Respiratory OTC - Acute Sinusitis

Question 1

Which patients are suitable for pharmacy first pathway for acute sinusitis? (2)

Answer 1

Adults
Children 12+.

Question 2

What are the common symptoms of a patient with acute sinusitis? (8)

Answer 2

Congestion
Nasal Discharge
Facial Pain
Headache
Reduced sense of smell
Cough

Question 3

How long does acute sinusitis symptoms last for? (1)

Answer 3

< 10 days

Question 4

Outline the pharmacy first pathway for acute sinusitis.

Answer 4

Symptoms > 10 days with no improvement: If yes, continue pathway.
- Does the px have 2 or more:
- Marked deterioration after mild phase.
- Fever (>38 degrees)
- Unremitting purple nasal discharge
- Severe localised unilateral pain particularly pain over teeth (toothache) and jaw.

Shared Decision making

Question 5

What are the treatment options for children suffering from acute sinusitis?

Answer 5

Not for < 6yrs:
- Antitussives
- Expectorants
- Nasal Decongestants
- Antihistamines

Codeine (restricted use):
- Not for < 12 yrs = respiratory s/e
- Not for 12-18 years who have problems with breathing.
- > 18 years only.

Question 6

What counselling is given to children suffering from acute sinusitis? (5)

Answer 6

Analgesics/anti-pyretics only
Fluids
Rest
Child sleeps on side
Vapour rub/inhalants/saline nasal drops .

Question 7

What are the alarm symptoms of children suffering from acute sinusitis? (5)

Answer 7

Noisy breathing/wheezing
Croup/Whooping Cough
Ear Tugging
Persistent/externally high temperature
Persistent nocturnal cough

Question 8

What are the alarm symptoms of adults suffering from acute sinusitis? (7)

Answer 8

Asthma
Coloured mucus (blood)
Dyspnoea +/or chest pain
Influenza (infants & elderly)
Cardiac/lung disease
Antivirals (oseltamivir/inhaled zanamivir)

Question 9

What general counselling should be given to patients suffering from acute sinusitis? (7)

Answer 9

Steam inhalation vs. Salt water nasal cleaning.
Avoid over treatment
Care with analgesic dose
Caution with sedative antihistamines.
Improvement after 1 week.
Diabetes

Question 10

Explain the steps on how to clean your nose with salt water solution. (7)

Answer 10

Boil 1 pint of water and leave it to cool.
Mix a teaspoon of salt and bicarbonate of soda into the water.
Wash your hands.
Stand over the sink and cup one palm and pour a small amount of solution into it.
Sniff the water into one nostril at a time.
Repeat until nose feels comfortable.
Use a fresh one every day. (Don’t have to use all of the solution.)