Flashcards in Colds and flu Deck (47):
What are most colds?
Although despite this a lot of people still decide to buy OTC treatment for symptomatic relief
Where do you need to pay special attention when giving out OTC cold remedies?
Taking a medication history and selecting an appropriate product
OTC cold remidies can interact with a lot of prescription medication, occasionally with serious consequences
Why does age make a difference when responding to cough and cold symptoms?
1) Choice of treatment
2) Whether referral to a doctor is needed. children are more susceptible to upper respiratory tract infections (URTI)
Why is the duration of symptoms and their onset important when responding to cold and flu symptoms?
Rapid onset is more characteristic of flu
Gradual onset is more characteristic of cold
How long do the symptoms of cold usually last for?
7 -14 days
Some symptoms however such as cough my persist after the worst of the cold is over
What are the common symptoms of cold and flu?
Aches and pains/headache
Facial pain/frontal headache
What are the main symptoms experienced in summer colds?
These are more likely to be due to allergic rhinitis.
Why does sneezing and coughing occur?
Because the nasal passages are irritated and congested (sneezing)
Because they pharynx is irritated (producing a dry and tickley cough) or as a result of irritation of the bronchus
Why may headaches occur during cold and flu?
headaches occure due to inflammation and congestion of the nasal passages and sinuses
What may a persistent or worsening frontal headache be due to?
When may joint and muscle aches occur?
People with flu often report joint and muscle aches
More likely to occur in people with flu than people with cold
What is a high temperature an indicator of?
People with cold often complain of feeling hot but a high temperature will not be present
The presence of fever may be an indicator of flu rather than a cold
What is sometimes the first sign that a cold is imminent?
A sore throat
It often feels dry and sore during a cold
What isa common complication of colds?
Earache - especially in children.
When the middle ear fills with fluid, this can further lead to acute otitis media (infection)
In 80% of children, acute otitis media will resolve within 3 days without antibiotics
A painful ear however can be managed using paracetamol or ibuprofen with regards to AOM
What might facial pain or frontal headache be an indicator of?
When are antibiotics recommended for sinusitis?
If symptoms persist for 10 days or more
And when symptoms are severe with fever, facial pain, nasal discharge over 3-4 days
When it develops following a recent cold which has started to develop
When is flu considered to be likely over the cold?
When temperature is 38 degrees or higher (37.5 in elderly)
A minimum of one respiratory symptom - cough, sore throat, nasal congestion or rhinorrhoea is present
a minimum of one constitutional symptom - headache, malaise, mylagia, sweats/chills, prostration is present
Give a general description of flu-like symptoms?
Flu often starts abruptly with sweats and chills, muscular aches and pains and chills
pain in the limbs, dry and sore throat
often bed bound, cannot go abut daily activities
How can flu be complicated?
A secondary lung infection (pneumonia)
Who are complications of flu more likely to occur in?
pre-exisiting heart disease
respiratory disease (asthma, COPD,
weak immune systems
What can respiratory viral infections trigger in asthmatics?
Most Asthma sufferers learn to start or increase their usual medication to prevent such occurrence
If these measures fail, referral is recommended
What should be done with COPD patients presenting with cold and flu symptoms?
COPD should be considered in people over 35 who have a risk factor such as smoking, SOB on exercise, long-term cough, regular sputum production, frequent winter "bronchitis" or wheeze.
What is the referral criteria for cold and flu?
Earache not settling with analgesic
In the very young
In the very old
In those with heart or lung disease (COPD, kidney disease, diabetes, compromised immune system)
Persisting fever with productive cough
With pleuritic type chest pain
Once the pharmacist has recommended treatment, how long should patient be advised to wait until they see a doctor?
10-14 days if the cold has not improved with treatment
In what age group should OTC cough and cold remedies not be sold to?
Children under 6 years old
- Antitussives ( dextromethorphan and phlocodine)
- Expectorants ( guaifenesin and ipecacuanha)
- Nasal decongestants (ephedrine, phenylephrine)
CHILDREN AGED 6-12 CAN STILL USE THESE PREPARATIONS BUT WITH ADVICE TO LIMIT USE TO 5 DAYS
What can decongestants be used to treat?
Reduce nasal congestion
These are sympathomimetics (e.g pseudoephedrine)
How do decongestants work?
They constrict the dilated blood vessels in the nasal mucosa
What are the problems associated with decongestants?
Ephedrine and pseudoephedrine
Can keep patients awake because of their stimulating effects on the nervous system
They can cause stimulation of the heart, an increase in blood pressure and may affect diabetic control because they can increase blood glucose levels
In what conditions should decongestants be used in caution?
What formulations are decongestants available in?
Can be given orally or applied topically
When are sympathomimetics more likely to cause unwanted effects?
when taken by mouth
they are unlikely to do so when taken topically
In patients where oral drugs are less suitable, nasal drops and sprays can be reccommended
What do sympathomimetics interact with?
Monamine oxidase inhibitors (phenelzine)
Reversible inhibitors of monoamine oxidase A
Tricyclic anti-depressants e.g amitriptyline
Why can antihistamines be used in cold?
They can reduce some of the symptoms of cold
Runny nose (rhinorrhoea) and sneezing
These effects are due to the anticholinergic
What are antihistamines not so effective at reducing?
Give an example of an antihistamine which is is included in cold remedies?
diphenhydramine for its antitussive action or to help the patient sleep
included in combination products to be taken at night
What does evidence indicate about antihistamine use alone in the common cold?
Alone they are not of benefit to the common cold
in combination with decongestants, analgesics and cough suppressants they offer more benefit
List some "older" antihistmaines
List some non-sedating antihistmamines
What is the problem with using antihistamines?
Drowsiness (particularly with the older type such as chlorphenamine)
Alcohol will increase this effect
As will drugs such as benzodiazepines and phenothiazines
What interaction should you be aware of with antihistamines?
What are the common side effects of antihistamines?
What are the cautions to be aware of for antihistamines?
Closed angle glaucoma
What other OTC medication can be used for the treatment of cold symptoms?
Analgesics e.g paracetamol and ibuprofen
Products for sore throat
What are the 3 licensed medicines for flu?
Only the first 2 are recommended for use by the UK department of health and WHO for use in panademic
What does NICE support with reference to antivirals in flu?
The use of neuraminidase inhibitors such as a Oseltamivir and Zanamivir for those who are in at risk groups for seasonal flu outbreaks
Who are the at risk groups for flu?
(they can receive the flu vaccine on the NHS)
Chronic respiratory disease
chronic heart disease
Immunosuppression due to disease or treatment