Colds

Question 1

What types of pathogens/antigens cause colds?

Answer 1

90% of colds are caused by rhinoviruses, but can be caused by adenoviruses, etc. There are 200 different antigens and there is no vaccine to prevent infection.

Question 2

What are the symptoms of a cold?

Answer 2

Day 1: Sore throat, rhinorrhea, sneezing
Day 2: Nasal congestion, sinus headache(caused by mucous build-up), plugged ears (inflamed eustachian tube)
Day 3: cough

Question 3

What are two types of colds?

Answer 3

Head colds and Chest colds, chest colds need more attention as they could be more serious

Question 4

What are the different types of cough?

Answer 4

Congested/productive: cough associated with chest congestion and the expectoration of phlegm

Congested/nonproductive: cough associated with chest congestion, but little expectoration, but it should become productive unless you have COPD/smoker

Dry/nonproductive: cough not associated with chest congestion; no phlegm. This is not a useful cough

Question 5

How do colds present in infants?

Answer 5

Similar symptoms as adults, but can show early fever(39*C) and this is where we refer to pediatricians, GI upset(diarrhea), and congestion

Infants on average have 8 colds/year

Question 6

How are colds spread between people?

Answer 6

Direct contact with a cold sufferer
Inhaled droplets
eye/nose contact with direct/indirect contact with affected surfaces

The mouth is not where the cold enters, but while kissing noses are in proximity

Question 7

How to prevent the common cold?

Answer 7

Hand washing limits the number of viral particles coming into direct contact with either your eyes or nose

Question 8

How is the flu different from the common cold?

Answer 8

The flu hits you harder (bed rest is crucial)
Faster onset (within a day)
Systemic symptoms(body aches)
Cough more severe(dry/unproductive)
Spiking fever

Question 9

How are seniors affected by the flu?

Answer 9

90% of influenza-related deaths are among elderly patients.

Question 10

Why is influenza underdiagnosed in seniors?

Answer 10

If we require fever and cough to rule in the flu, we will miss more than half of the older people who have influenza. This is why flu vaccines are really important for seniors

Question 11

How does the treatment of influenza differ from the common cold?

Answer 11

Acetaminophen is added to the mix to help with body aches

Question 12

What is a pharmacist’s scope of practice with respect to colds/flu?

Answer 12

Non-pharmacologic treatment:
Recommend fluids and rest for the patient
Suggest ways that they could help reduce the spread of the virus

Pharmacologic treatment: (OTC products)
Analgesics and antipyretics to relieve fever, headache, and myalgia
ex. acetaminophen and ibuprofen

Question 13

When can pharmacists prescribe oral antiviral agents?

Answer 13

Only during an epidemic or pandemic declared by the Cheif Medical Health Officer for Saskatchewan

Question 14

What is the future of differentiating between colds and the flu?

Answer 14

Rapid testing devices can help pharmacists accurately determine what level of healthcare is needed for a given patient

Question 15

How is asthma different compared to either the cold or flu?

Answer 15

Although uncommon to discover asthma in the pharmacy, it is characterized by a cough without cold-like symptoms. Coughing and wheezing can be caused by exercise, allergens or cold.

We should refer this patient to a doctor so they can be examined properly.

Question 16

How is GERD different compared to the cold or flu?

Answer 16

Cough caused by GERD is usually dry and unproductive. It is also associated with an irritated throat and heartburn caused by stomach acid in places where it is not supposed to be.

Question 17

How is Post Nasal Drip different compared to the cold or flu?

Answer 17

PND is characterized by mucous dripping back into the throat. This causes a sore throat followed by throat clearing. PND also has an unproductive cough caused by throat irritation.

Question 18

How is Allergic Rhinitis different compared to the cold or flu?

Answer 18

Allergic rhinitis is usually seasonal and it will go away once the allergen is no longer in the environment. If allergic rhinitis is perennial, symptoms will last longer than colds and are characterized by rhinitis, sneezing, itch, ocular symptoms.

Question 19

How is smoker’s cough different compared to the cold or flu?

Answer 19

Characterized by a dry unproductive cough, and it is worse in the morning. There is minimal sputum.

Question 20

How is chronic bronchitis (COPD) different compared to the cold or flu?

Answer 20

This is the natural progression of a smokers cough, but the difference is much more mucous is produced.

Question 21

How is acute bronchitis different compared to the cold or flu?

Answer 21

This is like a chest cold, but there is much more coughing. Coughing is initially unproductive but becomes productive. The patient can help us differentiate by asking them if their symptoms are worse than a regular cold, if yes then they have acute bronchitis.

Question 22

How is pneumonia different compared to bronchitis?

Answer 22

Pneumonia combines symptoms from bronchitis, but the patient also experiences fevers, chills, fatigue, and feels very ill. They need more help than we can provide and need to be directed to the hospital.

Question 23

Do high blood pressure medications on their own have any effect on coughing?

Answer 23

Blood pressure medicines can exacerbate chronic coughing caused by the inflammatory response.

Question 24

How is ACE inhibitor-induced coughing different from the cold or flu?

Answer 24

Coughs that last a long time; ask what other medicines the patient is on then we can figure it out from there
Side effect of ACEi = dry, raspy cough that lasts for a long time
~ 10-30% of users
Cough (dry, hacking) is only symptom
Via Substance P or bradykinin 🡪 bronchoconstriction
Can take 1 year of tx to occur

Question 25

What ailment does a sore throat characterize?

Answer 25

Sore throats are not a differentiating symptom as it could be anthing. If the situation resolves in 3-5 days, it was just a sore throat.

Question 26

How to differentiate a sore throat from strep throat?

Answer 26

Strep Throat
~15% of acute pharyngitis
Acute sore throats
Increased fever and increase pain
Cough is less common
Exudate/swollen glands (hurt along jaw line)/rash (splotchy)
More common in kids 5-15 years old

examination of tonsils and administration of lab tests is outside of a pharmacist’s scope of practice

Question 27

Do doctors prescribe antibiotics for Strep throat?

Answer 27

Strep does not have to be treated with antibiotics, but doctors often give it to prevent further complications. Strep throat can complicate into Rheumatic fever (deeper into the system) 🡪 heart disease (very rare in modern society) 🡪 kidney

Question 28

How is tonsilitis different compared to strep throat?

Answer 28

Tonsilitis characterized by swollen tonsils that haved white streaks caused by buildup of leukocytes.

Question 29

How is laryngitis different compared to tonsiliitis?

Answer 29

Laryngitis is an inflammation of the vocal chords. In most cases, it resolves itself with self-care measures. Children with laryngitis can develop another respiratory illness called croup.

Question 30

What is pregnancy rhinitis?

Answer 30

~20% of pregnancies
Hormones can cause:
Runny nose and congestion (1/5 women)
Women who have a runny nose and congestion may not have a cold, it may be pregnancy induced rhinitis, but it is more likely she has a regular cold.

Question 31

What is fifth and sixth disease?

Answer 31

Skin conditions in kids after cold symptoms, this doesn’t happen eveytime.

Question 32

How is bronchiolitis different from the cold/flu?

Answer 32

Bronchiolitis is characterized by rapid or shallow breathing and wheezing after 3 days of symptoms.

Question 33

How is croup different from the cold/flu?

Answer 33

Croup is found in younger kids and it is associated with laryngitis. The virus is in the voice box and the bark-like cough sounds a lot worse than it actually is due to the location of inflammation.

Question 34

How is whooping cough different compared to the cold/flu?

Answer 34

Whopping cough is caused by a bacterial infection and it is characterized by a whooping sound following a cough. This is the sound of air rapidly entering the lungs, the person with whooping cough is essentially suffocating

Question 35

How is mononucleosis different compared to the cold/flu?

Answer 35

Mono presents itself like a cold, but it has a longer onset. Once mono has set in, see swollen neck glands and no coughing.

Question 36

What is a good way to do differential diagnosis when it comes to coughs and colds?

Answer 36

1. Common Cold( if no congestion, then move on)
2. Bronchitis (feels like cough is coming from the chest and productive cough. if you have a fever and body aches, then move on)
3. Influenza (this is especially worrisome for senior patients, if neck glands are swollen are draining white fluid, then move on)
4. Strep throat (you have a 50:50 chance you are right, so refer to a doctor to properly examine and figure out exact cause.

Question 37

How can the presence or absence of a fever help differentiate between different conditions?

Answer 37

Patient has fever: flu, strep, and Covid

Patient does not have fever: allergies, cold, and bronchitis

Question 38

How can the presense or absense of a cough help differentiate between different conditions?

Answer 38

Patient has cough: cold, Flu, Bronchitis, covid (ask type of cough)

Patient does not have cough: allergies and strep throat

Question 39

How can the duration of a cough/cold help us provide care to a patient?

Answer 39

Depending on their age and risk, longer durations make pharmacists to refer to a doctor for more thorough examination

Question 40

How can the presense or absense of a bad sore throat help differentiate between different conditions?

Answer 40

Patient has a bad sore throat: strep, flu

Patient does not have a bad sore throat: Cold, Bronchitis, and Allergies

Question 41

When should pharmacists refer kids with colds to physicians?

Answer 41

Under 1: automatic referral
1-2 years old: Be cautious and we are more referral-happy
3-6 Remain cautious and think about drug safety and legality of giving kids under 6 cough/cold meds

Pharmacists usually refer 10% of kids, nut only 1% of adults

Question 42

When should pharmacists refer sinusitis to physicians?

Answer 42

Headache, flu, cold, or sinusitis
Bacterial lasts longer than viral, so if it continues, go to the doctor to get it checked out
Give best advice at day 2/3 when they come into the pharmacy
< 10-14 days – viral?
> 10-14 days – bacterial?
Acute viral cases = < 10 days
Acute bacterial cases (need antibiotics, therefore MD referral)

Question 43

When should pharmacists refer fevers to physicians?

Answer 43

<3 months
Refer
3 months – 2 years
< 39 C
No drug (no Tylenol/advil)
>39 C
Treat (seek MD if >1 day)
> 2 years
>39 C
Treat (seek MD if > 3 days)
Child behavior is more important than specific temperature
Rule
1 day – 1 year
2 days – 2 years
3 days – 3 years

Question 44

When should pharmacists refer coughs to physicians?

Answer 44

Head cold VS chest cold

When to get worried
Patients choose care – at home VS pharmacists VS medical appointment
For whatever reason (comfort level, first kid VS fifth kid)

Refer infants if…
Always worry < 1 year
But normally cough ~11 times / day

Refer kids if…
1-3 year olds [ 1 ] weeks
4-6 year olds [ 2 ] weeks
Refer patients on to the doctor when we are nervous

Only refer adults if cough persists for more than 1 year.

Question 45

What are some trigger words for referral?

Answer 45

“Not the usual”
Worst than last time

“Worsening

“Fever”
Always worried about this even though we have numbers to watch out for

“It got better, now its back” (Double-sickening)
Bad cold for 7 days, fine for a week, then comes back again (suspicious for seniors)

Question 46

What are some common causes for chronic cough?

Answer 46

Smoker’s cough and subsequent COPD

Asthma

PND

GERD

ACE inhibitor-induced