Rx Note

Introduction In a community pharmacy setting, almost on a daily basis, we recommend oral antihistamine to our customers, which could be for prevention and treatment of symptoms in allergic rhinitis , allergic conjunctivitis, urticaria , or a variety of other allergic diseases. 1st and 2nd Generation As an overview, antihistamines can be classified into 1st and 2nd generation. This dichotomy was introduced in 1983 to indicate a major pharmacological difference between terfenadine and astemizole. Being less lipid soluble, the second generation antihistamines is thus believed to be less readily penetrated the blood brain barrier, and hence does not cause drowsiness. However, second generation antihistamines are still able to penetrate the blood brain barrier and may cause drowsiness (thought it rarely occurs). In fact, there are textbooks using the terminology of "less sedating antihistamines" to describe the second generation antihistamines, instead of "non-sedating antih...

Introduction Rhinitis is simply inflammation of the nasal lining, characterized by rhinorrhoea nasal congestion sneezing, and itching Most cases that present in a community pharmacy will be a viral infection or allergic in origin. Allergic rhinitis is a mucosal reaction in response to allergen exposure. The ARIA classification is based on the timing of the symptoms and is divided into intermittent or persistent. Priming to allergen refers to the phenomenon of increased nasal responsiveness to allergen with repeated allergen exposure. Patients, after a period of continuous allergen exposure, may find that they experience the same level of severity in symptoms with lower levels of allergen exposure. Similarly, symptoms will be worse than previously experienced when levels of the allergen are the same. NOTE: The typical atopy triad is asthma , hay fever and eczema . Conditions to Eliminate Infective rhinitis Other symptoms such as cough and sore throat are much more prominent. Nonall...

Introduction Because common cold has no specific cure and is self-limiting , it would be easy to dismiss the condition as unimportant. Nonetheless, colds, along with coughs , represent the largest caseload for primary healthcare workers. Clinical Features Following an incubation period of between 1 and 3 days (although this can be as short as 10-12 hours), the patient develops a sore throat and sneezing, followed by profuse nasal discharge and congestion. Cough and upper airway cough syndromes (UACS) commonly follow. In addition, headache, mild to moderate fever (<38.9°C), and general malaise may be present. Most colds resolve in 1 week, but up to 25% of people will have symptoms lasting 14 days or more. NOTE: Acute otitis media is commonly seen in children following a common cold and results from the virus spreading to the middle ear via the Eustachian tube, where an accumulation of pus in the middle ear or inflammation of the tympanic membrane (eardrum) results. Questions to ...

Introduction Insects Stinging insects - those that use some sort of venom as a defence mechanism or to immobilize their prey. Examples include bees, wasps and ants. Biting insects - those that feed off the blood supply of humans and other creatures. Examples include mosquitoes, ticks and fleas. Clinical Features Reactions to insect bites or stings are generally mild , but local or systemic reactions can occur due to hypersensitivity, allergic reaction, transmission of infection, or envenomation. Itching papules, which can be intense, is the hallmark symptom of insect bites. Weals, bullae and pain can occur, especially in sensitized individuals. Lesions are often localized and grouped together, and occur on exposed areas, for example hands, ankles and face. Scratching can cause excoriation, which might lead to secondary infection. In contrast, stings are associated with intense burning pain. Erythema and oedema follow but usually subside within a few hours. If systemic symptoms are ex...

Introduction Urticaria is characterised by very itchy weals (hives) with or without surrounding erythematous flares. It may also be accompanied by angioedema. Aetiology Urticaria can be classified according to its duration. Acute urticaria (<6 weeks duration) Often gone within hours to days. Most often results from type 1 hypersensitivity reactions. Chronic urticaria (>6 weeks duration) May be spontaneous or inducible. Most often results from idiopathic causes or autoimmune disorders. NOTE: Acute cases (70%) are more common than chronic (30%). Management The main treatment for all forms of urticaria is with an oral second-generation H1- antihistamines . Second generation antihistamines are preferred because of once-daily dosing and are less sedating. If the standard dose is not effective, the dose can be increased up to 4-fold. They are stopped when the acute urticaria has settled down. In severe acute urticaria where non-sedating antihistamines are ineffective, systemic cort...

Introduction Itch without rash usually has a simple cause that is not serious - most commonly, it is due to xerosis (dry skin) . Known causes, in approximate order of incidence are listed in tablet below. Management For itch without rash that has a definite cause, the itch typically resolves when the cause is treated or removed. Treating dry skin Treating scabies Removing irritants A trial of stopping or changing a drug can be useful Itch without rash in children is often caused by dermographism ; initial therapy is an oral antihistamine . Less-sedating antihistamines and sedating antihistamines (for sleep disturbance associated with itch) can be used. If the cause of the itch is dry skin or is not known, improve the skin condition by Using a soap substitute Avoid long, hot showers and baths, especially elderly patients with dry skin. After bathing, avoid rubbing the skin to dry. Instead, pat the skin dry with a towel. Apply moisturizer several times a day, especially after bathing....