Key summaries of minor ailments related to the gastrointestinal tract, respiratory system, musculoskeletal system, obstetrics, insomnia, skin, eye, ear and childhood conditions commonly seen in community pharmacy practice as a quick reference guide for pharmacy students, foundation trainees and pha...
Minor Symptoms Treatment option Danger Elimination/ Timesca Lifestyle advice
Ailment When to refer le for
referral
Mouth Painful sores that + Antibacterials - prevents + > 3 weeks 1 week + Avoid spicy, acidic, salty or
ulcers appear in the mouth bacterial infection: chlorhexidine + Painless hot food & drink until the
Self-limiting; heal (corsodyl mouthwash 12+) causes + Crops of > 5 ulcers ulcer heals
within a 1 or 2 weeks reversible brown staining of teeth major apthous ulcers – + Iron, folate, zinc, b12
May be aphthous & tongue large I.e. up to 30mm in deficiency: increased risk of
(major/minor) or + Local analgesics – pain relief: size; common in mouth ulcer – especially in
herpetiform ulcers benzydamine (difflam oral rinse ulcerative colitis, also IBD & malabsorption
Most cases are 12+); choline salicylate (bonjela appears on pharynx & syndromes
minor aphthous adult 16+) nb: choline salicylate not palate + Brush teeth before
ulcers: white/yello for < 16s herpetiform ulcers – chlorhexidine: helps reduce
centre with outer + Local anaesthetics – pain relief: small, numerous I.e. up staining but rinse mouth
inflammed red ring lidocaine 12+ (Anbesol Adult to 100 coalesces thoroughly after as
(appears on tongue, Strength Gel), benzocaine (oragel) together; affect mouth toothpaste can inactivate
lips, cheeks; occurs +Topical corticosteroid – floor/gums chlorhexidine
in crops of one to antiinflammatory: hydrocortisone + > 10mm in size
five up to 5mm in oro-mucosal tablets + Unexplained weight
size) (Hydrocortisone 2.5mg muco- Loss
adhesive buccal tablets 12+) + Associated recurrent
diarrhoea
+ ADRs (NSAIDs,
sulfasalazine, mtx)
+ OTC treatment failure
Oral Caused by candida + 4 months+ Miconazole (daktarin + Diabetics 1 week High dose ICS: encourage pts
thrush albicans 2% oral gel): apply four times a day + Painless lesions to use a spacer, rinse mouth
Common in babies after meals, retain in mouth for as + Recurrent infection out after use & correct
long as possible, continue for at inhaler technique; can treat
, White patches on least 1 week after symptoms have + OTC treatment failure OTC pts on corticosteroid
tongue & mucosal cleared, do not apply gel to the > 1 week inhaler with miconazole
surfaces inside back of the throat - possible + All except babies (less Treat nappy rash if also
mouth (cannot be choking; significant interaction: common in children & present
scraped off easily; warfarin + miconazole (enzyme adults unless they are Regularly sterilise all
raw & sore inhibitor) =bleeding taking steroid inhalers)* dummies, bottle teats &
underneath) other mouth toys used by
your baby to prevent re-
infection
If breastfeeding, apply
miconazole cream to nipple
and wipe away before feed
Leave your dentures out
overnight, or for at least six
hours daily. Constant
wearing of dentures, and
not taking them out at night,
can cause oral thrush
Dyspeps Vague abdominal + Antacids (rennies, tums, ALARM symptoms Smoking cessation; avoid
ia pain above the belly gaviscon) - neutralise acid: short + Anaemia (iron- excess alcohol; caffeine,
button (epigastric term use, immediate symptom deficiency) chocolate; avoid aggravating
pain); bloating, relief in 15 – 30min, lasts ~ 3 hours; + Loss of weight fatty or spicy foods; avoid
belching, flatulence; liquids are most effective & quicker + Anorexia lying down, bending over or
feeling full too early; than tablets + Recently changed or slumping after a meal, wait
n+v; heartburn Salts incl. sodium = fluid retention; new, unexplained at least three hours; small
Caused by potassium; aluminium = dyspepsia in >55 years regular meals; maintain a
+ indigestion constipating; magnesium = unresponsive to healthy weight; avoid tight
(functional laxating; calcium = rebound acid treatment clothing e.g. belts
dyspepsia) - no secretion, bismuth = neurotoxic + Malaena,
specific cause Sodium & potassium salts: most haematemesis,
+ GORD – reduced soluble, work quicker but for a persistent vomiting,
muscle tone in the shorter duration; magnesium & dysphagia (difficulty
lower oesophageal swallowing symptoms
,sphincter which aluminium salts: less soluble, work incl. coughing when
causes reflux and slower for a longer duration eating, regurgitation,
retrosternal Calcium salts: work quick for a long food sticking in throat;
heartburn, bitter duration not just pain on
acid taste at the Interactions: impairs absorption of swallowing)
back of mouth other drugs (2 hour gap); high + Persistent symptoms
+ Gastritis - sodium content – avoid in sodium (>= 4 weeks)
inflammation of restricted diet (or low sodium + ADRs
stomach lining preparations: mucogel, maalox); + OTC treatment failure
+ Gastric (brought on damage enteric coatings by + Refuse ppi, h2ra if due
by increased increasing stomach pH for endoscopy/ c-urea
stomach acid in the + Alginates (gaviscon range incl. test in 14 days
presence of food Gaviscon infant 1+) - form raft on + Previous gastric
usually 30 minutes top of stomach contents: suitable ulcer/gi surgery
after eating) or in pregnancy; 1st line in + Severe liver disease
duodenal ulcers GORD/heartburn + Persistent gnawing,
(pain when stomach Pt counselling: after each main boring pain from one
is empty; 2 – 3 hours meal and at bedtime or when point in the abdomen:
after eating and required gastric or duodenal
keeps awake at + H2 Antagonists (ranitidine 16+ = ulcer?
night) – caused by zantac 75: max use 6 days) - acid + Pain precipitated by
nsaids or h. pylori suppressor: onset 1 hour; lasts 9 exercise & not relieved
infection hours; not recommended in by antacids, severe,
pregnancy or breastfeeding; masks radiating to jaw, back &
symptoms of gastric cancer arms: cardiovascular
Ranitidine pt counselling: where problem?
dyspepsia is known to be brought + Children
on by food, one 75mg tablet. If
symptoms persist for more than
one hour or return, take another
tablet. Max 2 tablets in 24 hours;
max supply a pack of 12; ses:
, headaches, rashes, dizziness,
diarrhoea
+ PPIs (omeprazole = pyrrocalm
20mg, boots acid reflux 10mg,
pantoprazole = pantoloc control
20mg, esomeprazole = nexium
20mg) - acid suppressor: onset 1 –
3 days; lasts 24 hours; for reflux
18+; max. supply 14 days = pack of
14; max. use 4 weeks; not suitable
in pregnancy or breastfeeding: ppis
may be rxed in pregnancy for
severe acid reflux; ses: abdominal
pain, n+v, diarrhoea, flatulence
(long term use: osteoporosis (may
need osteoporosis prophylaxis in
high risk pts) & hypomagnasaemia)
Refer to GP: > 2 weeks OTC failure,
> 4 weeks continuous use
Omeprazole (enzyme inhibitor)
interactions: warfarin (increased
inr), phenytoin (toxicity),
clopidogrel (reduced antiplatelet
effect), methotrexate (decreased
clearance)
Pt counselling: once (20mg) daily,
swallow whole (gastro-resistant),
do not take with another acid
suppressor (e.g. h2 antagonist); can
take antacids while waiting for PPI
to work
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