RESPIRATORY TRACT CONDITIONS AND INFECTION Flashcards
WHAT ARE THE INFECTIONS THAT ARE LIKELY TO BE IN THE UPPER RESP TRACT?
*Acute bacterial sinusitis
*Acute pharyngotonsillitis- sore throat
*Acute otitis media -earache.
Infections are likely to be found in the lower respiratory tract
- Acute bronchitis
- Acute exacerbation of COPD
- Pneumonia.
Rhinitis
inflammation and swelling of the mucous membrane of the nose.
What are the characteristics and common causes of rhinitis??
*Runny nose, sneezing and stiffness
*Cold and allergy
Bacterial rhinitis:
*last for 7-10 days.
*Symptoms: headache, fever, facial/ dental tenderness and pain. Discharge
Viral and allergic rhinitis
*Last for 2-3 days
*Nasal congestion / obstruction, watery discharge from both nostril, itching and watering
*Snoring at night
* Mouth breathing
class of drug that Relieve the itching, sneezing, and runny nose of allergic rhinitis, but they do not relieve nasal congestion??
= Antihistamines
Antihistamines can not be used alone, they must be used along with nasal steroids or decongestants.
This is done to have a greater relief than using only antihistamines.
Types of antihistamines drug:
*Non-sedating antihistamines- long-lasting.
*Sedating antihistamines- onset, not taken before working
-E.g. Chlorpheniramine
What are the adverse effects of nasal steroids?
burning, stinging, dry nose or sneezing
Drugs that treat allergic rhinitis:
*Corticosteroids- fluticasone but for children of the age of 6 upwards
*Antihistamine for short effect – chlorpheniramine - oral
*Nocturnal nasal steroids- oxymetazoline ( as a topical nasal decongestant)
Which drug should be used for the long-term effects of allergic rhinitis and who should use it?
Cetirizine for both kids and adults
antihistamines are not used to children of which age?
less than 2 yrs.
VIRAL RHINITIS - what are consideration for patients with viral rhinitis
Just limit strenuous activity, ensure adequate hydration and return to the clinic if present with symptoms of pain, tenderteness and earache greater than 14 days.
What is the treatment for pain, fever, and nasal congestion?
Saline nose drops …………for dryness and liquefies mucus
For pain and fever : paracetamol, aspirin, ibuprofen
Name the commonly used nasal decontestant.?
Oxymetazoline
* Phenylephrine
* Xylometazoline
* Pseudoephedrine
What is the mechanism of action of nasal decongestants?
Nasal decongestants have a parasympathetic response. They act a1 receptors: oxymetazoline, phenylephrine, and Xylometazoline. They constriction of blood vessels, less blood flow, and less mucous produced
Inhaler and nebulizer for asthma treatment?
corticosteroids and bronchodilators
Inhaler decongestants
Eucalyptus oil, Friar’s balsam
Combination drugs for URTIs and allergies
Combination = Antihistamines + sympathomimetics + analgesics
what are Characteristics of Acute sinusitis?
inflammation of the sinuses and fluid filled in them
Bacterial rhinitis characteristics ?
Happens after cold after 7-10 days.
* Headache
* Purulent nasal discharge, especially if unilateral
* Nasal obstruction
* Fever
* Pain
* Tenderness
Treatment ( nose drops drugs ) of Bacterial sinusitis?
*Oxymetazoline-for 5 days, nose steroids
*Amoxicillin for 5 days – penicillin
*Saline drop- sodium chloride- 0.9 %
Drug for bacterial infection pain and fever
paracetamol
A 19 year old male student meets you in the cafeteria on campus. He
complains of a 2 day history of sore throat, runny and blocked nose
and dry cough. He was just at the doctor, who told him that he did not
need an antibiotic, but rather prescribed an anti-histamine and saline
nose drops. He asks you to explain why an antibiotic was not
prescribed. * What other information would you require to make this explanation
more complete/rational?
* Questions you can ask
* Investigations
Allergies (hayfever) would have itchy, watery and red eyes, itchy and
red throat due to postnasal drip, bouts of sneezing, and dry cough
due to throat irritation
it lasts for 2-3 days
mouth breathing, snoring, watery discharge, itching.
No temperature and normal vitals
* As colour and viscosity of the nasal discharge from both nostrils. * Viral and allergic usually have watery discharg
How would a bacterial sinusitis have presented?
- Happens after cold after 5/7-10 days.
*Headache
*Purulent nasal discharge, especially if unilateral - Nasal obstruction
- Fever
- Pain
- Tenderness
Painful when tapping the sinuses - Discharge from one nostril * Discharge is coloured and purulent.
what is Acute pharyngotonsillitis (sore throat):
A painful red throat and/or enlarged inflamed tonsils. White pus exudates, either spots or patches, may be present. Tender anterior cervical lymphadenopathy may be present.
What is the 20% cause of pharyngotonsillitis ?
Group A beta haemolytic streptococcus and may result in rheumatic fever.
what causes majority of pharyngotonsillitis
Viruses
symptoms of virus pharyngotonsillitis
sore and red throat
sore and red tonsils
symptoms of bacterial infection
swollen throat and tonsils
red throat and tonsils
white spots
gray tongue
General measures of acute pharyngotonsillitis
hydration
avoid irritants.
homemade salts mouthwash.
Antibiotics are used for pharyngotonsillitis that is caused ?
Bacteria
Antibiotics are not required for all patients with a sore throat
but given to patient to eliminate streptococcus and at risk of rheumatic fever.
with enlarged and exudates tonsils
no cough
no runny nose
drug for treating Acute pharyngotonsillitis
- Benzathine benzylpenicillin-narrow
- Amoxicillin- broader-diarrhea,pneumonia
- Phenoxymethylpenicillin-narrow
- Macrolide: azithromycin 500 mg daily for 3 days.
what causes skin rash in children
drug-disease interaction between amoxicillin and ampicillin and Epstein- Bar virus.
complication can be :
. retropharyngeal or peritonsillar
abscess.
Tonsillitis accompanied by difficulty in opening the mouth (trismus). * Recurrent tonsillitis
* Suspected acute rheumatic fever. * Suspected acute glomerulonephritis. * Heart murmurs not previously diagnosed
Clinical symptoms of rheumatic fever?
arthralgia or arthritis that may shift from one joint to another
* carditis including cardiac failure
* heart murmurs
* subcutaneous nodules
* erythema marginatum
* chorea (involuntary movements of limbs or face)
* other complaints indicating a systemic illness e.g. fever
what is Rheumatic fever?
is a condition in which the body produces antibodies against its own tissue following a streptococcal throat infection.
Rheumatic fever – medicine treatment for eradication of streptococci in the throat?
Phenoxymethylpenicillin/amoxicillin, po, for 10 days/benzathine
benzylpenicillin, im, stat (severe pen allergy) azithromycin
what is the acute stage of rheumatic fever?
bed rest and supportive care
All patients with confirmed rheumatic fever and persistent rheumatic
valvular disease:
Treat lifelong.
* Benzathine benzylpenicillin (depot formulation), IM, every 3–4 weeks
(preferred treatment).
* Phenoxymethylpenicillin, oral, 12 hourly.
* Severe penicillin allergy: Macrolide, e.g.: Azithromycin, oral, daily
Otitis externa
Inflammation of the external ear may
be one of the following: * Diffuse: An infection of the ear
canal, often due to Gram negative
bacilli (especially P. aeruginosa).
Pain is increased when chewing and
the lining of the canal may be either
inflamed or swollen with dry or
moist debris or even a white or
clear discharge. * Swimmer’s ea
Furuncular otitis media
caused by staphylococcus aureus.
A Painful localized swelling is present at the entrance to the ear canal.
May be precipitated by trauma.
caused by scratching, e.g.
matchsticks, earbuds
Fununcular drug treatments?
cefalexin-oral- broad
flucloxacillin
azithromycin -macrolide
Inflammation of the middle ear? acute otitis media
pain
* drum perforation
* loss of hearing
* fever in about half of the cases
* red bulging eardrum
* loss of the normal light reflex of the eardrum
Mild redness of the eardrum and
rubbing the ear are not reliable signs
acute otitis media drug treatmet?
Amoxicillin
co-amoxiclav
azithromycin
