Cold And Flu

Question 1

Self limiting? True or false

Spread by infected person coughing, sneezing and touching infected surfaces? True or false

Answer 1

True

True

Question 2

Common Symptoms

Answer 2

Blocked/ runny nose
Cough
Sore throat

Question 3

Less common symptoms of a cold

Answer 3

Fever, aches and pain
Headache 
Sinus pain
Earache
Irritated, watery eyes (conjunctivitis)

Question 4

How does the flu differ from the common cold??

Answer 4

Flu is More sudden and severe.

Includes headache, marked myalgia, chills, Malaise or high grade fever

Question 5

What causes the headaches and sinus pain??

Answer 5

Inflammation of sinus (air filled cavities just under the eyes and cheek bone areas)

Sinuses produce mucus which drains in to the nose but the nasal passages become blocked due to inflamed sinus lining

Question 6

What can help with sinus pain??

Answer 6

Decongestant

Question 7

Referral criteria

Answer 7

No improvement - 2 weeks

Middle ear pain not improving with analgesics (acute otitis media)

Persistent productive cough and high grade fever(flu can be complicated by pneumonia??

Vulnerable patients: COPD, asthma, kidney disease, diabetes, or immune improvised. Very young <3 months, very old

Question 8

During a cold, what complication is more common in children?

And what to do in when it occurs?

Answer 8

Middle ear infection (acute otitis media)

Suggest using some analgesics

Normally resolves in 3 days without Abx, but if pain persists despite analgesics: REFER to GP!!

Question 9

Pneumonia is common in which age group?

And what are it’s symptoms

Answer 9

Age: children and elderly

Persistent productive cough and high grade fever

Question 10

What is the referral duration for pneumonia symptoms in children

Answer 10

> 24 hrs: 3-6 months

>72 hrs: 6 months

Question 11

Referral temperature for pneumonia symptoms in children?

Answer 11

>= 38c in <3 months
>= 39c in 3-6 months

Question 12

OTC products for fever aches and pains and the doses

Answer 12

Analgesics

Paracetamol - 2 x 500mg QDS
Ibuprofen - 200-400mg TDS
Aspirin - 1-3 x 300mg QDS

Question 13

OTC products for nasal congestion?

Answer 13

Nasal decongestants - sympathomimetics (construct dilated blood vessels in the nasal mucosa)

Question 14

Oral decongestants available OTC

Answer 14

Psuodoephidrine(Sudafed)

Phenylephrine (sudafed PE)

Question 15

What is the legal restriction for pseudoephedrine??

Answer 15

Maximum 720mg = 60mg x 12 tablets

Question 16

Nasal spray decongestants available OTC

Answer 16

Xylometazoline (otrivine)

Oxymetazoline (sinex)

Question 17

How long should nasal decongestants be used for? And why??

Answer 17

Do not use for more than 7 days

Because of rebound nasal congestion

Question 18

What conditions should you avoid nasal decongestants in?? And why??

Tip: nasal sprays are sympathomimetics(stimulate sympathetic nervous system)

Answer 18

Hypertension: raises bp
Hyperthyroidism: vulnerable to heart irregularities
Diabetes: hyperglycaemia
CVD: stimulant effect
Glaucoma: raised intraocular pressure
Prostatic enlargement: urinary retention

Question 19

What medications should you avoid nasal decongestants in? And why??

Answer 19

MAOIs (hypertensive crisis if <14 days after stopping)
TCAs (theoretical risk of hypertensive crises)
Beta blockers (antagonised effect)

Question 20

How to treat runny nose and sneezing??

Answer 20

Antihistamines: Diphenhydramine and promethazine in cold/flu combination products

Dries up nasal secretions to relieve runny nose and sneezing via anticholinergic action

Question 21

What are the legal considerations for cough and cold remedies for children < 6 YRS??

Answer 21

Certain ingredients in cough and cold remedies should nit be given to children under 6

Give second line in 6-12 yrs as second line to best practice for 5 DAYS only

Question 22

Best practice for nasal congestion

Answer 22

Steam inhalation e.g with olbas oil (3 months +)

Saline sprays/drops in < 3 months

Question 23

List of ingredients in cold and cough that can’t be given to children

Answer 23

Decongestants: xylometazoline, oxymetazoline, pseudophederine, phenylephrine
Antihistamines: chlorphenamine, diphenhydramine, doxylamine, brompheniramine, promethazine, tripolidone
Anti-tussives: pholcodine, dexteomethorpan
Expectorants: guafenesin, ipacacuanha, ammonium chloride, squill

Question 24

Advice for cold and flu?

Answer 24

Vitamin c and echinacea: helps prevent and alleviate cold symptoms
Wash hands regularly: avoid directs transmission
Cough or sneeze into a tissue: avoids air droplets transmission
Annual flu jab if at risk group e.g diabetes