Symptoms In The Pharmacy - Ears, Nose, Throat Flashcards
What % of sore throat cases are viral/ go to the GP?
- Only about 5% of people with sore throat go to their GP
- Most sore throats (90%) due to viral infection
- Majority self-limiting whether viral or bacterial
- Often associated with other symptoms of a cold
- Antibiotics make no difference to majority of bacterial sore throats – however, still one of the main reasons for prescribing in the UK
What questions should you ask a patient with a sore throat?
- Age: children of school age more likely to have streptococcal infection,
young children more likely to develop croup - Duration: usually resolves within a week, longer than this may warrant
referral - Severity: if extremely painful after 24-48h, especially when other symptoms
of a cold are absent, will warrant referral - Associated symptoms: cough and cold, aches and pains expected, but
difficulty swallowing and hoarseness may be signs of more serious
condition - Current medication: especially inhaled steroids, carbimazole and
immunosuppressants
What are some things to exclude from a sore throat patient consultation?
- Laryngitis (sore throat and diminished voice) in babies and young
children may lead to croup (difficulty breathing and stridor) - Long-standing hoarseness (> 3 weeks, esp. without other
symptoms)may also be a sign of laryngeal cancer - Glandular fever (caused by Epstein-Barre virus) presents with severe
sore throat and dysphagia, swollen lymph glands, malaise, fever,
creamy exudate on tonsils - Oral thrush
What are examples of OTC treatment for a sore throat?
*simple analgesia (paracetamol, ibuprofen, aspirin) >16 only
*Anti-inflammatory, anaesthetic and antiseptic lozenges and sprays
When should you refer a patient with a sore throat?
- respiratory distress
- drooling
- systemically very unwell
- unable to swallow
- difficulty opening mouth
- muffled voice – or making a high-pitched sound as they breathe (stridor)
- dehydrated or unable to take fluids
- signs of being systemically unwell and at risk of immunosuppression
What is oral thrush caused by?
- Infection of the mouth caused by Candida albicans
Overview of oral thrush, treatment age/ condition?
- Can be treated in pharmacy from age of 4 months
- Common in babies in first few weeks of life
- In older children and adults usually associated with antibiotics or
inhaled corticosteroids (or underlying disease involving
immunocompromise, e.g. diabetes)
What are the accompanying symptoms of oral thrush with babies + older children/ adults?
- Babies:
- do not want to feed
- nappy rash
- Older children and adults:
- cracks at corners of mouth (angular cheilitis)
- not tasting things properly
- unpleasant taste in mouth
- pain/soreness
- difficulty eating and drinking
What is the treatment for oral thrush?
- Antifungal, miconazole
- Applied qds in adults and children >6years,
bd for younger - Interacts with a number of other medicines,
including warfarin and statins
When to refer a patient with oral thrush?
- Babies under 4 months
- Older children and adults without an obvious cause
- Recurrent or persistent infection
- Failed medication
- Patients taking an interacting medicine that can’t be stopped, e.g.
warfarin
Overview of ear wax
- Normal physiological substance (cerumen)
- Is antibacterial and cleans, lubricates and protects ear canal
- Excessive build-up of hardened wax can affect some people
What are the Symptoms of ear wax buildup
- sensation of blockage
- temporary deafness
- discomfort (not pain)
- tinnitus
- rarely, dizziness/nausea
What is recommended to treat ear wax related problems?
- Do NOT use earbuds to try to remove wax
- Olive oil, almond oil (not if pt allergic) or sodium bicarbonate drops
recommended - warm drops to room temperature before use
- a few drops into the ear with affected ear uppermost, staying like this for a few
minutes after use - use qds for 3-5 days
What is otitis externa?
- Inflammation and infection of skin in the ear
canal - 1 in 10 people affected at some point in life
- May be localised (e.g. a boil) or diffuse
What are the symptoms of otitis externa?
- Localised – severe pain
- Diffuse – pain, itching, hearing loss, discharge
What is otitis media?
- Infection of the middle ear compartment
- Middle ear normally airtight other than via Eustacian
tube into back of throat - Viral cold can block tube and lead to fluid build-up in
middle ear (may be secondarily infected with bacteria)
What are the best treatment options for otitis media?
- Best treatment is with analgesia
- Antibiotics do little even if bacterial infection
When to refer someone with otitis media?
Refer if: under 2 yrs, no resolution in a few days,
systemically unwell, discharge from ear
What is “glue ear” what it entails and kind of treatment?
- Also known as “serious otitis media”
- OM that persists or is recurrent
- Can be bilateral
- Can cause deafness, which in turn affects language development
- Often spontaneously resolves
- Sometimes requires operation to remove fluid
What are the symptoms to motion sickness?
- Nausea
+/- - Vomiting
- Pallor
- Cold sweats
- Hypersalivation
What are the avoidance measures for motion sickness?
- Elevated seating position
- Look at horizon
- Fresh air
- Keep cool
- Breaks
- Avoid stimuli
- Distractions
What are non pharmacological treatments for motion sickness?
*ginger
*wristbands (pressure point)
What are pharmacological treatments for motion sickness?
- Hyoscine hydrobromide
- From age 3 OTC (BNFc says age 4 for motion sickness)
- Antimuscarinic adverse effects
- Short-acting (up to 4 hours)
*scopoderm patches
* Over 10 years
* Apply 5-6 hours before journey (or night before)
* Lasts for up to 3 days, so remove when journey finished
* Adverse effects may last for 24 hours after removal
- Cinnarizine
- Min. age 5 years
- Intermediate acting – up to 8hours
- Promethazine
- Min. age 2 years
- Long-acting – more than 8 hours
What is allergic rhinitis?
- Allergic rhinitis
- general term
- defines nasal inflammation in response to histamine
- Up to 25% of UK population affected – rising
- Onset usually in children and young adults
- May be past history of atopic allergy
- Patient may have suffered before
- May develop asthma
What are the symptoms for allergic rhinitis?
- Rhinorrhoea/nasal congestion/nasal itching/sneezing
- Eye symptoms
What are some nonpharmalogical treatment options for allergic rhinitis?
- When the pollen count is high the person should:
- avoid pollen by closing windows, wearing wraparound sunglasses and
avoiding grassy areas particularly during early morning, evening and night - avoid drying clothes outside
- apply Vaseline around their nostrils to trap the pollen
- shower and wash their hair after being outdoors to remove pollen
- vacuum regularly and dust with a damp cloth
What are some pharmacological treatment options for allergic rhinitis? (1)
- For people with occasional symptoms of allergic conjunctivitis, children aged
2–5 years and people who prefer an oral formulation treat with an oral
antihistamine. - If the predominant symptom is sneezing or nasal discharge treat with an oral
antihistamine
What are some pharmacological treatment options for allergic rhinitis? (2 + 3)
- For people with more persistent symptoms, and predominant symptom is
nasal blockage, treat with an intranasal corticosteroid (people over 18 years
[OTC]) - For people with signs of allergic conjunctivitis sodium cromoglicate eye drops
may provide additional relief.
When to refer someone with allergic rhinitis?
- wheezing/SoB
- ear pain
- facial pain
- person is pregnant or breastfeeding
- uncontrolled symptoms continue after 2–4 weeks despite correct use of medication
- urgent resolution of severe symptoms affecting quality of life is required
- person is a child under 2 years requiring treatment
- there is nasal blockage in the absence of rhinorrhoea, nasal itch and sneezing
- there is unilateral nasal discharge, especially in a young child, to check for a trapped foreign body
