Colds Flashcards
Colds are a _____ of upper respiratory tract
viral infection
There are ______ cases annually
one billion
- part of top 5 diagnosed illnesses in the US
Approximately ______ spent annually on nonRx cold and cough
$7 billion
When is cold season?
late august - early april
- can occur at any time of year though
Colds are the leading cause of…
work and school absenteeism
Colds are limited to…
upper respiratory tract
Stimulation of sensory fibers results in…
sneezing
Cholinergic and sympathetic nerves innervate…
glands and arteries that supply the glands
The nose contains _____ nerves
- sensory
- cholinergic
- sympathetic
Cholinergic stimulation leads to…
dilation of arterial blood flow
Sympathetic stimulation leads to…
constriction of arterial blood flow
Majority of colds are caused by…
rhinoviruses
Modes of viral transmission of cold:
- self innoculation
- aerosol transmission
Pathophysiology of colds:
- rhinoviruses bind to intercellular adhesion molecule-1 receptors on respiratory epi cells in nose and nasopharynx
- infected cells release chemokines
- cytokines activate inflammatory responses
- inflammatory mediators and PNS causes hypersecretion of watery nasal fluid
- swelling of nasal mucosa
- inflammatory processes obstruct airways
Risk factors of colds:
- higher exposure rates
- less diverse social networks
- allergic disorders affecting nose/pharynx
- weakened immune system
What causes a weakened immune system?
- smoking
- sedentary life style
- chronic psychological stress
- sleep deprivation
Signs/symptoms of colds:
- day 1: sore throat
- day 2: nasal symptoms
- day 3: cough
Symptoms of colds will last:
7 - 14 days
- coughs can last up to 3 weeks
Exclusions to self-treatment:
- fever: > 101.5 F
- chest pain
- shortness of breath
- symptoms worsening from self treatment
- underlying cardiopulmonary disease
- AIDS/chronic immunosuppresive therapy
- elderly
- infants < 9 months
Influenza is a highly contagious…
respiratory infection caused by influenza virus
Symptoms of flu are more abrupt in…
onset and severity
Symptoms of the flu:
- high fever
- chills
- myalgia
- fatigue
- sore throat
- stuffy nose
- headache
Best way to prevent flu is to…
get flu vaccination every year
- for people > 6 months old
Flu season:
october - may
- peaks in january
Antibodies against the flu virus develops…
2 weeks after vaccination
____ vaccine is now the standard of care
quadrivalent
Rhinosinusitis is the inflammation of the…
mucosal lining of nasal passage and paranasal sinusitis
Rhinosinusitis can be caused by…
- viral (90%): rhinovirus/coronavirus
- bacterial (10%): acute bacterial rhinosinusitis (ABRS)
Viral sinusitis symptoms:
- nasal discharge that starts clear and watery and turns thick/discolored by day 4 or 5
- nasal congestion, cough, and sore throat
- fever/myalgias in first 24-48 hours
Bacterial sinusitis symptoms:
- lasts > 10 days w/out improvement
- high fever
- purulent nasal discharge
- facial pain
- worsening symptoms after initial improvement
Cold prevention:
- frequently wash hands w/ soap and water for at least 20 seconds
- use tissues to cover mouth/nose when coughing/sneezing
- use antiviral products to clean surfaces
Non-pharmacologic cold relief:
- adequate rest
- drink lots of fluids
- use humidifier/vaporizer b/c loosens mucus and promotes sinus drainage
How to relieve sore throat:
- sucking on hard candy
- gargling salt water (1 tsp salt/8 oz)
- drinking fruit juices/hot tea w/ lemon
Pharmacologic cold relief:
- decongestants
- antihistamines
- local anesthetics
- systemic analgesics
- cough suppressants/expectorants
- combo products
Mechanism of action of decongestants:
- adrenergic agonists (sympathomimetics)
1. stimulation of alpha-adrenergic receptors leads to vasocontriction
2. decreases sinusoid vessel engorgement and mucosal edema
Decongestants will temporarily relieve…
- common cold symptoms
- upper respiratory allergy
- sinusitis
Types of decongestants:
- direct
- indirect
- combo
Direct acting decongestants will…
bind directly to adrenergic receptors
Indirect acting decongestants will…
displace norepi in nerve terminals
Combination decongestants will…
do both direct and indirect activities
Examples of direct acting decongestants:
- phenylephrine
- oxymetazoline
- tetrahydrozoline
Examples of indirect acting decongestants:
ephedrine
Examples of combo decongestants
pseudophedrine
Systemic decongestants:
- pseudoephedrine (PDE): 60 mg every 4-6 hours
- phenylephrine (PE): 10 mg every 4 hours
Phenylephrine is less effective because…
it undergoes extensive systemic metabolism, which leads to low bioavailability
Naphazoline:
- topical intranasal decongestant
- short acting
- directions: 1-2 gtts not more than Q6H
Phenylephrine:
- topical intranasal decongestant
- short acting
- directions: 2-3 gtts Q4H
Xylometazoline:
- topical intranasal decongestant
- long acting
- directions: 2-3 gtts Q8-10H
Oxymetazoline:
- topical intranasal decongestant
- long acting
- directions: 2-3 gtts Q10-12H
Topical intranasal decongestants take how long to work?
- onset of action: 30 minutes
- peak effects: 1-2 H
Adverse events of decongestants:
- cardiovascular stimulation
- CNS stimulation
- device related effects
Examples of cardiovascular stimulation:
- elevated bp
- tachycardia
- palpitations
- arrhythmias
Examples of CNS stimulation:
- restlessness
- insomnia
- anxiety
- tremors
- fear
- hallucinations
Examples of device related effects:
- burning
- stinging
- sneezing
- dryness
Overuse of nasal congestion can lead to…
- nasal spray addiction
- rebound congestion
Rebound congestion can be avoided by…
stopping topical decongestant use after 3 days
Treatment of rebound congestion:
- withdrawal of topical decongestant
- replace topical decongestant w/ topical normal saline
- rhinostat kit
Decongestant drug interactions:
- w/ MAO inhibitors (selegiline, phenelzine)
- diseases that are sensitive to adrenergic stimulation
Examples of diseases that are sensitive to adrenergic stimulation:
- hypertension
- coronary heart disease
- diabetes
- hyperthyroidism
- prostatic hypertrophy
T/F: pseudoephedrine can’t be used to make meth
F
Methamphetamine Epidemic Act:
- written in 2005
- classified pseudoephedrine as “scheduled listed chemical product”
- purchase restrictions
What are the purchase restriction on pseudoephedrine :
- need a valid ID
- limit of 3.6 g/day
- limit of 9g/month
T/F: monotherapy of antihistamines are enough to treat colds
F, need combo of first gen antihistamines and decongestants
Systemic analgesics are used to treat…
- aches
- fever
Examples of systemic analgesics:
- aspirin: avoid in children
- acetaminophen
- ibuprofen: NSAID
- naproxen: NSAID
Directions for aspirin:
325-650 mg Q4-6H
- max: 4g/day
Directions for acetaminophen:
650 mg PO Q4-6H
- max: 3g/day
At high doses of acetaminophen…
there’s a risk of liver toxicity
Directions for ibuprofen:
400 mg PO Q4-6H
- max: 1.2 g/day
Directions for naproxen:
200 mg Q8-12H
- max: 600 mg/day
Local anesthetics provide temporary relief of…
sore throat
Examples of local anesthetics:
- benzocaine
- dyclonine hydrochloride
Forms of local anesthetics:
- lozenges
- sprays
T/F: local anesthetics are effective for viral infections
F
Local anesthetics can be used every…
2-4H
Onset of local anesthetics occur…
immediately on contact
Adverse effects of local anesthetics:
- mouth tingling
- mouth numbness
- irritation
Avoid use of local anesthetics in…
- children < 2 YO
Cough suppressants are used to treat…
nonproductive coughs
- reduces cough frequency
Examples of cough suppressants:
- codeine
- dextromethorphan
- topical agents
Expectorants are used to treat…
symptomatic relief of productive cough
(Guaifenesin)
- reduces chest discomfort from excess mucus
T/F: combination products are inconvenient
F, are convenient
Combination products carry the risk of…
unnecessary drugs
Special populations:
- pregnant women
- breastfeeding women
- pediatrics
- elderly
Providers recommend ____ therapy for pregnant women
nonRx
Avoid _______ in first trimester b/c of possible birth defects
pseudoephedrine
Preferred topical decongestant during pregnancy:
oxymetazoline
Preferred decongestant for lactating mothers:
pseudoephedrine
Risk of _________ w/ systemic decongestant use in lactating mothers:
decreased milk production
FDA made a public health advisory for OTC products in pediatrics during what year?
2008
FDA stated…
- should avoid use of OTC cough and cold medications in children < 2 YO
- potential serious and life threatening adverse effects
In October 2008, manufacturers voluntarily updated labels advising non-use in children ______ YO
< 4
FDA guidelines in 2011 for liquid nonRx products that included dispensing device:
- dosing device needs to be included w/ all oral liquid nonRx products
- device needs to be calibrated to dose recommended in product directions
- device used only w/ product
- markings remain visible when liquid is in device
Dosing for elderly:
- start low and go slow
Treatment of sore throat:
local anesthetics and/or systemic analgesics
Treatment of dry, nonproductive cough:
cough suppressant
Treatment of wet, mucus-producing cough:
expectorant
Treatment of nasal congestion:
topical/systemic decongestants
Treatment of aches and pains:
systemic analgesics
Treatment of fever:
systemic antipyretics
