Colds & Allergic Rhinitis Flashcards
Common Cold Timeline (ie. Day 1 / 3 / 6)?
Day 1: Sore Throat (scratchy / tingly), Rhinorrhea, Sneezing
Day 3: Nasal Congestion, Sinus Headache, Plugged Ears, maybe Elevated Temp but rarer with cold (very low-grade fever)
Day 6: Coughing
What happens in terms of cold severity as the depth increases (ie. Head down into lungs)?
-Increasing severity as depth increases!
Head Cold < Bronchitis < Bronchiolitis < Pneumonia
Describe the three cough types.
1) Dry / Nonproductive - Cough IS NOT associated with chest congestion & no phlegm expelled.
2) Congested / Nonproductive - Cough IS associated with chest congestion, but little amounts of phlegm expelled. Will become productive!
3) Congested / Productive - Chest Congestion evident & lots of phlegm being expelled. This cough is VERY useful to the body!
How do cold symptoms in Infants differ from those seen with kids & adults?
-May show early Fever
-GI distress / diarrhea
-Frequency… 8x / yr (compared to 1x / yr for adults)
In terms of relative frequency, order the following cold-like conditions from least likely to greatest likelihood to occur:
COVID-19
Strep Throat
Common Cold
Bronchitis / Sinusitis
Influenza
1) Strep Throat
2) COVID-19
3) Influenza
4) Bronchitis / Sinusitis
5) Common Cold
What kind of differential questions can you ask a patient when distinguishing a common cold from influenza?
-How hard is illness hitting you?
-How quick did illness begin working?
-Any body aches?
-Chills? Fever?
-Any phlegm coming up with cough?
-Chest Congestion or Stuffy Nose?
-Runny Nose &/or Watery Eyes?
What group(s) of people are we most concerned with in terms of Influenza effects?
-Sr.’s (& little kids)!!! Very concerned with Sr.’s, as Influenza can deepen further & further into the lungs (& eventually kill them if left untreated).
Marg is an 85yr old resident at Luther Tower. She comes to your Pharmacy in October complaining about fatigue & systemic weakness (indicative of General Malaise). She presents a dry cough as well, but no fever. What are you thinking could be wrong with her [& what is the next step]?
-Could be Influenza!!! Malaise is much (MUCH) more common in the elderly than in adults presenting Influenza, & the dry / unproductive cough supports this rationale. Sr.’s also demonstrate Fever at a reduced rate compared to adults with Influenza.
-Next step should be a referral to a Dr. to make sure the potential Influenza gets treated ASAP & we prevent a possibly dangerous infection from occurring.
What are Pharmacists authorized to do when viral epidemics / pandemics are declared by the SHA?
-Prescribe Anti-Virals such as Oseltamivir or Zanamivir.
In terms of distinguishing COVID-19 from the Common Cold or Flu, what’s one major symptom that could help us in our screen?
-Shortness of breath!
-Much more common complaint than with the Common Cold or Flu. Fever & Aches are common with COVID too, but they’re also common with Flu. So, ask for shortness of breath & recommend testing for COVID if feverish symptoms or aches exist.
-Can also ask about loss of taste or smell (might help discern COVID).
Angie is a 24yr old patient who comes to your Pharmacy presenting a persistent cough & occasional wheezing. She tells you that her cough gets worse after she goes for long jogs, & the annoying cough has lasted about three months. She is otherwise healthy. What might Angie be presenting?
Asthma!
Johnny comes to your Pharmacy complaining about an irritated throat & heartburn, accompanied by an unproductive, dry cough that’s persisted for months. He tells you that laying down at night further exacerbates the symptoms. What might Johnny have?
GERD!
Andrew comes to your Pharmacy in late May & tells you that he can’t stop sneezing. He tells you that he’s started working a landscaping job planting flowers & other greenery for the City of Saskatoon. He tells you that his nose has also been super runny, and his eyes are “so damn red and itchy”! What condition might Andrew have?
Allergic Rhinitis! Exposure to pollen from flowering plants might be the root cause of irritation.
What distinguishing factors differentiate a Smoker’s Cough from COPD?
Smoker’s Cough: Worse in morning & minimal sputum (but cough becomes more productive with time).
COPD: TONS of sputum & persistent cough for many many years. Effects usually rear their head around 20-30yrs post-smoking start.
Acute Bronchitis differs from the common cold how?
-Cough rate is increased & presents itself earlier.
-Cough is initially unproductive & becomes productive.
-Can last up to 3 weeks… Cold usually resolves itself around 7-10 days.
-Presence of Green Sputum (suggests bacterial / viral infection).
Greg is a 65yr old patient phoning into to your Pharmacy. He complains of a dry, raspy cough that’s been persisting for 6 weeks. You look at his patient history prior to the encounter and notice that he’s started to take Ramipril (an ACE Inhibitor) as of 6 weeks ago. Explain how the Ramipril that Greg is taking might be causing the dry, raspy cough.
-ACE (Angiotensin-Converting Enzyme) is responsible for degrading Substance P and Bradykinin.
-If we inhibit ACE, Substance P & BK accumulate in the lungs at higher concentrations, which induces bronchoconstriction, increasing coughing, & inflammation.
What are some telltale signs of Strep Throat (vs. just a run-of-the-mill sore throat)?
-Increased rates of Fever & elevated pain when swallowing
-Often an absence of cough or runny nose
-Swollen Lymph Nodes / Glands / Tonsils
-Tonsil exudate
-Red Spotting on roof of the mouth
What potentially fatal health condition most commonly arises in children with untreated Strep?
Rheumatic Fever
Why are antibiotics prescribed for Strep?
-NOT to treat Strep itself!!!
-Are ACTUALLY prescribed to prevent bacterial spreading into vital organs such as the Heart or Kidneys (ie. Prevention of Rheumatic Fever).
What causes Tonsilitis?
Bacterial: 15-30% (most commonly Strep)
Viral: 70-85% (Epstein-Barr Virus)
What (usually) causes Laryngitis?
-Overuse of the voice box or viral infection
-Bacterial infections can cause Laryngitis (although less common)
Angela brings her 4yr old child, Trey, into your Pharmacy. She lifts up his shirt and shows you a rash that has developed on his stomach. You investigate further and discover that Trey was in the Dr.’s office 6 weeks ago for virally-induced Acute Bronchitis. What is the name of Trey’s presented condition?
Fifth / Sixth Disease!
-Viral URTI’s cause ~40% of hive rashes in kids.
What is the name of the virus most commonly responsible for causing Bronchiolitis?
Respiratory Syncytial Virus (RSV)
T or F: Croup is treated with antibiotics.
False… Is VIRALLY caused!
-Croup clears on its own after 5-7 days.
Victor is a 17yr old patient who comes to your Pharmacy with a sore throat, fever, and he’s complaining to you about being extremely tired. He tells you that his HS graduation party was three weeks ago, and that this was the only time he’s left the house to intermingle with his friends. He also tells you that drinks were being shared amongst guests at the party. Given the length of time for symptoms to appear, what might you suscept Victor has?
Mono!
-Symptoms present like the Flu or Strep Throat, but the onset is SLOWER!
What are some common signs & symptoms that patients with Lyme Disease demonstrate?
-Fever / Chills / Headache (similar to Flu).
-Unlike the Flu, rash often appears at the site of a Tick bite.
-“Bullseye Rash” in some patients.
-Dizziness, Mental Confusion / Brain Fog, Nervous System Disorders.
When it comes to cold referrals, what age-based rules do we follow for Infants & young kids?
< 1yr: Automatic Referral
1-2yrs: Be very cautious
3-6yrs: Cautious
What’s the youngest age in which we can use cold medicines?
6yrs… NEVER use cold medicines on kids < 6yrs of age!
When should you see a Dr. with regards to a persistent cold that’s either worsening or staying the same (ie. No Improvements)?
14 days (generally)
Acute, Virally-Induced Sinusitis lasts roughly how long?
< 10 days
What is “Double-Sickening”?
-Indicative of Bacterial Sinusitis or Pneumonia… Cold-like symptoms for about a week, improvements for a few days, and then the cold comes back after a few days of improving conditions.
How long do we wait to make an MD referral for cough for the following age groups:
< 1yr:
1-3yrs:
4-6yrs:
< 1yr: Automatic!!!
1-3yrs: 1 week (more cautious)
4-6yrs: 2 weeks (similar to adults)
The average cough length is what (how many days)? What is the expected / perceived normal length for a cough to persist?
Avrg Cough: Lasts 18 days!
Patient: Thinks 7 days!
Three most common causes of chronic cough (account for 95% of cases): What are they?
1) Asthma
2) Post-Nasal Drip
3) GERD
Brain Centre that regulates body temperature… What is it?
Hypothalamus
Fever temperatures in the following bodily compartments: What are they?
Rectum
Mouth
Armpit
Ear
Rectum - 37.5 Celsius
Mouth - 37 Celsius
Armpit - 36.5 Celsius
Ear - 37.5 Celsius
What are the ideal methods for each corresponding age group with regards to checking for Fever?
0-2yrs:
2-5yrs:
> 5 yrs:
0-2yrs: 1 = Rectum, 2 = Armpit
2-5yrs: 1 = Rectum, 2 = Ear or Armpit
> 5 yrs: 1 = Mouth, 2 = Ear or Armpit
Why aren’t digital ear thermometers recommended for newborns?
-Size of a newborn’s ear canal… Hard to position properly for an accurate reading b/c of the nature of how much smaller their ear canals are.
Procedurally, if you were planning to take an Otic temperature reading of a baby that’s < 12 months, how would it differ from taking the temperature of an older child (say, 5yrs of age)?
< 12 months: Earlobe pulled DOWN & BACK for proper probe positioning.
5yrs: Earlobe pulled UP & BACK.
-Shape & size (as seen before) of the baby’s earlobe differs!
What is the “39 - 1 / 2 / 3 rule”?
-Describes Fever referrals (ie. When to see MD)…
1yr old: > 39 degrees for a day
2yr old: > 39 degrees for two days
3yr old: > 39 degrees for three days
What criticism does Jeff have with Pediatrician recommendations for treating Fever?
-They have a tendency to chase the number (39) rather than treat the child’s discomfort… Should gauge how a child is feeling rather than simply treating when temps exceed 39 degrees.
Infant Tylenol vs. Advil Pediatric Drops… Which product is better for treating Fever?
-Either is good! Ace & Ibu can both be used, but Ibu does offer up more convenient dosing & slightly better anti-pyretic effects.
Administration Regiments for treating Child Fever with Ibu & Ace: What are they?
Ace:
-10-15mg / kg Q4-6H… DO NOT EXCEED 5 DOSES IN 24hrs!!!! So, maximum of 75mg / kg / day.
Ibu:
-Kids < 6 months: 5 mg / kg Q8H
-Kids > 6 months: 5-10mg / kg Q6-8H
Why do Dr.’s not recommend swapping between Ace & Ibu for Fever treatment?
-Can lead to dosing errors!
What OTC product should kids & teens not be given for Fever treatment due to its increased risk of developing Reye’s Syndrome?
Aspirin
Ace or Ibu: Which one are we most concerned with in terms of toxicity risk?
Acetaminophen!!! Ibu is MUCH safer.
Types of Children’s Acetaminophen formulations: What do we have?
-Infant Tylenol or Tempra Drops (less common than Tylenol)
-Children’s Tylenol Suspension
-Children’s Tylenol Fastmelts
-ACET 120 / 160 Suppositories (very uncommon)
(Michael Pt. 1)
Michael is a 3yr old boy who weights 36.9lbs. Calculate the maximum amount of Children’s Tylenol that he can take in one week.
[10-15 mg / kg Q4-6H… Maximum of 5 doses / day!]
Michael’s Weight:
(36.9lbs) x (1kg / 2.2lbs) = 16.8 kg
Dose Calculations:
(15 mg / kg) x (16.8kg) = 252 mg / dose
(252 mg / dose) x (5 dose / day) = 1260 mg / day [Max]
(1260 mg / day) x (7 days / week) = 8820 mg / week [Max]
(Michael Pt. 2)
Use your calculation from Pt. 1 & determine how many Children’s Tylenol Fastmelt tablets Michael can take in one week (round to the nearest whole tab).
[160 mg / tab = Dose Strength of Children’s Tylenol Fastmelts]
-Determined that Michael can take a maximum of 8820 mg / week…
(8820 mg) / (160 mg / tab) = 55.125 tabs… Rounds down to 55 tabs in one week!
