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General Health This module covers the following topics First aid, wound care & sports products Oral care Eye care Gastrointestinal & laxatives

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General Health

This module covers the following topics

• First aid, wound care & sports products

• Oral care

• Eye care

• Gastrointestinal & laxatives

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First Aid, Wound Care and Sports Products

Fast Facts

• Children often injure themselves during play, and older children and adults can be injured during

sporting activities or at work or home. While the body is very good at healing itself, cuts, grazes,

burns, scalds and sporting injuries usually heal more quickly if basic first aid steps and wound

care principles are followed.

• Topical pain relievers are the highest value in this category ($30.1 million), followed by

antiseptics ($22.7 million), wound care ($12.9 million) and braces ($7 million). Topical pain

relievers are discussed in more detail in the Pain relief section of the Medicines category.

This topic covers the following areas of First Aid, Wound Care & Sports Products:

• Minor cuts & grazes

• Burns & scalds

• Basic wound care

• Insect bites & stings

• Sports tape, mouthguards & braces

The information covered in this topic is very basic and does not replace a first aid course.

This category covers the following ingredients that are available in the First Aid, Wound

Care & Sports Products section of the pharmacy:

• Antiseptics (chlorhexidine, cetrimide, chloroxylenol, povidone-iodine, benzalkonium chloride,

triclosan)

• Hydrogels (propylene glycol, sodium chloride, water)

• Local anaesthetics (lignocaine)

• Anti-inflammatories (bufexamac)

• Soothing (aluminium sulfate)

• Anti-itch (calamine, pine tar, crotamiton)

• Antihistamines (less-sedating)

• Hydrocortisone

• Wound dressings

The Pain relief section of the Medicines category includes more information on sporting injuries and pain

relieving heat rubs. The Skin & hair conditions section of the Medicines category includes more

information on products for fungal infections.

First Aid, Wound Care and Sports Products Checklist

Before recommending any first aid, wound care or sports product, you need to ask your customer if they

are up to date with their immunisations. You will need to know how long it has been since they last had a

tetanus injection.

You will also need to ask the following questions:

• Is the product for a baby, infant or child?

• Is the product for an older person?

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• Have you already tried any treatment for this problem?

• Do you have any other symptoms?

• Are you pregnant or breastfeeding?

• Do you have any allergies?

• Do you have any other medical condition?

• Are you taking any other prescription, over-the-counter or natural medicines (including

medicines that you buy from your supermarket or health food store)?

If the customer answers ‘yes’ to any of these questions, or is not up to date or doesn’t know when they

had their last tetanus injection, refer them to the pharmacist, as it will affect which type of product they

can use.

Minor Cuts and Grazes

• All minor cuts and grazes should be gently and thoroughly cleaned with a sterile non-toxic

solution, e.g. water or saline (also called sodium chloride solution). Any foreign body (e.g. dirt,

grass, etc) in a wound will delay healing and may lead to secondary bacterial infection.

• Your customer should also wash gently around the edges of the wound using water and a sterile

gauze pad.

• If cotton balls are used they must always be moistened well. Cotton fibres can be left in the

wound from dry cotton balls.

• If the wound is bleeding, apply pressure and elevate the affected area to reduce the flow of

blood.

• Apply a clean or sterile dressing, e.g. bandage or band-aid. Antiseptics may also be helpful to

reduce the risk of secondary bacterial infection in a dirty wound.

• Even minor cuts and grazes can become infected. Your customer should see their doctor if their

wound becomes red, swollen, pussy or sore.

• Refer your customer to the pharmacist if they answer ‘yes’ to any of the questions on the ‘First

Aid,

• Wound Care & Sports Products Checklist’, if they are unsure when they had their last tetanus

injection, or if their wound is:

– Deep or longer than 1cm (it may need stitches).

– Bleeding severely.

– Dirty

Antiseptics

• Antiseptics may be helpful to prevent secondary infection in minor cuts and grazes.

• Examples of antiseptics include chlorhexidine, cetrimide, chloroxylenol, povidone-iodine,

benzalkonium chloride, and triclosan.

• They are available as creams, ointments, gels, solutions, powders and sprays. Individual dosages

vary, so always check the pack for exact recommendations.

Burns and Scalds

• Burns are caused by contact with dry heat (fire), chemicals, electricity, sunlight or friction.

• Scalds are burns that are caused by moist heat, e.g. hot liquid or steam.

• Burns and scalds are serious injuries because they can cause permanent damage to the skin and

can cause scarring.

• The first line of treatment for burns and scalds is cold running water. The person should hold the

area under cold running water for at least 20 minutes (bitumen burns should be cooled for at

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least 30 minutes) until the pain and heat is gone from the area. If running water is not available,

a cold compress will do. Do not apply ice.

• Unless it is sticking to them, your customer should remove clothing and jewellery from the area

soon after the burn has occurred (and before any swelling has begun).

• Your customer should not apply butter to a burn or scald. It can hold the heat in. Once blisters

appear, they should not pop them, because this increases the risk of infection.

• In some situations the pharmacist may need to refer your customer for urgent medical

assistance.

Refer your customer to the pharmacist if:

– The person with the burn or scald is a baby, child or an older person.

– The affected area is larger than a 20 cent piece.

– The hands, feet, face or genitals are burnt.

– It is a chemical or electrical burn.

– The person is in severe pain.

– The skin is charred (black), broken or blistered.

Helpful Products

• For the temporary relief of the pain and discomfort of minor burns, your customer may benefit

from the use of a ‘hydrogel’ product. Hydrogels are water-based products with soothing

ingredients, e.g. propylene glycol, sodium chloride, water. They are applied to minor burns

(under a non-adhesive dressing) to hydrate and soothe the skin.

• There are other products available for the temporary relief of symptoms of minor burns and

scalds but you should discuss their use with the pharmacist. Often a pharmacist will

recommend against the application of any other remedy including creams, ointments, powders,

sprays and lotions.

• There are products available that contain combinations of ingredients including antiseptics, local

• anaesthetics and anti-inflammatories for the treatment of minor burns and scalds. They are

generally not recommended for the treatment of acute burns and scalds so always check with

the pharmacist before recommending.

• Antiseptics are used to prevent secondary infection in minor burns and scalds. Examples of

antiseptics include chlorhexidine, cetrimide, chloroxylenol, povidone-iodine, benzalkonium

chloride, and triclosan.

• Always check with the pharmacist before recommending.

• Products that contain a local anaesthetic, e.g. lignocaine are used for the temporary relief of

pain associated with minor burns and scalds. Local anaesthetics work by numbing the affected

areas. Always check with the pharmacist before recommending.

• Bufexamac is an example of an ingredient with anti-inflammatory properties. It is contained in

products to help provide temporary relief of the heat, pain, redness and swelling associated

with minor burns. Always check with the pharmacist before recommending.

Insect Bites and Stings

• Insect bites often go unnoticed when they occur and the discomfort becomes a problem some

time afterwards. The effects of an insect bite can last for several days.

• In contrast, stings are felt straight away and the pain and discomfort lessens over a few minutes

or hours.

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• Insects bite to get access to our blood. They puncture and secrete saliva into the skin. The saliva

may contain a local anesthetic so that the bite is not noticed at the time. This allows the insect

to continue feeding without getting caught. The insect’s saliva then causes the skin to swell.

• Stings are an insect’s weapon. They are used to attack prey or defend themselves against

threats.

• The pain and inflammation associated with a sting occurs because of the ingredients in the sting

itself, including histamine, other proteins and enzymes. Your customer may experience hives

and itching because their body has had an allergic inflammatory response to the histamine and

other ingredients in the sting.

• Reactions to bites and stings vary with each individual. Your customer should seek urgent

medical attention for serious bites or stings.

Refer your customer to the pharmacist if:

– The reaction is severe or covers a large area.

– They are in a lot of pain.

– The person is wheezing, coughing, having difficulty breathing or has swelling of the face,

lips or tongue.

– They have been bitten or stung by a spider, snake or any other venomous creature –

they will need urgent medical attention.

– There is a lot of swelling, itching or burning.

– The reaction is getting worse.

– The symptoms have persisted, become worse or returned despite appropriate

treatment.

– They have any other symptom that is worrying them.

– They answer ‘yes’ to any of the questions on the ‘First aid, Wound Care & Sports

Products Checklist’.

Helpful Products

• Local Anesthetics

– If the bite or sting is painful, your customer may benefit from using a product that

contains a local anaesthetic. Local anaesthetics are most beneficial immediately after a

bite or sting when the pain is most intense.

– Lignocaine is an example of a local anaesthetic used in products for bites and stings.

• Soothing

– Aluminium sulfate has powerful soothing properties and is used as a 20% solution to

minimise the pain, inflammation and itching associated with the stings and bites of most

insects and plants.

• Anti-Itch

– Calamine is a traditional remedy still recommended to provide relief from the itch

associated with some skin conditions, bites and stings. It has soothing, cooling and anti-

itch properties and can be used together with an oral antihistamine (see next section).

– The benefits of calamine are that it can be applied as often as is needed and it is

relatively cheap.

– Pine tar may be helpful at relieving the itch associated with bites and stings. It is

available as a soap-free bar, gel, and bath solution. It can be used together with an oral

antihistamine (see next section).

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– Crotamiton is another anti-itch ingredient available as a cream or lotion. It is applied to

the affected areas 2–3 times a day (unless contraindicated).

– Camphor, menthol and phenol are cooling ingredients occasionally added to products to

help relieve itching, but we will not be discussing them in detail here.

Insect Bites and Stings

Helpful Products

• Antihistamines

– Because histamine is a major ingredient in insect bites and stings, antihistamines are a

logical choice for the relief of pain, itching and inflammation. Antihistamines are used

for a variety of allergies including hay fever, hives, and insect bites or stings.

– Antihistamines are discussed in more detail in the Allergy & sinus section of the

Medicines category. Please review this section now, particularly ‘When to refer’ and the

‘Allergy & sinus products check list’ before recommending any of these products for

insect bites and stings.

• Hydrocortisone

– In some cases, hydrocortisone may be helpful to reduce the swelling, redness and

itching associated with insect bites, but this needs to be discussed with the pharmacist.

– Hydrocortisone is available in two strengths (0.5% and 1.0%) as a cream or ointment.

The 1.0% hydrocortisone cream may only be sold by the pharmacist, so we haven’t

included any specific information or warnings for it here.

– Hydrocortisone is discussed in more detail in the ‘Eczema & dermatitis’ area of the Skin

& hair conditions section. Please review this section now, particularly ‘When to refer’

and the ‘Skin Care Products Checklist’ before recommending any of these products for

insect bites and stings.

• Bufexamac

– Bufexamac is an example of an ingredient with anti-inflammatory properties.

– It may be helpful to temporary relieve the redness and swelling associated with insect

bites.

– Unless contraindicated, bufexamac may be applied to the affected areas 3–4 times a

day.

– Bufexamac is available as a single ingredient cream or in a cream combined with an

antiseptic and local anaesthetic. Always check with the pharmacist before

recommending.

Basic Wound Care

• Wound healing is an absolute must for survival. If our body can’t heal wounds, it will succumb to

blood loss or infection.

• A wound will heal more rapidly if the environment is moist and warm. Pain is also greatly

reduced if air is excluded from the environment.

• A constant body temperature of 37°C encourages wound healing. Solutions used on wounds

should be at body temperature (not cold), and dressings should only be changed when required

(unless otherwise stated).

• Wound dressings help to prevent infection, protect the wound and surrounding skin, and help to

control bleeding, discharge and odour.

• Exudates is the term used for the fluid discharge that is often leaked from wounds, e.g. blood,

pus, debris.

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Types of Dressings

• There are so many dressings with different features that it is impossible to cover them all here.

We will cover the main groups of dressings and give a brief description of when they would be

used.

Non-Stick, Inert Dressings (suitable for wounds with little or no exudate)

• These dressings are used to absorb small amounts of exudate and protect a healing wound from

further damage.

• They are available as cotton or acrylic pads or gauze.

• Some gauze products have added white soft paraffin to reduce the amount of gauze fibres that

get stuck in the wound. Some gauze products contain the antiseptic chlorhexidine to help

prevent infection.

• In most cases these dressings do not stick to the skin. This means your customer will need to use

a bandage, medical tape or a secondary dressing to hold an inert dressing in place.

• Inert dressings are used for the management of minor clean wounds such as minor burns, cuts

and grazes.

Island Dressings (suitable for wounds with little or no exudate)

• These dressings combine a non-adherent absorbent dressing in the middle with an outer sticky

layer. The middle (island) sits over the wound to absorb and protect, and the outer sticky layer

allows the dressing to be attached to the skin.

• Some island dressings are waterproof.

Film Dressings (suitable for wounds with little or no exudate)

• These dressings are usually made up of a thin membrane that is sticky on one side.

• They are flexible (they act like a second skin), waterproof, and allow oxygen but not bacteria

through into the wound.

• They are used for the management of minor clean wounds such as minor burns, cuts and grazes.

Hydrocolloid Dressings (used for low-moderate exudate wounds)

• These dressings consist of a material that forms a soft gel when in contact with the exudate. This

allows the removal of dressing with little damage to tissue.

• These dressings are used for leg ulcers, pressure wounds, burns and donor sites.

Hydrogels

• These are gels that contain up to 95% water.

• They can provide moisture to a dry wound and absorb limited amounts of exudate.

• They have a strong cooling effect on skin, and are therefore very useful in thermal burns and can

significantly reduce pain in wounds. They are useful for minor burns, cuts and grazes.

• Hydrogels are applied either as a sheet or gel and covered with a secondary dressing.

Foam Dressings (for medium-high exudate wounds)

• These dressings do not stick to the skin and can be applied directly to the wound. They absorb

large amounts of exudate and provide a moist wound environment.

• They maintain a wound core temperature of 37°C.

• Most foams are not waterproof and will need a secondary dressing, tape or bandage to hold

them in place.

• They can be used for cavity wounds, ulcers, donor sites and minor burns.

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Alginate Dressings (medium-high exudate wounds)

• These products are derived from seaweed.

• They are used for leg ulcers, pressure sores, cavity wounds and donor sites. These dressings are

also good as an initial treatment for moderately bleeding wounds.

Hydrofibres (highly exudative wounds)

• Hydrofibres are very similar to alginates, but made of an ingredient called sodium

carboxymethylcellulose.

• The products are highly absorbent and absorb exudate to form a soft gel, therefore maintaining

a moist environment.

• They are used for leg ulcers, minor burns, donor sites, pressure sores etc.

Mouthguards, Braces and Tape

• Mouthguards are available from the pharmacy or specially fitted from the dentist (more

expensive).

• A well-fitted mouthguard can save your customer from injury in a wide range of sports. They

won’t prevent all injuries but compared to the cost of traumatic dental work, they’re a good

investment. They must be wellfitted to work.

• Mouthguards purchased from the pharmacy require a bit of preparation before use. Your

customer will need to boil the mouthguard for the specified amount of time, then bite into it to

get the correct fit. The process is really important so you must ensure that your customer

understands. You should find a mouthguard in the pharmacy now and review the process so you

are familiar with it.

• Sports braces/supports are used to provide added stability to joints. Braces and supports are

available for ankles, knees, hands, elbows, backs and wrists.

• Sports braces/supports are used to manage injuries from sport or other strenuous activities, to

manage repetitive strain to muscles and tendons, to offer general support for weakened or

aching joints, and to provide compression in the RICER treatment process of acute sports

injuries (see ‘Sporting injuries’ in the Pain relief section for details of RICER).

• Braces/supports are also available as ‘thermal wraps’. These are supports that are made from a

special material that produces and retains warmth. They have a three way action – heat,

compression and support.

• In addition to their use as sports braces or supports, thermal wraps may help to ease the pain of

arthritis and rheumatism.

• Sports braces/supports (including thermal wraps) are available in different sizes, so your

customer will need to measure around the centre of the joint they are trying to protect. Always

check the packs for exact measurement recommendations.

• Sports tape is used as preventative strapping for sports activities. It provides support and

minimizes excessive joint movement that can cause injury.

• It is available in various widths and flexibility depending on the type and location of strapping

required.

• There are different types of taping techniques depending on the joint involved. You should refer

your customer to the pharmacist if they require instructions on how to tape a joint.

In many cases, a customer requesting a sports brace/support or tape will have been referred by a doctor

or physiotherapist and will be able to tell you exactly what their requirements are. Any customer that

asks for these products and is unsure what they need should be referred to the pharmacist.

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Oral Care Fast Facts

• Good oral health means healthy gums, teeth, tongue and mouth.

• Customers often visit their community pharmacy for relief from problems such as pain and

discomfort from cold sores or mouth ulcers, denture problems, teething, toothache, bad breath

and fungal infections such as thrush.

This topic covers the following areas of oral care:

• Basic oral hygiene

• Cold sores

• Mouth ulcers

• Oral thrush

Toothache is covered in the Pain relief section of the Medicines category and teething in the Baby health

section of the Baby category.

The following is a list of ingredients covered in this topic that are available for conditions affecting the

mouth:

• Antivirals (aciclovir, idoxuridine)

• Local anaesthetics (lignocaine, benzocaine)

• Pain relieving ingredients (choline salicylate, benzydamine)

• Pastes

• Antibacterials (cetalkonium chloride, cetylpyridinium chloride, aminacrine, benzalkonium

chloride)

• Oral antifungals (miconazole*, nystatin*)

* Pharmacist only

Oral Care Products Checklist

Before recommending any product for the temporary relief of minor oral conditions, you need to ask

your customer these questions:

• Is the product for a baby, infant or child?

• Is the product for an older person?

• Have you already tried any treatment for this problem?

• Do you have any other symptoms?

• Are you pregnant or breastfeeding?

• Do you suffer from eczema or have any allergies?

• Do you have any other medical condition?

• Are you taking any other prescription, over-the-counter or natural medicines (including

medicines that you buy from your supermarket or health food store)?

If the customer answers ‘yes’ to any of these questions refer them to the pharmacist, as it will affect

which type of oral care product they can use.

Basic Oral Hygiene

• The reason we brush and floss is to remove plaque.

• Plaque is a sticky film of bacteria that is constantly forming on our teeth. It is one of the main

causes of tooth decay and gum disease.

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• Using a soft-bristled toothbrush, teeth should be brushed at least twice a day for a minimum of

two minutes.

• Toothbrushes should be replaced at least every three months or sooner if the bristles are worn

out.

• Dental floss should be used at least once a day to clean in between teeth. Flossing should be

done before brushing.

• Eating a balanced diet helps to keep teeth and gums healthy.

• We all know that we should visit our dentist at least twice a year for a professional examination.

What your customers may not know is that they should also make a point of seeing a hygienist

at least twice a year for a professional and thorough teeth cleaning.

Helpful Products

• Power toothbrushes may provide more effective tooth brushing. Their brushing action is

different to a manual toothbrush because they do the job of brushing.

• If your customer chooses a power toothbrush, you will need to remind them that they still need

to guide the toothbrush to all parts of their mouth including the inner and chewing surfaces, and

behind their back teeth.

• They still need to floss too.

• Mouthwashes are available that contain germ killing ingredients. These may be helpful as part of

regular oral hygiene to kill the germs that cause bad breath, plaque and gum disease.

• As a part of regular oral hygiene, mouthwashes are generally recommended twice a day after

brushing and flossing. Individual recommendations may vary so always check the pack for exact

instructions.

• Mouthwashes are not generally recommended for children because they may accidentally

swallow the solution.

Pregnancy

• Pregnant women should take extra care of their teeth and gums. Because of the hormonal

changes in the body during pregnancy, they are at a greater risk of gum disease.

• Sugary food cravings and morning sickness can also make pregnant women more vulnerable to

cavities.

• They should continue to visit their dentist throughout the pregnancy and follow good oral

hygiene principles (see ‘Basic oral hygiene’). Always remember to check with the pharmacist

before recommending any products for a pregnant woman.

• Women who are trying to get pregnant or believe that they are pregnant should tell their

dentist or hygienist straight away. It may not be safe to have x-rays or some other treatments

during pregnancy.

• A dentist will also need to know that they are trying to get pregnant or are pregnant just in case

they need to prescribe any medicines for them. Encourage your customer to also let their

dentist know about any medicines that they are taking.

Cold Sores

Fast Facts

• About 40% of Australians are affected by cold sores at some time.

• Cold sores are caused by the herpes simplex virus type 1 (HSV). HSV type 2 usually causes genital

herpes.

• There are 4 main stages of cold sores:

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(1) A burning, tingling or itchy feeling around the lips a few hours before the cold sore

appears.

(2) A red swollen area that appears and then gets covered in tiny blisters.

(3) The blisters burst and fluid leaks out.

(4) The cold sore dries up and forms a scab which heals after about 7 days.

• Colds sores are highly contagious and can be passed to other people from the time you feel the

tingle right through until the blisters have healed. They are commonly passed between people

through kissing.

• Cold sores are triggered by being stressed or rundown, sunburn, fever, periods, some foods,

colds, flu and other sickness (they get their name because they are often triggered by the

common cold).

Self-Help Ideas

• You should remind your customer that there is no cure for a cold sore, but there are antiviral

medicines available that fight the cold sore virus. Staying healthy may also help them to reduce

the number of cold sores they get.

• Working out the cause of their cold sores may also help your customer to prevent future

outbreaks.

• Your customer should avoid kissing other people, touching their cold sore, rubbing their eyes or

touching other people.

• They should not share eating and drinking utensils, towels or face cloths.

• Lip balms that contain sunscreen are helpful to prevent cold sores.

• Encourage your customer to avoid picking at the cold sore, especially at the scab stage. You do

not want to open the cold sore up to infection.

Helpful Products

• Cold sore products that contain antiviral medicines may be especially helpful (unless

contraindicated).

• Examples of antiviral medicines include aciclovir and idoxuridine. Aciclovir is generally

considered more effective than idoxuridine.

• They need to be applied as early as possible, ideally in the tingle stage. The earlier your

customer applies the treatment, the greater chance they have of preventing the cold sore from

appearing.

• Other products are available that contain:

– Antibacterials, e.g. povidone iodine, alcohol and benzalkonium chloride to help stop

infection with bacteria. Povidone-iodine also has action against some viruses.

– Local anaesthetics, e.g. lignocaine to relieve pain.

– Other ingredients to assist drying up of the cold sore.

• Products that contain antibacterial ingredients are useful to help prevent bacterial infection

when the cold sore reaches the weeping stage. Povidone-iodine has actions against both

bacteria and virus and may be helpful if your customer's cold sore has gone past the tingle and

blister stage. Anaesthetics are particularly helpful for painful cold sores.

• There are complementary products such as lysine, zinc and vitamin C that may also help. L-lysine

can reduce the chances of recurring cold sore attacks and when taken at the ‘tingle’ stage, L-

lysine may also help to reduce the severity and duration of symptoms. Vitamin C and zinc work

well with L-lysine. See the Colds & allergy section of the Natural health category for more

information on natural medicines for cold sores.

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Refer your customer to the pharmacist if:

– They are a baby, infant or child.

– They have eczema.

– They have any symptoms affecting the eyes, e.g. eyes that are red, watery and sensitive

to light.

– The inside of the mouth, eye, genitals or other parts of the body are affected.

– They have other symptoms such as fever or their glands are enlarged.

– They have cold sores that have lasted longer than 7 days, or persisted or returned

despite appropriate treatment.

– They answer ‘yes’ to any of the questions on the ‘Oral Care Products Checklist’.

Precautions

• Cold sore products must only be used on affected areas. Do not use in deep wounds, for

prolonged periods or over large areas.

• Keep cold sore products away from the eye, and membranes of the nose, mouth and throat.

• If your customer has any health conditions or is taking any medicines that affect their immune

system you should refer them to the pharmacist. Always refer your customer to the pharmacist

if they have any other health conditions or are taking any other medicines.

• Products that contain aciclovir should not be used in children under 2 years of age.

Mouth Ulcers

Fast Facts

• Mouth ulcers are a very common condition and affect about 10-20% of the population.

• Although anyone can get mouth ulcers, they are more common in students, young adults and

people under stress. They can be hereditary and passed between generations.

• They are more common in women and occur most often between the ages of 10 and 40.

• They are small painful sores normally about 0.5cm wide that appear on the tongue and on the

inside of the lips or cheeks. They have a white/grey or yellowish centre with a raised red edge.

• Mouth ulcers usually heal themselves within 7-14 days without scarring.

Refer your customer to the pharmacist if:

– They have a mouth ulcer that is larger than normal, e.g. more than 1cm in diameter.

– They have multiple mouth ulcers, or many small sores.

– The sores bleed.

– Their mouth ulcer is not painful.

– Their mouth ulcer has not healed, or has become worse after 7 days.

– They get mouth ulcers frequently.

– There are blisters or sores on the lips or around the mouth or other parts of the body.

– They have associated symptoms such as a fever, sore throat or rash.

– They have experienced diarrhea, difficulty in eating or weight loss.

– They answer ‘yes’ to any of the questions on the ‘Oral Care Products Checklist’.

Self-Help Ideas

• Working out the cause of their mouth ulcers may help your customer to prevent future

outbreaks.

• Common causes include:

– Stress or infection.

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– Trauma or injury to the mouth, tongue, inside of the cheeks or lips such as that caused

by biting or chewing, or hot or acidic food.

– Braces or dentures that don't fit correctly.

– Braces that have just been fitted or adjusted.

– Vitamin B, folic acid or iron deficiency.

– Hormonal changes, e.g. just before a period.

– Some medicines or medical conditions that affect the immune system.

• Avoid spicy foods or very hot foods or drink.

• Sometimes sucking on ice chips can help to reduce the pain of mouth ulcers (beware, ice-cubes

are a choking hazard).

Helpful Products

• There are a number of products available that may be helpful to relieve the pain and discomfort

of mouth ulcers. They contain a combination of local anaesthetic, antibacterial and pain-

relieving ingredients.

• The products are available as gels, paints and liquids and need to be reapplied frequently

because they tend to be fairly rapidly washed away by the saliva.

• Examples of local anaesthetics include lignocaine and benzocaine. They achieve pain relief by

numbing the affected areas.

• Choline salicylate has actions similar to aspirin and is an example of a pain-relieving ingredient.

• Benzydamine is an anti-inflammatory ingredient with pain-relieving properties.

• Antibacterial ingredients help prevent the mouth ulcer from becoming infected. Examples

include cetylpyridinium chloride, cetalkonium chloride, aminacrine and benzalkonium chloride.

• Pastes are also available for the management of mouth ulcers. They are thick products that form

a protective barrier over the ulcer giving it a chance to heal. They relieve the pain, redness and

swelling.

• If your customer is an adult and their mouth ulcers are difficult to reach to apply gels, paints, or

pastes, they may benefit from an anti-inflammatory spray or mouthwash that contains

benzydamine.

• It may help your customer to keep their mouth clean by using an antibacterial mouthwash such

as chlorhexidine or cetylpyridinium. Antibacterial ingredients may help prevent the mouth ulcer

from becoming infected.

• The ingredient triamcinolone acetate (a type of cortisone) is available in a thick paste and is

helpful to reduce the pain and discomfort of mouth ulcers. It has anti-inflammatory properties

that can help the mouth ulcer heal faster. This product may only be sold by the pharmacist so

we haven't included any specific information or warnings about it here.

Precautions

• Products containing choline salicylate should not be given to infants under 4 months of age.

• Aspirin should never be given to children under 18. This is even more important if they are using

products for mouth ulcers that contain choline salicylate (choline salicylate has a chemical

structure similar to aspirin).

• Products containing choline salicylate may not be or are not recommended for use by people

with asthma or active peptic ulcer. Always refer your customer to the pharmacist if they have

any other health conditions.

• Products containing choline salicylate interact with some medicines, including those that thin

the blood.

• Always refer your customer to the pharmacist if they are taking any other medicines.

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• Products containing benzydamine should be used with caution in people with liver or kidney

disorders.

• Always refer your customer to the pharmacist if they have any other health conditions.

Oral Thrush

Fast Facts

• If your customer describes creamy white patches in the mouth, they may be experiencing the

symptoms of oral thrush. These patches look similar to milk curds, but unlike milk curds they are

difficult to remove, and if scraped reveal sore red patches that may bleed.

• Oral thrush is caused by a fungus. It is the same fungus that causes vaginal thrush and

complicates nappy rash.

• Oral thrush is common in newborns because they pick up the fungus on the way through the

birth canal.

• It may be a side effect of certain medicines, e.g. some antibiotics and puffers used for asthma.

Helpful Products

• Antifungal products used in the management of oral thrush may only be sold by the pharmacist.

This is why we haven't included any specific information or warnings for these products here.

• Ingredients include miconazole and nystatin. They are available as oral drops (liquid) or gel and

are usually applied four times a day.

Eye Care Fast Facts

• Almost two out of every three Australian adults suffer eye discomfort. This means that

pharmacies have the opportunity to offer information, advice and suitable products.

• Customers are looking for products to soothe, relieve and enhance the appearance and

performance of their eyes.

• Eye symptoms can be a warning sign of serious eye disorders.

Refer your customer to the pharmacist if:

– They have experienced an injury to the eye, e.g. being hit or scratched, chemical spill,

welding flash.

– They have a foreign body in the eye.

– They are a baby, infant, child or older person.

– Only one eye is affected.

– Pupils are cloudy or different sizes.

– The tissue surrounding the eye (skin and eyelids) is or becomes swollen.

– There is pus or clear discharge from the eye, or the lids stick together on waking.

– They are sensitive to light or there is blurriness or loss of vision.

– Only the iris is red.

– The eye is painful or tender.

– There is associated fever, nausea and vomiting, headache, loss of appetite or

drowsiness.

– They wear contact lenses.

– Symptoms have returned, or are getting worse or not going away after 24–48 hours

despite using the recommended treatment.

– The customer answers ‘yes’ to any of the questions on the ‘Eye Care Products Checklist’.

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This topic covers the following areas of eye care:

• Infectious conjunctivitis

• Sore, red eye

• Allergy eye

• Dry eye

• Sties

• Contact lenses

The eye care category is worth $54 million. Of this total, pharmacy currently holds 70% of the category.

Optometry (25%) and grocery (5%) are other competitors. Lubricants hold the biggest share of the total

category (35%), followed by decongestants (30%), contact lens care (21%) and anti-infectives (14%).

This topic covers the following ingredients that are available for the temporary relief of eye

discomfort:

• Anti-infectives (sulphacetamide, yellow mercuric oxide, propamidine and dibromopropamidine)

• Decongestants (naphazoline, phenylephrine, tetrahydrozoline and xylometazoline)

• Antihistamines (antazoline, pheniramine and levocabastine)

• Miscellaneous products (lodoxamide, sodium cromoglycate)

• Lubricants (carmellose, hypromellose, hydroxyethylcellulose, polyvinyl alcohol, paraffin).

Eye Care Products Checklist

Before recommending any eye products, you need to ask your customer these questions:

• Is the product for a baby, infant or child?

• Is the product for an older person?

• Have you already tried any treatment for this problem?

• Are you pregnant or breastfeeding?

• Do you wear contact lenses?

• Do you have high blood pressure, diabetes, or a thyroid disorder?

• Do you have any other medical condition or allergies?

• Do you have any disorders of the eye, e.g. glaucoma?

• Are you taking any other prescription, particularly antidepressants, or over-the-counter or

natural medicines (including medicines that you buy from your supermarket or health food

store)?

If the customer answers ‘yes’ to any of these questions, refer them to the pharmacist, as it will affect

which type of eye care product they can use.

Infectious Conjunctivitis

Fast Facts

• Infectious conjunctivitis occurs when there is inflammation of the transparent membrane

covering the eye and may be caused by bacteria or virus. It presents as sore, red, gritty eyes with

or without discharge.

• Bacterial conjunctivitis commonly causes redness, grittiness and pus. It may start in one eye,

however both eyes eventually may become infected. Your customer may complain of burning

and their eye(s) sticking together when they wake up.

• Bacterial conjunctivitis will frequently clear up on it's own but may need antibiotic eye drops or

ointment from the doctor to speed recovery and reduce the spread of infection to other people.

• Viral conjunctivitis presents as painful, red, itchy and watery eyes. There is not usually any pus,

but the person may have recently had a cold or viral infection.

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Self-Help Ideas

• If you suspect your customer has bacterial or viral conjunctivitis they should speak with the

pharmacist.

• Bacterial and viral conjunctivitis are contagious. Encourage your customer to avoid touching

their eyes or sharing towels. They should wash their hands before and after using eye drops or

ointment.

• Encourage your customer to rest their eyes and avoid bright light. If possible try not to rub the

eyes, especially if they are already irritated (this is easier said than done for small children!).

• If your customer wears contact lenses they should avoid wearing them if they suspect they have

infectious conjunctivitis.

Helpful Products

The information in this section applies to propamidine and dibromopropamidine. You should check with

the pharmacist for more information and warnings for use with yellow mercuric oxide. Sulphacetamide

may only be sold by the pharmacist so we haven’t included specific warnings for it here.

• Frequent bathing of the eye with warm water or sterile saline solution will clear away mucus,

pus and debris and is an important part of managing infectious conjunctivitis. The eye(s) should

be bathed to remove discharge before using any eye products.

• For bacterial conjunctivitis there are products that contain the anti-infective ingredient

sulphacetamide that the pharmacist can recommend (unless contraindicated). Because the

product may only be sold by the pharmacist, we haven't included any specific information or

warnings about it here.

• Yellow mercuric oxide ointment, propamidine drops and dibromopropamidine ointment are

other products available over-the-counter for infectious conjunctivitis (unless contraindicated).

• Always follow the general principles about using eye products (see ‘Eye care – Using eye

products’), especially short-term use and expiry dates.

• Anti-infective ingredients are antibacterial and work by preventing bacteria from reproducing

themselves.

• The usual dose of propamidine eye drops is 1–2 drops up to 3–4 times daily.

• Dibromopropamidine eye ointment is applied 2–3 times a day.

• Anti-infective eye products are used for the temporary relief of symptoms. They should not be

used for more than 2–3 days without a doctor’s advice. Remind your customer that if symptoms

persist or worsen they should see their doctor.

Allergy Eye

Fast Facts

• Allergy may cause inflammation of the transparent membrane covering the eye. As a result the

eyes water a lot and feel intensely itchy. Often, there are also other signs of hay fever or allergy

including itchy nose and sneezing.

• Allergies that cause eye symptoms are quite common, and around one in four people have had

an eye allergy at some stage.

• Some common causes of allergy eye include pollens, house dust mites, cosmetics, smoke, eye

drops, contact lenses and solutions.

• Many people experience allergic conjunctivitis during certain seasons (particularly spring and

autumn) when there are pollens and other irritants in the air that can cause an allergic reaction

in the eye.

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Self-Help Ideas

• For best results in the treatment of allergy eye, your customer should try their best to identify

and avoid the things they are allergic to (their allergens).

• Encourage your customer to rest their eyes and avoid bright light. If possible try not to rub the

eyes, especially if they are already irritated (this is easier said than done for small children!).

• Avoid smoky areas such as restaurants, cafes and work places.

• Wear goggles in pools and sunglasses on bright, sunny days.

• Cold water compresses applied to the eyes can also soothe irritation.

Helpful Products

• For mild symptoms of allergy eye, bathing the eyes with a sterile saline solution may be all that

is needed.

• For more active treatment of itchy and watery eyes, your customer may try a combination eye

drop that contains a decongestant plus an antihistamine (unless contraindicated).

• Decongestant ingredients constrict the blood vessels of the eye hence relieving redness, burning

and stinging.

• Antihistamines (either as a single ingredient or added to decongestants) act to reduce the

effects of histamines and hence relieve allergic symptoms such as itchy, puffy, watery eyes.

• Examples of decongestants include naphazoline, phenylephrine, tetrahydrozoline and

xylometazoline.

• Examples of antihistamines include antazoline and pheniramine.

• Always follow the general principals about using eye products (see ‘Eye care – Using eye

products’), especially short-term use and expiry dates.

• In general, 1–2 drops should be used in the affected eye(s) 2–4 times a day (unless

contraindicated).

• Individual doses vary so always check the pack for specific dosage instructions.

• Decongestant and antihistamine eye products are used for the temporary relief of symptoms.

They should not be used continuously for more than 3–5 days. If they are used beyond this time,

there is a risk that the eyes will get used to the decongestant and symptoms similar to red eyes

will occur when the eye products are stopped.

• There are also products that contain the antihistamine levocabastine as a single ingredient for

itchy, red, watery eyes.

• If your customer knows what triggers their allergy eye symptoms, they may be able to use eye

drops that help prevent the symptoms from occurring.

• Examples of such ingredients are lodoxamide and sodium cromoglycate. These eye drops need

to be used at least one week before allergic symptoms appear, but will not provide immediate

relief for allergy symptoms once they occur.

• If other symptoms of allergy are present, e.g. runny nose, sneezing, wheezing or rash, speak

with the pharmacist about recommending an oral antihistamine. Antihistamines are discussed in

more detail in the Allergy & sinus section of the Medicines category. Please review this section

now, particularly ‘When to refer’ and the ‘Allergy & Sinus Products Checklist’ before making any

product recommendations.

Sore, Red Eye

Fast Facts

• Sometimes we get overtired or spend too long in a smoke-filled room or in front of a computer.

As a result our eyes become red and sore.

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• Eyes become red because something causes swelling in the blood vessels of the eye. This allows

more blood to flow to the area making it look red and feel hot.

• Common causes include dust, tobacco smoke, being tired, staring at a computer screen too

long, rubbing the eyes, pool chlorine, overindulgence with alcohol and sunlight.

Self-Help Ideas

• If there is no itch, discharge or signs of bacterial or viral involvement, or any other reason to

refer, your customer may simply be looking for a basic product to reduce redness. Cold water

compresses applied to the eyes can also soothe irritated eyes.

• If irritation is a problem your customer should avoid smoking and smoke-filled areas. They

should ask for non-smoking sections of restaurants, cafes and in the workplace.

Helpful Products

• Ingredients that constrict the blood vessels in the eye (decongestants) may help to relieve

burning and stinging and reduce redness (unless contraindicated). These ingredients include

naphazoline, phenylephrine, tetrahydrozoline and xylometazoline.

• In general, 1–2 drops should be used in the affected eye(s) 2–4 times a day (unless

contraindicated).

• Individual doses vary so always check the pack for specific dosage instructions.

• Decongestant eye products are used for the temporary relief of symptoms. They should not be

used continuously for more than 3–5 days. If they are used beyond this time, there is a risk that

the eyes will get used to the decongestant and symptoms similar to red eyes will occur when the

eye products are stopped.

• Always follow the general principals about using eye products (see ‘Eye care – Using eye

products’), especially short-term use and expiry dates.

Dry Eye

Fast Facts

• Tears are our eyes' natural defense mechanism. By the time you are 40, the amount of tears

that you produce is half that of when you were 10.

• Dry eye is a common symptom in pharmacy and is estimated to affect up to one in four

Australians.

• It is caused by decreased tear production or increased tear evaporation. As a result there are

not enough tears for the surface of the eye to function normally.

• Dry eyes feel gritty and irritated, and strangely enough, they may be watery. There may be

sensitivity to light, redness, burning and stinging and occasionally a stringy mucus discharge.

Some people will even describe a sensation of something being caught in the eye, e.g. sand or

dust.

• Dry eye is common in people over 50, particularly post-menopausal women.

• It can also be caused by medical conditions such as Sjogren's syndrome (a condition linked with

arthritis), or as a side effect of certain medicines (for example sedating antihistamines or fluid

tablets).

• Other causes of dry eye include contact lenses, lack of blinking, eyelid problems, computer

work, air travel, reading or studying for long periods, air pollution, dust, wind, air conditioning

and living in a dry climate.

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Self-Help Ideas

• The symptoms of dry eye may be relieved by humidifying the air and reducing exposure to air-

conditioning and hair driers. Wearing sunglasses when outside may also help.

• You could suggest to your customer that they could blink more, particularly when studying,

reading or in front of the computer, as this will help to coat the eyes with tears.

• Always follow the general principals about using eye products (see ‘Eye care – Using eye

products’), especially short-term use and expiry dates.

Helpful Products

• Over-the-counter eye lubricants are helpful for dry eye (unless contraindicated). They act like

tears and coat the eye to protect and nourish its surface.

• Products may contain carmellose, hypromellose, hydroxyethylcellulose, polyvinyl alcohol or

paraffin and are available as drops, ointments and gels.

• Unless contraindicated, lubricant eye drops can generally be used as often as needed. The usual

recommendation is 1–2 drops 3–4 times a day increasing as required. Individual

recommendations may vary so always check the pack for specific instructions.

• Eye lubricant ointments and gels are also helpful (unless contraindicated) but generally used

only at night before bed. However, if this is the preferred product and more frequent

application is required for more severe symptoms, they may be applied as needed only as

directed on individual packs.

Styes

Fast Facts

• A stye is an infection of the glands associated with the eyelash follicle. They are not contagious

and if managed correctly, generally clear themselves up after 7–10 days.

• Styes look like a pimple and appear near the edge of an eyelid. They may cause itch, mild pain,

tenderness and swelling and may also fill with pus and become a small boil.

Self-Help Ideas

• Hot water compresses applied for about 5 minutes, with gentle massage, 3–4 times a day may

be helpful to relieve the pain and help clear the infection.

• If your customer is looking for more active treatment, you can refer them to the pharmacist.

They may need to see their doctor to receive antibiotic drops or ointment.

• Your customer should avoid squeezing the stye. This may spread the infection to other parts of

the eye, or cause other styes to form.

• Your customer should visit their doctor if the inflammation lasts for more than a few days, gets

worse, or the styes come back, or the stye rubs against the eye and irritates it.

Contact Lenses

Fast Facts

• 5% of Australians wear contact lenses.

• There are two types of contact lenses – hard and soft:

– Hard lenses are made of denser material and are less delicate and last longer than soft

contact lenses. They make up a very small percentage of the contact lens market.

– Soft contact lenses are more comfortable, more permeable (allow more oxygen to flow

through) and can be worn for longer periods than hard lenses.

• Lens wearers may be more prone to irritated eyes. Dry eyes are especially common because the

lens draws moisture away from the eye.

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• Keeping contact lenses clean is really important. Traditional lenses should be cleaned at least

once every day. Tears can cause protein and other substances to build up on the lens. This can

lead to clouded or blurred vision. Dirt and bacteria on the lens could increase the risk of eye

irritation and infection.

• Lens wearers should stick with the cleaning system that was recommended to them by their eye

care practitioner. Different systems contain different preservatives which may irritate the eyes.

Self-Help Ideas

• Makeup and hair products should be used with caution. Aerosols should be used before putting

lenses in and makeup should be applied after the lenses are in.

• Lenses should always be stored in the proper solution when not in use.

• Your customer should avoid wearing contact lenses if their eyes are irritated, red or sore. A

spare pair of glasses is essential for this situation.

• The preservatives in some eye products can damage soft contact lenses. Where possible choose

preservative-free products or products specifically designed for lens wearers.

• Unless an eye practitioner has recommended it, contact lenses should not be worn overnight

(there are some lenses now available that can be worn day and night).

• Eye irritation may be caused by lenses that have been left in too long, or lenses that have been

used past their expiry date (e.g. disposable lenses).

• To help prevent irritation and infection, lens wearers should always wash their hands before

touching the lens or their eyes.

Precautions

• Products that contain decongestants and/or antihistamines are generally not recommended for

use by people with glaucoma, high blood pressure, irregular heartbeat, diabetes, and overactive

thyroid. Always refer your customer to the pharmacist if they have any other health conditions.

• Products that contain decongestants and/or antihistamines interact with some medicines

including antidepressants and more. Always refer your customer to the pharmacist if they are

taking other medicines.

• Some eye products are not suitable for use in children. Always refer infants and children to the

pharmacist for advice and product recommendation.

• Always follow the general principals about using eye products (see ‘Eye care – Using eye

products’), especially short term use and expiry dates.

Using Eye Products

• Eye drops can be administered by tilting the head back, pulling down the lower lid to form a

pouch and then administering the drops. It is easier if someone else helps or some people may

find a mirror useful.

• If possible, after putting the eye drops in, your customer should pinch the top of the nose firmly

for three minutes. This blocks off the tear duct and helps prevent the eye drops from getting

into the general circulation. Once again, this is easier said than done for small children!

• Eye ointments are useful at night because they stay around in the eye longer. Ointments may

also be particularly useful for children. However, ointments are difficult to administer to

yourself and they may cause blurred vision.

• Ointments are administered by tilting the head back, pulling down the lower lid and squeezing a

small amount (about 1 cm unless otherwise stated) into the pouch and then blinking several

times to spread the ointment.

• Wearing contact lenses is not recommended while using eye products.

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• Because they can become contaminated by micro-organisms, advise your customer to throw

away eye drops and ointments after 28 days, regardless of how much has been used, unless

otherwise stated.

• If eye products are stored or used incorrectly, they can themselves produce sore, red, irritated

eyes.

• Always wash your hands before and after using eye products.

• Eye products are for the temporary relief of symptoms and should not be used continuously

without a doctor's advice. Only use eye products for a few days at a time. If symptoms persist

remind your customer to see their doctor.

• The preservatives in some eye drops can contribute to eye irritation. There are preservative-free

products available that contain smaller amounts of liquid and are intended to be used as single

doses. They are generally more expensive than the traditional eye product but are extremely

useful if preservatives are a problem, and they may interfere with contact lenses. The

pharmacist can provide more information on single dose eye products.

Gastrointestinal The gastrointestinal and laxative market in Australia is valued at just under $100 million with pharmacy

accounting for 64% of the total market. Over the years, more products in this category are appearing in

supermarkets and other non pharmacy retail outlets.

This category covers the following gastrointestinal conditions:

• Indigestion, heartburn & reflux

• Diarrhoea

• Constipation

• Haemorrhoids

• Motion sickness

Threadworm is covered in the Children's Health section of the Medicines category and oral thrush is

covered in the ‘Oral Care’ screens earlier in General Health.

This topic covers the following list of ingredients that are available for the temporary relief of

gastrointestinal complaints:

• Antacids (calcium carbonate, sodium bicarbonate, magnesium trisilicate, magnesium carbonate,

magnesium hydroxide, aluminium hydroxide)

• Alginates (alginic acid, sodium alginate, magnesium alginate)

• Histamine receptor blockers (ranitidine, famotidine)

• Anti-gas (simethicone, peppermint oil)

• Rehydration solutions

• Antidiarrhoeal ingredients (loperamide, codeine, atropine, diphenoxylate, kaolin, pectin,

attagpulgite)

• Laxatives (bulking agents, softeners, stimulants, osmotic laxatives)

• Haemorrhoid products (local anaesthetics, skin protectants, astringents, antibacterials, cooling,

wound healing).

• Ingredients to manage motion sickness (dimenhydrinate, hyoscine, ginger)

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Gastrointestinal Products Checklist

Before recommending any product for the management of gastrointestinal conditions, you need to ask

your customer these questions:

• Is the product for a baby, infant or child?

• Is the product for an older person?

• Have you already tried any treatment for these symptoms?

• Do you have any other symptoms?

• Are you pregnant or breastfeeding?

• Do you have any allergies?

• Do you have any other medical condition, particularly bowel, liver or kidney problems?

• Do you have or have you ever had a gastric ulcer or heart condition?

• Are you taking any other prescription, over-the-counter or natural medicines (including

medicines that you buy from your supermarket or health food store)?

• Are you on a low sodium diet?

• Do you need to drive, operate machinery or do anything else that requires alertness?

If the customer answers ‘yes’ to any of these questions, refer them to the pharmacist, as it will affect

which type of product they can use.

Indigestion, Heartburn and Reflux

Fast Facts

• Indigestion is often described by customers as pain or discomfort in the area between the belly-

button and breastbone. They may have a bloated stomach, stomach cramps and wind or gas.

• Indigestion occurs after eating or drinking too much which causes discomfort by making the

stomach swell.

• Heartburn is often referred to as ‘reflux’. It is a burning discomfort or pain felt in the stomach

and passing upwards behind the breastbone. There is often an acidic, sour or bitter taste in the

mouth.

• Heartburn or reflux occurs when the acid and contents of the stomach move backwards up into

the oesophagus (food pipe) thus causing discomfort and damage.

• It occurs when the muscle ring between the stomach and the food pipe does not close properly.

This ring normally allows us to swallow food, but stops it from coming back up.

• The incidence of heartburn or reflux is increasing by an estimated 10% per year and it is

reported that 15% to 20% of adults experience symptoms at least once a week.

• The symptoms of heartburn or reflux are often made worse by lying down or bending forward.

• It occurs more commonly in people over the age of 55, or who are overweight, and during

pregnancy (it is estimated that half of all pregnant women suffer from heartburn or reflux).

• Indigestion, heartburn or reflux can be caused by certain foods and medicines, pregnancy, too

much food or too much alcohol.

• Care must be taken to ensure that the symptoms being described by your customer are not due

to more serious conditions such as peptic ulcer, gall bladder or heart complaints.

• The symptoms of indigestion, heartburn or reflux respond well to products that decrease the

acid content of the stomach. These products work either by neutralizing the acid in the stomach

or by reducing the amount of acid that is produced.

Refer your customer to the pharmacist if:

– They use products to relieve indigestion, heartburn or reflux on a regular basis.

– Their symptoms are severe or they look unwell (pale face or palms).

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– Their symptoms are made worse by physical activity.

– Their symptoms have appeared for the first time, especially if they are aged over 40

years.

– They are an infant, child (less than 18 years), or older person (older than 50 years).

– There is intense pain and/or there is pain down the customer's arm or radiating through

to the jaw and/or back.

– There are other symptoms such as unexplained weight loss, nausea or vomiting,

particularly if there is blood in the vomit.

– Their bowel motions are black and tar-like.

– There is difficulty swallowing or they are regurgitating food.

– Their symptoms have returned, or are getting worse or not going away after 24–48

hours despite using the recommended treatment.

– They are a smoker or regular alcohol drinker.

– They answer ‘yes’ to any of the questions on the ‘Gastrointestinal Products Checklist’.

Self-Help Ideas

• Lifestyle changes should be recommended as the first step in the treatment of indigestion,

heartburn or reflux.

• You should recommend that your customer try the following lifestyle changes:

– Give up smoking.

– Maintain an ideal weight. Your customer may need to speak with their doctor or

pharmacist about a weight loss program if required.

– Reduce fatty/greasy foods in the diet. Other foods that may worsen symptoms include

chocolate, citrus fruits, tomatoes, garlic, onions and spicy food.

– Avoid alcohol.

– Eat slowly and try smaller meals. Try not to overeat.

– Avoid eating or drinking late at night before bed.

– Reduce or eliminate caffeine intake.

• Your customer may like to enjoy a short walk after their main meal. This will assist the digestive

processes by encouraging blood and oxygen flow to the bowel.

• Raising the bed head and avoiding stooping, lying down or sitting in a low chair straight after

eating may also help.

Helpful Products

• Antacids can be recommended for mild symptoms (unless contraindicated). Alginates are often

added to antacids and are useful if reflux is present. Products called ‘histamine receptor

blockers’ can be recommended for more severe symptoms (unless contraindicated). All product

recommendations should be accompanied by lifestyle advice.

• These products will help to relieve the symptoms, but will not cure any underlying problems.

• Examples of antacids include calcium carbonate, sodium bicarbonate, magnesium trisilicate,

magnesium carbonate, magnesium hydroxide and aluminium hydroxide.

• Examples of alginates include alginic acid, sodium alginate and magnesium alginate.

• Ranitidine and famotidine are examples of ‘histamine receptor blockers’ available from

pharmacy.

• Simethicone and peppermint oil are sometimes added to antacids and may be helpful to relieve

the symptoms of wind and gas.

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Indigestion, Heartburn and Reflux

Antacids and Alginates

Fast Facts

• Antacids work by neutralising the acid in the stomach.

• Alginates work by forming a foamy ‘raft’ on the top of the stomach contents. This stops

the contents of the stomach from being pushed up into the food pipe.

• Simethicone and peppermint oil work by causing smaller wind bubbles to join together

to form larger ones. This allows your customer to get rid of excess wind and gas by

burping.

• Antacids and alginates are often found together in products and are helpful for

heartburn and reflux symptoms.

• Antacids and alginates are available in powders, chewable tablets, ‘rolltabs’ (roll tabs

are round tablets presented in packets similar to ‘Lifesavers’) and liquids.

• Liquids and powders are considered more effective than tablets or rolltabs but your

customer may find them less convenient. Many customers prefer tablets over liquids or

powders.

Precautions

• Traditional antacids interact with many other medicines. Advise your customer to take

antacids at least two hours before or after other medicines.

• Some antacids are high in sodium (salt). These preparations should be avoided by

people on a low-sodium diet or those with high blood pressure, kidney or heart disease.

Refer your customer to the pharmacist if they have any other health conditions.

• Some antacids and alginates have high sugar content. Customers with diabetes need to

be aware of this and talk to the pharmacist.

• Antacids are best taken at least 1 hour after a meal. They will stay around in the

stomach longer if taken at this time. Advise your customer to take antacids between

meals and at bedtime if required.

• If your customer chooses a product that contains aluminium or calcium they may

experience constipation. These products should therefore be used with caution in

people who may be at risk of this side effect, especially the elderly. In contrast, products

that contain magnesium may cause diarrhoea. Products that contain both aluminium

and magnesium have little adverse effect on the bowel.

• Some medicines may cause the symptoms of heartburn, reflux and indigestion, e.g.

antiinflammatories. You should ask your customer about any medicines that they are

taking.

• Antacids interact with some antibiotics, medicines used for arthritis and osteoperosis,

antifungals, medicines that regulate heartbeat, decongestants, aspirin and more. Always

refer your customer to the pharmacist if they are taking any other medicines.

• These products are generally not recommended for people with kidney or liver disease,

thyroid disorders, high calcium in the blood or urine, and certain heart conditions.

Always refer your customer to the pharmacist if they have any other health conditions.

• Indigestion, heartburn or reflux may be confused with the symptoms of heart disease or

heart attack. Always check with the pharmacist if you are unsure, or if your customer is

experiencing these symptoms for the first time.

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Indigestion, Heartburn and Reflux

Histamine Receptor Blockers

Fast Facts

• Histamine receptor blockers block the histamine receptors that are essential for the

production of stomach acid. This reduces the amount of acid that the stomach

produces.

• They keep working for longer than antacids and alginates, but unfortunately do not act

as quickly. They are also more expensive.

• Under the guidance of the pharmacist, you could recommend these products for your

customer with more severe symptoms, or for symptoms that have not responded to

antacids and alginates alone.

• If your customer suffers from indigestion particularly at night, histamine receptor

blockers may be helpful.

• If your customer is anticipating symptoms of indigestion, heartburn or reflux these

products can be taken about 1 hour before meals to try and prevent any problems.

Antacids and alginates are not as helpful in preventing symptoms.

Precautions

• Some medicines may cause or worsen the symptoms of indigestion, heartburn or reflux,

e.g. antiinflammatories. Always refer your customer to the pharmacist if they are taking

any other medicines.

• Histamine receptor blockers are generally not recommended for people with kidney,

liver or heart disease. Always refer your customer to the pharmacist if they have any

other health conditions.

Indigestion, heartburn or reflux may be confused with the symptoms of heart disease or heart attack.

Always check with the pharmacist if you are unsure, or if your customer is experiencing these symptoms

for the first time.

Diarrhoea and Vomiting

Fast Facts

• Occasional diarrhoea or vomiting is not an illness in itself, but a symptom of many other

conditions.

• Diarrhoea and vomiting are commonly referred to as ‘gastro’ by customers and are often a

result of a bacteria or virus in the bowel. Symptoms occur as the body tries to flush out the

bacteria or virus causing the infection.

• Other causes of diarrhoea and vomiting include stress, food intolerance, over indulgence, travel

and irritable bowel syndrome.

• Most episodes of gastroenteritis usually resolve within 24–72 hours.

• Diarrhoea and vomiting in babies, infants, children and the elderly can be serious because they

can become dehydrated very quickly. Always refer babies, infants, children and the elderly to

the pharmacist so they can check for any signs of dehydration and suggest appropriate

management.

Refer your customer to the pharmacist if:

• Their normal bowel habit has changed, especially if they are over 40 years of age.

• They are a baby, infant, young child or older person.

• They have other symptoms such as fever or abdominal pain.

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• They have bowel motions or vomit that contains blood or mucus.

• They have severe vomiting or have been vomiting for 2–4 hours or more.

• Diarrhoea doesn't stop within 24–48 hours.

• Their symptoms have persisted or returned despite appropriate treatment.

• They have had more than 8 runny bowel motions in 24 hours or can't keep anything

down.

• They are unable to drink fluid or haven't passed urine for 6–8 hours or more.

• They are cranky, sleepy or floppy or have sunken eyes or shadows under the eyes.

• They have altered breathing.

• Their skin feels cold and clammy, or it stays up for a second or two after being pinched.

• They have a very dry mouth, tongue and lips, or no tears.

• They have recently returned from an overseas trip.

• Answer ‘yes’ to any of the questions in the ‘Gastrointestinal Products Checklist’.

Self-Help Ideas

• Encourage your customer to drink plenty of clear fluids – either water or a rehydration solution.

They should avoid undiluted sweet or sugary drinks because these drinks can make diarrhoea

worse.

• If vomiting is a problem, your customer may find sipping small amounts of fluid helpful. Sucking

ice chips can also help (beware, ice-cubes are a choking hazard).

• Your customer should eat if they are hungry. Encourage them to avoid sweet or fatty foods, but

try other starchy foods such as rice, potatoes, bread or dry biscuits, or cooked cereals. They can

then gradually return to a normal diet.

• Encourage your customer to stay away from other people until they are well again.

Helpful Products

• Unless referral is required (see ‘Diarrhoea & vomiting – When to refer’) or products are

contraindicated, diarrhoea and vomiting should initially be managed with rehydration solutions.

These are products that prevent dehydration by replacing fluid, sodium, glucose and potassium

that the body may have lost.

• Rehydration solutions are available as dispersible tablets or powders that are mixed with water

and sipped slowly. They are available in a variety of flavours. Ice-blocks are also now available.

• Anti-diarrhoeal products and products to relieve nausea and vomiting are generally not

recommended in children. These products do not prevent dehydration and can have serious

side effects. They also allow any bacteria or virus to stay around in the bowel longer.

• Anti-diarrhoeal products may be recommended for the temporary relief of symptoms in adults

(unless contraindicated). They are available as tablets and contain ingredients such as

loperamine, codeine, atropine and diphenoxylate that slow down the movement of the bowel.

• Anti-diarrhoeal products may be used with rehydration solutions in adults, unless

contraindicated.

• Other products for diarrhoea contain ingredients such as attapulgite, kaolin and pectin that bind

water in the bowel. These ingredients may still be requested by customers for adults and older

children.

• Ginger may be a useful natural alternative for nausea and vomiting (unless contraindicated).

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Anti-Diarrhoeal Products

Precautions

This information refers to the ingredients codeine, diphenoxylate, atropine and loperamide. Other

ingredients such as attapulgite, kaolin and pectin are not ingredients of choice so we haven't included

them here. For more information and warnings for these ingredients please check with the pharmacist.

• Many medicines can cause diarrhoea. Examples include antacids, antibiotics, iron, laxatives,

antiinflammatories and more. Always check with the pharmacist if your customer is taking any

other medicines or has recently finished a course of antibiotics.

• These products interact with a variety of medicines including fluid tablets, alcohol,

antidepressants, medicines used for Parkinson’s disease, sleeping tablets, pain relievers and

more. Always refer your customer to the pharmacist if they are taking any other medicines.

• These products are not recommended for people who have obstructions in the bowel or other

bowel disorders, glaucoma, bladder or prostate disorders, liver or kidney disorders. Always refer

your customer to the pharmacist if they have any other health conditions.

• These products are not recommended for use in children under 12 years of age.

Constipation

Fast Facts

• Over 20% of adults are likely to have constipation at some point.

• Every person has their own bowel habit. Normal emptying of the bowel should occur anywhere

between three times a day and twice a week. The bowel contents should be soft.

• The frequency of bowel motions is dependent on fluid intake, diet and physical activity.

• Constipation occurs when bowel motions become harder or drier than usual. They may not be

passed as often, or they may be difficult to pass causing your customer pain and strain.

• Common symptoms associated with constipation include discomfort when trying to pass a

bowel motion, straining, harder or less frequent bowel motions, bloating or stomach cramps, a

feeling that the bowel has not been completely emptied, and pain in the lower back or stomach.

• Most people seeking relief from constipation want gentle, natural products, although some

customers place more importance on fast and effective relief.

• Many people believe that a daily bowel motion is essential for good health and often take

laxatives to ensure this happens.

• Working out what causes constipation may help your customer to prevent future episodes.

• Common causes include:

– Lack of fibre in the diet

– Lack of fluid in the diet or excessive sweating

– Lack of physical activity

– Stress

– Putting off passing a bowel motion

– Some medicines

– Change to daily routine, e.g. change of job, loss of work, retirement and travel

– Recent surgery

• Constipation is also a common symptom during pregnancy. About one-third of pregnant women

may suffer constipation because of hormonal changes or direct pressure on the bowel by the

growing baby.

• Constipation in children may be caused by emotional factors. It may be helpful to ask whether

or not a recent change to the child's routine may have triggered the constipation, e.g. starting a

new school, kindergarten, etc.

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• Children are also more likely to be frightened about going to the toilet or to become distracted

and forget to empty their bowel when they need to.

• Laxatives are often abused either intentionally or unintentionally.

– They are intentionally used by people, (often women) who are dieting or who have

eating disorders.

• These people falsely believe that laxatives are the answer to controlling weight.

– People who use stimulant laxatives continuously may not realise that their bowel may

become dependent on the laxative for normal function.

Refer your customer to the pharmacist if:

– They are an infant, child or older person.

– Their normal bowel habit has changed, especially if they are over 40 years of age.

– They swing between constipation and diarrhoea.

– There is blood in the bowel motions or the bowel motions are tar-like.

– Bowel motions are painful to pass.

– They need to use regular laxatives to help them pass bowel motions.

– They have other symptoms such as tiredness, lack of energy, nausea, vomiting, weight

loss, headache, or fever.

– Their symptoms persist or worsen after 24–48 hours despite appropriate treatment.

– Symptoms have returned.

– They answer ‘yes’ to any of the questions in the ‘Gastrointestinal Products Checklist’.

Constipation

Self-Help Ideas

• Mild cases of constipation may respond to the lifestyle measures below. You should warn your

customer that changes to lifestyle will help constipation but will take time.

• Fibre. Your customer should include more fibre in their diet (unless their doctor has told them

not to). This helps keep bowel movements regular. Fibre passes into the bowel where it sits and

absorbs fluid. This means that more fluid is retained and the bowel motions become softer,

bulkier and easier to pass. Foods that contain good amounts of fibre include wholemeal cereals,

bread, nuts and seeds, dried and canned beans and fresh fruit and vegetables.

• Fluid. Try to drink at least six to eight glasses of water every day (check with the pharmacist if

your customer has heart or kidney problems). Try to avoid drinks that contain caffeine or a lot of

sugar. Drinking plenty of water helps soluble fibre to absorb many times its weight in water,

helping to make bowel motions more bulky and soft. Without this water, some very high fibre

foods may actually make constipation worse.

• Physical activity. Being active has many health benefits and also helps to encourage peristalsis,

the wavelike movements that keep waste products moving through the bowel.

• Your customer should try to relax whenever they can. A few minutes of meditation every day is

wonderful for the soul.

• Encourage your customer not to ignore the urge to go to the toilet.

• If your customer has a tendency toward constipation they should try and avoid those medicines

that may cause constipation. Antacids that contain aluminium, calcium and iron supplements

and pain relievers that contain codeine are some examples of medicines that may cause

constipation.

• Castor oil is sometimes requested by customers for use as a traditional remedy for constipation.

It is no longer recommended, especially in pregnant women and should not be sold for

constipation.

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Helpful Products

If the constipation is not relieved by lifestyle measures your customer may require a laxative medicine.

When recommending any laxative for constipation you should always remember to give appropriate

lifestyle advice.

• There are different ways of classifying laxatives. For pharmacy staff, it can help to think of

laxatives in 4 broad categories:

– Bulking agents

– Softeners

– Stimulants

– Osmotic laxatives

• Some laxatives can be habit-forming and should only be used for the temporary relief of

symptoms.

• Prolonged use can lead to serious damage of the bowel and problems with the balance of

important components in the blood such as Vitamin D and calcium.

Constipation

Bulking Agents

Fast Facts

• Bulking agents work by adding extra fibre or ‘bulk’ into the bowel. Once inside the bowel, they

absorb water and swell up. The extra bulk in the bowel stimulates the bowel to contract and

relax and expel its contents.

• Bulking agents are the first step in the treatment of mild constipation and, in addition to lifestyle

measures, may be all that is required for your customer to return to normal bowel habit.

• Examples include psyllium husk, ispaghula, sterculia and methylcellulose. They are available as

powders and granules that are mixed with fluid and taken by mouth.

• These laxatives are slow to act and may take up to 24–72 hours to work.

• You should remind your customer to take these laxatives with 1–2 large glasses of water. If fibre

is taken without enough fluid it may form a blockage in the food pipe. They should not be taken

immediately before going to bed or lying down because this also increases the risk of a blockage

in the food pipe.

Precautions

• Many medicines can cause or contribute to constipation. Examples include cough suppressants,

pain relievers that contain codeine, antacids, sedating antihistamines, iron supplements, and

more. Always refer your customer to the pharmacist if they are taking any other medicines.

• Bulking agents should only be used in older children under medical supervision. They are not

recommended for use in children under 6 years of age.

• Some products contain the ingredient ‘aspartame’ and should not be used by people with a

health condition called phenylketonuria.

• Some products contain sugar which is important for your customer to know if they have

diabetes.

Softeners

Fast Facts

• As their name suggests, softeners work by making the bowel motions softer and more slippery.

This makes them easier to pass.

• Examples of softeners include docusate, liquid paraffin and poloxamer.

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• Softeners take about 24–72 hours to work if given orally and 2–15 minutes to work if given as a

suppository or enema.

• They are particularly useful if your customer needs to avoid straining, e.g. after surgery, or if

they suffer from haemhorrhoids or heart disease.

• Softeners are available as tablets, liquids, suppositories and enemas.

Precautions

• Many medicines can cause or contribute to constipation. Examples include cough suppressants,

pain relievers that contain codeine, antacids, sedating antihistamines, iron supplements, and

more. Always refer your customer to the pharmacist if they are taking any other medicines.

• Liquid paraffin may reduce the absorption of vitamins A, D, E & K into the bloodstream.

• Liquid paraffin is not recommended for people with reflux. Always refer your customer to the

pharmacist if they have any other health conditions.

• If your customer is taking liquid paraffin, they should avoid taking a dose near bedtime. If liquid

paraffin is taken shortly before lying down it may reflux into the lungs causing serious damage.

Stimulants

Fast Facts

• Stimulant laxatives work by encouraging the muscles of the bowel to contract and relax, thus

increasing the movement of the bowel. They do this by stimulating the nerves in the bowel that

control bowel movement.

• Examples of stimulant laxatives include bisacodyl, senna, aloin, frangula bark and sodium

picosulfate.

• Preparations that are administered up the bottom give the quickest onset of action (5–15

minutes for enemas and 15–60 minutes for suppositories).

• Tablets and granules are slower to work and provide relief in about 6–12 hours. If your customer

takes a dose at bedtime, they are likely to see a response the next morning.

• Stimulant laxatives are the group of laxatives most associated with laxative abuse.

Precautions

• Many medicines can cause or contribute to constipation. Examples include cough suppressants,

pain relievers that contain codeine, antacids, sedating antihistamines, iron supplements, and

more. Always refer your customer to the pharmacist if they are taking any other medicines.

• Some stimulant laxative tablets contain a special coating. People who are taking antacids should

be warned to separate doses of laxatives and antacids by at least 2 hours.

• If your customer is elderly, they should speak with the pharmacist. Stimulant laxatives are not

generally recommended for use by elderly people.

• You should remind your customer that these laxatives are for short-term use. Continuous use of

stimulant laxatives may lead to their bowel becoming dependent on the product and requiring

continuously increasing doses. Their bowel may eventually become unable to function on its

own.

Osmotic Laxatives

Fast Facts

• Osmotic laxatives work by drawing water into the bowel. This makes the bowel contents softer,

bulkier and easier to pass. The added bulk in the bowel also stimulates the muscles of the bowel

to contract and relax, thus expelling the bowel contents.

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• Osmotic laxatives are used for moderate to severe cases of constipation when rapid effect is

required. They are available as liquids, enemas and suppositories.

• Examples of osmotic laxatives include macrogol, glycerol, lactulose, sorbitol and magnesium

salts.

• Preparations that are administered up the bottom give the quickest onset of action (5–30

minutes for suppositories and enemas). Liquids are slower to work and provide relief in about

24–72 hours. Magnesium salts taken by mouth provide relief in 0.5–3 hours.

Precautions

• Many medicines can cause or contribute to constipation. Examples include cough suppressants,

pain relievers that contain codeine, antacids, sedating antihistamines, iron supplements, and

more. Always refer your customer to the pharmacist if they are taking any other medicines.

• Osmotic laxatives interact with antacids, antibiotics and other laxatives. Always refer your

customer to the pharmacist if they are taking any other medicines.

• Osmotic laxatives are generally not recommended for people with phenylketonuria, kidney or

heart disease, high blood pressure, obstruction of the bowel and some other bowel disorders.

Always refer your customer to the pharmacist if they have any other health conditions.

• Some products contain significant amounts of sugar and may not be recommended for people

with diabetes.

• Osmotic laxatives are not recommended for use in the elderly.

Fast Facts

• Also known as ‘piles’, haemorrhoids are enlarged veins in the area around the anus. They can

either be internal (inside the anus) or external (outside the anus).

• Your customer may complain of pain and discomfort, particularly when sitting or passing a

bowel motion.

• There may also be bleeding, itching, burning, swelling and a bulge or tag of skin around the

anus.

• The blood from haemorrhoids is fresh and bright red. It may be seen on the bowel movement,

on the toilet paper, or in the toilet bowl.

• Haemorrhoids are a common and often embarrassing problem for your customers. It is

estimated that 50% of the adult population have experienced haemorrhoids at some time.

• They are experienced equally by both men and women and occur most often in people between

the ages of 20 and 50 years.

• Because of the sensitive nature of the problem, some people may be discouraged from seeing

their local doctor.

• Working out what causes their haemorrhoids may help your customer to prevent future

episodes.

• Common causes of haemorrhoids include:

– Constipation, straining or putting off going to the toilet

– Diet e.g. lack of fibre or fluid

– Frequent diarrhoea

– Heavy exertion

– Prolonged sitting or standing

– Lack of physical activity

– Pregnancy and childbirth

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Refer your customer to the pharmacist if:

– This is the first time they have had haemorrhoids and have not yet seen a doctor.

– Their normal bowel habit has changed, especially if they are over 40 years of age.

– They think that their haemorrhoid is caused by constipation.

– They are an infant, child or older person.

– There are associated symptoms such as stomach pain or vomiting.

– There is bleeding or oozing from their bottom.

– They can feel the haemorrhoid sticking out of their bottom.

– Their symptoms persist after 7 days despite appropriate treatment.

– Symptoms have returned or become worse.

– They answer ‘yes’ to any of the questions in the ‘Gastrointestinal Products Checklist’.

Self-Help Ideas

• A major contributing factor in haemorrhoids is constipation. If your customer suffers from

constipation, they should try the self-help ideas recommended in the constipation section (see

‘Constipation – Self-help ideas’).

• Maintain good toilet hygiene. Each time after passing a bowel motion and as often as possible,

your customer should clean the area with warm water.

• Avoid straining when going to the toilet. Do not sit on the toilet for more than a few minutes

trying to pass a bowel motion.

• There are soothing wipes available that contain hamemelis (witch hazel) which your customer

can use to cleanse the area. These wipes can also be used in the place of toilet paper to reduce

irritation.

• Cold compresses applied to the anal area may help to shrink blood vessels. Soothing wipes

applied to the affected area can also be used as compresses.

Helpful Products

• Haemorrhoid products contain a variety of different ingredients in various combinations aimed

at relieving symptoms.

– Local anaesthetics (e.g. benzocaine, lignocaine) – Reduce pain and itching.

– Skin protectants (e.g. zinc oxide, kaolin, aluminium acetate) – Protect the skin from

moisture and soothe irritation.

– Astringents (e.g. zinc oxide, hamamelis (witch hazel), allantoin) – Relieve irritation and

inflammation.

– Antibacterial (e.g. resorcinol, chlorhexidine) – Kill bacteria on the surface of the area.

– Cooling agents (e.g. menthol, phenol, camphor) – Provide a cooling sensation which is

soothing and also takes the person's mind off the pain.

– Wound healing (e.g. shark liver, live yeast, vitamin A, balsam of Peru) – May assist tissue

repair and healing.

• When recommending any product for haemorrhoids you should always remember to give your

customer appropriate lifestyle advice including increasing the amount of fluid and fibre in their

diet and maintaining regular physical activity (unless contraindicated).

• Unless contraindicated, most haemorrhoid products can generally be used morning and night,

and after each bowel motion. The dosage for each individual product may vary, so always check

the pack before giving any recommendations.

• Products that contain hydrocortisone are helpful to reduce itching, inflammation and

discomfort. Addition of a local anaesthetic helps to reduce pain and itching. Products that

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contain hydrocortisone plus a local anaesthetic may only be sold by the pharmacist so we

haven't included any specific information or warnings for these products here.

Precautions

• Always refer your customer to the pharmacist if they are taking any other medicines. Medicines

that thin the blood (anticoagulants) may worsen bleeding associated with haemorrhoids. Many

medicines can cause diarrhoea which in turn can cause haemorrhoids. Examples include

antacids, antibiotics, iron, laxatives, anti-inflammatories and more. Many medicines can cause or

contribute to constipation which in turn can cause haemorrhoids.

• Examples include cough suppressants, pain relievers that contain codeine, antacids, sedating

antihistamines, iron supplements, and more.

• Products that contain resorcinol are generally not recommended for people with certain thyroid

conditions.

• Always refer your customer to the pharmacist if they have any other health conditions.

• Some people are allergic to local anaesthetics or other ingredients in haemorrhoid products.

Always remember to check if your customer has any allergies before recommending any

products.

Motion Sickness

Fast Facts

• Motion sickness is that discomfort felt on a moving boat, train, aeroplane, or automobile. Some

people even experience motion sickness in an elevator or on a swing.

• It is caused by irregular and abnormal motion. This motion disturbs the sensitive balance system

in the inner ear.

• Your customer may experience nausea, vomiting, dizziness, headache, loss of colour and cold

sweats.

• Motion sickness is most common in young children.

Self-Help Ideas

• Your customer can help to prevent motion sickness by being well rested and in good health prior

to the journey.

• If possible, get plenty of fresh air and exercise during the trip. Avoid stuffy rooms and strong

smells.

• Eat small, easily digested meals on the journey. Avoid meals high in fat.

• Children will find it helpful to avoid reading during the journey and sit near a window so they

can see out. Games are useful to keep children busy and keep their mind off any sickness.

Helpful Products

• Products that contain the sedating antihistamine dimenhydrinate may be helpful (unless

contraindicated). Another helpful ingredient is hyoscine.

• Products for motion-sickness should generally be taken half an hour before departure. For long

journeys your customer may need to repeat the dose. Dosages vary so always check the pack

before making any recommendations.

• If your customer would like a natural approach to motion sickness, they may like to try ginger.

Several products that contain ginger are available.

• Ginger may be a useful alternative for people who have to drive since it does not cause

drowsiness.

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• Acupressure wrist bands may also be helpful for the nausea associated with motion sickness.

These bands apply pressure to a specific point on the inside of the wrists.

Precautions

• Products used to prevent and treat motion sickness may cause drowsiness. You should warn

your customer that their children may be more sleepy than normal. If adults are taking the

preparation, they should not drive a car or operate heavy machinery.

• Avoid these products in children under 2 years.

• Products used to prevent and treat motion sickness interact with a variety of medicines

including antidepressants, alcohol, sleeping tablets, medicines used for Parkinson's disease,

anticoagulants and more. Always refer your customer to the pharmacist if they are taking any

other medicines.

• These products are generally not recommended for people with asthma or breathing disorders,

liver or kidney disorders, bladder disorders, heart conditions or high blood pressure, glaucoma,

stomach disorders or ulcers, overactive thyroid, prostate enlargement or epilepsy. Always refer

your customer to the pharmacist if they have any other health conditions.