Respiratory Conditions Flashcards
What are the strains of the flu? (Explain briefly)
Type A = most virulent, causes pandemics
Type B = only found in humans, milder localised fly
Both A + B = annual flu outbreak
Type C = less common, mild symptoms spread by cough/sneeze droplets
How is flu spread?
droplet transmission
hand-to-hand, shared objects = less common
Onset of symptoms = usually sudden
Flu signs and symptoms
Symptom onset = 1-3 days after infection
Symptoms = sudden high fever, chills, sweating, headache (severe, photosensitivity), generalised joint/muscle pain, weakness, fatigue
Initial resp symptoms = scratchy throat, runny nose, dry cough
Later resp symptoms = persistent, raspy, productive cough
Acute symptoms = subside 2-3 days, fever up to 5 days
What are notable differences between cold and flu?
Flu = sudden onset, systemic illness, prominent headache, body aches, prolonged weakness/fatigue, fever
Discuss the aims of cold and flu treatment
Reduce symptoms
Help patient function and feel better
Rest, adequate fluid intake
Discuss the use of cough and cold medicine in children
Cough and cold medicine in children is restricted
Children <2 = S4 only
2-6 yrs = not to be given
6-11 yrs = only on advice of doctor, pharmacist, nurse practitioner
What oral decongestants are used for cold/flu/covid treatment?
pseudoephedrine
phenylephrine
Considerations for oral decongestants
C/I = severe/uncontrolled HTN
ADRs = CNS stim, tremor
What nasal decongestants are used for cold/flu/covid treatment?
oxymetazoline
xylometazoline
phenylephrine
tramazoline
Considerations for nasal decongestants
short term use = rebound congestions
What sedating antihistamines are used for cold/flu/covid treatment?
Promethazine
Chlorpheniramine
Considerations for sedating antihistamines
Some evidence for runny nose
ADRs = antichol effects, sedation, drowsiness
What cough mixtures are used for cold/flu/covid treatment?
Expectorants (productive) = senega, ammonium salts, gauifenesin
Mucolytics (productive cough) = bromhexine, acetylcysteine
Cough suppressants (dry cough) = codeine, dexamethorphan, dihydrocodeine, diphenhydramine
What is a 1st line antiviral medication for flu?
Neuraminidase inhibitors (S4) = Zanamivir (diskhaler), oseltamivir (Capsule/powder)
When should antivirals be used to treat flu?
Within 48 hrs of symptom onset, not recommended for healthy people
shortens duration by 1 day, may reduce complications
Who gets free flu vaccines?
Children <6 months - < 5 yrs
First Nation’s People <6 months
pregnant women, people ages >65 yrs
What age groups can pharmacists administer flu and covid vaccines to?
Covid = >5 yrs
Flu = >6 months
Common COVID signs and symptoms
Fever, dry cough, fatigue
Less common COVID symptoms
loss of smell/tase, nasal congestion, sore throat, headache, muscle/joint pain
GI disturbances, chills, dizziness
What medications (other than vax) treat COVID?
molnupiravir
nirmatrelvir + ritonavir
Discuss viral tonsillitis
Limited tonsillar exudate
occurs at any age, may be associated with cough
lasts 3-7 days
Discuss bacterial (strep) tonsillitis
Common bacterial cause, common <15 years of age
Tonsillar exudate = white/yellow patches
swollen tender glands, fever >38C, cough is rare
How is acute tonsillitis treated?
Throat swab used to diagnose
Antibiotics = severe cases or when at risk of rheumatic fever
What antibiotics can be used to treat acute tonsillitis?
phenoxymethylpenicillin = 10 days
cephalexin for 10 days
Azithromycin for 5 days
What is rheumatic fever?
Develops 2-4 wks after strep
Fever, joint pain, involuntary muscle movement
Risk factor = malnutrition, poverty
How is recurrent tonsillitis treated?
tonsillectomy = modest reduction in number of sore throats
beneficial for patients with = breathing difficulties, freq ear infections associated with tonsillitis
What is glandular fever?
Another cause of sore throat, A.K.A. Epstein-Barr virus (‘kissing disease)
symptoms - pharyngitis, fever, cervical lumphadenopathy, fatigue, malaise
How is epstein barr/glandular fever treated?
Supportive management = avoid strenuous activity, rest, pain relievers
No vaccine, no exclusion period
antibiotics not indicated
corticosteroids have role in severe cases
What drug cause drug-induced sore throats? What are symptoms?
Drugs that cause agranulocytosis = captopril, carbimazole, cytotoxic, clozapine) > immediate referral
Occur in 3 months of treatment
Symptoms/Signs = sore throat, fever, rash, fatigue, mouth ulcers, reduce granulocytes
Non-pharm treatments of sore throat
Drink warm drinks
scuk lozenges
sucking on ice
What are some pharm treatments of sore throats?
Anti-inflammatories = flurbiprofen (>12 yrs old), benzydamine (all patients, >6 yrs)
What antiseptic agents are used for sore throats?
Most sore throats are viral
Chlorhexidine rinse, povidone iodine (virus, bact, fungi)
What local anaesthetics can be used for sore throats?
Benzocaine (children >6), lignocaine (short duration)
What is rhinosinusitis?
complication of common cold in 2% people, nasal secretions stagnate and become infected
Acute rhinosinusitis (=/> 2 lasting less than 3 months) = nasal blockage/nasal discharge, facial pain, reduction or loss of smell
What are some avoidable asthma triggers?
Cigarette smoke, allergens (pets, moulds, dust mites, pollen)
Airborne/environmental irritants (cold/dry air, smoke, perfumes, home reno material)
Medicines = aspirin, NSAIDs, bee products
What are some unavoidable asthma triggers?
Exercise, laughter, resp tract infection, certain medicines (aspirin, anticholinergics, beta blockers)
Comorbid medical conditions = allergic rhinitis, nasal polyps, obesity, GORD
physiological/psychological change = extreme emotion, hormonal changes, pregnancy, sexual activity
What are some asthma signs and symptoms?
dyspnoea, chest tightness, wheezing, cough sputum production
reduced airflow/inc airway resistance, hyperinflation of lungs, bronchial hyperresponsiveness
What are the three asthma management plans?
Asthma management plan, asthma action plan, asthma first aid plan
What are the 6 steps to asthma management plan?
Assess asthma severity
achieve best lung function
maintain best lung function by avoiding triggers
maintain best lung function with optimal medication
develop individualised, written action plan
educate and review regularly
What is an asthma flare up?
Inc wheezing, chest tightness, cough, SOB
waking at night with asthma symptoms
use reliever again within 3 hrs
What is an asthma emergency?
symptoms worsen quickly
severe SOB, cant talk comfortably, lips look blue
What does an asthma action plan show?
allows carer to take early action
Give clear instruction on what to do in response to worsening asthma symptoms
Instructs on how to adjust meds in response to symptoms
when/how to get medical care (inc. emergency)
What is the acronym for asthma emergency?
4x4x4
Do not rely on wheeze or lack thereof
How is asthma first aid different in children?
Lower dose
Children 1-5 yrs = 6 puffs
children 6-11 yrs = 12 puffs (same as adult)
Prednisolone = 1mg/kg daily (max 50mg) 3-5 days
Briefly discuss pressurised metered dose inhalers
Requires breath coordination, most generic type
can attach a spacer
Briefly discuss actuated pressurised metered dose inhalers (thicker pMDI w/ lever)
relies on patient to breathe in
limited amount of medicines available for this time
Briefly discuss dry powder inhalers (multi dose)
requires inspiratory breath
can’t be used with spacer
has no taste
Briefly discuss dry powder (capsule) inhalers
May be difficult to hold
require big breath in
cant attach a spacer
Briefly discuss mist inhaler
More drug gets to lung
does not require breath/hand coordination
What are some considerations for asthma devices?
Patient age, manual dexterity (Weak hands, arthritis)
ability to form good seal around mouthpiece (cognitive impairment, facial weakness)
language barrier = difficult to provide instructions, consider interpreter
multiple inhaler use = avoid confusion and use same type of device
