Pharyngitis, laryngitis and glandular fever (2.6) Flashcards
For Pharyngitis (sore throat);
A) What is it
B) What causes it
A)
- Infection/irritation of the pharynx or tonsils
B)
- Viral (70-90% of cases)
- Bacterial (strep throat) –> most common between 5-15 yrars
- Fungal (more likely in the very young and very old)
- Medication-related
- Also allergy, trauma, cancers
How to differentiate between bacterial sore throat (strept throat) and viral sore throat?
- Viral is more likely if other upper respiratory sx are present i.e. coughing, sneezing, runny nose
- Bacterial are more likely if:
> 5-15 years old
> Marked tonsillar exudate
> Tender cervical glands
> Fever over 38
> No cough
> Sore throat persisting >1 week
REFER IF BACTERIAL
What is agranulocytosis? What are some medicatiosn that cause it
Results from medications that cause a complication –> manifests as sore throat, fever, mouth uclers and small haemorrhages under the skin
- Cytotoxics (anti-cancer therapy)
- Carbimazole (anti-thyroid drug)
- Clozapine (antipsychotic)
- Sulfonamide antibiotics
- Penicillamine, sulfasalazine (rheumatoid arthritis)
For sore throat;
A) Who is the patient?
B) What are the symptoms?
C) How long have symptoms been present?
D) Actions taken?
E) Medications?
F) Medical conditions
G) Allergies
A)
- Indigenous patients aged 2-25 from central and northern australi, maori and pacific islander groups (refer)
B)
- Associated skin rash - scarlet fever (refer)
- Dysphagia/dysphonia (refer)
- Marked tonsillar exudate with high fever and swollen glands (children and adolesecents) –> refer
C)
- More than 2 weeks (refer)
D) N/A
E)
- Suspected ADR (agranulocytosis) –> refer
F)
- Hx of rheumatic heart disease (refer)
G) N/A
What are the treatment options for a sore throat?
- Symptomatic pain relief (paracetamol, aspirin,nsaids) –> for adults
- Salt water gargles, soluble aspirin gargles (for adults)
- Self care (lozenge preferred to gargle –> longer contact time , stimulates saliva annd lubricates the throat)
- Anti-inflammatory agents
- Local anaesthetics - lidocaine (lignocaine), benzocaine
- Antibacterial and anti viral agents
Give some examples of anti-inflammatory agents used in a sore throat? Explain how the work
Benzydamine, flurbiprofen
- (COX inhibtors –> NSAIDs) - inhibit COX responsible for PG synthesis
Benzydamine –> atypical NSAID
- Lozenge, spray, mouthwash
- Proven efficacy
- Mouthwash may cause stinging
Flubiprofen
- Lozenge
- Efficacy questionable
- Avoid in asthma, aspirin/NSAID allergy, stomach ulcers, renal impairment, heart failure
Give some examples of local anaesthetics used in a sore throat? Explain how they work
Lidocaine (lignocaine), benzocaine
MOA: Block voltage sensitive Na+ channels –> block initiation and propaganda of AP in nerve fibres –> local nerve block = numbing of mouhth and throat
- Little evidence in sore throat but widely used
- Short duration of action –> frequent dosing necessary
- Risk of hypersensitivity
- Caution with hot food and drinks; biting of tongue, cheek, lip
Give some examples of antibacterial and antiviral agents. Explain how they work
Antibacterials (also antifungal): chlorhexidine, benzalkonium chloride, phenolics
- Membrane-active agents
- Included in many propietary products
- Most sore throats are viral so USELESS
Antibacterial/antiviral/antifungal/antiprotozoal: providone iodine
- Iodine disassoicates from complex –> penetrates cell membrane –> interacts with proteinsm nucleotides, FAs –> cell death
- No evidence in sore throat
What are some of the recommendations that pharmacists can make it when it comes to sore throat?
- Consider patient symptoms and preference
- Specific patient populations:
Children:
> Local anaesthetics, benzydamine - 6 years + and flurbripofen 12 years +
> Avoid aspirin
- Pregnancy: avoid benzydamine and flurbropfen (3rd trisemester)
Referral when necesary
What is laryngitis? What causes it? What are some signs and symptoms?
Inflammation of the larynx (voice box)
Causes:
- URTI, LRTI (Viral)
- Excessive use of voice
- Inhalation of irritating substacnes e.g. smoke
- GORD
- Asthma inhlers
Signs and symptoms:
- Loss of voice
- hoarseness
- sensation of tickling
- rawness
For laryngitis;
A) Who is the patient?
B) What are the symptoms?
C) How long have symptoms been present?
D) Actions taken?
E) Medications?
F) Medical conditions
G) Allergies
A)
- If young child, can become croup (refer)
B)
- Severe pain and dysphagia, only in severe inflammation (refer)
C)
- Hoarseness > 3 weeks (refer)
- Had before? Recurrent*
D)
- Tx failure?
E)
- ICS - hoarseness, carbimazole
F)
- N/A
G)
- N/A
What is the treatment for laryngitis?
Usually self limiting; lasts 7-10 days
Treatment:
- Voice rest
- Steam inhalation
- Hydration
- Smoking cessation
For glandular fever;
A) What is it
B) What are some signs and symptoms?
C) How to treat it?
A)
- Aka infectious mononucelosis (mono kisssing disease)
- Acute disease due to Epstein-Barr virus affecting adolescents, young adults
- Transmission: person to person- salivary primary vehicle
- Incubation 4-8 weeks
B)
- Fatigue/malaie: several days to week in acute stage
- Fever <38 C
- Sore throat: severe, painful, exudative (creamy white coating on the tonsils in 33% of the cases)
- Swollen lymph nodes
- Rash over the body (5% of patients)
- Enlarged spleeen (50%)
C)
- Largely supportive (rest during acute phase)
- NO antibiotics - 90% of patients with glandular fever will develop a florid rash with amoxicillin
- Avoid heavy lifting and contact sports for 2 months after presentation (risk of splenic rupture)
- Symptomatic treatment ( analgesic, antipyretic: paracetamol or NSAIDs –> avoid aspirin)
- To prevent the spread:
> Proper hygience, including handwashing
> Avoid sharing drink containers
> Disinfect articles soiled with nose and throat discharges, for example, handkerchiefs
