OTC respiratory medication Flashcards
what method do you approach an OTC consultation?
ASMETHOD
what are the main red flags associated with Respiratory OTC?
- Chest pain
- Shortness of breath
- Wheezing•Swollen ankles
- Blood in sputum
- Palpitations
- Persistent cough
- Whooping cough
- Croup
- Sputum mucoid, coloured
what are the considerations associated with OTC medicine?
- Interactions= with prescribed, non prescribed and herbal medications
- Contraindications= with conditions already present•Age of patient!!!!
- License restrictions…….You MUST begin to use SmPC’shttps://www.medicines.org.uk/emc•Legal issues
- Confidentiality
define the common cold
A mild, self-limiting upper respiratory tract infection characterised by nasal stuffiness and discharge, sneezing sore throat and cough
what causes the common cold?
- Viral Cause –antibiotics are of no value!!!! –Important counselling point
- Rhinovirus associated with half of all colds
- Over 100 different subtypes –hence vaccination is almost impossible
how is a cold spread?
Highly infectious, spread in 2 ways:–Inhale drops of mucus containing cold virus
–Touch something carrying the virus and then rub eyes/nose.
when do symptoms appear for a cold?
2-3 days after being infected
what are the symptoms of a cold?
- Runny/blocked nose
- Sneezing/coughing
- Headache/aches and pains
- Temperature –unlikely to be raised much in a common cold•Sore throat
- Earache –blocked and uncomfortable = normal•-Acutely painful = referral
what is the difference between a cold and flu?
Flu is a much more debilitating virus
what are the symptoms of a flu?
•Symptoms–as per the common cold PLUS….
–Onset -very rapid
–Weakness and fatigue
–Many patients bed bound–Fever (if present) tends to be more severe in children.
–Resistance is reduced during long term illness, stress, fatigue, depression
–Flu jab offered from Sept-Nov.
what makes the flu more serious than a cold?
Complications –much more likely….–Bronchitis/Pneumonia….may require admission to hospital–Exacerbations of asthma and COPD–Otitis media–Sinusitis
how do you treat a cold or flu?
Aim -Symptomatic relief
•Plenty of fluids
•Rest
•Hand hygiene
Symptom: Fever/chills/headaches/muscle aches/fatigue
•Analgesics with antipyretic action to reduce pain and temperature
•Paracetamol –1stline
what are the possible treatments for congestion?
- Nasal wash/drops v steam inhalation2. Decongestants(sympathomimetics)
how do decongestants work?
- Constrict blood vessels in nasal mucosa
- Relieve nasal stuffiness
- Ingredient in oral cold remedies, nasal sprays & drops
what are the two types of decongestants?
Oral Decongestants
1.Ephedrine2.pseudoephedrine3.phenylephrine
Topical Decongestants
1.ephedrine2.oxymetazoline3.xylometazoline
what are the side effects associated with deocngestants?
Side effects
•Rebound congestion (topical)…….avoid long term use
•CNS Stimulants –do not take at night (orally)
when do you not give decongestants?
- Hypertension/Heart disease -stimulation of heart and increase in BP
- Diabetes –can increase blood glucose levels
- Hyperthyroidism
what do decongestants interact with?
- MAOIs
* beta blockers
what are the legal issues associated with PSEUDOEPHEDRINE/EPHEDRINE ?
- Misused to produce methylamphetamine(crystal meth)
- Max sale of 720mg packs (12x60mg tabs)
- Limit of 1 pack per person
how would you treat inability to sleep?
Antihistamines –promethazine/diphenydramine
•Anticholinergic activity
•Reduces rhinorrhea and sneezing
•DO NOT reduce nasal congestion
•Included in night remedies to promote sleep
what would you be cautious about when using antihistamines?
- Severe respiratory disease
- closed angle glaucoma
- prostatic hypertrophy
- epilepsy
- liver disease
what do antihistamines interact with?
alcohol- inc sedative s/e
when do you refer patients for respiratory symptoms?
- Asthmatics??? OK short term –Be cautious!!!•Earache
- Mucus containing blood
- Dyspnoeaand/or chest pain
- Suspected influenza in –infants, elderly, at risk groups
- Cardiac/lung disease/lowered immune system
how would you council a patient on a respiratory infection?
- Steam inhalations v salt waternasal cleaning
- Avoid over treatment
- Care with analgesic dose
- Caution with sedative antihistamines
- Expect improvement after 1 week
- Diabetics
how do you clean your nose with a salt and water solution?
- Boil a pint of water, then leave it to cool
- Mix a teaspoon of salt and a teaspoon of bicarbonate of soda into the water
- Wash your hands
- Stand over a sink, cup the palm of one hand and pour a small amount of the solution into it
- Sniff the water into one nostril at a time
- Repeat until your nose feels more comfortable
- You don’t need to use all of the solution, but use a fresh one each day
define cough
Definition: Reflex response to airway irritation
•Part of body’s natural defense mechanism
•Not a condition but a symptom
•Treatment aim is to relieve the cough
what causes a cough?
- Upper respiratory tract viral infections
- Cold/dry atmosphere
- Smoking
- Other conditions: asthma/COPD/Heart failure/allergies
- Medication: ACEI
what are the two types of cough and what are theyre symptoms?
Non-productive cough (Dry)
•dry, tickly irritation of throat and chest
•no sputum
Productive cough (Chesty)
•excess sputum
•thin & clear removed by cough (Mucoid)•thick and difficult to clear chest
•coloured sputum
what should you avoid when treating a cough?
Avoid combination products
what would you use to suppress a cough?
(Antitussives) Codeine Linctus –(> 18yrs) •constipation •abuse Pholcodine Linctus •fewer side effects Dextromethorphan •less potent/effective •few sideeffects
antihistamines •Eg. Diphenhydramine, promethazine, triprolidine •Dry secretions •Reduce cough frequency •Cause drowsiness
what are Demulcents for?
Soothe throat/cough
•Sugar or syrup base -pleasant to take
•Glycerin, honey & lemon
what are Expectorants used for?
chesty cough
1.stimulate bronchial mucus secretion –liquefying sputum
2.emetic reflex response
•guaifenesin •ipecacuanha•ammonium salts
what counsilling would you give for a cough?
- Increase fluid intake –liquefy secretions/soothe throat
- Steam inhalation?? –add inhalant egmenthol??
- Sugar free remedies -diabetics
when do you refer someone for a cough?
- Lasting longer than 3weeks (nhs.uk 2019)
- Blood in sputum
- Chest pain (PE/Pleurisy)
- Shortness of breath and / or wheeze
- Recurrent nocturnal cough (particularly children)•Suspected whooping cough or croup•ADRs
- Smokers with recurrent cough
what are the two types of allergic rhinitis
Seasonal -symptoms occur at the same time each year
❖response to grass and tree pollens (also known as hayfever)
Perennial-symptoms occur throughout the year
❖house dust mite/animal fur/feathers/fungal spores/dust
what are the symptoms of allergic rhinitis?
- sneezing
- rhinorrhoea
- nasal congestion
- nasal itch
- irritation of mouth & palate
- itching eyes with lacrimation, oedema& conjunctivitis
what are the aims of treatment for hayfever?
Prevent release of the inflammatory mediator histamine
•Diminish effect of histamine
•Symptomatic relief/ prophylactic treatment
•Reduce exposure•
Treatments can be oral (systemic) or topical
what are the two types of oral antihistamines
Sedative
•limited by side effects•equally effective??•chlorphenamine(Piriton–from 1 yr) -rapid onset, need frequent dosing.•promethazine (phenergan) -highly sedative…not recommended
Non-sedative•low incidence of side effects•loratadine(Claritynfrom 2 years) -once daily•cetirizine (Zirtek, Piriteze, Benadryl-from 6 yrs) -once daily•acrivastine(Benadryl Allergy relief -from 12 yrs) -three times daily
what are the nasal prep available for allergic rhinitis?
Corticosteroid
Beclometasone and Fluticasone nasal sprays
•For 18 years +
•anti-inflammatory
•start 2 weeks before symptoms expected •regular use throughout season –ensure compliance
what are the side effects for corticosteroid?
- dryness & irritation of nose
* nose bleeds
what are Mast Cell Stabilisers?
Topical Sodium Cromoglycate(Rynacrom/Opticrom)
Stabilises mast cells to prevent histamine release -used prophylactically
what topical antihistamies are available?
Combination product: Otrivine-Antistineye drops •antazolinewith xylometazoline •antihistamine with vasoconstrictor •short term use •2 or 3 times daily no more than 7 days •not for children
Azelastine(Rhinolastnasal spray) POM
intra-nasal
•non-sedative, potent
•twice daily
what counsilling would you give to patients for allergic rhinitis?
•Avoid going out when pollen count is high•Keep windows, doors, car windows and vents closed•Wear sunglasses•Shower and change clothes after being outside•Avoid camping, mowing lawn•Do not leave clothes on washing line•Caution contact lens wearers
