Common Cold Flashcards
What is the common cold
Viral URTI
What occurs when the virus is exposed to the mucosa?
it invades the nasal and bronchial epithelia, attaching to specific receptors and causing damage to the ciliated cells, which results in inflammatory mediators leading to inflammation of the tissues lining the nose.
Why would a pt sneeze and feel congested?
the permeability of the cell wall increases, resulting in oedema
Why might the pt experience a cough or a sore throat?
fluid might drip to the back spreading the virus
When are cold most contagious?
first 1-2 days of symptoms
What are symptoms a pt may have with the common cold?
cough, runny/blocked nose and sneezing, sore throat, irritated/watery eyes, headache, fever aches and pains, earache and acute otitis media, severe pyrexia (body temp >38 or >37.5 in elderly)
When is the flu most common? what are symptoms of the flu?
winter months, abrupt symptoms occurs within hours
myalgia, chills, malaise, loss of appetite, shivering, insomnia, non-productive cough
what are aggravating factors when someone has the common cold?
headache/pain worsened when sneezing/coughing/bending over, ear pain
What is acute rhinosinusitis? How does it come about?
inflammation of one or more of the paranasal sites
following a cold, the air-filled spaces drain into the nasal cavity and filled with nasal secretions and can then becoming infected with strep and haemophilus
What are the symptoms of rhinosinusitis?
blockage or congestion
discharge or UACS
facial pain or pressure
reduction or loss of smell
What can exacerbate the pain ?
moving forwards, moving the eyes from side to side, coughing/sneezing
What tx is usually required?
analgesics for pain relief
oral and nasal sympathomimetics
antibiotics not usually prescribed but amoxicillin given or doxy if penicillin allergic
What is acute otitis media?
common in children, occurs from the common cold where the virus spreads to the middle ear, results in accumulation of pus and inflammation of the eardrum
What are the main types of flu and why is it important to vaccinate?
type A and type B - many different strains which alter their antigenic structure therefore requires vaccination
When would you REFER a pt who has the common cold?
- Acute sinus problems that does no respond with OTC decongestant therapy
- middle ear pain that doesnt respond with analgesia - most earaches are self-limiting and resolve within 3 days
- very old
- very young
- persisting fever, symptoms of flu and productive cough
- long-term conditions, such as COPD, asthma, kidney disease, diabetes
What are alternative therapies used for the common cold?
Vitamin C, Echinacea - prevention and alleviates cold symptoms, vapour inhalation (menthol crystals, oblas oil) - aids clearance of the nasal passage, recommended for those whom decongestants are C/I), saline sprays, garlic
what are sympathomimetics? How do they work?
Oral decongestants - constrict dilated blood vessels and swollen nasal mucosa, easing congestion and helping breathing
Name some sympathomimetics and what are the age restrictions?
How long should children use them for?
Phenylephrine >12 years
Pseudoephedrine >6 years
6-12 years should only be used for a duration of 5 days MAXIMUM
What drugs can sympathomimetics interact with? What can occur?
MAOI’s - fatal hypertensive crisis - the danger of interaction persists for up to 2 weeks after tx with MAOIs is discontinued
pts with hypertension - sympathomimetics increase BP which can alter control of BP in hypertensive pts and in diabetics but with SHORT COURSES it should be ok
Avoid in pts taking BB’s
hyperthyroidism - heart irregularities
What would be an alternative in pts that cannot take sympathomimetic drugs?
topical sympathomimetics
What are the side effects associated with sympathomimetics? What advice should you give to pts when taking these?
insomnia, restlessness, tachycardia
do not take the dose before bedtime as their mild stimulant action can disturb sleep
Can you give these to pregnant or BF?
Pregnancy - no
BF - yes
What are the pack size restrictions for sympathomimetics?
max pack size are limited to 720mg
Which products is phenylephrine available in?
lemsip, sudafed, beecham in doses ranging 5 and 12mg TDS/QDS for adults and children over 12 years
What is the standard dose of pseudoephedrine?
60mg TDS or QDS and half the adult dose 30mg is suitable for children between 6-12 years
Which is the safest route to use when taking sympathomimetics? Which pts are able to take it?
nasal administration
pregnancy after 1st trimester, pre-existing heart disease/diabetes, HTN, hyperthyroidism
When should nasal sympathomimetics be avoided?
pts using MAOIs and moclobemide - risk of hypertensive crisis as some of the small quantity may be swallowed
What are the side effects of NASAL sympathomimetics? and how long are pts allowed to take them for?
local irritation in 5% of pts
should not be used for longer than 5-7 days otherwise rebound congestion can occur
Name nasal sympathomimetics. What are the age restrictions for their use?
oxymetazoline - >12 year
xylometazoline - >6 years - otrivine child nasal drops
ephedrine - over 12 years 1-2 drops in each nostril QDS PRN
How frequent should oxymetazoline and xylometazoline be used ?
these are longer acting and require less frequent dosing - two-three times a day
What else can be used for the tx of the common cold? Why
antihistamines - relieve runny nose and sneezing by their anticholinergic action
What are the old generation antihistamines? What are the main side effects?
chlorphenamine, promethazine - greater anticholingeric action so greater side effects like constipation/dry mouth/sedation/blurred vision
What are the new agents of antihistamines?
loratadine, cetirizine, acrivastine
What is the best way to administer nasal drops?
Head downward position facing the floor
What can be given to a baby?
saline drops
What are ways to limit viral spread?
use disposable tissues rather than handkerchiefs
wash hands frequently especially after blowing the nose
do not share hand towels
try to avoid touching your nose
