pharmacy first shingles Flashcards
(14 cards)
what age group does this apply to
adults (18+)
what serious should we check for that require immediate referral
Serious complications suspected
☐ Meningitis (neck stiffness,
photophobia, mottled skin)
☐ Encephalitis (disorientation,
changes in behaviour)
☐ Myelitis (muscle weakness, loss
of bladder or bowel control)
☐ Facial nerve paralysis (typically
unilateral) (Ramsay Hunt)
if shingles is in this place it requires immediate referral to A&E
Shingles in the
ophthalmic distribution
☐ Hutchinson’s sign — a
rash on the tip, side, or
root of the nose
☐ Visual symptoms
☐ Unexplained red eye
What type of patient does the pathway not apply to
☐ Shingles in severely
immunosuppressed patient
☐ Shingles in
immunosuppressed patient
where the rash is severe,
widespread or patient is
systemically unwell
what are some of the clinical features of shingles
abnormal skin sensation and pain in affected area
pain described as: burning, stabbing, throbbing
rash 2-3 days after pain
rash: red spots on pink red background
fluid-filled blisters
unilateral!!!
dermatomal distribution
crusting where blisters have burst
what else needs to be checked for if we catch it within 72 hours
Does the patient meet (ANY) of the
following criteria:
☐ Immunosuppressed (see below)
☐ Non-truncal involvement (shingles
affecting the neck, limbs, or perineum)
☐ Moderate or severe pain
☐ Moderate or severe rash (defined as
confluent lesions)
☐ All patients aged over 50 years
if the patient has had it for up to a week, what do we ask for
Does the patient meet (ANY) of the
following criteria:
☐ Immunosuppressed (see below)
☐ Continued vesicle formation
☐ Severe pain
☐ High risk of severe shingles (e.g.
severe atopic dermatitis/eczema)
☐ All patients aged 70 years and over
what are the two drugs associated with shingles treatment under the PGD
Aciclovir, valaciclovir
when would valaciclovir be given instead of aciclovir
Offer valaciclovir:
☐ Immunosuppressed patients
☐ Adherence risk: already taking 8 or more medicines a
day or is assisted in taking their medicines
what is the max time a patinet can have symptoms of shingles and we are still able to supply them with medication via pharmacy first
7 days
is shingles contagious
Shingles is not caught from someone who has shingles or from someone who has chickenpox.
It develops when the inactive herpes zoster virus awakens, for example when a person’s immune defences are weaker than normal. However, a person affected by shingles can give chickenpox to someone who has never previously had chickenpox.
A person with shingles is infectious from the point of the first blister until the blisters crust over (approximately 7 days).
What is the purpose of the antiviral medication
To shorten the outbreak - the medicine slows the replication of the virus before its peak, so it cannot be used after the peak, which is usually around seven days
What meds can be given to someone with shingles to aid discomfort?
painkillers: paracetamol, ibuprofen - ineffective = refer to GP
what other actions should be done when supplying someone who is immunosuppressed with an antiviral
offer appropriate treatment and call GP urgently - request a review by the GP
advice on worsening infection - seek immediate medical attention - a&e or 999
