A4. Common peadiatric conditions Flashcards
Describe hay fever
-Can present at any age
Symptoms :
-Runny and/or itchy nose
-Itchy, runny or red eyes
-sneezing
treatment for hayfever?
OTC treatment – age dependent:
Eye drops - sodium cromoglicate 2%
Nasal drops – saline
Oral – chlorphenamine, cetirizine
Formulation choice?
red flag symptoms for hay fever?
-failed OTC treatments
-SOB/ Wheeze
-Pain head, ear, sinuses
< 2 years
Describe eczema
Atopic Eczema
GP for initial diagnosis
-Red, itchy skin creases
-Dry skin
red flag symptoms for eczema? and how can it be treated?
-signs of infection
-no response after 7 days
-steroid
management for eczema?
Nonpharmacological advice:
-Emollients and soap substitutes
-Prescribed or purchased
Topical steroids :
-Age/usage restrictions – not on face
-Side effects
red flags for eczema?
-signs of infection
-no response after 7 days steroid
Describe headlice and worms- other causes of itching
-Persistent head scratching sometimes with visible lice
-Very common in primary school age children
-Harmless!
-Reassurance of parents not a sign of poor hygiene (in fact opposite)
treatment for headlice?
-Non-pharmacological management – keep hair short or tied back
-Wet combing
-Pharmacological treatment :OTC products available
red flag for headlice?
<6 months
Describe threadworms
-Very common in young children
-Itching around anus, worst at night, sometimes visible in faeces
treatment for threadworms?
Non-pharmacological:
-Hand washing
-Strict hygiene
Pharmacological:
OTC products - mebendazole
red flags for threadworms?
-weight loss
-persistent stomach ache after 2 weeks
-persistent symptoms after 2 weeks of treatment
Describe tonsilitis
Infection of the tonsils (back for the throat)
Average age 5-15
signs and symptoms of tonsilitis?
-Sore throat/ pain on swallowing
-Raised temperature
-Difficulty eating (and drinking)
-Pharmacy First?
red flags for tonsilitis?
-Severe symptoms
-Difficulty swallowing
-Ongoing pain/ inflammation despite analgesia (>4 days)
-No improvement within 48hrs of antibiotics if given
-Unable to tolerate oral fluids
management of tonsilitis?
-Analgesia: Paracetamol or ibuprofen,NOT aspirin under 16 years of age, Topical sprays?
-Fluids
-Rest
-Children should NOT gargle with salt water!
-Antibiotics (if signs of bacterial infection): Pharmacy First?
-Tonsillectomy if recurrent
What is meningitis?
Meningitis is the infection of the meninges around the brain and spinal cord
general symptoms of meningitis?
-High temperature
-Headache
-Cold hands and feet
-Vomiting
-Confusion
-Rapid Breathing
-Pale, mottled or blotchy skin
-Rash
-Aches and pains
symptoms of meningitis in babies?
-Refuse feeds
-Be irritable
-Have a high-pitched cry
-Have a stiff body or be floppy or unresponsive
-Have a bulging soft spot on the top of their head
treatment of meningitis?
-Urgent referral of suspected cases
-Will require hospital diagnosis and management
-May be given antibiotics if bacterial meningitis suspected BEFORE confirmation
-Treatment is with high dose antibiotics
Vaccinations for meningitis?
Some strains added to the UK vaccination schedule:
-Meningitis B- 8 weeks, 16 weeks 1 year,
-ACWY – 14 years
red flags of meningitis?
confusion, tachypnoea, muscle and joint pain, stiff neck, pale, mottled or blotchy skin, non blanching rash, photophobia
Describe type 1 diabetes?
-Autoimmune condition - cause unknown
-Insufficient insulin produced resulting in an accumulation of glucose in blood
-Lifelong condition
-Average age of diagnosis = 13 years
-Long term complications – neuropathy, retinopathy, nephropathy
symptoms of type one diabetes?
-Polydipsia
-Polyuria
-Weight loss
-Fatigue
management of type 1 diabetes?
-Patient education
-Monitoring – blood sugars
-Finger prick test, Continuous Glucose Monitoring (CGM) or Flash Glucose Monitoring
-Blood glucose 4-7 mmol/l
-HbA1c – personalised target
-Insulin – SC injections
-Lots of different types of insulin with very similar names
-Risk of poor compliance (particularly in adolescent/ young adult populations)
Pharmacists role for type 1 diabetes?
-Ensuring supply of medication:
Managing shortages, Keeping adequate stock
-Support with equipment: Patient counselling on use, Advice around waste disposal
-Practical advice; Eg travelling with medicines such as insulin
-Signposting and advice: Support organisations and reputable sources
-Supporting lifestyle modifications:
Diet advice, exercise (?smoking/vaping in older children?)
-Identification of complications: Hyperglycaemia, Hypoglycaemia
-Appropriate referral
what is acne?
-Common skin condition
-Can affect adolescents through all of adulthood but most common in teenagers - based on hormonal changes
presentation of acne?
-Open and closed comedones
-Papules, pustules and nodules (resulting from ruptured comedones)
-Mild, moderate or severe
-Areas affected are commonly:
face – this affects almost everyone with acne
back – this affectsmore thanhalf of people with acne
chest – this affectsabout 15% ofpeople with acne
aims of treatment for teenage skin and acne?
-Heal existing lesions and prevent occurrence of new lesions
-Prevent scarring
-Relieve psychological distress (improve self esteem)
-Reassurance
-Signpost for support
OTC management of acne?
-Topical agents eg benzoyl peroxide
-Can bleach clothing or bedding, can cause skin irritation
-Self help advice (next slide)
POM management of acne?
Oral antibiotics eg a tetracycline
Oral isotretinoin (specialist use
red flags of acne?
-severe acne
-OTC treatment failure
-concerns regarding mental health
Self help advice for teenage skin?
-Wash affected areas of skin maximum twice a day.
-Usea mild soap or cleanser and lukewarm water.
-Do not try to squeeze blackheads or spots, tempting though it may be!
-Avoid make-up, skincare and suncare products that are oil-based (sometimes labelled “comedogenic”).
-Completely remove make-up before going to bed.
-If dry skin is a problem, use a fragrance-free water-basedemollient.
-Regular exercise can boost your mood and improve your self-esteem.
-Shower as soon as possible once you finish exercising
-Wash your hair regularlyand try to avoid lettingyour hair fall across your face
Describe inflammatory bowel disorders?
-Lifelong auto immune conditions- cause is not fully understood
-May present in later teenage years (15 and over)
what are the two types of inflammatory bowel disorder?
Crohns Disease
Ulcerative Colitis
red flag symptoms of inflammatory bowel disorders?
-abdominal pain
-abdominal bloating
-bloody diarrhoea
-unexplained weight loss
-extreme tiredness
-anaemia
management for inflammatory bowel disorders?
-Diagnosed and treatment initiated by hospital
-Aim to initiate remission
-Maintenance therapy
-Flare ups –may require inpatient stay with similar treatment as initiation.
inflammatory bowel disorder in community pharmacy?
-Ensuring supplies of medication
-Supporting patients and their families/carers
-OTC advice
-Patient counselling on medications
-Adherence
-Looking out for adverse drug reactions
-Addressing concerns
-Signposting
-Appropriate referral
Describe mental health
ONE NOTE
Describe Attention deficit hyperactivity disorder (ADHD)
-Identification and/or recognition
-High risk groups – children who were premature, epilepsy, family history, mood disorder, neurodevelopmental disorders
-Symptoms – hyperactivity and impulsiveness
-Diagnoses can only be made by a specialise psychiatrist or paediatrician based on lots of different factors
management of ADHD?
-Education – how this will impact their life (school, social, adult)
-Non-pharmacological advice: ADHD-focused group parent-training programme, CBT
-Pharmacological advice: Medication, Commonly use controlled drugs
risk factors of depression?
-“single recent undesirable life event”
-Family History
-Previous diagnosis of depression or mood disorder
-Looked after children or those known to local safeguarding teams
symptoms of depression
-Irritable or grumpy / on “edge”
-No longer interested in things they used to enjoy
-Tired/ exhausted/ sleeping more than usual or trouble sleeping
-Loss of confidence
-Problem behaviour (particularly older children)
management of depression?
-Managed by CAHMS – either predominantly in community
-Non pharmacological –CBT, healthy lifestyle, family support
-Pharmacological – first line therapy is a SSRI
Describe eating disorder?
-Role in recognising symptoms and sign posting
-Anorexia Nervosa (AN), bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID)
-All need to diagnosed by a specialist
-Community managed where possible
Describe bulimia and binge eating?
-Not always associated with weight loss: harder to identify “as an outsider”
-Change in behaviour related to shame
-Require specialist support after diagnosis
Describe ARFID
-Much younger age group
-Signs – picky eating/ lack of interest, only eat certain foods, associated weight loss
-Risk factors- OCD, ASD, anxiety, ADHD
-Management – vitamin/mineral correction, CBT, Speech and language therapy (SLT)
Describe anorexia
-Highest risk age group 13-17 – can affect males and females
-Signs- low or very low BMI, rapid weight loss, social withdrawal, dieting/restrictive eating, physical signs of malnutrition, laxative misuse,
management of anoxeria?
-specialist care – working towards gaining and maintaining healthy weight
-In-patient admission if needs NG tube for calorie intake or electrolyte monitoring
-Non-pharmacological: Main emphasis – family therapy or individual CBT
pharmacological management of anorexia?
-vitamin/mineral support to prevent re-feeding
-bone protection e.g calcium and vitamin D supplement
-Medications such as antidepressants not routinely offered to <18 and should NEVER be used alone
