pharmacy 1st

Question 1

simple uti

Answer 1

* Criteria for inclusion:
* Non-pregnant women aged 16 – 64 years
* Must have 2-3 key diagnostic signs / symptoms:
* dysuria (burning pain when passing urine),
* new nocturia (passing urine more often than usual at night)
* Urine cloudy to the naked eye
* Treatment:
* Nitrofurantoin 100mg M/R BD for 3/7
* Urgent referral to GP / out of hours services for same day assessment if:
* Systemically unwell (not sepsis!)
* Signs and symptoms of upper UTI / pyelonephritis (fever, shaking chills (rigors), kidney pain /
tenderness)

Question 2

sore throat

Answer 2

Criteria for inclusion
* Acute sore throat due to suspected streptococcal infection in children aged 5 years and over and adults
* Must have FeverPAIN score of 4 or 5 with severe symptoms for antibiotic treatment:
* FEVER in previous 24 hours
* Purulent tonsils
* Attend rapidly (symptom onset <3 days)
* Severe tonsillar inflammation
* No cough / coryza
* Treatment
* Phenoxymethylpenicillin
* Clarithromycin
* erythromycin
* Urgent referral to GP / out of hours services for same day assessment if:
* Extensive list! See PGD
* Signs or symptoms of scarlet fever / quinsy / glandular fever
* Patient is immunosuppressed
* Suspected malignancy: persistent mouth ulcers, unable to swallow, mass or unilateral swelling present

Question 2

• Infected insect bite

Answer 2

* Criteria for inclusion
* Infected insect bite(s) or sting(s) in children aged 1 year and over and adults
* Evidence of infection:
* Redness of the skin / Pain or tenderness to the area / Swelling of the skin and hot to
touch
* Redness or swelling of the skin surrounding the bite(s) or sting(s) is spreading
* Evidence of pustular discharge at site of bite(s) or sting(s)
* Treatment
* Flucloxacillin
* Clarithromycin
* erythromycin
* Urgent referral to GP / out of hours services for same day assessment if
* Human bite / animal bite / bite or sting outside of UK eg mosquitos
* Severe pain out of proportion to the wound
* Patient has significant co-morbidities and is systemically unwell.

Question 3

Shingles (herpes zoster infection)

Answer 3

Criteria for inclusion
* Adults aged 18 years and over
* Rash: maculopapular lesions that develop into clusters of vesicles at onset or continuous
vesicle formation
* Non-truncal involvement (shingles affecting the neck, limbs or perineum)
* Moderate to severe pain
* Treatment
* Anti-virals: aciclovir or valaciclovir
* Urgent referral to GP / out of hours services for same day assessment if:
* Pregnant women
* Systemically unwell or immunosuppressed.

Question 3

Impetigo (a bacterial skin infection)

Answer 3

Criteria for inclusion
* Localised non-bullous impetigo in children over 1 year and adults who are
systematically well and not at high risk of complications
* Lesions with thin walled vesicles or pustules which release exudate forming a gold /
brown crust
* Mild itch
* Treatment
* Hydrogen peroxide cream
* Fusidic acid cream
* Po antibiotics: flucloxacillin, clarithromycin, erythromycin
* Urgent referral to GP / out of hours services for same day assessment if:
* Patient is systemically unwell with bullous impetigo or spreading infection
* Patient is immunosuppressed

Question 3

Acute otitis media (earache)

Answer 3

• Criteria for inclusion
• Caused by viruses or bacteria, usually self-limiting
• Treat if symptoms are moderate – severe:
• Otoscopic examination: red / yellow / cloudy tympanic membrane. Bulging of the tympanic membrane.
  Perforation of tympanic membrane.
• Severe pain not controlled by regular analgesia
• In children earache may present as: holding, tugging or rubbing of the ear, fever, crying, poor feeding,
  restlessness etc.
  * Treatment
• Local relief of pain in children aged 1 year and over and young people (under 18 years of age): Otigo® (phenazone
  40mg/lidocaine hydrochloride 10mg/g) ear drops, solution
• Antibiotics: amoxicillin , clarithromycin or erythromycin
• Urgent referral to GP / out of hours services for same day assessment if:
• Patient is very unwell with systemic features
• The patient is at high risk of complications due to co-morbidities e.g. children with significant heart, lung, kidney,
  liver or neuromuscular disease, severe immunosuppression or immunosuppression, cystic fibrosis and young
  children who were born premature

Question 4

Sinusitis

Answer 4

Criteria for inclusion
* Acute sinusitis in children aged 12 years and over and adults
* Nasal blockage/obstruction/congestion or nasal discharge (discoloured or purulent
discharge). Reduction (or loss) of the sense of smell.
* Facial pain/pressure (or headache).
* Symptoms > 10 days
* Fever
* Treatment
* Mometasone nasal spray
* Fluticasone nasal spray
* PO antibiotics: Phenoxymethylpenicillin, Clarithromycin, Erythromycin, doxycycline
* Urgent referral to GP / out of hours services for same day assessment if:
* Periorbital oedema or cellulitis, displaced eyeball, double vision, etc
* Severe frontal headache, swelling over frontal bone, symptoms or signs of meningitis