharma Azoles (imidazole) - BD for 2 wks and after for another 2 wks Allylamines & tertf - as per box 3 / 10 Warts RED flags Anogenital warts Facial warts Diabetics Immunocompromised patient Bleeding or itching Changed in size or colour OTC treatment that has been unsuccessful following 3 months of treatment Wide spread Warts TREAT non pharma 1st Line - Salicyclic acid - Soak area in warm water - Apply a few drops daily - Apply vaseline around or cut hole in bandage - rub with pumice stone 2nd line - Glutaraldehyde (same as salicyclic acid) Home Cyro - 1 treatment can be repeatd in 15 days Eczema / Dermatitis RED flags <2 or >65 Systemic effects >1% BSA Changes in morphology Other conditions (Diabetes, COPD) Infection Long Duration Diarrhoea TREAT pharma Anti molitity Loperamide: 1st does usually 4mg, then 2mg after every motion (16 mg MAX) Atropine as per box Allegeric Dermatitis / Ezcema TREAT non pharma Avoid offending agents such as: - Drying agents (Hot showers) - Use of soap (Replace w/ substitute) 4 / 10 - Stress or Environment can cause this - REGULAR use of MOISTURiser Allegeric Dermatitis / Ezcema TREAT pharma Hydrocortisone & Clobetasone - 7 days max - BD - Stop once inflammation is under control - >2 - not on broken skin - Preggo safe - Use APPROPRIATE amount Acid Reflux RED flags LOOK FOR PEPTIC ULCER INSTANT HOSPITAL REFERAL <18 or >85 Experience Heartburn >1 a week Wakes them up @ night Worsening of symptoms Unexplainable weight loss Vomitting w/ blood or coffee grounds Bowel motions black & tarry or bloody Coughing and/or sore throat OTC Failure & escalation No clear trigger Acid Reflux TREAT Non pharma Triggers: Large meals -> reduce meal size Specific foods like spicy, fatty and/or alcohol -> minimise Eating too close to bedtime -> 2 hours before Smoking -> cessation GENTLE EXERCISE after meal Elevated sleeping (more pillows @ head Stress -> relaxation excerisises 5 / 10 For intermittent symptoms / 1st line Antacids - After or in between meals - MAX duration 2 Wks - Mg salts = diarrhoea Al salts = consta Na salts = retention - Rapid onset 1 to 3 Hrs Alginates - After meals - Forms raft to minimise reflux Acid Reflux TREAT pharma 2nd line or long-term management H2 Antagonists (acid secretion reducer) - Ranitidine & cimetidine - Slower onset Longer duration - 300 mg max per day - use when you can predict heartburn Proton Pump Inhibitors ( acid secretion reducer) - Omeprazole, Pantoprazole & Rabeprazole - same as H2 Diarrhoea RED Flags >14 days When cannot tolerate adequate fluid intake Severe Dehydration Blood or mucus in bowel motions REcurrent / Chronic diarrhoea TRAVELLERS >48 hours of vomitting (24 between 3-6) (12 between 6 months - 3) <6 months Diabetes etc Diarrhoea TREAT Non pharma Acute is self limiting Infectious rarely requires antibiotics Avoid meds to hold it in unless VBusy KEEP FLUIDS HIGH (Special formulations not soft drinks or sports drinks 6 / 10 Diarrhoea TREAT pharma Anti molitity Loperamide & atropine as per box Constipation RED Flags Not opening bowels Rectal Blood loss, tar stools or mucus Weight loss Fever Rectal Pain Anorexia, nausea, vomiting Family history of IBS <12 months >50 Drug induced: Opioids etc 1st Line: Exercise Fluid intake Respond to urges Stool to open bowels Contsipation TREAT non pharma Trial of increased fibre Bulk Forming Laxatives - increases stool volume - onset of 2 - 3 days - Flatulence and abdominal distension - Drink adequate amounts of fluid to avoid intestinal obstruction - Do not take before bedtime Constipation TREAT pharma Osmotic (Drink plenty of Water) - Saline - Usually an enema - Rapid onset - Not for maintainence - Sorbitol - 1 - 3 days onset - Care needed for diabetics - OK for mainatinence 7 / 10 - Macrogols - Same as sorbtiol Stool softeners - Coloxyl & glycerol suppository - 1 - 2 days onset - works like soap - Brown sugar + water for babies Stimulant Laxatives - Bisacodyl, senna, Piconsulfate - 15 minutes - 12 hours - Prone to misuse & prefered for drug induced Haemorrhoids RED flags Large Blood loss Fever No improvements after 7 days Increasing pain (especially when in motion) Stomach pain or vomitiing Haemorrhoids TREAT non pharma Treat underlying cause such as Constipation and straining Apply ice packs pat with damp paper don't wipe warm baths avoid sitting for long periods Haemorrhoids TREAT pharma EXTERNAL Creams containing - Corticosteroids (hydrocortisone) - Local anaesthetic (Lignocaine) - Astringents to sooth (Zinc oxide) INTERNAL Cream w/ applicator and suppositories - same as above 8 / 10 Cough RED flags >3 weeks blood in cough A dry cough persistent at night Breathlessness / Wheezing Pain in chest and or while breathing Regular reoccurence Overseas Travel OTC failure Chesty Coughs (Productive) TREAT non pharma if Acute , then SELF LIMITING Resolve in 3 weeks DONT SUPPRESS COUGH Chesty Coughs (Productive) TREAT pharma Expectorants: - Decreases viscosity thus expelling secretions Dry Cough (Unproductive Coughs) TREAT non pharma if Acute , then SELF LIMITING Resolve in 3 weeks SUPPRESS COUGH Dry Cough (Unproductive Coughs) TREAT pharma Suppresents - helps soothe Sore throat RED flags >2 weeks Difficulty in swallowing indigenous fever and tonsil hurts OTC failure Sore throat TREAT pharma Straight forward: Local Anaesthetics : Lignocaine and / benzocaine (medicated lozenges like Strepsils) Analgesics (Pain relief) (Paracetamol, Ibuprofen, aspririn) Anti bacterial Growth Anti inflammatory (Difflam or Logicin) Oral antihistamines - first line w/ no congestion - OD - rapid onset (30mins) 9 / 10 Allergic Rhinitis TREAT pharma Intranasal corticosteriods - Stabilises MAst cells - most effective for all symptoms - slow onset (24 - 48 hours) - Start b4 season 10 / 10