Burn managment: 1-run under water for 20 minutes

2- remove jewllary or clothings donot: apply ice, oils, lotions, towells, cotton, wool, burst
3- apply hydrogel any blister, remove any thing attached to burn area
4- sterile deressing
Lloydy’s

5-Minute OTC Consult for Trainee Pharmacists

Wound managment:
1. wash hands
2. clean wound under runny water or saline
3. pat dry with clean lint free material
4.if bleeding continues, apply pressure using lent free material
and raise area above head if possible
5. apply appropriate antiseptic (check allergies) for 5 minutes ( donot leave for more than 5 min as it might slow healing process)
6.rinse wound with water or saline 7. cover with appropriate sterile dressing

Use: - sterile saline ampoules, savlon or betadine or detol as antiseptic, woundcare gel such as solusite or solugel to aid the moist wound
healing (less need of antibiotic, lower chance of scaring, faster healing)
antiseptic: - povidone iodine( not suitable for ; bf, preg, thyroid , more than 14 days, skin irritation, less than 6 months old)\
Cetrimide and chlorohexidine (savlon cream)(not suitable for allregies)
-Chloroxynol triexonal (detol cream and liquid) (must be diluted before use 1:20)

dressing: sensitive dressings ( for sensitive skin),water proof dressing (for daily activities and sports), plastic dressings (less prone to get wet)
fabric dressing( more flexible and suitable for knees and elbows), adheseve (for non hairy area),, non adhesive for (hairy areas or allergy to
adhesive dressings), antibactirial dressing. 1
DERMATOLOGY PAEDIATRICS WOMEN’S HEALTH
Head Lice 3 Teething 24 Period pain (primary dysmenorrhoea) 43
Scabies 4 Febrile Convulsions/Fever in Children 25 PMS 44
Eczema/Dermatitis 5 Gastroenteritis & Dehydration 25 Cystitis 44
Psoriasis 6 Colic 26 Vaginal Thrush 45
Fungal skin infections (Athlete‘s foot, tinea, jock itch) Cradle Cap 26
7 Nappy rash 27 PREGNANCY/BREASTFEEDING
Nail infection 7 Nutrition & General Health advice during Pregnancy
Acne 8 EYE DISORDERS 46
Chickenpox 9 Dry Eye Syndrome 28 Back pain in pregnancy 47
Corns/calluses 9 Viral Conjunctivitis 28 Constipation 47
Warts 10 Bacterial Conjunctivitis 29 Reflux 47
Dandruff 11 Allergic Conjunctivitis 30 Nocturnal muscle cramps in legs 48
Sunscreen/Sunburn 12 Stye 30 Pruritis in Pregnancy 48
Hair loss 12 Chalazion 31 Breast & Nipple Thrush 48
Hydrocortisone Topical Cream 13 Contact Lens Care 31 Problems with lactation 48
Shingles 13 Blepharitis 31 Mastitis 48
German Measles (Rubella) 14 Red Eyes 32 Morning Sickness 49
Measles 14 Vasoconstrictor eye drops 33
Antihistamine eye drops 33 PAIN
ORAL HEALTH Ocular lubricants 33 Musculoskeletal pain 50
Cold Sores 15 Insect bites 50
Dry Mouth (Xerostomia) 15 EAR, NOSE & THROAT Headache 51
Aphthous (mouth) ulcers 16 Ear Ache 35 Bruising 52
Gingivitis 17 Ear Wax 35 Tennis elbow 52
Oral thrush 17 Otitis Externa 36
Toothache 18 Allergic rhinitis 36
MISCELLANEOUS
Oral Hygiene 18 Sore Throat 37
Nicotine Replacement Therapy 53
Intranasal Decongestants 38
Orlistat 55
GASTROENTEROLOGY & GENITOURINARY Nasal corticosteroids 38
Emergency Contraception 56
Haemorrhoids 19 Nasal antihistamines 38
Travel Health 57
Heartburn 20 Sleep 59
Diarrhoea and Vomiting 21 RESPIRATORY Antihistamines 60
Motion Sickness 21 Cough 39
Constipation 22 Cold and Flu 41
Irritable bowel 23 Asthma inhalers 42
Threadworm

2
Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other
DERMATOLOGY
**shampoos not as good as solution because they are diluted by water to Not < 2 Preferred Safe Check and treat other
Head Lice subtherapeutic conc. family members if
Permethrin infected.
Itch (rash): back of scalp, neck Permethrin (Quellada lotion 1%, Pyrifoam liquid 1%) safe for Clean sheets and
and behind ears. Apply to clean, damp hair after washing with normal shampoo Pregnancy clothes in hot water, sun
Eggs (nits): white specks stuck to and towel drying. dry).
hair near the scalp Leave in for 10 minutes, rinse out and dry then comb with a Treatments coat hairs
Live lice fine tooth comb. from root to tip. Esp
Repeat in 7 days. back of neck and
behind the ears
Maldison (Lice Rid lotion 0.5%, KP 24 lotion 0.5%) Not < 2 No No Repeat treatment 7
1. Head lice present? Apply sufficient amount to dry hair, massage well and allow to dry days after to kill newly
2. Used lice tx before? Did it naturally and leave on for 12 hrs, wash out in the hatched lice.
work? Used properly? morning and comb out dead lice Itch may continue up to
3. Under 2y.o? Repeat in 7 days. 1 week post eradication.
4. Pregnant or breastfeeding? KP24 lotion is alcohol based: avoid in child with asthma (↑ bronchospasm
5. Swollen glands, Avoid ―natural‖ alternatives
weeping/crusty rash? Infectn? in pregnancy as may
Pyrethrin/piperonyl butoxide (Banlice mouse) Not < 2 No No
6. Tx head lice regularly? contain essential oils which
Apply mouse to dry hair, leave in for 10 mins, wash out with normal shampoo, are contraindicated
7. Want to know more about
remove lice and eggs with fine tooth comb.
head lice prevention?
Prevention:
o ↓ head-to-head
contact.
Dimeticone 4% in cyclomethicone (Hedrin Lotion) OK Safe Safe o Do weekly head
Apply to dry hair, allow to dry naturally, checks or comb
wash out with shampoo at least 8 hours after with nit combs.
o Avoid sharing
combs, hats and
pillows
o Keep long hair tied
back.
Wet combing preferred when < - - o Notify school but
Apply conditioner to dry hair from tip to root. Comb with a fine tooth comb from 2 no need to exclude
scalp to tip in sections. Clean comb with tissue and repeat each section 5 times. children from
Repeat every 2 days until no head lice seen for 10 consecutive days school once Tx
- Do this after each treatment above to remove dead lice and eggs given.

Resistant Lice
Retreat with a different chemical treatment Or Wet Combing Self Care Card: Head
Lice
**Only permethrin and maldison are ovicidal – ie killing lice egg as well as lice

3
Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other
Cool shower and dry thoroughly. Apply to whole body starting from the neck down (include neck, face and scalp when treating Must reapply 7 days
Scabies children <2 and elderly). Pay attention to skin folds, belly button and groin after 1st application!
Mite – burrowing under skin
leaving trait of papule/vesicle
Allow to dry and put on clean clothing. Leave for at least 8 hours* and then wash off thoroughly the next morning. Repeat in 7 days. Scabies treatments may
Intense itching which is worse at
actually CAUSE skin
night or when skin=warm.
If hands washed during treatment, should be reapplied. irritation!
Scratching of the skin can lead to
changes in its appearance *Increase contact time to 24 hours in treatment failure. ―P‖ (permethrin) for
(distort the trait of burrow).
―pregnancy‖
Commonly affects web space of
Permethrin 5% (Lyclear cream, Quellada Scabies Lotion) 30 mg tube Refer <2y.o. Preferred Preferred Itching can continue for
the fingers and toes, wrists,
Dose: 1-2 tubes for adults. (TG: >6 months) several days/weeks after
armpits, buttocks and genital
½ tube for children 5-12. ¼ tube 1-5 years successful treatment, i.e.
area. not a sign of treatment
A/E: burning, stinging or tingling from application Treat neck, face
May cause rash around the
and scalp failure. – Suggest
midriff, underarms, inside of
Antihistamine or
thighs and around ankles.
Crotamiton cream
(Eurax®) for itch
Flaking skin is infective to others.
Benzyl benzoate (Ascabiol 25%) Lotion diluted with an B2 No
Apply with a new paint brush as per instruction above except equal quantity of Refer:
leave product on for 24 hours water for children o babies and children
1. Confirm dx?
under 12 years of o infected skin (weeping
2. HOPC – other family
age, and with 3 yellow discharge)
members affected?
parts of water for o treatment failure
3.Check for burrows? – small, o unclear diagnosis
babies
raised bumps under skin, may
appear as thread-like grey lines
4. Age – refer children on the next day, all clothes, towels, bed linen, soft toy or personal belonging coming in close contact for the last 24-36 hours
2. Symptoms; commonly affects should be machine- washed at >50oC. Self Care Card:
Item that cannot be washed should be stored in tightly sealed plastic bags for one week. Scabies
‗web space‘ – fingers, toes, writs,
armpits, buttocks, genital area Try not to scratch your skin as this can lead to bacterial infection of the rash
5. Signs of infection- weeping/ Any person with scabies should stay home until the day after treatment has started. Patient should be warned to minimise
yellow discharge direct contact with other!!! The childcare centre or school should be notified of a case of scabies
6. Medication All members of the same household should be treated on the same day even if they are not itchy as symptoms can take up to 6
weeks to develop
Paraderm Plus (chlorhexidine 0.1%, lignocaine 1%, bufexamac 5%) - Cat A - For a mild reaction:
Bites - antisepetic, anaesthetic, anti-inflammatory & soothing o wash the area with
- apply tds/qid soap and cool water
Often present as an itchy wheal o apply ice in a cool,
that develops into a firm, itchy st
Eurax® (Crotamiton) cream – 1 line Ok Ok Ok wet cloth to reduce
papule. Apply gently to affected area 2-3 times a day. swelling
o apply an anti-itch
Mild reactions can be treated Stingose® (Aluminium sulfate) solution Ok Ok Ok preparation (see
successfully with OTC products Apply promptly and liberally to affected area(s) prn. below); can use an
whereas moderate-severe antihistamine for
(including those with sx of additive relief from
Soov Bite (Cetrimide, lignocaine) > 2yrs Ok Ok
bacterial infection) require referral itch
Dab onto affected skin up to 4 times a day.
to doctor.
4
Eczema/Dermatitis 1.Emollients/Moisturisers/Bath oils & washes: Advice:
- acute management & prevent relapse - avoid environmental or any precipitating irritants
- apply after bath/shower (3 min window)
Smx:
- creams, washes – safe to use in infants & applied to the face Non-drug management:
o Acute: red, itchy inflamed rash
- FREQUENT application is important * Wet Wrap Treatment
(poorly defined edge) +/-
aveeno: oat meal moisturiser - soak towels in tepid water (or Burrow‘s solution if area infected) to create
papules – if broken - weeping
Bath oils & washes a wet wrap treatment
o Chronic: dry, scaly, can crack QV bath oil, Hamiltons, Dermaveen oil, Oilatum Bath oil -applied after hydration (ie bath) & emollients/CS‘s applied – leave on for
or fissure. Bath: 10-15mins once a day  qid when flare-ups occurs 15-60mins to enhance topical therapy absorption
Moisturisers -reserved for SEVERE/recurrent cases
o Degree of itch varies: day to
Face & Body – Dermeze, Hydraderm, QV cream, Dermaveen lotion - qid
day, b/w individuals, under *Other advice:
Creams & Ointments are MORE effective than lotions.
stress, at night, heat etc -avoid getting to hot. Avoid over-warm clothes or temperature in the home
Humectants - glycerin, PEGs, urea, propylene glycol -bath less often or for shorter time. Use lukewarm not Hot water
Cause: - attract & retain water in the skin -avoid scratching. To relieve itch, pat the skin, cool the area or apply
-depends on the TYPE of moisturiser. Keep fingernail short and clean and wear gloves at night
eczema being experienced Emollients: eg. soft paraffin, dimethicone, liquid paraffin, lanolin, vegetable oils -identify & eliminate environmental irritants or allergens. Rinse clothes well
- sooth roughened skin, reduce water loss, to remove detergent
TYPES -?food link – potential – if so avoid
*Exogenous – contact with external Dermaveen (colloidal oatmeal) Cleansing Bar /Shower & Bath Oil/ Eczema Cream: -routine moisturisation via humectants, occlusive moisturizers = mainstay
agents eg. allergic contact dermatitis, of preventative treatment
photoallergy dermatitis -AVOID detergent and SOAP and use soap substitutes.
*Endogenous – internal predisposition
QV Bar: Dimethicone
eg. seborrhoeic dermatitis, atopic QV Bath Oil: Liquid Paraffin
QV Cream: WSP, Liquid Paraffin, Glycerol * Eczema Referral:
eczema, varicose eczema
QV Skin Lotion: WSP, Glycerol - secondary bacterial infections  Abx
ATOPIC ECZEMA = typical - patch testing for allergens
eczema/dermatitis Hamiltons Dry Skin Cream: Urea - treatment of warts & molluscum contagiosum is difficult in eczema
- ?unknown cause Hamiltons Dry Skin Lotion: Liquid Paraffin, Glycerol - herpes simplex  000
- common in ectopic people Hamiltons Oil: Liquid Paraffin - ? fungal infection
- Red, scaly eruption
2. Corticosteroids In children common aggravating factors include:
- Use in acute flare up when moisturers don‘t provide enough relief -sand, dust
DDx: -rough clothes, abrasive surfaces like carpets
-Scabies Hydrocortisone 1% (Sigmacort/Dermaid) – Apply taa 2-4 times/day up to 7 days -calamine lotion
-Fungal infection: itchy, central o Use for all areas of body esp for think skin areas such as face, flexures or in -extremes in heat
clearing with defined advancing children)
edge. o Paed: >2yr Refer:
-Psoriasis Clobetasone 0.05% (Eumovate) – Apply taa bd up to 7 days o Child <2 yr in need of corticosteroid
-Urticaria – like dermatitis, skin o Use for more severe dermatitis or areas such as palm, trunk) o Rashes on face unresponsive to emollients
can be oedematous and o Paed: >12 yr o OTC tx failure
blanches when pressed o Widespread or sever dermatitis
- Apply sparingly and for short term - one fingertip unit of crm (from tip to 1st
crease) for an area twice the size of an adult flat hand.
- Emollient could be applied 30min after application of a corticosteroid prep.
- Oint is better for dry/scaly skin whereas cream is better for cracked/wet or
weeping skin

3.Other such as antihistamine and tar solution

5
 no itch
Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other
- - - Tx should be
Psoriasis Moisturisers/Emollients
recommended in
a chronic relapsing skin condition Where scaling or irritation is prominent features, moisturiser hydrates
the skin, softens scaling and reduces irritation. Best if applied after a conjunction with
and often marked with plaque,
shower. education to emphasise
symmetrical distribution and/or
that cond‘ might be
family history.
Q.V. Moisturising Lotion, DermaDrate, Dermaveen, Cetaphil chronic and the probable
glycerol 10% in sorbolene cream benefit from tx must be
Can occur anywhere on the body glycerol in 10% sorbelene
made clear to pt.
but often on the extensor areas
It is also beneficial to use soap substitutes such as QV Bath Oil as dry skin Refer cases of
such as the elbows, knees or the
conditions often exacerbated by soaps and detergents. suspected but
trunk or scalp, in the flexors
undiagnosed psoriasis.
(perianal, submammary or
axillary regions). Keratolytics Ok Ok Ok
Salicylic acid is used to reduce scaling and soften plaques in psoriases. Tar, dithranol and
Commonly salicylic acid 2% to 10% in sorbolene cream, emulsifying ointment or white soft salicylic acid can be
get pitting of paraffin
egopsoryl irritating on the skin and
the Egopsoryl TA® gel (Sulfur 0.5%, phenol 0.5%, coal tar solution 5%; menthol should NOT be used in
fingernails. 0.75%, glycerol 18%) Apply 2-4 times daily acute inflammatory
Egoderm cream - Ichthammol 1% - Apply 3 times daily or as needed psoriasis, on the face or
Community pharmacist could Coal Tar - - in the flexures.
only treat plaque and scalp Tars are anti-inflammatory and antipruritic. Although
psoriasis. considered first-line therapy, use is limited by patient Minimise or eliminate
Plaque psoriasis: pinkish acceptability due to problem with staining and smell. potential triggers:
lesions with silver-white scales
o Stress/trauma:
and well defined boundaries. If scalp cleanser: Ionil® T: Coal Tar 5%, Sal acid 2% Consider stress
the scales are removed gently Sebitar® : Pine Tar 1% Coal Tar 1%, Sal management
and the lesion is then rubbed, it acid 2% sebitar techniques, exercise,
reveals pinpoint bleeding from
Hydrocortisone (DermAid, Sigmacort) 0.5%, 1% >2 Ok Ok avoid scratching.
the superficial dilated capillaries.
Apply thin layer to affected area 2-4 times/day; reduce frequency as condition Soap, detergent.
improves. o Smoking cessation
Scalp psoriasis: can be mild
and reduction of
with redness to severe with alcohol intake.
marked inflam‘ and thick scaling. Good for flare ups but prolonged use can cause skin atrophy
o Weight reduction will
The redness often extends
see TOPICAL CORTICOSTEROIDS help patients with
beyond the hair margin and is
flexural psoriasis or
commonly seen behind the ears.
Avoid Avoid Avoid plantar psoriasis
Dithranol
Ddx: eczema, seborrhoeic Antiproliferative effect on psoriatic skin; useful in thick plaque psoriasis.
dermatitis, and tinea. Atopic
eczema occurs on the flexor dithranol 0.1% to 2% with salicylic acid 2 to 5% (to prevent oxidation of dithranol
aspects of the limbs rather than and remove scale) in yellow soft paraffin, apply topically to lesions each day then
the extensor aspects, as in wash off 10-30 minutes later with lukewarm water
psoriasis.

6
Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other
Azole: Continue
Fungal skin Clotrimazole 1% (Canestan®, Clonea®) 1% cream All ages Ok Ok treatment for 2 weeks
infections Apply 2-3 times a day until infection clears and for 2 weeks after symptoms resolve.
after.
Athlete’s foot- tinea pedis: itchy, Miconazole 2% (Daktarin® in crm, lotion, dusting powder, spray powder, tincture) Fungus thrives in warm,
flaking and fissuring of the skin Apply bd until clear and 2 weeks moist conditions good
Econazole 1% (Pevaryl foaming solution)
dactarin powder personal hygiene is
and will appear white and
macerated. Feet also smell. Apply on wet body (skin/scalp) after showering in 3 consecutive nights, rub in well important:
Ringworm- tinea corporis: itchy for 3-5 min then dry and leave on overnight till next morning to wash off. *dry between toes
red scaly patches with well- *use a separate towel for
defined inflamed border. S/E: mild itching or burning infected area(s)
Jock itch – tinea crusis: rash *wearing sandals in
Bifonazole (Canestan Once Daily®, Mycospore®) 1% cream -
isolated to the groin and the inner public showers and
Ketoconazole (Nizoral®, DaktaGOLD®) 2% cream B3: Avoid Ok
thighs but can spread to the change rooms
buttock. *change socks
Apply once at night until infection clears and for 2 weeks after.
(preferably cotton) daily
DDx: Terbinafine (Lamisil®) 1% cream *avoid tight, synthetic
-Psoriasis: no central clearing. >12 yr B1: safe to Ok shoes
Apply once a day for 1-2 weeks use
Tend not to itch but with more * Athletes foot: 2-4 weeks *dust shoes with
scaling and familial history. * Jock itch: 1-2 weeks fungicidal powder
-Dermatitis: usually has family *does not require further course once symptoms relieved as do other topical antifungals as Refer:
and personal history of what fungicidal (faster acting) aids compliance o diabetic patients
could trigger the rash. *For Lamisil Once, a single application of the film forming solution MUST be applied to both o severe or recurrent
feets even if only one side is affected. o treatment resistant
infection
Instructions: o sx of bacterial infection
- clean & dry affected areas thoroughly o involvement of nails
- apply to affected area and surrounding area – apply a thin layer
1. Symptoms? Itchy, - regular use is required for successful treatment
erythematous, flaky white skin, Self Care Card:
- Smx should resolve within a few days Tinea
plaques - Tm shouldn‘t extend beyond 4 weeks
2. Severity? Inflammation, Clotrimazole 1% + hydrocortisone 1% (Hydrozole®) Apply 2-3 times/ day >2 yr A Ok
weeping, puss, yellow crust Miconazole 2% + hydrocortisone 0.5-1% (Resolve plus® 0.5, 1) Apply bd
(bacterial infection)
3. Previous treatment?
Apply for only up to 7 days to control severely inflammed fungal infection. Once
4. Diabetic, immuno-
inflammation settle, continue tx with plain Azole product until clear and another 2
compromised? weeks after.

Cream - generally preferred; useful for dry, scaling tinea

Lotion - drying; useful for tinea between the toes and on large or hairy areas
Powder - can absorb moisture and decrease friction; can be used on the feet and
in the groin and intertriginous areas
Spray - for large, hairy or painful areas
Tincture - for use on nails only

econazole (pevaryl): apply on body leave for

7
tinea versicolour: scaly lesion along trunk, not so itchy, gets worse on sun exposure night wash in morning, use for 3 days, repeat
clotrimazole: apply 2 times daily for 10 days one months later safe in preg/bf
Patient Problem latral yellow streaks and chalky grey nail with debris underneath
Treatment Children (ok in…) Pregnancy Lactation Other
Amorolfine 5% (Loceryl®) nail lacquer No No Refer:
Fungal nail Apply once or twice a week for usually 6 (finger nail) to 12 (toe nail) months. - when the entire nail
infection 1. File down infected areas on an infected nail (don‘t use file on a healthy nail afterwards) yes matrix is infected
2. clean nail surface with a cleaning pad - Non prescription Tx
Amorolfine is the only topical 3. dip spatula into lacquer fails
antifungal which can penetrate 4. paint over the entire nail surface - Suspected poor
the nail, 5. close bottle tightly compliance
i.e. Daktarin (miconazole) tincture 6. allow 3-5mins for nails to dry
is useless. 7. clean spatula and neck of bottle with same cleaning pad Hygiene measure:
**be careful not to let lacquer contact skin -Keep area clean
For more severe/resistant fungal Bifonazole 1% + Urea (Canesten® fungal nail treatment set) S/E: local rash, itching or redness Avoid Avoid -Change socks regularly
nail infections refer to the Dr for -Avoid trauma to the
Phase 1: (2-3weeks) – to soften and manually removing the infected nail nails
systemic oral treatment or make sure nail is not affected til apex
1. Soak the affected hand/foot in warm water for 10min then dry thoroughly
removal of nail. -Avoid sharing towels.
2. Apply a thin layer of the Urea Crm on ONLY the infected surface ONCE daily
3. Cover the treated nail by folding the given plaster as directed so it is fitted as a protective cap
4. The plaster should be removed every day and the nail then needs to soaked in warm water for 10 min Nail polish or fake nail
Miconazole 2% (Daktarin 5. After soaking, use the plastic nail scraper to remove the soften nail. Dry the nail thoroughly. should not be used
Tincture) – Apply bd with the 6. Repeat step 1-4. Clean the scraper thoroughly before and after each use. during Tx
brush provided. Tx is to be 7. This routine is to be continued daily until no more softened infected nail can be removed
continued until infected nail has Always wash hands
Phase 2: (4 weeks) – Once nail bed is exposed, felt soft to touch, treat WHOLE nail with antifungal crm
come off and new nail has before and after
1. Clean and dry the nail thoroughly
regrown out. 2. Rub Canesten Bifonazole Cream sparingly into the affected nail bed once a day preferably before application
bedtime.
3. Continue Tx every day for 28 days to avoid recurrence, even if the infection seems to have cleared.

Chickenpox Paracetamol for fever.(NOT aspirin) Pt= infectious from 48

hours before
 May start with a headache,
Solugel (amorphous hydrogel) applied liberally to lesions provides a soothing appearance of rash until
runny nose, mild fever, cough
effect and reducing formation of scab and scar– place in fridge the all lesions have
and general unwell feeling.
crusted.
 Rash appears as small, red
Pinetarsol or Dermaveen bath products for warm bathing (emollient, antipruritic,
spots that quickly become very
and anti-inflammatory). Take care not to slip when stepping out of bath. Incubation time (time
itchy blisters. The blisters
btwn contact and
usually last 3 to 4 days then
Polaramine (dexchlorpheniramine) for kids at night to avoid night time scratching. development of rash) is
dry out to form crusts (scabs)
Mouthwash – sooth blister in mouth and throat usually ~2 weeks.
Could be anywhere on the body,
 Rest as much as possible Pt = excluded from
commonly affecting trunk, face
 Keep child well hydrated even if doesn‘t want to eat (prodromal symptom). school/work until all
and scalp but also can occur on
 Keep skin cool, cold & wet compresses to reduce itching. blisters have dried
mucous membranes (throat,
 Cut child‘s nails short (scratching increases the risk of secondary bacterial (~5days from first rash)
vagina)
infection and scaring).
 Anti-itch creams (e.g. Paraderm, Eurax) may be useful. Spread by respiratory
 Blister can get infected by
 Use good personal hygiene (cover whn sneeze/cough, wash hand often, do droplets, direct contact
bacteria and can leave scar
not share food or utensil) with varicella vesicles.
 Symptomatic treatment (self
Keep pt away pregnant woman, elderly, immunocompromised ppl.
limiting, usually clears in 7-14
AVOID calamine lotion as dries out skin causing further irritation and resulting Self Care Card:
days) and good hygiene to
scaring when itched. Chicken Pox
avoid secondary infection.

8
Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other
Refer young Ok Ok Gently cleanse the
Acne Benzoyl Peroxide (Benzac, Oxy, Panoxyl) 2.5,5,10% - antibacterial activity and is children affected areas
mild anti-comedogenic effect twice a day and after
Acne is an androgenically
exercise with a
stimulated, inflammatory disorder
 Apply once or twice a day, begin treatment with lower strengths (2.5 or 5%) then specific acne cleanser
of the sebaceous glands caused
change to 10% after 3-4 weeks if tolerated and acne resistant. or soap substitute.
by increased sebum production,  Can cause skin irritation at first including reddening, burning/peeling, especially Do not squeeze or
abnormal follicular keratinisation at beginning of treatment. Thus best to start with building skin tolerance by slowly pick the acne lesions
and proliferation of
increasing exposure time over nights, ie leave crm on for 1 hour then wash off for (pimples).
Propionibacterium acnes.
1st night… 3hr … overnight (goal) Oil-based creams and
 If irritation is bad, stop using the product for 1-2 days before starting again. cosmetics can make
Usually peak between the ages
of the 14-17 for girls and 15-19 acne worse. Use oil-
Usually takes between 8-12 weeks of treatment to see benefit. free,
for boys.
Can bleach hair, clothing and bedding. Avoid contact with eyes, mouth and other Exercise regularly and
Questions
mucous membranes. Always wash hand after use. eat a healthy diet with
How old?
Azelaic acid (Finacea 15%gel, Acnederm lotion)- inhibit growth of P. Acne - B1 – no Data lots of fresh food and
How long have had acne for?
data lacking water. This will
Previous treatment? How was
Apply morning and night. Improvement often seen in 4 week but regular use is improve general
previous treatment used?
required for up to 6 months for optimal result. health and be
DDx: reflected in the skin
Less irritating than benzoyl peroxide but may cause hypopigmentation, use with condition.
Rosacea - inflammatory disease caution in patients with dark complexions.
of the skin follicle with unknown
causes but suspected to be UV light can be helpful
**can also be used for papulopustular rosacea – acne usually gets
related with bacterial pathogen.
Triclosan face-wash solution ( ®) - Ok Ok better during summer
Normally seen in adult>40 yr with
recurrent blushing of the central
Use as a face wash three times daily.
face, esp nose and medial cheek.
Eyes irritation and blepharitis is Refer:
Wash hands thoroughly with pHisoHex. Wet face and apply enough pHisoHex into o Moderate - severe acne
also common in 20% pt palm to cover a 20 cent coin. Gently massage over the face, concentrating on o failed medication
Med induced acne – Lithium,
problem areas and avoiding the eye area. Rinse and repeat. Rinse thoroughly and o suspected drug-
OCP (with high progestogen)
pat dry with a clean towel. induced or rosacea
phenytoin, azathioprine,
o very young children or
androgen, haloperidol, rifampicin.
Discontinue use if irritation develops. older adults
Polycystic ovary syndrome –
- o occupational acne
manifested with ance, hirsutism,  Read and follow instructions for acne products carefully.
o mild acne not
and menstrual irregularity,  Before applying, wash affected area with mild soap or soap substitute and warm
overweight. responsive to treatment
water; gently pat dry.
for 8 weeks
Dermatitis  Wash hands after application.
 If skins is dry from tx, moisturising skin with oil free product would prevent oil
Self Care Card:
production that might clog pore.
Acne
 Keep hair clean and away from face and neck.
 Consult a pharmacist or doctor if any acne treatment stings or irritates your skin
 Some acne preparations can make the skin more sensitive to the sun. Use an
oil-free, SPF30+ sunscreen every day.

9
Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other
Self-limiting infection –
Warts usually disappear
Human papilloma virus (HPV). st
Duofilm Gel (salicylic acid 27%) 1 line – preferred Ok Ok spontaneously within 6
in children months to 2 years.
 Usually asymptomatic, i.e. no
Duofilm (lactic acid 16.7%, salicylic acid
itch or pain (unless knocked or
16.7%) Treatment may take up
rubbed).
Wart-off stick (salicylic acid 40%) to 3 months.
 Appear mostly on hands,
knees and elbows (feet)
Using applicator, apply once at night. Allow to dry and cover with occlusive Preparing infected area
 Discrete edge with
dressing. Continue until wart is completely removed for Tm:
raised/roughened cauliflower
Pre-soak affected area
appearance. Plantar warts
in warm water for 5-10
usually not raised & grow up
Wartner (dimethyl ether, propane) mins to soften and
into the foot
Hold applicator to lesion for 20 secs; repeat every 15 days as Avoid < 4 Avoid Avoid hydrate skin, then
 Separate skin lines rather than
necessary (max 3 times) remove dead skin from
skin lines running over the top
surface of wart by gently
of them.
rubbing with a pumice
 Warts supplied by a network of
stone.
capillaries. When pared (e.g.
with pulmus stone) → a
Diswart (glutaraldehyde) – will stain skin brown but will fade after Protecting surrounding
bleeding points appears.
treatment complete No No No skin:
Apply twice a day. Mask healthy,
1. Diabetes? Refer
surrounding skin with
2. Age? Common in children
vaseline or nail polish or
3. Appearance? Wart vs
Corns/calluses a bandaid with holes cut

10
 corn/callous Treatment should be aimed at relieving pressure – can use circular corn pad or out. Apply treatments
4. Location? Refer facial or other forms of padding to relieve friction and absorb pressure. with applicator (not
anogenital finger)
5. Duration? Treated with keratolytics same as for warts if required.
Corns/calluses
White or yellowish MUST address the underlying issue to resolve the problem & prevent reoccurrence Refer:
o diabetic pts
hyperkeratinised/thickened areas
E.g. Scholl corn pads/foam (Salicylic Acid 40%) o anogenital warts
of skin which occur on pressure
* Feet should be clean and dry
use also schol cushions to relieve presure o non-responsive to Tx
areas such as the top of toes and
along the side of feet (i.e. over * Remove medicated disc from backing and place adhesive surface of disc over o multiple and

bony prominences of the feet). corn and cover with pad widespread
* Repeat treatment daily until corn removed o lesions on the face

DDx from warts: Press down firmly and secure with adhesive straps. Repeat treatment daily for 2-3 o > 50 y.o.

Do not have ―black dots/spots‖ days, or in stubborn cases, until corn is completely removed. o warts that change

but rather expose layers of white colour or shape

o bleed/itch without
keratin when pared.
Caution/Precautions adjust shoe's fitting, use sandals, moisturizers provocation
Do not separate the skin lines on * DO NOT use for diabetics  Refer to Dr
the sole of the foot * DO NOT use on broken or inflamed skin
* Check for any circulation problems before using  Refer
* Avoid use in <16yrs
* If corn remains after 2 weeks  seek medical advice

Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other

note: no evidence for
Dandruff
Hyperproliferative skin condition Ketoconazole ( Nizoral® 1%, 2% ) coal tar shampoos in the
Apply to wet scalp, lather, then leave for 5 minutes; rinse thoroughly. Use Ok Ok ok treatment of dandruff
Greyish-white flakes or scales on twice a 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.
patient‘s clothing.

Condition associated with the Ok Ok Ok

Zinc pyrithione (Head and Shoulders®, Fongitar®) Shampooing on a daily
yeast Pityrosporum ovale.
Apply to wet hair, lather, then leave for 5 minutes; rinse thoroughly. Use 2- basis with a mild,
3 times a week until treated then once a week for prophylaxis. hypoallergenic, non-
Treatments are either antifungal
medicated shampoo
or cytostatic (reduces rate of cell use 2-3 times a week helps prevent dandruff.
turnover). *antifungal and cytostatic
Ensure to thoroughly
wash out shampoo.

shampoo on daily basis

avoid stress

11
DDx: Use a conditioner to
seborrhoeic dermatitis (scales moisturise your scalp.
are yellowish and greasy-looking Selenium sulphide (Selsun Blue®) >5yr Ok; avoid Ok
and there is usually some Lather into wet hair for 5 mins, repeat and rinse thoroughly; initially twice 1st Avoid using hair gels
inflammation with reddening and trimester and other products that
crusting of the affected area;
weekly, then as necessary contain alcohol, which
typically affects centre of face, tend to dry out skin.
eyebrows, nasolabial folds and *cytostatic: avoid if patient has inflamed or broken skin. May stain
midchest) – treated same way as jewellery and alter the colour of hair dyes.
dandruff
Refer:
psoriasis (scales are silvery-white o treatment resistant
and associated with red, patchy dandruff
plaques and inflammation; Flow of diagnosis: o suspected psoriasis
typically affects the knees and 1. Is the problem confined to only the scalp? o signs of infection
elbows, face rarely being
2. Recent use of new hair product? - contact dermatitis
affected)
3. Is there any well circumscribed hair loss? Yes  tinea infection
Self Care Card:
contact dermatitis (use of new
4. Any sign of erythema/redness – inflammation? Yes  psoriasis or seborrheic dermatitis Dandruff
hair products?) 5. Is there similar problem or plaque developed in other areas on the body, eg arm, elbow, back, leg??
6. If no to all, then dandruff

Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other

Sunscreen/Sunburn Application of sunscreen: Gently apply cool or cold compresses.
Prevention is better than - use an SPF 30+ broad-spectrum, water resistant sunscreen Alternatively, bathe the area in cool water.
treatment. - apply liberally to clean, dry skin 30 mins before going outside Drink plenty of water, because you‘re
- reapply sunscreen every 2 hours, more often if swimming , playing probably dehydrated as well as sunburnt.
SPF 30+ has greatest protection. sport and in children

banana boad titanium dioxide , oxybenzone

12
 Avoid using soap, as this may irritate your
Slip on a shirt, Treatment of sunburn includes: skin.
Slop on some sunscreen, - systemic analgesia Don‘t pop blisters. Consider covering itchy
Slap on a hat and - Solugel® (propylene glycol, sodium chloride);
Slide on some sunnies.
blisters with a wound dressing to reduce the
Apply liberally prn. Store in fridge for extra relief on application. risk of infection
Will sooth and hydrate skin Allow the dead skin sheets to detach on their
Refer:
Severe sunburn - extensive own
blistering and pain
- SOOV Burn Spray® (cetrimide, lignocaine, phenoxyethanol) Apply antiseptic cream to the newly revealed
Sunburn over a large area Hold the bottle 10 cm from the affected area and spray until skin to reduce the risk of infection
Headache skin is wet.
Nausea and vomiting For treating the face, spray onto fingers and then apply gently.
Self Care Card:
Fever Apply up to four times daily. Sense in the Sun
Dizziness or altered states of
consciousness

Hair loss Minoxidil (Rogaine®) 20mg/mL, 50mg/mL >18 No No Response is best when
Male-pattern baldness
Apply 1 mL twice a day to area where hair regrowth/stabilisation is required. Apply many thin, miniature
(androgenic alopecia) is the most to clean, dry scalp and allow to dry naturally. Do not wash hair for 4 hours. hairs still remain before
common form of hair loss
**Avoid in HTN patient and pregnant women starting treatment. No
presenting in pharmacy.
SE: local skin irritation, redness, itching 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 3–4 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
Refer:
increase the amount absorbed through the skin causing unwanted effects. continuous treatment
Fungal scalp infection - Side effects may include mild dermatitis or unwanted hair growth above (discontinue treatment if
Patient under 18 yr eyebrows and on cheeks. no response by 6
Possible endocrine cause months).
(Diabete mellitus,
hypopituitarism Benefit of treatment is
hypothyroidism) lost within 6–12 months
Nutrition factor – Fe def esp in of stopping.
women
Trichotillomania- Psych cond‘ Self Care Card:
impulsive desire to twist and Male Pattern Hair Loss
pull hair.

Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other

Bites: apply DEET (diethy toloudamide) 20-50% for children apply lower strength 10 % not for bf or pregnant
soov: cetrimide, lignocaine not for Bf or pregnant
aluminium acetate (stingose): suitable for preg/Bf/child not likely to work if more than 30 min of sting
13
dexchlorophenramine: suitable for child preg/Bf
hydrocortisone 1% for preg/Bf/child
Hydrocortisone >2 unless under Ok Ok Topical hydrocortisone
Hydrocortisone cream 0.5% or 1% (Dermaid®, Sigmacort®, Cortic-DC®) supervision of should not be used
Topical Cream pharmacist where the cause of the
S2 0.5% Apply thin layer to affected area 1-3 times daily (0.5%) or 1-2 times daily (1%). /doctor skin condition is
S3 1% (30g or less) unknown. In particular,
S4 1% 50g should not be used
where a viral or bacterial
Temporary relief of symptoms cause is suspected.
associated with acute and
chronic corticosteroid responsive
conditions including minor skin
irritations, itching and rashes due Should not be applied to
to eczema, dermatitis, contact broken skin.
dermatitis (such as rashes due to
cosmetics and jewellery),
psoriasis, anogenital pruritus and
sunburn. Where skin is dry,
should apply an
Used any other cream/ointment? emollient first to the
Have acne, cold sore, chicken entire area of dry skin
pox, or shingles? before the application of
Unsure if rash is infected? topical hydrocortisone to
For an infant? Nappy rash? the targeted area(s).
Rash on the face? Questions to consider when taking s dermatological history
Have diabetes or arthritis?
Pregnant or breastfeeding?
Where did the problem first start?
Already used for 7 days or more?
o Some condition would start off at one area, then spread to another area.
Recurrent problem?
o Patient tends to report the most severe and obvious problem that they want Tx for but neglect to tell that there is also other
Skin broken?
problem at other areas as well.
Dry skin?
Are there any other symptoms?
o Generally most would involved itch and/or pain. But sometimes, feeling of numbness, sharp pain, nerve pain, weeping,
discharge, fever, headache, burning…. would be the critical point.
Occupational history?
o Usually relevant to adult only, could guide to causative factor if it was contact dermatitis
General medical history?
o Many skin signs could be first marker of internal disorder. Eg puritus can be manifested from diabetes,
Travelling history?
o This could account some skin lesion that traveller might contract from tropical diseases
Family and household contact history?
o Infection such as scabies can infect people who the patient might be in close contact with and vice versa.
The patient’s thoughts on the cause of the problem?
o Sometimes getting to know what the cause the patient might suspect of could help with the diagnosis as they would know
more of what has happened to them.

Patient Problem Treatment Children (ok in…) Pregnancy Lactation Other

14
Shingles Drug Treatment: Aciclovir, Famciclovir (250mg q8h for 7/7), Valiciclovir – within Reactivation of varicella-
72hrs (reduces pain, viral shedding, duration of rash & ophthalmic complications) – zoster
(Herpes Zoster)
Tm: 7 days Post-herpatic
neuralgia
-Antiviral tx should be initiated in
Non-drug Treatment: severe in adults Zostrix
the 1st 72hrs of attack
- bathe lesions in saline tds to soothe and remove the crusts - 3-4x daily
(Chickenpoxshingles)
- rest & fluids - don‘t apply broken or
- cover lesions with non-adherent dressing (Melolin) irritated skin, eyes,
Smx:
- Solugel mucous membranes
- prodromal general malaise
- Analgesia for pain or others: prednisolone & amitriptyline for nerve pain - see doctor if neuralgia
(headache, fever, sore throat etc)
- Once the rash has healed, capsaicin 0.025,0.075% cream (Zostrix®or HP) or persists after 14 day
- blistering rash – usually trunk,
lignocaine gel may help relieve post herpetic neuralgia trial
back (along a nerve)
- burning on application
- extreme pain
more with infrequent
-cluster of Apply a cool wet compress (bandage) or an ice pack to the blisters to help use
- lesions erupt over a week & relieve the pain and itch - rub in thoroughly, wipe
heal within 2 weeks Pt should avoid coming in physical contact with other ppl esp children, pregnant excess with tissue
women, immunocompromised ppl. - wash hands with soap
If child affected – refer!
wear gloves if burning

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, eye defects,
* pink on face/neck/body mental speech etc)
* tender glands
Measles (Rubeola) Prodrome:
Parmyxovirus - fever, runny nose, mailaise, reduce appetite & Koplik’s spots in mouth (24-
HIGHLY CONTAGIOUS!!! 48hrs 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
- VACCINE effective if given within 48-72hrs for treatment
- Check all family members

Pregnancy: risk miscarriage or premature labour

15
Patient Problem Treatment Children (ok Pregnancy Lactation Other
in…)
ORAL HEALTH
Aciclovir 5% (Zovirax®) >2 yr B3; can No Spread by contact & very
Cold Sores Apply asap at first sign of lesion 5 times a day for 5 days (q4h when use but contagious.
4 main stages:
awake) preferably
Tingle –few hours preceeding avoid Advice:
Blister/vesicle – days Penciclovir 1% (Vectavir®) -use sunscreen (sun can
Weeping – spreads
Apply at least 6 times per day (every 2 hours while awake) for 4 reactivate virus)
Scab – healing (week)
days at the first sign of recurrence. -use moisturising lip balm
>12 B1 ; No No to prevent drying out and
*HSV infectious from tingle stage
Idoxuridine (0.5%) with lignocaine (Virasolve®) cracking which can lead to
until blisters have healed
Apply thin layer at first sign of lesion hourly on 1st day then every 4 hours until lesion 2o infection
disappears -avoid astringent cold sores
Virus reactivation – incl stress,
-avoid contact
colds, fever, altered immu‘ system
Good for MILD attacks -don‘t touch eyes after
and sun exposure or minor trauma
touching coldsore
to the area. -use separate towel to dry
Povidone(10%)-iodine lotion (Betadine®) - No No hands after applying and
DDx:
Apply qid for 5 days avoid touching eyes.
Impetigo: small red, itchy patch of
inflamed skin that quickly
* Aciclovir and idoxuridine should be applied early during tingling stage to Refer:
develops into vesicles – bacterial
o lesions affecting the inside
infection ↓ duration and severity. (aciclovir: only recommend if pt has prodomal Sx)
SE: stinging of the mouth, eye or
Angular cheilitis: ass‘ with corner * Povidone iodine may dry weepy cold sores and prevent 2o infection. (skin genitals
of the mouth = cracked, fissured, o large area >10cm piece
staining one SE)
red. Lesion = boggy, macerated o persistent & recurrent
and slow to heal due to mouth o secondary infection
>18yr Topical Topical
movement and excessive o very young person (child)
Famciclovir 1500mg stat, approved for treatment of herpes labialis (cold sores) in antiviral is antiviral
moisture o painless without
immuno-competent patients preferred is
preferred itch/tingling prior to
Refer - Most effective when initiated within a few hours of symptom onset, preferably at the B1 blistering - impetigo
1. Taking any other meds? first sign of an outbreak. Treatment initiated more than 24 hours after onset of
2. Pregnant or breastfeeding? symptoms may have limited efficacy Self Care Card
3. Child or infant? Refer - May be the preferred treatment for severe and disabling symptoms Cold Sores
4. Have eczema? Refer - is likely to be requested for patient-initiated treatment of future outbreaks of cold
5. Tinging, blisters or pain? If not, sores so Tx is given promptly at the onset of prodromal symptoms and can
may be impetigo (yellow crust) maximise treatment efficacy.
or school sores. Refer
6. Location? Inside the mouth, S/E: may cause headache, fatigue, nausea or diarrhoea following single dose
eye? Refer treatment
7. Duration? >2 weeks, refer
8. Severity? Big >10cm? Rapid
spreading to other areas? Also
with fever and malaise?

16
Patient Problem Treatment Children (ok Pregnancy Lactation Other
in…)
- Sip water and sugar free
Dry Mouth MANAGEMENT: drinks regularly throughout
(Xerostomia) mouthwashes – bicarbonate/plain water – q2h the day.
? Reason – elderly, drug (TCA‘s, gentle brushing of teeth with soft tooth brush - Suck on ice chips or sugar
anticholingerics, chemoTx, artificial saliva – spray, mouthwash, liquid, gel – Biotene, Oralube, free ice blocks.
palliative-care ?mouth breathing Oralbalance – qh - Eat moist foods. Use
?diuretics ?beta blockers ?oxygen Sugar-free lollies or chew sugar free gum to incr saliva flow gravies, sauces and
therapy Regular drinks, adequate hydration, ice cubes, water q30h purees to soften food.
? Severity Vaseline to lips - Try smaller, more frequent
? lifestyle – smoking, alcohol, high Room humidifier meals.
caffeine - Rinse mouth with plain
Reduce causative meds
? Treatments already tried water after eating.
Rx: pilocarpine eye drops to mouth (SE: sweating)
Presentation: - Don‘t smoke.
-dry cracked lips - Limit alcohol and caffeine
-teeth stuck to lips drinks
-dry, cracked, furrowed tongue - Avoid salty, acidic or sugar
-difficulty swallowing & speaking containing foods and
-sore or burning mouth drinks.
- saliva that is ropy and scant
Self Care Card
Dry mouth
Tm: Requires removal by dentist
Gingivitis Prevention: good oral hygiene: brushing, flossing and using mouthwash to inhibit Refer:
Inflammation of the gums caused
plaque formation. - Spontaneous gum bleeding
by plaque and calculus deposits
caused by other factor:
on the teeth. Gum= swollen, red *Brushing: once-twice daily with fluoride toothpaste to prevent tooth decay. agranulycytosis,
and easily bleed with slight trauma
Electric toothbrush (with rotation oscillation action-where brush heads rotate leukaemia. Usually asso‘
in one direction and then the other) proven more effective than manual fatigue, weakness, signs
Sx: bad breath, gum swelling
brushing at plaque removal of systemic illness (fever).
(often painless), gum bleeding
when flossing or brushing - Medicine induced:
Mouth wash:
1.Chlorhexidine gluconate 0.1% - 0.2% mouthwash (Savacol®) Refer Ok Ok o Gum bleeding: warfarin,
Other causes for gingivitis include: Use 10mL held in the mouth for 1 minute twice daily. heparin, NSAID
smoking, diabetes mellitus, poor Continual use may lead to brown staining of tongue and teeth. o Gum hypertrophy:
nutritional status. phenytoin, cyclosporine,
2.Cetylpyridinium mouthwash (Cepacol) Refer Ok Ok nifedipine.
Rinse or gargle 10-15 mL for 15 seconds as desired; expel liquid
- Foul taste asso‘ with gum
3.Povidone –iodine – not for pregnant or with thyroid disorder pt Refer NO NO bleeding
1ml diluted to 20ml with water and use qid . Not to be used for >14 days due to
iodine absorption. - Loose teeth – periodontitis

17
Patient Problem Treatment Children (ok Pregnancy Lactation Other
in…)
Orabase® (Carmellose dental paste) forms protective mechanical barrier over ulcer(s) Refer < 10 Ok Ok Apply after food.
Aphthous (mouth) Apply prn.
ulcers
Painful lesion - shallow white or Kenalog in Orabase (Triamcinalone 0/1% in carmellose paste) - Cat C - No No Normally resolve within 7-
yellowish centre with an inflamed 14 days
red outer edge appearing on the Dab small amount onto ulcer and hold in position until paste becomes sticky and forms
tongue margin and inside the lips a think film. Apply at night or 2-3 times daily if required. Refer:
and cheeks. avoid irritating food o duration greater than 14
C/I: fungal, bacterial, viral infection of mouth/throat days
stress, apply ice o painless mouth ulcer(s)
Often recurrent and more common
in females. o children <10
SM33 (Lignocaine and salicylic acid) gel – reduce pain/inflammation - Ok Ok o ulcers in crops of five to
Question: (can use ten, or more
o Duration? >14 days? Apply to affected area every 3 hours as required. this product o ulcers >1cm in diameter
o Painful or sore? NO? > 6 months) o associated weight loss
o Age? <10yrs?
o From trauma? denture? Bonjela (choline salicylate) gel >4 month Ok Ok
brushing? Biting or chewing Apply to affected area every 3-4 hours as required Self care:
o No. of ulcers? More than 10? o try to identify the cause
Chlorhexidine 0.2% mouthwash (Savacol Mouth & throat rinse®) for ?? Ok Ok
o Lesion size >1cm in diameter? prevention of secondary infection. and act
o Any other medications? Use 10mL held in the mouth for 1 minute twice daily. o try sucking ice to ease
o Ulcers anywhere else? Hand, pain
foot and mouth disease? o brush teeth gently with
caution; can cause STAINING of the teeth and tongue when used for
o Food? Very hot? continuous periods of time soft toothbrush or with
o Diet? Low on Fe, folic acid, B12 electric one.
o Stress? Hormone change? o Try relaxation if stress is
the issue
Common medication causes of
mouth ulcers:
-cytotoxics, NSAIS, thiazides,
tetracycline, anticholinergics, OTC – Vitamin B2 supplementation: Self Care Card:
diuretics - mouth ulcers may be due to Vit B2 deficiency Mouth Ulcers
- take: Vit B2 15mg tds for 1st week then 25mg/d
DDx:
*herpes simplex: just on lips,
outside mouth, fever, tingling
*Bechet‘s syndrome: more
extensive and resistant to
treatment

18
Patient Problem Treatment Children Pregnancy Lactation Other
Use treatments after food
Oral thrush Miconazole ( ®) 2% Orange flavoured >6 month Ok Ok and avoid taking food or
Drop gel on tongue; keep in mouth for as long as possible before swallowing. drink for one hour after the
Oral thrush is common in babies,
For infants, divide dose into several portions and place at the front of mouth (prevent dosing.
particularly in the first few weeks
obstruction).
of life.
If baby has oral thrush
Adults, children: 1/2 spoonful using provided measuring spoon 4 times daily should check for nappy
Affects surface of the tongue and Infants < 1 year: 1/4 spoonful using provided measuring spoon 2 times daily rash. Treat both at a time.
inside of cheeks. Appear as white
patch which, when wiped away,
Administration instructions: For bottle-fed babies,
leave a sore and reddened area of
spoon should NOT be used for administering the gel sterilize bottles and teats.
mucosa which may sometimes
use a clean finger, apply small amount of gel at a time to the inside of cheeks
bleed.
and over the tongue Refer:
Continue treatment for at least 48 hours after the symptoms have totally disappeared. o >3 weeks
Other cause:
o diabetics
Diabetes
Nystatin (Nilstat®) OK OK OK o immunocompromised
Immunocompromised
patients
Dry mouth sufferer
1 mL (100,000 units) four times daily. o painless lesions
Recent ABx tx
The dose should be administered under the tongue or in the buccal o OTC treatment failed
Inhaled corticosteroid
cavity and held in the mouth as long as possible before swallowing. o recurrent
Ill fitting denture
Treatment should be continued for at least 48 hours after symptoms
have resolved.

Symptomatic relief options: Dental therapy is best

Toothache avoid hot, cold, sugary,smokingoption for pain relief →
1. Analgesics provide symptomatic relief
Reason: do: milk, flossing,use toothpaste
- paracetamol: 1-2 tabs q4-6h prn and refer
- ? infection, ?wisdom
- Ibuprofen: 200-400mg q6-8h prn Max: 1200mg/d
teeth/molars cutting through, drink tap water (flourinated)
?tooth extraction, ?braces
2. Nyal® Toothache drops (ethanol, phenol & benzocaine)
Directions: moisten cotton bud with 1-2 drops and place in cavity of
Ask about dental hygiene – how aching tooth for about 1 minute. Max qid
frequently brush teeth, types of
mouthwashes used, last time saw oraleze: benzocane, clove bud oid, phenol) drops (same as Nyal)
dentist
AVOID mouthwashes! Most commercial mouthwashes contain large amounts of
Oral Hygiene alcohol which are carcinogenic to oral membranes.
- Colgate PLAX gentle (pink bottle)
- Biotene Mouthwash – enzymatic rinse

Brush with a soft toothbrush after each meal.

Floss teeth regularly.

Soak dentures in white vinegar overnight.

19
Patient Problem Treatment Children Pregnancy Lactation Other
GASTROENTEROLOGY & GENITOURINARY
Haemorrhoids/Piles Proctosedyl® (Cinchocaine 0.5%, Hydrocortisone 5%) – ointment/suppositories Refer <12 yr Ok Ok o Treat constipation by
SOOV IT® (Lignocaine 5%, hydrocortisone 0.5%) - ointment increasing fluids, fibre
Internal & external or laxative to reduce
Sx: Apply sparingly tds for 1st week, bd for 2nd week then d for 3rd week. Max 4 weeks
straining during
o Pain or discomfort – usually a dull Do not use when bleeding present. May exacerbate candidiasis. VIP
defecation and reduce
ache SE: stinging, burning at site. Prolonged/overuse: skin atrophy/infection recurrence
o Anal irritation, burning, itching – CI: uncontrolled infections, STDS, viral infections
o Do not put off the urge
often the most troublesome
to open bowels
symptom Rectinol® (Cinchocaine 0.5%, Zinc Oxide 20%) – ointment/suppositories Refer <12 yr Ok Ok o Exercise regularly, to
o Bleeding – bright red blood Insert into rectum morning and night and after each bowel motion. (Lotion: smear develop and maintain
o haemorrhoid protruding from the small qty over anal region) good abdominal
anus
muscle tone.
o A lump or swelling in the anus Refer <12 yr Ok Ok
Anusol (Zinc Oxide, Benzoyl Benzoate, Balsam-peru) - thought to precipitate o Learn to lift properly to
DDx: surface proteins thus producing a protective coat over the haemorrhoid. prevent straining
o -Pure itchiness - eg threadworm,
o Avoid long periods of
thrush or contact dermatitis
Supps: insert morning and night and after each bowel motion standing or sitting,
o -Anal fissure which can increase
Question: Oint: Insert/apply bd to perirectal area and the mucosa of the rectal canal to a point
about 1 cm above the anal sphincter. pressure in the anus
1. Take any other meds? (May be
o Pregnancy:
causing constipation/diarrhoea) recommend pelvic floor
2. Pregnant or breastfeeding? Non medicated management:
o Sitz bath: provide relief by sitting on warm water (≈40oc) that has table salt added. exercise.
3. Diagnosed by a doctor?
4. Constipation or altered bowl o Cold compress during cleaning after bowel motion to shrink and reduce inflammation
o Try dabbing with wet tissue or special marketed wipe (Anusol or Rectogesic wipe) instead. Rectogesic powder could be Refer:
habit?
o blood mixed in with
5. Blood or pain? used for itching.
o Donut pillow for prolonged sitting to relieve pressure on the perianal area. stool or large qty
6. Recurring problem? >1week,
o abdominal pain
refer
o fever
7. Swelling or itching? o Supp‘s admin: Remove the foil or plastic cover and insert the supp into the rectum with a finger, while lying with one knee up
o dark-coloured blood
and stay in position for 5-10 min
o leakage of mucous
o If using a rectal applicator for ointment, lubricate it with lubricant eg WSP before use and wash it well afterwards. Oint with
Anal Fissure - is a split of anaesthetic could be applied prior to insert of application to give some numbing effect o sharp stabbing pain on
the anal canal skin. Often caused by defecation
passage of a hard stool with anal o >3 weeks, not resolve
Rectogesic® (GTN) – for treatment of anal fissures by promoting healing via Refer <12 yr No No
pain (worse on defecation) and vasodilation with treatment
bright red rectal bleeding o need to be manually
Insert 1-1.5 cm strip of ointment into anal canal tds
reduced haemorrhoid
Mx: avoid hard stools (by using o unaccountable rectal
Constipation can cause/aggrevate anal fissures so it
stool-softening or bulking agents), is also a good idea to offer a stool softener if bleeding
use warm salt baths after bowel constipation is problem.
movements, and apply topical SE: may cause headaches & facial flushing in some patients Self Care Card:
glyceryl trinitrate if needed Haemorrhoids

20
Patient Problem Treatment Children Pregnancy Lactation Other
Causes: Non drug measures:
Heartburn/Indigestion - Smoking, alcohol/caffeine - eat small, frequent meals
- Certain foods (e.g., rich, spicy and fatty food and chocolate, peppermint, onions, - avoid precipitating foods Refer: - ALARM
Indigestion (dyspepsia) is poorly
tomatoes) - avoid alcohol, caffeine and
o Anaemia
localised upper abdominal
- Overweight - cease smoking
pain/discomfort and often come with o Loss of weight
- Pregnancy, esp late pregnancy - don‘t eat late in the day
feeling of fullness. - Drug-induced (NSAIDs, alendronate, doxycycline etc) - posture – avoid bending, stooping and
o Anorexia

- A large meal, eating quickly lying flat. Bedhead elevation o Rcent on set of
Heartburn (reflux oesophagitis) - a progressive
- Physical activity soon after a large meal - weight reduction
burning sensation along the symptoms
- Stress and anxiety - avoid tight, constrictive clothing
oesophagus and sometimes with
- avoid NSAIDs where possible o Melaena, dysphagia,
acidic taste in back of throat. odynophagia
Mylanta® Original (AlOH, MgOH, Simethicone) >6 yr Cat A Ok haematemesis
DDx:
10-20mL prn up to 4 times daily Drug of o Severe/debilitating pain
o Peptic ulceration – mid-
shake well , choice in that wakes pt up at
epigastric pain –
*contain high amounts of Na so avoid in patients on pregnancy night
contant,gnawing.
sodium-restricted diet or with HT, CCF, renal o Persistent vomiting
o Gastric ulcer: pain comes
impairment etc o Refered pain
whenever the stomach is
**Al salts tend to cause constipation whilst Mg causes diarrhoea o Sensation of food is
empty, usually 30min after
Gaviscon - All has SODIUM >12yr Cat A Ok ‗sticking‘ in the throat
eating and is generally
o Tx failure - symptoms
relieved by antacid or food Gaviscon® Double Strength liquid (Na alginate, KHCO3, CaCO3)- 5-10 mL prn
**Precaution: Patients on a sodium restricted diet. not adequately
and worsened by caffeine or
Alginate: 1st line for reflux as it works by forming a physical barrier floating on top of controlled after a two
alcohol. Pt could hav wt loss
gastric content. week trial of initial
and GI bleeding.
therapy
o Duodenal ulcer: pain is
o Abdominal mass.
usually 2-3 hour after eating Ranitidine (Zantac) >12yr B1: safe to Only if
o <18 (unusual) or >50
and pain could often wake pt 150 mg bd or Max 300 mg d use essential
** swallow whole with water. Do not take more than two tablets yrs (possible cancer)
up at night
o symptoms that occur
o Medicine induced dyspepsia in 24 hours
daily or that are
o IBS Pantoprazole 20mg (Somac Heartburn Relief 14 tablets) >18 yr B3: limited No recurrent, recurring
o Gastric/ Oesophageal carcinoma Swallow whole 20mg od for initial TWO WEEKS. data within five days of
(>55yr with sudden progressive . spontaneous recovery
symptoms) Rabeprazole 10mg (Pariet 10mg 14) or stopping treatment
o Atypical angina Swallow whole 10mg od for initial 2 weeks

- Swallow whole, don‘t crush or chew

- Refer if longer maintenance required Self Care Card:
- Only appropriate when symptoms are experienced two or more times a week but Heartburn and
less than daily Indigestion
- If adequate symptom control is achieved with an initial two-week course of a PPI,
patients might be able to cease therapy or control symptoms by taking either an
H2-antagonist or a PPI as needed. Referral is recommended if ongoing
maintenance or a higher dose is needed
Simethicone 100mg (DeGas®) – >6yr Cat A
antiflatulent - Relieving stomach wind, gas and bloating.
Adt/> 12 yrs: 100-200mg pc prn

21
Patient Problem Treatment Children Pregnancy Lactation Other
st
Gastrolyte®, Repalyte® (NaCl, KCl, citrate, glucose) 1 line Ok – but ok ** Energy drink/sport
Diarrhoea and Two effervescent tablets or the contents of one powder sachet when in drink/flat
vomiting should be made up with 200mL of fresh drinking water. doubt refer lemonade/fruit juice
correction of dehydration and in case ARE NOT good
electrolyte disturbance is the priority ORS= more palatable if frozen and present as an ice-block something
st
Solution should be refrigerated and drunk within 24 hours. else wrong
substitute of ORS as
in all cases - 1 line in children
some of these have
**Children can dehydrate rapidly; Loperamide (Gastrostop®, Imodium®) 2mg capsules >12 yrs No – B3 Safe for no electrolyte but way
need careful monitoring; Initially, 4mg (2 caps), then 2mg (1 cap) after each loose occasional too much sugar
continued large fluid loss or short term
bowel action; max 8/day
inability to tolerate fluid use
replacement requires urgent ONLY recommend for short term and for convenience purpose Refer:
medical attention in adults should let gastro ‗run its course‘ so offending factors could be eliminated o diarrhoea with n/v
from the system. o signs of dehydration;
Question: > 12yrs No - C Safe for
Diphenoxylate+atropine 2.5mg/25mcg (Lomotil®) dry mouth/mucous
o Taking any other medications?
5mg 3 or 4 times d prn. Max 20mg/d occasional membranes, sunken
Antibiotics recently? short term eyes, tiredness,
o Pregnant or breastfeeding?
*may have an additive effect with drugs which act on the CNS,
use irritability, deep
o Blood in stools? Black stools?
avoid combination Note: atropine added to discourage misuse breathing, rapid pulse,
o High temperature?
– causes dry mouth and blurred vision, urinary retention low blood pressure,
o Child or older person?
May cause drowsiness or dizziness and may increase effects of EtOH; do not drive decreased urination
o Duration? Longer than 48 hours?
o blood or mucus in
o History of recurrent diarrhoea/ or operate machinery if affected
st stools
constipation? Diarrhoea 1 thing - Try BRAT food: Banana, Rice, Applesauce, Toast as these are easier to digest food o drug-induced
each mane -IBS? - Avoid dairy product such as milk or cheese o diarrhoea for >1 day in
o Bad pain or vomiting? - You may need to avoid or have less raw fruit, vegetables, and whole wheat breads and cereals. infants; 2 days in
o Kidney, liver or heart disease?
children under 3 and
Glaucoma or bladder problem? - Continue to breastfeed infants – offer more feeds and oral rehydration solutions in between feeds. elderly pts; 3 days in
o Recent travelling? Giardiasis? - Stop formula milk for 6-24 hours or until condition improves adults and older
o Recent food history?
children

Motion sickness Dimenhydrinate 50mg, Hyoscine hydrobormide 0.2mg, Caffeine 20mg >2 Ok Ok – How to minimise the
(Travacalm Original) monitor risk.
Hyoscine hydrobormide (Kwells, Travacalm HO) 0.3mg baby for o avoid alcohol and
Tips:
Adults: 1-2 tabs q4-6h prn Max 4 tablets daily sedation decrease oral intake,
o In a car, sit in the front seat and
look at the distant scenery. SE: Dry mouth, sedation take half an hour before trip take frequent small
meals
o On a boat, go up on the deck and
o Avoid rear facing seats
watch the motion of the horizon. Ginger extract 500mg (Travacalm natural) Adults: 2-3 tabs then 1 tab q2h prn >6 Ok, up to
SE: Gastric irritation and heartburn 2g in any form of
o In an airplane, sit by the window
transport,
and look outside.
o Ensure good
o Also, in a plane, choose a seat Pheniramine 45.3mg (Avil®) – sedating antihistamine >5 Ok, use Ok, use
Adults: ½ - 1 tab up to tds only if only if ventilation by opening
over the wings where the motion the window,
is minimized 5-10yrs: ½ tab up to tds strictly strictly
o o Avoid reading or
o fix vision 45 angle above horizon indicated indicated
Some pt complains of having dry mouth while taking travel sickness med and this could be overcome by sucking a sweet to focusing on games
o take first dose 30 mins before
o Focus on stationary
travel stimulate saliva secretion.
Precaution: pt w/ close angle glaucoma, prostate enlargement or other med with anticholinergic effects eg TCA, neuroleptic object

22
promethazine, dimehydramine
Patient Problem Treatment Children Pregnancy Lactation Other
BULKING AGENTS Non-drug therapy:
Constipation
Isaghula granules (Fybogel®) Onset: 24-72 ½ adult dose Ok Ok increase dietary fibre
Caused by inadequate dietary fibre, 1 teaspoon/sachet, 1 to 2 times daily. hrs; increase exercise
fluid intake and activity/exercise as *Take 2 hrs before or after taking any meds to => Do not Refer <6yo ensure adequate fluid
well as inappropriate bowel habit. minimize any effect on drug absorption use for intake
acute relief toilet after meals
Psyllium Metamucil Granular o Mix with 250ml water and drink solution immediately or
Adult, >12yrs, 2 teaspoons (7g) 1-3 times daily it will set. When to start drug Tx:
o Requires adequate hydration otherwise risking If response to dietary
A/E: (Common) flatulence, bloating, abdominal hardening stool and worsening constipation and lifestyle changes is
discomfort o C/I in bowel obstruction
Considerations: inadequate or Tx is
o underlying causes (e.g. OSMOTIC/SALINE LAXATIVES required while they take
hypothyroidism, hypercalcaemia, 1-2 days 5-15mL d Ok Ok effect (usually few days
Lactulose (Actilax®, Duphalac®, Genlac®) but may be many
depression, dehydration, anal (only under
fissure); Adult: Take 15 to 30 mL daily in one or two divided doses. medical weeks); faecal impaction;
o causative drugs (e.g. AL- o Ok in diabetes as not absorbed supervision) starting opioid analgesia
containing antacids, o Tastes very sweet; may help to mix with fruit juice, water
anticholinergic drugs, Ca, Fe or milk ‗Normal‘ bowel habit can
supplements, opioids, verapamil); o AEs: (Common) Flatulence, abdominal discomfort, range from 3 times a day
o lack of fibre/fluids, cramps; to 3 times a week.
o mechanical obstruction, Glycerol Supps (Adults 2.8g, Children 1.4g, Infants 0.7g) 5-30 min o>1yr: Ok Ok Reassure patients.
o Inadequate exercise/ activity, etc. Adult, 1 adult supp once d prn 1.4g prn
o<1 yr: 700mg Hormonal changes and
AEs: (Infrequent) rectal discomfort prn direct pressure on the
Admin‘ position: Lying on left side with left knee slightly bent and the
bowel causing
right leg drawn up, or knee to chest position. (same for both
BULKING AGENTS – for mild decreased mobility
enema/supp) common cause of
constipation; diarrhoea (and
Macrogol (PEG) 3350 (Movicol®) 0.5-3hrs >12yr Ok Ok constipation during
occasionally faecal incontinence),
to improve stool consistency, to Adult, >12yrs: 1 sachet d, increasing to 2-3 sachets d prn. pregnancy → bulk
regulate faecal consistency o Dissolve 1 sachet in 250ml water then drink. Follow with a glass of o Note: Fluid and electrolyte disturbances are less of a forming, osmotic and
water. Drink plenty of water and increase fibre in diet risk with PEG laxatives than with other osmotic stool softener preferred
OSMOTIC/SALINE LAXATIVES – o AEs: (Common) N, V, diarrhoea, anal irritation, abdominal laxatives (e.g. saline laxatives
for constipation; hepatic distension, cramps or pain o Movicol: the electrolytes also present in the formulation
encephalopathy (lactulose); faecal o Store solution refrigerated and discards any solution not used to ensure that there is virtually no net loss of sodium,
impaction (Movicol); bowel prep within six hours. potassium or water.  no risk of electrolyte disturbance
(ColonLYTEly, Glycoprep, etc). o
Sodium methyl hydroxybenzoate (Fleet Ready–to-use enema) 2-30min < 3yo: ½ A – Ok Ok
STOOL SOFTENERS – for Sodium citrate, Sodium lauryl sulfoacetate (Microlax Enemas adult dose
constipation; prevent straining after 5ml) (best to
rectal surgery and in pt with anal Adult: Administer contents of one tube rectally as a single dose squeeze out
o Ensure adequate hydration
half prior to
fissures/haemorrhoids (docusate)
o Precautions: risk electrolyte disturbances. Caution in pts with insertion,
active IBD, CVD, renal impairment, elderly, children (use less then use
STIMULANT LAXATIVES: - for
conc. saline laxative) administer
constipation; bowel prep
o AEs: N, bloating, fluid and electrolyte disturbance, rectal irritation
the remaining
(bisacodyl);

23
 STOOL SOFTENERS:
Docusate 50mg Senna 8mg (Coloxyl & Senna) 1-3 days Poloxamer is Ok (senna Ok
preferred for <3 only short Refer:
Take 1-2 tablets; up to 4 tabs d prn yr term) o blood in stools
Take tablets with plenty of fluid <6 month 0.3 ml tid
1. Sx? Normal bowel frequency? o abdominal pain,
2. when was the last bowel 6-18 month 0.5 ml
Poloxamer 100mg/ml Coloxyl Oral drops –Choc flavour 2-3tid 11
days vomiting, bloating,
movement? weight loss.
<6mths- 3yrs:10- 25 drops tds
3. taking any other medications?
-Should be added into bottle feeds or fruit juice
> 18 month 0.8 ml tid - Docusate and poloxamer are o fevers, anorexia
4. pregnant or breastfeeding? surfactants ; liquid paraffin is a o age >40yr with sudden
-AEs: abdominal discomfort, diarrhoea (with excessive
5. elderly or children? lubricant change in bowel habit
doses)
6. recent surgery? o failure of OTC
7. any bleeding from the rectum? 2-3 days medicines
Liquid Paraffin (Parachoc 50% choc/vanilla)
pain on defecation? o family Hx of IBD or
Adult: initially 40ml once d
8. alternating constipation and colon cancer
7-12yrs, initially 20ml once d
diarrhoea? o suspected depression
1-6yrs, initially 15ml once d
9. intense pain? or hypothyroidism
** Do not take dose immediately before lying
10. taking laxatives often? o young children: pain on
11. heart or kidney problems?*avoid down  risk of choking defecation causing pt to
laxatives containing Na and Mg salts STIMULANT LAXATIVES: suppress defecatory
Biscodyl 5mg tab(Dulcolax®, Bisalax®) Oral: 6-12h >4 Ok; avoid Ok reflex.
10mg sup (Dulcolax/Fleet sup) Supp: in late o Duration >14 days

Adult: 5-15mg tab nocte. OR insert 1 supp nocte 15-60mins stage

daily. Enema: Self Care Card:
- Swallow tabs whole on empty stomach 5-15 mins Constipation
- Avoid milk and antacid within 1 hour from last
dose
- AEs: (infreq) diarrhoea, fluid & electrolyte
imbalance (with prolonged use or excessive
doses), abdominal discomfort, cramps, N

Senna 7.5mg (Senokot) 6-12hrs

Take 2-3 tabs on an empty stomach nocte. Max 6
tabs/day
Or Adult: 7.5-30mg nocte o Precautions: dehydration, hypoK (avoid high doses or
AEs: (Infreq) discolouration of urine (yellowish prolonged use; otherwise use with caution and monitor
brown or red); closely); elderly ( risk faecal incontinence)
if no improvement after 3 days of Tx  Dr o Generally short-term use is preferred; usually taken at
investigation night to help produce a bowel motion the following
morning;
Sodium picosulfate (Dulcolax® SP drop) o May be used long term for constipation e.g. in spinal
Adult, children > 10 yrs: initially 10 drops (5 mg), may damage, chronic neuromuscular disease and pts on
incr to 20 drops (10 mg) od nocte opioid Tx; often used with other laxatives
Only use if other fails o Prone to misuse
A/E: Dizziness, syncope (defecation, vasovagal); o Usual dosing time is NIGHT so time taken over night
abdominal cramp, pain, discomfort; GI upset; would be sufficient to allow defecation in the next
hypersensitivity incl angioedema, skin reaction morning

24
Patient Problem Treatment Children Pregnancy Lactation Other
Antispasmodics act on smooth muscle in the gut, causing relaxation and thus .Refer:
Irritable Bowel reducing abdominal pain and distension. o children under 16
Syndrome o patients over 40 with
Peppermint oil (Mintec®) 0.2mL caps Refer <16 Ok Ok (AMH) recent change to bowel
Chronic abdominal pain associated Swallow whole 1 capsule three times a day half an hour before meals. habit and no previous
with alteration in bowel habit S/E: heartburn history of IBS
(between constipation and Do not break or chew capsules as peppermint oil can irritate the mouth o pregnant women
diarrhoea) and without apparent and throat. o blood in stools
aetiology. Pain often accompanied o unexplained weight loss
by abdominal distension/bloating. Hyoscine butylbromide 10 or 20mg (Buscopan®) o signs of bowel
20mg qid >6yr B2 - avoid Ok (AMH) obstruction
More commonly reported by S/E: constipation or dry mouth o unresponsive to
females and often develops in Precaution: with anticholingeric drug interaction. appropriate treatment
young adult life. Constipation- predominant IBS : Bulk forming (psyllium, ispaghulla) or osmotic laxative (stimulant laxative is not recommended) o Fever, nausea and
Diarrhoea –predominant IBS: Loperamide 2mg vomiting
Treatment is aimed at symptomatic - Avoid trigger factors including stress, large meals, fatty foods, caffeine and exacerbating medications.
relief of predominant symptom(s) - Keep a diary of; when you experienced symptoms and what you were doing before they started, what you were eating or
and avoidance of trigger factors. drinking before symptoms began, how you were feeling at the time (e.g. stressed) and any medications you were taking
Pyrantel 100mg (Combantrin® chocolate squares) >6months. B2: can Ok: avoid if Perianal itching may
Threadworms Adult/Child: 10mg/kg, MAX is 1g as a single dose Refer if <1 use but can continue for several days
Common in young children.
y/o avoid in 1st after treatment.
- Itching around anus or vagina,
Pyrantel 50 mg/mL (Combantrin suspension) trimester.
especially at night ( The pregnant
1ml/5kg Repeat drug treatment
female worm lay ova around the
in 2-4 weeks.
anus and this causes intense itch) Mebendazole 100mg (Combantrin-1, Vermox, Deworm)
- Restless sleep, Increase irritability Adult, child >10 kg: 100mg stat >2 y/o B3: Avoid Ok: avoid if
Refer:
- Change in appetite or stomach Child <6 months and <10kg: 50mg stat can
- Recent overseas
ache - best to be taken on empty stomach
travelling, especially
- Can sometimes be seen moving - tablet can be crushed, chewed or swallowed whole
Asia or Africa;
on the outside of a bowel motion - Tx may be repeated in 14 days
- blood in faeces;
or around the anus, especially at A/E: infrequent abdominal pain, diarrhoea and rash
- abdominal pain;
night and first thing in the morning
Look for worms: - accompanied diarrhoea
o On the outside surface of bowel motions. Do not mistake mucous or fluff for threadworms – look for movement. or vomiting;
Dx: need to sight worms (white
o Moving around outside the anus when the child is complaining of itch, at night (often about an hour after going to sleep) or first - excessive weight loss;
thread-like objects ~5-10mm long);
thing in the morning. - the skin around the
found in faeces or protrude from
o In the morning before bathing, briefly press a piece of sticky tape over the anus. Any eggs will stick to the tape. Ask a doctor to anal area is broken due
anus at night. Sticky tape over anus
have the tape examined under a microscope. to scratching; or
in morning → eggs stick to tape.
Prevention of re-infection can be done by - A child < 6 months old
- Infection is common and not a sign of poor hygiene or parental neglect of children. - Medicine failure
1. Pregnant or breastfeeding?
- Treat all family members even if asymptomatic as may be in early stages of infection (sensitisation to irritant substances - Secondary infection of
2. Recent travel abroad? Other type
surrounding eggs may take several days). perianal skin due to
of worm infestation scratching
- Vacuum and damp dust furniture, bedrooms and around the toilet to remove any eggs
3. Unsure if threadworms present?
- scrubbing underneath your fingernails and keeping them short, as eggs may lodge under the nails
4. Less then 2 y.o?
- Wash hands after going to the toilet and before handling food to prevent transmission. ―P‖ (pyrantel) for
5. Liver disease? LFT abnormalities
- Wash and iron bed linen, sleepwear, clothes and towels. pregnancy
with pyrantel/mebendazole
- Showering/bathing in morning to wash away eggs laid previous night.

25
Patient Problem Treatment Children Pregnancy Lactation Other
PAEDIATRICS
Reassure parents. *AVOID: PainStop
Teething Suggest teething ring, clean cloth or pacifier for gumming. NIGHT – bc poor ratio –
Gentle massage of gums with fingers. may not control pain*
Infants first teeth usually erupt at
Cool fluids although avoid frozen foods or objects as may cause thermal damage
age ~ 4 months and teething
Teething biscuits in older children
drooling
completed by 2-3 years of age.
chewing on fingers
Paracetamol 15 mg/kg q4 -6h
Excessive drooling, chewing on
Ibuprofen 5-10 mg/kg q6-8h with food (>3 months)
fingers, restlessness, irritability,
disturbed sleep/feeding patterns,
Bonjela (choline salicylate) children >4 months
rubbing at cheeks etc
Apply 0.5 cm to the gums every 3 hours; max 6 times/day

Gastroenteritis & 1. ORT DO NOT GIVE ANTI-

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

26
 cough for kid: steam inhalation

Patient Problem Treatment Children Pregnancy Lactation Other

Counselling: The treatment of febrile
Febrile -normal occurrence in children who are concurrently ill with a fever seizures:
Convulsions/Fever in -don‘t cause long-term problems - rectal/IV diazepam
-should stop by 6yrs for children who have
Children suffered from it before
Treatment/Management: may use diazepam
-convulsions associated with a high 1. Paracetamol – should manage the fever with paracetamol 15mg/kg q4-6h prn rectal/oral at the onset of
fever >38oC (however, antipyretics may not reduce the chance of a seizure occurring) fever for prevention of
-NOT epilepsy recurrence
-brief, generalised, occur within 2. Convulsion management:
24hrs of fever -place child on side, chest down, head turned to size. DON‘T lie on back.
-in children 6months-5yrs -ensure child cool – cool washes, undress to child to their singlet
-30-50% risk of recurrent febrile - get medical attention
seizures but LOW risk of
developing chronic epilepsy
General Measures: Refer: Reassure parents that
Colic o sooth by holding and rocking the baby o infants that are failing to put on weight colic is not the result of
o use a dummy – may help calm a baby with a strong need to suck o medication failure bad parenting.
Colic – usually starts in the first few
o use of gentle rhythmic motion (e.g. strollers, infant swings, car rides) o over anxious parents
weeks of life and usually resolves
o Soft music – try something with a definite beat or rhythm. A ticking clock may o Woken up over and over in the night, Prevent caregiver
by the age of 3-5 months
help with screaming not related to feeding burnout by advising
It is a disorder of the GI tract where
o burp baby after meals o Vomiting and/or diarrhoea that is getting parents to get proper rest
painful contractions cuase
o employ 5 ―S‘s‖ (need to be done concurrently): worse or has lasted for more than 24 breaks, sleep, and help
excessive crying, and might be
1) Swaddling – tight wrapping with blanket 2) Side/Stomach – laying baby on side or hours in caring for infant.
caused by allergy to cow milk, stomach 3) Shushing – loud white noise 4) Swinging – rhythmic, jiggling motion 5) o Constipation
defined as excessive crying in an
Sucking – sucking on anything (e.g. nipple, finger, pacifier) o Changed from being alert when awake, Usually subsides 3-6
otherwise healthy baby.
to being sluggish months of age.
Diet o Severe, long lasting swelling of the belly
Predominantly occurs between 2
o avoid under- or over-feeding o A high temperature (38°C or more). Colic has no bearing on
weeks and 4 months of age.
o check feeding technique as underfeeding can result in excessive sucking resulting baby‘s intelligence or
in air being swallowed and leading to colic-like symptoms future development.
o teat size of the bottle should be checked so that when the bottle is turned upside
Intense crying, high-pitched
down the mil should drop slowly from the bottle Keep the phone number
screams, inconsolability, flushed
o if formula feeding, consider a one-week trial of switching to hypoallergenic of the
face, fish clenching, back arching,
formulas (if breastfeeding, continue to do so as switching to formula will not help) Australian Breast
drawing up legs to abdomen with
o switching to soy formula may be beneficial Feeding Association,
periodic extension of legs, arms stiff
or a helpline, close at
tight and extended, symptoms may
If suspected that crying is due to excessive wind caused by air swallowing during - - - hand
occur more often in late afternoon
crying or feeding then can use:
and evening.
Self Care Card:
Simethicone (Infacol Wind Drops®) Infant Colic
Infants 1 month-2 years: add 0.2 mL to bottle or give orally immediately before
breastfeeding

(> 2 years: 0.4 mL 4 times/day (after meals and at bedtime); max. 12 doses/day)

Gripe water (dilseed, carawy,clove oil, cinnamon, cardamon) 1-6 months 5 ml - 6-12 months 10 ml
infant friend: cassia oil, delseed oil,anise oil: less than one months 10 dps, 1-3 months 10-20 dps 3-6 months 20-30 dps
27
older 5 ml give after feed
Cradle Cap - - - Reassure parents –
Remove thick scale by massaging warm olive or mineral oil gently into scalp → cradle cap is a common,
a.k.a infantile seborrhoeic
leave on for several hours/overnight → wash off with a mild soap and a soft bristle self limiting condition and
dermatitis
toothbrush or terry cloth washcloth. will clear spontaneously
i.e. NOT contagious,
Greasy, yellow scaling and crusts Frequent shampooing with a mild, non-medicated shampoo. Failing this: child WILL grow out of it,
on the scalp and face. Rash does usually DOESN‘T need
not itch and rarely irritates infant Severe Cases: any treatment, NOT due
(impt for DDx) to hygiene
Egozite Cradle Cap Lotion (salicylic acid, olive oil, castor oil)
Age of onset usually ~1 month and Ensure scalp is dry and apply to crust only twice daily for 3-5 days without Recurrent cases may be
resolves by 8-12 months. washing hair, then wash with a gentle shampoo. Repeat for remaining due to proliferation of
crust. yeast in the scalp and
may respond to
* AVOID: contact with eyes & non-crusted areas* ketoconazole shampoo
(Nizoral®)
Preventative measures:
Nappy rash - Frequent nappy checking and changing.
If fungal infection also
present, apply
- Nappy-free periods where possible. clotrimazole (Canestan,
Erythematous rash on the buttock - Use mild detergents to wash nappies and ensure thoroughly rinsed.
and groin area caused by urine, Clonea) cream to
- Breathable nappy liners or change to disposable nappies (Huggies most absorbent) affected area od or bd
bowel motions or other irritants
- Avoid plastic/waterproof pants. after bath. Continue for 1
around the nappy area
- Cleanse skin between each nappy change with warm water or olive oil/dilute bath oil using cotton balls or a warm face washer week after symptoms
& apply barrier cream at EACH nappy change. Pat skin dry (do not rub it) and leave uncovered until completely dry cease.
Causes:
- AVOID: soap, talc, wipes that may irritate skin
o Bowel motions (faeces) –
- Oatmeal bath oil can help soothe the irritated area Refer:
especially loose motions caused
by certain foods, medicines, o Rash spreads outside
Apply a barrier cream with each nappy change. the nappy area
infections or teething
o Urine – especially when the o Rash is no better after
Zinc (Zinc cream, Sudocrem, Amolin, Desitin, RCH nappy goo) is soothing. five days of treatment
nappy is left on too long or is
Lanolin (Alpha Keri lotion) hydrates skin. o Skin is broken and rash
covered by plastic pants.
Castor oil/cod liver oil provides a water-resistant layer on skin. (Herron Zinc & Castor oil cream) is severe
o Irritating chemicals – detergents,
soaps, bleach, water softeners, Hydrocortisone 1% (Dermaid, Sigmacort, Cortic-DC) o Rash shows signs of
fabric softeners and nappy rinses Applied sparingly to inflamed area 1-3 times daily after bath. For short term use only. bacterial infection (e.g.,
can be irritating pus, weeping,
o Friction – nappies with a rough To minimise systemic absorption, use highly absorbent disposable nappies, change nappies more frequently and maximise blisters,crusts)
surface (e.g. cloth nappies) can nappy-free periods. o Baby also has a fever,
damage sensitive skin. is irritable, is not eating
Questions: well or generally seems
Antifungal barrier OINTMENT
o Broken or unbroken skin? ill.
(miconazole/zinc oxide)
o Infection? Bacterial (weeping or Apply without rubbing at each nappy change to water cleaned dry skin (don‘t use soap)
yellow crusting), fungal (satellite Self Care Card:
Use for at least 7 days and until clear.
pustules) Nappy Rash
o Duration? >2 weeks, refer Apply antifungal first and then steroid.
o Previous Hx? Can use Hydrazole® (hydrocortisone/ clotrimazole) initially but revert back to clotrimazole cream for rest of
course once inflammation resolved

28
 Any eye problem ask about contact lenses
Patient Problem Treatment Children Pregnancy Lactation Other
EYE DISORDERS
Dry Eye Syndrome Treatment: EYE LUBRICANTS – many different artificial tear supplements available OK A A Advice in regards to
SE: local irritation, slight stinging , blurred vision (carbomer and polyvinyl alcohol) management:
Main types: preserved, preservative free, drops, ointments, gels - avoid precipitating
(keratoconjunctivitis sicca or
factors eg. AC, smoke
keratitis sicca xerophthalmia)
Dose: 1 drop every 1-12hrs as required – lubricants may be used as often as required - regular use of eye
Ointment (eg: polyvisc- wool fat): reserved for night as can cause some blurring in the lubricants (drops during
* Smx:
vision day & ointment at night)
-tired/burning feeling, dry, itchy,
-reduce evaporation by
―gritty‖, irritated, watering eyes
Products available: wearing wrap-aroudn
- Polytears (hypromellose, dextran) & (hypromellose) wear sun glasses glasses or humidifying air
Reasons;
– contain least-irritant preservative- polyquad protective glasses for swimming
- drug causes: anticholinergics,
Directions to insert eye
diuretics, OCP, retinoids, HRT,
propranolol avoid long use or eyes in drops:
-wash hands and ensure
-envirom’t: AC, smoke, dry air, air computer
- Systane (PEG, Propylene Glycol) clean
pollution, computer use
- slightly more viscous thus more lubricating (but should be -unscrew/twist off
-contact lenses used last if used with other drops due to its viscosity container
-medical conditions: Sjoegren‘s
- actually helps in the healing process -tilt head back
syndrome, Steven-johnson;s,
-with one hand create a
chronic conjunctivitis, post-herpes pouch with the lower lid
zoster -position bottle directly
- Genteal Gel=HPMC PAA (hypromellose, carbomer 980) & Viscotears Liquid gel= above pouch & drop
WHY? – Aqueous tear deficiency
PAA (carbomer 980) -close eye
– lack of tears of production of
- good for night-time use -press on nose for 1-
tears of poor quality
2minutes
-repeat process in a few
Check:
mins if >1 drop needed
1. Age of px – common in elderly Products suitable to be worn with contact lenses
2. Other Smx - ?redness, pain,
Refresh Contacts (carmellose) Remember:
pus/discharge, uni/bilateral,
Bion Tears (preservative-free single use containers) -never share eye drops
blurred vision, flashing lights  -d28
Refer hypromellose (dextran) -avoid touching the tip of
3. Occupation the bottle with the eye
4. Current medications/medical
My usual recommendations:
conditions
Mild: Polytears/Refresh/Genteal during the day and Genteal Gel at night Self Care Card:
5. Duration? >3 weeks of
persistent dry eye Mod: Systane during the day & Genteal at night Dry Eyes
6. Dry mouth? Drug induced? Preservative free for anyone prone to allergies/contact lens wearers
7.Failure to prev OTC treatment?

29
Viral Conjunctivitis Self-limiting condition 1-3 weeks to resolve -HIGHLY Contagious –
appropriate hygiene
(aka ―pink eye)
SYMPTOMATIC Treatment ONLY essential – washing
cold compress hand, not sharing towel
Smx:
artificial tear supplements – hourly use if needed
- very watery, itchy, irritated eye
-bilateral, mild discomfort analgesics – paracetamol -School/Work exclusion
avoid bright light until discharge stops
-foreign body sensation
-redness
Discard all eye make-up/cosmetics

Bacterial COMMENTS: Contagious – appropriate

* self-limiting – resolves in 5-14 days hygiene is essential (ie.
Conjunctivitis * contagious – good hygiene is essential washing hands, face-
* recurrent infections may be associated with abnormalities in lacrimal drainage system cloths & towels)
Smx:
- red, spreads quickly to other eye, Treatment: Not in Safe Safe Discard all eye-makeup
irritated Propanimide (Brolene) – drops & oint infants and cosmetics
- sticky discharge that reforms o for MILD conjunctivitis
during the day/overnight o 1-2 drops tds-qid for 5-7 days Counsel how to apply
- mucopurulent discharge increase o Should have noticeable improvement within 2 days eyes drops and oint
over 1-2days o SE: burning, irritation, stinging
- gritty feeling Suggest pressing corner
Sulfacetamide (Bleph-10) – drops only > 2 months CAT C – ? Potential of eye for few minutes to
Check: o For MILD conjunctivitis AVOID! for infant avoid taste disturbance.
? duration of Smx o 1 drop q2-4h for 2 days, then if there is improvement, 1 drop qid for 5 absorption VIP
? changes in vision days Soft contact lenses are
? deep seeded pain, flashing o initial improvement within 24hrs not to be worn while eyes
lights, headaches, neurological o SE: irritation & redness (due to sulphur) being treated and for
changes 48hr afterwards bcos
? Hx of URTI/cold Chloramphenicol eye Drops & Ointment: Safe Cat A Safe preservatives in product
? child – possible blocked tear o Drop: 1-2 drop tae q2h for first 48hr, then qid for up to 7 days unless could damage the lens.
ducts rather than bacterial otherwise for at least 2 days after eyes become normal (whichever Refer <2 - If contact lenses worn –
conjunctivitis comes first) Red eye wear disposable ones
? Ddx: viral, allergic, foreign body o Oint: 1cm tae 3-4 time/day or just once at night for and instil after instilling
ALLERGIES: Sulfur o SE: unpleasant taste possible chlorsig drops.

Cause: G+ve & G-ve discard makeup

soft lenses not to be worn till48 hrs after
use separate towel for eyes
use saline to clean eyes
hyegiene

30
Allergic TREATMENT REGIMENS: Make sure to carefully
check the PREGNANCY
Conjunctivitis Mild Symptoms: Safe Safe Safe Cats & what AGE these
irrigate with NaCl 0.9% - bd drops can be used in!
Smx: Cold compress prn/regularly
- red, itchy, watery eye Artificial tear supplements: 4-8times/day
- conjunctivial oedema
- shouldn‘t be discharge Mod Symptoms:
Oral antihistamine may be useful
Check: Topical drugs: > 6yrs AVOID – Suitable if
-pollens, dust mites, cosmetics, o Levocabastine (Livostin) B3 needed
contact lenses/solutions  Antihistamine
-?visual acuity  Dose: 1 drop bd – incr to tds/qid if needed
-?papillae or lumps under the lid  SE: stinging, mild eye irritation
(follicles)
- drugs/medications o Ketotifen (Zaditen) > 3YRS ? B1 Suitable if
 Antihistamine-mast-cell stabiliser! needed
 FAST onset of action – within 15mins
Referal point: for red eye:  Dose: 1 drop bd
-redness localised around pupil  SE: local irritation
-Red caused by foreign body > 4yrs B1 – limited Limited
-True eye pain (from the back, o Lodoxamide (Lomide) data data
sharp pain)  Mast-Cell stabiliser: 1 drop/eye qid for 1week-1 month prior
-Clouding of the cornea, to allergy season
associated vomiting, vision  SE:stinging on instillation
distortion – blurred, haloes around
light, photophobia - Glaucoma 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: 1-2 drops QID up to 5 days (good short term to
reduce redness)

Severe Symptoms:
Seek specialist advice
Topical CS‘s may be required

Recurrent Symptoms:
Refer to a specialist
Oral Antihistamine may also be useful
Mastcell stabiliser is effective as a preventive measure
o Eg. Zaditen – Ketotifen – 1 drop bd
o Eg. Lomide - Lodoxamide

31
Stye - Internal & External Treatment: Ddx:
-chalazion – painless
Warm compress to aid drainage 10-20mins tds – qid until drains (Warm will lump
Smx:
help make it burst) -acute dacryocystitis
- slightly painful lump near lid
Can pull out associated eye lash follicle to aid recovery -blepharitis – red,
- us able to see a small white pus
‗head‘ Lid hygiene – LidCare irritating/itchy or burning
If internal  Refer  may require Abx with excessive tearing
- swelling and redness around the and crusty debris
area
-eye lid trauma
TREATMENT/Management DDx: stye
Chalazion
may rupture spontaneously, however severe cases may require surgery to
Meibomian cyst – blockage of one
remove if affecting vision or troublesome
of the Meibomian glands in the
Self-limiting – take a few weeks to resolve
upper or lower lids)
Blepharitis = risk factor
Smx: Likely to suffer from recurrent chalazions – so good lid hygiene is essential
- looks similar to a stye
- BUT: no ‘pus filled head’ &
usually painless lump
- develops over weeks

Check:
- other eye conditions
- ?blepharitis
- ?eye make-up
Caring for Contact Lenses requires:
Contact Lens Care - 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
cleaner
- 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

When to clean lenses: at night as soon as you take them off (not in morning)/donot change brand solution without telling ur optomitrist
wash hands first/rinse off all soap/dry with lint free cloth
Rubing: put some of the solution in one hands and put the lens on the tip of index finger of the other hand then rub the lens into the solution for 20 sec.
turn the lens inside out and rub again for 20 sec
Rinsing: hold the lens by both thumb and index and rub under stream of solution again
Storage: put the lid in the correct side of case and cover with solution and screw the lid on and shake the case
32
Reinistalation: rinse the lens again with solution and put it on and threw the old solution in the case away
Blepharitis MANAGEMENT
warm compresses
1) Eyelid hygiene
- CHRONIC inflammation of the
- essential due to the CHRONIC nature of the condition
margins of the eyelids, eyelash
- removal of crusts and debris daily with warm water or a 1 in 10 dilution of baby
follicles, along the edge of the
shampoo
eyelid
- daily or twice daily (if severe)
- or LidCare product may be used
Smx:
- avoid wearing eye make-up/discard old makeup
-crusting of the eyelids, soreness,
greasy appearance
2) Control Cause
-flaking, irritation, foreign body
- treat the underlying cause
sensation, some discharge
- eg. Control scalp seborrhoea
Main 3 causes: 3) Symptomatic management
1) Seborrhoeic Blepharitis
-artificial tear supplements  relieve dry eyes & itching
2) Rosacea Blepharitis
3) Staph Blepharitis
Possible Causes: Questioning: If no apparent sinister
Red Eyes - conjunctivitis – bacterial, allergic, viral ? pain – type, severity, intensity cause can treat short
- allergy, hay-fever, irritation ? loss of vision term with decongestant
MANY possible reasons why
- dry eyes ? sensitivity to light eye drop but make sure
someone develops a RED eye!!
- foreign body – irritation, redness, tearing, foreign body ? alleviating & aggrevating factors refer to doctor if doesn‘t
sensation ? ocular conditions clear within a few days.
Questions: - contact lens problem – associated with contact lense use
? how long? >1 weeks? ? ocular swelling/ protrusion
- ? glaucoma (rare)
? other Smx (discomfort, blurred
- hormonal changes – menopause
vision, pain, discharge) Main Issue: make the correct diagnosis!
- trauma – burn
? had before? Tx failed?
- ? iritis (sometime more sinister )
? injury ?irritants
? contacts or glasses Conjunctivitis Iritis Glaucoma Episcleritis/Scleritis
? medication/medical conditions Pain Burning Moderately severe Very SEVERE Episcleritis: irritation
? allergies NOT severe PHOTOPHOBIA Nausea, emesis Scleritis: severe pain
? reason for redness Vision NORMAL Moderately decreased Considerable NORMAL
decreased
Lacrimation or Mucous or Lacrimation Lacrimation Lacrimation
discharge mucopurulent
Pupils NORMAL Small, irregular Mild-dilated NORMAL
Unreactive Self Care Card:
Response to Light NORMAL Minimal Minimal NORMAL Red Eyes

Counselling Contact lenses

It is important to write the date you open the eye preparation on the bottle or tube and to discard it 28 days Do not wear contact lenses when using eye ointments.
later (unless told otherwise). Wearing soft contact lenses is generally not recommended while using eye drops.
Some people find it easier if they have someone help them or if they use a mirror. They may be removed before using an eye drop, then reinserted after a period of at
Wash your hands then sit or lie down. Tilt your head back, look up and gently pull down your lower eyelid to least 5 minutes. If drops are used twice daily you can insert the lens after putting in
form a pouch. Avoid letting the tip of the dropper or tube touch your eyes, skin or any other surface. the morning drop and remove the lens before the evening drop.
Use a clean tissue to mop up any excess. If drops are used accidentally while lenses are in, remove them and rinse well with
an appropriate solution before reinsertion.

33
Drops Soft (hydrogel) lenses can be stained by some drugs (check with your pharmacist).
Shake suspensions (cloudy liquids) gently before use. Disposable lenses can still be worn.
Put 1 drop into the pouch (see above). If you think that the first drop missed your eye, put in another. Some drugs may make your eyes feel dry.
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 Ointments
helps reduce the amount of medicine that gets into the rest of your body where it may cause side effects. Squeeze a small amount (about 1 cm length) along the pouch (see above) then
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 blink several times to spread the ointment. If you need to use drops at a similar
several minutes before using it. time of day, use the ointment last.
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.

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.
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 don‘t 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 - - -

34
Patient Problem Treatment Children Pregnancy Lactation Other
(ok in…)
EAR, NOSE & THROAT

Deafness Pain Irritation/ Tinnitus/ Disch rge Upper Comments

itching ve tigo respiratory tract
infection
Ear wax ✓ ✗ ✗ ✗ ✗ ✗ Ear discomfort, feeling of fullness and slight
g adual hearing loss. Associated with cotton bud
deafness, sense of fullness, no discharge or pain use.
Otitis externa ✓ ✓ ✓ ✗ ✓ ✗ Initially irritation alone, progressing to pain and
disch rge. If oedema, can get conductive hearing
irritation, pain, discharge loss. Can be precipitated by swimming warm
weather and dermatitis.
Otit s media ✓ ✓ ✗ ✗ ✓ ✓ Ear pain tends to be throbbing/aching. Pain is
relieved on rupture of the tympanic membrane,
ear pain, throbing, pain, disharge, rep infection which releases a mucopur lent 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 – Perichodritis: 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 fever & vomiting
- children under 6 years with ear pain or hearing impairment
- fever and general malaise in children
- tinnitus/vertigo – underlying inner ear problem
- OTC Tx failure, symptoms persisting for 7 days after initiation of tx.

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.

35
Ear Ache General:
- can be caused by infection, foreign body, dermatitis, ear plugs, referred pain from
teeth, jaw, sinuses
1. Age - chronic infections  hearing damage/loss
2. Type of pain? Common causes:
3. Severity of pain? Radiation? Otitis media:
4. Other Smx? -inflammation of the middle ear just Neurofen or panadol
5. Hearing difficulties? Vertigo? -most common in children
Dizziness?
Glue ear: - otitis media with effusion
6. Travel? Swimming? Loud music
-type of chronic otitis media
concert? Etc
-long term build up of thick, sticky, fluid in the middle ear & behind the ear drum
7. Med? - ototoxic meds
-hearing loss/difficulties is common
8. Discharge?
Ear Wax:
9. Associated trauma? Self Care Card:
-hearing problems – requires wax removal & softening
Swimmers’ Ear: Ear Problems
If can‘t identify a CAUSE for the
ear ache  REFER! -water accumulation  bacterial growth, inflammation, swelling  pain
Cerumenolytics Ok for all - MANAGEMENT:
Ear Wax - avoid using cotton buds,
Pt usually reports gradual hearing
Waxol® Ear Drops – Docusate – aqueous based pushing plugs into the ear
loss, ear discomfort, recent
Use enough to fill the ear canal for no more than two consecutive night sometimes clears without
attempts to clean ears. Itching, -
or treatment in 5 days
tinnitus and dizziness are
uncommon. Cerumol® Ear Drops (dichlorobenzene + chlorbutol) - oil based if severe  REFER: may
Instil 5 drops bd for a few days. Note: contain peanut oi – check peanut allergy l vip need gentle syringing by
>12 yrs doctor
Common in the elderly. or
Associated with hearing Cerumenolytic agents are
aids/cotton bud use EarClear for ear wax® (carbamide peroxide) often used for a few days
Refer: Instil 5-10 drops bd for up to 4 days. Note: temporary effervescence will occur as the before syringing
o Associated trauma-related
urea hydrogen peroxide complex liberates oxygen.
conductive deafness audiclea: sodium chloride
o Dizziness or tinnitus
S/E: irritation
o Foreign body in the ear canal
Ear candle is not marketed for ear wax and it doesn’t work but carries risk of burn while
o OTC medication failure
needing another person to hold and supervise use.
o Pain originating from middle ear

Management: If inflammation is present: > 12yrs Ok - Isopropyl alcohol reduces

Otitis Externa  Refer to Dr (possibly need antibacterial/CS combination) moisture. Acetic acid
 Avoid use of antiseptic/drying agents when inflammation present  will cause pain increases acidity of the ear
- itching, inflammation, irritation of
 Simple analgesics such as panadol or nurofen = best for pain VIP canal to create an
the external ear canal
inhospitable environment for
- may be due to dermatitis, local
Prevention of recurrence: use OTC Antiseptic/Drying Agents. bacteria.
trauma, foreign objects,
Swimming related:
Aquaear® or EarClear for Swimmers ear® (acetic acid, isopropyl alcohol) - regular use of drying agents
Usually bacterial but can be
or after swimming
fungal. (discharge colour vary from
EarClear Dry & Clear® (isopropyl alcohol, glycerol) *less irritating - careful/meticulous cleaning
thin white to fluffy white or other) - ear plugs/cap for swimming
Dose: Instil 4-5 drops into each ear after swimming or bathing - avoid swimming while have
Could also involve systemic Sx: infection
fever or cold symptoms.
36
 Oral antihistamines (non-sedating) Prefer Safe to Refer:
Allergic rhinitis Loratadine (Claratyne®) Adult: 10mg once daily >1 sedating use o wheezing, SOB, tight chest
Children: 2-12yo: 5ml d (syrup: 1mg/ml) agents but o painful ear/sinuses
Seasonal or perennial.
1-2yr: 2.5ml d can use o purulent conjunctivitis
Common allergens: grass/tree
Cetirizine (Zyrtec®) Adult: 10mg once daily >1 (Cat B1) o failed treatment or
pollen, fungal mould spores,
Children: >6yr: 10ml od (syrup: 1mg/ml) prolonged symptoms
house-dust mite and animal hair.
2-6yr: 5ml od
1-2yr: 0.25mg/kg od o OTC tx fails
Steroid nasal spray – S/E: nasal irritation, stinging, sneezing, bitter taste, nosebleeds o Med induced rhinitis
o Nasal obstruction not
mometasone: nasonex cleared
Budesonide (Rhinocort®) 32, 64mcg
1-2 sprays into each nostril daily >12 Ok Ok o Unilateral discharged, esp
Sx: rhinorrhoea (runny nose), in children.
nasal congestion, nasal itching, Fluticasone 24hr(Flixonase Allergy and Hayfever®) 50mg/dose
itchy roof of mouth, itchy/watery Initially 2 sprays daily then 1 spray daily
>12 Ok Ok
eyes, sneezing. Beclomethasone dipropionate 12hr (Beconase Allergy & Hayfever)
Initially 2 sprays daily then 1 spray daily
>12
**Regular use is essential for full benefit and should be used each day during hay fever
Questions season. Onset of action takes 3-4 days (i.e. not for immediate relief of symptoms, can
1. Onset and duration use decongestant (e.g. oxymetazoline) in the interim).
2. Symptoms Nasal decongestant S/E: local burning, stinging, rebound congestion
3. Previous History - Seasonal vs >6 mths Safe Safe
perennial allergy Oxymetazoline (Dimetapp, Drixine, Logicin nasal sprays) 0.05%, 0.025%
4. Wheezing, chest tightness, 1-2 sprays into each nostril up to tds
SOB, coughing? Possible exac. of Xylometazoline (Otrivin nasal drops junior) 0.05%
asthma Adult and >6yr: 2-3 drops 6mths -6yr: 1 drop into each nostrils up to tds.
5. Secondary infection – earache, **Do not use for longer than 3 days
facial pain, purulent conjunctivitis
6. Previous treatment? Nasal anticholinergic >12 B1-avoid
Ipratropium (Atrovent 21mcg/puff)
2 TDS or QID
Ophthalmic antihistamines S/E: local irritation, bitter taste (Azep), blurred vision (Livostin) Avoid Ok if
indicated
Livostin® (levocabastine) eye drops **Shake well before use
1 drop into each eye twice daily, incr up to 3-4 times/day if necessary >6
Zaditen (ketotifen) eye drops
1 drop into each eye twice daily. Remove contacts prior instillation >3
Eyezep® (azelastine) S/E: infreq bitter taste
1 drop into each eye twice daily, incr up to 3-4 times/day if necessary >4

Nasal antihistamines No No
Some topical antihistamine
S/E: local nasal stinging, sneezing, bitter taste (Azep), headache (Livostin)
esp. levocabastine could
Azep® (azelastine HCl) cause drowsiness and the
>5 B3
One spray into each nostril twice a day. Suitable for long term use. effects of alcohol may be
Livostin® (levocabastine) **Shake well before use increased, do not drive etc if
>6 B1
2 sprays/nostril twice daily; incr to 3-4 times/day if necessary; found affected.

37
 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
Sore Throat Paracetamol and ibuprofen provide rapid and effective relief of pain in sore throat and Usually self-limiting.
should be used first line
Refer for more than 2 weeks SUGAR FREE? – very small
Majority caused by viral infection
Benzydamine, Lignocaine, Dichlorobenzyl alcohol (Difflam AAA® lozenges) (SF) >6 Cat B2: Avoid amount to affect BSL so its
(90%); bacterial infection
Use: 1 lozenge every 2-3 hours as required; max 12 loz/day Avoid ok for diabetic pt to take.
(streptococcal), glandular fever,
herpes simplex, candidiasis and
Benzydamine (Difflam anti-inflammatory throat spray) Patient with all anaesthetic-
varicella accounting for the rest.
Use: 4 sprays onto sore/inflamed area every 1½ -3 hours as necessary based product should be
discouraged from hot
Questions about associated
Benzydamine (Difflam solution) food/drink
symptoms will often help in
Use: 15mL gargled/rinse for 30 secs every 1½ -3 hours as needed; expectorate
making differential diagnosis.
Refer:
Lozenges is preferred as it has longer contact time o duration of more than 2
Viral sore throat often associated weeks
Benzocaine, cetylpyridinium (Cepacol plus with anaesthetic® lozenge) >6 Ok Ok
with generalised malaise, fever,
Use: 1 lozenge every 2 hours as required; max 8 loz/day deleted o signs of bacterial infection
headache and cough.
(i.e. marked tonsillar
Benzocaine, cetylpyridinium, ethanol (Cepacaine® solution) (SF) exudate accompanied with
Streptococcal infections are more
Gargle or rinse 10-15 mL for 10-15 secs and expel liquid; repeat every 2-3 hours as a high temp. and swollen
prevalent in school-aged children. glands)
necessary.
Sore throat usually accompanied
o hoarseness >3 weeks
by fever, marked tonsillar exudate,
Povidone-iodine (Betadine® Sore Throat Gargle) 10mg/mL = 0.1%: o difficulty swallowing
tender cervical glands and no
Measure and gargle 15mL for 30 seconds, then spit it out – every 3 to 4 hours - Avoid Avoid o recurrent bouts of infection
cough.
o associated skin rash
o adverse drug reaction (e.g.
Other causes: medicine,
clozapine, sulfasalazine,
trauma, drugs causing
agranulocytosis, inhaled
corticosteroids)

38
Amylmetacresol , Dichlorobenzyl alcohol (strepcils) avoid ok ok
 younger age than 6 use hedra helix avoid dry air , use humidifier
Patient Problem Treatment Children Pregnancy Lactation Other
(ok in…)
RESPIRATORY
Expectorants (productive cough) Most dry coughs are
Cough caused by a viral
Bromhexine (Bisolvon) 4mg/5mL >6 Ok Ok infection and are self
Mucopurulent sputum can just be limiting. Most coughs
10-20 ml tds
viral infection and thus doesn‘t resolve within 7 - 10
need autonomic referral; unless it
days.
is persistent/prolonged coloured
Guaifenesin (Robitussin EX) 100mg/5mL >6 Ok Avoid
sputum (green or yellow thick
10-20mL q4h
mucus) which is usually
Cough suppressants may
suggestive of a chest infection,
Cough Suppressants (non-productive cough) cause drowsiness,
referral is then needed.
constipation, n/v and
Demulcents (simple linctus, sucrose and glycerol syrups), which sooth the throat by Refer <2 yr - - are C/I in respiratory
Do not treat productive cough with
forming a protective layer over sensory receptors in the pharynx, are particularly useful failure, asthma, COPD
cough suppressant as results in
pooling and retention of mucus in in children and pregnancy. Caution high syrup content in patients with diabetes.
Caution in recommending
the lungs and higher chance of syrups to diabetics due to
infection. >6 Ok Ok
Pholcodine (Duro-Tuss® Regular) high sugar content.
10 - 15mg 3-4 times daily (Duro-tuss =sugar free)
Postnasal drip often causes a
cough as sinus or nasal discharge Refer:
flows into the throat. Signs include >6 Ok Ok
o cough lasting 2 weeks
patient having to swallow mucous Dextromethorphan (Bisolvon®, Benadryl® Dry)
or more and not
or notice they are clearing their 10 - 20mg every 4 hours or 30mg every 6-8 hours
improving
throat more often. Usually worse o coloured sputum
* Dextromethorphan is C/I within 14 days of treatment with a MAOI and should not be combined
at night. Treat with antihistamine/ with drugs that may contribute to serotonin syndrome. o severe systemic Sx
sympathomimetic. o chest pain

>6 Ok Ok o SOB/ wheezing

A recurrent night-time cough can o whooping cough or
Dihydrocodeine (Rikodeine®) 1.9mg/mL
indicate asthma, especially in croup
Take 5 - 10mL every q4-6h
children. Ddx from cough caused o recurrent nocturnal
by post-natal drip. cough
Self care card:
o suspected adverse SE
Take notice of the type and pattern of your cough.
Questions: o failed treatment
Always cover your mouth when coughing, preferably with a tissue or the bend of your elbow, not your hand. Turn your head
Other meds o persistent nocturnal
away from food and others. This will help to stop infection spreading.
Medical conditions: asthma, cough in children
After coughing up mucus, discard it in a tissue. Do not swallow it.
stomach problem, glaucoma?
Stop a bout of coughing by sipping water or sucking lozenges. Do not give lozenges to young children.
Liver, heart, thyroid disease? BP
or diabetes? Have steam inhalations (or hot showers) to loosen mucus. Self Care Card:
Fever? How long? Wash your hands well after coughing, before eating, preparing food or caring for others. Use hand sanitiser if there is no water Cold and Flu
Age? Don‘t smoke.
Sputum coloured, smelly or w/ Get plenty of rest and relaxation, especially if unwell.
blood? Eat regular, healthy meals, including plenty of fruit, vegetables and grains. Limit foods high in fat, sugar or salt.
Driving or opertating machinery? Drink enough water every day to satisfy your thirst and to keep your urine ‗light-coloured‘.(unless a doctor advises not to).
Chest pain, sore thorat or cough If you lose urine when you cough, try wearing ‗panty liners‘ or incontinence pads for protection. Regular pelvic floor exercises
wont go away? can improve bladder control.

39
Duro-Tuss Range: Bisolvon – Chesty:
Bromhexine 4mg per 5ml (mucolytic)
Dry Cough: Pholcodeine – cough suppressant – centrally acting, shouldn‘t 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 Pholcodeine/5ml – Dose: 5ml q6h prn Dimetapp
o Regular: 15mh Pholcodeine/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: Pholcodeine, Bromhexine o Brompheniramine 2mg, Phenylephrine 5mgper 5ml
o Pholcodeine 15mg, Bromhexine 12mg/15ml o Adult: 10ml q6-8hr prn
o Dose: 10-15ml q6h prn Chesty Cough Elixir:
o Guaiphenesin 200mg, Bromhexine 8mgper 10m
Robitussin Range: o Adult: 10ml q8h prn

DX – Dry Cough Forte: Cough Suppressant:

o Dextromethorphan 30mg per 10ml
o Adult: 10ml q6-8hr prn
DM – Cough & Chest Congestion: Cough Suppressant & Expectorant:
o Dextromethorphan 30mg & Guaiphenesin 200mg per 10ml
o Adult: 10ml q6-8hr prn pholcodine: 10-15 mg qid
ME – Chesty Cough Forte: Mucolytic & Expectorant:
o Guaiphenesin 200mg & Bromhexine 8mg per 10ml dextromethorphan: 30 mg qid
o Adult: 10ml q8h prn
bromohexine: 12 mg tid
Benadryl Range: guaphensin: 200 mg q id
Original: Diphenhydramine 12.5mg, Ammonium Cl 125mg, Sodium Citrate 50mgper
5ml
o Adult: 10ml q4h prn
Dry Forte: Dextromethorphan 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

40
 avoid dry air use humidifier
use vit C
Cold and Flu SYMPTOMATIC Treatment: Rest and increase fluid
Analgesia – paracetamol, ibuprofen, paracetamol/codeine intake.
Symptoms of common cold: refer more than 2 weeks
**ADULT and Child >6 yrs ONLY** Cough may persist after
runny/blocked nose, sore throat,
Nasal decongestants – pseudoephedrine, phenylephrine, oxymetazoline worst of the cold is over.
cough, sneezing, headaches,
earache Cough suppressants – dextromethorphan, pholcodeine, codeine
Antihistamine – doxylamine, triprolidine HCl, chlorpheniramine Use paracetamol for
headaches and pain.
Condition specific qns:
What symptoms are you → see COUGH
experiencing? Which are most → see SORE THROAT
Refer:
troublesome?
Sympathomimetics - constrict the dilated blood vessels in the nasal mucosa. o symptoms lasting
How long have you had these
C/I: heart disease, hypertension, hyperthyroidism, diabetes, MAOI → use saline nasal sprays (e.g. Fess®) for relief of symptoms greater than 10-14 days
symptoms for?
for patients in these groups. o dry cough develops into
High temperature for 3 days of productive cough
more? Oral
o severe earache (child)
Child or older person? Sudafed Sinus Pain Relief (Paracetamol 500mg, Pseudoephedrine 30mg) > 12 B2; avoid Avoid use
o facial pain/frontal
Severe earache? 2 tabs 3-4 times daily (max 8 tabs/day) use if not if not
neccessary necessary headache (sinusitis)
Nature of cough? Sputum colour?
o very young or old
Chest pain, sore throat or cough Sudafed Day and Night (Day: as above, Night: as above + Triprolidine 1.25mg)
o heart or lung disease
that won‘t go away? 2 daytime tabs twice daily, 2 nightime tabs at bedtime
o persistent fever and
productive cough
o delirium
Treatment specific qns: Codral products contain codeine.
o asthma, COPD
Taking any other medications? *No evidence for efficacy of phenylephrine*
o acute sinus involvement
High blood pressure, diabetes?
Pregnant or breastfeeding? Nasal Sprays
Liver, heart or thyroid disease? Oxymetazoline (Dimetapp, Drixine, Logicin) 0.5 mg/mL >6 unknown; Avoid use
Asthma, stomach problems, 1-3 sprays in each nostril twice daily probably if not
ok necessary Self Care Card:
glaucoma, prostate or
Nasal sprays should not be used for longer than 3 days as can cause rebound Cold and Flu
constipation?
congestion.

Differential Diagnosis: FLU

- persistent temperature of >38oC FOR CHILDREN < 6 Yr
- at least one respiratory Fess® Nasal Spray (isotonic NaCl) Ok Ok Ok
symptom present Max 8 sprays per nostril every 2-3 hours as needed.
- at least one constitutional
symptom present (headache, Fess Little Noses (Nasal drops)
malaise, myalgia, sweats/chills,
prostration) Cough and colds (due to viral cause) are self-limiting conditions and will usually get better
- rapid onset with sweats/chills, by themselves.
muscular aches and pains in Ensure your child has plenty to drink and gets enough rest to help them get better faster.
limbs, a dry sore throat, cough Paracetamol or ibuprofen can be used to reduce your child‘s temperature.
and high temperature For children who have a blocked nose, saline nasal drops are available to help thin and
- bed bound, delirious clear nasal secretions.

41
Asthma Inhalers Salbutamol (Ventolin®, Asmol® CFC-free inhalers) 100mcg/dose, 200 doses Taking any other
Shake well and inhale 1 - 2 puffs as required, or 5-15 minutes before exercise; repeat 3-4 times a day as necessary. medications?
Record sale in patient‘s history to
enable monitoring of their use of o remove cap and shake MDI Have you seen your
reliever medications which may o exhale doctor (Re: asthma) in
indicate a worsening of their 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
o remove from mouth before exhaling
How are you using it?
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

42
 always ask about period
Patient Problem Treatment Children Pregnancy Lactation Other
WOMEN’S HEALTH
- Cat C, Ok Relieving acute pain:
Period pain (primary NSAIDs can be given 1-3 days before expected menstruation and continued avoid in o Massage the lower back and
dysmenorrhoea) through first day of period. late buttocks.
pregnancy o Lie flat on your back and put a

Pelvic pain occurring at or around the Ibuprofen (Nurofen, Panafen, Advil) 200mg pillow under your knees or lie
time of menses. 400 mg initially at the first sign of pain or menstrual bleeding, then 400mg every on your side and bring your
Age – Usually occurs during teens and four to six hours. Max 1,200 mg/day (6 tablets). knees to your chest.
o Place a hot water bottle/heat
20s
Suffered this type of pain before? How Naproxen sodium (Naprogesic) 275mg pack on your stomach or lower
treated? 550 mg stat, then 275 mg q6-8h as required. Max 5 tablets/day. (1375mg) back.
o Rest and warm baths
When is she expecting her period?
Mefenamic acid (Ponstan) 250mg o TENS – transcutaneous
Taking any other medications?
Two capsules (500 mg) three times daily with food. (max 1500mg) electrical nerve stimulation –
Already using an NSAID?
might help
Pregnant or breastfeeding? Ectopic *Mefenamic acid blocks production of prostaglandins as well as the action of already
pregnancy? formed prostaglandins – may be useful in period pain resistant to treatment with ibuprofen Lifestyle modifications:
Other symptoms? Changes in and naproxen.
o Reduce stress
menstruation pattern and nature? o Exercise regularly
Medical conditions? Have stomach S/E: GI discomfort, N, diarrhoea, GI ulceration and bleeding from prolonged use
o Smoking cessation
problems, asthma, heart, kidney or liver Care with NSAIDs:
o Diet: vegetarian diet low in fat,
disease, high blood pressure, arthritis -asthma, PUD, allergies
dairy products and eggs with
or gout? -Li+, anticoagulants, Warfarin, MTX, Digoxin, Antihypertensives
increased vegetables, raw
Type of pain? seeds, and nuts shown to
Mersyndol Night Strength (Paracetamol 450mg/Codeine 9.75mg/Doxylamine > 12 Cat A Ok significantly decrease pain.
5mg) – relax & assist in sleeping y.o. o Keep a diary of symptoms so
L – lower pelvic/abdomen or back 1-2 tabs every 4-6 hours as needed; max. 8 tabs/day you can plan for monthly
I – mild-severe S/E: sedation and constipation. periods.
N – crampy, spasmodic, ache, dragging
D – 1-24 hours
O – occur at beginning of menses Refer:
C – n/v, constipation, backache, o abnormal vaginal discharge
headache, fatigue etc Ddx: o abnormal bleeding
st
A - stress Endometriosis: pt >30yr presented for 1 time of worsening symptoms, with lower abdominal pain (aching rather o symptoms suggestive of 2
o

R – local heat, drugs than cramping) starting usually 5-7 days prior menstruation. Pain could be constant and severe and often worsen at dysmenorrhoea
R – lower back, inner thighs the onset of menstruation. o severe intermenstrual pain and
F – every month bleeding, wrong time
Pelvic inflammatory disease: symptoms involves dull bilateral lower abdominal pain and dysmenorrhoea, but with o failure of medication
fever, malaise vaginal discharge, irregular menses and dyspareunia (painful sexual intercourse). o pain with a late period
(possibility of eptopic preg)
o fever

Self Care Card:

Period Problems

43
Patient Problem Treatment Children Pregnancy Lactation Other
MANAGEMENT: Consider possible DDx:
PMS - refer if severe - renal/adrenal cause  fluid
- educate/treat mild MPS: retention
-poorly defined complex set of
- explain that NORMAL, lifestyle changes, tell partner (so more accepting), - mammary dysplasia  breast
psychological & physical Smx
adequate excerise, healthy diet, self-help swelling
-relieved during menstruation
- thyroid, PCOS, Psych disorder
-usually last ~ 2weeks TREATMENT:  requires referral to Dr
-av age: late 20‘s
? due to change in E2:P ratio
For Mild-Mod PMS, OTC treatment & self-help may be trialled: Common symptoms of PMS
1. Vit B6 (pyridoxine) – up to 100mg dailyfor 2-6 weeks trial. Physical Behavioural Psychological
Smx: S/E: only >500mg daily. D/I: with levodopa when admin’s alone.
-mood changes Swelling Sleep disturbance Irritability
-fluid retention, odema (abdo) 2. Calcium supp: 1200mg of elemental Ca daily for 3 month trial.
-bloating, breast tenderness S/E: nausea flatulence. Breast Appetite changes Mood swings
-headache, back pain/heaviness 3. Evening Primrose Oil (2x500mg bd – 3caps bd after 3/12)  then, tenderness
-other: eye/skin/respiratory complaints 4. Refer to Dr if still no improvement Aches Poor concentration Anxiety/tension
Refer:
Headache Decreased interest Depression
Psychological Sx alone
Sever or disabling Sx Bloating/weight Social withdrawal Feeling out of control
Sx that either worsen or stay the same
after the onset of menses
Women under 30 yrs
Cystitis Non-pharmacological - - - OTC treatments should only be
used for mild cystitis of short
1. drink large amounts of water (5L/day) to help encourage bladder voiding and
duration (<2 days) or until
Inflammation of the bladder mucosa. ―flush out‖ bacteria in bladder
2. void bladder immediately before and following sexual intercourse patient can consult a doctor.
3. reduce coffee and alcohol intake as tend to irritate bladder in some people refer for more than 2 days
Signs and symptoms: 4. ensure bladder is completely empty by waiting 20 seconds after passing urine
o Burning/pain during urination and then train to empty final drops; after each bowel movement toilet paper
Refer:
o Urgency, frequency should be wiped from front to back to minimize transfer of bacteria from the
o men, children<16, elderly
o Sensation of incomplete bladder bowel into the vagina and urethra
o pregnancy – ↑ complication
emptying 5. drinking unsweetened cranberry juice may help prevent and treat UTIs by
o diabetic
o Blood in urine inhibiting bacterial adherence to the bladder epithelium
o fever, nausea/vomiting
o Lower abdominal pain/cramping
o loin pain, tenderness
o Cloudy, odorous urine Ural® (sodium based salt – bicarbonate, citrate) 4g Refer No Avoid
o haematuria – blood in urine
o Nocturia Dissolve 1-2 sachets in cold water 4 times daily.
o vaginal discharge
o Itching/pricking sensation of urethra
o duration of longer than 2 days
Urinary alkalinizers can help relieve the symptoms of mild cystitis.
o recurrent cystitis
Risk factors to recurrent UTI: *avoid in patients with hypertension, heart disease, renal impairment or pregnant women
*Avoid with drug such as hexamine, quinolones, o failed medication
Adult: pregnancy, prev infection of upper
urinary tract, undiagnosed diabetes, use
of contraceptive device, more vigorous **There are lack of evidence to suggest Hexamine for prophylaxis but rather cranberry
sexual activity juice seems to be a better alternative. **
Children: mainly poor wiping technique. avoid in pregnancy
citravesent

44
Patient Problem Treatment Children Pregnancy Lactation Other
Fluconazole (Diflucan One®) 150mg tablet - Safe as a Safe as Self-diagnosis is unreliable;
Vaginal Thrush Take one capsule orally as a single dose. single a single advise the woman to seek
dose dose medical advice if symptoms
Common in women of child-bearing age.
Onset of relief: may be within one day, with complete relief possible in 2 days. persist or recur within 2 months
after using self-prescribed
Pregnancy, diabetes, antibiotics, oral treatment
Diflucan Duo® contains 1 capsule and a tube of antifungal cream which can be
corticosteroids and OC are strong applied twice daily, morning and night, to vulvovaginal and perianal area for
predisposing factors. Treatment of sexual partner
external vaginal itch or irritation. is not necessary as vaginal
Clotrimazole - Safe – use Safe candidiasis is not sexually
Signs and symptoms:
Canesten pessary (6 Day), 100mg , (1 Day), 500mg – longer transmitted
Intense itchiness or soreness around Insert one pessary into the vagina at night course tx
vagina. Vaginal antifungals may be
The tablets should be inserted as deeply as possible into the vagina once daily,
Vaginal discharge that is thick, white used during pregnancy; use a
preferably at night.
(curd-like) and odourless. 1-week course; vaginal
Dysuria (burning around outside of applicators may be used with
Canesten Cream (6 Day), 1%, (3 Day), 2%, (1 Day), 10% –
vagina wen passing urine). care in late pregnancy but
Insert one applicator full into the vagina at night until all used
Dyspareunia (painful intercourse). manual insertion may be
One applicator should be filled with cream and inserted as deeply as possible
Erythema and/or oedema of vulva. preferable.
into the vagina with the patient lying on her back. Can be applied externally as
well. Fungal infection on penis
DDx: could be transmitted so ideal to
Bacterial Vaginitis Canesten Clotrimazole Thrush Treatment Once Pessary + Cream (Combination treat the partner as well if
Unpleasant musty or fishy vaginal odour, pack) possible.
exacerbated immediately after
intercourse. Thin grey-white vaginal Miconazole (Resolve Thrush) 2% 40g Refer:
discharge. Insert 1 applicatorful PV each day for 7 days, pref before bed o first time infection
thrush (candidiasis) – thick white o pregnant
discharge Nystatin (Nilstat Vaginal Cream) 5g/dose -100,000units o diabetic/ immunocompromised
trichomonas - foamy unpleasant Insert 1 applicatorful PV – OD to BD – for 14 days or longer if necessary o >2 attacks in previous 6 months
smelling discharge o contact/history of STD
vaginosis (Gardnerella) – strong fishy If get period – continue use, use a sanitary pads rather than tampons o patients <16 or >60
smelling discharge o abnormal or irregular vaginal
- - -
Other bacteria (eg Gonorrhoea) - thick, bleeding
Keep genital area clean; use plain, unscented soap.
o blood staining of vaginal
yellow discharge. Take showers rather than baths discharge
Wear cotton underpants with a cotton crotch. Avoid synthetic and nylon o vulval or vaginal sores, ulcers or
Taking any other medications? underwear and tight-fitting jeans or pants. dysuria
Diabetes? Sleep in loose gown without underpants. o no improvement within 7 days of
Pregnant or breastfeeding? Thrush thrives in warm, moist environment avoid prolonged wear of wet treatment
Pelvic or lower back pain? clothing, especially a wet bathing suit or exercise clothing. o suspected bacterial cause, i.e.
More than 2 attacks in last 6 months? After urinating or bowel movements, cleanse by wiping from front to back vaginal discharge has an
Yellow, green or smelly discharge? (vagina toward anus). unpleasant odour or is yellow or
First time infection? greenish.
Lose weight if obese, and maintain euglycaemia in diabetic patients.
Diagnosed by a doctor? o Recent birth, miscarriage,
Delay sexual intercourse until the symptoms clear/discomfort resolves. abortion or insertion of IUD
Patient <16 or >60?
o Systemic symptoms: fever,
Vaginal cream is best to be used at night, just before bedtime. malaise
Self Care Card: Vaginal creams/pessaries can damage contraceptive diaphragms and latex o Pelvic or abdominal pain

Thrush condoms (but not polyurethane condoms). VIP

45
Patient Problem Treatment Children Pregnancy Lactation Other
PREGNANCY /BREASTFEEDING
Pre-conception & During pregnancy: - - - Many pregnancy multi-
Nutrition & General - folic acid 500mcg before conception and for first three months of pregnancy (reduces vitamins available.
Health advice during risk of neural tube defects eg. Spinda-bifida)
- ? any medications  discuss plans to become pregnant with dr Elevit or Blackmores is
Pregnancy - 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 Deli‘s/supermarkets - Listeria
- uncooked or smoked seafoods & shellfish – Mercury, Listeria, salmonella
- 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)

Elevet 1 tab daily has all supplements needed iron, vit c , iodine, zinc , ca, vit b1 , b2, b5, b6, vit d , vit e , folic acid
Pyridoxine vit b6 up to 150 mg daily for morning sickness
Elevet morning sickness 1 d : ginger 600 mg , B6 37.5 mg
bio oil : for stretch marks
breast feeding:
lanolin: for sore cracked nipeles or pawpaw cream (beeswax, petrolatum)
silicone or hydrogel discs to protect nipple during breastfeeding
46
Back pain in - - -
Paracetamol is treatment of choice, 1-2 tablets qid prn Avoid NSAIDs during
pregnancy pregnancy, especially in
Can use codeine but avoid close to term as may depress respiration in the newborn, 3rd trimester as there is
and exacerbate any constipation. increased risk of closure
Common complaint, caused by of fetal ductus.
strain on the muscles of the back Non-pharmacological treatment: don't: sit for long time,pick heavy, wt gain
as the uterus enlarges and grows 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
do's: massage, wear flat shoes, support back with pillows, heat pack
forward.
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

Non-Drug Options - - -
Constipation - plenty of fluid and exercise
- increase amount of fibre (however ONLY after acute bout of constipation has been
Common esp in later pregnancy
relieved)
Due to baby pressing on the
- healthy food: high fibre, whole grains, apples/pears, kiwi fruit (good to eat skin)
bowel, dehydration, need of Fe
- fibre supplementation: Metamucil, psyllum
supplementation
Drug treatment:
Check: st
1 line – Coloxyl (stool softener) or Lactulose
? blood in stools
(Lactulose takes 1-2 days onset of action, need to take regularly,
? haemorrhoids
Dose: 15-45ml for 3 days then reduce dose – may be used as maintenance dose)
? antacids (Ca2+) – excessive use
may be contributing to Note:
constipation
-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 in breastfeeding: fruit juice is not recommended for
Formula types: standard infant formula: suitable from birth up to 12 months, cow based milk infants
Follow on infant artificial formula: suitable for babies over 6 months 6-12 months
Soy formula: preferred if baby cannot tolerate cow's milk protien
Thickened artificial fromula AR (anti regurgitation): for babies with reflux, use with guidance for healthcare prof
Bifidus/probiotics/prebioticcs: good bacteria added into formula to help keep balance of the baby's digestive system
HA (hypoallergenic): protein has been divided into smaller sections for babies at high risk of allergies (asthma, eczema, how ever it is not designed for
babies who have a cow's milk allergy
47
lactose free: only needed for babies who are lactose intolerant
Gold: contains certain types of fat that are found in breast milk
 st
Reflux Antacids – Cat A – 1 line choice – safe & effective Refer Cat A Ok Other measures:
-smaller meals
Mylanta® Original (AlOH, MgOH, Simethicone) -remain upright during &
WHY?
10-20mL prn up to 4 times daily after eating
-foetus pressing on stomach 
-avoid spicy foods that
loosen sphincter  stomach
*contain high amounts of Na so avoid in patients on sodium-restricted diet may ppt reflux
contents reflux up  burning
*Al → constipation, Mg → diarrhoea -raise bed head
sensation = ‗reflux‘ *Avoid use within 2 hrs of taking other medications VIP -avoid fizzy rinks
*NB:// some pxs are concerned about the Al & Alzeheimers claim – reassure that the -avoid eating before bed
results of the study were later proven incorrect. Safe to use*
When questioning, exclude any
other causes of indigestion
Ranitidine – Cat B1 – ONLY if Dr has prescribed it!!!! –DON‘T recommend
? pain in arms
? vomiting

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

nb:// Mg may cause diarrhoea

Management: - - -
Pruritis in
Pregnancy 1) Shower oils/soap alternatives  see eczema section
2) Moisturisers eg. QV, Dermaveen, Sorbolene cream  see eczema section
-develops from 3rd month onwards 3) HC 1% (Dermaid, sigmacort)  to relieve itching
-due to oestrogen cholistasis  4) Sedating antihistamine:
build up of bilirubin  pruritis - Dexchlorpheriamine (Polaramine) – Cat A 0.5-1 tid
- Chlorpheniramine (Avil) – Cat A 1 qid
- Cyproheptadine (Periactin) – Cat A 1 tid

Breast & Nipple If confirmed by dr that nipple thrush: - - -

Thrush Nipples: miconazole gel or nystatin cream applied – after each feed after each feed
Oral treatment for mother: nystatin 500,000 U/tab – 2 tab tds
- Overgrowth of candida on Baby‘s mouth: miconazole gel qid for 7 days then once daily
nipples/breast
- significant amount of pain Possible SE‘s:
Smx: Mother: gel may irritate the skin
Nipple: burning, itching, pain, Baby: gel may cause babies to gag or vomit – consider changing to nystatin drops
stinging, pink, dry, flaky
Breast: shooting, stabbing, deep
aching breast pain. Uni/bi lateral
pain

48
Problems with Herbal preparations used to increase breast milk production (galactagogues) - - -
- caffeine, hops, fenugreek, fennel seek, blessed thistle, alfalfa – traditionally reported
lactation to increase breast milk BUT little data support their efficacy & safety
- be cautious when recommending herbal preps

Drug S4 therapy:
- Metoclopramine & Domperidone
Early management: - - -
Mastitis - maintain breastfeeding VIP
- analgesia: paracetamol
-inflammation of the breast – may
be an infective cause In this situation  REFER – in case of infection
Smx:
Breast: erythema, pain, odema,
swelling, lump
General: fever, lethargy, nausea,
anxiety, headache
- - -
Morning Sickness Ginger: MAX: 1g daily – high doses increases coagulation of blood Monitor mum for
symptoms of dehydration
Persistent vomiting in a pregnant
Pyridoxine (Vitamin B6); 50mg bd-tds. Max: 100-150mg/d (exceeding this max dose (e.g. rapid pulse, low BP,
woman that interferes with fluid
can lead to peripheral neuropathy – tell px NOT to incr dose even if not helping) sunken eyelids, reduced
and electrolyte balance, as well as
skin turgor, cool skin,
nutrition. deep/increased
Acupressure bands (e.g. Sea-band) worn on the wrist may be of benefit and are
unlikely to be harmful. respirations).
Particularly bad in first trimester
and effects 70-80% of women.
Changes to dietary or daily habits can help relieve morning sickness (the idea is to Can recommend a
Symptoms usually begin ~ 2 keep the stomach neither too full or too empty, both of which can exacerbate nausea): avoid: spicy, fatty, large meals, rehydration solution if
weeks after first missed period. o eat small frequent meals (4-6 daily) to maintain blood sugar levels- don‘t wait until patients feels they can
you are hungry alc, coffe, stomach it.
o eat a diet high in carbohydrates & protein (fruit, cheese, eggs, beef, poultry,
veges, toast, rice) and low in fat
eat: carbs, proteins, small snacks, biscuits when wake,
o avoid large meals and greasy, highly spicy meals plenty of water,
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 keep room ventilated, relax
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

49
 osteoarithritis: glucosamine sulphate 1000 mg 1-2 d CC avoid with jelly fish allergy, preg or Bf
Patient Problem Treatment glucosamine HCL (vegitarian) 1000mg 1-2 d CC
Children Pregnancy Lactation Other
(ok in…)
PAIN
Topical analgesics should be kept
Musculoskeletal Ibuprofen (Nurofen®) – 200 mg tabs, 5% gel >12 years Cat C; Avoid use away from the eyes, mouth and
pain avoid use as as mucous membranes and should not be
oral: 1 – 2 tablets three times a day before food, max 6 tablets (1200mg) daily may cause excreted applied to broken skin.
closure of in breast
RICE topical: rub 4 – 10 cm of gel into affected area until absorbed every 4 hours prn,
fetal ductus milk
Rest; avoid activity promoting max. 4 applications/dayVIP Refer:
arteriosus
bleeding and ↑ blood flow o suspected fracture
Ice; to reduce swelling and pain, apply Diclofenac (Voltaren Rapid 25, 50) >12 years o possible adverse drug reaction; falls in
every 2 hours for 20mins for the first elderly, unexplained bruising
48 hours. Not directly on skin but in oral:25-50mg q6-8h max: 6/days. Take with food. o head injury
wet towel, plastic bag etc o medication failure – 5 days
Compression; reduces pain and topical: rub gel gently into affected area 3-4 times daily. Do not use for longer o arthritis
swelling as well as providing support
than 2 weeks o severe, persistent back pain
for injured part
o back pain (and/or ‗pins and
Elevate; reduces bleeding, swelling
and pain – raise above level of the
Have asthma? Stomach ulcers? Other meds? needles‘/numbness) radiating down
heart. Deep Heat® (methyl salicylate, menthol) >5 Ok Ok legs
Apply and massage 2-3 times daily; or before, during and after sporting event. o Injuries in children<12yr or elderly

Avoid any HARM patient due to their bone fragility

Heat; increases bleeding Avoid contact with eyes or mucous membranes. Do not apply to broken skin or sensitive o Pain with markedly reduced or
areas excessive range of motion
Alcohol; increases swelling
Running; avoid exercising too soon o Pain – unable for the person to bear
Paracetamol (Panamax®, Panadol®) 500mg Ok, Ok Ok full weight on limb
Massage; or use of heat rubs in first
48-72 hours increases swelling and reduced o Marked pain, swelling, bruising
bleeding Adult/Child >12, 1 – 2 tablets every 4-6 hours prn, max. 8 per day. dose straight after injury – serious injury
Child <12, 15 mg/kg every 4–6 hours (max 60 - 90 mg/kg daily) that requires rigorous assessment

Avoid NSAIDS within 48 hours To assess injury restricting range of motion: Self Care Card:
of injury as increases bleeding and -Shoulder: raising hand straight up, touch hand with the back and the shoulder blade. Pain Relievers, Sprains and Strains
swelling.
Hirudoid (cream)– Herparinoid
Bruising - for bruises, swelling, treatment of scars and various inflammatory conditions of the viens
- Dose: thin layer to affected area ONCE or TWICE daily prn VIP
Determine reason – i.e. injury,
- DON‘T apply to open wounds or use when bleeding occurs or infected
warfarin (?over-anticoagulated)
Arnica Ointment - Treatment of bruises, sprains and assoc swelling.
Need a FULL medical Hx
Apply freely to affected areas
Cause: - - -
Tennis Elbow - 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:
- Compression Elastic support bandage
- Relative rest with reduction of aggravating activities
- Ice area for 10 minutes twice a day
- NSAIDS for short term relief
50
 Avoid trigger factors:
Headache Paracetamol (Panadol, Panamax, Panadeine-15) Refer Ok Ok - stress, tension, anxiety
500mg <12 - caffeine, alcohol, smoking
Most common are tension headache, migraine and sinusitis. - fasting, delaying or missing meals
Take 1 - 2 tablets qid prn (max. 4g daily)
- bright or flickering lights
Tension headache; bilateral feeling of heaviness, pressure or - strong fumes/smells
tightness that ―extends like a band around the head‖. Can affect - anything else associated with onset
Ibuprofen (Nurofen, Panafen) 200mg Refer No No
upper part of neck also.
Take 1 - 2 tablets tds (max. 1200mg daily) <12 Self care:
- keep a headache diary detailing times
Migraine; recurrent episodes of throbbing head pain, often migraines occur, drugs and dosages used,
Refer
unilateral (frontal, occipital or hemicranial). Swaps sides btw response to treatment and what may have
Anagraine® (metoclopramide 5mg, paracetamol <12 Ok Ok
attacks. Pain is severe and limits or stops activity and is usually triggered attack
500mg)
associated with nausea, vomiting and/or photophobia. Relieved - practice relaxation exercise
Take 1-2 tabs at first sign of migraine; repeat - exercise regularly
by lying in a dark quiet room. May be preceded by aura (usually
every 4 hrs if needed, max 6 tabs in 24 hrs. (½ - eat a well balanced, regular diet
visual disturbances such as flickering lights, zigzag lines, loss of
adult dose for children 12-17yo) - drink plenty of water
part or all vision). Initiate treatment at first signs of migraine.
- get adequate sleep
Prochlorperazine (Nausetil 5mg) <12 Cat C
Sinusitis; associated with an upper respiratory tract infection Refer headache:
5-10mg BD – TDS
o children <12 and adults with new sx >50
Acute treatment: 20mg stat, 10mg 2 hours later.
Cluster; orbital pain often worse at night and associated with o assoc. with injury/trauma
conjunctivitis and nasal congestion on the same side of the o severe and last >4hrs
head as the headache → refer o severe occipital headache (across back of
head)
o worse in morning then improves
DDx:
Mersyndol® (paracetamol 450mg, codeine Refer Ok Ok, o associated drowsiness, visual disturbance
-Medication overused headache – Ergotamine/Triptan/Analgesia or vomiting
-Meningitis: severe generalised headache with fever, generally 9.75mg, doxylamine 5mg) <12, watch for
o neck stiffness
ill, stiff neck, rash Take 1 - 2 tablets every 4-6 hours prn (max. 8 sedation
o frequent migraines
-Glaucoma: frontal/orbital headache with pain in the eye. Eyes tabs/day) ok if >12 in child
o OTC treatment resistant
could be red; vision could be blurred with haloes. o medication induced (e.g. pill)
-Depression: often present with tension-like headache, loss of o starts after exercise, sex, straining or

appetite, weight loss, decreased libido, sleep disturbances and coughing

constipation. (check for recent change in health, life could pick
out some hint) Self Care Card:
Headache/Migraine/Relaxation
Age? techniques/Pain Relievers/Sinus
Nature? Problems
Duration?
Other medications/medical problems?
Trauma?
Previous history/treatment?
LINDOCARRF

51
Patient Problem Treatment Children Pregnancy Lactation Other
MISCELLANEOUS
Nicotine Replacement Patches Counselling:
Therapy 16-hour patches (Nicorette) Tell pharmacist if experience any unpleasant side effects as it
*preferred if sleep disturbance is troublesome may mean that dose adjustment is necessary.

NRT relieves nicotine withdrawal 5 mg/16 hours, 10 mg/16 hours, 15 mg/16 hours
Store and dispose of products carefully and out of the reach of
symptoms (craving, anxiety, children as can be fatal. In particular patches still contain
agitation, irritability and hunger) nicotine and are dangerous to children and pets.
allowing the smoker to 24-hour patches (NicabateCQ, Nicabate CQ Clear, Nicotinell, QuitX)
*best for morning cravings Do not continue smoking whilst using these products as
concentrate on psychological
7 mg/24 hours, 14 mg/24 hours, 21 mg/24 hours increased amount of nicotine can produce toxic effects, such
aspects of quitting.
as feeling sick, vomiting, palpitations and chest pain
Moderate-high nicotine dependency:
NRT is only for >18yr Non-drug Counselling:
Apply 1 patch daily of either 21 mg/24 hours OR 15 mg/16 hours. Stop within 12 weeks
- contact support services such as Quitline or community
High dependence: waking at night based groups for extra support and tips
Low-moderate nicotine dependency:
to smoke or smoking within first 5 - avoid situations which were previously associated with
Apply 1 patch daily of either 14 mg/24 hours OR 10 mg/16 hours. Stop within 12 weeks
minutes of waking, usually >30 having a cigarette
cigarettes a day - carry a pen or gum for hand-to-mouth movement
Apply to a different skin site each day, on a non-hairy, clean, dry site on the upper body or outer - carry small snacks such as carrot sticks or lollipops
Moderate: smoking within 30 part of the arm. - regular exercise and may help you quit and also avoid
putting on weight
minutes of waking, usually 20-30 - smokers who plan before they quit and set a date are more
Recommended progression: Step 1 (21mg/24 hours) for 6 weeks, then Step 2 (14mg/24 hours) for
cigarettes per day successful
2 weeks, then Step 3 (7mg/24 hours) for 2 weeks
- when you get the urge remember the 4D‘s; do something
Low-moderate: not needing to else, delay, deep breathe, drink water
May cause local irritation (can be treated with topical corticosteroid). C/I in patients with eczema.
smoke within the first 30 minutes - if you have a cigarette it is not the end of your quit attempt
of waking, usually 10-20 cigarettes but rather a setback
Lozenge (NicabateCQ)
Low dependence: no needing to 2 mg, 4 mg Practice points:
Severe addiction or continual NRT failure – use patch and 2mg
smoke withing the first 30 minutes gum together.
of waking, usually <10 cigarettes a Moderate-high nicotine dependency, use 4 mg lozenges; low-moderate nicotine dependency, use 2
mg lozenge Strict dosing reduces cravings more than prn doses.
day Continue for 12 weeks (6-8 weeks for most people), including
the taper period. May require longer for some.
1. Number of cigarettes smoked a
day? Weeks 1-6: 1 every 1-2 hours, up to 15 in 24 hours C/I: recent MI, cerebrovascular event, arrhythmias
2. When they are smoked (how Weeks 7-9: 1 every 2-4 hours
soon after wakening? Weeks 10-12: 1 every 4-8 hours Pregnancy/breastfeeding:
Weeks 12-24: take when needed to maintain abstinence Try behavioural therapy first. NRTs are category D or C but
3. Previous attempts to quit?
often level of nicotine is less than from cigarettes refer for
4. Confidence and motivation to doctor to calculate risk/benefit ratio.
quit?
5. Recent MI, cerebrovascular Gum and lozenges contain large amounts of Na+ so use
event, arrhythmias? 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. with care in patients on sodium reduced diets.
Self Care Card: Smoking, Nicotine Replacement
NRT only indicated for people >16 Therapy
Note: can use sublingual tablets (Nicorette Microtab, 2 mg) in same way
years of age.

52
Gum (Nicorette, Nicotinell, QuitX)
2 mg, 4 mg
Hgh nicotine dependency, chew 10 – 15 pieces daily. Avoid use of >1 piece/hour. After 4-8 weeks
reduce to 2 mg, then stop or taper use over a further 4 weeks.

Moderate nicotine dependency, chew 8 – 12 pieces of 2 mg gum daily

Chew gum until tingling or peppery/bitter taste and then ―park‖ it between the cheek and upper gum.
When tingling stops, rechew and park; repeat for total of 30 minutes.

Avoid swallowing saliva/gum (can cause indigestion) and eating or drinking whilst using gum.

*max. 20 x 2 mg or 10 x 4 mg per day

maxium 10 per day
C/I in patients with dentures.

Note: microtabs

Microtabs (Nicorette)
2 mg
Place 1 or 2 tablets under the tongue every 1–2 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.
Place 1 or 2 tablets under the tongue and let them slowly dissolve over about half an hour. Avoid
chewing or swallowing the tablet.

Inhaler (Nicorette)
10 mg
Inhaled air through cartridge for 20minutes. Self-titrate according to w/drawal sx.
- Shallow puffs every 2 seconds OR 4 Puffs per minute maximum 6 per day
USUALLY: 6-12 cartridges/d for 3 months, then reduce over 1.5-2months after

Attempt to quit <6months – SMA if quitting not attempted after 9 months use.

53
Orlistat Xenical® Important for patients to have realistic goals. Average
Take one (120 mg) capsule with, or within 1 hour of the 3 main meals. weight loss of 10% in one year which is great for
To be used in adjunct with lifestyle
cardiovascular health etc. but often not satisfactory for
changes including increased
Only for >18 yrs and <75yrs (Refer to Dr if outside this age range) those seeking cosmetic sliming.
physical activity, eating
behavioural modification.
Counselling:
 this medication may cause fatty stools (flatus, faecal urgency, loose oily stools); more likely to Not appropriate in pregnancy or breastfeeding.
Only indicated in obese patients
occur when your diet is too high in fat
with BMI >30 or >27 with other risk
 it is important that whilst taking this medication you continue to practice caloric restriction with a D/I: For patients on warfarin, may increase INR as
factors e.g. hypertension,
diet high in fruit and vegetables, increase physical activity and eating behaviour modification reduces the absorption of vitamin K → monitor INR
diabetes, hyperlipidaemia.
 whilst taking this medication, it is recommended that you take multivitamin supplements containing closely.
the fat-soluble vitamins A, D, E, K – supplement should be taken 2 hours apart from orlistat Decreases plasma concentrations of cyclosporine and
BMI= weight/[height]2
 Do not take a dose if you miss a meal or if it does not contain any fat. amiodarone.
Question:
C/I: pancreatic enzyme deficiency, major GI surgery,
o Tried lifestyle changes?
malabsorption syndrome, cholestasis
o BMI?
o Take any other medications? Increased risk of disease associated with a waist
warfarin, amiodarone circumference of ≥102 cm in men and ≥ 88 cm in females.
o Pancreatic problems? Optislim, optifast
®
o Gallstones? Meal replacement—hypocaloric preparations (eg Optifast )
o Stomach problems or vitamin may cause weight loss in the short term, but weight is usually
deficiency? regained when treatment is stopped.
o Recent GI surgery?
o Kidney stones? Self Care Card: Weight & Health
o Diabetes, high blood pressure or
cholesterol?
o Pregnant or breastfeeding?
o Under 18?

54
 take her to private area
Emergency 1. When did you last have unprotected sexual intercourse? Within previous 72 hours? Patient Counselling
Contraception o Take the tablet as soon as possible.
2. Already pregnant or previous unprotected intercourse >72 hours earlier in same menstrual
Levonorgestrel (Postinor-2®) cycle? o If any vomiting or diarrhoea occurs within 2 hours of
Should not be taken due to a lack of benefit rather than any risk to the pregnancy (i.e. will not terminate an taking a tablet, an additional tablet will need to be
existing pregnancy). Patient should consider a urine pregnancy test if unsure. taken
The effectiveness of EC
3. Unexplained vaginal bleeding? Current/history of breast cancer? o You need to use a barrier method of contraception
decreases with the time taken
Refer until the onset of your next period
since unprotected intercourse:
<24 hours = 95%
4. Severe liver disease? o Your next period should occur around the anticipated
24-48 hours = 85% Refer
48-72 hours = 58% date but can occur one week before or after that time
– consult your doctor if menstruation does not occur
5. High blood pressure, diabetes, heart disease or history of stroke/DVT? within one week after the anticipated date (or 3 weeks
note: the overall failure rate when EC Refer
is taken within 72 hours is <2% after taking EC) or if the period is lighter than normal
or intermittent
6. Taking any other medications?
Drugs including anticonvulsants (phenytoin, carbamazepine), St John‘s wort, rifampicin, griseofulvin may
reduce the efficacy of EC. May interact with warfarin to raise INR. Refer o If pregnancy occurs after taking EC, consult your
doctor and let them know that you used the EC
7. Stomach problems? (increased risk of ectopic pregnancy)
Diarrhoea, vomiting or other causes of malabsorption (Crohn‘s disease, IBS etc) may reduce absorption and
thus efficacy of EC. Refer o Common side effects include nausea and vomiting,
breast tenderness, vaginal bleeding and headache
8. Pregnant or breastfeeding?
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 express to keep up the milk supply but discard the milk).
C/I: current pregnancy (last period
was late or lighter than usual), 9. Under 16?
unexplained vaginal bleeding, Refer- caution due to legal reason and chance of sexual assault.
current breast cancer, allergy to
levonorgestrel 10. Used emergency contraceptive before?
Need to discuss regular long-term methods of contraception with their doctor.

How old?
how many hours since unprotected sex? if she had an unprotected sex before , suggest to
when was last period? heavy , light? do pregnancy test first
have you had any unprotected sex more than 72 hours ago?
pregnant?
any medication? pills?
failed method?
any medical conditions?
55
have u used this before?
Travel Health Deep Vein Thrombosis (DVT)
DVT is the formation of clots in the deep veins of the leg which Prevention: Visit the
may result in life-threatening embolisms. Exercise ankles and calf muscles every half hour. www.smartraveller.gov.au
Some simple precautions include: website for travel information.
 seek specialist travel health advice
before travelling Symptoms (usually post flight): Keep legs straight, do not sit cross-legged.
- often no symptoms
 Take a spare pair of glasses. - leg pain, swelling and redness Drink plenty of water or juice but AVOID alcohol and
- a mild ache or tenderness in one or both legs, particularly in caffeine-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 pressure stockings
medicines are legal there. Carry legs (e.g. flying)
a letter from your doctor listing - taking hormone therapy (OC, HRT) excesice every half hour
the medicines, how much you will - personal/family history of DVT or blood clotting disorder
be carrying and that they are for - smoking drink prently of water
your personal use. Leave in - pregnancy
original packaging. - obesity
- >40 y.o Self Care Card:
 Consider purchasing health and Jet Lag Travel Health, First Aid,
travel insurance. An upset of a person‘s biological clock caused by travelling Prevention: Vomiting and Diarrhoea,
across several time zones in a short period of time and is If possible break the trip up by including stopovers. Sense in the Sun, HIV/AIDS
 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
 Wear a Medic Alert bracelet or eat/sleep according to this destination time during the flight. Visit the
necklace if you have a serious Symptoms include: Eat light, healthy meals and drink plenty of water. Limit www.smartraveller.gov.au
medical condition or allergy. - being alert, sleepy and hungry at the wrong times alcohol and caffeine-containing beverages. website for travel information.
- 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 do's: take spare glasses
bought locally. Always follow safe -
arrive at night, adjust clock, sleep eat in right
take condoms, carry first
sex practices. Remember that Travellers‘ Diarrhoea (TD)avoid caffiene, sleeping tablets
time,
the pill does not protect against Illness caused by consuming contaminated food/water. Prevention: aid kits, wear shoes, wear
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 medic bracelet if you have
prevent malaria can reduce ice.
effectiveness of OC. Treatment: - Avoid shellfish and cold cooked meats.
condition, consider health
Symptomatic treatment as appropriate. May include use of a - Don‘t eat fresh salads, raw vegetables or cut fruit – ―if you or travel insurance, contact
 Avoid contact with animals. rehydration agent (Gastrolyte), antidiarrhoeal drug can’t peel it, cook it or boil it, don’t eat it!”
(loperamide), antiemetic (metoclpramide) or antispasmodic - Avoid eating anything washed in local water. embassy before carrying
 Wear shoes and sandals. (hyoscine). If symptoms severe or last longer than 48 hours, - Avoid unpasteurised dairy products
seek medical advice. - Wash your hands before meals and dry them with your medications
 Avoid getting tattoos or body own towel or allow to air dry. Can use a chlorhexidine gel.
piercing. - Use bottled water to brush teeth and avoid swallowing
water whilst showering or bathing. don't: use ilicit drugs, tatoos
Avoid illicit drugs.
drink only canned, boiled ,botteled fluids ,
wash hands frequently, use sanitizers 56
avoid raw fresh veg or fruits, if you can't peel it cook it
 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.
Symptoms often occur several weeks after returning permethrin), air-conditioning, mosquito coils etc
from/leaving affected areas and typically include; - wear light-coloured clothing covering arms, legs and
fever, malaise, chills, headache nausea ankles when outdoors and especially after sunset
- use a DEET insect repellent at regular intervals
Patient presenting with febrile illness within 12 months of travel Self Care Card:
in endemic areas should be referred for immediate medical Prophylaxis: Travel Health, First Aid,
attention. Doxycycline 100mg daily; Vomiting and Diarrhoea,
2 days before + 2-4 weeks after endemic area Sense in the Sun, HIV/AIDS
Maximum recommended course 6 months.

Mefloquine (Larium) 250mg; (label 12)

>45kg: 250mg weekly
1 week before + 2 weeks after endemic area
Maximum recommended course of 3 months
- Allergy
- QT prolongation
- Seizure risk – epilepsy for Tx only not prophylax
- Dizziness, vertigo – don‘t drive or pilot
- Psychiatric symptoms – anxiety, paranoia,
depression, hallucinations – most likely in first
week, if symptomatic discontinue as could be
precursor to more severe symptoms.
Ensure you have enough medication to last full trip

57
Patient Problem Treatment Children Pregnancy Lactation Other
Advice on sleep hygiene - - -
Sleep Encourage
- address underlying causes
maintain routine bedtime and waking Sedating antihistamine
Should not be used to aid
Important to differentiate between
- maintain a routine with regular bedtime and waking time use bedroom only for sleep sleep for longer than 7-10
different types of sleep problems;
- regular daytime exercise days.
difficulty falling asleep, waking if you can't sleep get up
- creating a comfortable temperature and quiet environment for sleep Commonly cause
during the night, early morning - taking a hot bath before bedtime anticholinergic side-effects
waking, poor sleep quality, snoring - having a warm milk drink before bedtime hot bath, warm milk before bedtime (dry mouth, constipation,
- get up if you can‘t sleep and sit in another room until feel more sleepy avoid: large meals, caffiene, smoking blurred vision, tinnitus).
- use bedroom for sleeping and sexual activity only Should be warned of
Duration?
Previous history? Treatment?
alcohol, daytime napping , exercise before
possible next day sedation
Avoid as both diphenhydramine
Contributing factors? stress? bedtime, watching tv in bed
- avoid large meals, excessive alcohol, smoking and drinking caffeine-containing and doxylamine hav long
Noise, light? beverages close to bedtime half life
Recent change to daily routine? - daytime napping
Workload? Exercise or reading - strenuous exercise close to bedtime note: sedating antihistamines
before bed? - pets and clocks in the bedroom can cause paradoxical
Taking any other medications? - watching TV in bed excitement, restlessness or
Recent travelling? nervousness especially in
Daytime napping? children or elderly
> 12 Ok Ok
Pattern of sleep? Difficulty in Diphenhydramine (Unisom® Sleepgels) 50mg
falling asleep, staying asleep or 1 capsule at bedtime
lack of refreshment by sleep?
Refer:
> 12 Cat A; but No
o suspected depression
Insomnia in children- most Doxylamine (Restavit®) 25 mg avoid use
o chronic problem (longer
commonly asso‘ with bedwetting One or two tablets twenty minutes before bed.
or other causes such as than 3 weeks‘ duration)
Restavit should not be used for more than ten days consecutively.
o children <16
nightmare, fear of dark… but
o irrational insomnia
should be referred in all cases. >2 No No
o symptoms indicating of
Promethazine (Phenergan®) 10mg, 25mg, 5mg/5mL no anxiety or depression
adults 25-75 mg at night
o previously undiagnosed
children 6-12 yrs: 10-25 mg at night; 2-5 yrs: 5-15 mg at night.
Questions when supplying 0.5-1 mg /kg m=25 mg no medical conditions
o drug induced insomnia (eg:
sedation antihistamines: Avoid Avoid: no Avoid
- Recommended by a doctor? stimulant, beta blocker,
Valerian (Blackmores Valerian Forte) trials SSRIs, carbamazepine,
- Used them before? 1 tablet before bedtime
- Taking any other medications? phenytoin…)
- Glaucoma, prostate or thyroid - - -
problems? Nasal plasters for snoring
- Peptic ulcers or epilepsy?
- Liver disease?
- Pregnant or breastfeeding?
- Child or elderly? Self Care Card:
Sleeping Problems

58
Patient Problem Treatment Children Pregnancy Lactation Other
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 Zyrtec® (cetirizine) most
They penetrate the blood–brain barrier poorly and so have a reduced incidence of use 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, fexofenadien: avoid grape fruit
Take one tablet daily. prefer
sedating syrup: take with or without food , if
Child 2-12yo, 5mg d citrizine 6- adult 10 mg d anti-Hs
1-2yo, 2.5mg d u take with fatty meal may not be
2-6 5 mg d, 1-2 yr 2.5 mg bd absorbed
Fexofenadine (Telfast®) 30 (child), 60, 120 (rhinitis), 180 (urticaria) mg
Take one tablet daily. Zyrtic: avoid alchol
2-11 30 mg bd
Child 6-11, 30mg bd
6 month 15 mg bd
Sedating Antihistamines Used in allergic disorders, motion sickness, vertigo, itch associated with skin disorders, >2 This medication may make
nausea, and for sedation including premedication. They commonly have anticholinergic you sleepy; don't drive or
and CNS adverse effects (drowsiness). Many are short acting but some, operate machinery if this
eg promethazine, act for up to 12 hours. happens. Avoid alcohol and
other medication which may
Dexchlorpheniramine (Polaramine®) – allergy only Cat A Short cause sedation.
2mg tablets 2 mg qid 6 - 12; term
6mg CR tablets 6 mg bd, swallow whole 1mg
6-12: 1mg qid
0.4mg/mL syrup 0.04mg/kg/dose tds qid
2-6
Promethazine (Phenergan®) – sedation, allergy and nausea
10, 25mg tablets 25 – 75mg daily OR 10 – 25mg 2-3 times daily Cat C
1mg/mL elixir >2 yrs: 0.125mg/kg tds >2 Short
term
2-12 yrs m=12.5 mg

59