Clinical 02 - Basics of OTC Analgesics PDF

Clinical 2 B Painful OTC Conditions: The Basics of OTC Analgesia Sarah Hopkins [email protected]  OTC Pain Relief Aims ▪ To refresh knowledge of OTC pain relief ▪ Medications ▪ Doses ▪ Things to think about ▪ Assessment of pain ▪ Considerations  Common analgesics...

Clinical 2 B Painful OTC Conditions: The Basics of OTC Analgesia Sarah Hopkins [email protected]  OTC Pain Relief Aims ▪ To refresh knowledge of OTC pain relief ▪ Medications ▪ Doses ▪ Things to think about ▪ Assessment of pain ▪ Considerations  Common analgesics Paracetamol antifever ▪ Widely used effective analgesic and antipyretic ▪ Readily available in different formulations ▪ Legal classification can be GSL, P or POM depending on quantity – remember law lecture on legal classification - ▪ Can treat all age groups from 2 months old (but check the licensed indications!) ▪ Dangerous in overdose. Statutory warnings. X take other meds containing paracetamol ▪ Well tolerated with minimal side effects 74019 ▪ Dose may be weight dependent (including in adults)  Common analgesics Aspirin ▪ Widely available analgesic, antipyretic and anti-inflammatory medicine dswelling ▪ Long history – may have been used for over 3500 years! sing > > - antiplatelet ▪ Different doses for different indications 200mg, ▪ Many formulations available – consider which is most appropriate ▪ NOT to be used in children under 16 years of age – Reye’s Syndrome Warfarin ? ▪ Has interactions with some other medicines ~ ▪ Not suitable for some asthmatics or those with GI issues riskof Gl bleeding / ▪ Side effects nausea - worse getting  Common analgesics Ibuprofen ▪ Widely used effective analgesic, antipyretic and anti-inflammatory. - ▪ Readily available , 00 , 800m, groug 400ng ▪ Legal classification can be GSL, P or POM ▪ Can treat all age groups from 3 months old (check licensed indications) ▪ Different dosage forms available – consider which is appropriate ▪ Not suitable for some asthmatics or those with GI issues ▪ Has interactions with some other medicines ▪ Side effects gastric reflux ▪ Not for use in chickenpox - > worsen skin condition  Common analgesics Codeine and dihydrocodeine ▪ Stronger painkillers ▪ Only sold in combination with other medicines ▪ Side effects constipation nausea vomitting ▪ Drug interactions ▪ May only be sold for use for a maximum of 3 days ▪ Risk of addiction ▪ Extra caution needed when recommending these ▪ Packaging must state prominently: “Can cause addiction. For three days use only.” L max-duration 3 days :  Common Analgesics Repeat purchases ▪ Care with patients who wish to repeatedly purchase products containing codeine/dihydrocodeine ▪ Difficult conversations – Do you refuse to sell? ▪ Reasons? can't take more 3than days ▪ Justification? Not allowed by the law when themeds in prescription ▪ Ethical considerations provide ▪ Professional judgement  Common analgesics Topical preparations ▪ Topical NSAIDs ▪ Topical rubefacients ▪ Creams/Ointments/Patches ▪ Non-drug pain relief: ▪ Heat patch/Wheat bag/Hot water bottle totor ▪ Exercise e.g. yoga/stretching back injury (even in  Other combination products Other Combination Products ▪ Huge variety available ▪ Many different combinations ▪ Other analgesic ▪ Caffeine ▪ Decongestant ▪ Cough medicine ▪ All of these! ▪ Different formulations ▪ Risks and benefits?  Quiz – Case 1 Patient: ▪ Adult asking to purchase paracetamol for themself for occasional use ▪ No other medicines and has had them before ▪ 32 tablets ▪ Dose? ONE TWO tablets up to 4 times daily or ▪ Legal category? P medicine containing Paracetamol ▪ Advice? Do not take other  Quiz – Case 1 Patient: ▪ Dose: ONE or TWO tablets up to 4 times a day ▪ At least 4 hours between doses ▪ 32 is P medicine ▪ Not with any other paracetamol ▪ Care with combination products ▪ Do not exceed the stated dose  Quiz – Case 2 Customer: Please can I buy some ibuprofen? ▪ What do you need to know? ▪ WWHAM ▪ Customer's 5 year old daughter ▪ Has been generally unwell with a slight fever since last night ▪ Not tried anything yet but always use ibuprofen ▪ No regular medicines ▪ Advice?  Quiz – Case 2 Customer: Please can I buy some ibuprofen? ▪ Differential diagnosis? ▪ Check for red flags ▪ Likely viral ▪ Is ibuprofen appropriate? ▪ Yes ▪ Recommendation? ▪ Liquid formulation ▪ Be careful – different strengths available ▪ Confirm the dose with the parent  Assessment of Pain SOCRATES A useful assessment tool: ▪ Used in differential diagnosis of painful conditions ▪ Useful in history taking ▪ Provides a structure ▪ Can be applied to other situations but usually linked with pain. ▪ Can be built into an over the counter consultation or a prescribing event  Assessment of Pain SOCRATES ▪ Site ▪ Onset ▪ Character ▪ Radiation ▪ Associated Symptoms ▪ Timing ▪ Exacerbation ▪ Severity  Assessment of Pain L SOCRATES ▪ Site – Where is the pain, or the focus of the pain? Can you point to it? ▪ Onset – When did the pain start? Did something trigger it? Was it sudden or gradual? Did you do something ? ▪ Character – What does the pain feel like? Sharp, dull, burning, stabbing, crushing? Is it constant or intermittent? ▪ Radiation – Is the pain in one place or does it spread? Does it always radiate to the same place or in the same way?  Assessment of Pain SOCRATES ▪ Associated symptoms – eg numbness, tingling, swelling. For example: stomach pain – blood in stools, change of bowel habit. Sore throat – cough, difficulty swallowing. Any red flags? ▪ Time/duration – Has the pain changed over time? Has it got better or worse? ▪ Exacerbating or relieving factors – Does anything make the pain better or worse? Has the patient tried anything? ▪ Severity – How severe does the patient perceive the pain to be? Eg on a scale of 1-10 with 10 being the worst pain and 1 being the least.  Assessment of Pain SOCRATES ▪ Things to remember: ▪ This is a useful tool and framework ▪ Build into consultations but can ask additional questions if more information needed ▪ Does not replace WWHAM ▪ Look for red flags at each stage  OTC Pain Relief Have we met our aims? ▪ To refresh knowledge of OTC pain relief ▪ Medications ▪ Doses ▪ Things to think about ▪ Assessment of pain ▪ Considerations with all of these