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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
What antihistamines would work faster in nasal allergies; PO or nasal?
Nasal - fast acting + control breakthrough symptoms
26
How long could nasal decongestants be used for if buying OTC?
7 days due to rebound congestion. PO steroids are not recommended.
27
When would you offer sodium cromglicate 2% over nasal steroid preps?
Mild symptoms, seasonal + limited exposure
28
What can be used for mod-sev rhinitis?
Topical steroids and if v.severe short course of PO steroids to combat mucosal oedema
29
If watery rhinorrhoea persists despite being on topical corticosteroids and antihistamines, what can be added?
nasal ipratropium but has no effect on further symptoms
30
when would you consider montelukast for allergic rhinitis?
Patients with concomitant asthma
31
Which topical nasal steroids have a very small effect on rhinitis?
Fluticasone | Mometasone
32
Which topical nasal steroids have a high effect on rhinitis?
betamethasone
33
What should be monitored in children recieving various forms of steroids?
Growth
34
Recommendations for pregnant women with allergic rhinitis?
OTC: sodium cromoglicate POM: steroid nasal sprays e.g fluticasone has the lowest systemic absorption Steam inhalation
35
How do nasal decongestants work?
Vasoconstriction of blood vessels = reduced oedema
36
Options for eliminating nasal staphylococci?
Naseptic: neomycin and chlorhexidine (naseptin) or mupirocin: also used or MRSA eradication in a hospital setting.
37
Age category for OTC pseudoephedrine and ephedrine?
pseudo - 720mg Ephed - 180mg 6yrs+ and max 5days treatment
38
What can OTC decongestants interact with to cause a hypertensive crisis?
MAOIs
39
Risks of using decongestants in <6yrs:
death, psychosis, ataxia, hallucinations
40
what is sinusitis?
Inflammation of the mucosal lining in the nose
41
Symptoms of sinusitis?
nasal congestion, blockage, discharge, dental/facial pain, loss of smell
42
Sinusitis is self-limiting within ________
2-3weeks
43
Rarely, sinusitis can lead to:
Skeletal/orbital/intracranial complications
44
Sinusitis <10days what do you recommend?
Self-care: saline washes, olbas oil sticks, | analgesia
45
Sinusitis >10days what do you recommend?
High dose nasal steroids e.g. fluticasone and mometasone - 14 days (unlicensed) backup 7 day rx of antibiotics if symptoms worsen
46
Patient and carer advice for ipratropium nasal spray?
Avoid contact with eyes due to risk of ocular complications
47
MHRA warning with corticosteroids of any route?
Serious chorioretinopathy: report blurred vision, visual disturbances
48
Budesonide can be sold to the public. What age category? What max daily dose? and max period of time for use?
18+ Max single dose: 200mcg/nostril Max 3 month period Pack size 10mg Prevention and tx of seasonal allergic rhinitis
49
Fluticasone can be sold to the public. What age category? What max daily dose? and max period of time for use?
18+ Max 100mcg/nostril Daily: max 200mcg/nostril for 3 months 3mg pack Prevention and tx of seasonal allergic rhinitis
50
Dry mouth can be caused by various drugs. Name some drug classes:
Antimuscuranics TCA Antipsychotics Diuretics
51
Consequences of persistent dry mouth
Poor oral hygiene Inc cavities Inc infections denture intolerance
52
Lifestyle measures to relieve dry mouth?
``` Frequent sips Water Chewing or sucking on ice chips Sucking sugar free pastilles Sugar free gum stimulates salivation ```
53
Pharmacological treatment for dry mouth?
Artifical saliva e.g. saliveze
54
Disadvantages of lozenges/sprays?
Sore tongue and sore lips
55
Are mouthwashes effective?
Only a mechanical cleanse. Must use regularly and vigorously. Can mix half a teaspoon of salt in warm water which is very effective
56
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?
Mouthwash with hydrogen peroxide (check salt content if hypertensive) - due to anaerobic organisms
57
Chlorhexidine mouthwash is effective for ____
inhibiting plaque formation but is not a substitute for regular toothbrushing
58
Prolonged use of chlorhexidine can cause
brown staining of teeth and tongue
59
Age restriction for the use of chlorhexidine?
12yrs+
60
Advise for sodium fluoride toothpaste?
Rinse mouth after 3 minutes. Do not eat or drink 30 mins after using.
61
How long after should mouth ulcers be referred and why?
>3 weeks to exclude oral cancer
62
OTC treatment for mouth ulcers?
saline washes anitseptic washes lidocaine containing gels e.g. bonjela - limited evidence and short acting benzydamine/flurbiprofen - anti inflammatory and antiseptic
63
Abx treatment for pericoronitis (inflammation of soft tissue around crown)?
Only treat if there is accompanying systemic infections 1) Metronidaole 2) Amoxicillin 3 day or longer until symptoms resolve
64
Abx treatment for gingivitis? - acute necrotising
Metronidazole or amoxicillin - 3 days or until symptoms resolve
65
Abx treatment for dental abscess?
Amoxicillin or metronidazole - 5 day treatment
66
Abx treatment for peridontitis (gum infection)?
Metronidazole Doxycycline if 12yrs+
67
Abx treatment for acute sore throat?
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
Fungal infections of the mouth are often caused by:
Candida e.g oral thrush
69
Treatment for oral thrush/fungal infections:
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
Miconazole is contra-indicated in a patient taking _________
warfarin - as potent enzyme inhibitor and increases the risk of bleeding
71
Miconazole is not licensed for:
children <4months
72
OTC licensing for miconazole?
4months+ | Daktarin oral gel 2% available OTC
73
Patient and carer advice for nystatin or miconazole admin?
Hold in mouth after food
74
Most common cause of a sore throat?
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

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