Tutorial 2: Case 1

Question 1

Joshua, a 35 year old bus driver, enters the pharmacy and says: ‘I need something for a runny nose please’

A) Who is it for?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

Answer 1

A) Myself

B) Mainly a runny nose and I feel I need to blow my nose constantly

C) It has been about 2 weeks now

D) I took some garlic and horse radish tablets that I already had at home but they havent made a differrence

E) No medical conditions

F) None

Question 2

Appropriate extended questions

1. Are they any other symptoms? is the nose itchy?
2. Have you had this before
3. Can you describe the discharge from your nose i.e. clear/watery or thick/colored?
4. Do you prefer or oral or intranasal products
5. Has anything changed recently? Moved house? Any activities

Answer 2

1. My nose is really itchy and I have occasional fits of sneezing
2. I have had a cold before but I don’t remember the runny nose lasting this long
3. The discharge is clear and really runny, like a running tap
4. No preference, whichever you think is the best but I’m a driver so I do need to stay awake
5. I’ve recently moved to the northern suburbs as it is closer to my wife’s workplace. We bought a new house and I’ve been working in the garden a lot more than before.

Question 3

What is the diagnosis? Explain reasoning to patient

Answer 3

Allergic rhinitis (hayfever)

• Based on the signs and symptoms you have told me, I believe you have allergic rhinitis which is also known as hayfever
• The runny and itchy nose are common symptoms of hayfever
• Most likely triggered because of the gardening you have been doing (pollen)

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

Beclomethasone -> intranasal corticosteroid (first line for hayfever)

• Indication: can be used for long periods of time, will reduce inflammation and symptoms you are experiencing such as the runny nose
• Dosage and directions: block one nostril, cross arms and aim spray at the corner of the nose, keep heat tilted down, clean nozzle after each use. Use twice daily
• Adverse effects: may cause nasal irritation and nose bleeds
• Duration of treatment, time to recovery, when to refer: will take a couple of weeks to cure, refer if failed treatment with medication (after 2-4 weeks) or there is pain in sinuses
• Lifestyle/self-care: use mask when gardening, avoid allergen is possible, vacuum carpets in your home, check the pollen count

I will give you a self care-card for hayfever and a consumer medication information leaflet. Do you have any questions for me?