responding to symptoms 1- respiratory

In an OSCE, if you choose to treat the patient what will you do

Name the drug and formulation (e.g tablets)

In an OSCE, if choose refer patient you must provide what info

Where are you referring to ? gp/hospital. Community pharmacy service

How soon do they need to be seen ? Same day/next few days

What are the causes for the common cold

• mixture viral upper respiratory tract infections

• Generally gradual onset of

• Transferred via inhalation of infected droplets through mouth or nose

What are the signs and symptoms of the common cold

• self-limiting

• Rapid onset over q-w days

• Last 2-14 days, usually resolve after 7 days

• Runny/blocked nose

• Cough (may persist few days after other symptoms have cleared)

• Sore or irritated throat

• Aches and pains headache

What are the referral symptoms of the common cold

• wheezing/shortness of breath

• Pain on breathing or coughing (more painful than normal)

• Earache

• Blood stained mucus

• Symptoms for 3 weeks or longer

• Neck stiffness - indicator meningitis

• Chest pain

What are the non-prescription treatment options for a common cold

• self-limiting but patients often opt symptomatic releif

• Decongestants

• Demulcents

What are the causes of a cough

• reflex action of body due to infection, inflammation or irritation of airway

• Categorised as:

  • Productive/chesty - phlegm produced and cough reflex expels Phlegm

• Non-productive/dry

  • no phlegm production

What are the signs and symptoms of a cough

• self limiting

• Symptoms generally improve better within few days with or without treatment

What are the referral symptoms of a cough

• longer than 3 weeks duration and not improving

• Regularly recurring cough

• Shortness breath

• Chest pain/ pain breathing

• Coughing up blood

• Yellow, green, brown stained phlegm

• Offensive or foul smelling phlegm

• Fever

What are the non-prescription treatment options of a cough

• self-limiting but patients often opt for symptomatic relief

• Expectorants

• Suppressants

• Demulcents

What are the causes of a sore throat ?

• acute upper respiratory tract infection

• May occur alone or accompanied by other symptoms such as sinusitis, cough and headache

• May viral or bacterial in origin:

  • -No evidence duration or severity significantly different in either case

  • -Clinical examination unlikely be able

• other causes of sore throat may be GORD, physical or chemical irritation

what are the signs and symptoms of a sore throat ?

• usually self-limiting

• symptoms improve within 7 days

• pain in back throat

• swollen lymph glands may felt under chin or neck

• pain upon swallowing

what are referral symptoms of sore throats ?

• Dysphagia (difficulty swallowing)

• fever

• longer than 14 days

• hoarseness persisting more than 3 weeks

• sore throat with skin rash

• white spots, exudate or pus on tonsils with high temp and swollen glands

• recurrent bouts of infection

• failed treatment

• breathing difficulties

what are the non-prescription treatment options of a sore throat ?

• self-limiting but patients often opt for symptomatic relief

• Demulcents

• analgesics

• local anaesthetics

what is general advice for common respiratory minor ailments ?

• Self-care measures

  • adequate fluid intake

  • adequate rest, though staying off work/school not necessary

  • 
    

• Smoking- consider referring patient in to a stop smoking service

• Hand hygiene- use of alcohol gels and effective hand washing prevent transmission

• Flu vaccination

What are the non-prescription treatments for common respiratory minor ailments ?

Decongestants (for nasal symptoms)

(E.g. pseudoephedrine, phenylephrine, oxymetazoline)

• Work by constricting dilated blood vessels in

nasal mucosa

• Nasal membranes are effectively shrunk,

drainage of mucus and circulation of air

improved and feeling of nasal stuffiness

relieved.

• Stimulatory action may cause sleep disturbances

if taken at night

• Can be given orally or applied topically.

• Tablets: licensed for 12yrs +

• Liquids: licensed for 6yrs +

• Nasal spays: licensed for 12yrs +

• Nasal drops: licensed for 6yrs +

• Rebound congestion can occur with topically

applied

• Max. use 7 days for 12yrs+

• Max. use for 6-11yrs 5 days

What are the 2nd non-prescription treatments for common respiratory minor ailments ?

Expectorants (for chesty coughs)

(E.g. guaifenesin, squill extract)

• produce expulsion of

bronchial secretions, although no evidence that they can

specifically facilitate expectoration.

• BNF states that they more likely

to have a placebo effect and in

general are inexpensive, so may be

useful to offer to some patients who

feel the need to take something.

• Given orally

• Liquids: licensed for 6yrs +

What are the 3rd non-prescription treatments for common respiratory minor ailments ?

Suppressants (aka anti-tussives)

(for dry coughs)

(E.g. codeine, dextromethorphan)

• Suppress cough reflex

• Not be used if clearance of phlegm if needed

• codeine or opioid derivatives not ideal

because of the high incidence of side effects, such

as constipation and dependence.

• Pholcodine fewer side effects than codeine.

• Dextromethorphan (a non-sedating opiate) and

menthol both been shown suppress the cough

reflex without the adverse effects of codeine and

pholcodine

• Given orally

• Liquids: licensed for 12yrs +

• Those containing opioid derivatives are not

recommended for those 12-18 yrs old with breathing

problems

What are the 4th non-prescription treatments for common respiratory minor ailments ?

Demulcents (for dry coughs or sore

throats)

(e.g. glycerine, lemon & honey, simple linctus)

• Definition: a substance that relieves

irritation of the mucous membranes in the

mouth by forming a protective film.

• Do not contain any active ingredient

• Considered to be safe in children and

pregnant women.

• Now the treatment recommended for

children under 6 years old.

• Given orally:

• Liquids: paediatric and adult versions available

• Lozenges: avoid use in young children as they

pose a choking hazard

What are the 5th non-prescription treatments for common respiratory minor ailments ?

Analgesics (for general pain relief)

(e.g. paracetamol, ibuprofen)

• Paracetamol has analgesic and antipyretic

effects

• Max. adult dose 1000mg four times in any

24hr period

• Is contained in many non-prescription

cough/cold remedies, care must be taken to

avoid duplicate doses

• Ibuprofen has analgesic, anti-inflammatory

and antipyretic activities

• Classed as a non-steroidal anti-inflammatory

(NSAID)

• Causes less irritation and damage to the

stomach than does aspirin.

• Adult dose required for analgesic activity is

200– 400 mg and that for anti-inflammatory

action 300– 600 mg

What are the 6th non-prescription treatments for common respiratory minor ailments ?

Local Anaesthetics (for sore

throats)

(e.g. benzocaine, lidocaine)

• Should not be used if sensitivity

reactions are suspected

• Should not be used for longer

than five days.

• Given topically:

• Throat spray: licensed for 6yrs +

• Lozenges: licensing varies depending

on active ingredients usually 6yrs +