It’s been long time since the last time I wrote here.
Today, one of the many things I learned from my tutor is about the use of diclofenac together with the misoprostol which come in same one product. This combination product is used to relieve pain and inflammation due to rheumatoid arthritis, osteoarthritis, and postoperative pain.
The main reason for this combination is because diclofenac which is Non-steroidal anti-inflammatory drug (NSAIDs) may irritate the lining of the stomach despite its therapeutic use as painkiller and anti-inflammatory agent.
Meanwhile, the misoprostol (prostaglandin analogue) helps to protect the stomach lining from the irritation effect of diclofenac.
There are different types of eye problems such as dry eyes, conjunctivitis and glaucoma. Different type of treatments is available for each eye syndromes.
There are different types of eye problems that can occur to anyone throughout his or her life. Some of them have potential harm to the sufferer while some are minor and do not really need any interventions.
(1)Conjunctivitis
One of the common eye problems is the conjunctivitis. It is associated with painful red eye. In conjunctivitis, the conjunctiva in the eye becomes inflamed due to infection allergy or irritation.
There are two possible infections either by bacteria or virus. The bacterial infection is associated with stickiness and reddening of the eyes but viral infection is associated with watery eyes. It rarely occurs at both eyes but if it does, this may suggest other cause such as presence of foreign body or other condition.
Symptoms
(1)Eye discomfort like burning gritty and minimal pain.
(2)Minimal photophobia.
(3)Eyelids stuck due to discharge after sleep.
(4)Blurring vision by discharge. This can be cleared by blinking.
Referral to doctor
(1)Moderate to severe pain.
(2)If the eye become too red. This may suggest serious secondary cause and investigation need to be done.
(3)Loss of visual acuity.
Serious causes of a red eye
(1)Acute glaucoma
a.Raised intraocular pressure with pain in the eye, headache, and blurring of vision.
Treatment
There is no serious reason to start a treatment for conjunctivitis as it is self-limiting and will resolve within 1-2 weeks.
Chloramphenicol eye drops is typically used in the management of conjunctivitis and is applied every 2 hours for the first 48 hours and then 4 hourly for 5 days before it is discarded.
Fusidic acid is an alternative to chloramphenicol in case the use of chloramphenicol is contraindicated. Fusidic acid is more suitable for pregnant women and it is usually used twice a day for seven days.
(2)Stye
Stye eye is associated with redness, tenderness and pain in the eye. It is very obvious to the sufferers as they can diagnose it by detection of a spot pimple present below the eyelid.
It is common to people of all ages and usually resolved spontaneously within few two to three days. Antibacterial ointment is usually recommended for treatment of stye.
People with diabetes mellitus are more prone to get stye eye and is triggered by stress. Women and men are equally affected by stye. It is also believed that style is more prevalence in people with high blood lipid as the blockage may occurs.
Symptoms
(1)Redness, tenderness and pain
(2)Usually affecting one eye
(3)If left untreated, swelling with followed up with discomfort when blinking eye.
(4)Watering of the eye.
(5)Photophobia
Treatments
(1)Anesthetic to relieve the pain due to the stye.
(2)Antibiotic ointment. This requires prescription from the doctor is not available OTC.
Advices
(1)Don’t wear contact lenses during the infection.
(2)Avoid eye makeup.
(3)Use warm clothes and gentle compress the eye for about 10 mintues. This is in order to rupture the blockage to facilitate drainage.
(4)Don’t touch eye and keep the eye tools clean.
(5)Don’t squeeze the stye as it may promote infection.
(6)No contact lenses when suffering from stye.
Referral
(1)Symptoms persist for several days without improvement despite efforts ease it.
(3)Dry eyes
Dry eye syndrome is very normal and is nothing to worry about. It is due to disorder of the tear film and causes excessive evaporation from the surface of the eyes.
Symptom of dry eyes will be exacerbated by dry air, wind, dust and smoke.
Symptoms
(1)Not red but irritated especially when close eyes tightly.
Treatments
Artificial tears (Hypromellose 0.3% eye drops) are the treatment of dry eyes. Beware of the preservatives such as benzalkonium hexachloride that may irritate eyes. If more than 6 applications per day are needed; it is recommend using preservatives free preparation.
An eye ointment with paraffin or paraffin plus lanolin is used to provide lubrication to the affected eyes. It is best applied at night especially bedtime because it may blur vision.
Advices
(1)Don’t wear contact lenses.
(4)Glaucoma
Glaucoma is a serious eye problem and need to be referred to the GP as soon as possible. It is due to increased in intraocular pressure that built up due to fluids within the eyes.
Today my tutor explained to me why normally levodopa was prescribed together with carbidopa (Sinemet). The levodopa is prescribed for treatment of Parkinson’s disease which is due to low level of dopamine in the brain. Dopamine is responsible for movement or mobility.
Levodopa works by being converted to dopamine in the brain. However, before it is being converted to dopamine in the brain, it undergoes peripheral conversion to dopamine, thereby reducing the effectiveness of the drug while increasing the side effects such as nausea, vomiting and cardiovascular effects.
Therefore, carbidopa is prescribed in combination with the levodopa in order to prevent the levodopa being broken down before it reaches the brain. This then allows a lower dose of levodopa to be taken to avoid or minimize side effects such as nausea and vomiting.
At home I did extra study and found that the total daily dose of carbidopa should be a least 70mg. Lower dose of carbidopa may not achieve full inhibition of extracerebral dopa-decarboxylate.
Haemorrhoids are gastrointestinal tract problems that produce symptoms of itchiness, pain, swelling and soreness. They are due normally due to low fluid intake and inadequate dietary fibre.
Haemorrhoids are common to everyone and can be treated through healthy lifestyle and some medication which can be bought at over-the-counter.
The symptoms occur when the anal canal (last part of the rectum before stools are passed out) clumped with masses which can be masses of blood or stools.
Haemorrhoids can be differentiated into two types, internal and external haemorrhoids. Internal haemorrhoid occur at the upper part of the anal canal while external haemorrhoid at lower part of the anal canal.
During haemorrhoids, sufferers may find blood flashed over the toilet pan. The blood could appear as bright red and is due to mixing of the blood with the stools. If the blood appears as dark red, it is comes from the upper part of the GI tract.
It is believed that during bowel movement, the shearing force of the stools downward causes the enlargement of the anal canal and damage the muscle.
Haemorrhoid can be confirmed by the patients themselves by detection of any blood present that may flash over the toilet pan after defecation. It can also be diagnosed when there is a blood at the toilet paper after wiping.
Symptoms (1) Itchy and irritated at the perianal area. (2) Swelling of the anus or sometimes associated with pain. (3) Bleeding on bowel movement.
Who tends to get haemorrhoids? Haemorrhoids are equally common in men and women but more prevalence in older people around aged 45 to 65 years old. Pregnant women are also believed to have a higher incidence of haemorrhoids than non-pregnant women. This is because the progesterone levels are increased during pregnancy and subsequently relaxes the gut muscles, hence causing constipation. Constipation can exacerbate the symptoms of haemorrhoids.
When to refer to doctor for further investigation? (1) A severe, sharp pain on defecation. This is because it may indicate anal fissure which could be due to constipation. (2) Persistent irritation or pain which does not improved with medication. Approximately 1 week. (3) Bleeding occurs. (4) Symptoms present for more than 3 weeks. (5) Others symptoms such as abdominal pain and vomiting occur. (6) The desire to defecate when there is no stools present in the rectum. This may suggests tumour present in the rectum.
Treatments If the patient is constipated, the use of bulk laxatives may be of beneficial. Local anaesthetics such as lidocaine and benzocaine can be used to treat haemorrhoids. They can help by reducing itchiness and pain felt from the symptoms of haemorrhoids. However, their uses should be limited to 2 weeks from which referral are sought after that. Topical steroid, e.g. hydrocortisone can be purchased OTC in ointment and suppositories forms to reduce the inflammation and swelling due to haemorrhoids. It is best used in the morning, night and after a bowel movement. Hydrocortisone is licensed to those over 18 years and should not be used for longer than 7 days. Menthol and phenol have cooling effects that can be used to give a sensation of cooling and tingling. Skin protectors such as zinc oxide and kaolin have emollient and protective properties that can help to protect the skin from losing moisture.
Practical points (1) Wash perianal area with warm water after each bowel movement. (2) Use moist of soft toilet paper with better quality to prevent damaging the skin around the anus which will cause soreness. (3) Patting rather than rubbing the anus with toilet paper. (4) Insertion of suppositories form of treatment is easier with the patient crouching or lying down.
Colic occurs when a baby cry very loudly in uncontrolled manner without unknown cause. It affects boy and girl equally. This usually occurs late in the afternoon and evening, where the baby’s face may become red associated with passing winds and constipation. Research shows that baby with colic still will gain weight despite crying loudly. Therefore, if your baby doesn’t, then referral should be sought.
Colic is confirmed when a baby cries for at least 3 hours a day, at least 3 days per week for at least 3 weeks. During this period, the babies may lift their heads and clench their fists.
Treatments
There are not many options available for the treatment of colic. Normally colic will improve by itself without any intervention but if you find it’s very disturbing, then you can see your GP for any advices.
Dimethicone is an emollient used to treat colic by moisturizing the skin.
Traditional therapy such as Dicycloverine has been used to comfort stomach but there is evidence suggests that it will cause difficulty in breathing.
Cystitis is characterized by strong smelling and cloudy urine that indicate signs of bacterial infection. This is caused by inflammation of lining of bladder that is due to infection, irritation or damage. Cystitis is more common in women than men as women have a shorter urethra and is more susceptible to infection. Most of the cases will healed or resolved within 3 days even without treatment. There is no need for panic if women are having cystitis as this is very normal.
According to estimation, most women will have at least once infection of cystitis in their lives. However, if you have more than 3 attacks in one subsequent year, you should seek your general practitioner (GP).
Women who takes cytotoxic drugs e.g. Cyclophosphamide and methenamine hippurate (hexamine) are thought to have higher risk of developing cystitis due to the reason that they are likely to be more sexually active.
Referral Children present with cystitis need to be referred to the doctor for investigation due to the possibility of urinary tract infection that may damage the kidney or bladder. Any man who presents with cystitis should be referred immediately because this may indicate more serious conditions such as kidney or bladder stones.
Pregnant women who present with cystitis need to be referred to doctor as well because this can leads to kidney infection.
Haematuria (presence of blood in the urine) is also a sign for referral. This is due to the inflammation in the lining of the bladder that causes bleeding to occur. It can be taken care of with antibiotic treatment and will resolve quickly. However, if there is no pain felt during haematuria, it is important to see your doctor as there is a possibility of a tumor to develop in the bladder or kidney. Women with recurrent cystitis should also see their doctor.
If anyone experiencing excessive thirst, sudden weight loss and higher tendency to pass urine, he or she should be referred immediately as well as this may be caused by other serious illness such as diabetic.
Why women more susceptible to cystitis compare to men? The urethra of women are much shorter than men, therefore are more susceptible to infection. Bacteria can pass up along the urethra easily and multiply when they entered within the bladder. Besides, the prostatic fluid in males is believed to have antibacterial properties, giving them additional defence against bacterial infection.
Women who have painful intercourse despite using oestrogen cream should be referred. The oestrogen cream is used to give more lubricant in order to minimize irritation an cystitis attack.
What are the symptoms of cystitis? • Itching or pricking sensation in the urethra • Frequent desire to pass urine • Passing urine with only small amount or few painful drops • Dysuria • Vaginal discharge would indicate local fungal or bacterial infection (need to be refer too)
Practical points Avoid sexual intercourse (honeymoon cystitis) as this may precipitate an attack due to resulting infection as bacteria may be pushed further inside urethra. If you have sexual intercourse, it is best to go to pass urine immediately after that to flushed out possible bacteria present in the urethra.
Lack of hygiene is one of the factors affecting the severity of cystitis. During toiletries, it is recommended to wipe from front to back to minimize or avoid any bacteria from entering into vagina and urethra.
Take large fluids intake per day as this will increase the tendency to pass urine more frequently and as a result help the flushed out any bacterial reside within the bladder.
It is advised to wait for approximately 20s after passing urine to completely empty the bladder. Avoid any alcoholic and coffee drinks. These will cause irritation to the bladder in some people.
Treatments Cystitis should resolve itself within 3 days. If the symptoms have not improve after 3 days, referral to doctor is required.
Paracetamol and ibuprofen can be of help in treatment of cystitis.
Potassium and sodium citrate work by alkalinizing the urine. The urine become acidic due to bacterial infection and is thought to be responsible for dysuria. However, potassium and sodium citrate do not have antibacterial effect, therefore if the symptoms have not improve after 3 days, referral to doctor is required. Patients with hypertension are not recommended to take potassium and sodium citrate. They should not be taken by anyone taking potassium sparing diuretics, aldosterone antagonists or ACE inhibitors. It is important to advise the patient that the potassium citrate mixture tastes unpleasant and should be diluted with cold water.
Cranberry juice at 300ml per day is believed to have an antibacteriostatic effect.
I don’t really have much experience and knowledge about cold sore as I never had it before because it is occur more in women than men. According to Alison Blenkinsopp, the Symptoms in the Pharmacy, cold sore is caused by herpes simplex virus (HSV). There are two types of HSV; HSV1 which affecting mouth area and HSV2 affecting genital area.
Aciclovir is used to treat cold sore and should be initiated early in the course of infection and the cold sore is believe to resolve within 1-2 weeks. Cold sore is a bit irritating and tingling.
However, don’t mistaken cold sore with cancerous lesion as they may look similar in appearance. I distinguish them by how long the symptom lasted. This is because cancerous lesion last longer than cold sore. Another way to differentiate them is by how painful is the symptom. If you feel very painful, then it probably is the cold sore as cancerous lesion is painless.
Since I don’t have much experience in this, I can’t mention sufficient information about cold sore. Anyway, cold sores normally occur on the lips or face. But please be alerted that if the lesions occur inside your mouth or affect your eyes, please go see doctor immediately.
When you have cold sore, I would advise you not to go out during windy time or when the sunlight is very strong. This is because the wind and the sunlight can cause your cold sore even worse. For women, menstruation is also one of the precipitating factors. Also, if you are very stress while having cold sore, this may make the symptom even worse.
Cold Sore Treatment
Aciclovir cream 5% is an antiviral that is used to decrease the pain felt and also to make healing faster. It should be used before lesions appear and best started as soon as possible when symptoms are felt like tingling or itching. Aciclovir is applied 5 times a day for up to 5 days. If you still experiencing cold sore after this period, you need to go to see doctor. However, do keep in mind that Aciclovir may cause stinging sensation and the affected skin may become dry and flaky.
Antiseptics are also used in treatment of cold sore. It is used to prevent secondary bacterial infection, and not to reduce the time of healing. E.g. Povidone-iodine 10% in an alcoholic solution has an antiviral action and the cold sore will be dried by the alcoholic base. Other than Povidone-iodine 10%, benzalkonium chloride or cetrimide can also be used in this treatment and care should be exercise not to contact with the eyes. Please be aware that if you are pregnant, you mustn’t use Povidone-iodine. This includes anyone with history of iodine sensitivity.
Cold Sore Management
The HSV1 is contagious and can easily transmit to others by direct contact. Therefore, it is important to wash your hands after applying the treatment to the cold sore. You are not advised to share cup, towels, toothbrushes or face flannels until the cold sore has healed completely. If you are having cold sore, try not to have oral sex with someone as there is a risk of genital herpes type-2 to develop and vice versa.
The use of sunscreen cream can be useful if you are having a high exposure to the sunlight especially during summer season or on holiday to countries with hot climate.
Stress in life should be solved by discussing with your doctor or someone who may be of help.
