Acne
Acne, particularly acne vulgaris, is the most frequently encountered skin
disorder in the teenage and young adult population.
Girls tend to suffer earlier in life but boys tend to have more
severe acne. In most cases
acne resolves before the age of 30.
Acne is a disorder of the skin’s sebaceous follicles and is associated
with the extra greasiness of the skin due to hormonal changes at puberty.
Areas typically affected are the face, neck and shoulders, where
the greatest number of oil-producing skin glands occur.
Increased sebum production and occlusion of the follicular openings
in the skin result in the formation of comedones (white and black heads).
Micro-organisms in the skin then break down the excess subum into
fatty acids which cause inflammation and irritation.
Treatments for acne help by preventing the cause of the conditions (antibacterials)
or by alleviating symptoms (anti-inflammatory), and for mild to moderate
acne are usually topical. However,
systemic antibiotics may be prescribed for moderate to severe acne.
Topical
treatments fall into two main categories – Keratolytics and
antibacterials. Keratolytics
like benzoyl peroxide, salicylic acid, resosrcinol and sulphur are
abrasives and act upon keratin in the skin to break open blocked follicles
and generally increase the skin’s turnover rate.
Antibacterials, such as benzoyl peroxide and triclosan, are used to
reduce the number of bacteria on the skin and prevent re-infection.
A new treatment, nicotinamide, is now available as a topical
preparation and is indicated for mild to moderate acne.
Cleansing agents (detergents and alcohol) help remove excessive
sebum and loose cells form the skin’s surface and so help prevent the
formation of spots.
Hygiene
is important. Simple washing
with soap and water – an antibacterial soap is preferable - will help
mange the condition. Drying
vigorously with a rough towel removes oil and helps break up any
blackheads. The use of lots
of greasy makeup should be avoided as it may make the condition worse.
Any
acne treatments will take weeks, if not a couple of months, to produce any
real effect. Customers should
be warned not to expect instant results.
If the condition does not improve within a couple of months,
antibiotics may be necessary. Occurring,
as it does during teenage years, when self-confidence is important, acne
needs to be approached with tact.
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Analgesics
Analgesics form the largest category of medicines sold over the counter in
pharmacies. Most products in
the following list contain aspirin, paracetamol or ibuprofen, alone or in
combination with codeine or dihydrocodeine.
Most could be used to treat a wide variety of aches and pains but
some are aimed at a narrower range of specific indications
They are
suitable for headaches, cold and flu pains, toothache, fever, period pain
and for the relief of muscular or rheumatic pain.
Only where indications differ, particularly form the general list,
are they quoted.
Aspirin
has antipyretic, analgesis and anti-inflammatory properties.
It acts by inhibiting prostaglandin.
However, it causes gastric irritation and can damage the gastric
nucosa. Therefore, it should not be taken on an empty stomach and is
contra-indicated in patients with gastric ulcers.
Since an association was confirmed between aspirin dosage in
childhood and Reye’s syndrome, the rare brain and liver disease, aspirin
has not been recommended for children under 12 years of age.
Paracetamol
has analgesic and antipyretic properties, but little anti-inlflammatory
actions, so is less useful for muscular problems.
Overdosage with paracetamol causes hepatic damage that may not
become apparent for four to six days.
Patients should be advised not to exceed the stated dose.
Iboprofen,
like aspirin, has analgesic, anti-inflammatory and antipyretic activity.
Ibuprofen can also damage the gastric mucosa and must always be
taken with or after food or with milk.
Asthmatics are advised to consult their doctor before taking
ibuprofen. Certain brands of
ibuprofen are available as GSL in 12 tablet packs.
Codeine
and dihydrocodeine, both morphine derivatives are the strongest analgesics
available of OTC sale. They
are only availbale for OTC sale in combination products at relatively low
doses.
Since
SEPTEMBER 16. 1998 the quantity of solid dose forms of paracetamol and
aspirin has been restricted for sale as GSL or P medicines.
Ordinarily,
the restrictions are as follows: packs
of paracetamol or aspirin tablets or capsules available from supermarkets
and general stores will, by law, contain no more than `6 tablets or
capsules. Larger packs of 32
tablets or capsules will be available from pharmacies.
Pharmacists will be able to supply up to 100 tablets in justifiable
circumstances. For amounts of
more than 100 tablets, a prescription will be required.
Liquid paracetamol preparations will be available without
pharmacists’ supervision in limited quantities.
Aspirin and paracetamol preparations in effervescent, powder and
granule form are not affected. The
regulations now apply to aloxiprin products too.
The pack
size restriction for low-dose aspirin 75mg, allow Pharmacy only packs of
100 to be sold.
Packs of
paracetamol need to carry the warnings:
“Immediate medical advice should be sought in the event of an
overdose, even if you feel well”, and “Do not take any other products
containing paracetamol.”
Ibuprofen
is not affected by the restrictions. Also, ibuprofen 200mg is available
GSL in packs of up to 16 tablets or capsules.
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Athlete’s
Foot
Athlete’s
foot is an unsightly and irritating fungal infection that affects the skin
of the feet. It is common
among all ages, with the exception of young children.
Despite it’s name, athlete’s foot doesn’t only develop on
sporty feet, or the feet of young people who take a lot of exercise.
Anyone who works on their feet all day, particularly in a hot room,
is prone to athlete’s foot.
The cause of athlete’s foot is a fungus called
Tinea pedis. It is contagious
and the infection can be picked up just by walking barefoot across a damp
floor, for example in a communal shower or changing room.
The fungal spores are transferred from one person to another within
the fragments of skin protein (keratin) that are continually being shed
from the feet. They flourish
in the moist, warm, environment found between the toes.
At first the skin becomes itchy and sore, then it starts to crack
and peel. Sometimes the skin
may appear white or inflamed and weepy.
Most customers can recognise athlete’s foot
and will ask for a treatment over the counter.
As it is usually a mild condition there are a number of effective
products that can be recommended.
OTC athlete’s foot preparations are available
form the pharmacy as creams, sprays or powders.
They usually contain an antifungal drug and sometimes additional
agents which help to dry out the skin and/or an antiseptic to eradicate
any bacteria which may present as a secondary infection.
Treatment should be continued for two weeks after they symptoms
have disappeared to ensure it is completely cured.
There are a number of practical measures which customers can adopt
to prevent reinfection:
dry the
feet carefully, paying particular attention to the area
between the toes.
Use a separate foot towel and do not share towels with any one else
Cotton socks and leather shoes should be chosen which allow the feel to
breathe
Socks should be changed and washed before re-used.
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Cold
Sores
Cold sores are a highly contagious viral infection. The initial infection
usually occurs during childhood, probably my kissing an infected adult.
Cold sores reappear several times during the year. An attack usually
begins with a tingling sensation. A painful blister appears and then
collapses to form a weeping sore which dries to form a scab.
The antiviral agent
aciclovir, if used at the tingle stage, can prevent the progress of the
cold sore; either stopping the cold sore altogether or limiting the
severity of the attack.
Other treatments available
involve relief of pain and the application of soothing products which help
the sore to dry up. Products containing iodine claim to affect a cold
sore's progress if used quickly at the tingling stage. Sufferers should be
advised to avoid physical contact with others and wash their hands often
during an attack to avoid spreading the virus. If herpes spreads to the
eye and the infection is untreated there may permanent vision impairment.
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Colds
and Flu
Colds are a contagious infection of the upper respiratory passages, caused
by one or more of 100 different rhinoviruses. Sneezing and a sore throat
are accompanied by fever, headache, general malaise, a runny or stuffed
nose and reddened, watering eyes. Many people will claim they have flu in
the pharmacy but are really suffering from a cold.
There is no cure for the
common colds but a wide range of products can offer symptomatic relief.
Aches and pains, and fever
and high temperatures can be relieved with paracetamol, ibuprofen or
aspirin. The patient's attention should be drawn to the paracetamol
content of cold remedy and the maximum daily dose, as overdosage may occur
if the patient also takes oral analgesics. Asthmatics and those with
stomach problems should not take ibuprofen.
Antihistamines are often
included in cold remedies for their drying effect. Older generation
antihistamines, such as chlorpheniramine and brompheniramine, can cause
drowsiness. Patients with glaucoma should not use antihistamines, unless
the doctor specifically allows this.
Adrenegic agents such as
ephedrine, phenylephrine, phenylpropanolamine, psudoephedrine
oxymetazolone and xylometazoline, are included in cold remedies for their
decongestant effect. Topical preparations, such as nasal sprays, are only
intended for short-term use as they can cause rebound congestion if used
for longer periods. These products have sympathomimetic effects and should
not be recommended to patients with high blood pressure, hyperthyroidism,
coronary heart disease, diabetes, glaucoma, enlarged prostate, or those on
monoamine oxidase inhibitors (MAOIs). They also have varying stimulant
effects and should be avoided at bedtime if affected. Inhalations of warm
moist air are helpful and can be encourage with the use of volatile
substances such as menthol and eucalyptus.
An acute cold has serious
implications for patients with long-term chest conditions, such as
bronchitis or emphysema, and these patients should be referred to the
doctor.
Bacterial infection is a
possible complication and patients with sustained high temperature, or
those with white or yellow spots on the tonsils require further
investigation.
Although zinc is being
suggested as being of use in reducing the severity of a cold, not products
are available over the counter, which have been proven to have that
effect.
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Colic
Colic describes repeated episodes of excessive crying that cannot be
explained in an otherwise healthy, well-fed baby.
The crying bouts usually
occur in the late afternoon or evening. Bouts start around two or four
weeks of age and last for three or four months. It is most common in a
first child and is uncommon in babies older than six months.
The cause of colic is
unknown. Some possible causes are overfeeding, faulty feeding technique
where the baby pulps air with the milk, hunger, tiredness or excess wind.
There are no specific
preventative measures but the symptoms can sometimes be relieved. Gripe
mixtures are thought to settle the stomach by getting rid of wind. Other
products used for colic in infants contain dimethicone, which is claimed
to disperse the trapped gas causing the pain. Formulas containing anti-spasmodics
such as dicyclomine should never be given to infants under six months.
If the crying is
accompanied by vomiting, sickness or pallor or a rise in rectal
temperature to 38 C or higher, the doctor should be seen.
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Corns
and Calluses
Corns are small areas of thickened, often hardened skin with a central
core found in the feet. They are usually found on the knuckles of the toes
and, in particular, on the side of the little toe. Hard corns are usually
found on the upper surface of the toes, those found between the toes are
termed soft corns. They are the body's normal response to pressure and
friction and are generally caused by badly fitting footwear either shoes
of the wrong size or made from hard material, or with pointed toes or very
high heels.
While corns can be removed
by careful treatment, they will return if the cause is not removed.
Soaking corns in warm water may soften them sufficiently to allow removal
using a pumice stone or emery board. This should always be done gently,
for a number of days.
Corn removing treatments
usually contain salicylic acid which itself softens the hard skin of a
corn to allow its removal by gentle scraping. Care should be taken with
its use, however. Salicylic acid should only be applied to the corn; it
may burn healthy skin. Felt rings are often used to protect the corn and
ease the pressure of footwear.
Diabetics should not use
over the counter corn treatments. One of the side-effects of diabetes is
poor circulation in the extremities. A less than adequate blood supply
means poor recovery of damage and a lack of sensitivity, making the
application of skin-dissolving substances like salicylic acid potentially
very damaging. Diabetics should go to a chiropodist for regular foot
check-ups and treatment of foot problems. The elderly with poor
circulation and people with persistent corns should also be referred to a
chiropodist.
Calluses are more extensive
patches of toughened skin that can occur on any part of the body,
especially hands, feet or knees, that endure repeated pressure or
irritation. Treatment is the same as for corns.
Many products contain
salicylates which may affect those sensitive to salicylates including
aspirin, such as asthmatics.
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Coughs
A cough is a protective mechanism which clears the airways of irritants
and obstructions. Voluntary coughs are deliberate action to clear the
lungs and throat. Involuntary coughs are caused by mechanical, chemical or
nervous stimulation, such as chest infections, somoke, foreign bodies,
dust and mucus.
Productive coughs are often
described as "loose" or "chesty" and they Bring up
phlegm or mucus. Cough mixtures containing directly acting expectorants,
such as ammonium chloride, ipecacuanha and guaiphenesin, facilitate
coughing. Steam inhalation is effective in liquifying mucus. Cough
suppressants should not be recommended to patients with a chesty cough.
Green-yellow or rusty
coloured phlegm is symptomatic of a lung infection and the patient should
be referred. The same applies to patients coughing up blood.
Non-productive coughs are
the dry, barking cough and nocturnal tickle which keep the patient awake
at night. Non-productive coughs which have been present for any length of
time, require further investigation. Dry coughs only require treatment if
they are preventing sleep or causing the patient distress or
inconvenience. If sips of watr, wm drinks or bland linctuses do not
resolve the problem cough suppressants such as codeine, pholcodine and
dextromethorphan can be used. Codeine can cause constipation and is
commonly abused. Many cough preparations contain additional ingredients
such as antihistamines or decongestants - see the colds and flu section
for further information. Patients with a long-standing cough shortness of
breath, severe pain on breathing in or weight loss, require further
investigation and probably referral.
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Cradle
Cap
Cradle cap is a type of dermatitis in which baby's scalp is scaly and
crusting. It occurs during the first three months f life and generally
resolves spontaneously within a year. It is most common on the crown of
the head, but can appear under the hair. Shampoos and creams in this
section contain antiseptics, which are sufficient to clear the condition.
They should not, however, be applied to broken or inflamed skin. If cradle
cap has spread to the face, the baby should be seen by the doctor.
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Diarrhoea
Diarrhoea is characterised by the passing of watery, unformed stools at
frequent intervals. Acute diarrhoea is a common problem, which affects
most people at some time or another. It is usually self- limiting but can
be an inconvenience, especially when abroad on holiday. Bacteria or
viruses usually cause acute diarrhoea. Rotaviruses and Esthetician coli,
Shigella and Salmonella are the most common cause. These micro-organisms
are usually ingested with contaminated food or drink. However,
non-microbiological causes include a change of climate, stress, hot spicy
food, excess alcohol consumption and certain medicines like antibiotics.
In addition to watery,
unformed stools, other symptoms may include abdominal cramps, nausea,
vomiting and headaches. A 24-hour break from all food and drink, except
for water and soft drinks, is advisable with acute diarrhoea. Milk should
be avoided.
OTC treatments for
diarrhoea include opiates, such as morphine or codeine, which delay the
intestinal transit time, allowing more water to be absorbed from the
stools. Adsorbents such as kaolin, attapulgite and charcoal act by
adsorbing the toxins that the bacteria produce. Antimuscarinics like
belladonna alkaloids reduce the activity of the colon and are often used
in conjunction with other ingredients. The opiate derivative loperamide is
considered by many to be the short-term treatment of choice for adults
with uncomplicated, cute diarrhoea.
The greatest risk with
diarrhoea is in the very young and the elderly with the loss of body
fluids and electrolytes. This may lead to additional symptoms of headache
and tiredness. There are a number of oral rehydration products on the
market, either as soluble tablets or sachets. These are a combination of
sals and glucose and help replace those lost during the diarrhoea.
Directions on how to make up the solution and how much to be taken is
given for each product and should be followed closely. For infants and
young children, it may be necessary to first boil and cool the water to be
used to make up the electrolyte replacement sachets.
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Ear
Problems
The softening and removal of earwax is the only ear problem, which can
safely be treated without medical advice. If pain is present this could
indicate a more serious condition.
Removal of hard wax can
only be achieved effectively by syringing, but drops for softening wax can
be used for a few days before syringing or as a preventive measure in
patients prone to wax build up.
The ear has various
self-cleaning mechanisms, which help protect it from infection. Customers
should be dissuaded from inserting cotton buds or other devices into the
outer ear canal as this can impact the wax still further or even perforate
the eardrum.
Otitis external is an
inflammation of the outer auditory canal, often referred to as swimmer's
ear. Excessive exposure to water leads to removal of the protective,
ceruminous coat. Many cases recover after thorough cleansing by suction or
gentle syringing. Corticosteroid eardrops or astringents such as aluminium
acetate solution are considered to be the most effective treatments.
Topical aminoglycoisides, polymyxins or chlorhexidine should be avoided in
patients with perforated tympanic membrane as they may increase the risk
of drug-induced deafness. Systemic antibiotics and analgesics may be
required if there is severe pain.
Acute otitis media is
characterised by severe pain and deafness, possibly accompanied by fever,
nausea and vomiting. Severe attacks of bacterial origin may be treated
with systemic antibiotics, but the cause may be viral, in which case
treatments are with a simple analgesic.
Sero-mucinous otitis media
or "glue ear" is characterised by a viscous fluid in the middle
ear. It is most common in children and often follows repeated attacks of
acute otitis media arising from respiratory tract infections. The
condition is referred to hospital as it may result in permanent deafness.
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Eye
Problems
Many of the preparations listed in this section are for minor irritations
caused by tiredness, dust and so on. Conjuctivitis or "red eye",
which is potentially more serious, is an inflammation of the membranes
covering the outside of the eye, resulting in a feeling of burning or
itching. It may be caused by an allergy, for example to pollen, which is
eased by preparations containing antihistamines, or sodium cromoglycate.
Sodium cromoglycate is thought to stabilise mast cells, which release
histamine in the allergic response.
The presence of a discharge
as well as redness, particularly if there is difficulty opening the eyes
in the morning, suggests a bacterial infection for which a specific
antibacterial agent is indicated. More severe cases should be referred to
doctor, particularly if there is pain or sensitivity to light.
Viral conjunctivitis may be
herpetic or non-herpetic; in both cases medical attention should be
sought. Herpes simples, which can affect both the eyelids and the eye is a
threat to sight so the patient should not self-medicate but see the doctor
as soon s possible.
Blepharitis is an
inflammation of the eyelids, which appear reddened and thickened along the
edge. Treatment in simple cases involves bathing with salt solution to
remove the dandruff-like crusts. In unresponsive cases a weak steroid
ointment and/or antibiotic may be needed.
A stye is an infection of a
single, eyelash follicle. Treatment is by bathing with warm water,
antibacterial ointments may also help. If crops of styes occur, a course
of antibiotics may be needed.
Any eye condition that is
not clearing up after 2-3 days of treatment, or is getting worse, should
be referred to the doctor.
If there is any sudden pain
or blurred vision, the patient should be referred to the doctor as quickly
as possible.
Some of the preparations
listed are substitute tears, for use if natural tear productions are
inadequate. Dry eye is common in the elderly and is often associated with
connective tissue diseases such as arthritis.
Contact lens wearers,
particularly those with soft lenses, must not use many eye preparations.
Check packs for details. Eye drops should usually be discarded within one
month of opening.
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Haemorrhoids
Commonly known as piles, haemorrhoids are varicose veins, which occur in
or around the rectum. They are described as firs, second or third degree
haemorrhoids depending on their severity and as internal or external
haemorrhoids depending on where they occur. Severe haemorrhoids may
prolapse or protrude out of the anus when passing stools or when
straining.
There are a number of
possible causes of haemorrhoids, although in some people it may be due to
a number of factors. People whose job means they have to sit down or stand
up all day may be more prone than others, as may those whose work involves
a lot of muscular straining. Diet is very important and constipation, due
to lack of fibre in the diet, is a common factor in haemorrhoids. Other
causes are being overweight and the stresses and strains put on the female
body during pregnancy and labour.
While other medication may
not actually cause haemorrhoids, some drugs may make the situation worse.
Anticoagulants, aspirin and non-steroidal anti-inflammatory drugs such as
ibuprofen, may make any rectal bleeding worse. Antacids containing
aluminium salts and analgesics containing codeine may make constipation
worse.
The common symptoms of
haemorrhoids are usually itching, discomfort and sometimes pain, with a
dull ache. Haemorrhoids may also bleed when the bowels are open. This is
usually seen a traces of blood on toilet paper or actually on the surface
of stools. Anyone who reports significant amounts of bleeding or blood
that is dark, or mixed in with the stools, should be referred for further
investigation.
Patients whose symptoms
have lasted a long time, or who report a change in bowel habit, abdominal
pain or distensions, weight loss, frequent vomiting or the passage of
mucous with the stools should be referred to their GP.
OTC products usually
contain a combination of a local anaesthetic, an antispetic, and an
astringent to contract the swelling. One product containing hydrocortisone
is now available OTC. It is said to actually reduce inflamation, rather
than anaesthetise the area. Laxatives, or advice on increasing fibre in
the diet, can be given to relieve any underlying constipation and help
prevent a recurrence. Antiseptic toilet tissues will help adherence to
good toilet hygiene.
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Hair
Loss
Premature hair loss affects up to nine million people the UK in one form
or another, of which 20 per cent are women.
Male pattern baldness can
start in the late teens in men, and by the age of 35 nearly 40 per cent of
men will have some form of premature balding. In women the main problem is
hair thinning, usually occurring from their mid-thirties onwards.
Minoxidil was noted to
stimulate hair growth in patients taking the drug for high blood pressure.
Topical preparations have been shown to have a similar effect if applied
to the scalp.
Approximately, one third of
male users with partial hair loss see hair growth after about four months,
which develops into good growth within 12 months with continued use.
Another third get soft, downy growth. If hair regrowth occurs, twice daily
application is needed for sustained growth. If no hair growth is seen
after 12 months, treatment should be discontinued.
Regaine is currently the
only licensed medicine available off prescription for treating hair loss.
Two strengths are now available containing 2% and 5% minoxidil, the higher
strength only being suitable for men. The 5% solution may produce over 40
per cent more hair regrowth in men with hereditary hair loss, compared to
the 2% solution. It can also produce in 8 weeks, the same degree of hair
growth that could be expected after 16 weeks with the 2% solution, says
Pharmacia & Upjohn.
Regaine is not indicated
where hair loss is sudden or unexpected, where associated with certain
conditions such as pregnancy or thyroid disorders, or if there are
inflamed patches. In addition, Regaine Extra Strength should not be used
if the scalp has been shaved or if the patient is using occlusive
dressings or other topical medicines on the scalp or if they have or are
being treated for, high blood pressure. If there is concern over hair loss
where the cause is not known, the patient should be referred initially to
the doctor.
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Holiday
Skincare
In compiling this list of holiday skincare medicines, we have concentrated
on products for bites and stings and those specifically indicated fur
sunburn.
Sunburn can lead to serious
consequence - if not immediately than later in life in the form of skin
cancers - so obviously prevention is the best approach and customers
should be encourage to take suitable sunscreens with them when going on
holiday. Similarly, insect repellents are another wise buy.
Sunburnt skin should not be
covered with dressings and blisters should be left alone, not burst. Cool
baths will help, and drinking plenty of water will avoid dehydration.
Alcohol should be avoided as this may cause further dehydration. If a
sunburnt child is feverish or vomiting, see a doctor immediately.
Many of the creams and
lotions listed are essentially cooling, although they may contain
antiseptics and antihistamines. Many simple antiseptic creams can also be
used for burns. The listing does not include simple generic creams and
lotions, like calamine cream, which have long been stand-bys for sunburn.
The pain of bites and
stings can be eased by applying a cold compress or sting relief
preparations after first removing any visible sting or jellyfish
tentacles. (be careful not to squeeze a bee sting or more poison may be
forced out).
If bites or stings become
inflamed, topical hydrocortisone preparations are recommended provided the
usual precautions for OTC sale are followed.
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Indigestion
One of the problems with 'indigestion' is that it is a term used to
describe many different conditions by different people. Most commonly, the
patient who complains of indigestion will men symptoms relating to meals,
such as discomfort, distension, belching or heartburn. Occasionally, more
serious conditions present in a similar way. Anyone who buys repeated
quantities of indigestion remedies should be referred to a doctor, as
should any middle aged patient who has sudden onset of symptoms or sudden
weight loss and patients complaining of difficulty with swallowing.
There are a number of
causes for problems described as indigestion. It may be due to incomplete
digestion of the food or delayed emptying of the food from the stomach.
Certain foods or medicines, such as aspirin, ibuprofen or other arthritis
drugs, may irritate the stomach lining and gas may be trapped which causes
a bloated feeling with belching. The most common symptoms are pain,
nausea, and vomiting, bloating and flatulence. Anyone presenting with
indigestion should be asked if their symptoms are worse before or after a
meal, if the condition is words at night and if it varies with sitting up
or lying down. Severe pain, or that which is persistent and not improved
by OTC antiacids, should be referred to the doctor.
The more common OTC
indigestion products are antacids, usually a mixture of magnesium and
aluminium salts, calcium carbonate or sodium bicarbonate. Magnesium salts
tend to cause diarrhoea and aluminium salts constipation, so they are
often combined to cancel out these effects. A product with high sodium
content will be unsuitable for patients with high blood pressure or heart
conditions. Bismuth compounds are found in some OTC products. These are
thought to act by coating the wall of the stomach, providing protection
from further damage.
Dimethicone and/or
peppermint oil-containing products act as deflatulents. They have an
anti-foaming action and release trapped gas to assist belching. Alginate
products act by forming a 'raft', which floats on top of the stomach
contents and forms a physical barrier between the acidic contents of the
stomach and the lining of the oesophagus. They are thought to be
particularly appropriate with the symptoms are caused by reflux when the
contents of the stomach are pushed up into the oesophagus.
The choice between tablet
or liquid will often be the patient's personal preference although there
is some evidence that liquids work quicker but tablets, which are sucked
or chewed, have a longer lasting effect. Tablets are also more convenient
to carry around, but some have high sugar content. Most products available
are mint flavoured although some come in other flavours.
Alverine citrate,
previously available only on prescription, can be recommended for the
relief of GI spasm, such as irritable bowel syndrome. Products containing
hyoscine butylbromide 10mg can now also be sold over the counter (packs of
up to 24 tablets) for treating GI spasm. Hyoscine's anticholinergic action
alleviates the colicky pain of smooth muscle spasm but does not mask the
symptoms of more serious GI complaints. However, the severity of the
symptoms should be determined and patients referred to the doctor if
necessary. Hyoscine may occasionally cause a dry mouth, blurred vision or
palpitations. It is non-sedative and can be taken safely by drivers and
those who operate machinery.
Still relatively new to OTC
are H2 antagonist. These reduce gastric acid secretion by inhibiting the
action of histamine in two ways - by competing for histamine receptors on
parietal cells in the stomach and blocking the nervous and hormonal
pathways to acid secretion in which histamine is involved. Famotidine,
ranitidine and cimetidine are available in OTC packs for the short-term
relief of symptoms of heartburn, dyspepsia and hyperacidity. The maximum
treatment period is two weeks. Cimetidine is also licensed for the
prophylactic management of nocturnal heartburn or, in a certain combined
formulation with sodium alginate, for heartburn associated with acid
reflux. For specific precautions related to the sale of H2 antagonists,
consult the product monographs. However, as OTC use of the H2-antagonists
grows, the indications for use allowed by the product licence are
increasing to reflect more general 'indigestion' type usage.
Patients, who are
overweight, drink heavily or who smoke too much may suffer more than most
with indigestion. Greasy foods, coffee, chocolate and alcohol should be
avoided in people prone to indigestion.
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Iron
Preparations
Most iron preparations are indicated for the treatment of iron deficiency
anaemia and would be supplied on prescription because, even on
iron-deficient diet, iron deficiency is unlikely to develop without
abnormal blood losses or long-term deprivtion. Supplements re often
prescribed to prevent iron deficiency, particularly in pregnancy. These
may contain folic acid.
Ferrous salts are generally
preferred to ferric salts as they are better absorbed. Ascorbic acid
enhances the absorption of ferrous iron. Iron salts are astringent and may
cause gastro-intestinal irritation and diarrhoea. Oral iron preparations
may have a constipating effect in elderly patients.
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Irritable
Bowel Syndrome
Irritable bowel syndrome will affect an estimated one in five of the
population at some time in their life. Women are three times more likely
than men to suffer.
Diagnosis tends to be b
exclusion and should be confirmed by a qualified medical practitioner.
Symptoms include one or all other following: abdominal pain; bloating;
diarrhoea; constipation; excessive wind, changed stools and rectal
discomfort.
Patients who complain of
dark stools or the presence of blood in them, weight loss, or anaemia like
symptoms should be referred immediately to their doctor.
Stress and good ingestion
are often the main triggers if IBS, but change in diet or an infection may
precipitate an episode. However, IBS may develop some time after the
triggering agent has been eliminated from the body.
Patients should be treated
sympathetically. The subject can be embarrassing and many may feel their
GP considers them a nuisance with such 'trivial' symptoms.
Treatment can include
dietary changes such as increasing dietary fibre or by eliminating foods
that cause wind or loose stools. Exercise may also benefit the patient,
especially if they are complaining of trapped gas or constipation.
Treatment includes
peppermint oil which has carminative and antispasmodic action. Alverine
and the anti-muscarinic hyoscine are antispasmodics that relax smooth
muscle.
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Lice
Headlice are small, wingless insect which use large claws at the end of
each leg to hold onto shafts of hair. They feed off human blood obtained
by biting the scalp. In order to stop the blood clotting while feeding,
the lice injects a small amount of saliva containing an anticoagulant and
an anaesthetic. Some people are sensitive to these compounds and that can
cause itching that can be as symptom of headlice infestation after a few
months.
Adult female lice glue
their eggs to the base of the hair shaft near the scalp. The young lice
hatch and these egg cases - 'nits' - remain attached to the hairs,
appearing as small white grains. They are the most easily detected sign of
headlice infestation, particularly above and behind the ears and the back
of the neck.
There are a number of
insecticides which will eradicate headlice, available as lotions, shampoos
or crème rinses. Lotions are recommended rather than shampoo preparations
which are not recommended for younger children or asthmatics. Hair should
be dried naturally and not with a hair dryer or by sitting near a fire.
Carbaryl-containing
products are now only available on prescription following recommendations
by the Committee of Safety of Medicines and animal study data linking it
to incidence of cancer.
Rotation of insecticide
products helps prevent headlice developing resistance. Products may be
changed art regular intervals or different customers may be sold different
products in a more 'mosaic' pattern. This may be policy for local health
authorities or health boards.
Rappell, a louse-repellent
product containing piperonal can be recommended for customers who ask for
a headlice preventative. It should be sued daily by all adults and
children in the family aged 2 and over.
Most products used to kill
headlice are also effective against body lice or public lice (crabs). Read
the manufacturers instructions carefully.
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Nappy
Rash
Nappy rash, a form of dermatitis is one of the common disorders of
infancy. Painful, red, spotty and itchy skin in the nappy area is the most
obvious sign.
The causes of nappy rash
are excessive ammonia on the wet nappy skin caused by bacterial action,
fund=g infection or an allergy to soap, detergent or other chemicals.
Prolonged contact with wet
nappies increases the risk. Nappies should be changed as soon as possible
after soiling and the area washed with warm water and dried thoroughly
with a soft towel. Waterproof pants should be avoided s they deep the skin
wet.
The incidence of nappy rash
has been decreasing since the introduction of disposable nappies that draw
urine away from the surface of the nappy, leaving the infant's skin dry.
A mil preparation such as
zinc and castor oil ointment, which pertroleum jelly or barrier cream
should be applied as a preventative measure after each nappy change. Some
nappy rash treatments contain antibacterials such as certrimide and
benzalkonium chloride to reduce the number of bateria and prevent
secondary infection.
Nappy rash may be
complicated by fungal infection, in which cas antifungal preparation can
be recommended or the baby referred to doctor.
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Oral
Hygiene
Ailments affecting the mouth are extremely common and include gingivitis,
periodonits, toothache, dental caries, mouth ulcers, sensitive gums, dry
mouth and halitosis. The dentist carries out diagnosis and treatment of
those conditions and a wide range of products is available for OTC
treatment.
Gels and mouthwashes
containing antibacterial agents such as chlorhexidine or one of the
quaternary ammonium compounds can be used in the treatment of gingivitis
and periodonitits.
Mouth ulcers, although
common, are still poorly understood. Ill-fitting dentures, ovulation,
vitamin C deficiency and some forms of cancer treatments have been cited
as possible causes. Relief from symptoms may be obtained with preparations
containing local anaesthetics, analgesics and astringents. Hydrocortisone
lozenges or triamcinolone in adhesive base can be used to treat recurrent
mouth ulcers.
Dry mouth can be alleviated
with saliva substitute sprays or pastilles.
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Period
Pain and PMS
Perhaps as many as half of all menstruating women suffer from period pain
or dysmenorrhoea, and about one in ten may be incapacitated by it for at
least one day a month. Dysmenorrhoea is usually classified as either
primary - which occurs soon after the woman first starts having periods,
and secondary - in which the pain starts much later in life. The latter is
more likely to be associated with a medical cause.
Period pain is
characteristically a mild cramp-like pain in the lower abdomen, back and
even lets, felt at the start of the period, and which lasts for a day or
two. It usually subsides rapidly and does not interfere with the woman's
daily routine. However, in about 5 per cent of women the symptoms will
also include nausea, vomiting, diarrhoea, headache, dizziness and
fainting.
Aspirin and ibuprofen are
often beneficial in dysmenorrhoea because of their effects against
prostaglandins which are thought to be implicated in period pain.
Analgesic products marketed specifically for dysmenorrhoea are listed in
this section although some of the general analgesics listed elsewhere in
this guide are also applicable.
The term premenstrual
syndrome (PMS) is often used to describe a variety of physical, emotional
and behavioural changes that many women suffer from before their period.
Estimates of the percentage who suffer range from 15 to 90 per cent.
The change in hormone
levels, water retention caused by this change, and the lack of certain
nutrients, in particular the essential fatty acid gammalinolenic acid,
have been linked to many of the problems. Suggested therapies may include
pyridoxine, magnesium, diuretics, evening primrose oil, multivitamins, and
minerals, relaxation methods and even lithium!!
Following concerns over
plans to restrict the availability of high dose vitamin B6 (pyridoxine),
the Government has announced it is prepared to wait for advice from an
Expert Group on vitamin safety. It is still recommending that people
wanting to take daily doses of vitamin B6 higher than 10mg should only do
so on medical advice. In August 1998, the Royal Pharmaceutical Society
advised pharmacists that they may decide whether they wish to put high
dose vitamin B6 products on open sale or to treat them as P medicines. It
asks pharmacists to bear in mind the still unresolved safety issues when
deciding on advice to customers seeking to buy higher dose products.
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Thrush
and Vaginitis
Vaginal candidiasis or thrush is the most common vaginal infection. About
half of all women aged, 16-60 will suffer at some time and over a third
will have an attack at least once a year.
The yeast-like organism,
Candida albicans, causes thrush, which is a normal inhabitant of the
vagina, mouth, skin and GI tract.
The exact reason why this
organism sometimes grows out of control is not known but there are a
number of possible causes including being run down or under stress.
Wearing tight trousers or underwear can create the warm, moist environment
in which thrush flourishes, while the overuse of harsh or perfumed bath
additives can irritate the delicate skin of the vulva and make it more
prone to infection. Certain groups of women are more prone to thrush than
others including pregnant women and diabetics. Thrush is also more likely
to occur in people taking a course of oral antibiotics, the contraceptive
pill or oral steroids.
The most common symptoms
are itching and soreness of the vulva and vagina accompanied by redness or
swelling of the vaginal area. A thick white discharge is also common.
Other women may report dryness of the vagina, causing discomfort during
sexual intercourse or pain when passing urine.
There are a number of OTC
products that help relieve the external symptoms of thrush such as
itching. Creams and pessaries for internal use are available for over the
counter sale. They contain antifungal imidazoles: clotrimazole, miconazole
and isoconazole. The internal treatments are usually a single dose with
the creams being used for up to seven days. However, relief can be
achieved after the first application. It is possible that they my affect
rubber contraceptive products, like diaphragms or condoms, and reduce the
efficacy. This is most likely to happen with miconazole.
An oral treatment of thrush
has been introduced OTC for the first time in the form of fluconazole,
taken as a one-capsule single dose. Symptoms are said to be relieved
within 24 hours and complete relief achieved within two days.
Anyone with the following
characteristics should not self-treat but should be referred to the
doctor:
* First time
suffers.
* Anyone who has had more than two attacks in last six months
* Pregnant and breast feeding women
* Girls under the age of 16 or women over 60
* Blood stained vaginal discharge or irregular vaginal bleeding
* Abdominal pain
* Pin or difficulty in passing urine
* Fever or chills
* Diarrhoea or nausea or vomiting
* Ulcers or blisters on the vagina or vulva
* A previous history of sexually transmitted disease
* No improvement in seven days.
Vaginitis is inflammation
of the vagina, which may be caused by infectin (including thrush),
allergic reaction, hormone deficiency in older women or the presence of a
foreign body, such as a forgotten tampon, in the vagina. Treatment depends
on the cause; taking antibiotics or antifungals, avoiding irritant agents
or taking oestrogens. OTC treatments generally involve relief of
irritation.
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Tonics
In addition to vitamins and minerals, tonics often contain bitter
ingredients, such as gentian infusions, which are thought to stimulate the
appetite. Caffeine and glycerophosphates are two other common ingredients
of tonics. The alcohol content of tonics can be considerable therefore
interactions with other substances that depress the central nervous system
are possible.
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Travel
Sickness
About one third of the population is likely to suffer from travel
sickness, or motion sickness as it is often called. Children commonly
suffer. Travel sickness is thought to occur due to differences in what the
body's senses tell it is happening and what the eyes can see happening. In
the inner ear are three fluid-filled, semi-circular canals, set at right
angles to each other, which detect changes in the body's position.
Sickness is thought to occur when the signals from the canals tell the
brain the body is being moved around, but the eyes say the body is
stationary.
Symptoms include dizziness,
nausea, vomiting, sweating and increased saliva production. Prolonged
attacks can lead to dehydration and depression.
There are two main groups
of drug used to treat travel sickness OTC - anticholinergics and
antihistamines. Anticholinergics, such as hyoscine, act quickly but the
duration of action may be short. Side effects are not usually a problem at
the doses used for travel sickness, but may include drowsiness, blurred
vision, dry mouth and urinary retention. Anticholinergics are not
recommended for those with glaucoma, and should be used in caution in
patients with urinary problems, high blood pressure and heart disease.
Antihistamines, such as
dimenhydrinate, meclozine and cinnarizine, have a longer duration of
action. Drowsiness may be a problem. Phenothiazine-type antihistamines,
such as promethazine, may also cause sensitivity to sunlight, which may be
a problem for foreign holiday goers.
Anyone prone to travel
sickness should take a remedy before leaving home. Most are of little use
once an attack has begun because vomiting makes it difficult to keep
tablets down. Also the exit from the stomach may close preventing the
tablets reaching their site of absorption in the small intestine. Avoiding
large meals and alcohol before and during travel can reduce symptoms. On a
ship, the best place to be is in the centre of the vessel, fixing the eyes
on the horizon. In cars, sufferers should avoid reading and making sure
there is plenty of fresh air. Child seats can be fixed so the children can
look out of the window.
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Vitamins
and Minerals
Vitamins and minerals are essential for health and normal development. In
most cases the body cannot manufacture any or enough of these substances
to they have to be obtained from the diet. Primary deficiency diseases
occur when one vitamin is absent from the diet. Vitamin A deficiency
causes xerophthalmia, a dry eye syndrome. Deficiency of vitamin B1
produces beri beri, lack of vitamin C causes scurvy and vitamin D
deficiency leads to rickets. Secondary deficiency diseases occur when
absorption processes fail due to poor digestion, alimentary tract
disorders or laxative abuse.
A balanced diet usually
provides the minute quantities of vitamins required by the body. However,
certain groups of people are at greater risk of developing vitamin
deficiency and might need vitamin supplements.
* The elderly because of
loss of appetite, poor diet or malabsorption disorders.
* Dieters who are not eating a balanced diet
* Vegetarians, at increased risk of vitamin B12 deficiency
* Asian immigrants from an environment with high exposure to sunlight
often develop vitamin D deficiency.
* Pregnant and lactating women with higher nutritional needs
* Alcoholics who often have impaired vitamin B12, folic acid and
thiamine absorption.
The current levels of folic
acid recommended for women trying to conceive are 0.4mg daily in women
with no history of children suffering neural tube defects; 5mg daily for
those with a child suffering from neural tube defects. Folic acid should
be taken while trying to conceive and into the twelfth week of pregnancy.
Rich sources of folate/folic acid are green vegetables, oranges, wholemeal
bread and fortified breakfast cereals. Pregnant women are advised against
eating liver because the high levels of vitamin A may harm the unborn
baby.
Vitamins can be divided
into fat soluble (A D E and K) and water soluble (B group and vitamin C).
Iron and calcium are often
found combined with other vitamins and minerals or as single preparation.
High doses should only be taken under the supervision of the doctor.
Following concerns over
plans to restrict the availability of high dose vitamin B6(pridoxine), the
Government has announced it is prepared to wait for the advice from an
Expert Group on vitamin safety. It is still recommending that people
wanting to take daily doses of vitamin B6 higher than 10mg should only do
so on medical advice. In August 1998, the Royal Pharmaceutical Society
advised pharmacists that they may decide whether they wish to put high
dose vitamin B6 products on open sale or to treat them as P medicines. It
asks pharmacists to bear in mind the still unresolved safety issues when
deciding to provide customers seeking to buy higher dose products with
advice.
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Warts
and Verrucas
Warts are caused by a viral infection of the skin. They are contagious
from person to person and from one area to another on the same person.
They occur, particularly in teenagers, where they are picked up at school
sports centre, usually through a slight area of skin damage.
Warts have a rough surface,
irregular shape and clearly defined borders. There may be a black spot in
the centre. Sideways pressure may be painful. Getting rid of warts can be
a slow process, and customers buying wart removers from the pharmacy
should be advised to continue treatment regularly and thoroughly until the
wart has completely disappeared.
Treatments, which are not
intended for the face or genitals, contain skin-dissolving agents like
salicylic acid and lactic acid, nd glutaraldehyde and formaldehyde. Paring
down hard skin with a pumice stone or emery board may speed the
treatments. Care must b e taken to ensure the medication odes not come
into contact with surrounding skin.
Verrucas or plantar warts
affect the fee. They are caused by a virus, which causes an area of skin
to grow irregularly. Plantar warts grow into the sole of the foot and
cause pain on walking.
Treatment aims to gradually
reduce the size of the warts by slowly dissolving the skin. Salicylic acid
is the ingredient in many verruca treatments. Glutaraldehyde or
formaldehyde has similar actions, while podophyllin acts by preventing
division of the cells in the skin. Podophyllin is teratogenic and should
not be used by pregnant women as percutaneous absorption has been shown.
Treatment of verrucas is a
long process. Customers should be advised not to expect instant results.
Gentle rubbing away of the skin follows application of the selected agent,
avoiding the surrounding skin, so the next application attacks the skin
underneath.
Verrucas should not be
attacked with a knife or razor blade. Cutting may cause more problems than
it will solve. A chiropodist should treat diabetics and others with severe
circulatory disorders.
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Worms
Worms, or helminths, are well-developed parasites with a number of species
of medical importance to man. Light infections, particularly of
gastro-intestinal helminths, may be asymptomtic but poor sanitation and
hygiene when eating or handling food may lead to re-infection.
Tapeworms occur worldwide
in areas where poor standards of sewage disposal exist. The two main types
- beef tapeworm and pork tapeworm - are contracted by eating undercooked
or raw meat containing the worm's eggs. Once inside the gut, adult
tapeworms can reach lengths of up to 10 metres and live for as long as 20
years. The sufferer is usually alerted by 'crawling' sensation when
sections of the worm are passed in the faeces.
Roundworms, particularly
common in warm climates, are caught when eggs are ingested in contaminated
food and water. The hatched worms pass from the gut into the lymphatic
system and travel via the bloodstream, lungs and oesophagus. Mature female
worms, which may be up to 30cm in length, produce eggs that pass out of
the body in the faeces. Symptoms include fever, cough, dysponea and
urticaria. Large infections cause diarrhoea, colic and intestinal
obstruction.
Threadworms (pinworms)
measure up to half an inch in length and look like threads of cotton. They
can be seen, often moving, in stools, and are the most common worm
complaint dealt with in pharmacies. They are highly contagious and eggs
can remain viable outside the body for several weeks. Children often pick
up the eggs by sharing toys, food, schoolbooks and even pencils and get
infected when the eggs are transferred to their mouths. The most common
symptom is severe itching around the anus, particularly at night.
Threadworms are usually
treated with piperazine or mebendazole. Piperzaine is available in
granules, taken in two doses separated by a fortnight to ensure all worms
are expelled, or as an elixir taken daily for seven days. Mebendazole is
available as one-off, single dose tablet that should kill all worms.
Re-infection is unlikely if hygiene rules are followed. A follow up dose
can b e taken 14 days later if re-infection occurs, but this is unlikely
if hygiene rules are followed.
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