Introduction to OTC products 1 Flashcards
(23 cards)
Explain the wwhamm framework
Who is it for?
– What are the symptoms?
– How long have the symptoms persisted?
– Action already taken?
– Medication being taken by patient (OTC or Rx)
– Medical condition
What is a cough caused by and what should you consider when discussing treatment
Reflex action
* Stimulated by irritation of the respiratory mucosa
* Clear airways of contaminants
* Suppress or encourage?
* Acute or chronic?
* Productive vs non productive?
What are the signs symptoms and causes of a non productive cough
Generally not bacterial infection
* Viral coughs often worse in the evening
* Typical response (smoking, dry atmosphere, air pollution,
temperature change)
* Asthma
* Lung cancer
* ADR
– ACE inhibitors; NSAIDs; Β-blockers
What are the signs and potential causes of a productive cough
clear white sputum - no infection
yellow, green brown - infection
Thick yellow mucoid - asthma
offensive brown smelling - brocnhiectasis/ lung abscess
rust coloured- pneumonia
Dark red - carcinoma / tB
Pink tinged, thin and frothy - LVF
What other considerations should be taken into account with a cough
- Worse in morning – post-nasal drip; chronic bronchitis
- Croup – Children: 6 months – 2 years, barking
- Post-nasal drip – clearing throat more
- Allergy-related? – associated symptoms
- Recurrent cough and family history of eczema, asthma or hay
fever – asthma? - Smokers (What happens when you stop?)
- GORD? (uncommon)
Further considerations regarding time
- Self-limiting
3-21 days: upper respiratory tract infection
3-8 weeks: acute or chronic bronchitis
+3 months: COPD, TB, ADR, chronic bronchitis or carcinoma - Associated symptoms - nasal congestion, sore throat, fever and
sweating, myalgia
When should you refer with a cough
Longer than 2 weeks & not improving
* Chest pain/pain on inspiration
* Sputum type – blood, purulent
* SOB, wheezing
* Whooping cough/croup
* Recurrent nocturnal dry cough – esp children
* Malaise, sweats, fever for over a week – infection?
* Suspected ADR – ACEI, immunosuppressants
* Chronic respiratory conditions or heart failure
* Painful, red calf (DVT~PE)
* Recurrent
* Weight loss – TB/cancer?
How do cough suppressants work to treat coughs and what kind of coughs should
Cough suppressants (antitussives) “Dry, tickly” coughs
– Centrally acting act on cough centre in brain (codeine, dextromethorphan)
* Sedation, constipation, dependence, interactions
– Anti-histamines – older generation (diphenhydramine, promethazine,
triprolidine)
* Intrinsic anti-cholinergic activity
* Cough and head cold
* May cause sedation – required effect
How do Demuculents treat coughs
Demulcents (honey, glycerin, syrup)
* Coat pharyngeal mucosa
* Some protection from irritants
* Soothing placebo effect?
* Hydrate mucosal tissues
Useful in children and pregnancy
How do expectorants work to treat chesty coughs and what else can be used
Expectorants – “Chesty Cough”
– Guaifenesin
No clinically significant drug interactions, side effects or cautions
– Ammonium salts, ipecacuanha (use subemetic dose), citric acid,
sodium citrate (weak at doses used), squill, extracts of liquorice,
menthol, eucalyptus etc.
Increase bronchial secretions, making it easier to cough up mucus
Lack of objective data for use
– Hydration of airways will help production of non-viscous mucus from
lung lining – drink fluids, steam inhalation
What action should be taken with children
For all symptoms – non-pharmacological interventions such as advising that the child drinks plenty of fluids
For fever and pain – treat with paracetamol or ibuprofen.
NICE do not currently recommend using paracetamol and ibuprofen at the same time in children under 5 years.
Currently, the second of these medicines should only be considered if the child does not respond to the first
For nasal congestion – treat with saline nasal drops, vapour rubs or decongestants (aromatic e.g. Karvol), or
steam inhalation
For a cough – warm, clear fluids or warm lemon and honey drinks can be advised if the child is aged over 1
year. Also, simple cough mixtures such as glycerol or simple linctus can be recommended
No codeine for coughs in under 18
Many cough medicines are 6+
If symptoms persist refer
What are the causes of common cold
- Mixture of upper respiratory tract infections
- Self-limiting, but symptomatic relief often required
- Common - 3-12 per year
- Rhinovirus and adenovirus
- Direct contact transmission; droplet transmission
What are the symptoms of a cold
- Common- average adult has 2-4 a
year, all year - Gradual onset
- Initial discomfort of eyes, nose throat
- Sneezing, rhinorrhoea, congestion,
sore throat, dry, tickly cough,
headache - Mild fever in children, fever uncommon
in adults
What are the symptoms of influenza
- Can affect up to 15% population and
cause epidemics and pandemics
periodically, usually in Winter - Rapid onset
- Initially fever, shivering, headache,
myalgia, vertigo, nausea, back pain - May also get symptoms of cold
- Anorexia and depression for up to few
weeks after
When should you refer with cold and flu
- Acute sinus involvement
- Ear pain from middle ear
- Ear pain not settling with analgesia
- Very young or old -flu
- Persistent fever or productive cough
- Persistent purulent mucus
- Delirium
- Pleuritic chest pain
- Asthma
- COPD, kidney disease, heart disease, immunocompromised
What traditional advice and phrophylaxis can you offer for cold and flu
TLC
– Steam inhalation (less viscous mucus)
– Hot toddy
– Fluids (adequate hydration)
– Hygiene measures – catch it, bin it, kill it
What symptomatic treatments are there
Symptomatic treatment
– treat the symptoms that are troubling the patient
– Analgesics – aspirin, ibuprofen, paracetamol
– Decongestants
– Throat lozenges
– “Pick me up”
How can aromatic inhalations help manage cold and flu
Aromatic Inhalations
– Menthol & eucalyptus
– Capsules (Karvol)
– Vapour rubs
– On handkerchief/pillowcase
– Useful for children
– Relieve nasal congestion, soothe airways by cooling effect on
mucous membranes/placebo effect
– Do not use regularly for long periods – can damage cilia in mucosa
How can oral decongestants help treat cold and flu
Oral decongestants
– Phenylephrine, ephedrine, pseudoephedrine
* Sympathomimetics stimulate alpha-adrenoceptors
* Constrict dilated blood vessels
* Shrink inflamed tissue
* Some beta-agonist activity can cause bronchodilation
* Check interactions
* Effect on blood pressure and blood glucose
* Not in hyperthyroidism, MAOIs
* Side effects and counselling
* Abuse – RPS guidance
What are the legal restrictions on pseudoephidrine and ephedrine
Legal restriction on quantities sold OTC
* Illicit production of methylamphetamine
* No >720mg of pseudoephedrine OR 180mg of ephedrine in a
single transaction
* It is unlawful to sell or supply any pseudoephedrine product
together with an ephedrine product
What mechanisms do non medicinal approaches take
Zinc acetate or gluconate lozenges
– Some evidence may reduce continuing symptoms
* Echinacea
– Stimulates immune system
– May be no better than placebo, anecdotal evidence
– Prevention or treatment
– Product variability
* Vitamin C
– High-dose >1g/day
– Prophylactic – reduced duration
– Few trials
Who does the NHS offer for free vaccines for the flu to
NHS service: Which patients can access for free:
– Chronic conditions: asthma, COPD, heart failure, CKD, liver disease,
neurological disease, diabetes, sickle cell, immunosuppressed
– Pregnant women
– Front line health & social care workers, also carers
– Residential care/nursing home residents
– Infants aged 6 months-2 years, with any of the chronic conditions listed above
– Children 2-11 and some secondary school children
– Over 50s
* Pharmacy 2021/2022 administered 4.8 million NHS vaccines
* Private service – all additional groups – patient pays
What conditions are included in the pharmacy first pathways
Acute Sinusitis (Individuals 12yrs and over)
– How would you diagnose?
– Which resources could you use?
– Physical examination?
* Acute Sore Throat (Individuals 5yrs and over)
– Based on FeverPain score
– Antibiotic – phenoxymethylpenicllin (clarithromycin / erythromycin)
