Introduction notes

Question 1

What are the three most common RTIs?

Answer 1

1. Otitis media
2. Rhinosinusitis
3. Pharyngitis

Question 2

What % of antibiotics prescribed for RTIs are unnecessary?

Answer 2

30-50%

Question 3

What are common organisms in the Nasopharynx?

Answer 3

S. pneumoniae and H. influenzae are common organisms in the nasopharynx. M. catarrhalis is also sometimes implicated as well as S. pyogenes, S. aureus, and gram-negative bacill

Normally, these organisms are present but your body deals with them by eliminating through normal immune responses. When this response is compromised, infection can occur. Now the normal balance that occurs between the body (immune system) and “colonizing organisms” is disrupted which these organisms take advantage of it causing URTI and LRTIs.

Question 4

What important questions/considerations do we need to think about when assessing RTIs?

Answer 4

The important thing for a pharmacist to know is when it goes beyond your scope of practice and you must refer. Physical assessment in RTIs will assist in this. When assessing a RTI, try to find the focus (ears, lungs, nose, etc.). Are the symptoms isolated to a specific area (i.e. the focus) or does the patient have systemic symptoms as well such as fever, tachycardia/bradycardia, confusion, dehydration, rapid respiratory rate, and low blood pressure. These are all signs that badness is brewing.

Runny or stuffy noses, earaches, and sore throats are pretty much the bread and butter of a community pharmacy. These symptoms may also be associated with a cough. However, this cough may not be the primary symptom. These symptoms can occur alone or in combination, so you need to figure out what is the most common or burdensome symptom.

Question 5

What are the most common causes of patients who come to your pharmacy?

Answer 5

Viral infections, allergic rhinitis, vasomotor rhinitis, and bacterial rhinosinusitis make up the most common cause of patients who come to your pharmacy with the chief complaint of a runny or stuffy nose.

Question 6

Describe the Onset, quantity of discharge, quality of discharge, other symptoms, and fever associated with:
1. Cold
2. Allergic Rhinitis
3. Vasomotor Rhinitis
4. Influenza Virus
5. Bacterial sinusitis

Answer 6

Question 7

When is Acute otitis Media diagnosed?

Answer 7

When the Tympanic membrane is bulging.
Color - White, or yellow
Areas of Intense erythema - Indicated Acute inflammation

In the Abscence of middle ear effusion, the tympanic membrane will move briskley when air is pushed in or pulled out of ear canal. Mobility is less in Acute otitis media with effusion.

Question 8

WHen is Otitis Media with Effusion diagnosed?

Answer 8

When the tympanic membrane is neutral or retracted
Color - Typically Amber Color membrane, or Yellow

In the Abscence of middle ear effusion, the tympanic membrane will move briskley when air is pushed in or pulled out of ear canal. Mobility is less in Acute otitis media with effusion.

Question 9

When is otoscopy indicated?

Answer 9

• Children with URTI
• Unaccustomed tugging of the ears
• Irritability
• Difficulty Sleeping
• Fever
• Otalgia
• Otorrhea
• Hearing loss

Question 10

What types of coughs occur after lying down?

Answer 10

• GERD
• CHF
• POST NASAL DRIP

Question 11

What type of cough is often early in the morning?

Answer 11

-ASTHMA

Question 12

What are examples of acute and chronic PRODUCTIVE COUGHS?

Answer 12

Acute Bronchitis, Pneumonia, and COPD

Question 13

What are examples of Subacute, or chronic NON productive (Dry ) cough?

Answer 13

• TB
• Cancer
• GERD
• Drugs
• Pertussis

Question 14

WHat are examples of Mixed cough diseases?

Answer 14

• Upper airway cough syndrome
• Post0infectious cough syndrome
• INfluenza/viral pneumonia
• CHF
• Atypical pneumonia