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PHAR153 > Cough and Cold > Flashcards

Cough and Cold Flashcards

1
Q

Why is there no vaccine for the cold?

A

there are too many types of colds (>200)

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2
Q

What are the day 1 symptoms of a cold? Are they at the same level as the symptoms of allergic rhinitis?

A

sore throat (usually the 1st sign)
rhinorrhea
sneezing
no, they are not at the same level as allergic rhinitis
WE DO NOT FOCUS ON TREATING THESE SYMPTOMS

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3
Q

What are the day 3 symptoms of a cold?

A

nasal congestion
sinus headache (as the nose plugs, there is inflammation at the base of the skull)
plugged ears (more so with kids)

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4
Q

Which virus causes the most colds?

A

rhinovirus

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5
Q

Which symptoms of the cold does the public generally want treatment for?

A

cough
nasal congestion

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6
Q

Which type of chest cold is the most common?

A

bronchitis

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7
Q

Do we worry more about a chest cold if it is deeper or higher in the respiratory tract?

A

we worry more as it gets deeper (pneumonia being the most serious)

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8
Q

What is the congested/productive cough type?

A

it is useful to the body
cough is associated with chest congestion
you are coughing out the junk (phlegm expectoration

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9
Q

What is the congested/nonproductive cough type?

A

will become useful to the body
cough associated with chest congestion
body is not coughing out junk but it eventually will (little expectoration of phlegm)

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10
Q

What is the dry/nonproductive cough type?

A

not useful to the body
cough not associated with chest congestion
not coughing anything up (no phlegm)
probably smokers cough

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11
Q

What are the symptoms of the cold with infants?

A

similar symptoms
early fever (39C)
GI upset
congestion is a problem if breast-feeding

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12
Q

What are the symptoms of the cold with children?

A

less fever
more similar to adults

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13
Q

What should you do if a parent wants something for their 1 year old who has a cold?

A

referral
not really our realm
few cough medicines for this age

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14
Q

What are some ways the cold is spread?

A

direct contact with cold sufferer
inhaled droplets
eye/nose contact
inanimate objects

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15
Q

What is the vasomotor response? Is this an indication that a cold is coming?

A

we get a runny nose when our body is responding to drastic temperature changes
normal, not the cold

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16
Q

Why is wiping down everything in an area to prevent the cold considered to be pointless?

A

the first person to cough ruins it
the common cold is everywhere!

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17
Q

Rank the following in their relative frequency: strep throat, bronchitis/sinusitis, influenza, common cold, COVID

A

common cold
bronchitis/sinusitis
influenza
covid
strep throat

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18
Q

What should always be your starting point in the differential diagnosis process?

A

the common cold
dont dig yourself a hole by thinking its something less common such as strep throat

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19
Q

If a patient says they’re symptoms hit them hard and fast, they have a dry cough, they have a high fever, and body aches, what would you say this is?

A

influenza
the common cold does not have fast onset and hard hitting symptoms

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20
Q

Differentiate the symptoms of the cold vs the flu.

A

cold: symptoms build up (not hard hitting), rhinorrhea, sneezing, congestion, cough, sore throat
flu: fast onset (hard hitting), body aches, DRY cough, fever, headache, fatigue

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21
Q

What is the same about the cold and flu?

A

they both come from respiratory tract infections in your nose, sinuses, and throat

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22
Q

Why do we promote the influenza vaccine to seniors?

A

seniors have a higher mortality rate from influenza

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23
Q

Does treatment change much with the cold and flu? What got added to cold products, to allow companies to advertise their products as “cold and flu”?

A

treatment does not change much
they added acetaminophen for aches and fever of the flu

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24
Q

True or false: influenza prescribing as a pharmacist is common

A

false

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25
Q

What are the non-pharmacological treatments of the flu?

A

fluids and rest
reduce spread by staying home

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26
Q

What is the pharmacological treatment of the flu?

A

OTC: analgesics and/or antipyretics for fever, headache, myalgia

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27
Q

When can a pharmacist prescribe an antiviral agent for the flu?

A

when an epidemic or pandemic is declared by the Chief Medical Health Officerf

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28
Q

Determine the rarity of fever, fatigue, cough, and runny/stuffy nose in COVID, the cold, and the flu?

A

Fever: COVID=common, cold=rare, flu=common
Fatigue: COVID=sometimes, cold=sometimes, flu=common
Cough: COVID=common (dry), cold=mild, flu=common (dry)
Runny/stuffy nose: COVID=rare, cold=common, flu=sometimes

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29
Q

A patient has the following symptoms: a mild cough and a runny nose. Is it most likely the common cold, the flu, or COVID?

A

common cold

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30
Q

What are the most common COVID symptoms? Least common symptoms?

A

most common: fever, dry cough, tiredness
least common: sore throat, aches+pains, headache

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31
Q

What is a major difference between COVID and influenza?

A

with influenza, once the illness has subsided, the impact is over
with COVID, there can be lingering effects

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32
Q

What are some characteristics of asthma?

A

persistent cough (non-productive)
chest tightness
no cold-like symptoms
wheezing/shortness of breath

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33
Q

What can trigger the symptoms of asthma?

A

allergens
exercise
colds

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34
Q

How can you tell a patient does not have asthma, but most likely has a cold?

A

asthma does not cause fever, chills, muscle aches, or sore throats

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35
Q

What is a good way to determine that a cough is caused by GERD and not the common cold?

A

the cough is chronic and UNPRODUCTIVE
irritated throat/heartburn

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36
Q

What is post-nasal drip? What are the symptoms?

A

rhinorrhea leaks into the back of the throat and causes irritation
enough exposure can produce an unproductive cough
symptoms: sore throat, throat clearing, unproductive cough

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37
Q

What are the common symptoms of allergic rhinitis?

A

rhinitis
sneezing
itch
ocular symptoms (sore and itchy eyes)
COUGH IS RARE (differential process from common cold)

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38
Q

What are the symptoms of smokers cough? What should you recommend for them?

A

worse in morning
minimal sputum (unproductive cough)
hot cough
recommend a cough suppressant

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39
Q

Which symptom of a smokers cough changes as they progress to COPD?

A

the cough is dry at first and then it becomes productive
lots of sputum

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40
Q

Does coughing increase or decrease immediately after quitting smoking?

A

increases (smoking cessation cough)
damaged cilia are now repaired and removing foreign materials from the airways

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41
Q

What is acute bronchitis?

A

lower resp tract infection (chest cold)
similar to common cold but more cough
cough starts non-productive but becomes productive
can last 3 weeks (7 days is common for a head cold)
worse than a regular cold but not as bad as pneumonia

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42
Q

What is chronic bronchitis?

A

cough that persists for months
smoking is the most common cause

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43
Q

Why are ACE inhibitors hard to identify as being the cause of a dry/raspy cough?

A

it can take up to a year of taking an ACE inhibitor for a cough to occur

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44
Q

What are the symptoms of strep throat?

A

fever
no cough
tender lymph nodes
tonsillar exudate
sore throat

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45
Q

A patient has fever, no cough, tender lymph nodes, and tonsillar exudate. What are the chances that this is strep throat?

A

50:50

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46
Q

Why are antibiotics prescribed for strep throat?

A

strep can go beyond the throat and cause Rheumatic fever, Rheumatic fever can cause heart or kidney fever

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47
Q

True or false: a pharmacist should look down a patients throat to try and see if the patient has strep throat

A

false
suggests you know more than you do
cant determine if it is strep from the naked eye

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48
Q

What are some symptoms of tonsilitis?

A

sore throat
swollen tonsils
fever
difficulty swallowing
tonsils have white or yellow spots

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49
Q

What causes laryngitis? What is laryngitis? What is the best way to treat laryngitis?

A

viral infection
inflammation of the vocal cords
self-care measures and rest (usually resolves itself in 7 days)

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50
Q

Which illness can a child with laryngitis develop?

A

croup

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51
Q

What is common to see in a kid after a cold?

A

fifth/sixth disease
skin condition (rashes) that develops after a cold

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52
Q

What is bronchiolitis? MD or pharmacist assesment?

A

viral infection in the bronchioles, deeper cough than bronchitis
more common in younger children
MD assessment

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53
Q

A mother comes in and tells you her child has a dry cough that sounds like a bark. What is the most likely diagnosis? What do you tell her?

A

croup
tell her it will clear up on its own, it sounds worse than it is and some humidity can help

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54
Q

What are the symptoms of mono? How does it initially present itself?

A

sore throat
fatigue
fever
swollen neck glands
NO cough
initially presents itself as a flu or strep and gradually gets worse

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55
Q

For the following age groups, should we refer to them for a cold?
<1 year
1-2 years
3-6 years

A

<1=automatic referral
1-2=be very cautious
3-6=cautious

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56
Q

What is post-infectious cough?

A

nagging cough that can last an average of 18 days after a cold subsides

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57
Q

When does it become reasonable to contact a doctor for a cold?

A

symptoms persist for longer than 10 days

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58
Q

What are the symptoms of acute bacterial cases of sinusitis?

A

discoloured discharge
severe local pain
fever
double sickening

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59
Q

For a cough, when should we start to get worried for the following ages?
<1 year olds
1-3 year olds
4-6 year olds
adults

A

<1 year: always worry
1-3 year: 1 week
4-6 year: 2 weeks
adults: half of adults have post-cold inflammation, resolves spontaneously, GPs say if cough lasts longer than a month

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60
Q

What are common causes of chronic cough?

A

smoking
asthma
PND
GERD
ACE inhibitors

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61
Q

What are the most common causes of fever?

A

colds
gastroenteritis

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62
Q

What is the best way to measure temperature for the following ages:
birth-2
2-5
>5

A

birth-2: rectum
2-5: rectum
>5: orally

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63
Q

If a parent asked how to do a rectal temp measurement, what would you tell them? What about an oral measurement?

A

rectal: clean the thermometer, place baby on back with knees bent, insert thermometer 1 inch in, wait for the beep
orally: clean the thermometer, place under tongue, wait for the beep

64
Q

If an adult asked how to take an ear temp measurement for their kid, what would you tell them? What about for their infant?

A

kid: pull the ear up and back to position the probe
infant: pull the lobe down and back

65
Q

What is a reasonable guide to follow for when to refer to an MD for 1-3 year olds who have a fever?

A

Temp greater than 39 C
1 year old: 39 C and symptoms >1 day
2 year old: 39 C and symptoms > 2 days
3 year old: 39 C and symptoms > 3 days

66
Q

When should you refer a <3mo old with fever to an MD?

A

always

67
Q

What do pediatricians think about fever? What should we probably do?

A

peds say not to treat fever unless kid is noticeably bothered
we should still give the parent a recommendation if they come in

68
Q

In the vast majority of cases, what is a safe recommendation to make for the fever?

A

acetaminophen or ibuprofen

69
Q

What are the important values associated with acetaminophen in children dosing?

A

10-15mg/kg every 4-6hrs
max 75mg/kg per day

70
Q

What is more important in regards to acetaminophen for kids, weight or age?

A

weight

71
Q

Childrens Tylenol Fever & Sore Throat Pain is commonly found in the cough/cold section, is this a suitable agent for the cold?

A

no
fever is not common for cough/cold!

72
Q

What is ibuprofen commonly used for?

A

reduces pain and fever

73
Q

What are the important values to know for ibuprofen in children over 6 months? What about under 6 months?

A

over 6 months: 5-10mg/kg every 6-8hrs, max 40mg/kg per day
under 6 months: 5mg/kg every 8 hours (we rarely make recs)

74
Q

What should you do when it comes to <3month olds and ibuprofen?

A

talk to a doctor

75
Q

True or false: ibuprofen is harder on the stomach than acetaminophen at OTC doses

A

false

76
Q

What are some side effects that might occur with OTC doses of ibuprofen and acetaminophen? Are these serious side effects we should be concerned about?

A

nausea, abdominal pain, dyspepsia
these are nuisance side effects

77
Q

Is ASA an option for fever in kids? Who uses ASA?

A

no its not an option
only 18 years or older, mainly individuals with cardiovascular problems

78
Q

True or false: naproxen is not used for fever

A

true

79
Q

Is it okay to alternate ibuprofen and acetaminophen? What would this generally look like?

A

yes
8am: acet, 12pm: ibu, 4pm: acet, 8pm: ibu, 12am: acet, 4am: ibu
4 hours is the key number here

80
Q

How can you help a patient in understanding the schedule of alternating ibu and acet?

A

take a paper out and show them the alternating schedule

81
Q

Is it safe to take acetaminophen and ibuprofen at the same time?

A

yes BUT make sure there is a 4hr window for acet and an 8hr window for ibu

82
Q

Is the ibu+acet combo for fever? For kids?

A

no and no

83
Q

What is the Sask Health Influenza Program recommendation for antipyretics and immunizations?

A

only use antipyretics at least 6-8 hours after immunization (if the child is uncomfortable, refusing fluids and not sleeping)
just erroring on the side of caution

84
Q

What are febrile seizures? What causes them?

A

convulsions induced by a fever in a young child, they stop on their own
caused by viral infection and less commonly by bacterial infection
they are harmless

85
Q

Why do we give a child the normal dose of ibuprofen or acetaminophen after a febrile seizure?

A

because the child had fever in the first place
not doing anything for the febrile seizure that just occured

86
Q

True or false: antipyretics prevent febrile convulsions

A

false

87
Q

What are some non-drug measures that could be helpful for cough/cold?

A

chicken soup
rest/fluids
humidity
saline gargles (1/2tsp salt in 1 cup warm water)
nose drops
irrigation

88
Q

How much fluids should you be taking in when you have a cough or cold?

A

the same amount as usual

89
Q

Kids under 6 get ___, kids over 6 get ___

A

under 6 get drops
over 6 get sprays

90
Q

What is the general idea of using nose drops for a cold?

A

it is a saline solution that you spray/drop into the nose to try and loosen up dry mucus

91
Q

Do runny noses need saline or do congested/boogery noses need saline?

A

congested/boogery noses would need saline to help clear the nose

92
Q

Is Rhinaris gel for kids? What is the purpose of Rhinaris gel?

A

no its not for kids
the purpose is to try soothe sore noses in adults that often come as the result of seasonal allergies

93
Q

What is “irrigation”?

A

putting water in your nose to try flush out junk

94
Q

What are sinus rinses best used for?

A

allergic rhinitis

95
Q

What is the difference between a saline and a lubricant?

A

saline is to loosen up dry mucus
lubricants are to soothe irritated nasal tissue

96
Q

What do menthol and camphor do for nasal congestion? What is an example of a product with these?

A

menthol and camphor hit our cooling receptors in the nose so it feels like the air is cool which can feel soothing (not a decongestant)
the congestion is still present
VapoInhaler

97
Q

List the drugs for the following: oral decongestants, topical decongestants, analgesics, cough suppressants, antihistamines, expectorant

A

OD: pseudoephedrine, phenylephrine, phenylpropanolamine
TD: oxymetazoline, xylometazoline
analgesics: ibuprofen, acetaminophen
CS: DM, codeine, menthol, diphenhydramine, honey
AH: diphenhydramine, chlorpheniramine, brompheniramine, dexbrompheniramine
expectorant: guiafenesin

98
Q

What do aromatic compounds do? Are they good decongestants? Example?

A

menthol and camphor fumes get into the nose and hit the cool receptors
not a powerful dg, it just makes you feel like you are breathing better
VapoRub

99
Q

How do direct acting decongestants work?

A

they stimulate alpha receptors in the nose, causing constriction which lessens the pressure on tissues, thus making it easier to breathe

100
Q

How do indirect acting decongestants work?

A

they get absorbed in the small intestine, enter the bloodstream, then they hit neurons next to blood vessels in the nose and they kick out noradrenalin to constrict vessels in the nose

101
Q

Why is phenylephrine considered inferior to pseudoephedrine?

A

PE is variable in bioavailability, MAO has a big impact
pseudoephedrine does not care how much MAO is present, it gets absorbed regardless

102
Q

What are two biggest side effects with oral decongestants?

A

CNS effects (they are stimulants)
CV effects (raises BP by 3-5 points for 3D)

103
Q

Why is there not much concern about a decongestant raising blood glucose in a Type I diabetic?

A

when Type I diabetics have a cold, their blood glucose is already raised, so the effect on blood glucose of a decongestant is almost clinically irrelevant

104
Q

Why is narrow angle glaucoma cautioned on the label of a decongestant?

A

decongestants can dilate the pupils to minor extent so there is a chance of narrow angle glaucoma
very unlikely

105
Q

What is the side effect you mention to an old man taking an oral decongestant?

A

urinary retention

106
Q

True or false: SSRIs and TCAs are not a problem for drug interactions with decongestants

A

true
MAOIs are the problem

107
Q

What is the side effect to be concerned about with topical decongestants?

A

rebound congestion
the vessels dilate to a larger than normal size after the drug wears off thus causing congestion
you get addicted to the drug because it helps with the congestion but then once the drug wears off you are congested again=vicious cycle

108
Q

What is a safe number of days for using topical decongestants before we start to worry about rebound congestion?

A

7 days

109
Q

Which antitussives are centrally acting? Which are locally acting?

A

centrally: DM, DH, codeine, DPH
locally: menthol, camphor, honey

110
Q

Which coughs do we not want to supress? Which cough do we want to suppress?

A

not supress: congested/productive, congested/non-productive (unless for sleep)
suppress: dry/non-productive (ex: influenza, PND)

111
Q

Why does Benylin Cough and Congestion not make any sense?

A

DM is for cough suppression, guaifenesin is for expectoration
they are working against eachother, whats the point?

112
Q

What is the “best” cough suppressant?

A

DM
even though it works the same as placebo, its still the best we got

113
Q

Why is codeine not a great cough suppressant?

A

codeine is metabolized by 2D6 into morphine, we all metabolize it to a different extent, thus poor metabolizers might not get any morphine conversion

114
Q

What causes serotonin syndrome?

A

high levels of serotonin
can be caused by high levels of DM or codeine with high levels of SSRIs

115
Q

If an asthmatic or COPD wants codeine or DM for their cough. Should we concerned about these patients taking the antitussive?

A

probably not, the antitussive is probably not doing anything so it is probably not lowering their respiratory rate significantly

116
Q

Which age group do we never recommend DM or codeine to?

A

under 6 years old

117
Q

OTC codeine products such as Calmylin contain 3.3mg of codeine in a 5ml dose, will this be sufficient to suppress a cough?

A

no, this is subtherapeutic
minimum dose for cough suppression is 10ml

118
Q

Why is the bar set so low for the effects of honey on cough suppression?

A

well if DM is practically ineffective, why would honey be any better

119
Q

Are menthol or camphor good antitussives?

A

not really
they dont hit the cough centre in the brain, they act locally on cool receptors

120
Q

What might be a situation where diphenhydramine is used as an antitussive?

A

people wanting to try sleep (sedation) through a cough
dph is almost the same as placebo
recommend DM most of the time so that people dont feel sedated, unless they want sedation

121
Q

How does guiafenesin work?

A

irritates the esophagus thus stimulating the trachea which stimulates goblet cells to produce mucus
theoretically loosens stuff up

122
Q

Which cough are we trying to hit with guiafenesin?

A

congested/non-productive
it wont flip a dry/np into congested/productive

123
Q

Usually in pharmacy we want a patient to be on the lowest amount of medication as possible, except for what?

A

guiafenesin
rare time where we take the highest strength possible

124
Q

Which cough/cold medicine is Taylor okay with for kids?

A

guiafenesin
on an exam dont recommend anything for <6yrs even if we know its safe

125
Q

What do lozenges do?

A

hit the cool receptors at the back of the throat which can give some soothing feeling

126
Q

How could 1st gen anti-histamines help with a cold?

A

they are anti-cholinergic so they can reduce rhinorrhea
still not huge for the cold

127
Q

Who should avoid 1st gen antihistamines?

A

seniors due to anti-cholinergic effects

128
Q

Which symptom of the flu is less common in seniors?

A

fever

129
Q

What could cause a cough in a patient with allergic rhinitis?

A

the allergies cause PND, leading to a cough

130
Q

What kind of cough can an ACE inhibitor produce? How do ACE inhibitors produce a cough?

A

dry, raspy cough
ACE inhibitors enhance the levels of Substance P or bradykinin which causes bronchoconstriction

131
Q

What does a croup cough sound like?

A

bark like

132
Q

What are the symptoms of bronchiolitis?

A

rapid or shallow breathing
wheezing
deeper cough than bronchitis

133
Q

How do we describe Whooping cough?

A

whoop sound on inhale
100 day cough
bacterial

134
Q

Should you refer everyone under the 6 of age with a cough/cold to an MD?

A

no, be selective

135
Q

Do bacterial or viral cases of sinusitis last longer?

A

bacterial (viral is <10d, bacterial is >10d)

136
Q

What should you do if you suspect sinus involvement?

A

consider MD referral

137
Q

Which condition was caused by ASA use in kids?

A

Reyes syndrome, causes brain and liver damage

138
Q

Do you really need to treat fever?

A

no, but do your clinical workup, let the parents or patient know that its not necessary but we can still recommend something

139
Q

Are saline gargles a good idea for kids?

A

probably not, kids cant gargle well
more so for adults

140
Q

If you were to use a suction for your childs nasal congestion, what must you apply first?

A

saline must be applied first to get the mucus loose

141
Q

Why do oral decongestants cause CNS effects?

A

they are stimulants (noradrenaline is being released)
amphetamine sister drugs

142
Q

A 70 year old man comes in and tells you he has nasal congestion and is looking for a decongestant. You do some questioning and discover he is on blood pressure medications and also takes tamsulosin. What would your recommendation be?

A

a topical decongestant such as xylometazoline or oxymetazoline

143
Q

A mother comes in and tells you that her 2 year old has some nasal congestion and the kid is visibly irritated by it. She is holding Otrivin (xylo) in her hand and asks you if this is ok. What do you tell her?

A

tell her that topical decongestants such as xylo are not for use in kids
I would recommend a nasal saline drop to try help clear out the mucus that is causing the congestion

144
Q

A patient comes in and tells you they have had a cough for a few days now. You ask about this cough and the patient describes the cough as “wet”. They are holding Benylin Mucous and Phlegm and ask what you think about this.

A

I would tell them that this product wont be effective for the congested/productive cough that they described (guaifenesin does not make a cough more productive)

145
Q

Tylenol Sinus contains a strip of pills for day and a strip of pills for night. What is the difference?

A

the night time one contains a 1st gen AH for sedation

146
Q

What is the claim that echinacea makes?

A

claimed to stimulate the immune system
minimal benefit but it is safe

147
Q

Do we use topical nasal steroids for congestion due to the cold?

A

it can help with congestion but may need to take an oral decongestant in addition
probably more so for seasonal allergies

148
Q

What is the best way to decide on a product for cough/cold?

A

aim for the most bothersome symptom (usually cough or congestion)
you wont be able to treat all symptoms

149
Q

Combo products are the norm, are extra ingredients enough to reject product?

A

no, just live with it
accept that some ingredients will just be along for the ride

150
Q

What are the pediatric guidelines on decongestants?

A

not for use

151
Q

What should you try do when parents want something for their kid?

A

stress non-drug
educate on the benefits of a cough

152
Q

What are the recommendations for cough/cold therapy during pregnancy?

A

avoiding product use is best option

153
Q

What are the recommendations IF a pregnant lady is adamant for a therapy for her cough/cold?

A

selection process is the same (zero in)
decongestant (topical is safer)
analgesics are safe
DM is choice for anti-tussive
antihistamines are not needed
guiafenesin is safe

154
Q

What is the key question to ask a hypertensive patient if they are looking at oral decongestants?

A

“have you used one before?”

155
Q

How would you state a recommendation for a hypertensive that wants to use an oral decongestant?

A

I would rather not recommend this but if you want one then we can find one. If you have a blood pressure machine at home then I would recommend you monitor

156
Q

What might be the key for an asthmatic using an anti-tussive?

A

adjusted inhaler use

PHAR153 (20 decks)

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