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Approximately 600,000 people in the UK are living with epilepsy, and to this day, the cause in the majority of sufferers cannot be established. Fortunately, there are a whole host of treatments that can greatly assist in the management of this debilitating condition. (1)

What is epilepsy?

Epilepsy means that a person is prone to experiencing epileptic seizures (fits). A seizure occurs when there is a sudden surge in electrical activity in the brain and its electrical signals, which are vital for normal biological processes, become muddled. Seizures manifest themselves in various ways depending on the area of the brain in which these surges occur and the signalling pathways affected. (1,2)

Focal seizures begin on one side of the brain. Usually, they only last for up to two minutes. Symptoms can vary greatly and a person may experience one or more symptoms, including but not limited to stiffness, rhythmic movements, limpness or jerking in part of the body, changes in senses or hallucinations, a sense that the body is distorted, déjà vu and confusion. (3)

Tonic-clonic seizures are the ‘typical’ jerky seizures that people are generally familiar with. They can be focal or bilateral, meaning they may start on one or both sides of the brain. They are characterised by two phases – the ‘tonic’ phase, when the person may cry out and bite the inside of their mouth, then become stiff, unconscious and fall if standing; and the ‘clonic’ phase, involving rhythmic jerking, breathing difficulties and sometimes soiling oneself. They usually last no longer than three minutes. If they exceed five minutes, call 999 for an ambulance, unless you know for definite that seizures of this length which end by themselves are normal for the particular person. (4)

Tonic seizures follow the same course as the ‘tonic’ part of the aforementioned tonic-clonic seizure. They generally last no longer than one minute. (5)

Atonic seizures are the opposite of tonic seizures, with the body going limp instead of stiff. The affected person may fall or their head or knees may slump. They are normally up to two seconds long. (6)

Absence seizures begin on both sides of the brain and are split into typical and atypical forms. Typical absence seizures feature sudden abandonment of current activities, a very short loss of consciousness (but no falling) and then the appearance of daydreaming. There may also be fluttering of the eyelids, minor body jerking or repetitive movements. During a typical absence seizure, the affected person is unaware of what is going on around them and other people will be unable to interact with them. These seizures are short, lasting approximately 10 seconds, but can occur in hundreds in a single day. Atypical absence seizures have a greater duration of around 30 seconds, and tend to come on and wear off gradually. Movement is possible, but this will be clumsy in appearance due to limpness of the muscles. It may also be possible for other people to interact with the affected person. (7)

When is medical assistance needed?

As mentioned previously, a seizure exceeding five minutes in length warrants urgent medical attention, unless you know for a fact that the person regularly experiences seizures this long that subside on their own. (2, 4)

Other instances when you will need to call 999 and ask for an ambulance are as follows:

• A person experiencing their first seizure

• More than one seizure occurring without any recovery in between (this is a symptom of a condition called status epilepticus which requires urgent treatment)

• Breathing is affected

• Significant injury (2)

How is epilepsy treated?

The mainstay of treatment for epilepsy is antiepileptic drug therapy, of which there are a vast range of options. Antiepileptics alter the amount of certain chemicals within the brain, having a knock-on effect on electrical activity. The specific antiepileptic drug prescribed for a person will be determined by the seizures experienced, their age and whether they are likely to become pregnant in the near future, amongst other factors.

• Clonazepam and valproate can be used to treat any form of epilepsy. Clonazepam works by potentiating a specific inhibitory signalling chemical in the brain known as gamma-aminobutyric acid (GABA). This in turn reduces electrical activity. Valproate raises GABA levels and blocks chemical transport channels in the brain. Due to the risk of serious harm to unborn babies if taken in pregnancy, valproate is avoided in women of childbearing potential unless other medicines have failed to control the epilepsy.

• Tonic-clonic seizures can be treated withclonazepam, valproate, carbamazepine, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone and topiramate. Most block movement of chemicals through transport channels in the brain, with topiramate and lamotrigine also blocking receptors and enzymes associated with electrical activity. Phenobarbital enhances the effects of GABA. Phenytoin has many side effects, including depression, brittle bones and lupus, and has many interactions with other medicines including antacids and warfarin.

• Clonazepam, valproate, carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenytoin, topiramate and zonisamide can be used for focal seizures. The ways in which gabapentin, levetiracetam and zonisamide work are less clear, but most likely involve blocking of chemical channels.

• Clonazepam, valproate and ethosuximide can be given to treat absence seizures. Ethosuximide is a chemical channel blocker.

• There are several antiepileptic drugs which are used as adjuncts, meaning that they are not used as treatments alone, but rather to improve the effects of other antiepileptics. Such drugs include clobazam, brivaracetam, eslicarbazepine, perampanel, pregabalin, tiagabine and vigabatrin. (8)

If treatment is unsuccessful, brain surgery may be considered. If safe, the part of the brain responsible for seizures is removed. (9)

If brain surgery is unsuitable, vagus nerve stimulation (VNS) is another option. An electrical device is implanted in the chest and wired up to the vagus nerve. Electrical activity from this device overrides that of the brain, reducing the likelihood of developing a seizure. (9)

Deep brain stimulation, like VNS, uses an electrical implant, but wired up to the brain. Like VNS it is designed to override the faulty electrical activity of the brain, but carries more risks so is usually a last resort. (9)

Can anything else be done to prevent seizures?

As well as making sure you stick to taking your antiepileptic drugs as prescribed, you may also be able to identify certain triggers for your seizures. You can then try to avoid these triggers with the aim of reducing your seizure frequency. You may find it helpful to keep a diary of the time and place where you experience each seizure and any activities you undertake in the lead up to them to assist you in the identification of such triggers. (10)

Also, ensure you keep up to date with your medical reviews so that you and your doctor can address any problems and determine whether you’re getting the best treatment for your needs. (10)

For further information and support, click here.

References

1. Epilepsy action. What is epilepsy? [cited 16 November 2017]. Available from: https://www.epilepsy.org.uk/info/what-is-epilepsy

2. NHS Choices. Overview [cited 16 November 2017]. Available from: https://www.nhs.uk/conditions/epilepsy/

3. Epilepsy action. Focal seizures [cited 16 November 2017]. Available from: https://www.epilepsy.org.uk/info/seizures/focal-seizures

4. Epilepsy action. Tonic-clonic seizures [cited 16 November 2017]. Available from: https://www.epilepsy.org.uk/info/seizures/tonic-clonic

5. Epilepsy action. Tonic seizures [cited 16 November 2017]. Available from: https://www.epilepsy.org.uk/info/seizures/tonic-seizures

6. Epilepsy action. Atonic seizures [cited 16 November 2017]. Available from: https://www.epilepsy.org.uk/info/seizures/atonic-seizures

7. Epilepsy action. Absence seizures [cited 16 November 2017]. Available from: https://www.epilepsy.org.uk/info/seizures/absence-seizures

8. Epilepsy action. Epilepsy medicines available in the United Kingdom [cited 20 November 2017]. Available from: https://www.epilepsy.org.uk/info/treatment/uk-anti-epileptic-drugs-list

9. NHS Choices. Treatment [cited 20 November 2017]. Available from: https://www.nhs.uk/conditions/epilepsy/treatment/

10. NHS Choices. Living with [cited 21 November 2017]. Available from: https://www.nhs.uk/conditions/epilepsy/living-with/

    Author: Gabby Gallagher MPharm

    Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 27/11/17

Affecting as many as one million UK people annually, norovirus is a scourge of the late autumn and winter months. It can occur all year round, but its seasonal proliferation has led to it being labelled as the ‘winter vomiting bug’. Fortunately, despite its unpleasantness, it is a condition that can almost always be managed through self-care. (1, 2)

What is norovirus?

Norovirus is a general term for a number of different viruses that can be responsible for gastroenteritis (inflammation of the stomach and intestines), the main symptoms of which are sudden onset nausea (feeling sick), projectile vomiting (being sick with force) and diarrhoea. Other symptoms can include mild fever, stomach ache and aching in the arms and legs. Norovirus is highly contagious and often occurs in ‘outbreaks’ in which several people in a particular area or institution, such as schools, workplaces, care homes, hospitals, cruise ships or restaurants, are infected around the same time. (1, 2)

What can I do if I contract norovirus?

Norovirus is, on the whole, self-limiting. This means it clears up of its own accord without treatment. It doesn’t usually take longer than three days for the infection to run its course. Whilst you’re ill, these tips should help you to deal with the symptoms and to make sure you stay well-nourished and hydrated. (2)

• Drink plenty of water as vomiting and diarrhoea can cause dehydration. Juice or soup can be taken as well as water; however, don’t give juice or fizzy drinks to children as it can make diarrhoea more severe. Babies should be fed as normal, via breast or bottle.

• Fever and body aches can be alleviated with paracetamol.

• Stay indoors and rest as much as possible to allow your body to conserve the energy it needs to recover.

• If you think you are able to eat, stick to plain foods (such as bread, pasta, rice, potato).

• Look out for dark urine and dry mouth – these are signs of dehydration. Signs in babies and young children include a sunken soft spot on the head (babies only), sunken eyes, reduced tear production, urinating less frequently and, as with adults, dark urine and dry mouth. Rehydration sachets to be mixed with water can be bought over the counter at pharmacies and can be used at all ages.

• Over the counter medication to help with nausea, vomiting and diarrhoea, such as loperamide and bismuth subsalicylate, can be taken by adults. However, if you take any other medication, be sure to check with the pharmacist or read the leaflet within the package to make sure these products are safe to take alongside. (2)

Do I need to see the GP?

Don’t go to your GP surgery if you have norovirus, as this can assist its spread to other people. Additionally, as previously mentioned, there is no treatment for norovirus. If you need advice, you can call NHS Direct on 111 or speak to your GP over the phone. (2)

There are certain complications which can arise with norovirus. If you experience any of the following, call your GP or 111 as soon as possible:

• Symptoms have not eased after three days

• Blood in diarrhoea

• Severe dehydration (dizziness, losing consciousness, greatly reduced or no urination)

• Your child has had at least six episodes of diarrhoea or three episodes of vomiting in the last 24 hours

• Your child isn’t as responsive as usual, has a fever or a pallid appearance

You should also call for medical advice if you have a serious health issue such as kidney disease, and you contract norovirus. (2)

Reducing the spread of norovirus

Norovirus is highly contagious and it would be impossible to completely stop the spread. Nevertheless, the following steps can help to protect you and others around you during an outbreak.

• Wash your hands regularly with soap and water. This is especially important after using the toilet and before preparing or eating food.

• Regularly clean surfaces with a bleach-based disinfectant.

• Wash clothes, towels and bedding on a hot wash.

• Don’t share towels.

• Flush the toilet straight after an episode of vomiting or diarrhoea and disinfect the area.

• Wash fruit and veg before preparation and ensure food is thoroughly cooked before eating.

• Don’t return to school or work or make hospital visits before 48 hours have passed since your last symptom. (2)

References

1. NHS. Norovirus [cited 23rd April 2018]. Available from: https://www.nhs.uk/conditions/norovirus/

2. NHS Choices. Norovirus [cited 7 November 2017]. Available from: https://www.nhs.uk/conditions/norovirus/

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 10/11/17

With at least one million cases annually across the globe, meningitis is a major concern, and its tendency to peak in the winter months means now is the ideal time to review what we need to look out for. (1, 2)

What is meningitis?

Meningitis means inflammation of the meninges, which are the linings that shield the brain and spinal cord. (3) It occurs most commonly in children under the age of 5, teenagers and those in their early twenties, and people with weakened immune systems. (3, 4)

Viral meningitis

Viral meningitis is the most common form, but is not usually serious. People infected generally recover with no complications, although this may take some time, several months in some cases. (1, 5) Enteroviruses, which are usually involved in milder illnesses such as colds and upset stomachs, are the most common cause. (6)

Bacterial meningitis

Bacterial meningitis is the most severe form. The cause is often particular bacteria that live harmlessly in the nose or throat of healthy individuals that can be passed to others through coughing, sneezing or close contact. Equally, if a person’s immune system becomes weaker for whatever reason, they can also be at risk if any bacteria associated with meningitis live in their body, as their defences may not be enough to stop them from invading the meninges. (1, 4) Neisseria meningitidis is the most common type of bacteria which causes meningitis, followed by Streptococcus pneumoniae and Haemophilus influenzae Type B. (1)

Affected individuals can go from feeling perfectly healthy to seriously ill within hours. Up to a quarter of people who contract bacterial meningitis die as a result, many of whom will have only started showing symptoms 24 hours earlier. (1) This is why it is essential that we know the signs listed below and act immediately if we suspect meningitis.

Fungal meningitis

Fungal meningitis is uncommon, occurring mainly in those with weakened immune systems. It is caused by breathing in fungal spores present in the air. It may be severe if it develops. (1)

Other causes

Occasionally, meningitis may arise as a result of injury, surgery on the brain, medication, cancer or parasitic organisms. However, this is very rare. (1)

Signs and symptoms of meningitis

Recognising the following signs of meningitis is crucial to enable treatment to be started as early as possible, as the progression of the illness is so rapid. However, note that not all of these symptoms may appear and there is no set order:

• Body temperature of 38˚C or higher (fever)

• Stiffness of the neck

• Sensitivity to light

• Headache

• Vomiting

• Drowsiness

• Lack of responsiveness

• Seizures

• A rash appearing as red spots or blotches that doesn’t fade when pressure is applied (such as rolling a glass tumbler over the rash) (3)

These symptoms call for an urgent visit to A&E, or if you or the person concerned is too ill to get to A&E, dial 999 immediately for an ambulance. It is a common misconception that the main symptom of meningitis is the characteristic rash - this does not always appear. If you are in any doubt, call 111 for NHS Direct. (3)

Vaccinations against meningitis

There are several vaccines available that protect against different types of meningitis, the latest being introduced in 2015 in the UK.

• MenB vaccine – this protects against the strain of Neisseria meningitidis known as MenB. This vaccine is given to babies at the ages of 2 months, 4 months and 12 months. Since its introduction in 2015, the number of babies contracting MenB has dropped significantly. (7)

• MenC vaccine – introduced in 1999, this offers protection against the MenC strain of Neisseria meningitidis. It is administered at the age of 12 months in combination with the Hib vaccine and, since 2015, at 14 years as part of the MenACWY vaccine. It has almost eliminated MenC meningitis in the UK. (7)

• MenACWY vaccine –protecting against the MenA, MenC, MenW and MenY strains of Neisseria meningitidis, this vaccine was introduced in 2015 to be routinely given to 14 year olds as a result of the rise of MenW cases in the UK since 2009. MenW is a particularly dangerous strain, leading to death in a third of teenagers who contract it. However, since its introduction, no teenagers who have received the vaccine have fallen ill with any of the four strains it offers protection against. (7, 8)

• Pneumococcal vaccine – this protects against a different type of meningitis-causing bacteria, Streptococcus pneumoniae.It is given to babies at the ages of 2 months, 4 months and 12 months. (7)

• Hib vaccine – protecting against meningitis caused by Haemophilus influenzae Type B, this vaccine has cut cases dramatically to almost none since it was introduced in 1992. It is administered to babies at the ages of 2 months, 3 months, 4 months and finally 12 months. (7)

• MMR vaccine – this vaccine offers immunity against the measles, mumps and rubella viruses. These viruses can lead to viral meningitis in some cases. It is given to babies at 12 months. (7)

For further information on vaccines to protect against meningitis, click here.

References

1. Confederation of Meningitis Organisations. Types of meningitis [cited 30 October 2017]. Available from: http://www.comomeningitis.org/facts-about-meningitis/types-of-meningitis/

2. Oxford Vaccine Group. Meningococcal disease [cited 30 October 2017]. Available from: http://vk.ovg.ox.ac.uk/meningococcal-disease

3. NHS Choices. Meningitis [cited 30 October 2017]. Available from: https://www.nhs.uk/conditions/Meningitis/Pages/Introduction.aspx#outlook

4. Patient. Meningitis [cited 30 October 2017]. Available from: https://patient.info/health/meningitis-leaflet

5. Meningitis Research Foundation. What are meningitis and septicaemia? [cited 30 October 2017]. Available from: https://www.meningitis.org/meningitis/what-is-meningitis

6. Meningitis Research Foundation. Viral meningitis [cited 30 October 2017]. Available from: https://www.meningitis.org/meningitis/what-is-meningitis/viral-meningitis

7. Meningitis Research Foundation. Vaccine information [cited 31 October 2017]. Available from: https://www.meningitis.org/meningitis/vaccine-information

8. Oxford Vaccine Group. MenACWY Vaccine [cited 31 October 2017]. Available from: http://vk.ovg.ox.ac.uk/menacwy-vaccine

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 01/11/17

Despite causing pain, itchiness and sometimes embarrassment, warts and verrucae are not a serious condition and should clear up by themselves for most people, although this may take years. Nevertheless, there are treatments available if they are very bothersome or persistent. (1)

What are warts and verrucae?

Warts and verrucae are small lumps of keratin (a protein produced in the body which makes up hair and nails) that can form on any part of the body, but usually the hands and feet. They are caused by particular strains of the human papilloma virus (HPV). The term ‘wart’ is used for these lumps when they occur anywhere apart from the soles of the feet, where they are called verrucae (singular: verruca) or occasionally plantar warts. (1, 2)

The common wart is usually found on the fingers, but may affect the palms, knuckles or even knees. It protrudes from the skin, is firm to the touch and is characterised by a rough and rugged appearance. (1)

Verrucae are found on the soles of the feet. They differ from common warts in that they are predominantly flat from the pressure put upon them when walking, and contain small blood vessels which are visible as black dots. (1, 2, 3)

Plane warts are flat warts found mainly on the face, the backs of the hands, or the shins. They are yellow in appearance. They may occur as a single wart or in hundreds! (3)

Mosaic warts are clusters of warts or verrucae. (1)

How are warts and verrucae treated?

The most widely available and common treatment is salicylic acid, available in forms such as gels, plasters and skin paints. These products can be purchased over the counter at a pharmacy. Before applying the product, it is advised to soak the wart or verruca in water for at least five minutes to soften the skin. Then, carefully cover the healthy skin around the wart or verruca with a layer of petroleum jelly, as salicylic acid may damage healthy skin. After doing this, the product can be applied. This should be done on a daily basis. The wart or verruca can be filed with an emery board weekly to remove dead skin, but ensure that the emery board is thrown away after use and a new one used next time. (2)

Dimethyl ether propane is available over the counter as a spray to freeze warts and verrucae. However, it is not as effective as using salicylic acid products. (2)

If the wart or verruca persists despite use of these products, visit your GP who may consider treatment with liquid nitrogen. This is applied directly to the wart or verruca and works to freeze it off. It will need to be done numerous times to completely clear the wart or verruca up. Unfortunately, this does not always give the desired results, in which case your GP may refer you to a dermatologist who may look into minor surgery and other treatment options. (2)

Other reasons you will need to see your GP for warts or verrucae include:

• facial warts, which should not be treated over the counter, as the skin on the face is very delicate and can become damaged or scarred easily

• genital warts, which are caused by different strains of HPV to those associated with common warts and verrucae, and should be dealt with by your GP or a sexual health clinic

• recurring warts

• very big or painful warts

• warts that bleed or change in appearance

• diabetics

• pregnant women

• poor circulation in the hands and feet (2)

Protecting yourself and others from warts and verrucae

Although warts and verrucae are very contagious, there are steps we can take to reduce the spread. Touching warts and verrucae should be avoided, and if touched, hands should be washed as soon as possible. In communal places such as swimming baths and changing rooms, you should cover any verrucae you have with a verruca sock or waterproof plaster. Do not share footwear or towels with anyone else, and ensure you keep your feet and hands clean and dry, including a fresh pair of socks daily. (2)

If you find a lump on your skin and are in any doubt as to what it is or you are at all concerned, your local pharmacist is there to help.

References

1. National Health Service. Warts and verrucas [cited 8th September 2017]. Available from: https://www.nhs.uk/conditions/warts-and-verrucas/

2. NHS Choices. Warts and verrucas [cited 24 October 2017]. Available from: https://www.nhs.uk/Conditions/Warts/Pages/Introduction.aspx

3. Bupa. Warts and verrucas [cited 23 October 2017]. Available from: https://www.bupa.co.uk/health-information/directory/w/warts-and-verrucas

   
   

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 26/10/17

There are a number of conditions that can cause red eyes, with conjunctivitis being a common one. Other symptoms include itching, watering and sometimes stickiness of the eyelashes. The good thing is that in most cases, it can be controlled without the input of your GP! (1)

What is conjunctivitis?

Conjunctivitis means inflammation of the conjunctiva, which is a thin lining on the front of the eye. It can affect one or both eyes. (2)

What is the cause?

There is more than one cause of conjunctivitis, each of which usually yields different symptoms.

Infective conjunctivitis is caused by bacteria or a virus. As the name suggests, it can be caught from and passed on to other people.

• Bacterial conjunctivitis tends to produce a yellow pus that leads to stickiness and crusting of the eyelashes. It is usually spread when an infected person rubs their eyes, then touches a surface which is subsequently touched by another person, who can contract the infection if they then touch their own eyes.

• Viral conjunctivitis is often associated with a gritty, irritated sensation in the eye. It is passed to other people via coughing and sneezing as well as physical contact, so is the more contagious form. (2,3)

Allergic conjunctivitis is caused by allergens, usually pollen, dust mites or pet dander, coming into contact with the eye and inducing a reaction. Symptoms include itchy, red and watering eyes. It often appears with hayfever or perennial rhinitis. (2,3)

Irritant conjunctivitis is caused by foreign objects, such as a detached eyelash or grit from the outdoors, getting trapped under the eyelid and rubbing against the eye. It can also be caused by irritating substances such as shampoo or chlorine-treated water found in swimming baths coming into contact with the eyes. The eyes should return to normal shortly after the irritant is removed. (2,3)

How is it treated?

Infective conjunctivitis is generally a self-limiting condition, meaning it will probably clear up on its own, usually within a couple of weeks. In the meantime, to ease the symptoms, you can bathe the affected eye(s) in boiled and cooled water with the aid of cotton wool. If you have bacterial conjunctivitis and bathing is not sufficient to control the symptoms, visit your pharmacist who will assess your condition and sell you antibiotic eye drops (chloramphenicol) if they see fit. (1,2)

Allergic conjunctivitis can be managed with antihistamines, either in eye drop form (sodium cromoglicate) or taken by mouth in tablet or liquid form (such as chlorphenamine or loratadine). Avoiding contact with the allergen is also recommended, which may involve regular thorough cleaning of your home to minimise dust, or keeping windows closed where possible when the pollen count is high. (2)

When to see your GP

Despite most conjunctivitis cases being easily managed through self care or the pharmacy, there are instances where you will need to visit your GP. Pain in the eye, changes in vision, sensitivity to light or intensely red eyes all warrant an urgent GP appointment. Additionally, if you have a child under the age of two years, you will need to take them to their GP. (2)

Reducing the spread of infective conjunctivitis

If you are suffering with bacterial or viral conjunctivitis, be sure to wash your hands frequently and avoid touching your eyes. Do not share pillows or towels.

You should be fine to go to work or school unless your symptoms are severe and you don’t feel well enough to attend. However, if your job involves close contact with people, or use of shared phones or computers, it is advised that you stay at home until your symptoms have resolved, as the infection may be more easily spread. (2)

References

1. National Health Service. Chloramphenicol [cited 6 December 2018]. Available from: https://www.nhs.uk/medicines/chloramphenicol/
2. NHS Choices. Conjunctivitis [cited 16 October 2017]. Available from: http://www.nhs.uk/conditions/Conjunctivitis-infective/Pages/Introduction.aspx?nobeta=true
3. Optrex. What you need to know about conjunctivitis [cited 16 October 2017]. Available from: http://www.optrex.co.uk/eye-conditions/conjunctivitis/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 19/10/17

It’s that time of year again – the weather’s getting colder, the nights are drawing in and of course, the pesky common cold seems to be everywhere!

Many people think that the terms ‘cold’ and ‘flu’ are interchangeable, or that the flu is just a bad cold. It’s not surprising given that both share certain symptoms and tend to appear at the same time of year. However, different viruses are responsible for the common cold versus the flu, and the latter can end up being more serious for particular groups of people. (1)

What are the differences between cold and flu?

The common cold can be caused by a number of different viruses, including the rhinovirus and the coronavirus. Flu (short for influenza) is caused by influenza viruses. Despite the many similarities, there are some differences in symptoms and onset time that may help you to determine whether you are suffering from a cold or the flu. Firstly, colds tend to creep up on you gradually over a couple of days, whereas the flu will make a person feel unwell very quickly. Additionally, a blocked, runny nose and sore throat is more likely to be associated with a cold, and bodily aches and pains occur more commonly with the flu. People can feel very unwell during a bout of the flu, often so much that they are bedridden. Conversely, a person will usually feel well enough to go to work and get on with their everyday activities whilst they have a cold. (1)

Will I need to see my GP?

For most people, a cold or the flu will clear up on its own within a couple of weeks and no trip to the GP will be needed. Resting (especially for flu), drinking plenty of water and taking painkillers such as paracetamol to ease pain and fever should help to alleviate symptoms until you recover. However, there are certain groups of people who are more likely to suffer complications including pneumonia and bronchitis whilst suffering with the flu. If you fall into one of the following categories, see your GP if you think you have the flu:

• 65 or older

• diabetic

• pregnant

• serious heart problems

• chest problems such as asthma

• severe kidney or liver disease

• weakened immune system

• previous stroke or mini stroke

Your GP may consider prescribing oseltamivir or zanamivir, which are antiviral medicines. (1,2)

You can also receive a free flu jab if you are in one of these at risk groups. Care home residents and carers are also entitled. Speak to your GP or pharmacist to book an appointment. (3)

Please don’t beg your GP for antibiotics! Antibiotics are used to treat bacterial infections, whereas colds and flu are viral infections, so they won’t help to ease your symptoms. Furthermore, overusing antibiotics contributes to antibiotic resistance, which means if we are not careful with the antibiotics we have today, they may become useless against the bacteria they are supposed to target, making bacterial infections untreatable in future.

Reducing the spread of colds and flu

When we have a cold or the flu, droplets containing the virus are released into our surroundings when we cough or sneeze. These droplets can become airborne and therefore can be breathed in by other people, infecting them. Droplets may also settle on surfaces, and the virus can infect others when they touch the surfaces, then touch their nose, mouth or eyes. We can reduce the spread of these droplets by coughing or sneezing into a tissue, then throwing the tissue away and washing our hands. Hands should not be used to cover the nose and mouth when coughing or sneezing as this allows for transfer of the virus to commonly touched surfaces such as door handles, keyboards, banisters and even via a handshake! Surfaces should also be cleaned regularly. (1)

Getting a flu jab, particularly if you’re in an at risk group, will not only protect yourself, but will also help to protect other people you come into contact with. (1)

For any more information, speak to your local pharmacist or read more here.

References

1. National Health Service. Cold or flu? [cited 10 October 2017]. Available from: http://www.nhs.uk/Livewell/coldsandflu/Pages/Isitacoldorflu.aspx

2. National Health Service. Flu – Treatment [cited 10 October 2017]. Available from: http://www.nhs.uk/Conditions/Flu/Pages/Treatment.aspx
3. National Health Service. Who should have the flu jab? [cited 10 October 2017]. Available from: http://www.nhs.uk/Conditions/vaccinations/Pages/who-should-have-flu-vaccine.aspx

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 13/10/17

Affecting as many as 20% of women and 7% of men, migraine is a big problem in society. It can make sufferers’ lives a misery, with some left bedridden for days as they wait for symptoms to pass and then to recover. The upside is that there is a plethora of treatment options and lifestyle tips that can help to reduce or even banish migraines for good! (1)

What is migraine?

Migraine is a type of headache, usually experienced as a throbbing sensation on one side of the head. This is often accompanied by nausea (feeling sick) and sometimes vomiting (being sick). During a migraine, bright light, loud sounds, or sudden movement of the head can make the pain temporarily worse. They usually first appear when sufferers are young adults, but may start earlier or later in life than this. (1) A single migraine attack may last as long as three days.

Not all migraines are the same. Migraines with aura, also known as classic migraine, occur in around one in three migraine sufferers. Before the throbbing headache starts, other symptoms called aura appear, including visual disturbances (flashing lights, patterns or blind spots in the field of vision), numbness that migrates from the hand to the face, dizziness, slow speech, and less commonly, fainting. Migraines without aura, also known as common migraine, comes on without any of the aforementioned aura. Less common is migraine aura without headache, also called silent migraine, which involves the occurrence of aura, but not followed by a headache. (2)

What causes migraine?

It is believed that migraines occur due to temporary changes in the brain, causing it to function abnormally. The root cause of these changes has not been established, but it is known that in many sufferers, there are particular ‘triggers’ that induce a migraine attack. Triggers differ from person to person and may include sudden changes in temperature, stress, strong emotions, low blood sugar, bright light or loud sounds, and sleep deprivation. In some women, migraines occur at the start of their period, or a few days before. This is thought to be caused by the drop in steroid hormones that precedes a period, creating a withdrawal headache. Some people find that certain foods and drinks bring on a migraine, such as alcohol, caffeine, cheese and chocolate. However, it is thought that sufferers may experience cravings for some of these products as part of the prodromal (pre-headache) stage of the migraine, in which case consumption of said products would not be a trigger, but a symptom. (3)

It can be useful for sufferers to keep a diary of what seems to trigger their migraines, so that they can try to avoid these triggers where possible in future. (3)

How is migraine treated?

There are a number of medications available to treat migraines, including:

• Painkillers such as paracetamol, ibuprofen, aspirin and co-codamol can be helpful, especially if taken as early on in the attack as possible. This is because the gut becomes sluggish during a migraine, meaning tablets or capsules will take longer to dissolve and be absorbed. If painkillers cannot be taken as soon as possible, an effervescent tablet form which is dissolved in water before taking is the best option.

• Triptans such as sumatriptan and zolmitriptan are the next step if painkillers are not enough to ease migraine. They work by undoing the temporary changes in the brain that induce symptoms.

• Anti-emetics such as metoclopramide and domperidone are traditionally used to relieve nausea and vomiting associated with migraine, but may relieve migraines themselves, even if there is no nausea or vomiting present.

• Combination medicines combine painkillers with anti-emetics in one convenient tablet.

With painkillers and triptans, it is important not to use them too frequently as this can cause medication overuse headache. If you find that you are needing to use these medicines frequently, see your GP for an alternative or preventative medication. (4)

How is migraine prevented?

As well as avoiding triggers, medication can be taken to prevent migraine attacks from developing in the first place.

• Topiramate, originally used as an antiepileptic, can be taken once a day as a tablet to prevent migraines.

• Propranolol is a type of medicine known as a beta-blocker, originally used for high blood pressure and angina, which has also been found to help prevent migraines. It is available in tablet form and is taken daily in a single or divided dose.

• Botulinum toxin type A, also known as botox, is a toxin derived from the botulinum bacteria which paralyses muscles. It is given in injection form to numerous parts of the head and neck for migraine sufferers experiencing attacks on 8 or more days each month and have had no success with other preventative medications.

• For migraine related to the onset of a menstrual period, non-steroidal anti-inflammatory drugs (NSAIDs) or triptans can be taken from two days before the period begins to the end of the period to prevent migraine. Alternatively, hormonal contraceptives may be used or oestrogen patches or gels applied from three days before the beginning of the period and stopped after a week.

• Acupuncture can be tried as a last resort. (5)

If you think you may be experiencing migraine, or you are taking treatment but it is not working effectively, see your GP.

References

1. National Health Service. Migraine [cited 29 September 2017]. Available from: http://www.nhs.uk/Conditions/Migraine/Pages/Introduction.aspx
2. National Health Service. Migraine - Symptoms [cited 29 September 2017]. Available from: http://www.nhs.uk/conditions/migraine/Pages/symptoms.aspx
3. National Health Service. Migraine - Causes [cited 30 September 2017]. Available from: http://www.nhs.uk/Conditions/Migraine/Pages/Causes.aspx
4. National Health Service. Migraine - Treatment [cited 30 September 2017]. Available from: http://www.nhs.uk/Conditions/Migraine/Pages/Treatment.aspx
5. National Health Service. Migraine - Prevention [cited 3 October 2017]. Available from: http://www.nhs.uk/Conditions/Migraine/Pages/Prevention.aspx

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 10/10/17

The urinary tract is composed of the urethra, bladder, ureters and kidneys. The blood is filtered through the kidneys to remove waste products and excess water, forming urine. This then travels along the ureters to the bladder, where it is stored until the person passes the urine out of their body via the urethra.

Urinary tract infections (UTIs) can occur in any of these four areas. Depending on the location, the infection may be labelled as urethritis (urethra), cystitis (bladder), ureteritis (one or both ureters) or a kidney infection. (1)

Classic symptoms include a frequent, urgent need to pass urine (often in small amounts), a stinging or burning pain when passing urine, and lower abdominal pain. However, the urine may also contain blood and may have an unpleasant smell and/or a cloudy appearance. The person affected may feel generally unwell, and elderly sufferers sometimes even experience confusion. (1)

What causes UTIs?

The most common cause of a UTI is when faecal bacteria such as E. coli from the back passage get into the urethra. This happens more frequently in women than men, because there is a shorter distance between the openings of the urethra and back passage. Furthermore, the urethra itself is shorter in women, meaning the bacteria don’t have as far to travel to reach the bladder and higher portions of the urinary tract, leading to infection. (1) The urinary tract is usually a sterile (bacteria free) environment, so it can be quickly overwhelmed by invasive bacteria which have no competition for space and nutrition.

Other causes include conditions in which block part of the urinary tract, such as kidney stones; an enlarged prostate in men, which can make complete emptying of the bladder hard; a poorly functioning immune system, which increases a person’s susceptibility to bacterial infections; using a catheter; and pregnancy. (1)

How are UTIs treated?

For women, sodium or potassium citrate sachets are available that can be used at the first sign of a UTI. They help to reduce the acidity of the urine, therefore easing symptoms while the body fights the infection. One sachet is dissolved in a glass of water and taken three times a day for two days. If the symptoms persist or recur after this course, a GP appointment must be made as antibiotics may be needed to clear up the infection.

Men, pregnant women and children must be booked in to visit their GP upon the development of any UTI symptoms. Anyone with lower back or side pain, a raised temperature, chills, nausea, vomiting or diarrhoea related to a UTI should make an emergency appointment with their GP, as the infection may have spread up the urinary tract to the kidneys, which will need urgent treatment. (1)

Trimethoprim is the antibiotic of first choice for simple UTIs affecting the urethra and/or bladder. Nitrofurantoin, cephalosporins or norfloxacin can be used as an alternative if the former is unsuitable, or the higher portions of the urinary tract are affected. Courses of antibiotics must always be completed, even if symptoms have ceased, otherwise the infection may not be fully treated and may recur.

Paracetamol may also be taken for pain relief. (1)

Can UTIs be prevented?

There is no failsafe way to prevent UTIs, but there are steps that can be taken to make developing a UTI less likely. Always wipe from the front to the back after using the toilet, to prevent transfer of faecal bacteria to the urinary tract. Wear loose fitting, breathable underwear and try to use fragrance free body washes and soaps in the intimate area. Drink plenty of water, try not to hold in urine for too long and be sure to completely empty the bladder when you go to the toilet. Also, pass urine as soon as possible after sex to flush out any bacteria that have entered the urethra. (1)

If, despite following these steps, you still suffer with recurrent UTIs, your doctor may prescribe low dose antibiotics to help keep them at bay, or refer you to a specialist for further investigation.

National Health Service. Urinary tract infections (UTIs) [cited 24 September 2017]. Available from: https://www.nhs.uk/conditions/urinary-tract-infections-utis/

Author: Gabby Gallagher MPharm

Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 26/09/17

It was once a condition typically associated with rich, overweight, port-drinking men and was grossly misunderstood. Nowadays, due to changes in diet and lifestyle, gout is much more common within the general population. Fortunately, we have the knowledge and means to manage it in an effective way, and we don’t have to resort to trying the bizarre ‘remedies’ of bygone times!

“Roast a fat old goose and stuff with chopped kittens, lard, incense, wax and flour of rye. This must all be eaten, and the drippings applied to the painful joints” - Lorenz Fries, 1518 (1)

What is gout?

Gout is a form of arthritis (inflammation of the joints) which affects up to one in fifty people in the UK, mostly men over 30 and post-menopausal women. It typically occurs in the joints at or towards the extremities of the body – the toes, fingers, ankles and wrists – but it can develop in any joint. (2) In people affected by gout, the inflammation is caused by build-up of crystals composed of sodiumurate within and around the joints. (3) This leads to joints becoming painful, swollen and hot, with associated tenderness. The skin surrounding the affected joints may also take on a shiny appearance. Attacks of gout come on all of a sudden, with symptoms peaking after a few hours. This persists for three to ten days, after which symptoms subside. However, the gout will most likely recur at some point. (2)

What causes gout?

Uric acid is a metabolite (breakdown product) of purines, which are substances occurring naturally in the body. Purines are also found in certain foods. The more purine-containing foods a person eats, the higher the levels of uric acid in their blood. Excess uric acid can be filtered out of the body via the kidneys, but if there is too much for the kidneys to deal with, it can begin to be deposited at the joints as sodium urate crystals. Unbeknown to them, a gout sufferer will have had these crystals developing in their joints for years previous to their first attack. It is only when the hard crystals build up so much that they invade the joint cavity and come into contact with the soft tissue within the joint that symptoms develop. Over time, the crystals may grow to such a size that they form tophi that can disfigure the joint and be seen through the skin, occasionally even erupting through the skin. (3)

Gout can run in families due to a genetic link, so if you have a relative who suffers with gout you may be more likely to develop the condition yourself. (2)

How can gout be treated?

The aim of treatment during an attack of gout is to provide symptomatic relief (reduce pain and inflammation).

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, etoricoxib and naproxen are the first port of call in treating an attack of gout. They ease the inflammation and reduce pain. They should be taken as soon as symptoms start to develop and should be continued throughout the attack and for the following 48 hours once symptoms have subsided.

• Colchicine also reduces pain and swelling in affected joints and can be used as an alternative to NSAIDs if they are unsuitable or have failed to provide relief.

• Corticosteroids also target inflammation and pain as a last resort for severe gout or if other treatments are unsuitable. They may be administered in tablet form, or as an injection to provide instant relief. (4)

How can gout be prevented?

Both medication and lifestyle modifications can provide protection from gout attacks.

• Allopurinol taken once daily is the first choice preventative medication for gout. It works by decreasing uric acid production in the body, thereby decreasing blood uric acid levels. However, once started, it may trigger an attack of gout and attacks may continue for up to two years before the preventative effects of allopurinol kick in.

• Febuxostat is an alternative once daily medication that also lowers uric acid production. Like allopurinol it can cause an attack of gout at the beginning of therapy.

• Benzbromarone and sulfinpyrazone can be initiated by a specialist if other preventative medication has failed or is unsuitable. (4)

Lifestyle changes play an important role in preventing gout. Steer clear of foods containing high levels of the purines which raise uric acid levels such as red meat, offal (liver, kidneys, heart and sweetbreads), game, seafood, oily fish and meat or yeast extracts (Marmite, Bovril and gravy). Cutting down on alcohol will help as not only does alcohol stimulate the production of uric acid, it is also metabolised to lactic acid which slows the filtration of uric acid out of the body by the kidneys. Beer in particular should be avoided, as the fermentation process used in its production results in a high purine content. Maintaining a healthy weight will also help to keep attacks at bay, as being overweight increases uric acid levels and puts more strain on some of the joints that can be affected by gout. Additionally, drink plenty of water, as this can help your kidneys to flush out the excess uric acid and to stop it turning into crystals. (5)

Visit your GP if you think you may have gout, or if you do have gout and your medication hasn’t eased your symptoms within two days.

References

1. Fries L (1518). Spiegel der Artzny. Strasbourg: Grüninger.

2. National Health Service. Gout [cited 18 September 2017]. Available from: http://www.nhs.uk/Conditions/Gout/Pages/Introduction.aspx

3. Arthritis Research UK. What causes gout? [cited 18 September 2017]. Available from: https://www.arthritisresearchuk.org/arthritis-information/conditions/gout/causes.aspx

4. National Health Service. Gout – Treatment [cited 18 September 2017]. Available from: http://www.nhs.uk/Conditions/Gout/Pages/Treatment.aspx

5. UK Gout Society. All about gout and diet. Available from: http://www.ukgoutsociety.org/docs/goutsociety-allaboutgoutanddiet-0113.pdf

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 20/09/17

Dementia[1]  currently affects one in three people in the UK over the age of 65, with the number set to inevitably rise as time progresses due to an ever aging population. (1) So more than ever, it is important as a society to be aware of the signs and how we can help sufferers, their families and friends in their battle with the condition.

Dementia is far more than just ‘losing your marbles’. It is a wide range of symptoms linked to deterioration in brain function, caused by diseases of the brain. It not only affects memory, but language, perception of the world around them, reaction times and judgement. A black mat on the floor may appear to a dementia sufferer as a gaping hole, or a shiny surface may be perceived as wet. Many aspects of life become more difficult, including decision making, socialising, and thinking of the right words to use in conversation. (1) People with dementia may become more isolated in turn, either avoiding social situations or losing the company of friends and family who now struggle to know how to act around them.

The causes and symptoms can vary depending on the type of dementia.

Alzheimer’s Disease

This is the most common form of dementia. It is caused by ‘plaques’ of protein and ‘tangles’ of fibres forming in and around brain cells. This results in damage to the nerve cells which relay signals in and out of the brain, and also brain shrinkage. (2) One of the earliest symptoms is short term memory loss – the affected person may struggle to remember the name of someone they have recently met, or ask the same question over and over again. As more areas of the brain become damaged, more symptoms will appear, such as a reduction in organisational skills, confusion, reduced ability to problem solve and mood changes. (3)

Vascular dementia

Vascular dementia occurs when the blood supply to the brain is compromised, which leads to damage and death of brain cells. This can be a result of a stroke or ‘mini’ strokes, or blood vessels within the brain becoming narrowed or blocked. Symptoms include sluggish thoughts, waning concentration, disorientation and balance problems. (4)

Dementia with Lewy bodies

This form of dementia is caused by proteins accumulating inside brain cells and forming deposits known as Lewy bodies. It is believed that these deposits disrupt normal signalling between brain cells, leading to difficulties with movement and processing visual information, sleep disturbances, and alternating periods of alertness and confusion. (5)

Frontotemporal dementia

A less common type of dementia, frontotemporal dementia develops when protein deposits form specifically in the front and side sections of the brain (frontal and temporal lobes). These areas are responsible for the regulation of behaviour, speech and organisation. Therefore, associated symptoms include behavioural changes – selfishness and lack of empathy, impulsiveness and reduced motivation; slow and disordered speech, and reduced planning abilities. (6)

Treatment and management of dementia

Unfortunately, in most cases, dementia will only get worse as time goes on. That’s why it is essential to get a diagnosis as early on as possible and embark on the treatment that is available for some types of dementia, which should help to slow the progression of the condition.

• Acetylcholinesterase inhibitors include donepezil, galantamine and rivastigmine andare used for mild to moderate Alzheimer’s Disease and dementia with Lewy bodies. They work by stopping the breakdown of a chemical released by nerve cells called acetylcholine, which helps the cells to communicate. These medicines may cause heart problems, so ideally patients should be monitored via electrocardiogram (ECG). (7)

• Memantine is given in severe Alzheimer’s Disease, or when acetylcholinesterase inhibitors are unsuitable or ineffective. It works by blocking glutamate, a chemical that is released in large amounts in Alzheimer’s Disease sufferers and worsens the damage to the brain. (8)

• Antidepressants can be used in dementia patients suffering with depression, which is often linked to their struggle with dementia.

• Antipsychotics can be issued when aggression and other behavioural problems associated with dementia may pose a threat to patients themselves or others. However, the risks versus benefits should be thoroughly considered, as these medicines may aggravate the remaining dementia symptoms.

• Psychological treatments may help to ease symptoms of dementia, but will not prevent symptoms from getting worse. They comprise cognitive stimulation therapy and reality orientation therapy which are designed to help memory and state of mind, validation therapy which may help sufferers to be less affected by perceived irrational thoughts, and behavioural therapy, designed to help with problems such as aggression and depression. (7)

Helping people with dementia

As dementia progresses, sufferers will likely become more and more dependent on family, friends and other caregivers to look after them. Still, there are numerous ways in which you can help someone with dementia keep their mind active and experience pleasure in their day to day life.

Focus on helping the person to enjoy themselves. If they have a hobby it can be very helpful for them to continue with this to keep their mind active, as long as their condition allows. There might be a certain song or photograph that helps them to revisit and talk about happy memories from younger days, as long-term memory is usually much less affected than short-term.

Assist the person where possible with everyday tasks they now find more difficult, but be careful not to completely take over unless they want you to, as this may reduce their sense of self-worth. Also, do not be critical as this will probably discourage them from independent task handling in future.

Some people with dementia may find that taking part in creative activities or joining social groups really helps them to feel accomplished and improve their quality of life.

This information is not exhaustive and much more support and guidance can be found online. Visit www.dementiauk.org or take six easy steps to become a Dementia Friend at www.dementiafriends.org.uk/register-digital-friend.

References

1. National Health Service. About dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-guide/Pages/about-dementia.aspx

2. National Health Service. Alzheimer’s disease – Causes [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/Alzheimers-disease/Pages/Causes.aspx

3. National Health Service. Symptoms of dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-guide/Pages/symptoms-of-dementia.aspx#alz

4. National Health Service. Vascular dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/vascular-dementia/Pages/Introduction.aspx

5. National Health Service. Dementia with Lewy bodies [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-with-lewy-bodies/Pages/Introduction.aspx#causes

6. National Health Service. Frontotemporal dementia [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/frontotemporal-dementia/Pages/Introduction.aspx#treatment

7. National Health Service. How is dementia treated? [cited 6 September 2017]. Available from: http://www.nhs.uk/Conditions/dementia-guide/Pages/dementia-treatment.aspx

8. Alzheimer’s Society. Drug treatments for Alzheimer’s disease [cited 6 September 2017].  Available from: alzheimers.org.uk

   Author: Gabby Gallagher MPharm

   Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 14/09/17