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Flashcards in Colds and flu Deck (47):
1

What are most colds?

Self limiting

Although despite this a lot of people still decide to buy OTC treatment for symptomatic relief

2

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

3

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)

4

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

5

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

6

What are the common symptoms of cold and flu?

Runny/blocked nose

Sneezing/coughing

Aches and pains/headache

High temperature

Sore throat

Earache

Facial pain/frontal headache

7

What are the main symptoms experienced in summer colds?

nasal congestion

sneezing

irritated/watery eyes

These are more likely to be due to allergic rhinitis.

8

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

9

Why may headaches occur during cold and flu?

headaches occure due to inflammation and congestion of the nasal passages and sinuses

10

What may a persistent or worsening frontal headache be due to?

Sinusitis

11

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

12

What is a high temperature an indicator of?

Flu

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

13

What is sometimes the first sign that a cold is imminent?

A sore throat

It often feels dry and sore during a cold

14

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

15

What might facial pain or frontal headache be an indicator of?

Sinusitis

16

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

17

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

OR

a minimum of one constitutional symptom - headache, malaise, mylagia, sweats/chills, prostration is present

18

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

19

How can flu be complicated?

A secondary lung infection (pneumonia)

20

Who are complications of flu more likely to occur in?

Elderly

children

pre-exisiting heart disease

respiratory disease (asthma, COPD,

Kidney disease

diabetics

weak immune systems

21

What can respiratory viral infections trigger in asthmatics?

Asthmatic attacks

Most Asthma sufferers learn to start or increase their usual medication to prevent such occurrence

If these measures fail, referral is recommended

22

What should be done with COPD patients presenting with cold and flu symptoms?

Refer

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.

23

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 delerium

With pleuritic type chest pain

Asthma

24

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

25

In what age group should OTC cough and cold remedies not be sold to?

Children under 6 years old

This includes:

- Antitussives ( dextromethorphan and phlocodine)

- Expectorants ( guaifenesin and ipecacuanha)

- Nasal decongestants (ephedrine, phenylephrine)

- Antihistamines

CHILDREN AGED 6-12 CAN STILL USE THESE PREPARATIONS BUT WITH ADVICE TO LIMIT USE TO 5 DAYS

26

What can decongestants be used to treat?

Reduce nasal congestion

These are sympathomimetics (e.g pseudoephedrine)

27

How do decongestants work?

They constrict the dilated blood vessels in the nasal mucosa

28

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

29

In what conditions should decongestants be used in caution?

Diabetes

Heart disease

Hypertension

Hyperthyroidism

30

What formulations are decongestants available in?

Can be given orally or applied topically

Tablets

Syrups

Nasal sprays

Nasal drops

31

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

32

What do sympathomimetics interact with?

Monamine oxidase inhibitors (phenelzine)

Beta blockers

Reversible inhibitors of monoamine oxidase A

Tricyclic anti-depressants e.g amitriptyline

33

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

34

What are antihistamines not so effective at reducing?

nasal congestion

35

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

36

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

37

List some "older" antihistmaines

Chlorphenamine

promethazine

38

List some non-sedating antihistmamines

Loratadine

Acrivastine

Cetirizine

39

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

40

What interaction should you be aware of with antihistamines?

Alcohol

Hypnotics

Sedatives

Betahistine

Anticholinergics

41

What are the common side effects of antihistamines?

Drowsiness

Constipation

Blurred vision

42

What are the cautions to be aware of for antihistamines?

Closed angle glaucoma

Epilepsy

Liver disease

Prostatic obstruction

43

What other OTC medication can be used for the treatment of cold symptoms?

Analgesics e.g paracetamol and ibuprofen

Vitamin C

Cough remedies

Products for sore throat

44

What are the 3 licensed medicines for flu?

Oseltamivir

Zanamivir

Amantadine


Only the first 2 are recommended for use by the UK department of health and WHO for use in panademic

45

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

46

Who are the at risk groups for flu?

(they can receive the flu vaccine on the NHS)

Over 65

Chronic respiratory disease

Asthma

chronic heart disease

renal failure

diabetes mellitus

Immunosuppression due to disease or treatment

47

What is a serious complication of flu?

Pneumonia

Viral pneumonia -- antibiotics are no use