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1005 > Responding To Sympmtoms 1 > Flashcards

Responding To Sympmtoms 1 Flashcards

1
Q

How do patients present to the pharmacy?

A

1: requesting advice about their symptoms
2: asking to purchase a named medicine
3: combination of information about their symptoms and a product e.g. ‘is solpadeine the strongest thing for a headache?”

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2
Q

What does responding to symptoms involve?

A

Listening

Asking questions to gather information

Knowing about a lot of complaints/ conditions

Working with patients/ 3rd party

Considering the range of treatment options

Having good product knowledge

Knowing the evidence base

Giving general and lifestyle advice

Knowing when to refer

Knowing who to refer to

Distinguishing between minor and major illness

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3
Q

What is WWHAM?

A

Who is the patient?

What are the symptoms?

How long have the symptoms been present for?

Action already taken?

Medication being taken?

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4
Q

What does ASMETHOD mean?

A

Age/ appearance of patient

Self/someone else?

Medication currently taken?

Extra medication/herbal/supplements

Time symptoms have been present
History (medical/social/family)

Other symptoms

Dangerous symptoms

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5
Q

What does SIT DOWN SIR mean?

A

Site of symptoms

Intensity of symptoms

Type/ nature

Duration

Onset

With (any other symptoms)

Aggravated by?

Spread of symptoms?

Incidence (frequency) of symptoms

Relieved by?

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6
Q

Things to consider when using the WWHAM tool?

When asking ‘who is the patient?’

A

Age:
Diagnosis, seriousness, drug handling, OTC licence
Young/ child - OTC licensing
Elderly - poly pharmacy

Pregnant person -OTC licence/ product suitability

Person has other conditions - contra-indications

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7
Q

Things to consider when using the WWHAM tool?

When asking ‘what are the symptoms?’

A

Fid out about the symptoms
E.g. what is the pain like, where does it start, doe sit move? What makes it better to worse

Need follow up questions to make a working diagnosis:
E.g. when did it start? Does it come and go?

Helps to make a diagnosis

Gives indication of seriousness

May need to summarise to clarify that you have the right information to make a diagnosis

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8
Q

Things to consider when using the WWHAM tool?

When asking ‘how long have you had the symptoms?

A

Determines severity

First time/ persistent/ recurrent

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9
Q

Things to consider when using the WWHAM tool?

When asking ‘actions already taken? ‘

A

What have they done about it?
Nothing one taken medication already?
Alternative required? Has it made a difference? Treatment failure?

Seen a doctor/ specialist?

Also gives an indication of seriousness

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10
Q

Things to consider when using the WWHAM tool?

When asking ‘what medication is being taken?’

A

Interactions

Cautions

Contra-indications

Additive/cancelling symptoms

Is the medication causing the problem? (ADR)
E.g. ace inhibitors = cough

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11
Q

What should be checked when a patient requests medication by name?

A

Check:

If they have had it before

When they last had it

Has anything changed since that time

Is repeat treatment appropriate?

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12
Q

When to refer patients:

A

W: baby, young child, older person?

W: bleeding, shortness of breath, loss of consciousness, seizure, severe or worrying symptoms

H: sudden onset, recurring, long duration

A: tried something appropriate (treatment failure)

M: ADR’s, needs review, failed medication

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13
Q

What are reg flag referrals?

A

Long duration of symptoms

Worsening or recurring symptoms

Severe symptoms

Shortness of breath, tightness of chest, wheezing

Blood/bleeding

Suspected link with medication

Recently returned from travelling

Suspected meningitis

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14
Q

What are high risk groups of patients?

A

Babies and young children

Elderly patients

Pregnant women

Immunocompromised patients

Patients taking other medicines

Patients with pre-existing skin conditions

Patients with neuropathy

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15
Q

What is the common cold?

A

Mild

Self limiting

Viral

Upper respiratory tract infection

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16
Q

What is the cause of a common cold?

A

More than 200 different viruses can cause a cold

Rhinovirus is the most common cause of the common cause

25% of colds have no identifiable causes

Transmission by:
Direct contact: virus comes into contact with hands and then eyes/nose/mouth
Aerosol transmission: coughing and sneezing infected mucus particles

Particles containing the virus from coughs/sneezes can survive on surfaces e.g. doors/tables for several hours

People can remain infections for several weeks

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17
Q

What is the epidemiology of the common cold?

A

Can affect all ages

Adults experience an average of 2-3 colds per year

Young children (preschool/ primary school age) get an average of 5-8 colds per year

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18
Q

What are the signs and symptoms of a cold?

A

Incubation: 1 to 3 days

Symptoms can last up to 14 days

Nasal symptoms;
Irritation, congestion, nasal discharge (rhinorrhoea) and sneezing

Headache

Fever

Sore or irritated throat

Cough

Loss of smell/taste

Horse voice

General malaise (restless)

Irritable eyes

Earache = feeling of pressure in the ears

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19
Q

What are some common complications of the common cold:

A

1: sinusitis acute (rhinosinustitis)
2: lower respiratory tract infection (chest infection)
3: acute otitis media

20
Q

What is sinusitis?

A

Infection of the small air-filled cavities inside of the cheekbones and forehead

Pain and tenderness around the eyes, nose and forehead

Blocked and runny nose

21
Q

What is a chest infection?

A

E.g. bronchitis and pneumonia can occur after a cold, as them immune system is temporarily weakened

Severe cough

Sharp pain in the chest

Bloodstained phlegm

22
Q

What is otitis media?

A

Middle ear infection

Severe earache

Some loss of hearing

Accumulation of pus in the middle ear

Flu-like symptoms

Vomiting/dizziness

Lack of energy

23
Q

How to differentiate between the common cold and flu?

A

A cold comes on gradually and the flu comes on quickly

A cold mainly affects the nose and throat whereas the flu includes headaches, fever and aching muscles

The symptoms of a cold are fairly mild and don’t affect the family routine too much. There symptoms of the flu are severe enough to make you feel too unwell to continue normal activities

24
Q

What are some differential diagnosis of a common cold?

A

Coronavirus

Meningitis

Allergic rhinitis

Whooping cough

25
Q

What is coronavirus?

A

High temperature

Shortness of breath

Loss of taste or smell

These are less common inn a cold

Symptoms like a runny nose are a typical cold symptom not commonly seen in coronavirus. Both can present with a cold

26
Q

What is meningitis?

A

An infection of the membranes around the brain and spinal cord

Symptoms:
High fever, drowsiness, vomiting and loss of appetite, floppies, a tense or bulging fontanelle, non blanching rash, stiff neck, photophobia, severe headache, muscular pains, fits, abdominal cramps and/ or confusion

27
Q

What is allergic rhinitis?

A

In response to exposure to specific allergens

Nasal symptoms similar to those of the common cold may have been present for up to two weeks of more

Itchy eyes and a cough may also be present

28
Q

What is whopping cough?

A

Pertussis

Highly infectious condition caused by bordetella pertussis bacterium

Prodromal symptoms similar to the common cold, but the characteristic severe cough develops

29
Q

What patients presenting with a common cold should be referred?

A

Babies

Elderly

Pregnant

Those with heart and lung disease

With persisting fever and a productive cough

Coughing up blood

Chest pain

Breathing difficulties

Flu-like symptoms

Symptoms that persists for 10-14 days with no improvement

30
Q

What is some advice to give patients with a common cold?

A

Drink plenty of fluids

Rest

Eat health

Hygiene measures to prevent spread

Vapour inhalation (steam inhalation using menthol)

31
Q

What are some common cold treatment options:

A

1: analgesics
2: decongestants
3: antihistamines
4: alternative remedies
5: cough remedies
6: products for sore throats

32
Q

What is an analgesic?

A

Reduce pain ad fever (anti-pyretic)

33
Q

What is the action of paracetamol

List points to consider

A

Antipyretic and analgesic effects

Suitable from 3 months plus

Every 4-6 hours

Maximum 4 doses in 24 hours

Available as a liquid sachet, soluble tablets, melt tablets and normal tablets

Care in patients with liver disease

34
Q

What is the action of ibuprofen

List some points to consider

A

Antipyretic, analgesic and anti-inflammatory action

Suitable from 3 months plus

Maximum 3 does in 24 hours

Can cause GI disturbances

With or after food

Use with caution in asthmatics

35
Q

What is the action of aspirin

List some points to consider

A

Antipyretic, analgesic and Antoine-inflammatory action

Suitable from 16 years plus

Can cause GI Disturbances

Caution use in asthmatics

With or after food

36
Q

What is the mode of action of decongestants?

A

Constricts dilated blood vessels in the nasal passage and reduces swelling in the nasal mucosa. It improves air flow in the nasal cavity, making it easier to breath

37
Q

What are examples of systemic sympathomimetics (decongestants) ?

A

Phenylephrine and pseudoephedrine

38
Q

Discuss decongestants:

A

Some products suitable from 6 years plus (pseudoephedrine) and others are suitable from 12 years plus (phenylephrine)

Often in combination with other ingredients

Act as a stimulant

Side effects include insomnia - avoid doses late in the evening

Prone to misuse/ abuse so there is a limit on the amount that can be sold OTC

39
Q

What are the limits of pseudoephedrine and ephedrine?

A

Maximum pseudoephedrine: 720mg

Ephedrine: 180mg

40
Q

What patients should avoid/caution decongestants?

A

Diabetics: may interfere with blood glucose control

Patients with hypertension: may increase blood pressure

Patients with heart conditions: possibly can cause tachycardia

Patients taking medicines including:
Some antidepressants i.e. monoamine oxidase inhibitors = risk of hypertensive crisis
Tricyclic antidepressants = increase the effects of the sympathomimetics i.e. increase vasoconstriction
Beta blockers

Best to avoid in pregnancy as mild foetal malformations have been reported

Okay in breast feeding as amount secreted into breast milk is small however can reduce milk supply

41
Q

What are the legalities of pseudoephedrine?

A

Pseudoephedrine has the potential for misuse in the illicit production of methylamphetamine which is a class A controlled drug

Maximum amount of pseudoephedrine: 720mg

Maximum amount of ephedrine: 180mg

Ephedrine tablets are POM but nasal drops are P

It is unlawful to sell or supply pseudoephedrine and ephedrine at the same time without a prescription

Maximum 7 day use

42
Q

What are examples of topic sympathomimetics (decongestants)

A

Nasal decongestants e.g. ephedrine, oxymetazoline, phenylephrine and xylometazoline

They should not be used for longer than 7 days otherwise could get rebound. Congestion

Can cause local irritation

Avoid with MAOI’s

Some products suitable form 6 years plus (e.g. xylometazoline- otrivine nasal drops)

Some products suitable from 12 years plus (e.g. oxymetazoline)

Alternatives = saline nasal drops

43
Q

What is an alternative to topical sympathomimetics?

A

Saline nasal drops

Can be used from birth

Helps clear out excess mucus form the nasal passage (irrigates the sinuses) = can cause post nasal drip

Reduced inflammation

Helps to moisturise a dry nasal passage

Makes breathing easier

44
Q

How do antihistamines help in the treatment of a common cold?

What are some side effects

A

E.g. diphenhydramine and brompheniramine

Often included in cough and cold preparations

Purpose of antihistamines in cough remedies:
Cough suppressant
Dry up secretions = reduce rhinorrhoea (runny nose)

Side effects include:
Drowsiness (sedation)
Dry mouth
Constipation

Avoid in patients with glaucoma/ prostrate problems

Avoid if taking other sedating mediation e.g. opioids, antidepressants can cause sedation

45
Q

What are some alternative treatments for a common cold?

A

Steam inhalation: helps to relieve congestion

Vapour rubs (menthol and eucalyptus) = applied to the chest and back 
Do not apply to the nostrils because it can cause irritation and breathing difficulties

Nasal saline drops (Salt water) drops can help relieve a blocked nose

Gargling salt water = for a sore throat

Lozenges/menthol sweets = smooth a sore throat and can clear a blocked nose

Vitamin and mineral supplements:
Some evidence to suggest that taking since within a day of symptom starting will speed up recovery from a cold and reduce the severity of symptoms
Little evidence that taking vitamin C supplements is beneficial when a cold starts

46
Q

When to refer patients with the flu

A

Patients with flu symptoms who are:

Very young

Heart or lung disease

Immunocompromised

Pregnant/ breast deeding patients

Symptoms not improving / lasting longer than two weeks

Severe symptoms
Earache/stiff neck/ rash associated

1005 (14 decks)

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