RESPONDING TO A SYMPTOM
You will be addressing a patient in this station.
1. Introduce yourself
2. Confirm confidentiality
ASMETHOD

Age

Self/Someone else

Medication - are they stable or new? Any recent dose changes?

Extra medicines i.e. have they tried anything?

Time persisting

History of PC - including causes/contributing factors/have they had it before

Other symptoms & ALLERGIES

Danger symptoms i.e. referral criteria
End consultation by either REFERRING or SELLING appropriately.
Provide any necessary advice.
GI Danger Symptoms
Eye Danger Symptoms
Blood in stools/vomit
Loss of vision
Altering between constipation
& diarrhoea
Photophobia
Altered bowel habit
Weight loss
Difficulty swallowing
Recent travel
Pain in eye
Ciliary injection – diffuse area
of dilated blood vessels,
injection in a ring like pattern
around the cornea
Redness caused by
trauma/injury
Respiratory Danger
Symptoms
Ear Danger Symptoms
Persistent cough lasting over
2 weeks
Associated
dizziness/N&V/severe pain
Persistent dry cough at night
Severe deafness/tinnitus
Purulent sputum
(yellow/green/brown)
Previous middle ear/mastoid
surgery
Haemoptysis
Perforated tympanic membrane
Chest pain
Wheezing/difficulty breathing
Hoarseness for 3+ weeks
Difficulty swallowing
Loss of voice
CNS Danger Symptoms
MSK Danger Symptoms
Suspected depression
Associated fever
Chronic insomnia (over 3
weeks)
Head injury
Insomnia under 16
Headache associated with
injury/trauma
Severe back pain
Back pain radiating to legs
Presence of pins and
needles/numbness
Severe headache over 4 hours
/ frequent
Persistent/worsening pain
Children under 12
Suspected fracture
Associated
drowsiness/clumsiness
Middle/upper back pain
Frequent migraines requiring
prophylactic treatment
COC and headache
Bowel/bladder incontinence
Paediatric Danger Symptoms
Skin Danger Symptoms
Stiff neck
Weeping or broken skin
Photophobia
Signs of infection
Signs of dehydration e.g.
lethargy, reduced urine output,
skin turgor
Diabetics/immunocompromised/pregna
nt or breastfeeding/under 18 (fungal
nail)
Non-blanching rash
More than 2 nails affected (fungal
nails)
Prolonged diarrhoea or
vomiting
Child in pain, unresponsive,
lethargic
Women’s Danger Symptoms
Diabetics/immunocompromised (warts)
Bleeding warts/verrucae
Facial/genital warts
Warts/verrucae causing pain
Cystitis: symptoms for over 5 days, fever, pain in loins,
pregnant, elderly, children, haematuria, male patients
Thrush: under 16/over 60, diabetic,
pregnant/breastfeeding, 2 episodes in last 6 months,
history of STI, abnormal menstrual bleeding, lower
abdominal pain, symptoms for over 7 days
Dysmenorrhoea: unusual vaginal discharge, fever, over
45, irregular periods, bleeding between periods
Men’s Danger Symptoms
BPH: pain on urination (last 3 months), fever, blood or
cloudy urine (last 3 months), urinary incontinence
MAX 6 WEEKS BEFORE GP REFERRAL
ED: women, under 18, allergies, men who do not have
ED, premature ejaculation, hypotension, hepatic/renal
impairment, nitrate use
MAX 6 MONTHS BEFORE GP REFERRAL
GI OTC
Scenario
Customer (42) wants to buy something for diarrhoea.
For her daughter (10) – on no medication and has not tried
anything yet.
Started yesterday and has never had these symptoms
before; is going to the bathroom every couple of hours.
Treatment/Referral
Oral rehydration sachets - Dioralyte
(make up with water and sip small
amounts often; will keep for 24 hours if
kept in fridge)
Deh
diar
ade
Loperamide is licensed for 12 and over
Other symptoms: watery stools and some abdominal
cramping pain
Danger symptoms: no blood in stools, no severe vomiting or
fever, no recent travel abroad.
Patient (28) is pregnant and wants to buy senna tablets. On
no other medication, has not tried anything yet and has not
suffered from constipation since she was a teen.
Other symptoms: small, round, hard stools and some
abdominal discomfort when trying to pass stools.
Danger symptoms: no vomiting, no blood in stools
Ispaghula husk (fybogel) - 1 sachet BD can be given throughout pregnancy –
may experience some abdominal
discomfort (effect is not immediate)
Con
to fo
an i
Firs
Senna cannot be given in third trimester
Patient (58) has seen an advert for zantac and would like to Refer
buy some for himself.
He is on Ramipril for hypertension.
He has had indigestion for about 2 and a half weeks. Has
tried Rennies and Gaviscon but has had no relief therefore
wants to try zantac.
He has never had this before in the past.
Other symptoms: pain is severe; patient feels as though they
have lost some weight in the last two weeks and feels more
tired than usual
Danger symptoms: no blood in stools or vomit
Due
dura
failu
N.B
pain
abd
sen
mou
Patient (29) wants to buy something to ease the pain of a
Anbesol:
mouth ulcer.
1. Remove to top from the bottle and
She is on no other medication and has not tried anything yet.
cover the bottle opening with a
Has had it for one day and has had them before on a few
clean fingertip.
occasions but not recently.
2. Keeping the fingertip over the
opening invert the bottle once and
Other symptoms: image shows round white lesion with a
return to an upright position.
distinct red outer edge inside her lip; it is quite painful.
3. Apply two undiluted applications
Danger symptoms: N/A
using the fingertip directly to the
affected area.
4. Repeat if necessary, after three
hours.
Mou
Can
ADR
infe
Bongela (over 16 only)
Benzocaine (orajel, over 12)
Chlorhexidine mouthwash (more
appropriate if ulcer is due to infection e.g.
gingivitis)
Customer (52) wants to buy treatment for piles.
Anusol HC (over 18)
Apply morning, night and after each
It is for her husband (52) who is on Lisinopril 10mg. Has had bowel movement.
the pile for a few days and has not tried anything yet. Has
Not to be used for longer than 7 days.
had haemorrhoids in the past as he sits at work all day. Has
tried creams in the past, want the most effective treatment
that gives him fast relief.
Other symptoms: itching, discomfort, slight pain on passing
stools
Danger symptoms: no blood in stools, not change in bowel
habit
Can
how
Patient (25) would like something for diarrhoea.
She uses a symbicort and salbutamol inhaler.
She has had this for less than a day and has not tried
anything yet.
She has only had diarrhoea once when she was younger.
Refer
Other symptoms: feels bloated all the time, sometimes gets
constipated and then has diarrhoea again.
She feels as though she cannot get her bowel habit back to
normal; this is frustrating her and she hasn’t been able to
see her GP
Patient (34) is driving to France and would like to buy
something for travel sickness.
It is for herself and her daughter (6).
She takes paracetamol for occasional muscle ache, her
daughter doesn’t take anything.
Has not tried anything before.
History: patient suffers from sickness and has worn a band
before as she was pregnant at the time. Her daughter had
something for a school trip but cannot remember the name.
Pro
Hea
Foo
Reg
Exe
Red
Can
alre
If pa
hav
Meb
Pep
befo
Lop
Bulk
befo
fluid
Treat:
Bet
Antihistamines e.g.
whe
promethazine/cinnarizine 15mg- sturgeon
(over 5)
Side effects include blurred vision and
drowsiness 12 + : take 2 tablets 2 hours before
travelling then half a tablet every 8 hours
during journey if required
5-11 : 1 “”””
Anticholinergics e.g. hyoscine
hydrobromide (short duration of action,
take 20/30 minutes before journey) - if
long journey dose can be repeated after 6
hours - no more than 3 in 24 hours:
Kwells kids (over 4) - 1
Kwells (over 10) - 1
Patient (45) has been feeling nauseous for 24 hours and has Oral rehydration sachets - Dioralyte
recently vomited.
(make up with water and sip small
amounts often; will keep for 24 hours if
On metformin and atorvastatin.
kept in fridge)
Has tried anything yet and hasn’t suffered from this before.
Can’t think of any reason for it, thinks it may be a virus.
Other symptoms: nauseous and feels unwell
Danger symptoms: no fever, no blood in vomit
Ens
is a
Adv
mon
Is m
May
pers
If vo
No
vom
that
with
RESPIRATORY OTC
Scenario
Treatment/Referral
Customer (54) wants to buy oral decongestant.
Analgesia e.g. paracetamol 1g QDS
It is for her husband (53) who is suffering from a cold. He has
tried oral decongestants in the past and they were effective.
He is on simvastatin 40mg and Lisinopril 10mg.
He has had it for 3 days, has tried paracetamol but that hasn’t
helped with the congestion.
Saline nasal wash e.g. Sterimar
congestion relief or a topical
decongestant e.g. otrivine 1 spray BD
(maximum 7 days use due to rebound
congestion)
Sym
ther
dec
N.B
hyp
Other symptoms: headache, dry throat and sore, stuffy,
blocked nose.
Danger symptoms: no fever, no coloured sputum and no
prolonged headaches.
Patient (40) has a cough that is irritating her throat.
Guaifenesin (Robitussin Chesty Cough
SF)
If pa
- E
- In
c
in
Oral: Piriton - Chlorphenamine 4mg
every 4-6 hours - no more than 6 tablet
in 24 hours (most effective however it
causes drowsiness) or
loratadine/cetirizine 10mg OD
Life
outs
outd
(dus
doo
She currently takes metformin, aspirin, atorvastatin and
Ramipril.
Has had it for two days and has only tried boiled sweets so
far. Has had coughs in the past but not recently.
Other symptoms: cough is productive with sputum but sputum
is clear (not purulent/coloured).
Danger symptoms: N/A
Patient (29) would like something to help her eyes, they are
red and itchy.
She takes microgynon ED. Has not tried anything so far and
has been experiencing her symptoms for one day.
She has never experienced this before; eyes are red, watery
and very itchy; appears to be worse at night.
Other symptoms: She also has a runny nose and thinks she
may be getting a cold.
Danger symptoms: N/A
Topical: sodium cromoglycate eye drops
1-2 drops BE QDS
Customer (46) would like something for a sore throat.
Refer
It is for her son (16). He is not on any medication. He has tried
paracetamol 1g QDS for the pain and starting taking strepsils
yesterday but they haven’t helped. He has had it for 5 days.
He had tonsillitis last year.
Other symptoms: very tired, fever, headache, been in bed
Danger symptoms: extremely painful, difficulty swallowing
Dys
trea
Patient (38) would like something to help him stop coughing.
Cou
Pholcodine 10ml TDS/QDS
Ask
at th
Cou
tong
burn
He isn’t on any medications and has only tried honey and
Or
lemon lozenges so far. He has had it for two days. Had a
similar cough last year and bought some medicine that helped Dexamethrophan with diphenhydramine
but cannot remember the name.
e.g. Benilyn Dry Cough Original
Other symptoms: has been up all night coughing so would like
something to stop the cough so he can sleep.
Danger symptoms: no sputum, no SOB, etc.
Customer (44) comes in to buy a cough suppressant.
It is for his daughter (4). She occasionally takes
chlorphenamine 2mg/5ml for hay fever.
She has had it for about four weeks now; father is concerned
and looking to find a suppressant which will also help her
sleep. Has tried a glycerol based product to soothe the throat
but was no use.
Has never experienced this before.
Other symptoms: persistent dry cough, mainly at night, with
associated sleep disturbance
Danger symptoms: night time cough
Refer
Avo
Cou
hist
No
The
yea
disc
Customer (53) wants something to relieve hoarseness.
Refer
It is for his wife (50). She is on atorvastatin 20mg and
amlodipine 10mg.
She has tried strepsils, soothers and difflam throat spray –
none were effective and no improvement was seen.
She has had this for 4-5 weeks and hasn’t experienced
anything like this before. She smokes 20 cigarettes a day and
has done for 30 years.
Hoa
refe
Ref
smo
exp
Other symptoms: throat is not sore, just very hoarse and a
gravelly voice.
Danger symptoms: loss of voice
Patient (40) would like something to help a cough.
Refer
She is not on any medication and has not tried anything yet.
She had the cough for 3-4 days. Has not had any coughs
recently.
Gre
infe
Adv
unti
Other symptoms: chest cough; she is coughing up thick
sputum.
Danger symptoms: sputum is green/brown in colour, no blood
in sputum.
Patient (49) would like something for a bad cold.
She is on Ramipril 5mg.
Started feeling congested yesterday and hasn’t tried anything
yet.
It has been a while since she has had a cold like this.
Other symptoms: blocked nose, headache, sore throat
Danger symptoms: no coloured mucus, no prolonged
symptoms, no fever
Simple analgesic for headache (unlikely
to be sinusitis as too early) e.g.
paracetamol 2 QDS PRN
Cla
Ora
HPT
Soothing lozenge or antiseptic pastille
Flui
for sore throat; if severe sore throat, can
try one with an anaesthetic e.g. Strepsils If th
PRN up to QDS
sho
rebo
If sy
or th
PAEDIATRICS OTC
Scenario
Customer wants something for
her baby’s (3 months) scalp. Not
on any medication and has not
tried anything yet.
Has had it for ~5 weeks and is
not improving; was gradually
getting worse when baby was 6
weeks.
Other symptoms: N/A
Danger symptoms: N/A
Customer wants something for
her daughter’s (8 years) rash – it
is red and itchy on her torso and
behind her ears.
Not on any medication and have
not tried anything yet. Has been
feverish for two days and
developed red lumps yesterday.
Never has it more; more are
appearing and are filled with fluid.
Other symptoms: intense itch
Danger symptoms: N/A
Treatment/Referral
Can clear up without treatment
within a few weeks to months.
Dentinox – 2 applications of 23ml each bath time until scalp is
clear
Counselling Points
Cradle cap/seborrheic
dermatitis is common and
harmless
Regularly wash scalp with
baby shampoo and
brushing with a baby brush
to remove scales; do not
pick
Soften plaques with
baby/olive oil (do not use
soap, adult shampoo or
peanut oil)
Calamine lotion or cream
Keep cool: luke warm
(residue may cause dry skin and baths, loose fitting cotton
irritation) - apply 2-3 times and
clothing
at bedtime to stop the itching
Keep nails short to
Paracetamol to reduce fever
minimise damage from
(avoid NSAIDs)
scratching
360-375mg QDS
Drink plenty of fluids
Chlorphenamine to reduce
distress and help sleeplessness. Do not apply on broken
skin
Crotamiton cream or lotion
(Eurax) – apply 2/3 times daily
N.B. chicken pox is fluid
(licensed for over 3)
filled (infectious until
burst); measles is not fluid
filled.
Customer would like something
for daughter (9 months) as she
hasn’t been herself and is
chewing her hands.
Not on any other medication and
has not tried anything yet.
Has been like this for 3 days and
hasn’t been like this before.
Other symptoms: red hot checks,
dribbling around the mouth, cries
as if in pain
Danger symptoms: N/A
Teething gels:
Teething can occur
anytime from 3 months to
3 years, usually ~ 6
months.
Anbesol – (licensed for over 5
months):
1. Remove to lid from the
bottle and with a clean
Can also give paracetamol
fingertip cover the bottle 120mg QDS/ibuprofen.
opening.
2. Invert the bottle once and
return to an upright
position. This will
dispense a 0.25ml dose.
3. Apply one undiluted
application to the
affected area using the
fingertip.
4. After three hours if
necessary, repeat.
Dentinox – small amount, no
more than 6 times in one day
and for no longer than 7 days
(licensed from birth)
Customer would like something
for head lice for her
granddaughter (10 years).
She uses a ventolin inhaler. Has
not tried anything yet.
Not sure how long she has had
them and unsure whether she’s
had them before.
Hedrin (dimeticone 4% lotion):
leave on for 8 hours/overnight
then shampoo; repeat after 7
days (licensed from 6 months)
Other symptoms: scratching
scalp, grandmother shows you
head louse on tape
Danger symptoms: no broken
skin on scalp.
Child is asthmatic so avoid
alcoholic lotions.
Customer would like something
for an itchy bottom for his
daughter (6 years).
Not on any medication and has
not tried anything yet.
Has been complaining of
itchiness for past two days, never
had this before.
Ovex - Mebendazole 100mg:
take one then repeat after two
weeks to prevent re-infection
Live lice should be evident
before selling treatment.
Advise wet combing every
3-4 days for two weeks.
Derbac M (malathion): leave on
for 12 hours then shampoo,
repeat after 7 days
Hygiene:
- Wear close fitting
underwear and night
and change every
Recommend treatment for entire
morning
family (avoid in pregnancy).
- Bathe every morning
- Wash hands/scrub nails
regularly
Other symptoms: tired, distressed
- Discourage nail biting
and irritable due to itch and lack
- Avoid shared towels
of sleep.
- Cut nails short
Danger symptoms: no broken or
weeping perianal skin, no weight
loss
Customer wants something for
baby (2 months) who won’t stop
crying and seems to be in pain.
Not on any medication and have
not tried anything yet.
Has been crying for over 3 hours
every day (at least four days
every week). Crying seems to be
worse in the evening.
Other symptoms: pulling legs up
to chest
Danger symptoms: N/A
Infacol (simeticone): 0.5ml-1ml
before each feed
Colic usually starts a few
weeks after birth; baby
appears healthy otherwise.
Feeding technique:
Dentinox (dimethicone): 2.5ml
with/after feed, max 6 doses/day - Ensure correct teat size;
avoid swallowing too
much air
- Sit baby upright to
reduce air intake
- Burping baby after feed
Customer would like some
Meningitis: IMMEDIATE
paracetamol liquid for his son (5
REFERRAL
years).
Not on any medication and has
not tried anything but his son has
very poorly for about two days.
He has been subdued with a
temperature. Does not want to go
outside as ‘the sun is hurting his
eyes’.
Refer due to nonblanching rash,
photophobia, rash, nausea
and lethargic.
Other symptoms: developed a
purple rash, has a fever and is
nauseous.
Danger symptoms: non-blanching
rash
Paracetamol 120mg/5ml
Paracetamol 250mg/5ml
3-5 months - 60mg QDS - 2.5ml
6-7 years - 240-250mg QDS - 5ml
6-23 months - 120mg QDS - 5ml
8-9 years - 360-375mg QDS - 7.5ml
2-3 years - 180mg QDS - 7.5ml
10-11 years - 480-500mg QDS - 10ml
4-5 years - 240mg QDS - 10ml
12-15 years - 480-750mg QDS - 10-15ml
16-17 years - 0.5-1g QDS - 10-20ml
CNS/MSK OTC
Scenario
Patient (72) would like something to
help him sleep.
He takes losartan, simvastatin,
salbutamol and paracetamol.
Treatment/Referral
Diphenhydramine
25/50mg (Nytol) - 50mg
max at night 30 mins
before bed.
Do not use for more than
He hasn’t tried anything yet and has had 2 weeks without
sleepless nights on/off for the past two
consulting a doctor. 16+
weeks. He doesn’t usually have trouble
sleeping but he is worried about his
Promethazine 20mg
daughter who isn’t well.
(Sominex) - Take 1, 20
mins before bed
Other symptoms: N/A
Do not use for more than
Danger symptoms: N/A
7 days. 16+
Counselling Points
Sleep hygiene:
- Establish regular pattern
- Relax before bedtime
(no meals or exercise)
- No naps during the day
- Reduce extraneous
noise
- Restrict
alcohol/caffeine/nicotine
intake
- Warm bath 1-2 hours
before
- Avoid screens before
bed
Patient (32) would like to buy St John’s
Wort. He has read about it and would
like to try as he has been feeling a bit
down on and off four about four months.
He is on carbamazepine, citalopram and
amlodipine.
Neither: explain to patient
that effects of citalopram
can take up to 4 weeks; if
he does not see any
improvement after this, he
should see his GP
SJW is an enzyme inducer
and interacts with SSRIs
and anti-epileptics
therefore do NOT sell to
this patient.
Refer: (Crampex should
be used with caution in
patients with diabetes
and/or gout)
Nocturnal leg cramps are
common and usually
harmless but impact on
QOL.
He has not tried it before. If asked – he
has been on citalopram for ~2 weeks
and it has not helped.
He has had not history with depression
but at the moment, work is not going
well and he is struggling to make ends
meet.
Other symptoms: N/A
Danger symptoms: N/A
Customer (24) would like to buy
something for leg cramps.
It is for his grandma (66) who has leg
cramps at night. She takes allopurinol,
colchicine, co-codamol and metformin.
She hasn’t tried anything, this bout
lasted ~ few days. Has regular bouts on
and off for the past few months.
Exercise may help e.g.
stretching affected muscle
for ~5 mins TDS
Other symptoms: it is causing her sleep
disturbance therefore she is tired and
exhausted the next day.
Danger symptoms: N/A
Patient (57) would like something for
back pain (she appears overweight, in a
lot of pain and unable to stand up
straight).
She currently takes sertraline, Ramipril,
amlodipine, simvastatin and aspirin. She
has tried paracetamol (last dose 2 hours
ago) and voltarol extra strength.
Pain started during the day and got
worse last night; she stood up and felt
her back pull and now in agony. If asked
– she works in an office and sits for long
periods of time so back is always stiff.
Other symptoms: fine in herself, just
wants to shift the pain so she can get
back to work
Danger symptoms: N/A
Keep a diary or symptoms
Prop feet on pillow when
lying in bed
Paracetamol 1g QDS (full
dose)
Should see an
improvement within a
week.
Heat pads
Heat rub cream e.g. deep
heat (5+) - apply 2-3
times daily. Wash hands
after use
Topical NSAID e.g.
voltarol, ibuleve (do not
recommend oral NSAID
as GI risk with this
patient)
Important to stay
physically active; regular
exercise strengthens
muscles and prevent
recurrence.
Avoid sitting or standing in
one position for long
periods of time.
Customer (44) would like some nytol
herbal tablets.
Refer
Suspected depression
Sleep hygiene:
- Establish regular pattern
- Relax before bedtime
(no meals or exercise)
- No naps during the day
It is for his daughter (16) who is anxious
due to exams and this is affecting her
sleep. On rigevidon and has tried rescue
remedy but it wasn’t effective.
She has been feeling like this for ~2
weeks and hasn’t been sleeping
properly for 5 nights.
She has gotten anxious easily in the
past but this is the first time she is doing
important exams.
- Reduce extraneous
noise
- Restrict
alcohol/caffeine/nicotine
intake
- Warm bath 1-2 hours
before
Other symptoms: difficulty
concentrating, headaches
Danger symptoms: N/A
- Avoid screens before
bed
Patient (28) would like something for her Refer
headache.
She is currently on microgynon (started
3 months ago).
She has tried paracetamol and
ibuprofen; they helped a little but wants
something stronger. This current
episode started this morning.
Has been suffering from headaches on
and off for about two months.
Other symptoms: throbbing headache,
affecting one side and crossing her
forehead, feels nauseous
Danger symptoms: N/A
Patient (70) would like something for
aches and pains; she feels like she’s
getting the flu.
Currently takes Lisinopril,
bendroflumethiazide, simvastatin and
erythromycin (4 days into course but
thinks it has made her worse).
Has tried paracetamol but that hasn’t
touched the pain. Has had it for 2-3
days and has never experienced it
before.
Other symptoms: pain and tenderness
in muscles all over her body, feels
generally run down.
Danger symptoms: N/A
Refer
Migraines starting after
initiation of COC may
indicate cerebrovascular
changes; likely to be
changed to POP
Counselling:
- Identify and avoid
triggers e.g. certain
foods, bright lights,
strong smells, etc.
- Regular exercise
- Relaxation
Simvastatin and
erythromycin interaction:
increased plasma statin
levels causing myopathy.
Patient should have been
advised to omit statin
whilst taking antibiotic.
SKIN OTC
Scenario
Treatment/Referral
Patient (21) would like something for the Refer
rash on her knees and elbows. She is
not on any medication and has not tried
anything yet.
It started about a week ago; split form
boyfriend a week and a half ago and her
skin has not been right since.
Other symptoms: red and sore rash in
patches on knees and elbows, also feels
depressed.
Danger symptoms: Weeping and broken
skin
Counselling Points
Psoriasis must be
diagnosed first; skin is also
broken and weeping.
Trigger factors:
- Emotional
stress
- UV light
- Infection
- Trauma
- Medicine
Depression also need
assessing
Patient (56) would like something for a
rash on his back. He takes Lisinopril,
furosemide and aspirin.
He has tried aqueous cream but that
has not helped.
A tingling/burning sensation started two
days ago with pain and then a rash
appeared. Has never had this before.
Refer (as he is over 50,
Shingles is caused by
oral acyclovir is indicated) reactivation of the Herpes
Zoster virus.
Can recommend
paracetamol for the pain. Counselling:
- Maintain fluid intake
- Avoid scratching
- Wear loos fitting clothes
- Avoid contact with
Other symptoms: dull, throbbing pain
which comes and goes.
Danger symptoms: N/A (no signs of
fever or infection)
Customer (56) would like something for
acne. It is for her niece (18).
She only takes paracetamol PRN and
has not tried anything yet. Has had it for
two weeks; had acne when she was 14
and used PanOxy5 cream.
Other symptoms: few black and
whiteheads.
Danger symptoms: N/A
Patient (44) would like something for her
hands.
She takes lamotrigine and gabapentin.
She has tried E45 itch relief but that has
not helped.
She has had it for about one week. She
started a new job as a cleaner and in
the last few days she has noticed
spots/dryness on her hands; hasn’t had
this before.
Other symptoms: red papules on her
hands, burning and soreness present
Danger symptoms: N/A
babies under 1 month,
pregnant women and
immunocompromised
people
Benzoyl Peroxide 5% gel
(Acnecide)
(no specific age however
children should not use)
Dose: apply
daily/alternate days, then
increase to BD to affected
areas
Use for a maximum of 8
weeks; if no improvement
seen, refer to GP.
Irritant effects in the first
few days.
Wash hands thoroughly
after use.
Can bleach clothes/bed
linen/hair
Improvement is gradual;
manage expectations,
avoid trigger factors and
do not squeeze spots
(causes scarring).
Topical CS e.g.
Contact dermatitis:
hydrocortisone 1%:
- Avoid triggers by using
Apply thinly 1-2 daily for a
gloves and washing
maximum seven days
hands after contact
(licensed for over 10s)
- Protect skin using
emollient
Patient (31) wants something to help the
intense itching on his body.
He has hay fever – takes loratadine and
sodium cromoglicate.
Has tried an antihistamine cream which
alleviated the itchiness temporarily but
has not solved the problem. Has had it
for the past three weeks and has never
experienced it before.
Permethrin 5% cream
(Lyclear) or Malathion
lotion (Derbac M):
Apply to whole body and
repeat after 7 days.
Other symptoms: wrists and whole body
are itchy; tiny burrows evident on either
side of wrist flexure; itching worse at
night.
Danger symptoms: N/A
Scabies
Should ask whether there
is anyone else in the
family; in this case, he has
a wife (28) and son (2
months). They will also
require treatment.
OTC treatment for children
under 2 years should be
avoided; refer to GP.
Counselling:
- Keep away from
school/work until first
application is complete
- Wash clothes, towels,
bed linen at a hot
temperature
- Antihistamines/crotamito
n cream for the itch
- Itch may persist for
weeks after eradication
due to dead mites, etc.
Patient (42) would like something for a
small hard lump under her foot.
She takes Lisinopril,
bendroflumethiazide, metformin and
simvastatin.
She tried bazuka 5% gel for a week; this
helped but lump still there.
Has had it for 2 weeks and has not had
it before.
Other symptoms: N/A
Danger symptoms: N/A
Refer
Diabetic
N.B. OTC options are:
- Salicylic acid/lactic acid
e.g. Bazuka
- Cryotherapy e.g.
Bazuka Sub Zero
If a healthy patient:
- Treatment not always
necessary; verrucae are
self-limiting
Counselling:
- Treatment can take up
to 12 weeks
- Never cut/burn it
yourself
- Wear comfortable shoes
- Keep feet clean and dry
- Change socks daily
Patient (23) would like something for her
toe (thick and discoloured).
She is not on any medication but was
using Clotrimazole 1% for athlete’s foot.
She has had it for one month and has
not had it before.
Other symptoms: three nails affected
Danger symptoms: N/A
Refer – three nails
affected
N.B. Curanail: file and
swab nail before applying
therapy and allow to dry;
repeat weekly; can take
up to one year (review
patient every 3 months)
Fungal nail infection can
be treated with amorolfine
5% nail lacquer for a
maximum of two infected
nail: apply 1-2 times a
week after filing and
cleansing for 6 months
Counselling:
- Avoid ill-fitting shoes
- Keep nails short
- Do not use same nail
file on infected and
healthy nails
- Use antifungal powders
to keep shoes free from
pathogens
MEN’S HEALTH OTC
Scenario
Patient (40) wants to buy Flomax relief
tablets. He has had an initial 14-day
supply from another pharmacy; has not
seen the GP since first supply.
He takes mirtazapine, pimozide and
ezetimibe.
Treatment/Referral
Counselling Points
Treat with another 14-day Must see their GP within 6
supply.
weeks of treatment.
If urinary symptoms do not
improve or get worse after
supply, REFER.
Counselling:
- Avoid liquids one/two
hours before bed
- Stop/limit consumption
of alcohol and caffeine
- Regular exercise
Other symptoms: has been present for
at least 3 months
Danger symptoms: N/A
- Increase fruit and fibre
Patient (45) would like to buy Viagra.
He has not had it before. He takes
amlodipine, doxazosin and a GTN
spray.
Other symptoms: N/A
Danger symptoms: N/A
Refer
He is C/I due to GTN and
doxazosin use.
N.B. can be used for up to
6 months OTC; must see a
GP after this time.
WOMEN’S HEALTH OTC
Scenario
Patient (30) wants something for pain on
passing urine. Has been ‘up and down
all night’ but only passes a small
amount.
Takes cerazette, hasn’t tried anything
yet.
Treatment/Referral
Potassium citrate or
bicarbonate e.g.
Cystopurin sachets
Paracetamol/Ibuprofen
Other symptoms: N/A
Danger symptoms: N/A
Patient (59) wants to buy canestan
combi pessary and cream.
She takes metformin, gliclazide,
simvastatin, aspirin and Ramipril. It
started 2 days ago. She had thrush last
month but has not tried anything yet this
time.
Refer
Other symptoms: white discharge, itchy
Danger symptoms: second attack in 3
months
Patient (23) wants something for her
painful, heavy periods. She has already
tried paracetamol and ibuprofen. Not on
any other medication.
Naproxen 250mg
(Feminax Ultra): take 2
initially, further tablet 6-8
hours and then 1 TDS for
the next two days (max 3
Other symptoms: pain in lower back and day use)
top of legs
Danger symptoms: N/A
Tranexamic acid
(Femstrual): take 2 TDS
(max 2 QDS)
Counselling Points
Drink plenty of fluids
The following cannot be
treated OTC:
- Allergic
- Heart disease
- Hypertension
- Kidney disease
- Diabetic
Diabetic (could indicate
poor glycaemic control)
and second attack in 6
months)
General counselling:
- Wear loose fitting
clothes
- Avoid perfumed
products around vaginal
area
- Male sexual partners
should consider
treatment
Warmth to the abdomen
can help e.g. hot water
bottle, heat packs
Tea e.g. regular, camomile
or mint
TENS machine
EYE OTC
Scenario
Treatment/Referral
Patient (43) wants something for her
eye; it is bright red but not painful. She
woke up with it and has never had it
before.
She takes paracetamol and Lisinopril.
No therapy necessary but
may warrant a BP check
as she has hypertension;
could be a sign of raised
BP.
Customer (32) wants some drops for
‘sticky eye’. It is for her son (2) who
woke up with both eyes glued shut.
Never had it before, has not tried
anything and not on any medication.
Chloramphenicol 0.5%
drops:
Patient (25) hurt himself at work and a
headache started. He has a dull pain in
his right eye which has gradually
worsened. He also mentions slight
blurred vision.
Refer
Counselling Points
Sub conjunctival
haemorrhage – selflimiting and usually looks
worse that it is.
Counsel on eye hygiene:
- Swab eyes to clear
discharge
Drops: 1 drop every 2
- Avoid sharing
hours for first 2 days and
towels/pillows
then 1 drop every 4 hours
for next three days; store - Wash hands regularly
in fridge.
- Do not wear contact
lenses during and for 24
Ointment 1%: apply QDS
hours after course.
for five days.
Infection is self-limiting
Discard within 28 days of If symptoms do not
opening.
improve within 48 hours,
see GP
Trauma to the eye, pain in
his eye and blurred vision
– urgent referral.
Patient (37) describes having ‘a ball in
No treatment necessary
his eye’ for around 3 days. You examine but can offer:
and notice a small red lump on the
eyelid margin.
Propamidine isethionate
e.g. brolene or golden eye
drops - 1-2 drops up to
QDS
Dibrompropamidine
isethionate e.g. golden
eye ointment
Stye – self-limiting; will
point and discharge
spontaneously.
Presents as painful, red
swelling on the inside or
outside of eyelid.
Eye lid hygiene:
- Warm compress for 510 minutes, TDS/QDS
- Wash hands after
touching eyes
- Do not puncture stye
- Avoid sharing towls,
face clothes, etc.
EAR OTC
Scenario
Patient (39) wants something for ear
wax. Her ears feel full and blocked and
there is slight hearing loss. She has
used cotton buds in the past. Would
also like something for her partner.
Treatment/Referral
Treat: cerumunolytics
E.g. olive oil/sodium
bicarbonate/urea
hydrogen
peroxide/docusate
sodium (doses vary)
Counselling Points
CHECK ALLERGY:
patient’s husband is
allergy to peanuts
therefore arachis/almond
oil is C/I.
Can take up to 14 days for
desired effect.
Do not use cotton buds;
can push wax further in
and damage sensitive
lining of ear canal and
drum.
Patient (54) wants something for a red
sore ear. Ear canal appears swollen and
is itchy with a foul smelling discharge.
He is on metformin, aspirin and uses
E45 for eczema.
Refer due to foul smelling Otitis externa (eczema can
discharge which indicates contribute)
infection.
If infection symptom was
Recommend paracetamol not present, he could have
for the pain.
been treated with acetic
acid (Earcalm): 1 spray
TDS, max every 2-3 hours
and continue 2 days after
symptoms clear but no
more than 7 days.
Customer (40) would like something for Refer – antibiotics
his daughter (4) who has been awake all necessary as it has been
night, crying, with earache for the past 3 over 48 hours.
days.
Can recommend
Other symptoms: fever, pulling at ear,
paracetamol and warm
impaired hearing
compress on the ear to
relieve pain.
Otitis media – common in
children under 10.
Self-limiting so patients not
offered antibiotics in first
48 hours.