Community Pharmacy Flashcards
What is guaifenesin?
What is the dose?
Expectorant.
6-12yrs (discourage use): 100mg qid
Adults: 200mg qid
What is bromhexine?
Dose? Side effects?
Mucolytic.
8mg tds (up to 16mg tds first week).
SE: N/V/D
How to treat cough in children under 12?
Increase fluid. Potentially try non-pharmacological cough mixture such as a demulcent, eg. simple linctus
Egs of cough suppressants? Side effects?
Dihydrocodeine [Rikodeine - S3] (most abuse potential), pholcodine, dextromethorphan.
Opiate derivatives - caution sedation and respiratory depression, constipation.
Dextromethorphan - serotonin syndrome
5 most common viruses that produce symptoms of the common cold?
Rhinoviruses (30-50%), coronaviruses, parainfluenza virus, respiratory syncytial virus, adenovirus
Incubation period of the common cold?
Usually 1-3 days (can be short as 10-12 hours)
Normal body temp? Fever severity?
Normal 37*
Fever if oral/axillary >37.6* or rectal/ear >38.1*
Mild-mod less than 39*
(listening to farts is hotter than licking armpits)
What are the four pairs of sinuses called?
Frontal,
Ethmoid,
Maxillary,
Sphenoidal
When to prescribe antibiotics for rhinosinusitis?
- > 3 days & severe sx, high fever (>39*C)
- > 7 days with unilateral maxillary tenderness & purulent discharge
- worsening sx after initial improvement
Role of intranasal ipratropium in the common cold? What age suitable for?
Good for rhinorrhoea, no evidence for use in nasal congestion.
(For >12yo)
Types of influenza?
A - affect humans & animals. Cause seasonal epidemics.
Only type to cause pandemics (e.g. bird & swine flu).
Two surface proteins: hemagglutinin and neuraminidase.
B - affect humans only. Mutate more slowly than A.
Cause seasonal epidemics. Can be severe.
Two lineages: Victoria and Yamagata.
C - mild
D - affect cattle, do not appear to affect humans.
How to treat stuffy noses in babies?
Saline nose drops can be used from birth to help with congestion.
Phenylephrine/pseudoephedrine considerations?
- Age
- 3 SEs
- Drug interactions
- P&B
Not recommended <12yo
3 likely SEs: insomnia, may cause tachycardia. Can increase BP, but likely ok if short course.
Risk of hypertensive crisis with with MAOIs & moclobemide.
Caution in patients taking beta-blockers & TCAs. Consider topical.
Avoid in pregnancy & breastfeeding.
Topical sympathomimetics ok in breastfeeding & could use after first semester.
Differentiating viral sore throat from bacterial (usu. Strep).
Very difficult, but usually:
- Strep/bact: swollen glands, exudate, high-grade fever, no cough
- Viral: no swollen glands or exudate, low-grade fever, cough & headache
- Strep unlikely if <3yo
- Strep most prevalent in 5-15yo.
- EBV / glandular fever peak incidence teens & young adults.
- Viral more likely in adults.
What are the Centor criteria? What do you do if someone has 3 or all symptoms?
Used to determine likelihood of strep.
- Cough absent
- Exudate (pharyngeal/tonsillar)
- Nodes (swollen cervical glands)
- Temperature - high grade fever (>38*C)
Refer as more likely to be bacterial & require antibiotics, esp. if <15yo
Medications known to cause agranulocytosis?
Think “gran” for the mnemonic
The triple C had a PASS at gran(ulocytosis)
Cytotoxics, Captopril, Carbimazole Penicillamine Antipsychotics Sulfasalazine Sulfonamides
When to refer sore throat?
think of a painful plaited noose for the mnemonic
BRAIDD
Bacterial sx Rash ADR Indigenous 2-25yo remote/rural Dysphagia/phonia Duration >2 weeks
8 possible causes sore throat?
A common cold virus EBV Bacterial, eg Strep Mouth ulcers Candida Trauma Agranulocytosis from meds Cancer
Management of unilateral nasal congestion in a child?
Refer - likely foreign body blockage.
What is the least sedating antihistamine & why?
What is the most sedating of the less sedating antihistamines?
Loratadine - lowest affinity for histamine receptors in the brain.
Cetirizine.
intraocular antihistamines?
Which are also available intranasally?
Antazoline
Pheniramine
Ketotifen
Also intranasal: azelastine & levocabastine
Ocular sympathomimetics?
Naphazoline & tetrahydrozoline - caution rebound conjunctivitis
Treatment of allergic rhinitis in pregnant women?
Oral antihistamines: dexchlorpheniramine has most evidence, but less sedating antihistamines should also be safe to use (des/loratadine B1, fexo & cetir B2).
DO NOT USE promethazine.
Eye drops and nasal sprays okay.
Treatment of common cold in pregnant women?
Systemic sedating antihistamines OK (help sleep).
Intranasal sympathomimetics OK.
Intranasal ipratropium OK.
DO NOT USE promethazine.
DO NOT USE systemic sympathomimetics.
DO NOT USE combo products.
Treatment of common cold nasal congestion in breastfeeding?
Intranasal sympathomimetics OK.
Intranasal ipratropium for runny nose OK.
Avoid systemic pseudoephedrine - can decrease milk supply.
What are the possible symptoms of acute closed angle glaucoma and what action should be taken?
Quick onset (often in evening) Severe unilateral eye pain +/- headache Red eye Clouding of the cornea Blurred/decreased vision Associated vomiting
Immediate referral to GP or ED
8 classes of medications that can cause dry eye?
Diuretics Anticholinergics: TCAs, antihistamines SSRIs Isotretinoin HRT esp. oestrogen only Androgen antagonists Anti-arrhythmics Beta-blockers
Which lubricating eye drop?
Best: polyvinyl alcohol povidone, carbomer (better tolerated), or sodium hyaluronate
Spray: lecithin-based
Long-acting: hydroxypropyl guar is a liquid that turns into a gel on application
Less effective: hypromellose and carmellose
Long-term use consider preservatives:
- Best: sodium perborate, purite, minims, lecithin spray
- Avoid: benzalkonium chloride, polyquaternium
What could be the continued cause of symptoms in otitis externa after antibiotic treatment?
Fungal overgrowth, esp. Aspergillus niger.
Seborrhoeic dermatitis, psoriasis or other skin conditions
Differentiating otitis externa and media?
Externa: itch/irritation & pain, usually no discharge, but if so, then not mucopurulent, no systemic symptoms, inflamed ear canal
Media: Mucopurulent discharge, systemic symptoms, bulging tympanic membrane
Symptoms of meningitis in a child (requiring urgent referral)? (3)
Difficulty placing chin on chest
Headache
Temperature >38.9*C
What are complementary medications that could possibly be considered to prevent migraine?
Feverfew
Magnesium
Vitamin B2 (riboflavin)…
What are complementary medicines with evidence in PMS?
Calcium 1200mg elemental daily +/- vit D
Vitamin B6 up to 100mg daily (mostly small poor quality studies though)
Vitex agnus-castus (VAC) 20-40mg extract (180-360mg dried fruit) daily (issues with quality of studies)
OTC treatment of menorrhagia?
Mefenamic acid 2 x 250mg caps tds to max of 7 days
What are the signs/symptoms and cause of lichen planus?
Itchy, purplish flat bumps that can form scabs.
Painful, lacy, white patches on mucous membranes.
Hair and nails involvement possible.
Autoimmune disorder, can be triggered by hep C, flu vax NSAIDS and other meds.
What is leukoplakia?
Painless white lesion in mouth. Can’t be wiped off.
Precancerous, often assoc. with smoking. Typically men over 40.
When to refer oral thrush? (4)
- diabetes (could be poor control)
- immunocompromised (could be more severe)
- painless (could be cancer)
- more than 3 wks (likely not thrush)
3 risk factors for oral thrush?
Antibiotics
Dentures - check sterilisation technique
Inhaled corticosteroid
Dyspepsia signs/symptoms indicative of referral?
ALARM Anaemia Loss of weight Anorexia Recent onset of progressive sx Malaena, dysphagia, haematemesis
Also: persistent vomiting (ulceration or cancer), referred or severe pain (?MI), or pain that wakes during night (duodenal ulcer).
Signs of dehydration?
Mild: tiredness, anorexia, nausea, light-headedness
Moderate: dry mouth, sunken eyes, decreased urine output, moderate thirst and pinch test 1-2 secs or longer.
When to refer infants/children or elderly with diarrhoea?
- If signs of dehydration (mouth, eyes, pinch test, urine output)
- If vomiting precludes oral therapy
- Duration:
<1 yo >1 day
1-2 yo >2 days
>3 yo >3 days
What type of laxative is usually recommended for pregnant women?
Fibre supplementation and bulk-forming preferred.
Macrogols & other osmotics are also ok. Stimulants appear safe, but may stimulate uterine contractions.
Constipation in children - when to refer and OTC treatment?
Refer: younger than 3 months, longer than 7 days duration or if can’t determine cause
Treat: glycerol (stimulant), lactulose (osmotic), poloxamer (softener)
Others have varying ages, but all ok >6 yo, except docusate >12 yo
Which ocular antihistamines also have mast cell stabilising effects?
Azelastine
Ketotifen
Olopatadine
