Cases Flashcards
Mrs Thompson comes into your pharmacy asking for something for her husband (aged 53). She thinks he has the symptoms of a cold and wishes to purchase an oral decongestant because he used one before and it worked well for him. He takes simvastatin and lisinopril.
Discuss your treatment option and considerations.
Mr Thompson is suffering from a cold.
Paracetamol 1g QDS prn may be appropriate if he has a headache/sore throat.
He is taking lisinopril for hypertension, so an oral decongestant is not suitable. Could recommend steam inhalation or possibly a topical decongestant.
Mrs O’Hara (aged 40) comes into your pharmacy requesting something for a cough she has had for the past 2 days. From the information gathered it can be concluded that Mrs O’Hara is type 2 diabetic and has a productive chesty cough. Mrs O’Hara currently takes metformin, aspirin, atorvastatin and ramipril.
Discuss your treatment option and considerations.
Mrs O’Hara has a productive cough.
A sugar free preparation should be chosen to eliminate any risk (Robitussin).
Guaifenesin is an expectorant this should relieve chesty coughs by stimulating bronchial mucus secretion
Sugar free lozenges may also be recommended to soothe her sore throat as this is most likely caused by her persistent cough.
Although she is diabetic, as she is type 2, counselling on blood glucose levels is not as essential.
Mrs Smith comes into your pharmacy and would like something for her eyes as they are red and itchy. Symptoms are worse in the evening. She also has a runny nose and thinks she may
be getting a cold.
Discuss your treatment option and considerations.
Mrs Smith is presenting with symptoms of seasonal rhinitis.
Lifestyle advice is essential.
Oral antihistamines may be beneficial, consider the sedative side effects of chlorphenamine.
Beconase may be appropriate if nasal symptoms are particularly frustrating.
Sodium cromoglicate eye drops (also available in nasal spray) is available and acts as a mast cell stabiliser to prevent eye symptoms.
Mrs Scott comes into your pharmacy and wants to buy something for her 16 year old son’s sore throat. He is at home and wants something effective as soon as possible
He has tried some Strepsil lozenges and paracetamol but they’re not helping.
Discuss your treatment option and considerations.
Oral analgesics would be the most appropriate control, paracetamol 1g QDS prn. Soluble form may be beneficial if his throat is particularly sore.
Benzydamine (Difflam spray or mouthwash)
Reduces local pain and inflammation in the mouth and throat
Local anaesthetic (Benzocaine – Ultra Chloraseptic) numbs the throat and hence relieves pain. May also get benzocaine lozenges.
It is essential to consider to likelihood that he is suffering from glandular fever or tonsillitis.
Mr Kelly comes into the pharmacy requesting a cough medicine as he has been up all night with a dry cough.
He hasn’t tried anything yet but is anxious to get something which will help stop the cough and help him get some sleep.
Discuss your treatment option and considerations.
Cough Suppressants are useful in unproductive coughs especially where sleep is being disturbed. Pholcodine Linctus 10ml 3 to 4 times daily or Dextromethorphan.
Demulcents (eg. honey and lemon, glycerin, simple linctus) have no active ingredient but are used for their soothing effect
Antihistamines are found in a number of OTC cough suppressants (Benylin dry cough) added for their ability to dry up secretions and induce drowsiness, therefore when given at night they aid a restful sleep
Mr Wong comes into your pharmacy and asks you for a cough suppressant for his daughter (aged 4). She has had a cough for almost a month now and it is worse at night. It disturbs her sleep and Mr Wong has growing concerns about it, he would like something that will suppress his daughter’s cough which will also help her sleep.
Discuss your treatment option and considerations.
Mr Wong is requesting a cough suppressant which in this case would be unsuitable. Night cough can often be the first presenting symptom of asthma in children.
REFER
A middle aged man comes into the pharmacy seeking advice about his wife’s sore throat. She has had a hoarse voice for just over 1 month and has tried a number of different lozenges but none are effective. On further questioning you find out that Mrs Jones has smoked 20 cigarettes a day for over 30 years.
Discuss your treatment option and considerations.
Mrs Jones should be referred to her GP. This patient has a long term history of smoking and various failed OTC products. This is not a typical case of inflamed vocal cords (laryngitis).
A female patient (aged 40) would like something to help with a chesty cough. She describes the cough as productive with a lot of thick sputum that is a green/brown colour.
Discuss your treatment option and considerations.
This patient is describing symptoms that indicate a possible bacterial infection and she should be referred as it is likely she will need treatment with an antibiotic.
Advise steam inhalation in the short term until she can see her GP. This will help to help liquefy secretions and help clear the chest.
Mrs Simpson comes into your pharmacy and is looking to buy something for diarrhoea. When asked she states it is for her daughter (aged 10) who has been having watery stools since yesterday evening and is on no other medication.
Discuss your treatment option and considerations.
Oral rehydration therapy would be the only option for this patient. Dehydration is the biggest risk for diarrhoea especially in young children/babies and elderly.
Maintaining fluid intake is vital.
The diarrhoea is likely to pass within 24 hours and if it doesn’t she should visit her GP.
Mrs Price (aged 28) comes into your pharmacy asking for some senna. Her friend recommended it to her when she told her she was suffering from constipation. However, Mrs Price looks pregnant when she presents to your pharmacy.
Discuss your treatment option and considerations.
Constipation is common in pregnancy due to hormonal changes/ the baby occupying more room in the abdomen.
Therefore, Mrs Price can be given treatment but senna is not an appropriate choice as stimulant laxatives should be avoided in pregnancy.
Advice on increasing intake of fluids and fibre.
Could use a bulk forming laxative (e.g. ispaghula husk) although some abdominal discomfort may be experienced.
Mr Jackson (aged 58) comes into your pharmacy requesting Zantac for his indigestion. He has tried Rennies and Gaviscon already with no relief. Symptoms started about two and a half weeks ago, the pain is severe and he has lost weight in this time and is more tired than usual.
Discuss your treatment option and considerations.
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The patient has tried two treatments which were both ineffective. Ensure you investigate further if they used this product for an appropriate length of time and at appropriate doses before stating treatment failure, but in this case the patients symptoms seem to be worsening
Severe pain and loss of weight, location and duration of pain should be determined.
Persisting upper abdominal pain and associated ALARM symptoms could suggest GI cancer….this patient mentions weight loss and tiredness!
Patient has been experiencing persisting symptoms and is over 55 years of age suggesting their complaint could be more serious than just simple indigestion.
Ms Smith (age 29) attends your pharmacy looking for something to ease the pain of her mouth ulcer, she has had them before on a few occasions, the lesion appears to be small white and round with a red outer edge on the inside of her lip. She is on no other medication and has had the mouth ulcer for one day.
Discuss your treatment option and considerations.
Local analgesics such as Benzydamine mouthwash or spray or Choline salicylate gel (e.g. Bonjela).
Chlorhexidine Mouthwash is useful in hard to reach areas. More appropriate if the ulcers are likely to be caused by infection such as gingivitis.
Lidocaine/ benzocaine: Help numb the pain, gels and liquids may be applied using a cotton bud provided you can access the ulcer.
A female (aged 52 years) requests something for her husband to treat piles. He has had the condition before probably exacerbated by sitting down all day at work. He has used a cream before but can’t remember the name. He would like the most effective treatment for fast relief. He takes lisinopril.
Discuss your treatment option and considerations.
Local anaesthetics such as Benzocaine and lidocaine, provide relief from itching and any associated pain. Strength of anaesthetic reflects age limit, therefore always check product.
Topical steroids such as hydrocortisone, give relief from inflammation and swelling. They can also contain skin protectants, to soothe the perianal skin and act as a barrier. This is likely to give the fastest relief.
Products containing zinc oxide and bismuth are thought to offer protection to broken or irritated skin.
A woman (aged 25) asks you to recommend something for diarrhoea. She has had it for less than a day. On questioning further she explains that she is bloated all the time and sometimes suffers from intermittent constipation. Her bowel habit has been alternating for the last few months and she finds it rather frustrating . She hasn’t had time to make an appointment with her doctor as she works a lot so she is hoping you can give her something today that will get her back to her normal routine.
Discuss your treatment option and considerations.
It sounds like the patient has IBS. It is commonly associated with young adults. It should be first diagnosed by a doctor before treating over the counter.
If this patient had already been diagnosed by her doctor the treatment options available are:
Mebeverine 1-2 tds, with water, do not chew.
Peppermint oil 1-2 tds, 15-30mins before food, do not chew as this will cause the
treatment to be ineffective but also cause irritation to the mouth and oesophagus Loperamide can be offered for short-term relief
Bulk-forming laxatives help with constipation making stools softer and easier to pass.
Lifestyle advice is essential.
A woman presents at your pharmacy stating that she is going on a driving holiday to France. She would like something for travel sickness as she doesn’t like long journeys and tends to get very ill. On questioning, you find out that she would also like something for her daughter. She is 34 years old and her daughter is 6 years old.
Discuss your treatment option and considerations.
Hyoscine hydrobromide is likely the most appropriate option. Suitable for over 3 years old, anticholinergic SE’s, short duration of action, therefore take 20-30 mins before journey or at onset of nausea. Also available as a patch and less risk of sedation.
