CAOP Non-Prescription Medicines and Responding to Symptoms — Questions and Answers
Question 1: A 45-year-old man asks for an over-the-counter proton pump inhibitor for heartburn. Which finding most clearly requires referral to a doctor instead of self-treatment?
- Heartburn that occurs mainly after large, fatty meals
- Difficulty swallowing and unintentional weight loss over the past two months (Correct answer)
- Symptoms about twice a week for the past month
- Symptoms that go away within minutes after taking an antacid
Correct answer: Difficulty swallowing and unintentional weight loss over the past two months
Difficulty swallowing (dysphagia) and unexplained weight loss are alarm features that may point to oesophageal cancer or stricture. They need urgent medical investigation, not OTC acid suppression. The other options describe uncomplicated reflux that is suitable for self-care.
Question 2: A patient taking warfarin asks for something for a tension headache. Which non-prescription analgesic is the most appropriate choice?
- Ibuprofen
- Aspirin
- Paracetamol (Correct answer)
- Naproxen
Correct answer: Paracetamol
At usual short-term doses, paracetamol does not affect platelet function or irritate the stomach lining, so it is the preferred analgesic with warfarin. NSAIDs and aspirin raise bleeding risk because of their antiplatelet effects and GI erosion. Regular high-dose paracetamol can still raise the INR, so the patient should be told to use it only occasionally.
Question 3: Under TGA guidance, below what age should over-the-counter cough and cold medicines NOT be used in children?
- 2 years
- 6 years (Correct answer)
- 12 years
- 16 years
Correct answer: 6 years
In 2012 the TGA advised that OTC cough and cold medicines should not be used in children under 6 years, because evidence of benefit is lacking and there is a risk of harm. For children aged 6–11 they should be used only on the advice of a pharmacist, doctor or nurse practitioner.
Question 4: Which patient is the most appropriate candidate to receive OTC clotrimazole vaginal cream for suspected thrush?
- A 14-year-old with first-ever vaginal itch
- A woman with her fourth episode in six months
- A woman with a thin, grey, fishy-smelling discharge
- A 28-year-old non-pregnant woman with typical symptoms and a previous doctor-diagnosed episode (Correct answer)
Correct answer: A 28-year-old non-pregnant woman with typical symptoms and a previous doctor-diagnosed episode
OTC treatment suits women who have had thrush diagnosed before and who now have typical symptoms. Patients under 16, those with recurrent episodes (more than 2 in 6 months), and those whose discharge suggests bacterial vaginosis (thin, grey, fishy odour) should be referred.
Question 5: A customer asks for pseudoephedrine for nasal congestion. Which of their current medicines is a contraindication?
- Phenelzine (Correct answer)
- Paracetamol
- Cetirizine
- Omeprazole
Correct answer: Phenelzine
Phenelzine is a monoamine oxidase inhibitor. Combined with a sympathomimetic such as pseudoephedrine, it can cause a hypertensive crisis. Pseudoephedrine must not be supplied with an MAOI or within 14 days of stopping one.
Question 6: In which situation should loperamide be avoided for an adult with diarrhoea?
- Watery diarrhoea that started this morning, with no other symptoms
- Watery travellers' diarrhoea without fever before a long flight
- Bloody diarrhoea with a high fever (Correct answer)
- Mild diarrhoea after a change in diet
Correct answer: Bloody diarrhoea with a high fever
Bloody diarrhoea with fever suggests invasive bacterial infection (for example Shigella, Campylobacter or STEC) or inflammatory bowel disease. Antimotility agents can prolong infection and raise the risk of complications such as toxic megacolon, so the patient should be referred.
