Community Pharmacy Flashcards by Lauren W

What is guaifenesin?

What is the dose?

Expectorant.
6-12yrs (discourage use): 100mg qid
Adults: 200mg qid

How well did you know this?

Not at all

Perfectly

What is bromhexine?

Dose? Side effects?

Mucolytic.
8mg tds (up to 16mg tds first week).
SE: N/V/D

How well did you know this?

Not at all

Perfectly

How to treat cough in children under 12?

Increase fluid. Potentially try non-pharmacological cough mixture such as a demulcent, eg. simple linctus

How well did you know this?

Not at all

Perfectly

Egs of cough suppressants? Side effects?

Dihydrocodeine [Rikodeine - S3] (most abuse potential), pholcodine, dextromethorphan.

Opiate derivatives - caution sedation and respiratory depression, constipation.
Dextromethorphan - serotonin syndrome

How well did you know this?

Not at all

Perfectly

5 most common viruses that produce symptoms of the common cold?

Rhinoviruses (30-50%), 
coronaviruses, 
parainfluenza virus, 
respiratory syncytial virus, 
adenovirus

How well did you know this?

Not at all

Perfectly

Incubation period of the common cold?

Usually 1-3 days (can be short as 10-12 hours)

How well did you know this?

Not at all

Perfectly

Normal body temp? Fever severity?

Normal 37*
Fever if oral/axillary >37.6* or rectal/ear >38.1*
Mild-mod less than 39*

(listening to farts is hotter than licking armpits)

How well did you know this?

Not at all

Perfectly

What are the four pairs of sinuses called?

Frontal,
Ethmoid,
Maxillary,
Sphenoidal

How well did you know this?

Not at all

Perfectly

When to prescribe antibiotics for rhinosinusitis?

> 3 days & severe sx, high fever (>39*C)
> 7 days with unilateral maxillary tenderness & purulent discharge
worsening sx after initial improvement

How well did you know this?

Not at all

Perfectly

Role of intranasal ipratropium in the common cold? What age suitable for?

Good for rhinorrhoea, no evidence for use in nasal congestion.
(For >12yo)

How well did you know this?

Not at all

Perfectly

Types of influenza?

A - affect humans & animals. Cause seasonal epidemics.
Only type to cause pandemics (e.g. bird & swine flu).
Two surface proteins: hemagglutinin and neuraminidase.

B - affect humans only. Mutate more slowly than A.
Cause seasonal epidemics. Can be severe.
Two lineages: Victoria and Yamagata.

C - mild

D - affect cattle, do not appear to affect humans.

How well did you know this?

Not at all

Perfectly

How to treat stuffy noses in babies?

Saline nose drops can be used from birth to help with congestion.

How well did you know this?

Not at all

Perfectly

Phenylephrine/pseudoephedrine considerations?

Age
3 SEs
Drug interactions
P&B

Not recommended <12yo

3 likely SEs: insomnia, may cause tachycardia. Can increase BP, but likely ok if short course.

Risk of hypertensive crisis with with MAOIs & moclobemide.

Caution in patients taking beta-blockers & TCAs. Consider topical.

Avoid in pregnancy & breastfeeding.
Topical sympathomimetics ok in breastfeeding & could use after first semester.

How well did you know this?

Not at all

Perfectly

Differentiating viral sore throat from bacterial (usu. Strep).

Very difficult, but usually:

Strep/bact: swollen glands, exudate, high-grade fever, no cough
Viral: no swollen glands or exudate, low-grade fever, cough & headache
Strep unlikely if <3yo
Strep most prevalent in 5-15yo.
EBV / glandular fever peak incidence teens & young adults.
Viral more likely in adults.

How well did you know this?

Not at all

Perfectly

What are the Centor criteria? What do you do if someone has 3 or all symptoms?

Used to determine likelihood of strep.

Cough absent
Exudate (pharyngeal/tonsillar)
Nodes (swollen cervical glands)
Temperature - high grade fever (>38*C)

Refer as more likely to be bacterial & require antibiotics, esp. if <15yo

How well did you know this?

Not at all

Perfectly

Medications known to cause agranulocytosis?

Think “gran” for the mnemonic

The triple C had a PASS at gran(ulocytosis)

Cytotoxics, Captopril, Carbimazole
Penicillamine
Antipsychotics
Sulfasalazine
Sulfonamides

How well did you know this?

Not at all

Perfectly

When to refer sore throat?

think of a painful plaited noose for the mnemonic

BRAIDD

Bacterial sx
Rash
ADR
Indigenous 2-25yo remote/rural
Dysphagia/phonia
Duration >2 weeks

How well did you know this?

Not at all

Perfectly

8 possible causes sore throat?

Study These Flashcards

A common cold virus
EBV
Bacterial, eg Strep
Mouth ulcers
Candida
Trauma
Agranulocytosis from meds
Cancer

Management of unilateral nasal congestion in a child?

Study These Flashcards

Refer - likely foreign body blockage.

What is the least sedating antihistamine & why?

What is the most sedating of the less sedating antihistamines?

Study These Flashcards

Loratadine - lowest affinity for histamine receptors in the brain.
Cetirizine.

intraocular antihistamines?

Which are also available intranasally?

Study These Flashcards

Antazoline
Pheniramine
Ketotifen
Also intranasal: azelastine & levocabastine

Ocular sympathomimetics?

Study These Flashcards

Naphazoline & tetrahydrozoline - caution rebound conjunctivitis

Treatment of allergic rhinitis in pregnant women?

Study These Flashcards

Oral antihistamines: dexchlorpheniramine has most evidence, but less sedating antihistamines should also be safe to use (des/loratadine B1, fexo & cetir B2).
DO NOT USE promethazine.

Eye drops and nasal sprays okay.

Treatment of common cold in pregnant women?

Study These Flashcards

Systemic sedating antihistamines OK (help sleep).

Intranasal sympathomimetics OK.

Intranasal ipratropium OK.

DO NOT USE promethazine.
DO NOT USE systemic sympathomimetics.
DO NOT USE combo products.

Treatment of common cold nasal congestion in breastfeeding?

Intranasal sympathomimetics OK. Intranasal ipratropium for runny nose OK. Avoid systemic pseudoephedrine - can decrease milk supply.

What are the possible symptoms of acute closed angle glaucoma and what action should be taken?

``` Quick onset (often in evening) Severe unilateral eye pain +/- headache Red eye Clouding of the cornea Blurred/decreased vision Associated vomiting ``` Immediate referral to GP or ED

8 classes of medications that can cause dry eye?

``` Diuretics Anticholinergics: TCAs, antihistamines SSRIs Isotretinoin HRT esp. oestrogen only Androgen antagonists Anti-arrhythmics Beta-blockers ```

Which lubricating eye drop?

Best: polyvinyl alcohol *povidone*, carbomer (better tolerated), or sodium hyaluronate Spray: lecithin-based Long-acting: hydroxypropyl guar is a liquid that turns into a gel on application Less effective: hypromellose and carmellose Long-term use consider preservatives: - Best: sodium perborate, purite, minims, lecithin spray - Avoid: benzalkonium chloride, polyquaternium

What could be the continued cause of symptoms in otitis externa after antibiotic treatment?

Fungal overgrowth, esp. Aspergillus niger. | Seborrhoeic dermatitis, psoriasis or other skin conditions

Differentiating otitis externa and media?

Externa: itch/irritation & pain, usually no discharge, but if so, then not mucopurulent, no systemic symptoms, inflamed ear canal Media: Mucopurulent discharge, systemic symptoms, bulging tympanic membrane

Symptoms of meningitis in a child (requiring urgent referral)? (3)

Difficulty placing chin on chest Headache Temperature >38.9*C

What are complementary medications that could possibly be considered to prevent migraine?

Feverfew Magnesium Vitamin B2 (riboflavin)...

What are complementary medicines with evidence in PMS?

Calcium 1200mg elemental daily +/- vit D Vitamin B6 up to 100mg daily (mostly small poor quality studies though) Vitex agnus-castus (VAC) 20-40mg extract (180-360mg dried fruit) daily (issues with quality of studies)

OTC treatment of menorrhagia?

Mefenamic acid 2 x 250mg caps tds to max of 7 days

What are the signs/symptoms and cause of lichen planus?

Itchy, purplish flat bumps that can form scabs. Painful, lacy, white patches on mucous membranes. Hair and nails involvement possible. Autoimmune disorder, can be triggered by hep C, flu vax NSAIDS and other meds.

What is leukoplakia?

Painless white lesion in mouth. Can't be wiped off. | Precancerous, often assoc. with smoking. Typically men over 40.

When to refer oral thrush? (4)

- diabetes (could be poor control) - immunocompromised (could be more severe) - painless (could be cancer) - more than 3 wks (likely not thrush)

3 risk factors for oral thrush?

Antibiotics Dentures - check sterilisation technique Inhaled corticosteroid

Dyspepsia signs/symptoms indicative of referral?

``` ALARM Anaemia Loss of weight Anorexia Recent onset of progressive sx Malaena, dysphagia, haematemesis ``` Also: persistent vomiting (ulceration or cancer), referred or severe pain (?MI), or pain that wakes during night (duodenal ulcer).

Signs of dehydration?

Mild: tiredness, anorexia, nausea, light-headedness Moderate: dry mouth, sunken eyes, decreased urine output, moderate thirst and pinch test 1-2 secs or longer.

When to refer infants/children or elderly with diarrhoea?

- If signs of dehydration (mouth, eyes, pinch test, urine output) - If vomiting precludes oral therapy - Duration: <1 yo >1 day 1-2 yo >2 days >3 yo >3 days

What type of laxative is usually recommended for pregnant women?

Fibre supplementation and bulk-forming preferred. | Macrogols & other osmotics are also ok. Stimulants appear safe, but may stimulate uterine contractions.

Constipation in children - when to refer and OTC treatment?

Refer: younger than 3 months, longer than 7 days duration or if can't determine cause Treat: glycerol (stimulant), lactulose (osmotic), poloxamer (softener) Others have varying ages, but all ok >6 yo, except docusate >12 yo

Which ocular antihistamines also have mast cell stabilising effects?

Azelastine Ketotifen Olopatadine

Community Pharmacy Flashcards

(44 cards)