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2021 Pre-registration > Chapter 12: Ear, nose and oropharynx > Flashcards

Chapter 12: Ear, nose and oropharynx Flashcards

1
Q

What type of ear issues can a pharmacist usually treat OTC?

A

Only those that affect the external parts of the ear. If there is pain, vertigo or dizziness, the patient must be referred to GP.

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2
Q

If selling Cerumol/Exterol ear drops to help soften wax, what would you need to check?

A

If the patient has any nut allergies. it contains peanut oil

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3
Q

You decide to sell cerumol and other ear drops over the counter. Your assistant asks you how to counsel patients on these, what do you say?

A

Use the drops as directed on the bottle and using a cotton wool plug put some product on there and after each application use in the ear to help retain the liquid

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4
Q

What products would you not recommend a cotton wool plug?

A

peroxide-based - increased risk of hypersensitivity

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5
Q

What is otitis externa?

A

Inflammation of the out ear - usually associated with infection. Chronic: >3months

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6
Q

What type of activity increases the risk and contraction of otitis externa?

A

Swimmers

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7
Q

What kind of organisms are present in those with otitis externa?

A

Staphylococcus e.g. if boil use flucloxacillin
Streptococcus
Pseudomonas - if diabetic/immunocompromised use ciprofloxacin/aminoglycoside

Fungal: Aspergillus niger

Can use topical neomycin/cloquinol but increases risk of fungal growth so max 1 week

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8
Q

What preparations do manufacturers mention contra indications for due to risk of ototoxicity?

A

Gentamicin (aminoglycoside) ear drops (only specialist use) + counsel to report any hearing loss, do a hearing test before and during therapy

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9
Q

Symptoms of otitis externa?

A

Itching, irritation, inflammation, throbbing

Signs HCPs see: red, swollen, eczema-like ear canal and external ear

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10
Q

OTC treatment for otitis externa?

A

1) self-limiting - 3 days
2) Analgesia if fever and pain: para/ibu
3) Itch: antihistamines
4) Pain relief: earex plus (choline salicylate) 1yr+
5) Infection: if mild-mod use acetic acid spray 2% ear calm (poor evidence without adjunct steroid) 12yr+
7) inflammation - corticosteroid

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11
Q

Referral criteria for otitis externa?

A
  • pain in ear
  • OTC failure 48hrs
  • Worsens/hearing loss
  • tinnitus - inner ear issue
  • Mucusy discharge (req abx)
  • > /= 4 days since start
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12
Q

Lifestyle advice for otitis externa?

A

Can be caused by allergy/irritation of canal
Wear ear plugs
Avoid soap/ shampoo in ear

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13
Q

What is otitis media?

A

Inflammation of the middle ear common in children with flu/cold

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14
Q

Symptoms of otitis media?

A

Thrombing, discharge, pain, inflammation, rubbing, fever, irritated

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15
Q

OTC treatment for otitis media?

A

3 days self limiting + analgesia if required

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16
Q

Referral criteria for otitis media?

A

<2yrs and bilateral: need abx

pain not relieved by analgesia

Systemic symptoms: refer to A+E: need abx

No improvement in 72hrs

Increased risk of complication e.g. immunosuppressed

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17
Q

Antibiotic treatment for chronic otitis media?

A

Ciproflox/oflox ear drops or eye drops to use in ear: alternatives to aminoglycosides as they cause otoxicity

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18
Q

Otitis media exacerbation antibiotics?

A

Penicillin or if allergic; erythromycin

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19
Q

Symptoms of ear wax occlusion?

A

Temporary deafness, discomfort, sensation of blockage

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20
Q

OTC treatment for ear wax blockage?

A

Water based: sodium bicarbonate

Oil based: earol/cerumol - DO NOT GIVE IN NUT ALLERGIES contains peanut oil

Peroxide: hydrogen peroxide Otex

Surfactant - Docusate (waksol)

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21
Q

Referral for ear wax?

A

Discharge
Pain
Tinnitus
OTC failure

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22
Q

POM treatment for otitis externa?

A

Staph: Fluclox
Psedomonas: Cipro
Pen allergy/pregnant: macrolides

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23
Q

POM treatment for otitis Media?

A

1) Amoxicillin
2) Co-amoxiclav
3) Macrolides: Clarithro/Erythro

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24
Q

1st line for nasal allergies/irrigation?

A

sodium chloride 0.9%

Mild: antihistamines/topical nasal corticosteroids

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25
Q

What antihistamines would work faster in nasal allergies; PO or nasal?

A

Nasal - fast acting + control breakthrough symptoms

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26
Q

How long could nasal decongestants be used for if buying OTC?

A

7 days due to rebound congestion. PO steroids are not recommended.

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27
Q

When would you offer sodium cromglicate 2% over nasal steroid preps?

A

Mild symptoms, seasonal + limited exposure

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28
Q

What can be used for mod-sev rhinitis?

A

Topical steroids and if v.severe short course of PO steroids to combat mucosal oedema

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29
Q

If watery rhinorrhoea persists despite being on topical corticosteroids and antihistamines, what can be added?

A

nasal ipratropium but has no effect on further symptoms

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30
Q

when would you consider montelukast for allergic rhinitis?

A

Patients with concomitant asthma

31
Q

Which topical nasal steroids have a very small effect on rhinitis?

A

Fluticasone

Mometasone

32
Q

Which topical nasal steroids have a high effect on rhinitis?

A

betamethasone

33
Q

What should be monitored in children recieving various forms of steroids?

A

Growth

34
Q

Recommendations for pregnant women with allergic rhinitis?

A

OTC: sodium cromoglicate
POM: steroid nasal sprays e.g fluticasone has the lowest systemic absorption

Steam inhalation

35
Q

How do nasal decongestants work?

A

Vasoconstriction of blood vessels = reduced oedema

36
Q

Options for eliminating nasal staphylococci?

A

Naseptic: neomycin and chlorhexidine (naseptin)
or
mupirocin: also used or MRSA eradication in a hospital setting.

37
Q

Age category for OTC pseudoephedrine and ephedrine?

A

pseudo - 720mg
Ephed - 180mg

6yrs+ and max 5days treatment

38
Q

What can OTC decongestants interact with to cause a hypertensive crisis?

A

MAOIs

39
Q

Risks of using decongestants in <6yrs:

A

death, psychosis, ataxia, hallucinations

40
Q

what is sinusitis?

A

Inflammation of the mucosal lining in the nose

41
Q

Symptoms of sinusitis?

A

nasal congestion, blockage, discharge, dental/facial pain, loss of smell

42
Q

Sinusitis is self-limiting within ________

A

2-3weeks

43
Q

Rarely, sinusitis can lead to:

A

Skeletal/orbital/intracranial complications

44
Q

Sinusitis <10days what do you recommend?

A

Self-care: saline washes, olbas oil sticks,

analgesia

45
Q

Sinusitis >10days what do you recommend?

A

High dose nasal steroids e.g. fluticasone and mometasone - 14 days (unlicensed)

backup 7 day rx of antibiotics if symptoms worsen

46
Q

Patient and carer advice for ipratropium nasal spray?

A

Avoid contact with eyes due to risk of ocular complications

47
Q

MHRA warning with corticosteroids of any route?

A

Serious chorioretinopathy: report blurred vision, visual disturbances

48
Q

Budesonide can be sold to the public. What age category? What max daily dose? and max period of time for use?

A

18+
Max single dose: 200mcg/nostril
Max 3 month period

Pack size 10mg

Prevention and tx of seasonal allergic rhinitis

49
Q

Fluticasone can be sold to the public. What age category? What max daily dose? and max period of time for use?

A

18+
Max 100mcg/nostril
Daily: max 200mcg/nostril for 3 months
3mg pack

Prevention and tx of seasonal allergic rhinitis

50
Q

Dry mouth can be caused by various drugs. Name some drug classes:

A

Antimuscuranics
TCA
Antipsychotics
Diuretics

51
Q

Consequences of persistent dry mouth

A

Poor oral hygiene
Inc cavities
Inc infections
denture intolerance

52
Q

Lifestyle measures to relieve dry mouth?

A 
Frequent sips
Water
Chewing or sucking on ice chips 
Sucking sugar free pastilles 
Sugar free gum stimulates salivation
53
Q

Pharmacological treatment for dry mouth?

A

Artifical saliva e.g. saliveze

54
Q

Disadvantages of lozenges/sprays?

A

Sore tongue and sore lips

55
Q

Are mouthwashes effective?

A

Only a mechanical cleanse. Must use regularly and vigorously.

Can mix half a teaspoon of salt in warm water which is very effective

56
Q

Someone comes into your pharmacy. They tell you that they experiences gingivitis with their newly prescribed amlodipine. This has now been changed by the GP but they want to buy something OTC to help. What do you recommend?

A

Mouthwash with hydrogen peroxide (check salt content if hypertensive) - due to anaerobic organisms

57
Q

Chlorhexidine mouthwash is effective for ____

A

inhibiting plaque formation but is not a substitute for regular toothbrushing

58
Q

Prolonged use of chlorhexidine can cause

A

brown staining of teeth and tongue

59
Q

Age restriction for the use of chlorhexidine?

A

12yrs+

60
Q

Advise for sodium fluoride toothpaste?

A

Rinse mouth after 3 minutes.

Do not eat or drink 30 mins after using.

61
Q

How long after should mouth ulcers be referred and why?

A

> 3 weeks to exclude oral cancer

62
Q

OTC treatment for mouth ulcers?

A

saline washes
anitseptic washes
lidocaine containing gels e.g. bonjela - limited evidence and short acting
benzydamine/flurbiprofen - anti inflammatory and antiseptic

63
Q

Abx treatment for pericoronitis (inflammation of soft tissue around crown)?

A

Only treat if there is accompanying systemic infections

1) Metronidaole
2) Amoxicillin

3 day or longer until symptoms resolve

64
Q

Abx treatment for gingivitis? - acute necrotising

A

Metronidazole or amoxicillin - 3 days or until symptoms resolve

65
Q

Abx treatment for dental abscess?

A

Amoxicillin or metronidazole - 5 day treatment

66
Q

Abx treatment for peridontitis (gum infection)?

A

Metronidazole

Doxycycline if 12yrs+

67
Q

Abx treatment for acute sore throat?

A

Generally viral and resolves within a week. Abx only for systemic infections.

1) Phenoxymethylpenicillin: 5-10days
2) Macrolides: clarithromycin or erythromycin if pregnant: 5 days

68
Q

Fungal infections of the mouth are often caused by:

A

Candida e.g oral thrush

69
Q

Treatment for oral thrush/fungal infections:

A

1) Nystatin - topical as not absorbed by GI tract
2) Miconazole
3) PO fluconazole if above tx was ineffective
4) If fluconazole resistant: use itraconazole

70
Q

Miconazole is contra-indicated in a patient taking _________

A

warfarin - as potent enzyme inhibitor and increases the risk of bleeding

71
Q

Miconazole is not licensed for:

A

children <4months

72
Q

OTC licensing for miconazole?

A

4months+

Daktarin oral gel 2% available OTC

73
Q

Patient and carer advice for nystatin or miconazole admin?

A

Hold in mouth after food

74
Q

Most common cause of a sore throat?

A

Viral infection e.g. herpes
do not use abx treatment

Can give topical aciclovir zovirax 5xday for 5days GSL or PO aciclovir if very severe lesions

2021 Pre-registration (15 decks)

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