Rx Note

Introduction Osteoarthritis is a chronic musculoskeletal condition that affects the joint and peri-articular structures . The changes of osteoarthritis can affect the whole joint, including the cartilage, bone, synovial lining and synovial fluid. The most commonly affected joints are those of the hands (particularly the distal interphalangeal joints and the first carpometacarpal joints), the cervical spine, the lumber spine and the knees and hips. Symptoms The major symptoms of osteoarthritis are pain, stiffness and swelling , which can lead to impaired mobility and physical function. Pain is generally worse in the late afternoon and early evening but can also be worse in the morning soon after waking up. Stiffness following inactivity or morning stiffness in osteoarthritis is usually of shorter duration than in rheumatoid arthritis . The joint swelling in osteoarthritis may be bony (hard) due to osteophyte formation and/or spongy (soft) due to effusion or synovial thickening. Soft-ti...

Introduction Since medicines taken by breastfeeding mothers may pass into breast milk, this article explores the safe use of over-the-counter medications while breastfeeding Medicines that passed into breast milk in small quantities rarely affects breastfed babies. Pain Paracetamol is considered compatible with breastfeeding when used in usual recommended doses to treat mild pain, such as headaches, toothaches, muscular pains or to reduce fever. NSAIDs are safe to help relieve pain and inflammation, but selective NSAIDs (COX-2 inhibitors) have limited data. Of the NSAIDs, ibuprofen is considered the drug of choice. Naproxen should be used cautiously in breastfeeding women due to its long half-life and has been documented to cause prolonged bleeding, anaemia and thrombocytopenia in a breastfed infant. Cough For a dry cough , a cough suppressant such as dextromethorphan is considered safe while breastfeeding. For a chesty cough , an expectorant such as guaifenesin or a mucolytic such ...

Introduction Given the potential for teratogenic effects of certain drugs, this article explores the safe use of over-the-counter medications during pregnancy. Products containing alcohol should be avoided. Pain The use of paracetamol (acetaminophen) in recommended doses during pregnancy has not be associated with an increased risk of miscarriage or still birth. Nonetheless, paracetamol should be used at the lowest effective dose for the shortest duration of time to effectively treat the mother and protect the health of the foetus (inconclusive data on adverse events such as wheezing and asthma in early childhood, adverse effects on male reproductive development and ADHD or autism spectrum disorders) An increase in foetal death or spontaneous abortion may been seen following maternal overdose if treatment is delayed. In general, NSAIDs should be avoided in pregnancy and must be avoided after 30 weeks' gestation because of the risk of Miscarriage in early pregnancy; however, evi...

Introduction Ingrown toenail, or onychocryptosis, is a common condition in which the corner or side of a toenail grows into the soft flesh , causing pain, inflamed skin, swelling and sometimes, an infection. It usually affecting the skin on the side of the first toenail. These occur when a section of the nail presses into the soft tissue of the nail groove. The nail curves into the flesh of the toe corners and becomes embedded in the soft tissue of the toe, causing pain. Causes Anatomical predispositions to ingrown toenails are Congenital malalignment of the nail Hereditary overcurvature of the nail Imbalance between the width of the nail matrix and the nail bed Environmental factors include Trauma to foot (e.g. sports) Narrow or tight-fitting shoes. Certain medical conditions, such as diabetes mellitus , obesity or onychomycosis . Oral retinoids Incorrect trimming of nails (excessive or convex cutting of the nail) Management Initial management of an ingrown toenail should be conserva...

Introduction Pain is 'an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage'. In other words, it is a subjective phenomenon . Hence, if a patient finds that he is in pain, then he is in pain. The function of acute pain is to alert the body to a potential threat , prevent the body from further damage (e.g. by moving away from the trigger), and learn to avoid similar harm in the future. NOTE: Older people are often reluctant to disclose pain for fear of being a burden or developing a drug dependence. Pain Assessment The most commonly used pain scales include Numerical rating scale : rates pain on a number scale, e.g. from 0 (no pain) to 10 (worst imaginable pain). Visual analogue scale : 10-cm-long lines labelled with an extreme at each end, usually "no pain at all" and "worst pain imaginable". Wong-Baker FACES Pain Rating Scale : uses pictures of faces with different expressions...

Introduction The tympanic membrane (eardrum) is a thin layer of tissue between the ear canal and middle ear When air molecules push against the membrane, they cause it to vibrate at the same frequency as the sound wave. The vibrations are then transferred to the tiny bones in the middle ear. Symptoms Traumatic perforation of the ear drum causes sudden severe pain (that may subside quickly) sometimes followed by Bleeding from the ear Hearing loss Tinnitus (Ringing in the ear) Vertigo (Spinning sensation) It can also make middle ear vulnerable to infections NOTE: Perforation is generally evident on otoscopy. Small perforations may require otomicroscopy for identification. Management Most perforated eardrums (especially those less than 25% of the total drum surface area) heal without treatment within a few weeks. May take over-the-counter painkillers to relieve pain if needed. Persistent perforations typically require operative repair (e.g. tympanoplasty). In the meantime, protect i...

Introduction Otitis externa (Swimmer's Ear) involves inflammation and infection of the skin in the ear canal and is generally caused by bacterial infection . Otitis externa is 5 times more common in swimmers than non-swimmers. Otitis externa can be precipitated by Ear trauma, e.g. scratching, foreign body and use of cotton buds Swimming, especially in dirty or polluted water Chemicals, e.g. hairspray, hair dyes, shampoo and drops of earwax Skin conditions, e.g. eczema, seborrheic dermatitis and psoriasis Clinical Features Otitis externa is characterised by itching and irritation , which, depending on the severity, can become intense. This provokes the patient to scratch the skin of the EAM (external auditory meatus), resulting in trauma and pain. Chewing and manipulation of the tragus and pinna can exacerbate pain. Otorrhoea (ear discharges) follows, and the skin of the EAM can become oedematous, leading to conductive hearing loss. Otitis media (middle ear infection) is the most c...

Introduction Kidney stone disease (nephrolithiasis) is a common problem in primary care practice. The stones are formed on the inner surfaces of the kidneys when the urine becomes too concentrated, causing the minerals and other substances in the urine to crystalise. These crystals then tend to combine in time, forming a mass, known as kidney stones or renal calculi. Symptoms Patients may present with the classic symptoms of renal colic and haematuria . Others may be asymptomatic or have atypical symptoms such as Vague abdominal pain Acute abdominal or flank pain Nausea Urinary urgency or frequency Difficulty urinating Penile pain Testicular pain NOTE: Patients are often asymptomatic until a stone causes partial, intermittent, or complete obstruction, resulting in acute and potentially debilitating renal colic. Acute Management In general, if patients can take oral medications and fluids, they can be managed at home. Supportive measures include Hydration until the stone passes Pain c...