CASE 1

Baby of 3years has a running nose that sometimes gets blocked, and a dry cough that is very disturbing
especially at night.

Recommend 3 syrups and 3 brands of tabs.

CASE 2

A 1 month pregnant woman asks you what she can take for her cold. She says she has a running nose that
gets blocked sometimes especially at night.

Recommend something safe and comment on the safety of the following medicines in pregnancy and
breast feeding.

a) cetrizine
b) Chlorpheniramine
c) Avamys (fluoticasone)
d) Prednisolone
e) Dexamethasone

CASE 3

3 weeks baby has a running nose which sometimes becomes blocked and a feverish, mother asks you to
recommend something.

CASE4

72 year old man on Tamsulosin 400mcg caps OD for BPH. Wants you to recommend something for his
running nose and sneezing.

CASE 5

A hypertensive woman asks you which medicines you have are safe for her colds (running nose and
blocked nose). Recommend

CASE 6

A diabetic patient wants to catch a cold and ask you if you can recommend something. She has a blocked
nose that is sometimes running with sneezing.

Case8

A lady wants to purchase 6 probeta N eye drops for her child at school with allergic rhinitis. Comment
and advise accordingly

Case 9
Mr. NC (35 years old), who has previously been in good health, visits 4U “complaining of a ‘nasty,
painful, flue and irritating cough the same day’. On questioning, you establish that the patient has
retrosternal pain on coughing and that the cough is non-productive.

a) Diagnosis and management?

CASE 10

A physician recommends Apidone syrup for 5 months old to be taken 5ml x 3 daily. Comment and
recommend on the above prescription.

CASE 11

A mother of a 4year old brings him to the drug shop with heavy breathing. She believes the cold must
have exacerbated the asthma. She also complains that she has a dry cough. Recommend something.

CASE 12

A baby of 5years a running nose and dry cough. Another of 6years also has a blocked nose and a
headache

CASE 15

Mrs. PT visits the above GP complaining of a sore throat1 and a raised temperature. Following an
examination, the GP recommends that she take either paracetamol or ibuprofen, rest and take plenty of
fluids.

a) Is the treatment appropriate comment

CASE 16

Mrs. SP is the next patient and complains of the same symptoms. Following a throat examination the GP
observes pus exudates2 and enlarged cervical lymph nodes3. Phenoxymethylpenicillin (Pen V) 250 mg
four times daily was prescribed for 5 days.

a) State the differential diagnosis for symptom1 (sore throat)

b) Which medicines can cause a sore throat
1. Give the diagnosis in the following cases

Give the diagnosis of the following complaints

a) Acute or chronic cough with nasal discharge, frequent throat clearing, a “tickle in the throat”)
frequent hawking (clearing the throat), nasal
congestion…………………………………………………………….
b) Croupy or barking cough, change in voice, aspiratory
stridor……………………………………………..
 c) Chronic cough in a man who smokes marijuana and is worse in the morning while
rising………………………………………………………………………………………………
…………
d) Expectoration of large amounts of fowl smelling sputum, and blood in
sputum……………………….
e) Change in the pattern of cough in a long time smoker and blood in
sputum……………………………….
f) Chronic cough since early childhood, progressive dyspnea or difficulty in breathing and blood in
sputum………………………………………………………
g) Recurrent or chronic cough with or without wheezing or
dyspnea……………………………………
h) Noctural cough, frequent heartburn, swallowing disorder…………………………………
i) Initially dry cough usually followed by varying sputum production dependent on the cause and
systemic symptoms of infection…………………………………………………………………
j) Sudden onset or increased amount of often fowl smelling sputum………………………..
k) Acute cough with severe dyspnea, frothy and blood tinged
sputum…………………………………………..

2. List 4 common and 3 uncommon causes of cough in adults and in children

ADULTS ( common ) Adults ( uncommon) Children ( common ) Children ( uncommon)

 4 syrups you consider safe and effective in treatment of flu in children of 2 months – 1year

3. Give 5 Differences between colds and allergic rhinitis.

Allergic Rhinitis Flu or colds

6. John is a 48 year old male interstate truck driver with a chief complaint of a dry, hacking cough. He
states the cough started yesterday, but he has not had any fever, chills, sore throat, or congestion. His only
medical condition is hypertension, which is controlled with hydrochlorothiazide (HCTZ). What would be
the best recommendation for John's cough?

(A) Dextromethorphan

(B) Codeine

(C) Diphenhydramine

(D) Guaifenesin

7. The appropriate dose of pseudoephedrine for a 3-year-old child is

(A) 2.5 mg q4-6h.

(B) 5 mg q4-6h.

(C) 15 mg q4-6h.

(D) 30 mg q4-6h.

9. JB, a 42-year-old white male, complains of a scratchy throat, nasal congestion, and a cough that started
2 days ago. When he coughs, he brings up yellow-white phlegm. He has hypertension and dyslipidemia.

Which of the following would be the best recommendation for JB's cough?

(A) Codeine
(B) Dextromethorphan

(C) Diphenhydramine

(D) Guaifenesin

10. Which of the following would be the most appropriate over-the-counter (OTC) product for JB's nasal
congestion?

(A) Pseudoephedrine

(B) Phenylephrine

(C) Oxymetazoline

(D) Levmetamfetamine (VICKS vapor rub)

11. A 22-year-old female, asks for a recommendation for sneezing, watery and itchy eyes, and a runny
nose. She has no significant medical history. She is in the midst of final exams and must remain alert.
What would be the best recommendation for her?

HINT: least sedating

12. Alice is 27 years old and in the first trimester of her pregnancy. She needs a recommendation for
sneezing, rhinorrhea, and nasal itching, which started 2 days ago. She feels miserable with her symptoms,
which worsen when she cleans the house. Her current medications include calcium carbonate and
docusate sodium. Which of the following would be the best recommendation for Alice's symptoms?

(A) Chlorpheniramine
(B) Loratadine
(C) Cetrizine
(D) Pseudoephedrine
(E) Breathe Right Nasal Strips
(F) Intranasal cromolyn

13. TK 27 Year presents at Echopharm pharmacy with a running nose and a sore throat, feels feverish and
a dry cough he asks you to recommend some tablets? Morning shift dispenser recommends flufed or
Day nurse or Night nurse or Benylin for flu or Toffplusor Nasatab or mosedin plus capsules?

a) Which of the following would be the best 2 option and why? Mention the actives and the doses to
treat the patients?

15. What is the recommended dose of pseudoephedrine in the recommended age 2-5 yrs

a) 30mg qid
b) 60mg qid
c) 15mg qid
d) 45mg qid
16. What is the phenylphrine dose in a 2-5yrs old child?

17. Dispenser A gives piritex junior and another dispenser B gives contus plus. Which of the following
syrups would have fewer tendencies to cause increased heart beat? Which of them is more effective for
treating a blocked nose?

18. AM tells her child has chicken pox and a lot of itching, reduced appetite, and she lacks sleep? She
asks you to recommend syrup that can address all the above symptoms. What is the active drug in that
syrup?

22. Which anti histamines are the best for a running nose as a symptom?

23. Which is more sedating between diphenhydramineA, chlorpheniramineB, cetrizineC, tripolidineD,

promethazineE and loratadineF? Rank from more to less sedating

a) Which of them would you recommend for 75 years old and why?

23. How would you manage nasal polyps at the pharmacy?

24. AZ is a 6yrs old that has visited Ecopharm to purchase APFLU 10mls tds syrup on prescription for
her running nose, and headache. The dispenser on duty says APFLU is not the best option give your
reasons. And recommend

25. TR says she comes to the pharmacy with a history of a running nose 2 days ago but now says she has
a blocked nose and a migraine that is worsened by bending to pick something. She asks you to explain her
condition and recommend something. Do u think she has a migraine?

26. At what age should chlorpheniramine syrup be started to be given for treating any condition?

28. Mother visits u at pharmacy ask what medication u can recommend for her 5 year old child. She asks
which syrup you can recommend for her dry cough, running nose, which is sometimes blocked. List the
actives that address the following symptoms with the doses and which syrups have those combinations.

29. List the common complications of cold or flue

30. AD has been taking antimalarials, previously been having fevers but now says has a severe chest pain
and cough up blood with sputum? What could be the problem?

31. A mother comes to the pharmacy complaining of her 3years baby. She says that the baby has a dry
cough with no history of colds mostly at night. Another baby of hers has a rash on the neck, limb creases
and back of the wrists that was previously managed with hydrocortisone cream. What could be the cause
of a dry cough in 3 year old child and management?

Drug dosing
Sinaresttablets contains: (Chlorpheniramine 2mg, Phenylephrine 10mg, and Paracetamol 500mg). Ronah
says it can’t be given 2x3 while coldafex (chlorpheniramine 2mg, phenylephrine 5mg, paracetamol
500mg) can be given 2x3 for Adults. True or false. State your reasons

Flufed tablets contains: Tripolidine 1.5mg, paracetamol 300mg and pseudoephedrine 36mg. Adults take
1x3. Is the dose effective for a running and blocked nose

What’s the dose for a 3year old and 7 year old?

Apflu syrup contains: chlorpheniramine 0.5mg, paracetamol 120mg and vitamin C 50mg. A baby of 8kg
is to take it. How do you advise the baby to take it?

Is it suitable for a 5year old? Comment and advice on the dosing?

The following syrups are best for which age range and for which kind of symptoms

a) Ultrasolv
b) Zedex
c) Cadisten
d) Cadiphen
e) Histalin
f) Bronchophane
g) Apidone
h) Piritex junior (can it be used in 9months old?, Why?)

What’s the dosing of the following antibiotics?

a) cephalexin In 6.9kg baby (check BNF)

b) cefixime syrup in a 9month old baby (check BNF)
c) cefuroxime in 10kg baby and 13kg baby (check BNF)
d) Erythromycin syrup in a 3year old and tablets in an 8year old
e) co- amoxiclav in an 11month old using MOXICLAV 156mg/5ml
f) cledomox syrup in a 3year old

Questions

1. Give 3 anti Histamines with cough suppressant effects

2. Give 4 components used in dry cough syrups and their dosing in 2-5years, 6-12year and adults
3. Guaifensin is used as and expectorant. Give its dosing in the age groups below

2-5years:

6-12year:

Adults:

What additional advice would you tell a patient buying syrup containing guaifensin and why?
 4. A 67 year old complains of increased heart beats after taking bronchophane syrup for productive
cough. She the cough has also worsened with chest pains now.

5. At what age can start giving the following medications ( give dose in 2-5year and 6-12years)
a) Montelukast
b) Loratadine (also what dose can a child of 4years take)
c) Cetrizine
d) Diphenhydramine
e) chlorpheniramine

Difference between cold cap non drowsy (orange) and cold cap original ( pink)

Clarinase has pseudoephedrine 120mg SR and loratadine 5mg. how is it dispensed or dosed and why?

Whats the difference btn xylometazoline and oxymetazoline? Which one is appropriate for a 2 year
old ? state the brand chosen, dosage and dispensing advise