Treatment Recommendations (Part A Oral exam)

Seasonal Allergic Conjunctivitis

Drug: Levocabastine 0.05% eye drops (Zyrtec)

Dose: 1 drop both eyes 2-4 times daily

Duration: N/A

Counselling: Cold compresses may help to provide relief from discomfort

Ocular irritation can occur with administration of

Dyspepsia and Gastrointestinal Reflux (Liquid)

Drug: Sodium alginate, sodium bicarbonate, calcium carbonate (Gaviscon)

Dose:

12+: 10-20mL after meals up to QID prn

6-12: 50-10mL after meals QID 

Duration: up to 7 days

Counselling: Shake bottle well before use

Space apart from other oral tablets by 2 hours

Dyspepsia and Gastrointestinal Reflux (Tablets)

Drug: Calcium carbonate 680mg, magnesium carbonate hydrate 80mg (Rennie)

Dose: 1-2 tablets chewed prn (maximum 11 tablets per day)

Duration: up to 14 days

Counselling: Can be sucked or chewed

Lower IBS (Pregnancy safe)

Drug: Psyllium husk sachets (Metamucil)

Dose:

12+: 2 spoonful 1-3 times daily

6-11 yrs: 1 spoonful 1-3 times daily

Duration: N/A

Counselling: Mix in a glass of water with MORE than 250ml

Lower IBS (NOT Pregnancy safe)

Drug: Hyoscine Butylbromide (Buscopan)

Dose: >6 years: take 10mg TDS

Adult: 10-20mg 3-4 times daily

Duration: N/A

Counselling: Avoid using in combination with other medicines with anticholinergic effects

Can experience dry mouth and constipation

Acne

Drug: Benzyl Peroxide (Benzac) 

Dose: ONCE daily at night to start, can increase to TWICE daily (morning/night) if no improvement after 7 days

Duration: Can take up to 6 weeks to start fully working

Counselling: Start at 2.5% then titrate up (2.5, 5, 10%)

Wash affected area with mild cleanser + warm water and pat dry skin

Apply a thin film of benzac to affect areas ONCE daily, leave for 2 hours and rinse off with water and pat dry skin

After 3 days, if no discomfort, apply in evening and leave on overnight

After 7 days, if no improvement, apply TWICE daily (morning/night) if no experience of burning, peeling, redness

Apply light moisturiser after gel dries as causes dryness

Wash hands after application

Acute Lower Back Pain

Drug: Ibuprofen (Nurofen)

Dose: 200mg TDS, max 1200mg daily

Duration: up to 7 days

Counselling: Not safe in pregnancy, safe in breastfeeding

Give paracetamol 500mg, max 8 tablets daily

Child: >1 month 15mg/kg Q4-6H

Anaphylaxis

Drug: Adrenaline (Epipen)

Dose:

150mcg: <20kg

300mcg: >20kg

Duration: N/A

Counselling: Give injection into the outer mid-thigh (DO NOT inject into buttocks)

Blue to the sky and orange to the thigh

Ensure patient does not stand up, eat, or drink

Administer an autoinjector to a child, hold child’s leg firmly to minimise risk of injury

Call ambulance as soon as possible

Always keep TWO adrenaline autoinjectors with you

Mouth Ulcers

Drug: SM 33 Gel 10 g

Dose: Apply a pea sized amount to the affected area q3h prn, no max dose

Duration: Only use for a few days

Counselling: Wash hands before and after applying

Wipe away excess saliva and then apply

Massage into affected area

Best to use after meals and drinks

Avoid hot food and drinks because the numbing effect can increase risk of burns

Bloating

Drug: Simethicone 100 mg (De-Gas)

Dose: MUST be 12+, Take 1-2 capsules after meals prn, max 5 daily

Duration: N/A

Counselling: Can cause diarrhoea, nausea, constipation 

Separate dose from levothyroxine by at least 4 hours because this medication can lower effects of levothyroxine

Cold Sores (Cream)

Drug: Acyclovir 5% cream (Zovirax)

Dose: 5 times daily

Duration: 5 days

Counselling: It takes a total of 14 days for the cold sore to completely heal 

Once cold sore has crusted – can use antiseptic – Betadine cream

Hydrocolloid patch (all stages): promote wound healing and can prevent secondary bacterial infection, apply Q8H (when patch falls off) until cold sore is healed

Cold Sores (Tablets - NOT pregnancy safe)

Drug: Famciclovir 500mg (Elovax One Dose)

Dose: 18+: Take 3 tablets at once

Duration: Take on first sight of symptoms (within 48 hours)

Counselling: DO NOT take if cold sore has already crusted

Preferred in patients with lesions inside the nose or mouth

Bacterial Conjunctivitis

Drug: Chloramphenicol drops (Chlorsig)

Dose: 2+: 1-2 drops q2h for the first 48 hours then qid

Duration: up to 5 days

Counselling: Store in fridge before opening then store at room temperature

If symptoms do not improve in 2 days, see doctor

Viral Conjunctivitis

Drug: Hylo-forte (sodium hyaluronate)

Dose: Use as often as needed

Duration: Infection should resolve itself within 14 days, see a doctor if not improved by then

Counselling: Notice improvement after the first few applications of eye drops 

These eye drops will soothe symptoms but will not eliminate the viral infection

Dry Eyes

Drug: Sodium hyaluronate perservative free (Hylo-forte)

Dose: Use as often as needed

Duration: Should see improvements within 2 days

Counselling: Notice improvement after the first few applications of eye drops 

Can be used in contact lens patients

Onychomycosis

Drug: Amorlfine 5% (Loceryl)

Dose: Apply to the whole nail 1-2 times WEEKLY

Duration: Sumptoms can take up to 6 months for fingers and 9-12 months for toe

Counselling: File the whole nail and clean with cleaning pad then apply the lacquer

Stye

Drug: Warm towel compress

Dose: 5-10 minutes about 3-4 times a day

Duration: Symptoms should resolve within 7-10 days

Counselling: Dispose of any used “compress” towels or paper into rubbish bin so other people DO NOT have to handle it  

Chillblains

Drug: McGloin’s Chilblain Ointment

Dose: Apply 2-3 times a day as required 

Duration: N/A

Counselling: Camphor: alleviates pain, itching and improves circulation

Benzocaine: numbs the area

Balsam-Peru: antiseptic properties

Lanolin/paraffin base: moisturising effect and helps to retain heat

DO NOT USE HOT WATER

Constipation

Drug: Docusate 50mg (Coloxyl)

Dose:

Adults: 50-150 mg ONCE or BD, max 500 mg daily (divide dose)

6-12 years: 50-120 mg daily (can divide dose)

3-6 years: 50 mg daily

Duration: May take up to 3 days to provide relief

Counselling: Increase fibre intake (eg fruits, vegetables, wholegrain) in diet slowly to prevent bloating and wind

DO NOT strain

Chesty Cough (Liquid)

Drug: Guaifenesin 200 mg (Duro-Tuss Chesty Cough Liquid Forte)

Dose:

>12 years: 10 mL q4-6h prn, max 4 times in 24 hours

6-12 years: 5 mL q4-6h prn, max 4 times in 24 hours

Duration: N/A

Counselling: Reduce cough intensity, frequency, sputum viscosity

Keep hydrated

Chesty Cough (Tablets)

Drug: Bromhexine 8 mg (Bisolvon Chesty Forte)

Dose:

Adult: 8-16 mg (1-2 tab) tds

If required 2 tabs tds for first 7 days

>6 years: 8 mg (1 tab) tds

Duration: N/A

Counselling: STOP TREATMENT if develop skin swelling or rash

Dry cough

Drug: Dextromethorphan Hydrobromide Monohydrate 30 mg (Duro-Tuss Dry Forte)

Dose:

>12 years: 10 mL Q6-8H prn, max 4 doses in 24 hours

6-11 years: 5 mL Q6-8H prn, max 4 doses in 24 hours

Duration: N/A

Counselling: NOT SUITABLE for cough caused by asthma or COPD

Corns/Calluses/Warts

Drug: Salicylic Acid 40% w/w (Scholl Corn Removal Medicated Disc Pads)

Dose: N/A

Duration: Repeat therapy for up to 12 weeks

Counselling: Wash the feet clean and dry, thinning the thickened

Before applying, the affected area should be soaked in warm water and towel dried

Leave plaster in place for at least 48 hours before removing

Dermatitis

Drug: Hydrocortisone 0.5%, 1% (Dermaid)

Dose: Apply ONCE to TWICE a day to affected area

Duration: up to 7 days

Counselling: Distance from tip of adult index finger to first crease is enough to cover the area of 2 adult size hands (include fingers)

Refer if no improvement after 48 hours of treatment OR no complete resolution after 7 days

Diarrhoea/Dehydration (Rehydration)

Drug: Hydralyte

Dose:

Under 12 months: 100 mL every 90 minutes (maximum 1000 mL per day)

1-3 years: 100 mL every 90 minutes (maximum 1400 mL per day)

3-6 years: 100 mL every 60 minutes (maximum 2000 mL per day)

6-12 years: 100 mL every 30 minutes (maximum 2600 mL per day)

Adults: 200 mL every 30 minutes (maximum 4000 mL per day)

Duration: N/A

Counselling: Drink product slowly – sip on it

Diarrhoea/Dehydration (Treatment)

Drug: Loperamide 2 mg (Imodium)

Dose: Take 2 capsule and then 1 capsule after every loose bowel movement, max of 8 a day

Duration: Should go away on its own within 2 days, treatment should be short term only

Counselling: can experience side effects such as

abdominal cramps, nausea, constipation

Dry Mouth

Drug: Biotene Dry Mouth Mouthwash

Dose: 15 mL up to 5 times daily

Duration: N/A

Counselling: Rinse thoroughly for 30 seconds and spit out

Do not swallow

Do not drink from the bottle

Angular Cheilitis

Drug: Clotrimazole 1% Cream (Canesten)

Dose: TWICE daily

Duration: At least 14 days

Counselling: Continue for ANOTHER 14 days after symptoms are relieved

Fungal Nail Infection (Onychomycosis)

Drug: Amorolfine 5% (Loceryl)

Dose: Apply ONCE or TWICE a week until the nail regrows

Duration: Usually, 6 months for fingernails and 12 months or more for toenails

Counselling: File and clean the nail before each application and cleaned

Apply the nail polish evenly over entire surface of the infected nail and allow to dry

Don’t use commercial nail polish on affected nails

May take 3 months for the patient to see a difference

Continue treatment until the nail has fully regrown

Ear Wax

Drug: Docusate sodium 0.5% (Waxsol)

Dose: 8-10 drops to affected ear

Duration: Symptoms should resolve after 2 days

Counselling: Lie on your side with the ear you want to treat facing upwards

Instil the drops

Put a cotton ball (may or may not layered with Vaseline) into the ear to prevent drops from leaking

Stay in that position for 5-10 minutes

Turn to other side and treat the other ear if necessary

Otitis Externa (Swimmers Ear) - Prevention ONLY

Drug: Acetic acid plus isopropyl alcohol(Aqua Ear)

Dose: Instil 4-6 drops into ear canal immediately after swimming or bathing

Duration: Immediately after swimming

Counselling: Tip head to one side and instil 4-6 drops into ear canal

Hold position for 1 minute

Repeat for other ear

Keep bottle tightly closed

Tinea (Athletes foot, Ringworm, Jock Itch)

Drug: Terbinafine 1% (Lamisil)

Dose: Apple ONCE or TWICE a day

Duration: 1-2 weeks

Counselling: See a doctor if no improvement within after 1-2 weeks

Hemorrhoid

Drug: Hydrocortisone + Cinchocaine hydrochloride (Proctosedyl Ointment)

Dose:

EXTERNAL: apply a small amount using a clean finger onto the affected area tds for 7 days (twice a day AND after each loose bowel action)

INTERNAL: attach applicator to the nozzle of the cream

Duration: Use up to 3 weeks, if symptoms still persist - refer to doctor

Counselling: Refer if any abdominal pain, rectal bleeding, symptoms dont improve after 7 days of treatment

Anal Fissures

Drug: Glyceryl Trinitrate 0.2% Ointment (Rectogesic)

ONLY USE IF DOCUSATE DOESNT WORK

Dose: >18 years: insert 1-1.5 cm strip of ointment into the anal canal tds

Duration: At least 2 weeks

Counselling: If patient experiences severe headache or dizziness STOP treatment for at least 8 hours then restart on half the dose

Migraine - ONLY IF THEY HAVE HAD IT BEFORE

Drug: Sumatriptan 50mg

Dose: Take 1 tablet stat, another tablet in 2 hours if required

Duration: Max 2 tablets a day

Counselling: Only repeat dose if first dose improves symptoms, if does not improve symptoms DO NOT repeat

Most effective if taken when the headache is beginning to develop and not earlier (during aura) or later (when headache is more severe)

Headlice

Drug: Dimethicone 4% solution

Dose: Apply from roots to tips, back of the neck, around the temples, and behind ears – ensure scalp is fully covered

Duration: Leave on for 15 minutes

Counselling: Rinse off with shampoo

Wet comb every 2-3 days for 2 weeks to get rid of the nits – part hair into smaller sections and apply conditioner and comb through hair with fine tooth lice comb, wipe the comb after each pass with a tissue – live lice will be visible if they are present

Repeat treatment after 7 days to eliminate any chance of remaining lice

Can take up to 2 weeks to fully clear the eggs

Insomnia

Drug: Doxylamine 25mg (Restavit)

Dose: Take 1-2 tablets 30 minutes before bedtime

Duration: Max 10 consecutive days

Counselling: Safe using pregnancy/breastfeeding but try to use the lowest effective dose and for the shortest duration

Jetlag - NOT pregnancy/breastfeeding safe

Drug: Melatonin 2 mg (Voquily)

Dose: 1 tablet daily at local bedtime, after arrival in destination

Duration: Max 1 week

Counselling: Refer to doctor if symptoms don’t improve within a week of treatment

Nappy rash

Drug: Zinc oxide 15% (QV Barrier cream)

Dose: Apply to all skin surfaces, including skin folds and after each nappy change

Duration: Max 7 days

Counselling: If symptoms don’t improve after 7 days of treatment, refer to doctor

Improvement should be seen within 2-3 days

Nipple thrush

Drug: Miconazole cream (mother), Miconazole oral gel (baby)

Dose: Apply to nipples after each feed for at least 1 week (mother)

1 quarter of teaspoon qid for 1 week (baby)

1 quarter of teaspoon ONCE daily for another week (baby)

Duration: N/A

Counselling: Additional pain of nipple/breast REFER for oral antifungal treatment

Use finger to apply onto the cheeks and tongue – gradual application

Oral thrush

Drug: Nystatin drops (Nilstat)

Dose: Use 1 mL (100 000 units) FOUR times a day

Duration: 7-14 days

Counselling: Continue treatment for another 2 days after symptoms resolve

Use after meals

Swish around mouth for as long as possible (30-60 seconds) then swallow or spit out

Scabies

Drug: Permethrin 5% (Lyclear)

Dose:

Adults (over 12 years) 1x30g tube

5-12 years ½ tube

1-5 years ¼ tube

2-12 months 1/8 tube

Duration: Leave on for 8-24 hours – best to apply at bedtime

Counselling: Apply from neck down and pay attention to nooks and crannies (all skin folds eg between toes, fingers, armpit)

Apply to clean, dry, and cool skin (not hot skin to avoid systemic absorption)

Rinse off the following day

Repeat after 7 days to prevent treatment failure

After treatment wash everything in hot water to avoid reinfection

Sore throat

Drug: Benzydamine (Difflam Lozenges)

Dose: Take 1 every one to two hours when required (maximum 12 daily)

Duration: N/A

Counselling: N/A

Threadworms

Drug: Pyrantel 100 mg (Combantrin Chocolate Squares)

Dose: 10mg/kg MAX 750 mg as a single dose

For adults over 70 kg: 7 squares

Duration: Repeat after 7 days if the infestation is heavy

Otherwise repeat after 14 days

Counselling: Side effects include GI upset (nausea, vomiting, diarrhoea), headache, abdominal cramps

UTI - Cystitis

Drug: Methenamine Hippurate (Hiprex)

Dose: 1 tablet TWICE daily

Duration: N/A

Counselling: Avoid taking it with URAL

Go to the toilet as soon as you get the feeling of urination, don’t try hold it in

Bacterial Vaginosis

Drug: Astrodrimer Sodium (Fleurstat BV gel)

Dose: Insert 1 applicatorful of the gel into the vagina once daily at night

Duration: For 7 nights

Counselling:

Wash hands

Pull the plunger back on applicator

Attach applicator to the gel tube

Squeeze gel into applicator until it is full

Remove applicator

Lay on back with knees bent

Insert applicatory into the vagina

Pull the plunger and insert the gel

Remove and discard the applicator after use

Wash hands after use

Vaginal Thrush

Drug: Clotrimazole (Canesten Vaginal Cream)

Dose: Insert one applicatorful into vagina as deeply as tolerated ONCE daily at bedtime

Duration: Depending on the product either 1, 3 or 6 days

Counselling:

Wash hands before application

Pull out the plunger on applicator

Attach applicator to the tube of cream

Squeeze the tube until applicator is full of cream

Remove applicator from tube and lie down on back with knees bent

Insert the applicator into the vagina

Push the plunger to release cream

Remove applicator and wash hands

Dispose applicator and use new applicator for the next day