module 3 sinusitis and congestion module 3 sinusitis and what … · 2019-06-05 · module 3...

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WHAT ARE

SINUSES?

Sinuses are air-filled spaces or cavities within the skull that are lined with mucus membranes1a.

Humans have four pairs of sinuses2a:

1. Frontal sinuses – in the forehead

2. Ethmoid sinuses – between the eyes

3. Maxillary sinuses – behind the cheeks

4. Sphenoid sinuses – deep behind the ethmoids

The tiny hairs (cilia) in the sinuses make sure mucus gets dispelled1b. But an increase in mucus production due to viral, bacterial or fungal infections can block the sinuses1b, which leads to sinusitis.

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Module 3

Sinusitis andCongestion

What are sinuses?

What is sinusitis?

What is congestion?

What is a decongestant?

Case study

Test your knowledge

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Contents

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Module 3 Sinusitis and Congestion

The Causes of SinusitisSinusitis, or the inflammation of the sinuses, can be caused by any of the following:

Allergic reactions1c,5,4c

Nasal polyps4d Dehydration2b

Medications2b

Viral infections4a Bacterial infections4a

Fungal infections4b

WHAT IS SINUSITIS?

Sinusitis is the inflammation of the air cavities within the passages of the nose1a.

How to Spot Sinusitis

Here are some common symptoms to look out for in both acute and chronic sinusitis:

• Congestion in the nose3a

• Pain and swelling in the sinus areas3a

• Decreased sense of smell3a

• Headache, toothache, earache and eye pain2a

• Productive cough – especially at night3a

Discoloured discharge can be found in severe cases of sinusitis3a, while a post-nasal drip that irritates the throat is associated specifically with chronic sinusitis2a.

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DECREASED SENSE OF SMELL

Decreased sense of smell3c

BAD BREATH OR HALITOSIS

Possible bad breath or halitosis3c

POST-NASALDRIP

This irritates the throat tissue2c and is associated with chronic sinusitis3c

DISCOLOURED NASAL DISCHARGE

In severe cases3c

GENERAL FEELING OF FATIGUE2

Due to fever, immune response or coughing2c

PRODUCTIVE COUGH

Especially at night3c

FACIAL PAIN

Facial pain and tenderness3c

TOOTHACHE

Caused by pressure on surrounding nerves and tissues2c

EARACHE


SWELLING

Swelling over the infected sinus3c

CONGESTION

Congestion in the nose3c

EYE PAIN


HEADACHE

Due to pressure in blocked sinuses, bending down can increase pain2c

KEY SYMPTOMS

OF SINUSITIS

Sinusitis Due to a Cold or the Flu

Let’s take a step-by-step look at how sinusitis usually develops from a common cold3b:

1. During a cold the mucus membranes in the nasal cavity swell up and block the openings of the sinuses.

2. More air in the sinuses is absorbed into the bloodstream.

3. Pressure inside the sinuses decreases, drawing fluid into the sinuses and causing discomfort.

4. The build-up of trapped fluid encourages bacteria to multiply.

5. White blood cells and more fluid enter the sinuses to fight off the bacteria.

Sinusitis in Children

At first, it can be tricky to distinguish sinusitis from an upper respiratory tract infection in children4f. Sinusitis is, however, usually the suspect when pus-filled nasal discharge continues for more than 10 days, and the patient remains tired with a persistent cough3d.

DIAGNOSIS:TOP TIPAsk your patient whether they are experiencing fever and chills, because when these develop it may mean the infection has spread beyond the sinuses4e. Knowing the exact symptoms will help you establish what the best course of action is.

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URGENT ASSISTANCE !Complications of sinusitis include3f,2c:

1. Swelling of the tissue around the eye

2. Vision changes

3. Severe headaches

4. Confusion

5. Meningitis/Neck stiffness

6. Rare fungal infections

Patients with such symptoms/conditions should seek medical treatment immediately3f.

Place hot, wet towels over the sinuses

Consume hot drinks

Flush the nose with saline spray

Use a decongestant

Inhale steam over a hot basin or from a vaporiser

What Can Your Patients Do About

Congestion?3e

When patients get sick, congestion refers to the stuffiness or fullness they experience in the nasal or breathing passageways and the sinuses when they get sick6. Nasal and sinus congestion is usually caused by increased blood volume in the vessels that line the passages of the nose6. This increase happens because white blood cells rush to the area to defend you. This narrows the air passages in your nose, which restricts airflow.

WHAT IS A DECONGESTANT?

A decongestant reduces the swelling in the passages of your nose and allows you to breathe more easily7. Decongestants are often available in spray form3e, often with xylometazoline or phenylephrine, and in oral form, often with pseudoephedrine3e.

WHAT IS CONGESTION?

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Ask the following questions

• How long have the symptoms lasted for?

• Where is he experiencing facial pain?

• How severe is his headache?

• Does he have toothache?

• Does he have a fever?

• Does he have a cough?

• Does he have discoloured nasal discharge?

• Is he experiencing a feeling of malaise?

• Does he have a post-nasal drip?

• Has he taken any other medicine for the condition?

• Is he experiencing problems with his vision?

CASE STUDYSpencer, 39, Nature Photographer

• Spencer has come to the pharmacy to ask for advice.

• He tells you that his nose is blocked and that he is experiencing facial pain.

• He also cannot smell anything and his head and ears are aching.

• On top of this, he’s feeling lethargic.

• He would like to know what OTC product he can take to help him get over his symptoms and focus on his next shoot.

Spencer tells you that the symptoms started 48 hours before he came to your pharmacy. He’s feeling fatigued and a bit shivery and he says his face aches above and underneath his eyes, but he does not have discoloured discharge or a post-nasal drip that he’s aware of. He has not taken any other medication for his symptoms yet.

Diagnosis:

You establish that Spencer has sinusitis. It’s likely a cold or the flu that’s lead to Spenser’s condition, but it’s not a severe case of sinusitis, as he doesn’t have discoloured nasal discharge. It’s also an acute case as it only recently started and he doesn’t have a post-nasal drip.

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Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.

3Dosage• Adults & children over 12 years:

2 tablets every 6 – 8 hours. Do not exceed 8 tablets in 24 hours.

• Children under 12 years: Not recommended.

Dosage• Adults & children over 12 years:

One spray into each nostril 2 – 3 times per day, as required. Do not exceed 3 sprays per day. Do not use for more than three days.

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Dosage• Adults & children over 12 years:

1 – 2 tablets every 4 – 6 hours. Do not exceed 8 tablets in 24 hours.

• Children 6 – 12 years: A half to 1 tablet every 6 hours. Do not exceed 4 tablets in 24 hours.

• Children under 6 years: Not recommended.

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Sinutab® Sinus Allergy Congestion & PainSymptomatic relief of:

• Mild to moderate sinus and allergy pain

• General discomfort associated with fever

• Nasal and sinus congestion

• Hay fever, influenza and common cold

Sinutab® Sinus Pain Extra StrengthSymptomatic relief of:

• Severe sinus pain

• General discomfort associated with fever

• Nasal and sinus congestion

• Hay fever, influenza and common cold

Sinutab® Nasal SpraySymptomatic relief of:

• Nasal congestion caused by colds, hay fever, allergic rhinitis and sinusitis

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If the pain Spencer is experiencing is severe, you can also recommend:

Treatment You can recommend the following OTC products to help Spencer cope with the symptoms of sinusitis*:

If the congestion is bothering him too much and disrupting his regular functions, he can use Sinutab® Nasal Spray to alleviate this.

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How Sinutab Nasal Spray works

Sinutab® containing xylometazoline reduces the symptoms of nasal congestion13,14

Xylometazoline starts to work in 2 minutes17

Xylometazoline has a direct effect on alpha-adrenergic receptors, reducing

swelling of the inflamed nasal membranes – by shrinking dilated blood vessels.

By easing nasal congestion, it may also improve sinus ventilation and drainage to ease sinus

pressure and pain12,13,15,16

Xylometazoline helps cold sufferers breathe

freely for up to 10 hours so they can get on with

their day17

The decongestant effect of xylometazoline 0.1% nasal spray at 1 hour17

Mea

n up

per

air

way

co

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tanc

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m3/

s)

PS0.00001

Xylometazoline n=29 Saline n=32

384.23

226.42

400

300

200

100

0

12

13


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Product Portfolio

SINUSITIS ANDCONGESTION

WHY CHOOSE SINUTAB®Sinutab® has a unique range specifically formulated to treat all types of upper respiratory congestion and allows you to breathe more freely.

Sinutab® Nasal Spray

Sinutab® Sinus Pain Extra Strength

Sinutab® Sinus Allergy Congestion & Pain

Sinutab® Saline Spray


Ind

icat

ion

US

PA

ctiv

e In

gre

die

nts

Siz

e

SINUS NOSE

Sinutab® Nasal Spray Sinutab® Saline Spray

AGE 12+ AGE ALL

Nasal Congestion Daily Nasal Hygiene

10 ml 15 ml

Fast (2 min) and long lasting (10 hours) relief from Nasal congestion caused by colds, allergic rhinitis, hay fever, sinusitis

Supports treatment of nasal decongestion

• Cleans & Moisturizes nasal passages

Xylometazoline hydrochloride 1 mg*

• Starts to work in 2 minutes12

• Lasts up to 10 hours13

Isotonic Saline Solution

Pseudoephedrine 30 mg*• Starts to work

in 30 mins8

• Lasts up to

8 hours8

Paracetamol 500 mg*• Starts to work

in 30 – 60 mins10

• Lasts 4 – 6 hours10

Chlorpheniramine Maleate 2 mg*• Starts to work

in 30 mins9


Congestion + Pain + Allergy

20s

Symptomatic relief of:

• Mild to moderate sinus & allergy

• Malaise & Fever

• Nasal & Sinus congestion

• Hay fever, influenza & common cold

Sinutab® Sinus Allergy Congestion & Pain

Congestion + Severe Pain Relief + Allergy

24s & 12s

Symptomatic relief of:

• Severe sinus pain

• Malaise & Fever

• Nasal & Sinus congestion

• Hay fever, influenza & common cold

Pseudoephedrine 30 mg*• Starts to work

in 30 mins8

• Lasts up to

8 hours8

Codeine 10 mg*• Starts to work

in 1 hour11


Chlorpheniramine Maleate 2 mg*• Starts to work

in 30 mins9


Paracetamol 500 mg*• Starts to work

in 30 – 60 mins10


Sinutab® Sinus Pain Extra Strength

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AGE 6+ AGE 12+

CLEARS YOUR HEAD FOR UP TO

6 HOURS10,11

* Each tablet contains * Each tablet contains * Per ml


S2 SINUTAB® Sinus Pain Extra Strength. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Codeine Phosphate 10 mg, Chlorpheniramine Maleate 2 mg, Paracetamol 500 mg. Reg No. 37/5.8/0139.

S1 SINUTAB® Nasal Spray. Xylometazoline Hydrochloride 1 mg per ml (0,1 % w/v). Reg. No. P/16.1/184.

S2 SINUTAB® Sinus Allergy Congestion and Pain. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Chlorpheniramine Maleate 2 mg, Paracetamol 500 mg. Reg. No. 37/ 5.8/0260.


4 Which of the following ingredients helps manage pain rather than decongestion?

a Xylometazoline

b Phenylephrine

c Pseudoephedrine

d Paracetamol

References 1. Fae Farrer. Sinusitis and Allergic Rhinitis. South African Pharmacy Journal 2014; 81(8): 11–12. Available at www.sapajournal.co.za/

index.php/SAPA/article/view/598/917. Accessed on 20 December 2017.

2. MedicineNet.com. Allergies Centre. Sinus Infection (Sinusitis). Available at www.medicinenet.com/sinusitis/article.htm. Accessed on 21 December 2017.

3. Porter RS (Ed). Nose and Sinus Disorders: Sinusitis. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/ear-nose-and-throat-disorders/nose-and-sinus-disorders/sinusitis. Accessed on 20 December 2017.

4. Porter RS (Ed). Nose and Paranasal Sinus Disorders: Sinusitis. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/ear-nose-and-throat-disorders/nose-and-paranasal-sinus-disorders/sinusitis. Accessed on 20 December 2017.

5. Health24. 8 quick sinusitis facts. Available at www.health24.com/Medical/Sinusitis/about-sinusitis/8-quick-sinusitis-facts-20130626. Accessed on 21 December 2017.

6. Very well. What is congestion? Available at https://www.verywell.com/what-is-congestion-1191889 Accessed on 21 December 2017.

7. NHS Choices. Five facts about colds. Available at www.nhs.uk/Livewell/coldsandflu/Pages/Fivefactsaboutcolds.aspx. Accessed on 21 December 2017.

8. Drugs.com. Pseudoephedrine. Available at www.drugs.com/monograph/pseudoephedrine.html. Accessed on 15 January 2018.

9. Chlorpheniramine. DrugDex Evaluations. 2015.

10. Tucci J, Bandiera E, Darwiche R, Medos Z, Nashed R, Trinh D.Paracetamol and Ibuprofen for Paediatric Pain and Fever. Jnl Pharmacy Practice Research. 2009; 39(3): 223 – 225.

11. www.medsafe.govt.nz/profs/datasheet/c/codeine.

12. R Eccles. M Eriksson. S Garreffa, Shirley C. CHen, 2018. The nasal decongestant effect of xylometazoline in the common cold. American Journal of Rhinology, Vol 22, No. 5, 2008, page 493.

13. R Eccles, K Martensson, Shirley C. Chen, 2010, Effects of intranasal xylometazoline, alone or in combination with ipratropium, in patients with common cold, Current Medical Research & Opinion, Vol. 26, No. 4, 2010, page 889-899.

14. Witek TJ, et al. Rhinology 2015; 53.81-88.

15. Fokkens WJ, et al. Rhinology 2012;50(Suppl 23):1-298.

16. Graf P, et al. Expert Opin Pharmacother 2009;10:889-908.

17. Eccles R, et al. Am J Rhinol 2008;22:491-496.


1 Which one of the following symptoms requires urgent assistance when it comes to sinusitis?

a Severe headaches and confusion

b Eye pain

c A productive cough

d Earache

2 Which of the following Sinutab® products helps with congestion?

a Sinutab® Sinus Pain Extra Strength

b Sinutab® Sinus Allergy Congestion and Pain

c Sinutab® Nasal Spray

d All of the above

3 Which one of the following ingredients is not found in Sinutab® Sinus Pain Extra Strength?

a Pseudoephedrine Hydrochloride

b Codeine Phosphate

c Ibuprofen

d Paracetamol

You’ve reached the end of the module. You can test your knowledge right away while the info is fresh, or you can complete the full Class Test in one go once you reach the end of this Study Pack. See the back page of the booklet for more details on how to complete and submit your test.

Below are the questions from the Class Test that applies to the module you just finished. The full Class Test appears on the Fax Sheet included separately.

TEST YOUR KNOWLEDGE


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module 3 sinusitis and congestion module 3 sinusitis and what … · 2019-06-05 · module 3...

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