OTC Table

Lloydy and Rachelles
5-Minute OTC Consult for Trainee Pharmacists
Michael Lloyd and Rachelle Downie 2007 1

Foreword:
Hope this helps everyone. Ive intentionally avoided reviewing every treatment available for each condition and focused on the ones
with the most evidence and which are most commonly available seeming as though you only need to know two treatments for each in
the Board Exam. Please feel free to email me any additional information I could include in this table regarding either topics already
covered or else any additional ones.
Cheers,
Lloydy
lloydy_m@hotmail.com

DERMATOLOGY
Head Lice 5
Scabies 6
Eczema/Dermatitis 7
Psoriasis 8
Fungal skin infections (Athletes foot, tinea, jock itch) 8
Nail infection 9
Acne 10
Chickenpox 11
Warts 11
Corns/calluses 12
Dandruff 13
Sunscreen/Sunburn 13
Hair loss 14
Hydrocortisone Topical Cream 15
Shingles 15
German Measles (Rubella) 16
Measles 16
ORAL HEALTH
Cold Sores 17
Dry Mouth (Xerostomia) 18
Aphthous (mouth) ulcers 18
Gingivitis 19
Oral thrush 20
Toothache 20
Oral Hygiene 20
GASTROENTEROLOGY & GENITOURINARY

Haemorrhoids 21
Heartburn 22
Diarrhoea and Vomiting 22
Motion Sickness 23
Constipation 24
Irritable bowel 24
Threadworm 25
PAEDIATRICS
Teething 26
Febrile Convulsions/Fever in Children 26
Gastroenteritis & Dehydration 27
Colic 27
Nappy rash 28
Cradle Cap 29
EYE DISORDERS
Dry Eye Syndrome 30
Viral Conjunctivitis 31
Bacterial Conjunctivitis 31
Allergic Conjunctivitis 31
Stye 32
Chalazion 33
Contact Lens Care 33
Blepharitis 33
Red Eyes 34
Vasoconstrictor eye drops 36
Antihistamine eye drops 36
Ocular lubricants 36
EAR, NOSE & THROAT

Ear Ache 38
Ear Wax 38
Otitis Externa 39
Allergic rhinitis 39
Sore Throat 40
Intranasal Decongestants 41
Nasal corticosteroids 41
Nasal antihistamines 42
RESPIRATORY
Cough 43
Cold and Flu 45
Asthma inhalers 46
WOMENS HEALTH
Period pain (primary dysmenorrhoea) 47
PMS 48
Vaginal Thrush 48
Cystitis 49
PREGNANCY/BREASTFEEDING
Nutrition & General Health advice during Pregnancy 50
Back pain in pregnancy 51
Constipation 51
Reflux 51
Nocturnal muscle cramps in legs 52
Pruritis in Pregnancy 52
Morning Sickness 52
Breast & Nipple Thrush 53
Problems with lactation 53
Mastitis 54
PAIN
Musculoskeletal pain 54
Headache 55
Insect bites 55
Bruising 56
Tennis elbow 56
MISCELLANEOUS
Nicotine Replacement Therapy 57
Orlistat 59
Emergency Contraception 60
Travel Health 61
Sleep 63
Antihistamines 64
Patient Problem Treatment Children (ok in) Pregnancy Lactation Other

DERMATOLOGY
Head Lice **shampoos not as good as diluted by water to subtherapeutic conc. Not < 2 Preferred Safe Check and treat other
family members if
Itch (rash): back of scalp, neck Permethrin (Quellada lotion 1%, Pyrifoam liquid) infected.
and behind ears. Apply to clean, damp hair after washing towel drying. Leave in for 10 minutes, Clean sheets and
Eggs (nits): white specks stuck to rinse out and dry then comb with a fine tooth comb. clothes in hot water, sun
hair near the scalp Repeat in 7 days. dry).
Lice Repeat treatment 7 days
Maldison (Lice Rid lotion 0.5%, KP 24 lotion 0.5%) Not < 2 No No after.
Apply 20-40mL to dry hair, leave in overnight, wash out in the morning and comb Children can be sent
out dead lice back to school after first
1. Head lice present? treatment.
2. Used lice tx before? Did it Pyrethrin/piperonyl butoxide (Banlice) Not < 2 No No Itch may continue up to
work? Used properly? Apply to dry hair, leave in for 10 mins, wash out with normal shampoo, remove lice 1 week post eradication.
3. Under 2y.o? and eggs with fine tooth comb.
4. Pregnant or breastfeeding?
Wet combing preferred when < - - P (permethrin) for
5. Swollen glands,
pregnancy
weeping/crusty rash? Infectn? Apply conditioner to dry hair from tip to root. Comb with a fine tooth comb from 2
6. Tx head lice regularly? scalp to tip in sections. Clean comb with tissue and repeat each section 5 times. Avoid natural alternatives
7. Want to know more about head Repeat every 2 days until no head lice seen for 10 consecutive days in pregnancy as may
lice prevention? contain essential oils which
are contraindicated
Resistant Lice
Retreat with a different chemical treatment Or Wet Combing Self Care Card: Head
Lice
Scabies Shower and dry thoroughly. Apply to whole body starting from the neck down (include neck, face and scalp when treating children <2 Must reapply 7 days
and elderly). Allow to dry and put on clean clothing. Leave for at least 8 hours* and then clean off thoroughly. Repeat in 7 days. after 1st application!
Mite infestation.
Intense itching which is worse at Pay attention to skin folds, belly button and groin. Wash off thoroughly. Treat all family members
night. Scratching of the skin can and people with close
lead to changes in its If hands washed during treatment, should be reapplied. contact.
appearance.
*Increase contact time to 24 hours in treatment failure.
Commonly effects web space of Hot washing/drying of
the fingers and toes, wrists, clothing/bedding
armpits, buttocks and genital Permethrin 5% (Lyclear cream, Quellada Scabies Lotion) 30 mg tube Refer <2y.o. Preferred Preferred required (similar to head
area. Dose: 1-2 tubes for adults. (TG: >6 months) lice)
May cause rash around the tube for children 5-12. tube 1-5 years
midriff, underarms, inside of Treat neck, face Scabies treatments may
thighs and around ankles. and scalp actually CAUSE skin
irritation!
Flaking skin is infective to others.
May use an
Itching can continue for several Benzyl benzoate (Ascabiol 25%) Lotion diluted with an B2 No antihistamine to help
days/weeks after successful Apply with a new paint brush. equal quantity of relieve itch
treatment, i.e. not a sign of water for children
treatment failure. under 12 years of P (permethrin) for
age, and with 3 pregnancy
1. Confirm dx? parts of water for
2. HOPC other family babies Refer:
members affected? o babies and children
3.Check for burrows? small, o infected skin (weeping
raised bumps under skin, may yellow discharge)

appear as thread-like grey lines o treatment failure
4. Age refer children o unclear diagnosis
2. Symptoms; commonly affects

web space fingers, toes, writs,
armpits, buttocks, genital area Self Care Card:
5. Signs of infection Scabies
6. Medication

Eczema/Dermatitis Treatment Advice:
- avoid environmental or any precipitating irritants
Smx: 1.Emollients/Moisturisers/Bath oils & washes:
-red, scaly itchy rash - acute management & prevent relapse Non-drug management:
-degree of itch varies: day to day, - aqueous or sorbolene cream (QV, Dermaveen) or liquid paraffins (bath oils) * Wet Wrap Treatment
bw individuals, under stress, at - oatmeal bath oils & moisturisers also very soothing - soak towels in tepid water (or Burrows solution if area infected) to create
night, heat etc - apply after bath/shower (3 min window) a wet wrap treatment
- creams, washes safe to use in infants & applied to the face -applied after hydration (ie bath) & emollients/CSs applied leave on for
Cause: - FREQUENT application is important 15-60mins to enhance topical therapy abosorption
-depends on the TYPE of -reserved for SEVERE/recurrent cases
eczema being experienced Bath oils & washes
QV bath oil, Hamiltons, Dermaveen oil, Oilatum Bath oil *Other advice:
TYPES Bath: 10-15mins once a day qid when flare-ups occurs -avoid over-warm clothes or temperature in the home
*Exogenous contact with external -avoid using detergents aggrevate eczema
agents eg. allergic contact dermatitis, -identify & eliminate environmental irritants or allergens
Moisturisers
photoallergy dermatitis
Face & Body Dermeze, Hydraderm, QV cream, Dermaveen lotion - -?food link potential if so avoid
*Endogenous internal predisposition
eg. seborrhoeic dermatitis, atopic qid -routine moisturisation via humectants, occlusive moisturiers = mainstay of
eczema, varicose eczema preventative treatment
Humectants - glycerin, PEGs, urea, propylene glycol -AVOID SOAP!!
ATOPIC ECZEMA = typical - attract & retain water in the skin
eczema/dermatitis * Ecezma Referral:
- ?unknown cause Emollients: eg. soft paraffin, dimethicone, liquid paraffin, lanolin, vegetable oils - secondary bacterial infections Abx
- common in ectopic people - sooth roughened skin, reduce water loss, - patch testing for allergens
- Red, scaly eruption: - treatment of warts & molluscum contagiosum is difficult in eczema
*acute weeping, crusted Dermaveen Cleansing Bar: colloidal oatmeal - herpes simplex 000
*chronic thickened, dry & Dermaveen Shower & Bath Oil: colloidal oatmeal, paraffin oil - ? fungal infection
cracked (scratching can lead to Dermaveen Eczema Cream: colloidal oatmeal
lichenification In children common aggravating factors include:
QV Bar: Dimethicone -sand, dust
Sites vary with age: QV Bath Oil: Liquid Paraffin -rough clothes, abrasive surfaces like carpets
- Infants: face & nappy area QV Cream: WSP, Liquid Paraffin, Glycerol -calamine lotion
- Children: flexures of elbows, QV Skin Lotion: WSP, Glycerol -extremes in heat
knees, hands, feet
- Adults: flexures of elbows, Hamiltons Dry Skin Cream: Urea
knees, hands, feet and face Hamiltons Dry Skin Lotion: Liquid Paraffin, Glycerol
Hamiltons Oil: Liquid Paraffin
Creams & Ointments are MORE effective than lotions. Use lotion when eczema is
mild
2. Corticosteroids
- when moisturers dont provide enough relief
- use least potent to bring eczema under control
- strength, amt, frequency depends on age, area, disease extent
- Sigmacort 1% - face, body, groin, flexures
Directions:
- apply sparingly to the side affected
- avoid prolonged use due to risk of SEs
- may apply the less potent ones (eg. Sigmacort) bd
Psoriasis Moisturisers/Emollients - - - Refer cases of
Where scaling or irritation are prominent features, the soothing action of emollient suspected but
Well defined, red papules creams or ointments offer prompt relief. Best if applied after a shower. undiagnosed psoriasis.
coalescing to erythematous
plaques. Red plaques often Q.V. Moisturising Lotion, DermaDrate, Dermaveen, Cetaphil
covered by a silvery scale.
glycerol 10% in sorbolene cream Tar, dithranol and
Can occur anywhere on the body salicylic acid can be
but often appear on the extensor irritating on the skin and
areas such as the elbows, knees It is also beneficial to use soap substitutes such as QV Bath Oil as dry skin should not be used in
or the trunk or scalp, in the conditions often exacerbated by soaps and detergents. acute inflammatory
flexors (perianal, submammary or psoriasis, on the face or
axillary regions). Keratolytics Ok Ok Ok in the flexures.
Salicylic acid and sulphur are used to lift and soften thick scale in psoriases.
Commonly get pitting of the
fingernails. salicylic acid 2% to 10% in sorbolene cream, emulsifying ointment or white soft
paraffin
Coal Tar - - -
Tars are anti-inflammatory and antipruritic. Although considered first-line therapy,
use is limited by patient acceptability due to colour and smell.
LPC 2% to 10% cream or ointment topically, apply twice daily

Ddx: eczema, seborrhoeic
dermatitis, and tinea. Atopic salicylic acid 2-4% can be included in coal tar preparation
eczema occurs on the flexor
aspects of the limbs rather than Hydrocortisone (DermAid, Sigmacort) 0.5%, 1% >2 Ok Ok
the extensor aspects, as in Apply thin layer to affected area 2-4 times/day; reduce frequency as condition
psoriasis. improves.
Good for flare ups but prolonged use can cause skin atrophy
Avoid trauma (e.g. scratching,
sunburn), frequent use of soaps see TOPICAL CORTICOSTEROIDS
and detergents, and alcoholic
beverages. Dithranol Avoid Avoid Avoid
Aantiproliferative effect on psoriatic skin; useful in thick plaque psoriasis.
dithranol 0.1% to 2% with salicylic acid 2$ to 5% (to prevent oxidation of dithranol

and remove scale) in yellow soft paraffin, apply topically to lesions each day then
wash off 10-30 minutes later with lukewarm water
Fungal skin infections Continue treatment for 2

(Athletes foot, tinea, jock Clotrimazole (Canestan, Clonea) 1% cream - Ok Ok weeks after symptoms
itch) Miconazole (Daktarin) 2% cream, lotion, dusting powder resolve.
Apply 2-3 times a day until infection clears and for 2 weeks after. Fungus thrives in warm,
Creams preferred moist conditions good

personal hygiene is
Lotions for large/hairless areas - important:
Bifonazole (Canestan Once Daily, Mycospore) 1% cream B3: Avoid Ok *dry between toes
Powders on feet, groin (inside Apply once at night until infection clears and for 2 weeks after. *use a separate towel for
socks and shoes) infected area(s)
*wearing thongs in public
showers and change
- rooms
Terbinafine (Lamisil) 1% cream Ok Ok *change socks
Apply once a day for 1-2 weeks (preferably cotton) daily
*avoid tight, synthetic
* Athletes foot: 2-4 weeks shoes
* Jock itch: 1-2 weeks *dust shoes with
fungicidal powder
*does not require further course once symptoms relieved as do other topical antifungals as
fungicidal (faster acting) aids compliance
1. Symptoms? Itchy, Refer:
erythematous, flaky white skin, o diabetic patients
plaques o severe, treatment
Instructions:
2. Severity? Inflammation, resistant infection
- clean & dry affected areas thoroughly
weeping, puss, yellow crust o sx of bacterial infection
- apply to affected area and surrounding area apply a thin layer
(bacterial infection) o involvement of nails
- regular use is required for successful treatment
3. Previous treatment? - Smx should resolve within a few days
4. Diabetic,
- Tm shouldnt extend beyond 4 weeks
immunocompromised?
Self Care Card:
Tinea
Nail infection Amorolfine (Loceryl) nail lacquer No No No
Apply once or twice a week for 6 (finger nail) to 12 (toe nail) months.
Amorolfine is the only topical
antifungal which can penetrate 1. File down infected areas on an infected nail (dont use file on a healthy
the nail, i.e. Daktarin nail afterwards)
(miconazole) tincture is useless. 2. clean nail surface with a cleaning pad
3. dip spatula into lacquer
For more severe/resistant fungal 4. paint over the entire nail surface
nail infections refer to the Dr for 5. close bottle tightly
systemic oral treatment or 6. allow 3-5mins for nails to dry
removal of nail. 7. clean spatula and neck of bottle with same cleaning pad
- use: once or twice weekly
- continue until infected nails are completely cured and regrown
us takes about 6 months for fingernails and 9-12months for
toenails
- be careful not to let lacquer contact skin

Acne Refer young Ok Ok Gradual improvement
Benzoyl Peroxide (Benzac, Oxy, Panoxyl) 2.5,5,10% - antibacterial activity and is children over time with treatment,
Before applying, wash affected mildly comedolytic usually within 8-12
area with mild soap or soap weeks after beginning
substitute and warm water; gently Apply once or twice a day, begin treatment with lower strengths (2.5 or 5%) then therapy.
pat dry. change to 10% after 3-4 weeks if tolerated and acne resistant.
Wash hands after application. Do not squeeze or pick
the acne lesions
Counselling: (pimples).
Can cause skin irritation including reddening and soreness, especially at beginning of
treatment.
Acne is an androgenically Avoid wearing heavy oil
stimulated, inflammatory disorder Can bleach hair, clothing and bedding. Avoid contact with eyes, mouth and other mucous based makeup and
of the sebaceous glands caused membranes. clean makeup off
by increased sebum production, thoroughly each night.
abnormal follicular keratinisation Usually takes between 8-12 weeks of treatment to experience benefit.
and proliferation of Exercise regularly and
Propionibacterium acnes. Inactivates topical tretinoin; apply 12-24 hours apart. eat a healthy diet with
lots of fresh food and
water. This will improve
Triclosan face-wash solution (pHisoHex) - Ok Ok general health and be
reflected in the skin
Use as a face wash three times daily. condition.
How old?
How long have had acne for? Counselling: UV light can be helpful
Previous treatment? Successful? Wash hands thoroughly with pHisoHex. Wet face and apply enough pHisoHex into palm to acne usually gets better
How was previous treatment cover a 20 cent coin. Gently massage over the face, concentrating on problem areas and during summer
avoiding the eye area. Rinse and repeat. Rinse thoroughly and pat dry with a clean towel.
used?
Discontinue use if irritation develops.
Refer:
o severe acne
o failed medication
Azelaic acid (Finacea gel, Acnederm lotion) - B1 no Data o suspected drug-induced or
data lacking rosacea
Apply morning and night. o very young children or
older adults
Less irritating than benzoyl peroxide but may cause hypopigmentation, use with o occupational acne
o mild acne not responsive
caution in patients with dark complexions.
to treatment for 8 weeks
Self Care Card:

Acne

Chickenpox Paracetamol for fever. Pt infectious from 48
hours before
Crops of teardrop vesicles on Solugel (amorphous hydrogel) applied liberally to lesions provides a soothing appearance of rash until
erythematous bases. Starts with effect and accelerates healing place in fridge the all lesions have
small red lumps (papules) fluid crusted.
containing blisters (vesicles) Pinetarsol or Dermaveen bath products for bathing (emollient, antipruritic, and
rupture, forming crusted spots. anti-inflammatory). Take care not to slip when stepping out of bath. Incubation time (time
btwn contact and
Areas commonly affected: Phenergan(promethazine, 10-25 mg n for kids) or Vallergan(Trimeprazine) at night development of rash) is
Trunk, face and scalp. to avoid night time scratching. usually ~2 weeks.
Can occur on mucous
membranes. Kids can return to school
Keep child well hydrated even if doesnt want to eat (prodromal symptom). when lesions have
Keep skin cool, cold compresses to reduce itching. scabbed over, temp is
Prodromal symptoms: Cut childs nails short (scratching increases the risk of secondary bacterial normal and sense of
Fever, malaise, anorexia, infection and scaring). well-being returned.
headache Anti-itch creams (e.g. Paraderm, Eurax) may be useful.
Spread by respiratory
Symptomatic treatment (self AVOID calamine lotion as dries out skin causing further irritation and resultant droplets, direct contact
limiting, usually clears in 7-14 scaring when itched. with varicella vesicles.
days) and good hygiene to avoid
secondary infection. Self Care Card:
Chicken Pox
Warts Self-limiting infection

Human papilloma virus (HPV). usually disappear
Duofilm Gel (salicylic acid 27%) 1st line preferred Ok Ok spontaneously within 6
*Usually asymptomatic, i.e. no in children months to 2 years.
itch or pain (unless knocked or Duofilm (lactic acid, salicylic acid)
rubbed). Treatment may take up
*Appear mostly on hands, knees Wart-off stick (salicylic acid) to 3 months.
and elbows (feet)
*Discrete edge and have Using applicator, apply once at night. Allow to dry and cover with occlusive
raised/roughened, skin-coloured dressing. Continue until wart is completely removed
surface & raised
*Separate skin lines rather than
skin lines running over the top of
them.
*Warts supplied by a network of Pasafilin paint (podophyllum resin, salicylic acid) No No No DDx:
capillaries. When pared (e.g. with As above. Corns/calluses (See
pulmus stone) thrombosed, below)
blackened capillaries or bleeding
points appear.
*cauliflower appearance
*plantar warts usually not raised Wartner (dimethyl ether, propane) Avoid < 4 Avoid Avoid
& grow up into the foot Hold applicator to lesion for 20 secs; repeat every 15 days as necessary (max 3
times)

Preparing infected area for Tm:
Pre-soak affected area in warm
water for 5-10 mins to soften and Diswart (glutaraldehyde) will stain skin brown but will fade after treatment No No No
hydrate skin, then remove dead complete
skin from surface of wart by Apply twice a day.
gently rubbing with a pumice
stone. Refer:
- - - o diabetic pts
Protecting surrounding skin: o anogenital warts
Mask healthy, surrounding skin Alternative method: Easiest and least expensive. Cover wart with waterproof tape o non-responsive to Tx
with vasciline or nail varnish or a (e.g. duct tape) and leave on for 6 days, then soak, pare with pumice stone/emery o multiple and
bandaid with holes cut out. Apply board, leave overnight then reapply tape cyclically for 8 cycles widespread
treatments with applicator (not o lesions on the face
finger) o > 50 y.o.
o warts that change
1. Diabetes? Refer colour or shape
2. Age? Common in children o bleed/itch without
3. Appearance? Wart vs provocation
corn/callous
4. Location? Refer facial or
anogenital
5. Duration?
Corns/calluses Treatment should be aimed at relieving pressure can use circular corn pad or - - - Encourage pts to wear
other forms of padding to relieve friction and absorb pressure. open shoes such as
White or yellowish thongs and sandals.
hyperkeratinised/thickened areas
of skin which occur on pressure
areas such as the top of toes and Treated with keratolytics same as for warts if required. MUST address the
along the side of feet (i.e. over underlying issue to
bony prominences of the feet). E.g. Scholl corn pads/foam resolve the problem &
* Feet should be clean and dry prevent reoccurrence
Hard and circular-shaped with a * Remove medicated disc from backing and place adhesive surface of disc over
polished or central translucent corn and cover with pad
core. * Repeat treatment daily until corn removed
DDx from warts:

Do not have black dots/spots Caution/Precautions
but rather expose layers of white * DO NOT use for diabetics Refer to Dr
keratin when pared. * DO NOT use on broken or inflamed skin
* Check for any circulation problems before using Refer
Do not separate the skin lines on * Avoid use in <16yrs
the sole of the foot * If corn remains after 2 weeks seek medical advice

Dandruff note: no evidence for
coal tar shampoos in the
Hyperproliferative skin condition Ketoconazole (Nizoral 1%, 2%) Ok Ok ok treatment of dandruff
Apply to wet scalp, lather, then leave for 5 minutes; rinse thoroughly. Use twice a
Greyish-white flakes or scales on week until treated, then once every 1 or 2 weeks for prevention. Dandruff should improve
an itchy scalp. Visible dead cells within 1 2 weeks of
(flakes) can often be seen on the beginning treatment.
patients clothing.
Condition associated with the Zinc pyrithione (Head and Shoulders, Fongitar) Ok Ok Ok Shampooing on a daily
yeast Pityrosporum ovale. Apply to wet hair, lather, then leave for 5 minutes; rinse thoroughly. Use 2-3 times basis with a mild,
a week until treated then once a week for prophylaxis. hypoallergenic, non-
medicated shampoo helps
Treatments are either antifungal prevent dandruff. Ensure to
or cytostatic (reduces rate of cell *antifungal and cytostatic thoroughly wash out
turnover). shampoo.
Use a conditioner to
moisturise your scalp.
DDx:
seborrhoeic dermatitis (scales Selenium sulphide (Selsun Blue) >5 Ok; avoid Ok Avoid using hair gels and
other products that contain
are yellowish and greasy-looking Lather into wet hair for 5 mins, repeat and rinse thoroughly; initially twice weekly, 1st
alcohol, which tend to dry
and there is usually some then as necessary trimester out skin.
inflammation with reddening and
crusting of the affected area; *cytostatic: avoid if patient has inflamed or broken skin. May stain jewellery and
typically affects centre of face, alter the colour of hair dyes.
eyebrows, nasolabial folds and Refer:
midchest) treated same way as o treatment resistant
dandruff dandruff
o suspected psoriasis
psoriasis (scales are silvery-white o signs of infection
and associated with red, patchy
plaques and inflammation;
typically affects the knees and Self Care Card:
elbows, face rarely being Dandruff
affected)
contact dermatitis (use of new

hair products?)
Sunscreen/Sunburn
Application of sunscreen:
Prevention is better than - use an SPF 30+ broad-spectrum, water resistant sunscreen
treatment. - apply liberally to clean, dry skin 30 mins before going outside
- reapply sunscreen every 2 hours, more often if swimming or playing sport

SPF 30+ has greatest protection. Treatment of sunburn includes:
- systemic analgesia
- Solugel (propylene glycol, sodium chloride);
Slip on a shirt, slop on some Apply liberally prn. Store in fridge for extra relief on application.
sunscreen, slap on a hat and
slide on some sunnies. - SOOV Burn Spray (cetrimide, lignocaine, phenoxyethanol)
Hold the bottle 10 cm from the affected area and spray until skin is wet. Self Care Card:
For treating the face, spray onto fingers and then apply gently. Apply Sense in the Sun
up to four times daily.
Hair loss
Minoxidil (Rogaine) 20mg/mL, 50mg/mL >18 No No Response is best when
Male-pattern baldness many thin, miniature
(androgenic alopecia) is the most Apply 1 mL twice a day to area where hair regrowth/stabilisation is required. Apply hairs still remain before
common form of hair loss to clean, dry scalp and allow to dry naturally. Do not wash hair for 4 hours. starting treatment. No
presenting in pharmacy. benefit is seen where
there is no visible hair.
Thinning of the hair and a frontal Counselling:
receding hairline; often Continuous treatment is required to maintain response. Noticeable hair growth
accompanied with hair loss at the Response may not be seen until about 4 months of treatment. occurs by 34 months
crown. Wash hands well after application. with maximal response
Do not wear a wig, scarf or hat for at least 1 hour after application as this may after 12 months of
increase the amount absorbed through the skin causing unwanted effects. continuous treatment
Side effects may include mild dermatitis or unwanted hair growth above eyebrows (discontinue treatment if
and on cheeks. no response by 6
months).
Benefit of treatment is
lost within 612 months
of stopping.
Self Care Card:

Male Pattern Hair Loss

Hydrocortisone Topical >2 unless under Ok Ok Topical hydrocortisone
Cream Hydrocortisone cream 0.5% or 1% (Dermaid, Sigmacort, Cortic-DC) supervision of should not be used
S2 0.5% pharmacist where the cause of the
S3 1% (30g or less) Apply thin layer to affected area 1-3 times daily (0.5%) or 1-2 times daily (1%). /doctor skin condition is
S4 1% 50g unknown. In particular,
should not be used
Temporary relief of symptoms where a viral or bacterial
associated with acute and cause is suspected.
chronic corticosteroid responsive
conditions including minor skin
irritations, itching and rashes due
to eczema, dermatitis, contact Should not be applied to
dermatitis (such as rashes due to broken skin.
cosmetics and jewellery),
psoriasis, anogenital pruritus and
sunburn.
Where skin is dry, should
Used any other cream/ointment? apply an emollient first to
Have acne, cold sore, chicken the entire area of dry
pox, or shingles? skin before the
Unsure if rash is infected? application of topical
For an infant? Nappy rash? hydrocortisone to the
Rash on the face? targeted area(s).
Have diabetes or arthritis?
Pregnant or breastfeeding?
Already used for 7 days or more?
Recurrent problem?
Skin broken?
Dry skin?
Shingles Drug Treatment: Aciclovir, Famciclovir (250mg q8h for 7/7), Valiciclovir within Reactivation of varicella-
(Herpes Zoster) 72hrs (reduces pain, viral shedding, duration of rash & ophthalmic complications) zoster
-Antiviral tx should be initiated in Tm: 7 days Post-herpatic neuralgia
the 1st 72hrs of attack severe in adults
(Chickenpoxshingles) Non-drug Treatment:
Smx: - bathe lesions in saline tds to soothe and remove the crusts If child affected refer!
- prodromal general malaise - rest & fluids
(headache, fever, sore throat etc) - cover lesions with non-adherent dressing (melonin)
- blistering rash us trunk, back - Analgesia for pain (aspiring/ paracetamol/ paracetamol extend) others:
(along a nerve) prednisolone & amitriptyline
- extreme pain
- lesions erupt over a week &
heal within 2 weeks

German Measles (Rubella) Presentation NOT as common due to vaccination
Rubella Virus Infectious: 7 days BEFORE rash until 7 days after

Vaccination available Treatment:
SMx: - fluids & rest
*blotchy flat rash (cf chickenpox - fever: paracetamol
which is rased) Problem for pregnant women defects in unborn child (hearing, mental speech
* pink on face/neck/body etc)
* tender glands
Measles Prodrome:
Parmyxovirus - fever, runny nose, mailaise, reduce appetite & Kopliks spots in mouth (24-48hrs
HIGHLY CONTAGIOUS!!! before the appearance of a rash)
Vaccine available Rash:
RARE in Aust - non-itchy, starts behind ears, spreads to trunk & extremities in 24hrs, blotchy flat
Smx: rash & coincides with high fever
* initially cold Smx Recovery:
* incubation prodrome Rash - cough for 1-3 weeks
Recovery
Treatment:
- rest & fluids
- fever: paracetamol
Patient Problem Treatment Children Pregnancy Lactation Other

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ORAL HEALTH
Cold Sores Aciclovir 5% (Zovirax) Refer B3; can No Spread by contact & very
4 main stages: Apply at first sign of lesion 5 times a day for 5 days (q4h when awake) use but contagious.
Tingle few hours preceeding preferably
Blister days avoid Advice:
Weeping spreads - B1 ; No No -use sunscreen (sun can
Scab healing (week) Idoxuridine (0.5%) with lignocaine (Virasolve) reactivate virus)
Apply thin layer at first sign of lesion hourly on 1st day then every 4 hours until lesion -use moisturising lip balm
disappears to prevent drying out and
cracking which can lead
Good for MILD attacks to 2o infection
*HSV infectious from tingle stage -avoid astringent cold
until blisters have healed sores
- No No -avoid contact
Povidone(10%)-iodine lotion (Betadine) -dont touch eyes after
Apply qid for 5 days touching coldsore
-use separate towel to dry
* Aciclovir and idoxuridine should be applied early during tingling stage to duration hands after applying and
and severity. avoid touching eyes.
* Povidone iodine may dry weepy cold sores and prevent 2o infection. (skin staining one
SE) Refer:
o lesions affecting the inside
of the mouth, eye or
genitals
1. Taking any other meds? o large area >10cm piece
2. Pregnant or breastfeeding? o persistent & recurrent
3. Child or infant? Refer o secondary infection
4. Have eczema? Refer o very young person (child)
5. Tinging, blisters or pain? If not, o painless without itch/tingling
may be impetigo (yellow crust) or
school sores. Refer Self Care Card:
6. Eye irritation? Refer Cold Sores
7. Duration? >2 weeks, refer

Dry Mouth (Xerostomia) MANAGEMENT:
mouthwashes bicarbonate/plain water q2h
? Reason elderly, drug (TCAs, gentle brushing of teeth with soft tooth brush
anticholingerics, chemoTx, artificial salivas Biotene, Oralube, Oralbalance qh
palliative-care ?mouth breathing ? Sugar-free lollies
diuretics ?beta blockers ?oxygen Regular drinks, adequate hydration, ice cubes, water q30h
therapy Vaseline to lips
? Severity Room humidifier
? Diet Reduce causative meds
? Treatments already tried
Rx: pilocarpine eye drops to mouth (SE: sweating)
Presentation:
-dry cracked lips
-teeth stuck to lips
-dry, cracked, furrowed tongue
-difficulty swallowing & speaking
-sore or burning mouth
- saliva that is ropy and scant
Aphthous (mouth) ulcers Orabase (Carmellose dental paste) forms protective mechanical barrier over ulcer(s) Refer < 10 Ok Ok Apply after food.
Apply prn.
White or yellowish centre with an
inflamed red outer edge appearing Normally resolve within 7-
on the tongue margin and inside 14 days
the lips and cheeks. Kenalog in Orabase (Triamcinalone 0/1% in carmellose paste) - Cat C - No No
Dab small amount onto ulcer and hold in position until paste becomes sticky and forms
Often reoccurring. a think film. Apply at night; 2-3 times daily if required.
Nutritional deficiencies
More common in females. C/I: fungal, bacterial, viral infection of mouth/throat (B12, iron and folic acid),
trauma to mouth,
Duration? hereditary, stress.
Painful or sore? SM33 (Lignocaine and salicylic acid) gel reduce pain/inflammation - Ok Ok
Age? Apply to affected area every 3 hours as required. (can use Refer:
Trauma related? this o duration greater than 14
No. of ulcers? More than 10? product > 6 days

months) o painless mouth ulcer(s)

Lesion size >1cm in diameter? Chlorhexidine 0.2% mouthwash (Sepacol) for prevention of secondary infection. ?? Ok Ok o children <10
Any other medications? Use 10mL held in the mouth for 1 minute twice daily. o ulcers in crops of five to
? cause ten, or more
? ulcers anywhere else on other caution; can cause STAINING of the teeth and tongue when used for continuous o ulcers >1cm in diameter
parts of your body periods of time o associated weight loss
? changed diet, describe diet
Common medication causes of Self Care Card:

mouth ulcers: Mouth Ulcers
-cytotoxics, NSAIS, thiazides,
tetracycline, anticholinergics,
diuretics
OTC Vitamin B2 supplementation:
DDx: - mouth ulcers may be due to Vit B2 deficiency
*herpes simplex: us on lips, - take: Vit B2 15mg tds for 1st week then 25mg/d
outside mouth, fever, tingling
*Bechets syndrome: more
extensive and resistant to
treatment
Gingivitis Chlorhexidine 0.2% mouthwash (Sepacol) Refer Ok Ok

Use 10mL held in the mouth for 1 minute twice daily.
Inflammation of the gums caused
by plaque and calculus deposits Continual use may lead to brown staining of tongue and teeth.
on the teeth.
Sx: bad breath, gum swelling

(often painless), gum bleeding
when flossing or brushing
Tm: Requires removal by dentist

and good oral hygiene: brushing
and flossing, chlorhexidine
mouthwash to inhibit plaque
formation.

Oral thrush Use treatments after food
Miconazole (Daktarin Oral Gel) 2% Ok Ok Ok and avoid taking food or
Oral thrush is common in babies, Drop gel on tongue; keep in mouth for as long as possible before swallowing. drink for one hour after
particularly in the first few weeks For infants, divide dose into several portions and place into front of mouth (prevent the dosing.
of life. obstruction).
Affects surface of the tongue and Adults, children: 1/2 spoonful using provided measuring spoon 4 times daily If baby has oral thrush
inside of cheeks. Infants < 1 year: 1/4 spoonful using provided measuring spoon 2 times daily should check for nappy
rash. Treat both at a time.
White plaques form which, when Administration instructions:
wiped away, leave a sore and spoon should NOT be used for administering the gel For bottle-fed babies,
reddened area of mucosa which use a clean finger, apply sm amts of gel at a time to the inside of cheeks and sterilize bottles and teats.
may sometimes bleed. over the tongue
Continue treatment for at least 48 hours after the symptoms have totally disappeared. Refer:
Presents differently to candidal o all except babies
nappy rash infection which Nystatin (Nilstat) OK OK OK o recurrent infection
presents as red papules (satellite o failed medication
papules) on the outer edge of the 1 mL (100,000 units) four times daily. o diabetics
area of nappy rash. The dose should be administered under the tongue or in the buccal cavity and held in o immunocompromised
the mouth as long as possible before swallowing. patients

Treatment should be continued for at least 48 hours after symptoms have resolved. o painless lesions
Toothache Symptomatic relief options:
Reason: 1. Analgesics
- ? infection, ?wisdom - paracetamol: 1-2 tabs q4-6h prn
teeth/molars cutting through, ? - Ibuprofen: 200-400mg q6-8h prn Max: 1200mg/d
tooth extraction, ?braces
2. Nyal Toothache drops (ethanol, phenol & benzocaine)
Ask about dental hygiene how Directions: moisten cotton bud with 1-2 drops and place in cavity of aching tooth for
frequently brush teeth, types of about 1 minute. Max qid
mouthwashes used, last time saw
dentist
Dental therapy is best option for

pain relief provide symptomatic
relief and refer
Oral Hygiene AVOID mouthwashes! Most commercial mouthwashes contain large amounts of alcohol
which are carcinogenic to oral membranes.
Brush with a soft toothbrush after each meal.

Floss teeth regularly.
Soak dentures in white vinegar overnight.

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GASTROENTEROLOGY & GENITOURINARY
Haemorrhoids Anusol (Zinc Oxide, Benzoyl Benzoate, Balsam-peru) ointment/suppositories Refer Ok Ok Treat after stools and
Supps, insert morning and night and after each bowel motion children lubricate applicators.
Itching, burning, pain, swelling and <12
discomfort in perianal area and Oint, Insert/apply bd to perirectal area and the mucosa of the rectal canal to a point Avoid soap products,
anal canal. Uncomfortable and about 1 cm above the anal sphincter. rough toilet paper (can
feeling of incomplete evacuation wash instead of wipe),
on defecation. Bright red blood on Astringents thought to precipitate surface proteins thus producing a protective coat over the nylon clothing.
haemorrhoid.
toilet paper.
Treat cause; i.e.
Ok Ok constipation by increasing

Proctosedyl (Cinchocaine 5mg, Hydrocortisone 5mg) ointment/suppositories fluids and fibre (fruit,
Insert tds for 1st week, bd for 2nd week then d for 3rd week. bulking agent) in diet and
exercising regularly, stool
Do not use when bleeding present. May exacerbate candidiasis. softener
SE: stinging, burning at site. Prolonged/overuse: skin atrophy/infection
CI: uncontrolled infections, STDS, viral infections
Suggest pelvic floor
Ok Ok exercise for pregnant
Rectinol (Cinchocaine, Zinc Oxide) ointment/suppositories woman.
Insert into rectum morning and night and after each bowel motion. (Lotion: smear small
qty over anal region) Refer:
o blood mixed in with stool or
No No large qty
Rectogesic (GTN) for treatment of anal fissures by promoting healing via o abdominal pain
vasodilation o fever
1. Take any other meds? (May be o dark-coloured blood
Insert 1-1.5 cm strip of ointment into anal canal tds
causing constipation/diarrhoea) o leakage of mucous
2. Pregnant or breastfeeding? o sharp stabbing pain on
Constipation can cause/aggrevate anal fissures so it is also a good idea to offer a stool softener if
3. Diagnosed by a doctor? constipation is problem. defecation
4. Constipation or altered bowl o >3 weeks, not resolve with
SE: may cause headaches & facial flushing in some patients
habit? treatment
o need to be manually
5. Blood or pain?
reduced
6. Recurring problem? >1week,
refer
7. Swelling or itching? Self Care Card:
Haemorrhoids

Heartburn/Indigestion Non drug measures: Heartburn common in
o eat small, frequent meals pregnancy due to raised
Indigestion (dyspepsia) is poorly o avoid large meals and fatty/spicy foods progesterone levels
localised upper abdominal pain o avoid alcohol, caffeine and chocolate as can all relax lower oesophageal sphincter causing smooth muscle
which may be brought on by o cease smoking relaxation of oesophageal
particular foods, excess food, o dont eat late in the day sphincter; also increased
alcohol or medications. o posture avoid bending, stooping and lying flat. Elevate bedhead upwards pressure on
o weight reduction stomach.
Heartburn (reflux oesophagitis) o avoid tight, constrictive clothing
presents as a burning sensation in o avoid NSAIDs where possible Refer when:

stomach and passing upwards Failure to respond to Tx
behind breastbone. May cause Pain radiating to arms
acidic taste in back of throat and is Antacids refer Ok Ok Difficulty swallowing
often associated with precipitating Regurgitation
factors (certain foods, too much Mylanta Original (AlOH, MgOH, Simethicone) Long duration
food, alcohol, bending or lying 10-20mL prn up to 4 times daily Increasing severity
down) and more common in Children
overweight patients. *contain high amounts of Na so avoid in patients on sodium-restricted diet or with HT, CCF,
renal impairment etc
1. aggravating/relieving factors? **Al salts tend to cause constipation whilst Mg causes diarrhoea
2. previous history/treatment?
3. other medications? NSAIDs etc
4. severe pain, difficulty H2 antagonists refer B1: safe to Ok
swallowing? Radiating pain down use
arm? CVD Ranitidine (Zantac)
5. blood in vomit or black tarry 150 mg bd or 300 mg d
stools? bleeding ulcer
6. pregnant or breastfeeding?
7. symptoms dont go away or
keep coming back?
8. smoker? alcohol?
9. under 18 or over 50? refer
children as unusual and ppl > 50
incase gastric cancer Self Care Card:
10. unexplained weight loss? Heartburn and Indigestion
possible gastric carcinoma
Diarrhoea and vomiting 1st line Ok but ok Avoid dairy products for
Gastrolyte, Repalyte (NaCl, KCl, citrate, glucose) when in duration of the diarrhoea,
refer if longer than 48 hours Two effervescent tablets or the contents of one powder sachet should be made up with doubt refer particularly in children
200mL of fresh drinking water. Refrigerate and discard after 24 hours. in case
something Continue to breastfeed
else wrong infants offer more feeds

correction of dehydration and Loperamide (Gastrostop, Imodium) 2mg capsules >12 yrs No B3 Safe for and oral rehydration
electrolyte disturbance is the 2 stat, then 1 after each loose bowel action; max 8/day occasional solutions in between feeds.
priority in all cases short term
Stop formula for 6-24 hours
use
or until condition improves.
*ONLY recommend when px needs to be at work etc in adults should let gastro run
its course*
note: antidiarrhoeals should not be
used in children, treat with fluid and Refer:
electrolytes o diarrhoea with n/v
Diphenoxylate+atropine 2.5mg/25mcg (Lomitil) > 12yrs No Safe for o signs of dehydration; dry
2 tabs 2-4 times a day; max 8/day occasional mouth/mucous
short term membranes, sunken
*may have an additive effect with drugs which act on the CNS, avoid combination use
Taking any other medications? **although ADEC Category B3 is preferred treatment for diarrhoea during pregnancy; avoid in later
eyes, tiredness,
Antibiotics recently? stage of pregnancy irritability, deep
Pregnant or breastfeeding? breathing, rapid pulse,
Blood in stools? Black stools? low blood pressure,
Hight temperature? decreased urination
Child or older person? o blood or mucus in stools
Duration? Longer than 48 hours? o drug-induced
History of recurrent o diarrhoea for >1 day in
diarrhoea/constipation? infants; 2 days in

Bad pain or vomiting? children under 3 and
Kidney, liver or heart disease? elderly pts; 3 days in
Glaucoma or bladder problem? adults and older children
Recent travel overseas?
Recent food history? Self Care Card:
Vomiting and Diarrhoea
Motion sickness >2 Ok Ok

Dimenhydrinate (Dramamine, Dramamine Junior) 2.5mg/mL, 25mg, 50mg monitor
caused by excessive vestibular Adult: 1 2 tablets (50-100mg) every 46 hours as needed. Max: 400mg/day baby for
stimulation sedation
SE: drowsiness
Tips:
o sit in middle of plane or boat >2 Ok Ok
o avoid alcohol and decrease oral Hyoscine hydrobormide (Kwells, Travacalm HO) 0.3mg
intake, take frequent small Adult: 12 tablets, repeat every 4-6 hours as needed; max 4/day tablets
meals
o
o fix vision 45 angle above >5 Ok, use Ok, use
horizon Pheniramine 45.3mg (Avil) sedating antihistamine only if only if
o avoid reading while actively Adults: - 1 tab up to tds strictly strictly
travelling 5-10yrs: tab up to tds indicated indicated
o take first dose 30 mins before
travel

Constipation Time to adult Ok Ok Non-drug therapy:
Bulk forming onset dose increase dietary fibre
Caused by inadequate dietary Isaghula granules (Fybogel) Usually 24 increase exercise
fibre, fluid intake and 1 teaspoon/sachet, 1 to 2 times daily. hours; 2-3
ensure adequate fluid
activity/exercise as well as days for full
*Requires adequate hydration. intake
inappropriate bowel habit. affect
C/I in bowel obstruction toilet after meals
Stool softener + stimulant 6-12 hours poloxamer Ok (senna Ok Normal bowel habit can
Coloxyl (docusate 50mg) with Senna (Coloxyl only short range from 3 times a day
Take 1-2 tablets daily. Drops) term) to 3 times a week.
preferred for Reassure patients.
children
<3 years; Hormonal changes and
1. Sx? Normal bowel frequency? 10-25 drops direct pressure on the bowel
2. when was the last bowel in bottle or causing decreased mobility
movement? with fruit common cause of
3. taking any other medications? juice constipation during
4. pregnant or breastfeeding? Osmotic laxatives 1-2 days 5-15mL d Ok Ok pregnancy bulk forming,
5. elderly or children? Lactulose (Actilax, Duphalac) with fruit osmotic and stool softener
Take 30mL daily in one or two divided doses. juice, water preferred
6. recent surgery?
or milk
7. any bleeding from the rectum?
pain on defecation? *Ok in diabetes as not absorbed Refer:
8. alternating constipation and o blood in stools
diarrhoea? Simulant laxatives Oral: 6-12h >4 Ok; avoid Ok o abdominal pain,
9. intense pain? Biscodyl (Durolax, Bisalax) Supp: 15- in late vomiting, bloating,
10. taking laxatives often? Take 1-2 tablets daily. 60mins stage weight loss
11. heart or kidney problems? OR o age
*avoid laxatives containing Na and Mg Use one suppository daily. o failure of OTC medicines
salts 15 30 - - -
Glycerin suppositories minutes Self Care Card:
Insert 1 suppository well up in the rectum as required Constipation
Irritable Bowel Syndrome Antispasmodics act on smooth muscle in the gut, causing relaxation and thus reducing Avoid trigger factors
abdominal pain and distension. including stress, large
Chronic abdominal pain meals, fatty foods,
associated with alteration in bowel Peppermint oil (Mintec) 0.2mL caps Refer <16 Avoid Avoid caffeine and exacerbating
habit (between constipation and Swallow whole 1 capsule three times a day before meals. medications.
diarrhoea) and without apparent
aetiology. Pain often accompanied Mebeverine HCl (Colese, Colofac) 135mg Keep a diary of; when you
by abdominal distension/bloating. Take 1 tablet three times a day before meals. experienced symptoms and
what you were doing before

Bulking agents are recommended regardless of predominant symptom. they started, what you were
Rome II criteria: 12 weeks or more eating or drinking before
in past 12 months of abdominal symptoms began, how you
were feeling at the time (e.g.
pain or discomfort that has 2 of 3 Isaghula granules (Fybogel) Refer <16 Ok Ok
stressed) and any
features of; relieved by defecation, 1 teaspoon/sachet, 1 to 2 times daily. medications you were taking.
onset associated with change in
frequency of stool, onset Psyllium powder (Metamucil, Mucilax) Refer:
associated with change in form of 1 teaspoon 1 to 3 times daily o children under 16
stool. o patients over 40 with
recent change to bowel
- - - habit and no previous
More commonly reported by history of IBS
females and often develops in see CONSTIPATION o pregnant women
young adult life. o blood in stools
see DIARRHOEA o unexplained weight loss
o signs of bowel
Treatment is aimed at obstruction
symptomatic relief of predominant o unresponsive to
symptom(s) and avoidance of appropriate treatment
trigger factors.
Self Care Card:
IBS
Constipation
Vomiting and Diarrhoea
Threadworms Perianal itching may

Pyrantel (Anthel/Combantrin tablets 125, 250mg; Combantrin/Early Bird 100mg >6 months. B2: can Ok: avoid if continue for several days
Common in young children. Night- chocolate squares) Refer if <1 use but can after treatment.
time perianal itching (female lays Dosage based on bodyweight 10mg/kg as a single dose (M=750mg) y/o avoid in 1st
eggs at night) and consequent trimester. Repeat drug treatment in
sleep disturbance, tiredness and Combantrin suspension 1mL/5kg 2-4 weeks.
daytime irritability; teeth grinding;
nose picking, abdo pain, loss of Refer:
appetite. Mebendazole (Combantrin-1, Vermox, Banworm; 100mg tablets/squares) >2 y/o B3: Avoid Ok: avoid if o Infection other then
Dx: need to sight worms (white One (100mg) tablet stat regardless of age. can threadworm suspected
thread-like objects ~5-10mm o travel abroad
long); found in faeces or protrude o medication failure
from anus at night. Sticky tape Infection is common and not a sign of poor hygiene or parental neglect of children. o persistent symptoms
over anus in morning eggs stick o pregnant family member
to tape. Treat all family members even if asymptomatic as may be in early stages of infection o children >6 months
(sensitisation to irritant substances surrounding eggs may take several days).
1. Pregnant or breastfeeding?
2. Recent travel abroad? Other type Cut fingernails short and thorough clean hands and brush nails after going to the toilet P (pyrantel) for pregnancy
of worm infestation and before handling food to prevent transmission.
3. Unsure if threadworms present?
4. Less then 2 y.o? Wash and iron bed linen, sleepwear, clothes and towels.
5. Liver disease? LFT abnormalities Self Care Card:
with pyrantel/mebendazole Showering/bathing in morning to wash away eggs laid previous night. Threadworms

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PAEDIATRICS
Teething Reassure parents. *AVOID: PainStop NIGHT
Suggest teething ring, clean cloth or pacifier for gumming. bc poor ratio may not
Infants first teeth usually erupt at Gentle massage of gums with fingers. control pain*
age ~ 4 months and teething Cool fluids although avoid frozen foods or objects as may cause thermal damage
completed by 2-3 years of age. Teething biscuits in older children
Excessive drooling, chewing on Paracetamol 15 mg/kg q3-6h

fingers, restlessness, irritability, Ibuprofen 5 - 10 mg/kg q6-8h with food (>3 months)
disturbed sleep/feeding patterns,
rubbing at cheeks etc Bonjela (choline salicylate) children >4 months
Apply 0.5 cm to the gums every 3 hours; max 6 times/day
Febrile Convulsions/Fever in Counselling: The treatment of febrile

Children -normal occurrence in children who are concurrently ill with a fever seizures:
-dont cause long-term problems - rectal/IV diazepam
-convulsions associated with a -should stop by 6yrs for children who have
high fever >38oC suffered from it before
-NOT epilepsy Treatment/Management: may use diazepam
-brief, generalised, occur within 1. Paracetamol should manage the fever with paracetamol 15mg/kg q4-6h prn rectal/oral at the onset of
24hrs of fever (however, antipyretics may not reduce the chance of a seizure occurring) fever for prevention of
-in children 6months-5yrs recurrence
-30-50% risk of recurrent febrile 2. Convulsion management:
seizures but LOW risk of -place child on side, chest down, head turned to size. DONT lie on back.
developing chronic epilepsy -ensure child cool cool washes, undress to child to their singlet
- get medical attention

Gastroenteritis & Treatment DO NOT GIVE ANTI-
Dehydration DIARRHOEALS!
1. ORT
viral gastro bug - replace loss of electrolytes with Gatroylte/Hydralyte
- frequent small volumes Always recommend that if
Smx: - ensure adequately rehydrated! the vomiting/diarrhoea
- diarrhoea, vomiting, abdo pain, DOESNT improve see
crying, fever, reduced appetite, Hydralyte NaCl, K citrate, Citric acid, Glucose Dr or Hospital
irritability, Directions: immediately
- <12 months: 100ml every 90 mins
Duration: 2-3 days - 1-3yrs: 100ml every 90 mins Stress how children can
- 3-6yrs: 100ml every 60mins become dehydrated
Problem: infants/children incr risk - 7-12yrs: 100ml every 30mins VERY quickly
of dehydration treat cautiously! Seek advice if diarrhoea persists for more than:
- <6months: 6hrs * Mild-Moderate
- 6months-3yrs: 12hrs Dehydration:
Check - 3-6yrs: 24hrs - urine concentrated
1.?Age - 6yrs-Adult: 48hrs - hx of vomiting &
2. ?Duration of symptoms diarrhoea
3. ?Worse or improving Gastrolyte NaCl, KCl, Na citrate, glucose - ORT should be suffice
4. ?keeping any fluids down Directions:
5. ?degree of dehydration - dissolve 1 sachet into 200ml of water *Severe dehydration:
v.impt in determining whether to - drink freshly & frequently may be stored in fridge for 24hrs -REFER to hospital
treat vs refer Directions: Volume to be taken in 6hrs -impaired peripheral
6. ?blood in vomit or stools - 5kg: 150-210ml perfusion
7. ?fever & other Smx - 10kg: 300-420ml -dry mucous membranes
8. ?food causes - 15kg-450-630ml -sunken eyes
9. ?anyone else in the family - 20kg -600-840ml -not urinating
affected - 30kg 900-1260ml -increased pulse
-low blood pressure
2. Other foods
- bland/dry foods (avoid dairy, spicy & irritant foods)
- breastfeeding and bottle feeding SHOULD be continued during illness
- complex carbos well tolerated
Colic - - - Reassure parents that

General Measures: colic is not the result of
Colic is defined as excessive o sooth by holding and rocking the baby bad parenting.
crying in an otherwise healthy o use pacifier
baby. o use of gentle rhythmic motion (e.g. strollers, infant swings, car rides) Prevent caregiver burnout
o place near white noise (e.g. vacuum cleaner, clothes dryer) by advising parents to get
o burp baby after meals proper rest breaks, sleep,
Wessel criteria or the rule of o employ 5 Ss (need to be done concurrently): and help in caring for
three: crying last for >3 hours a 1) Swaddling tight wrapping with blanket 2) Side/Stomach laying baby on side or infant.
day, >3 days a week, and persist stomach 3) Shushing loud white noise 4) Swinging rhythmic, jiggling motion 5)
>3 weeks. Sucking sucking on anything (e.g. nipple, finger, pacifier)

- - - Usually subsides 3-6
Diet months of age.
Predominantly occurs between 2 o avoid under- or over-feeding
weeks and 4 months of age. o check feeding technique as underfeeding can result in excessive sucking resulting Colic has no bearing on
in air being swallowed and leading to colic-like symptoms babys intelligence or
o teat size of the bottle should be checked so that when the bottle is turned upside future development.
Intense crying, high-pitched down the mil should drop slowly from the bottle
screams, inconsolability, flushed o if formula feeding, consider a one-week trial of switching to hypoallergenic formulas
face, fish clenching, back arching, (if breastfeeding, continue to do so as switching to formula will not help)
drawing up legs to abdomen with o switching to soy formula may be beneficial Refer:
periodic extension of legs, arms o infants that are failing to put
stiff tight and extended, symptoms - - - on weight

o medication failure
may occur more often in late If suspected that crying is due to excessive wind caused by air swallowing during crying o over anxious parents
afternoon and evening. or feeding then can use:
Simethicone (Infacol Wind Drops)

Infants 1 month-2 years: add 0.2 mL to bottle or give orally immediately before
breastfeeding Self Care Card:
Infant Colic
(> 2 years: 0.4 mL 4 times/day (after meals and at bedtime); max. 12 doses/day)
Nappy rash - Frequent nappy changing. - - - If non-responsive to OTC

- Nappy-free periods where possible. treatment after 1 week
Erythematous rash on the buttock - Use mild detergents to wash nappies and ensure thoroughly rinsed. should be referred.
and groin area caused by - Breathable nappy liners or change to disposable nappies (Huggies most absorbent)
contact of urine and faeces with - Avoid plastic/waterproof pants.
skin, wetness and maceration of - Cleanse skin between each nappy change with warm water or olive oil/dilute bath oil
skin due to infrequent nappy using cotton balls or a warm face washer & apply barrier cream at EACH nappy
changes and inadequate skin care change If fungal infection also
- AVOID: soap, talc, wipes that may irritate skin present, apply
- Oatmeal bath oil can help soothe the irritated area clotrimazole (Canestan,
Clonea) cream to affected
area d or bd after bath.
Apply a barrier cream with each nappy change. Continue for 1 week after
Broken or unbroken skin? Zinc (Zinc cream, Sudicream, Amolin, Desitin, RCH nappy goo) is soothing. symptoms cease.
Infection? Bacterial (weeping or Lanolin (Alpha Keri lotion) hydrates skin.
yellow crusting), fungal (satellite Castor oil/cod liver oil provides a water-resistant layer on skin. Apply antifungal first and
pustules) then steroid.
Duration? >2 weeks, refer
Previous Hx? Hydrocortisone 1% (Dermaid, Sigmacort, Cortic-DC) Can use Hydrazole
Applied sparingly to inflamed area 1-3 times daily after bath. For short term use only. (hydrocortisone/
clotrimazole) initially but
To minimise systemic absorption, use highly absorbent disposable nappies, change revert back to
nappies more frequently and maximise nappy-free periods. clotrimazole cream for

If signs of candidal involvement, can use: rest of course once
inflammation resolved
Miconazole + zinc oxide (Daktozin)
Apply without rubbing at each nappy change to water cleaned (do not use soaps) dry Self Care Card:
skin; continue until cleared or for greater than or equal to 7 days. Nappy Rash
Cradle Cap Remove thick scale by massaging warm olive or mineral oil gently into scalp leave - - - a.k.a infantile seborrhoeic
on for several hours/overnight wash off with a mild soap and a soft bristle toothbrush dermatitis
Greasy, yellow scaling and crusts or terry cloth washcloth.
on the scalp and face. Rash does Reassure parents
not itch and rarely irritates infant Frequent shampooing with a mild, non-medicated shampoo. Failing this: cradle cap is a common,
(impt for DDx) self limiting condition and
will clear spontaneously
Severe Cases:
Age of onset usually ~1 month i.e. NOT contagious, child
and resolves by 8-12 months. WILL grow out of it,
Egozite Cradle Cap Lotion (salicylic acid, olive oil, castor oil)
usually DOESNT need
Ensure scalp is dry and apply to crust only twice daily for 3-5 days without washing hair,
any treatment, NOT due
then wash with a gentle shampoo. Repeat for remaining crust.
to hygiene
* AVOID: contact with eyes & non-crusted areas*
Recurrent cases may be
due to proliferation of
yeast in the scalp and
may respond to
ketoconazole shampoo
(Nizoral)

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EYE DISORDERS
Dry Eye Syndrome Treatment: EYE LUBRICANTS many different artificial tear supplements available OK A A Advice in regards to
management:
(keratoconjunctivitis sicca or Main types: preserved, preservative free, drops, ointments, gels - avoid precipitating
keratitis sicca xerophthalmia) factors eg. AC, smoke
Dose: 1 drop every 1-12hrs as required lubricants may be used as often as required - regular use of eye
* Smx: Ointment: reserved for night as can cause some blurring in the vision lubricants (drops during
-dry, itchy, gritty, irritated, day & ointment at night)
watering eyes Products available: -reduce evaporation by
- Polytears (hypromellose, dextran) & Genteal (hypromellose) wearing wrap-aroudn
Reasons; contain least-irritant preservative glasses or humidifying air
- drug causes: anticholinergics,
diuretics, OCP, retinoids, HRT, - Systane (PEG, Propylene Glycol) Directions to insert eye
propranolol - slightly more viscous thus more lubricating drops:
-evnviro: AC, smoke, dry air, air - actually helps in the healing process -wash hands and ensure
pollution, computer use clean
-contact lenses - Genteal Gel (hypromellose, carbomer 980) & Viscotears Liquid gel (carbomer 980, -unscrew/twist off
-medical conditions: Sjoegrens PAA) container
syndrome, Steven-johnson;s, - good for night-time use -tilt head back
chronic conjunctivitis, post-herpes -with one hand create a
zoster pouch with the lower lid
Products suitable to be worn with contact lenses -position bottle directly
WHY? Aqueous tear deficiency Refresh Contacts (carmellose) above pouch & drop
lack of tears of production of Bion Tears (preservative-free single use containers) -close eye
tears of poor quality -press on nose for 1-
2minutes
Check: My usual recommendations: -repeat process in a few
1. Age of px common in elderly Mild: Polytears/Refresh/Genteal during the day and Genteal Gel at night mins if >1 drop needed
2. Other Smx - ?redness, pain, Mod: Systane during the day & Genteal at night
pus/discharge, uni/bilateral, Preservative free for anyone prone to allergies/contact lens wearers Remember:
blurred vision, flashing lights -never share eye drops
Refer -d28
3. Occupation -avoid touching the tip of
4. Current medications/medical the bottle with the eye
conditions
Self Care Card:
Dry Eyes
Viral Conjunctivitis Self-limiting condition 1-3 weeks to resolve Discard all eye make-
(aka pink eye) up/cosmetics
SYMPTOMATIC Treatment ONLY
Smx: cold compress
- very watery, itchy, irritated eye artificial tear supplements hourly use if needed
-bilateral, mild discomfort analgesics paracetamol
-foreign body sensation avoid bright light
-redness
HIGHLY Contagious appropriate hygiene essential

Bacterial Conjunctivitis COMMENTS: Contagious appropriate
* self-limiting resolves in 5-14 days hygiene is essential (ie.
Smx: * contagious good hygiene is essential washing hands, face-
- red, spreads quickly to other eye, * recurrent infections may be associated with abnormalities in lacrimal drainage system cloths & towels)
irritated
- sticky discharge that reforms Treatment: Not in Safe Safe Discard all eye-makeup
during the day/overnight Propanimide (Brolene) drops & oint infants and cosmetics
- mucopurulent discharge increase o for MILD conjunctivitis
over 1-2days o 1-2 drops tds-qid for 5-7 days
- gritty feeling o Should have noticeable improvement within 2 days
o SE: burning, irritation, stinging
Check:
? duration of Smx > 2 months CAT C ? Potential
Sulfacetamide (Bleph-10) drops only
? changes in vision AVOID! for infant
o For MILD conjunctivitis
? deep seeded pain, flashing absorption
o 1 drop q2-4h for 2 days, then if there is improvement, 1 drop qid for 5
lights, headaches, neurological
changes days
? Hx of URTI/cold o initial improvement within 24hrs
? child possible blocked tear o SE: irritation & redness (due to sulphur)
ducts rather than bacterial
conjunctivitis
? Ddx: viral, allergic, foreign body
Cause: G+ve & G-ve
Allergic Conjunctivitis TREATMENT REGIMENS: Make sure to carefully

check the PREGNANCY
Smx: Mild Symptoms: Safe Safe Safe Cats & what AGE these
- red, itchy, watery eye irrigate with NaCl 0.9% - bd drops can be used in!
- conjunctivial oedema Cold compress prn/regularly
- shouldnt be discharge Artificial tear supplements: 4-8times/day

Check: Mod Symptoms:
-pollens, dust mites, cosmetics, Oral antihistamine may be useful
contact lenses/solutions Topical drugs: > 6yrs AVOID Suitable if
-?visual acuity o Levocabastine (Livostin) B3 needed
-?papillae or lumps under the lid Antihistamine
(follicles) Dose: 1 drop bd incr to tds/qid if needed
- drugs/medications SE: stinging, mild eye irritation
o Ketotifen (Zaditen) > 3YRS ? B1 Suitable if

Antihistamine-mast-cell stabiliser! needed
FAST onset of action within 15mins
Dose: 1 drop bd
o Lodoxamide (Lomide) > 4yrs B1 limited Limited

Mast-Cell stabiliser data data
Long term use of topical vasoconstrictors (Naphazoline, Phenylephrine,
Tetrahydrozoline) + Antihistamine combinations eg. Naphcon-A NOT
recommended bc of rebound conjunctivitis
o Napchon-A, Antistine-Privine (Naphazoline & pheniramine)
Dose: 1 drop q6-12 hr (good short term to reduce redness)
Severe Symptoms:
Seek specialist advice
Topical CSs may be required
Recurrent Symptoms:
Refer to a specialist
Oral Antihistamine may also be useful
Mast0cell stabiliser is effective as a preventive measure
o Eg. Zaditen Ketotifen 1 drop bd
o Eg. Lomide - Lodoxamide
Stye Treatment: Ddx:
(Internal & External Hordeolums) -chalazion
Warm compress to aid drainage 10-20mins qid until drains -acute dacryocystitis
Smx: Lid hygiene LidCare -blepharitis
- slightly painful lump near lid If internal Refer may require Abx -eye lid trauma
- us able to see a small white
head
- swelling and redness around the
area

Chalazion TREATMENT/Management DDx: stye
(Meibomian cyst blockage of may rupture spontaniously, however severe cases may require surgery.
one of the Meibomian glands in Self-limiting
the upper or lower lids) Blepharitis = risk factor
Likely to suffer from recurrent chalazions so good lid hygiene is essential
Smx:
- looks similar to a stye
- BUT: no head & painless lump
- develops over weeks
Check:
- other eye conditions
- ?blepharitis
- ?eye make-up
Contact Lens Care Caring for Contact Lenses requires:
- cleaning, disinfecting, soaking, wetting, lubricating
- some products have 1 solution to cover most of these steps
- WHY? protein builds up on contacts this should be removed daily with a
clearer
- Disposable/daily contacts less risk of developing eye infections but $$
Advice:
- wash hands thoroughly before touching contacts (In/out of eye)
- do NOT use water to wash contacts (risk of infection)
- do no moisten/clean with saliva
- caution before using drops not compatible
Blepharitis MANAGEMENT
- CHRONIC inflammation of the 1) Eyelid hygiene

margins of the eyelids - essential due to the CHRONIC nature of the condition
- removal of crusts and debris daily with warm water or a 1 in 10 dilution of baby
Smx: shampoo
-crusting of the eyelids, soreness, - daily or twice daily (if severe)
greasy appearance - or LidCare product may be used
-flaking, irritation, foreign body - avoid wearing eye make-up/discard old makeup
sensation, some discharge
2) Control Cause
Main 3 causes: - treat the underlying cause
1) Seborrhoeic Blepharitis - eg. Control scalp seborrhoea
2) Rosacea Blepharitis
3) Staph Blepharitis 3) Symptomatic management
-artificial tear supplements relieve dry eyes & itching

Red Eyes Possible Causes: Questioning: If no apparent sinister
- conjunctivitis bacterial, allergic, viral ? pain type, severity, intensity cause can treat short
MANY possible reasons why - allergy, hay-fever, irritation ? loss of vision term with decongestant
someone develops a RED eye!! - dry eyes ? sensitivity to light eye drop but make sure
- foreign body irritation, redness, tearing, foreign body ? alleviating & aggrevating factors refer to doctor if doesnt
Questions: sensation ? ocular conditions clear within a few days.
? how long - contact lens problem associated with contact lense use ? ocular swelling/ protrusion
? other Smx (discomfort, blurred - ? glaucoma (rare)
vision, pain, discharge) - hormonal changes menopause
? had before - trauma burn Main Issue: make the correct diagnosis!
? injury ?irritants - ? iritis (sometime more sinister )
? contacts or glasses
? medication/medical conditions
? allergies Conjunctivitis Iritis Glaucoma Episcleritis/Scleritis
? reason for redness Pain Burning Moderately severe Very SEVERE Episcleritis: irritation
NOT severe PHOTOPHOBIA Nausea, emesis Scleritis: severe pain
Vision NORMAL Moderately decreased Considerable NORMAL
decreased
Lacrimation or Mucous or Lacrimation Lacrimation Lacrimation
discharge mucopurulent
Pupils NORMAL Small, irregular Mild-dilated NORMAL Self Care Card:
Unreactive Red Eyes
Response to Light NORMAL Minimal Minimal NORMAL

Counselling
It is important to write the date you open the eye preparation on the bottle or tube and to discard it 28 days later (unless told otherwise).
Some people find it easier if they have someone help them or if they use a mirror.
Wash your hands then sit or lie down. Tilt your head back, look up and gently pull down your lower eyelid to form a pouch. Avoid letting the tip of the dropper or tube touch your eyes, skin or any
other surface.
Use a clean tissue to mop up any excess.
Drops
Shake suspensions (cloudy liquids) gently before use.
Put 1 drop into the pouch (see above). If you think that the first drop missed your eye, put in another.
Try not to blink after putting in a drop. Close your eyes and gently press against the inner corner of your eye with your finger (over the tear duct) for at least 3 minutes. This increases the
effectiveness of the eye drop and helps reduce the amount of medicine that gets into the rest of your body where it may cause side effects.
The eye pouch will be full after a single drop. If you need to use another eye drop at the same time of day, wait several minutes before using it.
If you find it difficult to tell whether a drop has gone into your eye and you don't have someone to help, try storing your eye drops in a refrigerator, so you can feel when the cold drop goes in your
eye.
Ointments
Squeeze a small amount (about 1 cm length) along the pouch (see above) then blink several times to spread the ointment. If you need to use drops at a similar time of day, use the ointment last.
Children
Hold the child's eyelids open between the index finger and thumb of one hand and put drops in with the other. If this is difficult, put a couple of drops onto the skin at the inner corner of the eye and
wait for the eyes to open.
Infants and toddlers may need to be held still while the eye preparation is given. If you don't have someone to help you may need to swaddle the child with a sheet or lay them on the floor and gently
hold their head still between your knees.
Contact lenses
Do not wear contact lenses when using eye ointments.
Wearing soft contact lenses is generally not recommended while using eye drops. They may be removed before using an eye drop, then reinserted after a period of at least 5 minutes. If drops are
used twice daily you can insert the lens after putting in the morning drop and remove the lens before the evening drop.
If drops are used accidentally while lenses are in, remove them and rinse well with an appropriate solution before reinsertion.
Soft (hydrogel) lenses can be stained by some drugs (check with your pharmacist). Disposable lenses can still be worn.
Some drugs may make your eyes feel dry.

Vasoconstrictor Indications: mild ocular congestion, i.e. allergic conjunctivitis, red eye No Safe to use Safe
(decongestant) eye drops Adverse effects: rebound hyperaemia, stinging on instillation short term
Counselling: (up to 5
- do not use for more than 5 days and seek medical attention if symptoms dont days)
improve within 48 hours
- although advertised for minor irritations, a cool compress is beneficial and is safer
- if used for too long these eye drops will cause symptoms similar to red eye (i.e.
rebound congestion/hyperaemia)
Naphazoline (Murine Clear Eye, Albalon, Naphcon Forte)

1-2 drops up to 4 times daily.
Tetrahydrozoline (Visine)
1-2 drops up to 4 times daily. Avoid combinations of
vasoconstrictor and
antihistamine as doubtful
benefit and should not
Antihistamine eye drops Indications: allergic conjunctivitis >6 B3, avoid Ok if use vasoconstrictor for
Adverse effects: stinging on instillation (more than others), mild eye irritation, headache use indicated longer than 5 days
Counselling: whereas antihistamine
- Shake before use. use may be indicated
- You may feel drowsy and the effects of alcohol may be increased; do not drive or indefinitely.
operate machinery if you are affected.
Levocabastine (Livostin) eye drops

1 drop into each eye twice daily, increasing to 3-4 times daily if necessary.
Ocular Lubricants see DRY EYE - - -

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EAR, NOSE & THROAT
Deafness Pain Irritation/ Tinnitus/ Discharge Upper Comments

itching vertigo respiratory tract
infection
Ear wax Ear discomfort, feeling of fullness and slight gradual
hearing loss. Associated with cotton bud use.
Otitis externa Initially irritation alone, progressing to pain and
discharge. If oedema, can get conductive hearing
loss. Can be precipitated by swimming, warm
weather and dermatitis.
Otitis media Ear pain tends to be throbbing/aching. Pain is
relieved on rupture of the tympanic membrane,
which releases a mucopurulent discharge. Most
common in children 3-6 years. If recurrent, otitis
media may develop into glue ear, which is sticky
fluid that has not drained from the middle ear.
Treatment of glue ear is usually surgical drainage
and insertion of grommets.
Inner ear problem Usually caused by viral infection.
Refer:
- foreign body
- generalised inflammation of outer ear may require antibiotics
- otitis externa may require antibiotics
- otitis media if no improvement after 24-48 hours usually treated with symptomatic analgesia/decongestants for first 24-48 hours unless child has ever & vomiting
- children under 6 years with ear pain or hearing impairment
- tinnitus/vertigo underlying inner ear problem
Ear Drop Administration:

o to make insertion more pleasant, hold the bottle in your hands for a few minutes prior to administration to warm solution
o tilt your head to one side, with ear pointing to the ceiling (can suggest resting head on arm of couch whilst watching tv)
o straighten the ear canal with one hand by pulling the ear upwards (adults)/ downwards (children) and back
o with the other hand, use the dropper to instil the correct number of drops into the ear holding the dropper as close as possible to the ear canal without touching it
o keep the head in the tilted position for several minutes
o return head to normal position and use a clean tissue to wipe away any excess solution.

Ear Ache General:
- can be caused by infection, foreign body, dermatitis, ear plugs, referred pain from
1. Age teeth, jaw, sinuses
2. Type of pain? - chronic infections hearing damage/loss
3. Severity of pain? ?radiation
4. Other Smx? Common causes:
5. Hearing difficulties? Vertigo? Otitis media:
Dizziness? -inflammation of the middle ear
6. Travel? Swimming? Loud music -most common in children
concert? Etc
7. Mx? - ?ototoxic meds Glue ear:
8. Discharge? -type of chronic otitis media
9. Associated trauma? -long term build up of thick, sticky, fluid in the middle ear & behind the ear drum
-hearing loss/difficulties is common
If cant identify a CAUSE for the
ear ache refer! Ear Wax: Self Care Card:
-hearing problems requires wax removal & softening Ear Problems
Swimmers Ear:
-water accumulation bacterial growth, inflammation, swelling pain
Ear Wax MANAGEMENT: >12 yrs
avoid using cotton buds, pushing plugs into the ear
Wax is normal part of the ear, sometimes clears without treatment in 5 days
protective role if severe REFER: may need gentle syringing by doctor to loosen wax Refer:
often use cerumenolytic agents before Syringing o Associated trauma-
related conductive
History of gradual hearing loss deafness
drops should be warmed before use (hold in hands for several minutes)
usually reported on o Dizziness or tinnitus
Tilt head and instill 5 drops into one ear. Repeat twice a day.
presentation to pharmacy with o Foreign body in the ear
ear wax impaction. Cerumenolytics canal
Waxol Ear Drops Docusate aqueous based o OTC medication failure
or o Pain originating from
Cerumol Ear Drops (dichlorobenzene + chlorbutol) - oil based middle ear

Common in the elderly.
Associated with hearing Dose: warm dropper bottle in hands for several minutes and then instil 5 drops in
aids/cotton bud use affected ear(s) twice daily for a few days OR 10-30mins before syringing by doctor
SEs: irritation Self Care Card:

Cerumol C/I in patients with peanut allergy Ear Problems

Otitis Externa Management: > 12yrs Isopropyl alcohol helps
If inflammation is present: reduce moisture. Acetic
- itching, inflammation, irritation of Refer to Dr (possibly need antibacterial/CS combination) acid increases acidity of
the external ear canal Avoid use of antiseptic/drying agents when inflammation present will cause pain the ear canal to create an
- may be due to dermatitis, local inhospitable environment
trauma, foreign objects, for bacteria.
To prevent recurrence can use OTC Antiseptic/Drying Agents such as:
Usually bacterial but can be Swimming related:
fungal. Aquaear (acetic acid, isopropyl alcohol) - regular use of drying
agents after swimming
or - careful/meticulous
cleaning
Ear Clear Dry & Clear (isopropyl alcohol, glycerol) *less irritating - ear plugs/cap for
swimming
Dose: Instil 4-5 drops into each ear after swimming or bathing - avoid swimming while
have infection
Self Care Card:

Ear Problems
Allergic rhinitis Oral antihistamines (non-sedating) >1 Prefer Safe to use

Loratadine (Claratyne) 10mg tabs, 1mg/mL sedating
Seasonal or perennial. Take one tablet daily. agents but
Common allergens: grass/tree can use
pollen, fungal mould spores, Children: 2-12yo, 5mg d (Cat B1)
house-dust mite and animal hair. 1-2yo, 2.5mg d
Steroid nasal spray seasonal allergic rhinitis

Budesonide (Rhinocort) 32, 64mcg >6 Ok Ok
1-2 sprays into each nostril daily
Sx: rhinorrhoea (runny nose), Fluticasone (Beconase Allergy and Hayfever) 50mg/dose > 12 Ok Ok
nasal congestion, nasal itching, Initially 2 sprays daily then 1 spray daily
itchy roof of mouth, itchy/watery
eyes, sneezing. **Regular use (only in adults, C/I in ppl <18) is essential for full benefit and should be
used each day during hay fever season. Onset of action takes 3-4 days (i.e. not for Refer:
immediate relief of symptoms, can use decongestant (e.g. oxymetazoline) in the o wheezing, SOB, tight
interim). chest
o painful ear/sinuses
Nasal decongestant >2 o purulent conjunctivitis
Oxymetazoline (Dimetapp, Drixine, Logicin nasal sprays) 0.05%, 0.025% o failed treatment or
1. Onset and duration 1-2 sprays into each nostril up to tds prolonged symptoms
2. Symptoms
3. Previous History - Seasonal vs Do not use for longer than 5 days.
perennial allergy
4. Wheezing, chest tightness, Ophthalmic antihistamines >6 Avoid Ok if
SOB, coughing? Possible exac. of Livostin (levocabastine) eye drops indicated
asthma 1 drop into each eye twice daily

5. Secondary infection earache, Nasal antihistamines >5 No No Self Care Card:
facial pain, purulent conjunctivitis Azep (azelastine HCl) Hay fever, Sinus
6. Previous treatment? One spray into each nostril twice a day. Suitable for long term use. Problems
Sore Throat Usually self-limiting.
Majority caused by viral infection Benzydamine (Difflam) anti-inflammatory >6 Cat B2: Ok Ok
(90%); bacterial infection
(streptococcal), glandular fever, lozenges 1 lozenge every 1-2 hours as required; max 12 loz/day
herpes simplex, candidiasis and
varicella accounting for the rest. spray 4 sprays onto sore/inflamed area every 1 -3 hours as necessary
Questions about associated solution 15mL gargled/rinse for 30 secs every 1 -3 hours as needed; expectorate
symptoms will often help in Refer:
making differential diagnosis. o duration of more than 2
weeks
Viral sore throat often associated o signs of bacterial
with generalised malaise, fever, Benzocaine (Cepacaine) mouthwash >6 Ok Ok infection (i.e. marked
headache and cough. Gargle or rinse 10-15 mL for 10-15 secs and expel liquid; repeat every 2-3 hours as tonsillar exudate
necessary. accompanied with a high
temp. and swollen glands)
Streptococcal infections are more
o hoarseness >3 weeks
prevalent in school-aged children.
o difficultyswallowing
Sore throat usually accompanied Caution with hot food and drinks after use.
o recurrent bouts of
by fever, marked tonsillar exudate,
infection
tender cervical glands and no
o associated skin rash
cough.
o adverse drug reaction
(e.g. clozapine,
Paracetamol and ibuprofen sulfasalazine, drugs
provide rapid and effective relief of causing agranulocytosis,
pain in sore throat and should be inhaled corticosteroids)
used first line.
Itch/sneeze Nasal discharge Nasal blockage Impaired smell

Intranasal corticosteroids
+++ +++ ++ +
Oral/intranasal antihistamines
++ ++ +/
Intranasal decongestants
+++
Cromoglycate
+ + +/
Ipratropium
+++
+++ very effective, ++ moderately effective, + marginally effective, +/ little or no effect, ineffective

Intranasal Decongestants Indications: relief of nasal congestion associated with acute and chronic rhinitis, Safe Safe Safe
common cold and sinusitis.
Cause local vasoconstriction and
therefore decrease nasal blood Caution with: MAOI, avoid in infants <6 months as rebound congestion can cause
flow and congestion. breathing difficulty.
Adverse effects: local burning, stinging, rebound congestion with prolonged use,
i.e. > 4-5 days
Oxymetazoline (Drixine/Dimetapp 12 hour/Logicin Drixine Paediatric drops)

Adults, 1-2 sprays into each nostril up to tds
Adults, 1-2 drops into each nostril up to tds
Nasal corticosteroids Indications: allergic rhinitis, nasal polyps Safe Safe Onset within 3 7 hours,
optimal effect after
Produce local anti-inflammation, Caution with: bleeding disorder (may cause nose bleeds), recent nose surgery or several days of use
decrease capillary permeability trauma. use regularly for seasonal
and mucus production and rhinitis.
vasoconstriction. Adverse effects: local nasal stinging, itching, sneezing, sore throat, dry mouth
Budesonide (Rhinocort) 32, 64mcg >6

1-2 sprays into each nostril daily
Fluticasone (Beconase Allergy and Hayfever) 50mg/dose > 12

Initially 2 sprays daily then 1 spray daily
Nasal antihistamines Indications: allergic rhinitis >6 B3; avoid Should be In allergic rhinitis,
safe intranasal antihistamines
Caution with: local irritation, nosebleeds are as effective as oral
antihistamines but less
Adverse effects: local nasal stinging, itching, sneezing, sore throat, dry mouth effective than regularly
used intranasal
corticosteroids.
Azelastine (Azep) 1mg/mL nasal spray
1 spray bd You may feel sleepy and
the effects of alcohol may
Levocabastine (Livostin) 0.5mg/mL nasal spray be increased whilst using
2 sprays bd increased to qid prn this medication, do not
drive etc if you are
affected.

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RESPIRATORY
Cough Expectorants (productive cough) Most dry coughs are
caused by a viral infection
Coloured sputum (green or yellow Bromhexine (Bisolvon) 4mg/5mL >1 Ok Ok and are self limiting. Most
thick mucus) is suggestive of a 10-20 ml tds coughs resolve within 7 -
chest infection and should be 10 days.
referred.
Guaifenesin (Robitussin EX) 100mg/5mL >2 Ok Avoid
Do not treat productive cough with 10-20mL q4h Cough suppressants may
cough suppressant as results in cause drowsiness,
pooling and retention of mucus in Cough Suppressants (non-productive cough) constipation, n/v and
the lungs and higher chance of are C/I in respiratory
infection. Demulcents (simple linctus, sucrose and glycerol syrups), which sooth the throat by - - - failure, asthma, COPD
forming a protective layer over sensory receptors in the pharynx, are particularly useful
Postnasal drip often causes a in children and pregnancy. Caution high syrup content in patients with diabetes.
cough and is characterised by

sinus or nasal discharge that flows > 2 y.o. Ok Ok Caution in recommending
behind the nose and into the Pholcodine (Duro-Tuss Regular) syrups to diabetics due to
throat. Signs include patient 10 - 15mg 3-4 times daily children 2- high sugar content.
having to swallow mucous or 5 years:
notice they are clearing their 2.5-5mL Refer:
o cough lasting 2 weeks or
throat more often. Usually worse >2 Ok Ok
more and not improving
at night. Treat with antihistamine/ Dextromethorphan (Bisolvon, Benadryl Dry) o coloured sputum
sympathomimetic. 10 - 20mg every 4 hours or 30mg every 6-8 hours o chest pain
o SOB
A recurrent night-time cough can * Dextromethorphan is C/I within 14 days of treatment with a MAOI and should not be combined o wheezing
indicate asthma, especially in with drugs that may contribute to serotonin syndrome. o whooping cough or croup
children. Ddx from cough caused o recurrent nocturnal cough
by post-natal drip. >2 Ok Ok o suspected adverse SE
Dihydrocodeine (Rikodeine) 1.9mg/mL o failed treatment
Take 5 - 10mL every q4-6h o persistent nocturnal cough
Avoid cough suppressants in
in children
children < 2
Self Care Card:

Cold and Flu

Duro-Tuss Range: Bisolvon Chesty:
Bromhexine 4mg per 5ml (mucolytic)
Dry Cough: Pholcodine cough suppressant centrally acting, shouldnt cause Adult: 10ml tds, may be increased up to 20ml tds for the first 7 days
sedation but may in sensitive individuals
o Forte: 15mg Phocodeine/5ml Dose: 5ml q6h prn Dimetapp
o Regular: 15mh Pholcodine/15ml Dose: 10-15ml q6h prn
Chesty Cough Liquid Forte expectorant & mucolytic ADULT Range:
o Bromhexine 8mg & Guaiphenesin 200mg/10ml DM Cold & Cough Elixir:
o Dose: 10ml q4-6h prn o Brompheniramine maleate 2mg, phenylephrine 5mg, dextromethorphan 10mg
Chesty Regular Liquid Regular: Bromhexine per 5ml
o Bromhexine 12mg/15ml o Adult: 10ml q4h prn
o Dose: 15ml q8h prn Elixir:
Expectorant: Pholcodine, Bromhexine o Brompheniramine 2mg, Phenylephrine 5mgper 5ml
o Pholcodine 15mg, Bromhexine 12mg/15ml o Adult: 10ml q6-8hr prn
o Dose: 10-15ml q6h prn Chesty Cough Elixir:
o Guiphenisin 200mg, Bromhexine 8mgper 10m
Robitussin Range: o Adult: 10ml q8h prn
DX Dry Cough Forte: Cough Suppressant: INFANT Range:

o Dextromethorphan 30mg per 10ml Infant Drops
o Adult: 10ml q6-8hr prn o Brompheniramine 4mg, phenylephrine 5mg per 5ml
DM Cough & Chest Congestion: Cough Suppressant & Expectorant: o For: >1 month old
o Dextrometyhorphan 30mg & Guaiphenesin 200mg per 10ml o Dose: 0.15ml/kg q6-8h
o Adult: 10ml q6-8hr prn DM Cold & Cough Elixir:
ME Chesty Cough Forte: Mucolytic & Expectorant: o Brompheniramine 2mg, phenylephrine 5mg, dextromethorphan 10mg per 5ml
o Guaiphenesin 200mg & Bromhexine 8mg per 10ml o For: > 1 year but really cough suppression in infants NOT advisable!
o Adult: 10ml q8h prn Chest Congestion:
o Guaiphenesin 100mg per 5ml (expectorant)
Benadryl Range: For: > 1 year but really cough suppression in infants is NOT advisable
Original: Diphenhydramine 12.5mg, Ammonium Cl 125mg, Sodium Citrate 50mgper 5ml

o Adult: 10ml q4h prn
Dry Forte: Dextromethorpan 15mg per 5ml
o Adult: 10ml q6-8hrs prn
Chesty Forte: Bromhexine 3mg, Guaiphenesin 100mg per 5ml
o Adult: 10-15ml q6h prn
Nightime:
o Dextromethorphan 10mg, diphenhydramine 12.5mg per 5ml
o Adult: 10ml q4h prn

Cold and Flu SYMPTOMATIC Treatment: Rest and increase fluid
Analgesia paracetamol, ibuprofen, paracetamol/codeine intake.
Symptoms of common cold: Nasal decongestants pseudoephedrine, phenylephrine, oxymetazoline
runny/blocked nose, sore throat, Cough suppressants dextromethorphan, codeine Cough may persist after
cough, sneezing, headaches, Antihistamine doxylamine, triprolidine HCl, chlorpheniramine worst of the cold is over.
earache
see COUGH Use paracetamol for
Condition specific qns: see SORE THROAT headaches and pain.
What symptoms are you
experiencing? Which are most Sympathomimetics - constrict the dilated blood vessels in the nasal mucosa.
troublesome? C/I: heart disease, hypertension, hyperthyroidism, diabetes, MAOI use saline nasal sprays (e.g. Fess) for relief of symptoms
How long have you had these for patients in these groups.
symptoms for? Oral
High temperature for 3 days of Sudafed Sinus Pain Relief (Paracetamol 500mg, Pseduoephedrine 30mg) > 12 B2; avoid Avoid use
more? 2 tabs 3-4 times daily (max 8 tabs/day) use if not if not
Child or older person? neccessary necessary
Severe earache? Sudafed Day and Night (Day: as above, Night: as above + Triprolidine 1.25mg)
Nature of cough? Sputum colour? 2 daytime tabs twice daily, 2 nightime tabs at bedtime
Chest pain, sore throat or cough
that wont go away?
Codral products contain codeine.
*No evidence for efficacy of phenylephrine*
Treatment specific qns:
Taking any other medications? Nasal Sprays
High blood pressure, diabetes? Oxymetazoline (Dimetapp, Drixine, Logicin) 0.5 mg/mL >6 B2; avoid Avoid use
Pregnant or breastfeeding? 1-3 sprays in each nostril twice daily use if not if not
Liver, heart or thyroid disease? neccessary necessary Refer:
Asthma, stomach problems, o symptoms lasting
Nasal sprays should not be used for longer than 5 days as can cause rebound
glaucoma, prostate or congestion. greater than 10-14 days
constipation? o dry cough develops into
productive cough
o severe earache (child)
Nasal Drops
Differential Diagnosis: FLU o facial pain/frontal
Drixine Paediatric Nasal Drops 0.25 mg/mL <6
- persistent temperature of >38oC 1-3 drops in each nostril twice daily headache (sinusitis)
- at least one respiratory o very young or old
symptom present o heart or lung disease
The head should be tilted backwards; this is best achieved by lying on a bench or bed.
- at least one constitutional o persistent fever and
After instillation of drops in the nostrils, the head should be slowly moved from side to
symptom present (headache, side to enable the solution to flow over the total area of the nasal lining. productive cough
malaise, myalgia, sweats/chills, o delirium
prostration) o asthma, COPD
- rapid onset with sweats/chills,
muscular aches and pains in
limbs, a dry sore throat, cough Fess Nasal Spray (isotonic NaCl) Ok Ok Ok
and high temperature Max 8 sprays per nostril every 2-3 hours as needed. Self Care Card:
- bed bound, delirious Cold and Flu
Fess Little Noses (Nasal drops)

Asthma Inhalers
Salbutamol (Ventolin, Asmol CFC-free inhalers) 100mcg/dose, 200 doses Taking any other
Record sale in patients history to Shake well and inhale 1 - 2 puffs as required, or 5-15 minutes before exercise; repeat 3-4 times a day as necessary. medications?
enable monitoring of their use of
reliever medications which may o remove cap and shake MDI Have you seen your
indicate a worsening of their o exhale doctor (Re: asthma) in
o place mouthpiece in mouth and tilt head back slightly last 12 months?
asthma.
o start to breathe in slowly and deeply
o at the same time as breathing in press down on canister to actuate 1 puff
o continue to breathe in
How often are you finding
o hold breath for at least 10 seconds you need to use your
o breathe out slowly inhaler? More than
o if a second dose is required repeat above usual? How long does
one inhaler last you?
How is your asthma

Terbutaline (Bricanyl turbuhaler) 500mcg/dose, 200 doses control at the moment? Is
Inhale 1 - 2 puffs as required, or 5-15 minutes before exercise; repeat 3-4 times a day as necessary. it affecting your exercise
or sleep?
o remove cap
o hold upright while turning base once to the right, and then back to the left until a click is heard (dose ready for inhalation) Are you using a
o exhale away from device preventative inhaler?
o place mouthpiece in mouth and breathe in forcefully and deeply How often?
o hold breath for at least 10 seconds How are you using it?
o remove from mouth before exhaling
o if a second dose is required, repeat above
o after use rinse mouth thoroughly with water and expel Have you got an Asthma
Action Plan?
Self Care Card:

Asthma, Asthma
medications

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WOMENS HEALTH
Period pain (primary - Cat C, Ok Relieving acute pain:
dysmenorrhoea) NSAIDs can be given 1-3 days before expected menstruation and continued through avoid in Massage the lower back
first day of period. late and buttocks.
Pelvic pain occurring at or around pregnancy Lie flat on your back and
the time of menses. put a pillow under your
knees or lie on your side
Ibuprofen (Nurofen, Panafen, Advil) 200mg and bring your knees to
Age Usually occurs during teens 400 mg initially at the first sign of pain or menstrual bleeding, then 400mg every four to your chest.
and 20s six hours. Max 1,200 mg/day (6 tablets). Place a hot water
bottle/heat pack on your
Suffered this type of pain before? stomach or lower back.
How treated? Rest and warm baths
When is she expecting her period Naproxen sodium (Naprogesic) 275mg

550 mg stat, then 275 mg q6-8h as required. Max 5 tablets/day. Lifestyle modifications:
Taking any other medications? Reduce stress
Already using an NSAID? Exercise regularly
Smoking cessation
Pregnant or breastfeeding? Diet: vegetarian diet low
Ectopic pregnancy? Mefenamic acid (Ponstan) 250mg in fat, dairy products and
Two capsules (500 mg) three times daily with food. eggs with increased
Other symptoms? vegetables, raw seeds,
*Mefenamic acid blocks production of prostaglandins as well as the action of already formed and nuts shown to
prostaglandins may be useful in period pain resistant to treatment with ibuprofen and naproxen. significantly decrease
Medical conditions? Have
stomach problems, asthma, heart, pain.
kidney or liver disease, high blood Keep a diary of
pressure, arthritis or gout? symptoms so you can
plan for monthly periods.
Type of pain?
Care with NSAIDs: Refer:
-asthma, PUD, allergies o abnormal vaginal discharge
L lower pelvic/abdomen or back -Li+, anticoagulants, Warfarin, MTX, Digoxin, Antihypertensives o abnormal bleeding
I mild-severe o symptoms suggestive of 2
o
N crampy, spasmodic, ache, dysmenorrhoea

dragging o severe intermenstrual pain
D 1-24 hours and bleeding, wrong time
O occur at beginning of menses o failure of medication
Mersyndol Night Strength (Paracetamol 450mg/Codeine 9.75mg/Doxylamine 5mg) > 12 y.o. Cat A Ok o pain with a late period
C n/v, constipation, backache, relax & assist in sleeping
headache, fatigue etc (possibility of eptopic preg)
o fever
A - stress 1-2 tabs every 4-6 hours as needed; max. 8 tabs/day
R local heat, drugs
Self Care Card:
R lower back, inner thighs
Period Problems
F every month

PMS MANAGEMENT:
- refer if severe
-poorly defined complex set of - educate/treat mild MPS:
psychological & physical Smx - explain that NORMAL, lifestyle changes, tell partner (so more accepting), adequate
-relieved during menstruation excerise, healthy diet, self-help
-us ~ 2weeks
-av age: late 20s Consider possible DDx:
? due to change in E2:P ratio - renal/adrenal cause fluid retention
- mammary dysplasia breast swelling
Smx: - thyroid, PCOS, Psych disorder
-mood changes
-fluid retention, odema (abdo) TREATMENT: requires referral to Dr
-bloating, breast tenderness 1st line OCP higher doses 50mcg, progestogens
-headache, back pain/heaviness
-other: eye/skin/respiratory For Mild-Mod PMS OTC treatment & self-help may be enough:
complaints Vit B complex/Mineral supplement for 3 cycles, then
Evening Primrose Oil (2x500mg bd 3caps bd after 3/12) then,
Refer to Dr if still no improvement
Vaginal Thrush - Safe as a Safe as a Self-diagnosis is unreliable;

single dose single dose advise the woman to seek
Fluconazole (Diflucan One) 150mg tablet medical advice if symptoms
Common in women of child-
persist or recur within
bearing age. Take one capsule orally as a single dose.
2 months after using self-
prescribed treatment
Pregnancy, diabetes, antibiotics, Onset of symptom relief may be expected within one day, with complete relief possible
oral corticosteroids and OC are in 2 days.
Treatment of sexual partner
strong predisposing factors. is not necessary as vaginal
Diflucan Duo contains 1 capsule and a tube of antifungal cream which can be applied candidiasis is not sexually
Signs and symptoms: twice daily, morning and night, to vulvovaginal and perianal area for external vaginal transmitted
Intense itchiness or soreness itch or irritation.
around vagina. Vaginal antifungals may be
Vaginal discharge that is thick, used during pregnancy; use
white (curd-like) and odourless. - Safe Safe a 1-week course; vaginal
Dysuria (burning around outside of applicators may be used with
vagina wen passing urine). Clotrimazole care in late pregnancy but
Dyspareunia (painful intercourse). Canesten Pessary (6 Day), 100mg Insert one pessary into the vagina at night for 6/7 digital insertion may be
Erythema and/or oedema of vulva. Canesten Pessary (1 Day), 500mg Insert one pessary into the vagina at night preferable.
The tablets should be inserted as deeply as possible into the vagina once daily,
preferably in the evening. They may also damage
DDx: Bacterial Vaginitis contraceptive diaphragms
Unpleasant musty or fishy vaginal Canesten Cream (6 Day), 1% Insert one applicator full into the vagina at night for 6/7 and latex condoms (but not
odour, exacerbated immediately Canesten Cream (3 Day), 2% Insert one applicator full into the vagina at night for 6/7 polyurethane condoms).
after intercourse. Canesten Cream (1 Day), 10% Insert one applicator full into the vagina at night for 6/7
Refer:
Thin grey-white vaginal discharge. One applicator should be filled with cream and inserted as deeply as possible into the
o first time infection
vagina with the patient lying on her back. Can be applied externally as well. o pregnant
o diabetic
Taking any other medications? Canesten Clotrimazole Thrush Treatment Once Pessary + Cream (Combination pack) o >2 attacks in previous 6
Diabetes? months
o contact/history of STD

Pregnant or breastfeeding? - - - o patients <16 or >60
Pelvic or lower back pain? Keep genital area clean; use plain, unscented soap. o abnormal or irregular
More than 2 attacks in last 6 Take showers rather than baths vaginal bleeding
o blood staining of vaginal
months? Wear cotton underpants with a cotton crotch. Avoid synthetic and nylon underwear and
discharge
Yellow, green or smelly discharge? tight-fitting jeans or pants. o vulval or vaginal sores,
First time infection? Sleep in loose gown without underpants. ulcers or dysuria
Diagnosed by a doctor? Thrush thrives in warm, moist environment avoid prolonged wear of wet clothing, o no improvement within 7
Patient <16 or >60? especially a wet bathing suit or exercise clothing. days of treatment
After urinating or bowel movements, cleanse by wiping from front to back (vagina o suspected bacterial cause,
toward anus). i.e. vaginal discharge has
Self Care Card: Lose weight if obese, and maintain euglycaemia in diabetic patients. an unpleasant odour or is
Thrush yellow or greenish.
Delay sexual relations until the symptoms clear/discomfort resolves.
Drink Yokult.
Cystitis Non-pharmacological - - - OTC treatments should

only be used for mild
1. drink large amounts of water (5L/day) to help encourage bladder voiding and flush
Inflammation of the bladder cystitis of short duration
out bacteria in bladder
mucosa. (<2 days) or until patient
2. void bladder immediately before and following sexual intercourse
can consult a doctor.
3. reduce coffee and alcohol intake as tend to irritate bladder in some people
4. ensure bladder is completely empty by waiting 20 seconds after passing urine and
Signs and symptoms: then train to empty final drops; after each bowel movement toilet paper should be
Burning during urination wiped from front to back to minimize transfer of bacteria from the bowel into the
Pain during urination Refer:
vagina and urethra o men, children, elderly
Urgency 5. drinking unsweetened cranberry juice may help prevent and treat UTIs by inhibiting o pregnancy
Frequency bacterial adherence to the bladder epithelium o diabetic
Sensation of incomplete bladder o fever, nausea/vomiting
emptying Ural (sodium citrotartrate) 4g Refer No Avoid o loin pain, tenderness
Blood in urine Dissolve 1-2 sachets in cold water 4 times daily. o haematuria
Lower abdominal pain/cramping o vaginal discharge
Cloudy, odorous urine o duration of longer than 2
Nocturia days
Urinary alkalinizers can help relieve the symptoms of mild cystitis.
Itching/pricking sensation of o recurrent cystitis
*avoid in patients with hypertension, heart disease, renal impairment or pregnant women
o failed medication
urethra

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PREGNANCY /BREASTFEEDING
Nutrition & General Health Pre-conception & During pregnancy: - - - Many pregnancy multi-
advice during Pregnancy - folic acid 500mcg before conception and for first three months of pregnancy (reduces vitamins available.
risk of neural tube defects eg. Spinda-bifida)
- ? any medications discuss plans to become pregnant with dr Elevit or Blackmores is
- consider a change of lifestyle if smoker, alcoholic, heavy caffeine consumer recommended
- healthy lifestyle & food recommendations
- careful when starting any new mx always check with Dr/pharmacist
Pregnancy:
Foods to AVOID:
- soft cheeses eg. Brie, Camember, Ricotta Listeria
- cold meats eg. From Delis/supermarkets - Listeria
- uncooked or smoked seafoods & shellfish Mercury, Listeria, almonella
- precooked or prepared cold foods e.g. salads, deli meats
- dried/fermented sausages eg salami
- soft-serve ice cream
- pate
- raw meat, eggs Salmonella
- caffeine safe in moderation
- alcohol
- unwashed vegetables Toxoplasmosis
- high sources of vitamin A
Listeria: a bacteria found in some foods. In pregnancy listeria can cause miscarriage,
stillbirth or premature labour. Early signs of listeria: fever, flu-like Smx. Mc aches,
general malaise
Should eat: well balanced & healthy diet fruit, veges, grains, fats, protein etc
May need Fe supplementation:

- mane best absorption & with vit C
- after food to reduce GIT upset
constipation problem in pregnancy (need to manage)

Back pain in pregnancy - - -
Paracetamol is treatment of choice, 1-2 tablets qid prn Avoid NSAIDs during
pregnancy, especially in
Common complaint, caused by Can use codeine but avoid close to term as may depress respiration in the newborn, 3rd trimester as there is
strain on the muscles of the back and exacerbate any constipation. increased risk of closure
as the uterus enlarges and grows of fetal ductus.
forward. Non-pharmacological treatment:
o do not stand or sit in same position for too long
o rest when pain is severe, sitting or lying with the legs raised
o support the back with a pillow when sitting
o wear flat shoes
o when picking up anything heavy (incl. children) take the strain on the legs instead of
the back
o combination of appropriate exercises to strengthen back, and sufficient rest
o a heat pack or massage may be helpful
o soak in a warm bath
o some women wear maternity belts
o may wish to consult a physiotherapist
o watch weight gain
Constipation Non-Drug Options - - -

- plenty of fluid and exercise
Common esp in later pregnancy - increase amt of fibre (however ONLY after acute bout of constipation has been
Due to baby pressing on the relieved)
bowel, dehydration, need of Fe - healthy food: high fibre, whole grains, apples/pears, kiwi fruit (good to eat skin)
supplementation - fibre supplementation: Metamucil, psyllum
Check: Drug treatment:

? blood in stools 1st line Coloxyl (stool softener) or Lactulose
? haemorrhoids (Lactulose takes 1-2 days onset of action, need to take regularly,
? antacids (Ca2+) excessive use Dose: 15-45ml for 3 days then reduce dose may be used as maintenance dose)
may be contributing to
constipation Note:
-sennosides (e.g. senna) should be avoided! (stimulation of labour)
- bulking agents cause bloating and wind only use after bowel actions have
returned back to normal

Reflux Antacids Cat A 1st line choice safe & effective Refer Cat A Ok Other measures:
-smaller meals
WHY? Mylanta Original (AlOH, MgOH, Simethicone) -remain upright during &
-foetus pressing on stomach 10-20mL prn up to 4 times daily after eating
loosen sphincter stomach -avoid spicy foods that
contents reflux up burning *contain high amounts of Na so avoid in patients on sodium-restricted diet may ppt reflux
sensation = reflux *Al constipation, Mg diarrhoea -raise bed head
*Avoid use within 2 hrs of taking other medications -avoid fizzy rinks
*NB:// some pxs are concerned about the Al & Alzeheimers claim reassure that the -avoid eating before bed
When questioning, exclude any results of the study were later proven incorrect. Safe to use*
other causes of indigestion
? pain in arms Ranitidine Cat B1 ONLY if Dr has prescribed it!!!! DONT recommend
? vomiting
Nocturnal muscle cramps in Recommendations - - -

legs
1. Increase fluid intake mc cramps could be due to dehydration
- common later in pregnancy due 2. Heat packs and massage the legs before bed time
to electrolyte imbalances 3. Stretching, loose clothing, flat shoes
4. Magmin: 1-2 tablets daily (Cochrane review)
nb:// Mg may cause constipation!

Pruritis in Pregnancy Management: - - -
-develops from 3rd month onwards 1) Shower oils/soap alternatives see eczema section
-due to oestrogen cholistasis 2) Moisturisers eg. QV, Dermaveen, Sorbolene cream see eczema section
build up of bilirubin pruritis 3) HC 1% (Dermaid, sigmacort) to relieve itching
4) Sedating antihistamine:
- Dexchlorpheriamine (Polaramine) Cat A
- Chlorpheniramine (Avil) Cat A
- Cyproheptadine (Periactin) Cat A
Morning Sickness - - -
Ginger: MAX: 1g daily high doses increases coagulation of blood Monitor mum for
Persistent vomiting in a pregnant symptoms of dehydration
woman that interferes with fluid (e.g. rapid pulse, low BP,
and electrolyte balance, as well as sunken eyelids, reduced
nutrition. Pyridoxine (Vitamin B6); 50mg bd-tds. Max: 100-150mg/d (exceeding this max dose skin turgor, cool skin,
can lead to peripheral neuropathy tell px NOT to incr dose even if not helping) deep/increased
Particularly bad in first trimester respirations).
and effects 70-80% of women.
Acupressure bands (e.g. Sea-band) worn on the wrist may be of benefit and are Can recommend a
unlikely to be harmful. rehydration solution if

Symptoms usually begin ~ 2 patients feels they can
weeks after first missed period. Changes to dietary or daily habits can help relieve morning sickness (the idea is to stomach it.
keep the stomach neither too full or too empty, both of which can exacerbate nausea):
o eat small frequent meals (4-6 daily) to maintain blood sugar levels- dont wait until
you are hungry
o eat a diet high in carbohydrates & protein (fruit, cheese, eggs, beef, poultry,
veges, toast, rice) and low in fat
o avoid large meals and greasy, highly spicy meals
o for nausea in the mornings- keep sweet biscuits by bedside to eat when you first
wake and after eating one or two, rest for about 20 mins before getting up
o drink plenty of water & fruit juices but avoid alcohol and large quantities of tea,
coffee or milk
o suck barley sugar, boiled sweets or peppermints when travelling
o drink liquids between rather than with meals to avoid bloating which can trigger
vomiting
o slowly sip a fizzy drink when feeling nauseated, or eat ice chips
o ginger or peppermint tea may be helpful
o if nausea is worse late in the day, prepare the main meal in the morning (or the
night before)
o keep rooms well ventilated and odour free
o relax, rest and get into the fresh air as much as possible
Breast & Nipple Thrush If confirmed by dr that nipple thrush: - - -
- Overgrowth of candida on Nipples: miconazole gel or nystatin cream applied after each feed
nipples/breast Oral treatment for mother: nystatin 500,000 U/tab 2 tab tds
- significant amount of pain Babys mouth: miconazole gel qid for 7 days then once daily
Smx:
Nipple: burning, itching, pain, Possible SEs:
stinging, pink, dry, flaky Mother: gel may irritate the skin
Breast: shooting, stabbing, deep Baby: gel may cause babies to gag or vomit consider changing to nystatin drops
aching breast pain. Uni/bi lateral
pain
Problems with lactation Herbal preparations used to increase breast milk production (galactagogues) - - -
- caffeine, hops, fenugreek, fennel seek, blessed thistle, alfalfa traditionally reported
to increase breast milk BUT little data support their efficacy & safety
- be cautious when recommending herbal preps
Drug S4 therapy:
- Metoclopramine & Domperidone

Mastitis Early management: - - -
- maintain breastfeeding
-inflammation of the breast may - analgesia: paracetamol
be an infective cause
Smx: In this situation REFER in case of infection
Breast: erythema, pain, odema,
swelling, lump
General: fever, lethargy, nausea,
anxiety, headache

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PAIN
Musculoskeletal pain Pain not relieved within 5
Ibuprofen (Nurofen) 200 mg tabs, 5% gel 5-10mg/kg Cat C; Avoid use as days of OTC treatment
RICE q6-8h avoid use as excreted in should be referred to Dr.
oral: 1 2 tablets three times a day before food, max 6 tablets (1200mg) daily may cause breast milk
Rest; avoid activity promoting
bleeding and blood flow topical: rub 4 10 cm of gel into affected area until absorbed every 4 hours prn, closure of Topical analgesics should
fetal ductus
Ice; to reduce swelling and pain, apply max. 4 applications/day be kept away from the
arteriosus
every 2 hours for 20mins for the first eyes, mouth and mucous
48 hours. Not directly on skin but in Diclofenac (Voltaren Rapid 25, 50) membranes and should
wet towel, plastic bag etc Children >12 not be applied to broken
Compression; reduces pain and oral: 100-150 mg/day in 2-3 divided doses. Take with food. months;
skin.
swelling as well as providing support 1mg/kg tds
for injured part
topical: rub gel gently into affected area 3-4 times daily. Do not use for longer than 2 Refer:
Elevate; reduces bleeding, swelling
and pain raise above level of the weeks o suspected fracture
heart. o possible adverse drug

reaction; falls in elderly,
Avoid any HARM Have asthma? Stomach ulcers? Other meds? unexplained bruising
Heat; increases bleeding o head injury
Alcohol; increases swelling o medication failure
Running; avoid exercising too soon Deep Heat (methyl salicylate, menthol) >5 Ok Ok o arthritis
Massage; or use of heat rubs in first Apply and massage 2-3 times daily; or before, during and after sporting event. o severe, persistent back
48-72 hours increases swelling and pain
bleeding Avoid contact with eyes or mucous membranes. Do not apply to broken skin or sensitive areas o back pain (and/or pins
and needles/numbness)
Paracetamol (Panamax, Panadol) 500mg Ok, Ok Ok radiating down legs
Avoid NSAIDS within 48 hours of reduced
injury as increases bleeding and Adult/Child >12, 1 2 tablets every 4-6 hours prn, max. 8 per day. dose Self Care Card:
swelling. Child <12, 15 mg/kg every 46 hours (max 60 - 90 mg/kg daily) Pain Relievers, Sprains
and Strains

Headache Avoid trigger factors:
Paracetamol (Panadol, Panamax, Panadeine-15) 500mg Refer <12 Ok Ok - stress, tension, anxiety
Most common are tension Take 1 - 2 tablets qid prn (max. 4g daily) - caffeine, alcohol, smoking
headache, migraine and sinusitis. - fasting, delaying or missing
meals
Tension headache; bilateral - bright or flickering lights
feeling of heaviness, pressure or Ibuprofen (Nurofen, Panafen) 200mg Refer <12 No No - strong fumes/smells
tightness that extends like a band Take 1 - 2 tablets tds (max. 1200mg daily) - anything else associated
with onset
around the head. Can affect
upper part of neck also. Self care:
- keep a headache diary
Migraine; recurrent episodes of Anagraine (metoclopramide 5mg, paracetamol 500mg) Refer <12 Ok Ok detailing times migraines
throbbing head pain, often Take 1-2 tabs at first sign of migraine; repeat every 4 hrs if needed, max 6 tabs in 24 occur, drugs and dosages
unilateral (frontal, occipital or hrs. ( adult dose for children 12-17yo) used, response to
hemicranial). Swaps sides btwn treatment and what may
attacks. Pain is severe and limits have triggered attack
or stops activity and is usually Mersyndol (paracetamol 450mg, codeine 9.75mg, doxylamine 5mg) Refer <12, Ok Ok, watch - practice relaxation exercise
associated with nausea, vomiting Take 1 - 2 tablets every 4-6 hours prn (max. 8 tabs/day) ok if >12 for - exercise regularly
and/or photophobia. Relieved by sedation in - eat a well balanced, regular
lying in a dark quiet room. May be child diet
preceded by aura (usually visual - drink plenty of water
disturbances such as flickering - get adequate sleep
lights, zigzag lines, loss of part or
Refer headache:
all vision). Initiate treatment at first
o children <12 and adults
signs of migraine. with new sx >50
o assoc. with injury/trauma
Sinusitis; associated with an upper o severe and last >4hrs
respiratory tract infection o severe occipital headache
(across back of head)
Cluster; orbital pain often worse at o worse in morning then
night and associated with improves

o associated drowsiness,
conjunctivitis and nasal
visual disturbance or
congestion on the same side of vomiting
the head as the headache refer o neck stiffness
o frequent migraines
o OTC treatment resistant
o medication induced (e.g.
Age? pill)
Nature? o starts after exercise, sex,
Duration? straining or coughing

Other medications/medical
problems? Self Care Card:
Trauma? Headache, Migraine,
Previous history/treatment? Relaxation Techniques,
LINDOCARRF Pain Relievers, Sinus
Problems

Insect bites For a mild reaction: - - -
o wash the area with soap and cool water
Often present as an itchy wheal o apply ice in a cool, wet cloth to reduce swelling
that develops into a firm, itchy o apply an anti-itch preparation (see below); can use an antihistamine for additive
papule. relief from itch

Eurax (Crotamiton) cream 1st line Ok Ok Ok
Apply gently to affected area 2-3 times a day.
Mild reactions can be treated
successfully with OTC products Stingose (Aluminium sulfate) solution Ok Ok Ok
whereas moderate-severe Apply promptly and liberally to affected area(s) prn.
(including those with sx of
bacterial infection) require referral Soov Bite (Cetrimide, lignocaine) > 2yrs Ok Ok
to doctor. Dab onto affected skin up to 4 times a day.
Paraderm Plus (chlorhexidine 0.1%, lignocaine 1%, bufexamac 5%) Cat A

- antisepetic, anaesthetic, anti-inflammatory & soothing
- apply tds/qid
Bruising Hirudoid (cream) & Lasonil (oint) Herparinoid - - -

- for bruises, swelling, treatment of scars and various inflammatory conditions of the
Determine reason i.e. injury, viens
warfarin (?over-anticoagulated) - Dose: thin layer to affected area bd or tds prn
- DONT apply to open wounds or use when bleeding occurs or infected
Need a FULL medical Hx
Arnica Ointment - Treatment of bruises, sprains and assoc swelling.
Apply freely to affected areas
Tennis Elbow - - -
Cause:
- Over use of the muscles and tendons in the forearm.
To Dx: Get them to make a fist - if it hurts in the forearm, then it is tennis elbow!
Management/Treatment:
- Elastic support bandage
- Relative rest with reduction of aggravating activities
- Ice area for 10 minutes twice a day
- NSAIDS for short term relief

(ok in)
MISCELLANEOUS
Nicotine Replacement Patches Counselling:
16-hour patches (Nicorette) Tell pharmacist if experience any unpleasant
Therapy
*preferred if sleep disturbance is troublesome side effects as it may mean that dose
5 mg/16 hours, 10 mg/16 hours, 15 mg/16 hours adjustment is necessary.
Store and dispose of products carefully and

NRT relieves nicotine withdrawal 24-hour patches (NicabateCQ, Nicabate CQ Clear, Nicotinell, QuitX) out of the reach of children as can be fatal. In
*best for morning cravings
symptoms (craving, anxiety, particular patches still contain nicotine and
7 mg/24 hours, 14 mg/24 hours, 21 mg/24 hours are dangerous to children and pets.
agitation, irritability and hunger)
allowing the smoker to
Do not continue smoking whilst using these
concentrate on psychological
Moderate-high nicotine dependency: products as increased amount of nicotine
aspects of quitting. can produce toxic effects, such as feeling
Apply 1 patch daily of either 21 mg/24 hours OR 15 mg/16 hours. Stop within 12 weeks
sick, vomiting, palpitations and chest pain
Low-moderate nicotine dependency:
Apply 1 patch daily of either 14 mg/24 hours OR 10 mg/16 hours. Stop within 12 weeks Non-drug Counselling:
- contact support services such as Quitline
Apply to a different skin site each day, on a non-hairy, clean, dry site on the upper body or outer part of the arm. or community based groups for extra
High dependence: waking at night
to smoke or smoking within first 5 support and tips
Recommended progression: Step 1 (21mg/24 hours) for 6 weeks, then Step 2 (14mg/24 hours) for 2 weeks, then - avoid situations which were previously
minutes of waking, usually >30
Step 3 (7mg/24 hours) for 2 weeks associated with having a cigarette
cigarettes a day
- carry a pen or gum for hand-to-mouth
May cause local irritation (can be treated with topical corticosteroid). C/I in patients with eczema. movement
Moderate: smoking within 30
- carry small snacks such as carrot sticks
minutes of waking, usually 20-30 or lollipops
cigarettes per day Lozenge (NicabateCQ)
2 mg, 4 mg - regular exercise and may help you quit
and also avoid putting on weight
Low-moderate: not needing to - smokers who plan before they quit and
smoke within the first 30 minutes Moderate-high nicotine dependency, use 4 mg lozenges; low-moderate nicotine dependency, use 2 mg lozenge
set a date are more successful
of waking, usually 10-20 cigarettes - when you get the urge remember the 4
Weeks 1-6: 1 every 1-2 hours, up to 15 in 24 hours Ds; so something else, delay, deep
Low dependence: no needing to Weeks 7-9: 1 every 2-4 hours breathe, drink water
smoke withing the first 30 minutes Weeks 10-12: 1 every 4-8 hours - if you have a cigarette it is not the end of
of waking, usually <10 cigarettes a Weeks 12-24: take when needed to maintain abstinence your quit attempt but rather a setback
day
Dissolve lozenge in your mouth when feel urge to smoke, do not chew or swallow it. It takes half an hour to dissolve;
do not eat or drink in this time. Practice points:
Severe addiction or continual NRT failure
use patch and 2mg gum together.
Note: can use sublingual tablets (Nicorette Microtab, 2 mg) in same way Strict dosing reduces cravings more than prn
doses.

1. Number of cigarettes smoked a Gum (Nicorette, Nicotinell, QuitX) Continue for 12 weeks (6-8 weeks for most
day? 2 mg, 4 mg people), including the taper period. May
2. When they are smoked (how Hgh nicotine dependency, chew 10 15 pieces daily. Avoid use of >1 piece/hour. After 4-8 weeks reduce to 2 mg, require longer for some.
soon after wakening? then stop or taper use over a further 4 weeks.
3. Previous attempts to quit? C/I: recent MI, cerebrovascular event,
4. Confidence and motivation to Moderate nicotine dependency, chew 8 12 pieces of 2 mg gum daily arrhythmias
quit?
5. Recent MI, cerebrovascular Chew gum until tingling or peppery/bitter taste and then park it between the cheek and upper gum. When tingling
event, arrhythmias? stops, rechew and park; repeat for total of 30 minutes. Pregnancy/breastfeeding:
Try behavioural therapy first. NRTs are
Avoid swallowing saliva/gum (can cause indigestion) and eating or drinking whilst using gum. category D or C but often level of nicotine is
less than from cigarettes refer for doctor to
*max. 20 x 2 mg or 10 x 4 mg per day calculate risk/benefit ratio.
NRT only indicated for people >16 C/I in patients with dentures.
Gum and lozenges contain large
years of age.
Note: microtabs amounts of Na+ so use with care in
Microtabs (Nicorette) patients on sodium reduced diets.
2 mg
Place 1 or 2 tablets under the tongue every 12 hours according to craving or withdrawal symptoms, for 8
12 weeks. Then gradually reduce use over next 4 weeks to zero. Maximum dose 40 tablets (80 mg) daily. Self Care Card: Smoking, Nicotine
Place 1 or 2 tablets under the tongue and let them slowly dissolve over about half an hour. Avoid chewing or Replacement Therapy
swallowing the tablet.

Orlistat
Xenical Important for patients to have realistic
Lifestyle changes including Take one (120 mg) capsule with, or within 1 hour, your 3 main meals. Do not take a dose if you miss a meal or if it goals. Average weight loss of 10% in
increased physical activity, eating does not contain any fat. one year which is great for
behavioural modification and fat cardiovascular health etc. but often not
and calorie restricted diet are first satisfactory for those seeking cosmetic
line and must accompany Counselling: sliming.
treatment with orlistat. this medication may cause fatty stools (flatus, faecal urgency, loose oily stools); more likely to occur when your
diet is too high in fat
Only indicated in obese patients it is important that whilst taking this medication you continue to practice caloric restriction with a diet high in fruit Not appropriate in pregnancy or
with BMI >30 or >27 with other risk and vegetables, increase physical activity and eating behaviour modification breastfeeding.
factors e.g. hypertension, whilst taking this medication, it is recommended that you take multivitamin supplements containing the fat-
diabetes, hyperlipidaemia. soluble vitamins A, D, E, K supplement should be taken 2 hours apart from orlistat D/I: For patients on warfarin, may
increase INR as reduces the absorption
of vitamin K monitor INR closely.
Tried lifestyle changes? Decreases plasma concentrations of
BMI? cyclosporine and amiodarone.
Take any other medications?
warfarin, amiodarone C/I: pancreatic enzyme deficiency,
Pancreatic problems? major GI surgery, malabsorption
Gallstones? syndrome, cholestasis
Stomach problems or vitamin
deficiency? Increased risk of disease associated with a
Recent GI surgery? waist circumference of 102 cm in men and
88 cm in females.
Kidney stones?
Diabetes, high blood pressure or Meal replacementhypocaloric preparations
cholesterol? (eg Optifast) may cause weight loss in the
Pregnant or breastfeeding? short term, but weight is usually regained
Under 18? when treatment is stopped.
Self Care Card: Weight & Health

Emergency Contraception
1. When did you last have unprotected sexual intercourse? Within previous 72 hours? Patient Counselling
Levonorgestrel (Postinor-2) o The first tablet should be taken as
2. Already pregnant or previous unprotected intercourse >72 hours earlier in same menstrual cycle? soon as possible after unprotected
Should not be taken due to a lack of benefit rather than any risk to the pregnancy (i.e. will not terminate an existing pregnancy). intercourse. Take the second tablet
Patient should consider a urine pregnancy test if unsure. 12 hours later (if safe can delay first
The effectiveness of EC
decreases with the time taken dose if necessary for convenience)
3. Unexplained vaginal bleeding? Current/history of breast cancer?
since unprotected intercourse:
Refer If vomiting occurs within 2 hours of
<24 hours = 95% o
24-48 hours = 85% taking a tablet, an additional tablet

4. Severe liver disease? will need to be taken
48-72 hours = 58% Refer
note: the overall failure rate when EC o You need to use a barrier method of
5. High blood pressure, diabetes, heart disease or history of stroke/DVT?
is taken within 72 hours is <2% contraception until the onset of your
Refer
next period
6. Taking any other medications?
Drugs including anticonvulsants (phenytoin, carbamazepine), St Johns wort, rifampicin, griseofulvin may reduce the efficacy of o Your next period should occur around
EC. May interact with warfarin to raise INR. Refer the anticipated date but can occur
one week before or after that time
7. Stomach problems? consult your doctor if menstruation
Diarrhoea, vomiting or other causes of malabsorption (Crohns disease, IBS etc) may reduce absorption and thus efficacy of EC. does not occur within one week after
Refer the anticipated date (or 3 weeks after
taking EC) or if the period is lighter
8. Pregnant or breastfeeding? than normal or intermittent
ADEC category D and should not be used during an existing or expected pregnancy. Levonorgestrel is excreted in small amounts
into breast milk and should be fine in breastfeeding but for those concerned, can avoid breastfeeding child for 3 days (continue to o If pregnancy occurs after taking EC,
express to keep up the milk supply but discard the milk). consult your doctor and let them
know that you used the EC
9. Under 16? (increased risk of ectopic pregnancy)
Refer
C/I: current pregnancy (last period
was late or lighter than usual), o Common side effects include nausea
10. Used emergency contraceptive before?
unexplained vaginal bleeding, and vomiting, breast tenderness,
Need to discuss regular long-term methods of contraception with their doctor.
current breast cancer, allergy to vaginal bleeding and headache
levonorgestrel

Travel Health Deep Vein Thrombosis (DVT)
DVT is the formation of clots in the deep veins of the leg which Prevention: Visit the
Some simple precautions include: may result in life-threatening embolisms. Exercise ankles and calf muscles every half hour. www.smartraveller.gov.au
seek specialist travel health advice website for travel
before travelling Symptoms (usually post flight): Keep legs straight, do not sit cross-legged. information.
- often no symptoms
Take a spare pair of glasses. - leg pain, swelling and redness Drink plenty of water or juice but AVOID alcohol and caffeine-
- a mild ache or tenderness in one or both legs, particularly in containing drinks.
If you are planning to carry the calves
medications overseas contact the Consider using pressure stockings.
embassy of the country(s) you Risk factors:
will be visiting to ensure your - sitting or lying still for long periods of time without moving
medicines are legal there. Carry legs (e.g. flying)
a letter from your doctor listing - taking hormone therapy (OC, HRT)
the medicines, how much you will - personal/family history of DVT or blood clotting disorder
be carrying and that they are for - smoking
your personal use. Leave in - pregnancy
original packaging. - obesity
- >40 y.o
Consider purchasing health and
Jet Lag
travel insurance.
An upset of a persons biological clock caused by travelling Prevention:
across several time zones in a short period of time and is If possible break the trip up by including stopovers.
Always carry a first-aid kit.
dependent on how many time zones crossed and which Try and plan for arrival at destination around bedtime
direction travelled, east or west(better). Set your watch to the local time of the destination and eat/sleep
Wear a Medic Alert bracelet or
according to this destination time during the flight.
necklace if you have a serious
Symptoms include: Eat light, healthy meals and drink plenty of water. Limit alcohol
medical condition or allergy.
- being alert, sleepy and hungry at the wrong times and caffeine-containing beverages.
- anxiety, feeling disorientated Wear loose, comfortable clothing during the flight and try to
Whether or not you are male or
- forgetfulness, poor concentration sleep during longer legs of the flight a mild sleeping tablet
female take condoms with you
- headache may help.
rather than relying on those
- weakness, irritability, tiredness, disturbed sleep
bought locally. Always follow safe
sex practices. Remember that
Travellers Diarrhoea (TD)

the pill does not protect against Illness caused by consuming contaminated food/water. Prevention:
STDs and that medicines used to Commonly causes stomach cramps, pain or bloating, frequent Drink small amounts of fluid often.
treat travellers diarrhoea and runny diarrhoea, nausea and vomiting, fever, bloodied stools. Drink only boiled, canned or bottled drinks do not add ice.
prevent malaria can reduce Avoid shellfish and cold cooked meats.
effectiveness of OC. Dont eat fresh salads, raw vegetables or cut fruit if you cant
peel it, cook it or boil it, dont eat it!
Avoid contact with animals. Avoid eating anything washed in local water.
Avoid unpasteurised dairy products
Choose safe modes of transport Wash your hands before meals and dry them with your own
towel or allow to air dry. Can use a chlorhexidine gel.
Wear shoes and sandals. Use bottled water to brush teeth and avoid swallowing water
whilst showering or bathing.
Avoid getting tattoos or body
piercing. Treatment:
Symptomatic treatment as appropriate. May include use of a
Avoid illicit drugs. rehydration agent (Gastrolyte), antidiarrhoeal drug
(loperamide), antiemetic (metoclpramide) or antispasmodic
(hyoscine). If symptoms severe or last longer than 48 hours,
seek medical advice.
Malaria
Malaria is a serious disease caused by a parasite that infects Prevention:
red blood cells. Avoid exposure to mosquitoes from dusk to dawn
- use mosquito nets treated with insecticide (e.g. permethrin),
Symptoms often occur several weeks after returning air-conditioning, mosquito coils etc
from/leaving affected areas and typically include; - wear light-coloured clothing covering arms, legs and ankles
fever, malaise, chills, headache nausea when outdoors and especially after sunset
- use a DEET insect repellent at regular intervals
Patient presenting with febrile illness within 12 months of travel
in endemic areas should be referred for immediate medical
attention. Prophylaxis:
Doxycycline 100mg daily; taking 2 days before entering, and Self Care Card:
continue for 24 weeks after leaving, an endemic area. Travel Health, First Aid,
Maximum recommended course 6 months. Vomiting and Diarrhoea,
Sense in the Sun,
Ensure you have enough medication to last full trip HIV/AIDS

Sleep Advice on sleep hygiene - - -
Encourage Sedating antihistamine
Important to differentiate between - address underlying causes should not be used to aid
different types of sleep problems; - regular bedtime and waking time sleep for longer than 7-10
difficulty falling asleep, waking - regular daytime exercise days.
during the night, early morning - creating a comfortable temperature and quiet environment for sleep
waking, poor sleep quality, snoring - taking a hot bath before bedtime Commonly cause
- having a warm milk drink before bedtime anticholinergic side-
- get up if you cant sleep and sit in another room until feel more sleepy effects (dry mouth,
Duration? constipation, blurred
Avoid vision, tinnitus).
Previous history? Treatment?
- avoid large meals, excessive alcohol, smoking and drinking caffeine-containing beverages
Contributing factors? Recent
close to bedtime note: sedating
stress?
- daytime napping antihistamines can cause
Taking any other medications?
- strenuous exercise close to bedtime paradoxical excitement,
- use bedroom for sleeping and sexual activity only restlessness or nervousness
- pets and clocks in the bedroom especially in children or
elderly
> 12 Ok Ok
Diphenhydramine (Unisom Sleepgels) 50mg
1 capsule at bedtime
Questions when supplying
sedation antihistamines: Refer:
>2 No No
Recommended by a doctor? o suspected depression
Promethazine (Phenergan) 10mg, 25mg, 5mg/5mL
Used them before? o chronic problem (longer
adults 25-75 mg at night
Taking any other medications? than 3 weeks duration)
children 6-12 yrs: 10-25 mg at night; 2-5 yrs: 5-15 mg at night.
Glaucoma, prostate or thyroid o children <16
problems? o irrational insomnia
Peptic ulcers or epilepsy? > 12 Cat A; but No
Liver disease? Doxylamine (Restavit) 25 mg avoid use
Pregnant or breastfeeding? One or two tablets twenty minutes before bed.
Child or elderly? Restavit should not be used for more than ten days consecutively.
Avoid Avoid: no Avoid

Valerian (Blackmores Valerian Forte) trials Self Care Card:
1 tablet before bedtime Sleeping Problems
- - -
Nasal plasters for snoring
ORAL ANTIHISTAMINES
Contraindications: in children < 2 because of link with SIDs (sedating antihistamines)
Adverse effects: sedating sedation, dizziness, blurred vision, n/v, constipation, dry mouth, incoordination i.e. Anti-SLUD
non-sedating drowsiness, fatigue, dry mouth, headache, nausea

Less-sedating Used only for allergic disorders (allergic rhinitis and conjunctivitis, chronic urticaria). Safe to use Zyrtec (cetirizine) most
They penetrate the bloodbrain barrier poorly and so have a reduced incidence of likely of less-sedating
sedation; anticholinergic adverse effects are reduced due to poor affinity for muscarinic antihistamines to cause
receptors. They have similar efficacy to the sedating antihistamines but are often better sedation.
tolerated. Most are long acting and can be taken once daily.
Loratadine (Claratyne) 10mg tabs, 1mg/mL B1, prefer

Take one tablet daily. sedating
anti-Hs
Child 2-12yo, 5mg d
1-2yo, 2.5mg d
Fexofenadine (Telfast) 30 (child), 60, 120 (rhinitis), 180 (urticaria) mg

Take one tablet daily.
Child 6-11, 30mg bd
Sedating Antihistamines Used in allergic disorders, motion sickness, vertigo, itch associated with skin disorders, >2 This medication may
nausea, and for sedation including premedication. They commonly have anticholinergic make you sleepy; don't
and CNS adverse effects (drowsiness). Many are short acting but some, drive or operate
eg promethazine, act for up to 12 hours. machinery if this
happens. Avoid alcohol
Dexchlorpheniramine (Polaramine) allergy only Cat A Short term and other medication
2mg tablets 2 mg qid 6 - 12; 1mg which may cause
6mg CR tablets 6 mg bd, swallow whole qid sedation.
0.4mg/mL syrup 0.04mg/kg/dose tds 2-6
Promethazine (Phenergan) sedation, allergy and nausea

10, 25mg tablets 25 75mg daily OR 10 25mg 2-3 times daily >2 Cat C Short term
1mg/mL elixir >2 yrs: 0.125mg/kg tds

OTC Table

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Lloydy and Rachelles

5-Minute OTC Consult for Trainee Pharmacists

Michael Lloyd and Rachelle Downie 2007 1

Michael Lloyd and Rachelle Downie 2007 2

GASTROENTEROLOGY & GENITOURINARY

EAR, NOSE & THROAT

Patient Problem Treatment Children (ok in) Pregnancy Lactation Other

3.Check for burrows? small, o infected skin (weeping

raised bumps under skin, may yellow discharge)

4. Age refer children o unclear diagnosis

2. Symptoms; commonly affects

Michael Lloyd and Rachelle Downie 2007 6

LPC 2% to 10% cream or ointment topically, apply twice daily

dithranol 0.1% to 2% with salicylic acid 2$ to 5% (to prevent oxidation of dithranol

Fungal skin infections Continue treatment for 2

Michael Lloyd and Rachelle Downie 2007 8

Michael Lloyd and Rachelle Downie 2007 9

Self Care Card:

Michael Lloyd and Rachelle Downie 2007 10

Warts Self-limiting infection

Michael Lloyd and Rachelle Downie 2007 11

DDx from warts:

Michael Lloyd and Rachelle Downie 2007 12

contact dermatitis (use of new

Michael Lloyd and Rachelle Downie 2007 13

Self Care Card:

Michael Lloyd and Rachelle Downie 2007 14

Michael Lloyd and Rachelle Downie 2007 15

Rubella Virus Infectious: 7 days BEFORE rash until 7 days after

Patient Problem Treatment Children Pregnancy Lactation Other

Michael Lloyd and Rachelle Downie 2007 17

No. of ulcers? More than 10? product > 6 days

Michael Lloyd and Rachelle Downie 2007 18

Common medication causes of Self Care Card:

Gingivitis Chlorhexidine 0.2% mouthwash (Sepacol) Refer Ok Ok

Sx: bad breath, gum swelling

Tm: Requires removal by dentist

Michael Lloyd and Rachelle Downie 2007 19

the mouth as long as possible before swallowing. patients

Toothache Symptomatic relief options:

Dental therapy is best option for

Brush with a soft toothbrush after each meal.

Soak dentures in white vinegar overnight.

Michael Lloyd and Rachelle Downie 2007 20

Michael Lloyd and Rachelle Downie 2007 21

presents as a burning sensation in o avoid NSAIDs where possible Refer when:

Michael Lloyd and Rachelle Downie 2007 22

Duration? Longer than 48 hours? o drug-induced

History of recurrent o diarrhoea for >1 day in

diarrhoea/constipation? infants; 2 days in

Motion sickness >2 Ok Ok

Michael Lloyd and Rachelle Downie 2007 23

Michael Lloyd and Rachelle Downie 2007 24

Threadworms Perianal itching may

long); found in faeces or protrude o medication failure

over anus in morning eggs stick o pregnant family member

Michael Lloyd and Rachelle Downie 2007 25

Excessive drooling, chewing on Paracetamol 15 mg/kg q3-6h

Febrile Convulsions/Fever in Counselling: The treatment of febrile

Michael Lloyd and Rachelle Downie 2007 26

Colic - - - Reassure parents that

Michael Lloyd and Rachelle Downie 2007 27

stiff tight and extended, symptoms - - - on weight