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Clinical Pharmacology > Upper Respiratory Tract Infections > Flashcards

Upper Respiratory Tract Infections Flashcards

1
Q

What makes up the upper respiratory tract?

A

*nasal cavity- defence- filters air
*pharynx- hallway for resp and digestive tract (epiglottis)
*larynx-passageway for air- vocal cords
*trachea- wind pipe

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2
Q

What are the defence mechanisms of the URT?

A

*smell
*mucociliary lining
*lymphatic tissue of tonsils and adenoids
*cough reflex

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3
Q

What is the normal flora of the URT?

A

S. aureus
-compete with pathogens for potential attachment sites
-produce toxins that are bactercidal

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4
Q

What are common URT infections?

A

*cold
*sinuitis
*cough
*croup
*sore throat
*otitis media- middle ear infection

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5
Q

What viruses cause the common cold?

A

*rhinovirus (most common)
*corona
*enterovirus

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6
Q

How is the cold transmitted?

A

Autoinoculation by contact with nose or eyes

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7
Q

What is the pathology of the cold?

A

*virus acquired
*virus infects cells lining nasal passage and pharynx
*virus sheds coat, releasing nucleic acids and replicates
*immune response triggered- inflammatory changes occur
*immune response- ciliated columnar epithelial cells destroyed and sloughed off
*destruction peaks day 2-5
*cells regenerate by roughly day 14

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8
Q

What is the timeline of the cold?

A

*after 2 days, symptoms start (immune response)
*sore throat, sneezing
*day 4- cough and sinus pain starts
*day 7- most symptoms gone but cough still there
*day 10- feel normal

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9
Q

What common cold management can be used?

A

Non pharmacological-
*lots of fluid
*rest
*eat healthy
Pharmacological-
*ibuprofen
*paracetamol
*symptom specific- cough bottle etc

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10
Q

What type of decongestants are there?

A

*oral
-pseudoephedrine
*topical
-ephedrine, oxymetazoline, xylometazoline (immediate effect-prolonged use causes rebound- no longer 7 days)

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11
Q

What groups are oral decongestants cautioned with? (Pseudoephedrine)

A

*diabetes
*hypertension
*hyperthyroidism
*hepatic or renal impairment
AVOID
*MAOI’s (type of anti depressants)

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12
Q

What can you not supply alongside pseudoephedrine?

A

Ephedrine products

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13
Q

What is (Rhino) sinusitis?

A

Inflammation of mucosal lining of sinuses

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14
Q

What are your sinuses?

A

*membrane lined air spaced in skull located near nose
*frontal sinuses- above nose on either side
*maxillary sinuses- under cheek bones
*ethmoid or sphenoid sinuses- deeper part of skill near eye sockets

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15
Q

What are the two classifications of sinusitis?

A

*acute sinusitis- resolves within 12 weeks
*chronic sinusitis- symptoms last more than 12 weeks

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16
Q

What pathogens usually cause sinusitis?

A

Bacterial- streptococcus pneumoniae
Virus- rhinovirus - main initial causes

17
Q

How is sinusitis diagnosed?

A

*follows common cold, increase in symptoms after 5 days/10 days but less than 12 weeks
Adults- congestion, nasal discharge, dental or facial pain, reduced smell
Children- congestion, discoloured nasal discharge, cough during day or at night

18
Q

What are red flag symptoms with sinusitis?

A

*bleeding
*sight issues
*immunocomp

19
Q

How is acute sinusitis managed?

A

*if symptoms 10 days or less- usually viral- no antibiotic needed- advise might take 2-3 weeks to resolve
*paracetamol, ibuprofen, nasal saline or nasal decongestants can be tried
*10 days or more/no improvement- nasal corticosteroids- mometasone 200mcg twice daily
*if >3 weeks, systemically unwell or red flag symptoms > GP

20
Q

If an antibiotic is needed (bacterial sinusitis), what is the treatment plan?

A

*1st line- phenoxymethylpen- 500mg four times daily for 5 days
*2nd line- doxycycline- 200mg stat, then 100mg once daily for 5 days
OR
Clarithromycin- 500mg twice daily for 5 days
SEVERE- co-amoxiclav 500/125mg- three times daily for 5 days
Pregnant- erythromycin 250-500mg four times daily

21
Q

What are the main differences between viral and bacterial sore throat?

A

*bacterial causes grey furry tongue- viral does not
*bacterial causes white spots on tonsils- viral does not
*bacterial causes swollen uvula- viral does not

22
Q

What bacteria is Scarlet fever caused by?

A

Streptococcus group A (strep A)

23
Q

What are symptoms of scarlet fever?

A

*sore throat, fever, headache, fatigue
*sandpaper like blanching rash- flushed red face but pale round mouth
*strawberry tongue

24
Q

How is scarlet fever managed?

A

*phenoxymethylpen for 10 days
*infection control- stay away from nursery, school etc for 24 hours after 1st dose of antibiotics

25
Q

What is the management of an acute productive cough?

A

*guaifenesin- cough bottle
*honey or pelargonium

26
Q

What is the management of an acute non productive cough?

A

*pholcodine
*dextromethorphan
*honey
*glycerin

27
Q

What age are most cough and cold remedies not allowed for?

A

Under 6

28
Q

What is croup?

A

*viral
*barking cough
*may be fever
*usually worse at night
*in 6months-3years old

29
Q

How is croup managed?

A

*mild-at home- resolves 48 hours
*paracetamol and ibuprofen for fever and pain
*adequate fluid
*NOT STEAM INHALATION
*severe- hospital- single oral dexamethasone- breathing affected call 999

30
Q

What is whooping cough?

A

*intense cough starts approx. 1 week later
*lasts few minutes
*usually brings up thick mucus
*whoop sound

31
Q

How is whooping cough managed?

A

*vaccines during pregnancy, 8,12,16 weeks, pre school
*macrolide antibiotic, rest, fluid
*avoid contact- especially with babies- HIGHLY CONTAGIOUS

32
Q

What is acute otitis media?

A

*infection of middle ear
*accompanied by URT symptoms eg cough, runny nose

33
Q

What causes acute otitis media?

A

*virus- rhinovirus
*bacteria- streptococcus pneumoniae

34
Q

How is otitis media diagnosed?

A

*otoscopic appearance (look in ear)
-bulging tympanic membrane
-changed membrane colour
-perforates tympanic membrane + pus discharge

35
Q

When should otitis media resolve?

A

Within 3 days without treatment

36
Q

When would an antibiotic be prescribed for otitis media?

A

*child under 2 with bilateral AOM
*high temp 38.5°C or vomit
*very bulging tympanic membrane
*4 days no improvement

37
Q

What is the antibiotic treatment line for bacterial AOM?

A

*adult 1st line- amoxicillin 500mg three times daily for 5 days
*2nd line/ allergy- clarithromycin- 500mg twice daily for 5 days
*child 1st line- amoxicillin strength based on age- three times daily for 5 days

38
Q

What should be avoided in children with AOM?

A

Formula mill
Passive smoking
Other kids

Clinical Pharmacology (26 decks)

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