Clinical recommendations for Common Cold, Flu, Seasonal & Allergic Rhinitis, Sinusitis (2.4) Flashcards
For the common cold;
A) Who is the patient?
B) What are the symptoms?
C) How long have symptoms been present?
D) Actions taken?
E) Medications?
F) Medical conditions
G) Allergies
A)
- Anyone can get a cold at any time, very common
- < 6 years, treatment has no proven benefit
- Children get it more (5- 10 cold per year)
B)
- gradual onset
- sneezing
- sore throat
- headache, fever (none to mild)
- runny nose - watery and profuse in first few days, then thicker, green/yellow after 24- 48 hour
- blocked nose
- Loss of smell & taste
- mild cough (30%)
- Severe cold sx’s can mimic the flu
C)
- 4-10 days if no complications
D)
- Other paracetamol containing products
- Tx failure?
E)
- Poorly controlled hypertension
- Hx of allergic rhinitis
- Heart or lung disease
- Immunocompromised
F)
- Codeine
For Influenza (flu);
A) Who is the patient?
B) What are the symptoms?
C) How long have symptoms been present?
D) Actions taken?
E) Medications?
F) Medical conditions
G) Allergies
A)
High risk of complications with;
- Elderly, heart & lung disease, the immunosuppressed
- Prevention - Yearly vaccination for high risk groups & for health care workers
B)
- abrupt onset
- similar sx’s to common cold
- fever (can be as high as 390C)
- chills
- non-productive cough
- muscle aches & pain
- fatigue/malaise
- loss of appetite
Usually debilitating (disease making someone very weak, so may not visit pharmacy themselves )
C)
- Can last up to several weeks
D)
N/A
E)
- Other paracetamol containing products
- Antidepressants (TCA’s, SSRI’s, MAO-I’s)
- Blood pressure medication
F)
- Poorly controlled hypertension
- Poorly controlled diabetic
G)
- Codeine
For symptomatic treatment of cold and flu where headache/fever is (>38˚C)
A) What are some of the types of drugs used? Give some examples.
B) What is some self care advice?
C) What drugs shouldnt be used in children and adolescents?
A)
analgesic, anti-pyretic (not always necessary)
- Paracetamol
- Ibrupofen
- Aspirin (can be used as a gargle for concurrent sore throat)
B)
- Rest, keep warm, drink plenty of fluids
C)
- DO NOT USE ASPIRIN IN CHILDREN & ADOLESCENTS –> reyes syndrome
For reyes syndrome;
A) what is it?
B) who does it effect?
C) what causes it
D) How to avoid it?
A)
- Rare but potentially deadly disease affecting major organs (liver, brain) –> acute liver failure and cerebral haemorrhage
B)
- It affects mostly children and teenagers and appears soon after flu-like infection or chicken pox
C)
- Link between Reyes syndrome and use of aspirin
D)
- People (especially children) with viral illnesses are encouraged NOT to use aspirin or any medications containing aspirin
- Avoid aspirin;
> children under 12 years old
> children aged 12-16 years with or recovering from chicken pox, influenza or fever
For the treatment of cold and flu;
What are some of the choices used for blocked nose and runny nose?
- Oral decongestants
- Intranasal decongestants
- Sedating antihistamines
- Saline nasal washes/sprays
- Combination products
- Day and night products
For Oral decongestant;
A) What is the active ingredients
B) How does it work
C) ADRs
D) C/Is
E) Interactions
F) Breastfeeding?
A)
- Pseudoephedrine, phenyelphrine
B)
- Produces vasoconstriction of dilated nasal vessels; decrease nasal blood flow, reduces tissue swelling and nasal congestion
C)
- insomnia, restlessness, tachycardia
D)
- in persons whose blood pressure is not well controlled
- Can use if >6 years
- pregnancy 1st trimester
E)
- MAOI’s, moclobemide
F)
- Breastfeeding safe but decreased milk
For Intranasal decongestant;
A) What is the active ingredients
B) Doses
C) ADRs
D) Pregnancy
E) What does it cause
A)
- Ephedrine, Phenylephrine, Xylometazoline, Oxymetazoline, Tramazoline
B)
- varies - 1-2 sprays both nostrils up to tds
C)
- ADRs: local irritation ~ 5%
D)
- Safe in pregnancy
E)
- Causes Rhinitis Medicamentosa (RM)/ Rebound congestion with prolonged use
For Rhinitis Medicamentosa (RM) (rebound congestion)?
A) What causes it
B) What is it
C) How to stop it
A)
- Caused by prolonged used of intranasal decongestants
B)
- Rebound vasodilation of the nasal arterioles further nasal congestion
C)
- Takes weeks to reverse
- Do not use for > 5 days at a time
- Encourage use of saline solution, Fess®
- If prolonged treatment required –> use oral decongestants (pseudoephedrine/phenylephrine tabs)
For Sedating antihistamines;
A) What is the active ingredients
B) How does it work?
C) Does it work?
A)
- brompheniramine, chlorpheniramine, diphenhydramine, doxylamine, promethazine
B)
- Included to dry up mucous
- sedating agent in combination product to counteract oral decongestant
C)
- No difference between antihistamines and placebo in mid to long term
- No evidence of effectiveness of antihistamines in children
- Little rationale for use on its own
For Combination products & Day and Night products
A) When is it recommended
B) What are the day ingredients
C) What are the night ingredients
Potential of overdose of paracetamol due to combo products (lemsip often considered to be a hot lemon dirnk)
A)
- Recommend only if multiple symptoms
B)
- Paracetamol, Ibuprofen, Codeine, Phenylephrine HCl Dextromethorphan HBr
C)
- Paracetamol, Ibuprofen Codeine, Chlorpheniramine Maleate Doxylamine succinate, Dextromethorphan HBr
Why is the scheduling of opoids changing from schedule 3 to schedule 4?
- Marked variability in conversion to morphine between individuals –> potential for very severe toxicity in ultra-rapid metabolisers
- Risk/benefit profile for codeine 8-15mg in combo. with other analgesics unfavourable
- Evidence suggests addition of codeine –> minor additional analgesic effect over simple analgesics
- Evidence of the harm caused by overuse and abuse of OTC codeine containing medicines
For Normal Saline sprays & washes;
A) What are some examples
B) How does it work?
C) Dosage
D) ADRs
E) Does it work?
A)
- Fess®, Narium®, Neilmed®, Flo®
B)
- Thins nasal secretions & encourages flow of mucous
- pH buffered isotonic saline
C)
- Up to 8 sprays per nostril every 2-3 hrs as needed
D)
- Safe with minor ADRs– irritation, burning sensation esp products using higher flows or concentrations
E)
- Significant reductions in a number of symptoms
- Including nasal scretions, sore throat, nasal breathing score and nasal obstruction as well as reduced use of additional decongestant medications
For Inhalations;
A) What are some examples
B) How does it work?
C) How to use it?
D) Used in children?
A)
- Steam inhalation
- Vapour Inhalation – adding aromatic ingredient e.g. eucalyptus oil
B)
- Widely believed to reduce nasal congestion and soothe air passages with hot, moist air to respiratory tract (subjective benefit)
C)
- Pour 4-5 cups of boiling water in a bowl
- Add 3 drops of Eucalyptus oil (optional)
- Hold your head over the bowl so that you are looking down
- Cover your head and bowl with a towel (face not too close to hot water
- Close your eyes and breathe slowly and deeply. Continue for 15 mins
D)
- Not recommended for young children – risk of scalding!
What is used for non-OTC treatment for influenza?
Antibiotics are not indicated (does not alter clinical outcome and only used in seconday bacterial infections)
Antivrial prevention and treatment available for influenza (prescription only)
Neuraminidase inhibitors;
- Oseltamivir (Tamiflu®), Zanamivir (Relenza® inhaler),
- Reduce influenza virus replication
- Influenza A and B
- Start w/in 48hrs of onset (zanamivir 36hrs)
- Usually recommended for people at risk of complications
Admantane: amantadine
What are some trigger points for referral of cold and flu
- Sx’s >10-14 days with no improvemen
- Acute sinus involvement
- Productive cough, discoloured sputum
- Middle ear pain
- SOB or wheezing
- Chest pain
- Persistent fever
- Vulnerable patients: (very elderly >65, very young <6, worsening sx of chronic lung disease (COPD, asthma))
What are some directions for nasal sprays?
