OTC ailments 1

• These are study notes on common minor ailments treatable with over-the-counter medication.

Common Cold

• Caused by viral upper respiratory tract infections.
• Transmitted through infected droplets inhaled through the mouth or nose.
• Symptoms appear 2-3 days after infection and last 2-14 days, resolving in about 7 days.
• Symptoms include runny/blocked nose, cough, sore throat, aches, pains, and headache.
• Referral symptoms include wheezing/shortness of breath, pain on breathing/coughing, earache, blood-stained mucus, symptoms lasting 3 weeks or longer, neck stiffness, and chest pain.
• Treatment involves symptomatic relief with decongestants and demulcents.

Coughs

• Coughs are a reflex action due to infection, inflammation, or airway irritation.
• Productive/chesty coughs produce phlegm, while non-productive/dry coughs do not.
• Symptoms usually improve within a few days with or without treatment.
• Referral symptoms include cough lasting longer than 3 weeks, chest pain/pain on breathing, shortness of breath, coughing up blood, yellow/green/brown/offensive phlegm, and fever.
• Treatment includes expectorants, suppressants, and demulcents.

OTC Treatment for Common Respiratory Minor Ailments

Decongestants

• Used for nasal symptoms (e.g., pseudoephedrine, phenylephrine, oxymetazoline).
• Constrict dilated blood vessels in the nasal mucosa to improve drainage and airflow.
• The stimulatory action may cause sleep disturbances if taken at night.
• Available in oral and topical forms.
• Tablets are licensed for 12 years and older, liquids for 6 years and older, and nasal sprays/drops for 12 years and older.
• Rebound congestion can occur with topical application and use should be limited to a maximum of 7 days.

Expectorants

• Used for chesty coughs (e.g., guaifenesin, squill extract).
• They supposedly facilitate the expulsion of bronchial secretions, but evidence is lacking.
• BNF suggests a placebo effect is more likely, but they are inexpensive and may be offered to patients who feel the need to take something.
• Administered orally, liquids are licensed for 6 years and older.

Suppressants

• Also known as anti-tussives, used for dry coughs (e.g., codeine, dextromethorphan).
• They suppress the cough reflex.
• Avoid if phlegm clearance is needed.
• Codeine and opioid derivatives have side effects like constipation and dependence.
• Dextromethorphan and menthol suppress the cough reflex without adverse effects.
• Administered orally, liquids are licensed for 6 years and older.
• Opioid derivatives are not recommended for those 12-18 years old with breathing problems.

Analgesics

• Used for general pain relief (e.g., paracetamol, ibuprofen).
• Paracetamol has analgesic and antipyretic effects.
• The maximum adult dose is 1000mg four times in any 24-hour period.
• Ibuprofen has analgesic, anti-inflammatory, and antipyretic activities and causes less stomach irritation than aspirin.
• The adult dose for analgesic activity is 200-400 mg, and for anti-inflammatory action, 300-600 mg.

Local Anesthetics

• Used for sore throats (e.g., benzocaine, lidocaine).
• Should not be used if sensitivity reactions are suspected or for longer than five days.
• Administered topically.
• Throat spray is licensed for 12 years and older, while lozenges vary depending on active ingredients but usually 6 years and older.

Sore Throats

• Usually a symptom of an acute upper respiratory tract infection, either viral or bacterial.
• Symptoms generally improve within 7 days.
• Symptoms include pain in the back of the throat, swollen lymph glands, and pain upon swallowing.
• Referral symptoms include dysphagia, fever, duration longer than 14 days, hoarseness persisting for more than three weeks, skin rash, white spots/exudate/pus on the tonsils with high temperature and swollen glands, recurrent bouts of infection, failed treatment, and breathing difficulties.
• Treatment includes demulcents, analgesics, and local anesthetics.
• Antibiotics make little difference in outcome for bacterial infections, so treatment is unnecessary in most cases.

Demulcents

• Used for dry coughs or sore throats (e.g., glycerine, lemon & honey, simple linctus).
• They relieve irritation of the mucous membranes by forming a protective film.
• Do not contain any active ingredient.
• Considered safe in children and pregnant women and is now the recommended treatment for children under 6 years old.
• Available orally in paediatric and adult liquids, but lozenges should be avoided in young children due to choking hazard.

General Advice for Common Respiratory Minor Ailments

• Stop smoking and consider referring to a stop smoking service
• Practice hand hygiene with alcohol gels and effective hand washing to prevent transmission.
• Get a flu vaccine.

Dyspepsia

• Describes symptoms including upper abdominal discomfort/pain, heartburn, acid reflux, and nausea/vomiting related to eating.
• Includes non-ulcer dyspepsia, GORD, and peptic ulcer disease.
• Referral symptoms include gastrointestinal bleeding, dysphagia, progressive unintentional weight loss, persistent vomiting, severe pain, pain radiating to other areas, and failed treatment.
• Caused by reflux of gastric contents into the esophagus, causing irritation.
• Symptoms include burning pain in the stomach rising behind the breastbone, and acid taste in the mouth.
• Treatments include antacids, alginates, and proton pump inhibitors.
• General advice includes eating smaller, more frequent meals, raising the head of the bed, stopping smoking, losing weight, and avoiding trigger foods.

Antacids

• Includes calcium carbonate, magnesium and aluminum salts.
• Provide symptomatic relief when taken after meals and at bedtime.
• May impair absorption of other drugs and should not be taken at the same time.
• Combination products are less likely to cause gastrointestinal upset.
• Magnesium salts can cause diarrhea, while aluminum salts can cause constipation.

Alginates

• Includes sodium alginate and potassium alginate.
• Form a raft on the stomach contents, providing symptomatic relief of reflux and protecting esophageal mucosa.
• Use potassium-based alginates for patients on a restricted sodium diet.

Proton Pump Inhibitors (PPIs)

• Includes omeprazole and esomeprazole.
• Inhibit gastric acid secretion.
• Omeprazole is licensed for short-term relief of reflux in those 18 years and older and treatment should be a maximum of four weeks.
• Esomeprazole is licensed for those 18 years and older with treatment a maximum of 14 days.

Constipation

• Caused by poor fiber and fluid intake, and a sedentary lifestyle.
• Referral symptoms include blood in the stools, pain on defecation, abdominal pain/vomiting/bloating, unexplained weight loss, failed treatment, and change in bowel habits lasting more than 2 weeks.
• Symptoms include reduced frequency of defecation, straining, passage of small/hard stools, abdominal discomfort/cramps, and feeling of incomplete bowel emptying.
• Treatments include bulk forming, osmotic, stimulant, and stool softener laxatives.
• General advice includes drinking plenty of water, eating high fiber foods, and remaining physically active.

Laxatives

• Bulk Forming (e.g., ispaghula): Retains water in the gut, increasing fecal mass and stimulating peristalsis. Must be taken with adequate fluids. Liquids are licensed for 6 years and older.
• Osmotic (e.g., lactulose, macrogol): Increases water absorption into the large bowel. Lactulose is licensed for use in babies and macrogol is licensed from 2 years and older depending on the formulation.
• Stimulant (e.g., senna, bisacodyl): Stimulates colonic nerves to increase intestinal motility. Senna is licensed for 18 years and older as bisacodyl is licensed for 12 years and older.
• Stool Softener (e.g., docusate, glycerol): Reduces surface tension and increases penetration of intestinal fluids into the feces and glycerol is licensed for use in children.

Constipation in Special Patient Groups

• Children: Normally resolves without treatment. Offer fruit juice and refer to a GP if not resolved.
• Pregnancy and Breastfeeding: Bulk forming and osmotic laxatives are the safest options. Senna enters breast milk and may cause colic and diarrhea in the infant.

Diarrhea

• Caused by viral or bacterial infections or diseases of the GI tract .
• Referral Symptoms: Drowsiness or confusion, dehydration signs, blood/mucus in stools, persistent vomiting, duration longer than 3 days in adults, and recent travel abroad.
• Symptoms include increased frequency of bowel movements with abnormally soft or watery feces, abdominal cramps, flatulence, and weakness/malaise.
• Treatment basis is electrolyte and fluid replacement. Anti-diarrheal drugs may be useful in some adults and older children.
• General Advice: Drink plenty of fluids, eat as normally as possible, and wash hands after using the toilet or changing nappies.

Oral Rehydration Sachets

• Electrolyte and fluid replacement considered the standard treatment for acute diarrhea. Licensing varies based on preparation.

Anti-Motility Drugs

• Loperamide reduces diarrhea duration, improves symptoms, and increases stool consistency. Should only be used when symptom control is necessary.

Allergic Rhinitis

• An inflammatory response involving histamine release due to allergens on the nasal and respiratory tract mucosa.
• Allergens responsible for seasonal allergic rhinitis include grass/tree pollens and fungal mold spores, while dust mites commonly cause perennial allergic rhinitis.
• Associated with asthma and eczema.
• Referral symptoms include chest tightness, wheezing, shortness of breath, ear pain, sinus pain, and purulent conjunctivitis.
• Treatments include antihistamines, nasal corticosteroids, sodium cromoglicate, and decongestants.
• General advice includes avoiding allergens; keep car and house windows closed when pollen counts are high and clean the house regularly to keep dust levels low.

Antihistamines

• Non-sedating antihistamines (e.g., acrivastine, cetirizine, loratadine, fexofenadine) are effective in reducing sneezing and rhinorrhea.
• Azelastine is available as a nasal spray on prescription.

Intranasal Corticosteroids

• Treatment of choice for moderate-to-severe nasal symptoms that are continuous. Regular use is essential with effects taking several days to come into place.

Sodium Cromoglicate Eye Drops

• Highly effective for the treatment of eye symptoms. Should be used continuously with effects apparent within an hour.

Headaches

• Causes include stress/tension and migraine triggers (bright light, certain foods, missed meals, weather extremes, long-distance travel, loud noises, altered sleep pattern).
• Referral symptoms include headache associated with injury/trauma, fever/rash, severity, headache in children under 12 years, drowsiness/unsteadiness/visual disturbances/vomiting/altered level of consciousness, neck stiffness, and frequent/persistent headaches.
• Treatments include analgesics (simple, opioid-containing), sumatriptan, and doxylamine.
• Simple analgesics include paracetamol and ibuprofen, which can be taken in combination with opioid analgesics, useful in treating tension headaches.
• Sumatriptan can be used for acute migraine relief with a clear migraine diagnosis and Doxylamine an antihistamine with sedative and relaxing effects, useful in treating tension headaches.
• General advice includes checking for recent eye tests, stress relief techniques, physical exercise, and identifying and avoiding migraine trigger factors + meningitis.

Vaginal Thrush

• Symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection with candida yeast.
• Antibiotic use, childbearing age, pregnancy, and diabetes are predisposing factors.
• Referral symptoms include first-time occurrence, pregnancy/suspected pregnancy, more than two attacks in 6 months, previous STD history, partner with STD, age under 16 or over 60 years, abnormal vaginal bleeding, vulval/vaginal sores, and failed treatment.
• Treatments are oral fluconazole 150mg capsule, topical clotrimazole cream, and intravaginal clotrimazole pessary.
• General advice includes ensuring privacy, considering patient preference, and discussing device use.

Athletes Foot

• General advice includes good foot hygiene, wearing open shoes and alter shoes every 2-3 days
• Superficial fungal skin infection of the feet and toes. Characterized by itching, flaking, and fissuring of the skin, appears white and "soggy".
• Referral symptoms include signs of secondary infection, diabetes, treatment failure, and involvement of toenails.
• Treatment involves antifungal creams (e.g., clotrimazole, miconazole, terbinafine).
• Topical external creams should be continued at least one week after disappearance of all signs and symptoms plus there should be good boot hygeine.

Oral Thrush

• A fungal infection of the mucous membranes of the mouth, often a side effect of inhaled corticosteroids and other drugs plus diabetics suffering from oral candidiasis may need renew of their treatment to achieve tighter blood glucose control
• Referral symptoms include babies under 4 months, adults and older children without obvious cause, and recurrent/persistent thrush.
• Treatment involves miconazole 2% oral gel, applied to the plaques where Dentures should be removed before treatment
• General Advice: Inhaled corticosteroid users should rinse mouth/take a drink after using the inhaler + advice on denture hygeine.