Colds 7.1 Flashcards
What is the pathophysiology for the common cold
- A viral invasion
- There are over 200 types of different colds
Do we care about the type of cold it is (what virus caused it)
- No We don’t care about what type of the cold as we cant differentiate between the types of colds
Is there a vaccine for the common cold
- Since there is no specific type this means there will not be a specific vaccine in the foreseeable future
Common symptoms of the cold day1,3,6
a) Day 1: sore throat rhinorrhea, sneezing
b) Day 3: nasal congestion (usually caused by rhinorrhea), sinus headache( 4 pairs of sinuses in the headache and is buildup as they cant discharge as much), plugged ears (more so with kids)
c) Day 6: cough
What are the symptoms of colds we usually focus on and want to treat
- Nasal congestion and cough
At what day do people with common cold come to the pharmacy
- Around day 3
When are symptoms worse during the day
- Perceived to be worse at night
How long can a cough stay after the cold
- Can last up to 18 days or even longer
What is the first thing we look at when trying to diagnose and treat with a common cold
- Head cold vs chest cold
What is worse between head and chest cold
- Start to be more concerned with chest cold
- Head cold is easier to deal with
What is the common chest cold (to less common as it gets deeper into the lungs)
- Bronchitis-> bronchiolitis-> pneumonia
- We cant differentiate between them as pharmacists
Different types of cough types
a) Congested/ productive (useful to body)
b) Congested/ non productive (will become useful)
c) Dry non productive (not useful)
Congested/ productive cough
- Useful to body
- Cough associated with chest congestion and the expectoration of phlegm
- Will tell them to use nothing as we cant promote them to make things better
- Can say hot water or lemon drop
- Cough associated with chest congestion and the expectoration of phlegm
Congested/ non productive cough
- Cough associated with chest congestion but little expectoration of phlegm
- They will become productive eventually unless you have something wrong
- Try to accelerate to productive, medicine doesn’t do to much
- Can tell them to take a hot shower…
- Could recommend an expectorant
- They will become productive eventually unless you have something wrong
Dry/ nonproductive cough
- Cough not associated with chest congestion, no phlegm
- Stimuli is far different then bronchitis
- Can become productive and turn into bronchitis
- Can stay like this
- We may be able to suppress this and give relief such as DM
- Stimuli is far different then bronchitis
What do we do with infants and children with the common cold
- We refer much quicker then someone who is older, harder to find medicines to kids, by law and morals
Do infants/ children get more or less colds
- They get on average 8 colds a year, adults get about 1
Infant vs children symptoms
a) Infants: similar symptoms, may show early fever (up to 39C) gastrointestinal upset (diarrhea), congestion is a problem if breast feeding
b) Children: less fever like and more like adults
How is the cold spread
- Direct contact with cold sufferer
- Inhaled droplets
- Eye/nose contact
- Inanimate objects
- Kissing? Believe that it is not because the mouth process is harder to get sick but can still get sick
From other ways through kissing
Can we get a common cold from cold/ wet weather
- It is a vasomotor response rather then a cold
- For the most part does not happen, when it is very cold and then warm up quickly vice vs, all you get is a vasomotor response (runny nose) to the temperature change, only lasts a couple hours so some people credit the meds to it stopping
Does hand washing and anti-viral tissues work with limiting spread of a cold
a) Hand washing: Does work to a point
- But do not need to do it extensively to get rid of every single germ
b) Anti viral tissues: Colds are going to happen either way
- Not a big player
How to do a differential diagnosis between the common cold and others
- Most common is the common cold and if you factor this out can go down the list
- Common cold-> bronchitis/sinusitis->influenza-> covid(gets all the attention)->strep throat
Differentiating between simple colds and influenza (the flu)
- Patients use cold and flu interchangeable but treatment is usually similar
a) Simple colds: When it gets to congestion and cough it gets our attention
- Takes a couple days to hit
- Doesn’t knock you out from the body stand point
b) Influenza:- Hits you hard (bed rest)
- Faster onset (could be hours)
- Systemic symptoms (especially body aches)
- Cough more sever (dry type)
- Spiking fever (can kill in elderly)
what symptoms lead us to thinking its a flu
- Hits you hard (bed rest)
- Faster onset (could be hours)
- Systemic symptoms (especially body aches)
- Cough more sever (dry type)
Spiking fever (can kill in elderly)
Within the flu vs cold medication what change
- With flu treatment all they add is acetaminophen or a pain killer as the flu has more body aches
Non pharmacologic treatment for influenza
- Recommend fluids and rest
- Reduce spread of virus by: washing hands, cover mouth when coughing/ sneezing, staying at home when not feeling well
Pharmacologic treatment of influenza
a) OTC
- Analgesics, antipyretics to aid fever, headache or myalgia
- Acet or ibuprofen
b) Prescription therapy
- Antivirals: may reduce symptoms if started within 48 hours and the sooner the better
When can pharmacists prescribe oral antiviral agents
- Pharmacists can only prescribe oral antiviral agents when an epidemic or pandemic is declared by chief medical health officer for sask
What is the most common virus causing a simple cold
- Rhinovirus
Covid 19 symptoms in comparison to the flu and common cold
How to tell if its asthma
- Persistent cough (maybe greater at night)
- No cold like symptoms (Although the common cold is one of the most common inducer of asthma)
- Wheezing/ shortness of breath
- Chest tightness
What are symptoms of asthma commonly triggered by
- Exercise, allergens, cold
Differential diagnosis of GERD
- Gastroesophageal reflux disease (occurs when stomach acid keeps flowing back in the esophagus)
- Irritated throat/ heartburn
- Unproductive/ dry cough (Can cause a chronic cough)
Differential diagnosis of Post nasal drip
- Sore throat (with throat clearing)
- Unproductive cough
- Sinus involvement often
- Enough of it can cause a dry unproductive cough, not in chest rather back of the throat
- Cause of chronic coughing
- A lot of attempting to clear throat
Differential diagnosis of allergic rhinitis
- “summertime colds”
- Colds are a lot less common in the summer so this is a very good indicator- Seasonal or chronic
- Last longer then colds ( Common colds can last 5-20 days while this can last all summer)
- Rhinitis, sneezing, itch, ocular symptoms,
- Cough is rare (unless allergies cause PND)
When trying to differentiate between conditions do we only look at the symptoms they have
We look at both the ones that they have and don’t have
Smokers cough
- Often worse in morning
- Minimal sputum
- Don’t think of from the get go
- Smoker usually says that they smoke
- 40% of smokers have a cough compared to 12% of non smokers
What can smokers cough cause
a) Chronic bronchitis (COPD)
- Ends with this
- Lots of sputum
Treatment of smokers cough
- Quit smoking (right after quitting cough often increases)
- Stay hydrated
- Salt water
- Cough drops or lozenges
- Inhale mink vapors
- Elevate head while sleep
- Spoonful of honey
Acute bronchitis
- Lower resp tract infection
- Chest cold
- Similar to common cold but increased cough
- Cough started non-productive and becomes productive
How long can acute bronchitis last
- Up to three weeks
What does green sputum in acute bronchitis mean (viral or bacterial)
- Is not necessarily bacterial but could rather a process of the inflammatory response
ACE inhibitors within cough
CE inhibitors are important in high blood pressure treatment
- About 8% of ACEi patients use antitussives (cough suppressant)
- Can get a cough (dry, raspy) when using ACEi but could take up to 1 year to occur
- If this happens discontinue agent and prescribe a new one (cough should clean in 1 week up to 3 months)
Who is strep throat common in
- Kids: 37% in 5-15y, while 15% in adults
Strep throat symptoms
- Increase fever and pain
- Cough is less common
- Exudate/ swollen glands/ rash
What type of infection is sore throat, strep throat, tonsillitis
- Need to do testing for strep and hard to tell by looking
a) Sore throat: viral
b) Strep: bacterial
c) Tonsillitis: the tissue in the case
How to diagnose strep (GABHS)
- If they have fever, no cough, tender lymph nodes, tonsillar exudate (fluid that leaks out)
- Have a 50:50 chance of being right
- And consider empiric treatment with antibiotics (not us)
Are antibiotics needed for strep throat
- Strep can cause effects on other tissues (rheumatic fever-> heart or kidney damage)
- Even though it is a bacterial infection we give antibiotics to ensure no damage on other organs
how long does it take bacterial or viral sore throats to resolve
- 40% symptom free in 3 days and 85% are symptom free in 7 days whether bacterial or viral
- If it resolves in 3-5 days it was just a sore throat
