Symptoms In Comm Pharm Flashcards
most coughs are acute, what are some differential diagnoses for acute coughs below 3 weeks
upper resp tract infection
acute exacerbation copd or asthma
acute bronchitis
pe if pain
what period in weeks is a subacute cough and could be post viral infection
3-8
coughs over what duration suggest a repetitive cause such as smoking or due to medication
8 weeks
what 3 conditions may cause long term cough
Indigestion/ HF/ lung cancer
why does clear sputum suggest that the cause of a cough is unlikely to be infectious
not bacterial
for infection what colour sputum would you expect to see
green, yellow maybe dark brown
what colour sputum indicates cancer
dark red- blood
what can a rust colour sputum sometimes be a sign of
pneumonia
what colour sputum might be indicative of left ventricular failure
pink
what professions make px more exposured to cough triggers
builders, dust workers
why should people presenting with a cough be asked about recent travel abroad
could be malaria
when a cough that is related to asthma be worse
night or early morning
cold weather
what qs would you ask px complaining of a ‘nasty cough’
- Duration and severity
- other symptoms: fever, chest pain, difficulty breathing
- recent exposure to sick individuals or irritants
- underlying health conditions or medications taken
- Tried remedies/ treatment? If not improving after bottle of cough mixture, seek further treatment
- other/ associated pain?
Qs to ask - Chesty/dry cough
- Smoker?
- Current meds
- Ongoing symptom from recent chest infection?
- Any allergies? Related to that maybe
- Sore throat alongside may indicate viral infection. Also may have fever
- Is it better or worse with/ after food? May indicate heartburn
- Shortness of breath, wheezing? More concerning
- Time cough occurs, worse at night? Or early morning? May indicate asthma- refer for assessment and diagnosis - post nasal drip/ chronic bronchitis?
- Onset
what drug class may cause dry cough
ACEi
what alongside cough may indicate viral infection
sore throat
with cough why ask Is it better or worse with/ after food?
May indicate heartburn
name some non-pharmacological tx for cough
hydration
rest
steam inhalation
a syrup would be soothing for a cough for providing relief, what active ingredient may be useful for a chesty cough
guaifenesin
what are the two groups that cough mixtures can be broken into
expectants and suppressants
expectants are well used and tolerated and available in several different brands, how do they work
eg guaifenesin
increase airways secretions by increasing water content of secretions and decreasing viscosity of mucus
what cough suppressant may be useful for use in dry coughs
dextromethorphan
what is the usual dose of dextromethorphan qds
100-200mg
a cough should be assessed if it exceeds x weeks
3
what different aspects of medication advice should you give to patients
take per dosing instructions
side effects
storage conditions
what temperature are cough mixtures usually stored at
room temp
what should px take for pain w cough if not asthmatic
paracetamol/ ibu
list some different red flags that could be associated with coughs
fever over 3 days
unexplained weight loss
sob
swelling of face and neck
repeated chest infections
over 3 weeks
coughing up blood
if px complians of intermittent leg pain, what else would you ask
duration
on calf/ further up
any trauma/ fall
character (SOCRATES)
swelling/ warts skin changes at site
traveled revently dvt
meds
recent surgery in risk clots
bruising
antihypers new can suggest fall
allergies
what drug class increases risk of muscular pain
statin
what is the main differential that you might think of with leg pain
dvt
dvt usually affects the calfs, is it usually one leg that is affected or both
one
list some symptoms of dvt in the leg
throbbing pain
warmth
redness
swollen veins
why might a patient want to choose 2.32% voltarol 12 hrly instead of 1.16% tds
pt doesnt have to apply as often but is more expensive
what acronym would be used for the management of a sprain or sporting injury
RICE
rest ice compression elevation
what could px take for pain, is it licensed for this indication
Ibuprofen 400mg, up tds PRN, with food,
(Naproxen only indicated for menstrual pain)
Reommended to use ibu for shortest time, lowest dose, few days 5 days… still not better need for help
what pain med switched from P to POM as more cardiovascular risk, so ibu safer
diclofenac
what px group is ibuprofen NOT given to
asthmatics- intolerant to NSAIDs, but if had it before and no problems, then fine to give
also dont give to
-warfarin px DDI
-SSRI DDI
-GI bleeds/ ulcer hx
why may ibu be betetr than paracetamol
anti-inflamm properties
what red flags symptoms can you list for leg pain
systemically unwell
fever
significant swelling or bruising
pain worsening
pain at rest
deformities
a patient that is having trouble bearing weight for x steps requires assessment
4
true or false, with shingles you expect the rash to be localised and affect one side of the body
true
what qs would you ask px with rash on lower back, to determine if shingles?
- Vaccination history, any recent vaccine – could it be adverse reaction to that
- Rash anywhere else on body?
- SOCRATES for pain, severity, radiation
- Ask to look at rash, take to consultation room, get consent
- Localised, widespread…
- immunocompromised? More at risk of getting viral infections etc, ask what medication she’s on- immunosuppressants- corticosteroids prednisolone, long term use
- RA, asthma, CKD = more at risk of shingles, undergoing chemotherapy, check allergies before recommending treatment
- Fever, refer on
what meds may mean px more at risk of getting viral infections in case of shingles etc
immunosuppressants- corticosteroids prednisolone, long term use
list some different conditions that put patients at more risk of developing shingles
ra, asthma, ckd
what infection causes shingles
herpes zoster
shingles is a viral infection of ?
individual nerve over its surface area
if you have x condition in childhood it is possible that is may reactivate and cause shingles in the future
chickenpox
what is the firstline treatment for shingles that is covered in the pharmacy first scheme and can be supplied under a pgd
acyclovir
the treatment for shingles first line is acyclovir 800mg 5 times a day for x days
7/7
the pgd for shingles treatment allows you to give what 2 strengths of acyclovir tabs to make up the required dose
200 and 400mg
why is it important that treatment for shingles is started within 72 hrs
thats when antiviral is most effective to reduce complications
name a common complication post shingles that can continue for months after but if treatment is well managed and early patients are less likely to get symptoms such as severe nerve pain
hepatic neuralgia
what drug should be offered for shingles in immunocompromised patients
valacyclovir
what is the treatment regimen for valacyclovir when used to treat shingles
1g tds for 7 days
how many weeks does it usually take for shingles to resolve
4 weeks
what are some common side effects of shingles treatment
vomiting
diarrhoea
nausea
abdominal pain
it is important that patients on acyclovir or valacyclovir complete the course for the full 7 days and space doses out in regular intervals, what advice should you give regarding missed doses
take as soon as possible unless time is close to next dose
what different safety netting is associated with shingles treatment
changes
gets worse
minimise contact with babies below 1 month, immunocompromised, pregnant
shingles is contagious until blisters have crusted over, how many days does this usually take
5-7
what is some general management advice for someone with shingles
avoid sharing towels and clothes
wash hands often
keep rash clean and dry
wear loose clothing
if rash cant be covered stay off work and indoors
true or false, if a patient has been treated for shingles and blisters have not crusted over/ new blisters have formed this is a red flag and they should be referred for a longer course of an alternative antiviral
true
can you treat pregnant women with shingles under the pgd pharmacy first scheme yes or no
no
true or false, even a second shingle infection requires referring as patients tend to be in severe pain and may require something stronger eg Gabapentin
true
if doesnt work see GP
shingles usually affects the trunk, back and flanks, what should you do if there is any involvement of the eye and why
refer GP due to risk of losing vision
Shingrix vaccine is available for shingles for patients that are aged x due to being most at risk of complications, however any patient who is above 50 and immunocompromised may also receive it
60-79
how is widespread impetigo defined
4 or more lesions or clusters
list some different causes of impetigo
previous skin conditions
flare ups
insect bites
trauma
abrasions
it is important to ensure that children that present with rashes do not have neck pain or photosensitivity to rule out
meningitis
how does bullous impetigo present
blisters
how does non bullous impetigo present
sores
what is the causative agent of impetigo
staph aureus
impetigo is common in younger children 0-4, where are some common sites for lesions
face
mouth
limbs and joints like elbow creases sometimes
the pharmacy first scheme only allows for the treatment of what type of impetigo and therefore the other type must be referred
non bullous
what is the first line treatment for non bullous impetigo if it is localised
hydrogen peroxide crystacide
when using hydrogen peroxide to treat impetigo a thin layer should be applied to the affected areas tds for x days
3
name an alternative localised treatment for impetigo instead of hydrogen peroxide that can be used tds for 5 days
fusidic acid
t/f impetigo with any blisters suggesting bullous, would refer
true
cant treat under pharm first
what is the treatment regimen of fluclox for impetigo
250mg qds 5 days
if impetigo is widespread a localised treatment will not be sufficient, in this case what oral abx would be appropriate
flucloxacillin
alternative drug to fluclox in the case of penicillin allergy
clarithromycin
if a patient is pregnant or suspected to pregnant what abx is appropriate to treat non bullous widespread impetigo
erythromycin
general advice for impetigo management
avoid school till lesions healed
reinforce dose and side effects
missed dose advice
complete course
storage
prevention measures for impetigo as it is contagious
avoid sharing towels
wash bed sheets
clean toys
avoid scratching
for people with impetigo they should keep off school/work for at least x hrs after starting treatment or until lesions have healed
48
what safetynetting is associated with impetigo
if it doesnt improve seek further help
impetigo red flags
systemically unwell
lethargic
bullous
recurrent infections
severely immunocompromised
true or false, if a rash crosses the spine it is less likely to be shingles
true
