Cold and Flu

Question 1

Name some considerations for patients when presenting with a cold

Answer 1

Patient age = young and old

Risk of complication, symptoms (and severity), other symptoms suggesting serious conditions (high fever, >39 degrees)

Recurrence of symptoms = allergy vs cold, immunocompromised

comorbidities = COPD, Asthma

Medications - interactions, contraindications, ADR

Smoking status

Immunisation status

Question 2

What is a cold?

Answer 2

Acute viral infection which damages cilia cells in nasal/bronchial epithelia

Releases inflammatory mediators

Self-limiting, 4-10 days, any time of year

Question 3

What are the symptoms of a viral cold?

Answer 3

sore throat, nasal congestion, sneezing

1-3 days after infection

Question 4

What is an example of a complication of a cold?

Answer 4

Secondary bacterial infection = fever, chills, green mucous

Question 5

What are the contributing factors to a cold?

Answer 5

spread via hand to hand combat, less frequently droplet transmission

Most contagious in 1-2 days after symptoms appear

Question 6

TRUE or FALSE

Colds have a gradual onset

Answer 6

TRUE

Colds have a gradual onset, last 10-14 days

Question 7

What are some signs and symptoms of a cold?

Answer 7

Sore throat (scratchy)/nose discomfort (first symptom)

Feeling unwell, nasal congestion, rhinorrhoea, sneezing

Nasal symptoms = initially water, clear, and profuse –> becomes mucoid and purulent (yellow-green)

Potential cough 4-5 days, mild but can last second week

Headache, malaise, fever uncommon. low-grade fever (38.9 deg)

Sore throat resolves quickly

Question 8

What are some symptoms associated with the flu?

Answer 8

Sudden high fever, chills, sweating, severe headache, photosensitivity

generalised muscle and joint pains, weakness and fatigue

Initially mild resp symptoms, scratchy throat, runny nose, dry cough

Lower resp system affected –> persistent, raspy, productive cough

Acute symptoms subside after 2-3 days, fever may last up to 5 days

Cough, fatigue, sweating = may last over 10 days to even weeks

Question 9

What are some alarm symptoms for cold and flu presentation?

Answer 9

Younger than 6 years old (to pharmacist), prolonged symptoms/getting worse, possible rhinosinusitis

Possible overuse of topical nasal decongestants, flu-like symptoms for selected medicines/conditions

Vulnerable patients = children, >65 y/o, chronic lung disease, asthma, aboriginal or torres strait islander

Possible middle ear involvement

Question 10

When should cold and flu symptoms be referred?

Answer 10

Temperature >38.5/chills, neck stiffness, severe headache, photophobia

chest pain/SOB/difficulty breathing

Skin rash, pale or molted skin, vomiting, difficulty waking/unusual drowsiness, persistent cough

aching muscles, blood stained sputum

refer children younger than 6 to the pharmacist

Question 11

When should a doctor be contacted with cold and flu symptom presentation?

Answer 11

Bulging fontanelle, high temp (<6 month old), excessive irritability, strange-high pitched cry

lack of energy, loss of appetite, not drinking, feeding poorly, earache

Question 12

Key factors to consider when comparing cold and flu

Answer 12

Cold = gradual onset, any time of year, summer cold needs to be differentiated from seasonal allergic rhinitis

Flu = sudden onset, abrupt and severe, typically in winter, body aches, fatigue

Question 13

What are some differential diagnoses for the common cold?

Answer 13

Allergic rhinitis = consistent runny nose, sneezing, itchy palate, itchy eyes, watery eyes (has trigger)

Acute rhinosinusitis = secondary inflam and bacterial infection of paranasal sinus, facial pain/pressure, loss of smell, congested nose, upper airways cough, initial mild localised pain that spreads and worsens

Otitis media = pain, pulling on ear, irritability, lethargy

Flu = severe and sudden symptoms, whole body, fever, chills more likely

Pneumonia = secondary complication, chest pain, difficulty breathing, fever, chills, nausea/vomiting, confusion

Tonsillitis = longer duration than typical, painful, difficulty swallowing, fever, bad breath, red and swollen tonsils

Question 14

What are the goals for treating cold and flu?

Answer 14

manage symptoms and allow rest

prevent dehydration, spread of infection, recognise risk of complication, refer appropriately

Question 15

What medicines are used to treat cold and flu?

Answer 15

Oral decongestants

Nasal decongestants

Sedating antihistamines

Cough mixtures

simple analgesics

Question 16

What are the active ingredients in oral decongestants? (ADRs, indications)

Answer 16

Pseudoephedrine, phenylephrine

Best used for blocker/stuffy nose

ADRS = CNS stimulation, tremor, excitability

Question 17

What are the active ingredients in nasal decongestants? (ADRs, indications)

Answer 17

oxymetazoline, xylometazoline, phenylephrine, tramazoline

Short term use only, cause rebound rhinitis (3-5 days)

ADRs = transient burning, stinging

Question 18

What are the active ingredients in sedating antihistamines? (ADRs, indications)

Answer 18

Promethazine, chlorpheniramine

Relieves runny nose

ADRs= antichol effects, sedation/drowsiness

Question 19

What are the active ingredients in simple analgesics? (ADRs, indications)

Answer 19

Paracetamol, Ibuprofen

Relieves headache, sore throat, body aches, fever

Question 20

How are cold and flu treated in children

Answer 20

cough and cold medicines restricted in children, potential harm

Children <2 = prescription only

2-6 yrs = no meds

Children 6-11 years = use only on advice of doctor, pharmacist or nurse practitioner

Question 21

Name some CAM medicines used to treat cold and flu

Answer 21

Vit C = prophylactic use, reduce severity of cold

Echinacea = some support for URTIs/strep, start with onset of symptoms, caution use in asthma and allergies

Zinc = evidence questionable

Probiotics = reduce cold duration, number of episodes, antibiotic use, school absence (low quality studies support)

Question 22

What are some cold and flu referral points

Answer 22

Temp > 38.5°c, neck stiffness, severe headache, photophobia

Chest pain/SOB/difficulty breathing, skin rash, pale or mottled skin

Vomiting, difficulty waking up or unusual drowsiness, persistent cough, aching muscles

Blood stained sputum

Children <6 to pharmacist

Question 23

Mention some referral (to doctor) points for children and babies

Answer 23

Bulging fontanelle, high temp (<6 months old), excessive irritability, strange high-pitched cry, lack of energy

Loss of appetite, not drinking, feeding poorly, earache

Question 24

Mention some helpful information you can tell the patient and cold and flu

Answer 24

There is no cure, can only manage symptoms

Match symptoms to active ingredients in combination medicines

Avoid cigarette smoke - worsen symptoms

Check for duplicates of active ingredients in products

Eat healthy diet, limit high fat/sugar/salt food, limit alcohol

Question 25

What are some tips on preventing the spread of cold and flu infection

Answer 25

Standard hygiene measures = wash hands, dont touch eyes/nose/mouth, sanitise/wash after cough/sneezing

Cover nose with tissue when sneezing, discard tissues immediately and wash hands

Sneeze/cough into bend of elbow, avoid sharing utensils