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2017 HCHB_digital

Sore Throat Sore throats

Sore Throat Sore throats are very common and symptoms can vary from a mild scratchiness at the back of the throat to severe pain. Visually, the throat may look dry and red and the tonsils inflamed and swollen. Often, lymph nodes in the neck become enlarged and tender and can be easily felt from the outside of the neck. It may be hard for the person to swallow and their voice may sound husky or hoarse. Sore throats can be associated with colds and flu, tonsillitis (inflammation of the tonsils caused by a bacterial or viral infection), or strep throat. Viruses account for almost 90% of all infections, with the cold virus the most common cause. The Epstein-Barr virus, which is responsible for glandular fever and the measles virus can also cause sore throat. If a cause other than a cold virus is suspected, the person should be referred to the pharmacist. Products available for viral sore throats temporarily relieve the pain associated with the sore throat. Products include oral and topical analgesics, and numbing sprays or lozenges. Even sucking non-medicated lozenges can provide some relief as the action of sucking produces saliva, which lubricates and soothes inflamed tissue. streptococcal (strep) sore throats Sore throats produced by Group A streptococcal bacteria tend to be more severe and persistent than other causes of sore throats. Symptoms may include a distinct pattern of white patches on the back of the throat or a high fever. Occasionally the person may develop a rash that feels rough to the touch. It may start on the neck and chest and eventually spread to the whole body. A strep throat infection accompanied by this distinctive rash is known as scarlet fever. The rash is caused by toxins produced by the streptococcal bacteria. Strep throats are more prevalent in people aged three to 45 years, particularly those under 15, and are highly infectious. If one person in a family develops a strep throat, then all members of a household should be tested for the presence of the bacteria. Refer anybody with a suspected strep throat particularly in areas of high strep throat occurrence to a free sore throat clinic (see www.health. govt.nz or call Healthline on 0800 611 116 for locations), or a doctor because untreated infections can result in rheumatic fever (an inflammatory disease that can permanently damage the heart) or kidney disease. Rheumatic fever is more common in Maori and Pacific Islanders, especially those in overcrowded living conditions. Always refer Maori or Pacific children aged four to 19 with a sore throat. Initial assessment Ask your customer for a description of their symptoms, or if appropriate, don a face mask and gloves and take them to a private area to look at their throat. Try to assess the degree of redness (ie, mild, moderate or severe) and look for any unusual features (such as white patches on the back of the throat or pus). Refer any customers with "yes" answers to the Refer to Pharmacist questions to a pharmacist. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, diabetes, is pregnant or breastfeeding)? • Does the person take any other medicine or complementary products, either prescribed by a doctor or bought from a shop? • Is the person a child aged less than 19 years? • Are the lymph nodes really swollen? • Is there any sign of pus or ulceration? • Are there any other symptoms, such as a rash, fever, vomiting, ear pain, breathlessness or generally feeling unwell? • Is swallowing extremely difficult, or preventing the person from drinking anything. Are they showing signs of dehydration? • Are there any white patches visible on the throat or tonsils? • Has swallowing been difficult for a long time (eg, weeks)? • Does the person often get sore throats? • Has the person taken any new medicine recently? • Does the person have any allergies to medicines? chicken soup. Avoid crunchy or spicy foods with severe sore throats. Increase water and fluid intake to offset dehydration. • Rest as much as you can. Talk to a doctor if your sore throat does not get better within a few days. • Regular sucking of lozenges or pastilles stimulates saliva, which will lubricate and soothe sore throats. Do not exceed the recommended dosage. • Avoid smoking – it can make a sore throat feel worse. • Cough into the crook of your elbow or cover your mouth with a tissue when you sneeze or cough to avoid spreading your sore throat. Wash your hands or use a sanitising hand gel immediately if you cough on your hands. • Wash hands thoroughly before preparing food and before and after tending to small children. Advice for customers • Eat cool, soft food such as smoothies and drink cool or warm liquids such as MANAGING PAIN FREE PROFESSIONAL DEVELOPMENT FOR Pharmacy assistants, technicians and students 4 Page 140 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION TREATMENT OPTIONS Category Examples Comments Soothing products Antiseptic/antibacterial agents Antiviral agents Anti-inflammatories (locally acting) eg, Radiance ManukaGuard Honey Lozenges eg, Weleda Throat Relief Oral Spray [GENERAL SALE] eg, Codral Sore Throat Lozenges Antibacterial Honey & Lemon*, Codral Sore Throat Lozenges Antibacterial Menthol*, Strepsils Soothing Honey and Lemon Lozenges*, Strepsils Children 6 + , Strepsils Sore Throat and Blocked Nose* [PHARMACY ONLY MEDICINE] eg, Difflam-C Solution Sugar-Free (+ antiinflammatory), Difflam Lozenges Sugar Free (+ anti-inflammatory) [PHARMACY ONLY MEDICINE] eg, Betadine Sore Throat Gargle* [PHARMACY ONLY MEDICINE] eg, benzydamine (Difflam range) Natural lozenges containing honey can help soothe the throat. Suck regularly but do not exceed the recommended dosage. Homeopathic ingredients such as arnica, belladonna and cinnabar can help soothe and maintain the health of the throat. Relieve the symptoms of sore throat. Also contain an antibacterial agent. Do not exceed maximum dose. Many contain an artificial sweetening agent that may have a laxative effect in some people. May irritate tongue and lips. May kill viruses and bacteria associated with sore throats but offers little symptom relief. Effective at relieving pain associated with sore throats. If solution stings, it may be diluted with water. Benzydamine is not recommended for children aged under six years. Locally acting anaesthetics Oral non-steroidal anti-inflammatory agents (NSAIDs) Locally acting non-steroidal anti-inflammatory agents (NSAIDs) Simple analgesics Treatment and prevention using natural bacteria Natural / herbal products / supplements [GENERAL SALE] eg, Codral Sore Throat Lozenges Antibacterial and Anaesthetic Lime & Lemon*, Difflam Lozenges Plus Anaesthetic, Strepsils Plus Anaesthetic Throat Spray*, Strepsils Plus Lozenges* [GENERAL SALE] eg, aspirin (Aspro range, Disprin) eg, ibuprofen 25s (Nurofen range), ibuprofen suspension (Nurofen for Children, Fenpaed), eg, ibuprofen + paracetamol (Maxigesic [50, 100], Nuromol [24, 48]) [PHARMACY ONLY MEDICINE] eg, flurbiprofen (Strepfen Intensive Honey & Lemon Lozenges*) [GENERAL SALE] eg, paracetamol (Children’s Panadol, Pamol, Panadol, Paracare range) [SUPPLEMENT] eg, Streptococcus salivarius K12 (BLIS K12 Throat Guard Boost, Blis K12 Throat Guard Daily) eg, honey, echinacea, eucalyptus, liquorice, slippery elm eg, Bosistos range, Comvita Fortacold Lozenges with Propolis, Kiwiherb Herbal Throat Formula These contain lignocaine or benzocaine and are effective at soothing and numbing sore throats. Warn customer to be careful when eating or drinking hot foods or drinks due to altered perception of heat. Not recommended for children aged under six years. Effective at reducing inflammation, which will help ease sore throat pain. Ibuprofen is the NSAID least likely to cause stomach irritation. NSAIDs may not be suitable for people on certain other medications or with some medical conditions (eg, asthma, kidney disease – see Refer to Pharmacist). Advise customer to stop taking if stomach upsets, increased bruising or prolonged bleeding occur. Soluble aspirin may be used as a gargle to treat a sore throat. Avoid aspirin in children aged under 12 years. See Reference Section, OTC Medicine Interactions, Precautions. Effective and well tolerated for the relief of sore throats. Not recommended for children aged less than 12. Usual precautions for NSAIDs apply. Effective at relieving pain but these are not anti-inflammatory, so will not relieve swelling or inflammation in the area. Suitable for people with contraindications to NSAIDs. Streptococcus salivarius helps replenish naturally occurring beneficial throat bacteria, providing one month’s protection. Several natural ingredients have soothing effects on the throat. Products with an asterisk have a detailed listing in the Sore Throat section of OTC Products, starting on page 262. To complete the work book assessment visit pharmacytoday.co.nz WIN ONE OF SEVEN $500 CASH PRIZES Page 141

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