Wk 15 OTC 2 2023 (SG) PDF

WEEK 14 OTC Medicines (2) Susan Gault Dale 121 [email protected] ttpoll.eu Session ID: OTC2 Slide 1 of 21 PHA113 MPharm WEEK 14 Learning Outcomes • Importance of keeping knowledge up to date • Recognising the causes, signs and symptoms of common minor ailments • Recognising whe...

WEEK 14 OTC Medicines (2) Susan Gault Dale 121 [email protected] ttpoll.eu Session ID: OTC2 Slide 1 of 21 PHA113 MPharm WEEK 14 Learning Outcomes • Importance of keeping knowledge up to date • Recognising the causes, signs and symptoms of common minor ailments • Recognising when to treat and when to refer • Recognising and understanding red flag symptoms • Common OTC products and doses 5 PHA113 MPharm WEEK 14 Common Minor Ailments 6 PHA113 MPharm WEEK 14 Allergic rhinitis Causes Signs and Symptoms • An inflammatory response involving the release of histamine, initiated by allergens being deposited on the nasal and respiratory tract mucosa. • • • • • • • • May also affect the eyes. • Allergens responsible for seasonal allergic rhinitis include grass/tree pollens and fungal mould spores. • Perennial allergic rhinitis occurs when symptoms are present all year Rhinorrhoea (runny nose) Nasal congestion Nasal itching Watery eyes Irritated eyes Discharge from the eyes Sneezing • Commonly caused by dust mites, animal dander and feathers. • Patients may suffer from a form of perennial rhinitis that becomes worse in the summer months • Allergic rhinitis is associated with asthma and eczema. 7 PHA113 MPharm WEEK 14 Allergic Rhinitis (cont.) Red flag/referral symptoms • • • • • • • 8 OTC Treatment Tightness of the chest Wheezing Shortness of breath Painful ear Painful sinuses Purulent conjunctivitis Severe symptoms only partially relieved by OTC preparations • • • • PHA113 Antihistamines Nasal corticosteroids Sodium cromoglicate Decongestants (short term) MPharm WEEK 14 General Advice for Allergic Rhinitis • Allergen avoidance is recommended but not always possible. • For seasonal allergic rhinitis (hay-fever): • Car windows and air vents should be kept closed while driving, to reduce amount of pollen/allergens entering the car. • House windows should be kept closed when the pollen count is high • For perennial allergic rhinitis: • Regular cleaning of the house to keep dust levels at a minimum 9 PHA113 MPharm WEEK 14 OTC Treatment for Allergic Rhinitis Antihistamines (Non-sedating: acrivastine, cetirizine, loratadine, fexofenadine) (Sedating: chlorphenamine) • First-line treatment for mild-tomoderate • Effective in reducing sneezing and rhinorrhoea • Usually given orally • Azelastine is available as a nasal spray on prescription 10 PHA113 MPharm WEEK 14 OTC Treatment for Allergic Rhinitis Intranasal Corticosteroids (e.g. Beclometasone, fluticasone, mometasone) • Treatment of choice for moderate-to-severe nasal symptoms that are continuous. • Acts to reduce inflammation that has occurred as a result of the allergen’s action. • Regular use is essential for full benefit to be obtained and treatment should be continued throughout the hay fever season. • Can take several days to be effective • Side-effects are rare • Licensing varies per product 11 PHA113 MPharm WEEK 14 OTC Treatment for Allergic Rhinitis Sodium Cromoglicate Eye Drops • Highly effective for the treatment of eye symptoms • Work within an hour • Should be used continuously to obtain full benefit. Decongestants • May be used short term to reduce nasal congestion alone or in combination with an antihistamine. • Can be useful in patients starting to use a preventer such as a nasal corticosteroid (see week 13 lecture notes for more info) 12 PHA113 MPharm WEEK 14 Headaches Causes Signs and Symptoms • Stress/tension • Migraine triggers • Tension Headache • Bilateral, dull ache with a pressing or tightening sensation across the forehead and/or base of skull • bright light • eating certain foods or missing meals • extremes of weather • long-distance travel • loud noises • altered sleep pattern • Migraine • Pulsating/throbbing headache • With or without aura/visual disturbances • Sinusitis • Usually unilateral behind and around the eye and is typically worse on bending forwards and sensitive to touch • Increased pressure in sinuses 14 PHA113 MPharm WEEK 14 Headaches (cont.) Red flag/referral symptoms OTC Treatment • Headache associated with injury/trauma • Headache associated with fever or rash • Severe headache for more than 4hrs • Headache in children under 12 years • Associated drowsiness, unsteadiness, visual disturbances, vomiting or altered level of consciousness • Neck stiffness • Frequent and persistent headaches • Sudden onset • Different or more severe than previous headaches 15 PHA113 • Analgesics • Simple • Opioid containing • Sumatriptan • Doxylamine MPharm WEEK 14 General Advice for Headaches • Has the patient had a recent eye test? • Eye strain can be a cause of headaches • Tension Headaches: • Reassurance and stress-relieving techniques are often useful in sufferers • Physical exercise can also help to alleviate symptoms, particularly as it is more common in sedentary lifestyles. • Migraines: • Avoidance of trigger factors • Keep a diary to help identify triggers • Meningitis should always be considered and ruled out when asked for advice on headache. Symptoms to watch out for are detailed under red flags • Refer if there is any doubt. 16 PHA113 MPharm WEEK 14 OTC Treatment for Headaches Simple Analgesics (e.g. paracetamol, ibuprofen) • Paracetamol has analgesic and antipyretic effects • Ibuprofen has analgesic, anti-inflammatory and antipyretic activities (see week 13 lecture notes for more info) Opioid Containing Analgesics (e.g. codeine, dihydrocodeine) • Only available OTC in combination with paracetamol or ibuprofen • Short term use only (max. 3 days), as can cause addiction • Not proven to help migraine pain 17 PHA113 MPharm WEEK 14 OTC Treatment for Headaches Sumatriptan • Can be used for acute relief of migraine with or without aura and where there is a ‘clear diagnosis of migraine’. • Should be taken as soon as possible after migraine onset Doxylamine • An antihistamine with sedative and relaxing effects • Useful in treating tension headaches. • Contained within Syndol • Used for the short term treatment of acute moderate pain, which is not relieved by paracetamol or ibuprofen alone. 18 PHA113 MPharm WEEK 14 Common Fungal Minor Ailments 20 PHA113 MPharm WEEK 14 21 Vaginal Thrush Causes Signs and Symptoms • Symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection with candida yeast. • Antibiotic use • Common in women of childbearing age, pregnancy and diabetes are strong predisposing factors. • Vulval itching • Local erythema • Vaginal discharge which is white, curd-like and odourless, • Dyspareunia (pain on intercourse) • Dysuria (pain during urination). PHA113 MPharm WEEK 14 Vaginal Thrush (cont.) Red flag/referral symptoms OTC Treatment • First time • Oral • Pregnancy or suspected pregnancy • More than two attacks in 6 months • Previous history of STD • Fluconazole 150mg capsule • Topical • Clotrimazole cream • Exposure to partner with STD • Intravaginal • Patient under 16 or over 60 years • Clotrimazole 500mg pessary • Abnormal or irregular vaginal bleeding • Clotrimazole 10% internal cream • Any bloodstaining of vaginal discharge • Vulval or vaginal sores/ulcers/blisters • Failed treatment 22 PHA113 MPharm WEEK 14 General Advice for Fungal Infections • Vaginal Thrush • Patients seeking advice about vaginal symptoms may be embarrassed, fearing that their conversation will be overheard. • It is therefore important to ensure privacy. • Consider patient preference when making a product recommendation • Patient may need counselled on the use of some products e.g. pessaries • Avoid nylon underwear and tights and using cotton underwear instead may help to prevent future attacks. • When washing only wash the external area and use unperfumed, mild soaps • When wiping after a bowel movement wipe from front to back • Treatment of male partners • Asymptomatic partners do not need to be treated • Those showing symptoms (e.g. an irritiating rash on the penis/glands) can be treated with clotrimazole cream for 7 days or a single fluconazole 150mg capsule 23 PHA113 MPharm WEEK 14 OTC Treatment for Fungal Infections Fluconazole 150mg Capsule • Treatment of vaginal thrush only • Often more convenient and has increased adherence • May take 12-24hrs for symptoms to improve • Age range: 16-60 yrs • Take ONE single capsule as a one off dose • Contraindicated in pregnancy and breastfeeding. • Also comes in combination packs • Capsule and cream 24 PHA113 MPharm WEEK 14 OTC Treatment for Fungal Infections Intravaginal Treatments (e.g. clotrimazole pessary or internal cream) Pessary: a small soluble block that is inserted into the vagina to treat infection or as a contraceptive. • Clotrimazole pessaries/internal creams are for treatment of vaginal thrush only • Single dose products • As effective as oral treatments • May give more immediate relief of symptoms such as itch and soreness • Also come in combination packs • With external cream 25 PHA113 MPharm WEEK 14 OTC Treatment for Fungal Infections Topical External Cream (e.g. clotrimazole) • The only antifungal cream licensed for vaginal thrush is clotrimazole • 1% and 2% strengths available but licensing varies • Used externally to reduce itch • Topical treatment with clotrimazole is considered to be safe for use in pregnancy and breastfeeding 26 PHA113 MPharm WEEK 14 28 PHA113 MPharm WEEK 14 Athlete’s Foot (Tinea Pedis) Causes Signs and Symptoms • Superficial fungal skin • Begins with scaling and infection of the feet and itching on one foot only toes. • usually between the fourth and fifth toes • Most common dermatophyte • Characterised by itching, infection flaking and fissuring of the skin • Appears white and “soggy” due to the maceration of the skin • Feet will often smell 29 PHA113 MPharm WEEK 14 Athlete’s Foot (Tinea Pedis) (cont.) Red flag/referral symptoms OTC Treatment • Signs of secondary infection • Antifungals • Weeping, pus or yellow crusts • Patient’s with diabetes • Treatment failure • Involvement of toenails 30 • Creams, powders, solutions, sprays and paints. • Creams are the most common treatment option • Powders and sprays may be used on shoes to help prevent re-infection PHA113 MPharm WEEK 14 General Advice for Fungal Infections • Athlete’s foot • Good foot hygiene such as washing daily and drying thoroughly • Especially between the toes • Wear open, non-occlusive shoes, alternating shoes every two to three days and changing socks every day will help to prevent recurrence of athlete’s foot. • Use protective footwear such as flip-flops or plastic shoes in communal changing areas or shower rooms. • Avoid scratching affected skin as this may spread infection to other sites • Hyperglycaemia (high blood sugar) predisposes diabetic patients to fungal infections • Patients with well-controlled diabetes may have less of a risk. 31 PHA113 MPharm WEEK 14 OTC Treatment for Fungal Infections Topical External Cream (e.g. clotrimazole, miconazole, terbinafine) • Multiple antifungal creams are available for the treatment of athlete’s foot • Treatment should be continued at least one week after disappearance of all signs and symptoms. • Some creams specify a different duration of treatment, always read the PIL 32 PHA113 MPharm WEEK 14 Oral Thrush Causes Signs and Symptoms • A fungal infection of the mucous membranes of the mouth • Side effect of inhaled corticosteroids and other drugs • Sore mouth and tongue • Burning tongue • Creamy white plaques on the tongue and inside of the cheeks • Plaques can be scrapped off to reveal raw red tissue beneath • Altered taste 33 PHA113 MPharm WEEK 14 Oral Thrush (cont.) Red flag/referral symptoms OTC Treatment • Babies under 4 months • Adults and older children without obvious cause • Recurrent/persistent thrush • If the symptoms have not cleared up within 1 week, patients should see their doctor. 34 PHA113 • Miconazole 2% oral gel MPharm WEEK 14 General Advice for Fungal Infections • Oral Thrush • Advice on denture hygiene may prevent re-infection. Dentures should be removed before treatment with miconazole gel. • Diabetics who are suffering from oral candidiasis may need review of their treatment to achieve tighter blood glucose control. • Patients who use inhaled corticosteroids should ensure they rinse their mouth out/take a drink after using their inhaler. 35 PHA113 MPharm WEEK 14 OTC Treatment for Fungal Infections Oral Gel (miconazole 2% oral gel) • an orange-flavoured product, which should be applied to the plaques using a clean finger • 6 yrs + : four times daily after eating • 4months – 6yrs : twice daily after eating • The gel should be retained in contact with the oral mucosa for as long as possible. • Treatment should be continued for 2 clear days, after the symptoms have apparently gone, to ensure that all infection is eradicated. • Not licensed for use in children under 4 months of age because of the risks of choking if it is not applied carefully. • Children under 4 months old should be referred to the GP for treatment with nystatin solution (POM) 36 PHA113 MPharm WEEK 14 37 Any Questions PHA113 MPharm WEEK 14 Follow Up Reading • Rutter, P. (2021) Community pharmacy : symptoms, diagnosis and treatment. Fifth edition. Amsterdam: Elsevier. (Available online from the library and as a hard copy) • • • • • Chapter 2: Pg 35-42 Chapter 5: Pg 97-109 Chapter 6: Pg 134-139 Chapter 7: Pg 168-171 Chapter 8: Pg 245-246 OR • Blenkinsopp, A., Duerden, M. and Blenkinsopp, J. (2023) Symptoms in the pharmacy : a guide to the management of common illnesses. Ninth edition. Hoboken, NJ: John Wiley & Sons Ltd. (Available from the library as a hard copy) • Read relevant chapters on topics covered in this lecture 38 PHA113 MPharm WEEK 14 Useful Resources • Common Clinical Conditions and Minor Ailments. NHS Education for Scotland. www.cppe.ac.uk [Accessed 04/10/2022] • Blenkinsopp, A, Duerden, M, & Blenkinsopp, J 2018, Symptoms in the Pharmacy : A Guide to the Management of Common Illnesses, John Wiley & Sons, Incorporated, Newark. Available from: ProQuest Ebook Central. [4 October 2022]. • Guidelines: summarising clinical guidelines for primary care 39 PHA113 MPharm