Cold + Flu

Question 1

Symptoms for cold

Symptoms for Flu

Answer 1

Cold

• Blocked runny nose, sneezing
• Cough
• Sore throat
• Fever, Aches and pains
• Headache, sinus pain
• Earache
• Irritated, watery eyes (conjunctivitis)

Flu
- More sudden and severe, headache, marked myalgia (muscle pain), chills, malaise, high grade fever

Question 2

When to refer for Cold + Flu?

Answer 2

• No improvement ~ 2 weeks
• Middle ear pain not improving with analgesics
• Persisting productive cough and high grade fever (24hrs+ in 3-6 months, 72 hrs+ in>6months) (38C+ in <3months, 39C+ in 3-6 months)
• Vulnerable patients (COPD, Asthma, kidney disease, diabetes, immunocompromised, <3months, old)

Question 3

OTC for Cold + Flu:

Fever, aches + pains

Answer 3

Oral analgesics: Paracetamol 2x500mg QDS
Ibuprofen: 200-400mg TDS (Max dose 600mg QDS)
Aspirin: 1-3 x 300mg QDS (Max dose 600mg QDS)

Question 4

OTC for Cold + Flu:

Nasal congestion

Answer 4

• Oral decongestant: Pseudoephedrine, Phenylephrine
  (Max OTC pseudoephedrine 12 x 60mg tabs)
• Nasal spray: Xylometazoline, oxymetazoline
  (Do not use for 7+ days = rebound nasal congestion)
  -It constricts dilated blood vessels

Question 5

When to avoid nasal decongestants? (conditions)

Answer 5

• Hypertension (raises bp)
• Hyperthyroidism (heart irregularities)
• Diabetes (hyperglycaemia)
• Cardiovascular disease (stimulant effect)
• Glaucoma (raised intra-ocular pressure)
• Prostatic enlargement (urinary retention)

Question 6

What meds do nasal congestants interact with?

Answer 6

MAOIs (hypertensive crises if <14 days after stopping

• TCAs (hypertensive crises risk)
• B-blockers (antagonize effect)

Question 7

Antihistamines in Cold/Flu

Answer 7

Diphenhydramine in cold/flu combination products - dries up nasal secretions via anticholinergic action

Question 8

Best practice for nasal congestion for children under 12?

When can cough and cold remedies be given to children?

Answer 8

• Steam inhalation with Olbas oil (3 months+)
• Saline sprays/drops in under 3 months
• Cough and cold remedies for 6-12 years SECOND line

Question 9

What type of drug is Xylometazoline?

Answer 9

Decongestant

Question 10

What type of drug is Oxymetazoline?

Answer 10

Decongestant

Question 11

What type of drug is Pseudoephedrine?

Answer 11

Decongestant

Question 12

What type of drug is Phenylephrine

Answer 12

Decongestant

Question 13

What type of drug is Chlorphenamine?

Answer 13

Antihistamine

Question 14

What type of drug is Diphenyhydramine?

Answer 14

Antihistamine

Question 15

What type of drug is Doxylamine

Answer 15

Antihistamine

Question 16

What type of drug is Brompheniramine

Answer 16

Antihistamine

Question 17

What type of drug is Promethazine

Answer 17

Antihistamine

Question 18

What type of drug is Tripolidine

Answer 18

Antihistamine

Question 19

What type of drug is Pholcodine?

Answer 19

Anti-tussive (cough suppressant)

Question 20

What type of drug is Dextromethorpan?

Answer 20

Anti-tussive (cough suppressant)

Question 21

What type of drug is Guaifenesin

Answer 21

Expectorant

Question 22

What type of drug is Ipecacuanha

Answer 22

Expectorant

Question 23

What type of drug is Ammonium Chloride?

Answer 23

Expectorant

Question 24

What type of drug is Squill?

Answer 24

Expectorant

Question 25

Advice for cold + flu

Answer 25

1. Vitamin C + Echinacea
2. Wash hands regularly
3. Cough or sneeze into a tissue
4. Annual flu jab for at risk groups