Symptoms in the Pharmacy

A Guide to the Management of Common Illnesses

Alison Blenkinsopp, Martin Duerden, John Blenkinsopp

• Publisher: Wiley-Blackwell
• Year: 2018
• Print ISBN: 9781119317968
• eBook ISBN: 9781119318002
• Edition: 8
• Topic: Medicine
• Subtopic: Pharmacology

Fully updated to reflect NHS moves to encourage greater self-care and more use of over-the-counter remedies Informed by the experiences and expertise of seasoned pharmacists and GPs, this reference guide provides pharmacists working in the community with the treatment information they need when they need it. Each chapter incorporates a decision-making framework which distills the information necessary for treatment along with suggestions on "when to refer" set off in summary boxes. Elucidating case studies are provided throughout, in which pharmacists and doctors describe, in their own words, listening to and treating patients suffering with a range of common problems, from migraine to eczema to IBS.

The indispensable guide to assessing and managing common symptoms seen in the pharmacy

• Includes information about medicines recently reclassified for OTC supply such as those for malaria prophylaxis and erectile dysfunction
• Now includes more highlights of "Red Flag" signs and symptoms
• Covers respiratory, gastrointestinal, skin, ear and eye, cardiovascular, and pain conditions
• Offers specific recommendations for women's, men's and children's health problems
• Provides decision making support for cases involving ethical dilemmas
• Features a visual display of relevant treatmentguidelines
• Emphasizes the evidence base for OTC medicines

With expert coverage of most common ailments which will be encountered by pharmacists on a daily basis, Symptoms in the Pharmacy, 8 th Edition is a professional resource you'll want to keep close at hand for frequent consultation.

Chapter 1
Respiratory Problems

Colds and flu

The common cold comprises a mixture of viral upper respiratory tract infections (URTIs). Although colds are nearly always self-limiting, some people go to their general practitioner (GP) for treatment, and increasingly there is concern about overprescribing of antibiotics when this happens as these do not improve outcome. Self-management or getting advice and support from a pharmacist are usually much better options. Many people choose to buy over-the-counter (OTC) medicines for symptomatic relief and this is to be encouraged. However, some of the ingredients of OTC cold remedies may interact with prescribed therapy, occasionally with serious consequences. Therefore, careful attention needs to be given to taking a medication history and selecting an appropriate product where indicated. Educating people on the self-limiting nature of symptoms is also important.

What you need to know

• Age (approximate)
  • Child, adult
• Duration of symptoms
• Runny/blocked nose
• Summer cold
• Sneezing/coughing
• Generalised aches/headache
• High temperature
• Sore throat
• Earache
• Facial pain/frontal headache
• Flu
• Asthma
• Previous history
  • Allergic rhinitis
  • Bronchitis
  • Heart disease
  • Present medication

Significance of questions and answers

Age

Establishing who the patient is – child or adult – will influence the pharmacist's decision about the necessity of referral to the doctor and choice of treatment. Children are more susceptible to URTI than are adults and may get complications. Very young children and babies are also at increased risk of bronchiolitis, pneumonia and croup, and these conditions need to be considered. Older people, particularly if they are frail and have co-morbidities (e.g. diabetes), may be at risk of complications such as pneumonia.

Duration

Patients may describe a rapid onset of symptoms over hours or a gradual onset over a day or two; the former is said to be more commonly true of flu, the latter of the common cold. Such guidelines are general rather than definitive. The symptoms of the common cold usually last for 7–14 days. Some symptoms, such as a cough, may persist after the worst of the cold is over and coughing for 3 weeks is not unusual. This is often poorly recognised, so expectations of recovery may be unrealistic, and it is worth advising patients that this may happen.

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Box 1.1 NICE Guideline: Respiratory tract infections (self-limiting)

The average total lengths of the illnesses are as follows:

• Acute otitis media: 4 days
• Acute sore throat/acute pharyngitis/acute tonsillitis: 1 week
• Common cold:
  
  weeks
• Acute rhinosinusitis:
  
  weeks
• Acute cough/acute bronchitis: 3 weeks

Source: NICE Clinical Guideline 69 (CG69) (July 2008).

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Symptoms

Runny/blocked nose

Most patients will experience a runny nose (rhinorrhoea). This is initially a clear watery fluid, which is then followed by the production of thicker and more tenacious, often coloured mucus. Nasal congestion occurs because of dilatation of blood vessels, leading to swelling of the lining surfaces of the nose and can cause discomfort. This swelling narrows the nasal passages that are further blocked by increased mucus production.

Summer colds

In summer colds, the main symptoms are nasal congestion, sneezing and irritant watery eyes; similar symptoms are commonly caused by allergic rhinitis (see Allergic rhinitis: Duration, later in this chapter).

Sneezing/coughing

Sneezing occurs because the nasal passages are irritated and congested. A cough may be present (see Cough: What you need to know, later in this chapter) either because the pharynx is irritated (producing a dry, tickly cough) or as a result of irritation of the bronchus caused by postnasal drip.

Aches and pains/headache

Headaches may be experienced because of inflammation and congestion of the nasal passages and sinuses. A fever may also cause headache. A persistent or worsening frontal headache (pain above or below the eyes) may be due to sinusitis (see below). People often report muscular and joint aches and this is more likely to occur with flu than with the common cold (see below).

High temperature

Those suffering from a cold often complain of feeling hot, but in general a high temperature (e.g. exceeding 38°C) will not be present. The presence of fever may be an indication that the patient has flu rather than a cold (see below).

Sore throat

The throat often feels dry and sore during a cold and may sometimes be the first sign that a cold is imminent. A sore throat can be a prominent feature in colds and flu, and it is often treated erroneously as a throat infection (see the separate section on sore throat later in this chapter).

Earache

Earache is a common complication of colds, especially in children. When nasal catarrh is present, the ear can feel blocked. This is due to blockage of the Eustachian tube, which is the tube connecting the middle ear to the back of the nasal cavity. Under normal circumstances, the middle ear is an air-containing compartment. However, if the Eustachian tube is blocked, the ear can no longer be cleared or air pressure equilibrated by swallowing and may feel uncomfortable and deaf. This situation often resolves spontaneously, but decongestants and inhalations can be helpful (see ‘Management’ below). Sometimes the situation worsens when the middle ear fills up with fluid and is under pressure. When this does occur, the ear becomes acutely painful and this is called acute otitis media (AOM). AOM is common in young children and usually the best treatment is pain relief. A secondary infection may follow, but even in the context of infection, the evidence for antibiotic use is conflicting with some trials showing benefit and others showing no benefit from taking antibiotics. Overall the evidence from clinical trials shows that without antibiotic treatment, symptoms will improve within 24 h in 60% of children and will settle spontaneously within 3 days in 80%...

Table of contents

• Cover
• Title Page
• Copyright
• Preface
• Introduction: How to Use This Book
• About the Companion Website
• Chapter 1 Respiratory Problems
• Chapter 2 Gastrointestinal Tract Problems
• Chapter 3 Skin Conditions
• Chapter 4 Painful Conditions
• Chapter 5 Women's Health
• Chapter 6 Men's Health
• Chapter 7 Eye and Ear Problems
• Chapter 8 Childhood Conditions
• Chapter 9 Insomnia
• Chapter 10 Prevention of Heart Disease
• Chapter 11 Malaria Prevention
• Appendix A: Summary of Symptoms for Direct Referral
• Appendix B: Resource and Reference Grid
• Index
• EULA