Cough and Cold Flashcards
Why is there no vaccine for the cold?
there are too many types of colds (>200)
What are the day 1 symptoms of a cold? Are they at the same level as the symptoms of allergic rhinitis?
sore throat (usually the 1st sign)
rhinorrhea
sneezing
no, they are not at the same level as allergic rhinitis
WE DO NOT FOCUS ON TREATING THESE SYMPTOMS
What are the day 3 symptoms of a cold?
nasal congestion
sinus headache (as the nose plugs, there is inflammation at the base of the skull)
plugged ears (more so with kids)
Which virus causes the most colds?
rhinovirus
Which symptoms of the cold does the public generally want treatment for?
cough
nasal congestion
Which type of chest cold is the most common?
bronchitis
Do we worry more about a chest cold if it is deeper or higher in the respiratory tract?
we worry more as it gets deeper (pneumonia being the most serious)
What is the congested/productive cough type?
it is useful to the body
cough is associated with chest congestion
you are coughing out the junk (phlegm expectoration
What is the congested/nonproductive cough type?
will become useful to the body
cough associated with chest congestion
body is not coughing out junk but it eventually will (little expectoration of phlegm)
What is the dry/nonproductive cough type?
not useful to the body
cough not associated with chest congestion
not coughing anything up (no phlegm)
probably smokers cough
What are the symptoms of the cold with infants?
similar symptoms
early fever (39C)
GI upset
congestion is a problem if breast-feeding
What are the symptoms of the cold with children?
less fever
more similar to adults
What should you do if a parent wants something for their 1 year old who has a cold?
referral
not really our realm
few cough medicines for this age
What are some ways the cold is spread?
direct contact with cold sufferer
inhaled droplets
eye/nose contact
inanimate objects
What is the vasomotor response? Is this an indication that a cold is coming?
we get a runny nose when our body is responding to drastic temperature changes
normal, not the cold
Why is wiping down everything in an area to prevent the cold considered to be pointless?
the first person to cough ruins it
the common cold is everywhere!
Rank the following in their relative frequency: strep throat, bronchitis/sinusitis, influenza, common cold, COVID
common cold
bronchitis/sinusitis
influenza
covid
strep throat
What should always be your starting point in the differential diagnosis process?
the common cold
dont dig yourself a hole by thinking its something less common such as strep throat
If a patient says they’re symptoms hit them hard and fast, they have a dry cough, they have a high fever, and body aches, what would you say this is?
influenza
the common cold does not have fast onset and hard hitting symptoms
Differentiate the symptoms of the cold vs the flu.
cold: symptoms build up (not hard hitting), rhinorrhea, sneezing, congestion, cough, sore throat
flu: fast onset (hard hitting), body aches, DRY cough, fever, headache, fatigue
What is the same about the cold and flu?
they both come from respiratory tract infections in your nose, sinuses, and throat
Why do we promote the influenza vaccine to seniors?
seniors have a higher mortality rate from influenza
Does treatment change much with the cold and flu? What got added to cold products, to allow companies to advertise their products as “cold and flu”?
treatment does not change much
they added acetaminophen for aches and fever of the flu
True or false: influenza prescribing as a pharmacist is common
false
What are the non-pharmacological treatments of the flu?
fluids and rest
reduce spread by staying home
What is the pharmacological treatment of the flu?
OTC: analgesics and/or antipyretics for fever, headache, myalgia
When can a pharmacist prescribe an antiviral agent for the flu?
when an epidemic or pandemic is declared by the Chief Medical Health Officerf
Determine the rarity of fever, fatigue, cough, and runny/stuffy nose in COVID, the cold, and the flu?
Fever: COVID=common, cold=rare, flu=common
Fatigue: COVID=sometimes, cold=sometimes, flu=common
Cough: COVID=common (dry), cold=mild, flu=common (dry)
Runny/stuffy nose: COVID=rare, cold=common, flu=sometimes
A patient has the following symptoms: a mild cough and a runny nose. Is it most likely the common cold, the flu, or COVID?
common cold
What are the most common COVID symptoms? Least common symptoms?
most common: fever, dry cough, tiredness
least common: sore throat, aches+pains, headache
What is a major difference between COVID and influenza?
with influenza, once the illness has subsided, the impact is over
with COVID, there can be lingering effects
What are some characteristics of asthma?
persistent cough (non-productive)
chest tightness
no cold-like symptoms
wheezing/shortness of breath
What can trigger the symptoms of asthma?
allergens
exercise
colds
How can you tell a patient does not have asthma, but most likely has a cold?
asthma does not cause fever, chills, muscle aches, or sore throats
What is a good way to determine that a cough is caused by GERD and not the common cold?
the cough is chronic and UNPRODUCTIVE
irritated throat/heartburn
What is post-nasal drip? What are the symptoms?
rhinorrhea leaks into the back of the throat and causes irritation
enough exposure can produce an unproductive cough
symptoms: sore throat, throat clearing, unproductive cough
What are the common symptoms of allergic rhinitis?
rhinitis
sneezing
itch
ocular symptoms (sore and itchy eyes)
COUGH IS RARE (differential process from common cold)
What are the symptoms of smokers cough? What should you recommend for them?
worse in morning
minimal sputum (unproductive cough)
hot cough
recommend a cough suppressant
Which symptom of a smokers cough changes as they progress to COPD?
the cough is dry at first and then it becomes productive
lots of sputum
Does coughing increase or decrease immediately after quitting smoking?
increases (smoking cessation cough)
damaged cilia are now repaired and removing foreign materials from the airways
What is acute bronchitis?
lower resp tract infection (chest cold)
similar to common cold but more cough
cough starts non-productive but becomes productive
can last 3 weeks (7 days is common for a head cold)
worse than a regular cold but not as bad as pneumonia
What is chronic bronchitis?
cough that persists for months
smoking is the most common cause
Why are ACE inhibitors hard to identify as being the cause of a dry/raspy cough?
it can take up to a year of taking an ACE inhibitor for a cough to occur
What are the symptoms of strep throat?
fever
no cough
tender lymph nodes
tonsillar exudate
sore throat
A patient has fever, no cough, tender lymph nodes, and tonsillar exudate. What are the chances that this is strep throat?
50:50
Why are antibiotics prescribed for strep throat?
strep can go beyond the throat and cause Rheumatic fever, Rheumatic fever can cause heart or kidney fever
True or false: a pharmacist should look down a patients throat to try and see if the patient has strep throat
false
suggests you know more than you do
cant determine if it is strep from the naked eye
What are some symptoms of tonsilitis?
sore throat
swollen tonsils
fever
difficulty swallowing
tonsils have white or yellow spots
What causes laryngitis? What is laryngitis? What is the best way to treat laryngitis?
viral infection
inflammation of the vocal cords
self-care measures and rest (usually resolves itself in 7 days)
Which illness can a child with laryngitis develop?
croup
What is common to see in a kid after a cold?
fifth/sixth disease
skin condition (rashes) that develops after a cold
What is bronchiolitis? MD or pharmacist assesment?
viral infection in the bronchioles, deeper cough than bronchitis
more common in younger children
MD assessment
A mother comes in and tells you her child has a dry cough that sounds like a bark. What is the most likely diagnosis? What do you tell her?
croup
tell her it will clear up on its own, it sounds worse than it is and some humidity can help
What are the symptoms of mono? How does it initially present itself?
sore throat
fatigue
fever
swollen neck glands
NO cough
initially presents itself as a flu or strep and gradually gets worse
For the following age groups, should we refer to them for a cold?
<1 year
1-2 years
3-6 years
<1=automatic referral
1-2=be very cautious
3-6=cautious
What is post-infectious cough?
nagging cough that can last an average of 18 days after a cold subsides
When does it become reasonable to contact a doctor for a cold?
symptoms persist for longer than 10 days
What are the symptoms of acute bacterial cases of sinusitis?
discoloured discharge
severe local pain
fever
double sickening
For a cough, when should we start to get worried for the following ages?
<1 year olds
1-3 year olds
4-6 year olds
adults
<1 year: always worry
1-3 year: 1 week
4-6 year: 2 weeks
adults: half of adults have post-cold inflammation, resolves spontaneously, GPs say if cough lasts longer than a month
What are common causes of chronic cough?
smoking
asthma
PND
GERD
ACE inhibitors
What are the most common causes of fever?
colds
gastroenteritis
What is the best way to measure temperature for the following ages:
birth-2
2-5
>5
birth-2: rectum
2-5: rectum
>5: orally
If a parent asked how to do a rectal temp measurement, what would you tell them? What about an oral measurement?
rectal: clean the thermometer, place baby on back with knees bent, insert thermometer 1 inch in, wait for the beep
orally: clean the thermometer, place under tongue, wait for the beep
If an adult asked how to take an ear temp measurement for their kid, what would you tell them? What about for their infant?
kid: pull the ear up and back to position the probe
infant: pull the lobe down and back
What is a reasonable guide to follow for when to refer to an MD for 1-3 year olds who have a fever?
Temp greater than 39 C
1 year old: 39 C and symptoms >1 day
2 year old: 39 C and symptoms > 2 days
3 year old: 39 C and symptoms > 3 days
When should you refer a <3mo old with fever to an MD?
always
What do pediatricians think about fever? What should we probably do?
peds say not to treat fever unless kid is noticeably bothered
we should still give the parent a recommendation if they come in
In the vast majority of cases, what is a safe recommendation to make for the fever?
acetaminophen or ibuprofen
What are the important values associated with acetaminophen in children dosing?
10-15mg/kg every 4-6hrs
max 75mg/kg per day
What is more important in regards to acetaminophen for kids, weight or age?
weight
Childrens Tylenol Fever & Sore Throat Pain is commonly found in the cough/cold section, is this a suitable agent for the cold?
no
fever is not common for cough/cold!
What is ibuprofen commonly used for?
reduces pain and fever
What are the important values to know for ibuprofen in children over 6 months? What about under 6 months?
over 6 months: 5-10mg/kg every 6-8hrs, max 40mg/kg per day
under 6 months: 5mg/kg every 8 hours (we rarely make recs)
What should you do when it comes to <3month olds and ibuprofen?
talk to a doctor
True or false: ibuprofen is harder on the stomach than acetaminophen at OTC doses
false
What are some side effects that might occur with OTC doses of ibuprofen and acetaminophen? Are these serious side effects we should be concerned about?
nausea, abdominal pain, dyspepsia
these are nuisance side effects
Is ASA an option for fever in kids? Who uses ASA?
no its not an option
only 18 years or older, mainly individuals with cardiovascular problems
True or false: naproxen is not used for fever
true
Is it okay to alternate ibuprofen and acetaminophen? What would this generally look like?
yes
8am: acet, 12pm: ibu, 4pm: acet, 8pm: ibu, 12am: acet, 4am: ibu
4 hours is the key number here
How can you help a patient in understanding the schedule of alternating ibu and acet?
take a paper out and show them the alternating schedule
Is it safe to take acetaminophen and ibuprofen at the same time?
yes BUT make sure there is a 4hr window for acet and an 8hr window for ibu
Is the ibu+acet combo for fever? For kids?
no and no
What is the Sask Health Influenza Program recommendation for antipyretics and immunizations?
only use antipyretics at least 6-8 hours after immunization (if the child is uncomfortable, refusing fluids and not sleeping)
just erroring on the side of caution
What are febrile seizures? What causes them?
convulsions induced by a fever in a young child, they stop on their own
caused by viral infection and less commonly by bacterial infection
they are harmless
Why do we give a child the normal dose of ibuprofen or acetaminophen after a febrile seizure?
because the child had fever in the first place
not doing anything for the febrile seizure that just occured
True or false: antipyretics prevent febrile convulsions
false
What are some non-drug measures that could be helpful for cough/cold?
chicken soup
rest/fluids
humidity
saline gargles (1/2tsp salt in 1 cup warm water)
nose drops
irrigation
How much fluids should you be taking in when you have a cough or cold?
the same amount as usual
Kids under 6 get ___, kids over 6 get ___
under 6 get drops
over 6 get sprays
What is the general idea of using nose drops for a cold?
it is a saline solution that you spray/drop into the nose to try and loosen up dry mucus
Do runny noses need saline or do congested/boogery noses need saline?
congested/boogery noses would need saline to help clear the nose
Is Rhinaris gel for kids? What is the purpose of Rhinaris gel?
no its not for kids
the purpose is to try soothe sore noses in adults that often come as the result of seasonal allergies
What is “irrigation”?
putting water in your nose to try flush out junk
What are sinus rinses best used for?
allergic rhinitis
What is the difference between a saline and a lubricant?
saline is to loosen up dry mucus
lubricants are to soothe irritated nasal tissue
What do menthol and camphor do for nasal congestion? What is an example of a product with these?
menthol and camphor hit our cooling receptors in the nose so it feels like the air is cool which can feel soothing (not a decongestant)
the congestion is still present
VapoInhaler
List the drugs for the following: oral decongestants, topical decongestants, analgesics, cough suppressants, antihistamines, expectorant
OD: pseudoephedrine, phenylephrine, phenylpropanolamine
TD: oxymetazoline, xylometazoline
analgesics: ibuprofen, acetaminophen
CS: DM, codeine, menthol, diphenhydramine, honey
AH: diphenhydramine, chlorpheniramine, brompheniramine, dexbrompheniramine
expectorant: guiafenesin
What do aromatic compounds do? Are they good decongestants? Example?
menthol and camphor fumes get into the nose and hit the cool receptors
not a powerful dg, it just makes you feel like you are breathing better
VapoRub
How do direct acting decongestants work?
they stimulate alpha receptors in the nose, causing constriction which lessens the pressure on tissues, thus making it easier to breathe
How do indirect acting decongestants work?
they get absorbed in the small intestine, enter the bloodstream, then they hit neurons next to blood vessels in the nose and they kick out noradrenalin to constrict vessels in the nose
Why is phenylephrine considered inferior to pseudoephedrine?
PE is variable in bioavailability, MAO has a big impact
pseudoephedrine does not care how much MAO is present, it gets absorbed regardless
What are two biggest side effects with oral decongestants?
CNS effects (they are stimulants)
CV effects (raises BP by 3-5 points for 3D)
Why is there not much concern about a decongestant raising blood glucose in a Type I diabetic?
when Type I diabetics have a cold, their blood glucose is already raised, so the effect on blood glucose of a decongestant is almost clinically irrelevant
Why is narrow angle glaucoma cautioned on the label of a decongestant?
decongestants can dilate the pupils to minor extent so there is a chance of narrow angle glaucoma
very unlikely
What is the side effect you mention to an old man taking an oral decongestant?
urinary retention
True or false: SSRIs and TCAs are not a problem for drug interactions with decongestants
true
MAOIs are the problem
What is the side effect to be concerned about with topical decongestants?
rebound congestion
the vessels dilate to a larger than normal size after the drug wears off thus causing congestion
you get addicted to the drug because it helps with the congestion but then once the drug wears off you are congested again=vicious cycle
What is a safe number of days for using topical decongestants before we start to worry about rebound congestion?
7 days
Which antitussives are centrally acting? Which are locally acting?
centrally: DM, DH, codeine, DPH
locally: menthol, camphor, honey
Which coughs do we not want to supress? Which cough do we want to suppress?
not supress: congested/productive, congested/non-productive (unless for sleep)
suppress: dry/non-productive (ex: influenza, PND)
Why does Benylin Cough and Congestion not make any sense?
DM is for cough suppression, guaifenesin is for expectoration
they are working against eachother, whats the point?
What is the “best” cough suppressant?
DM
even though it works the same as placebo, its still the best we got
Why is codeine not a great cough suppressant?
codeine is metabolized by 2D6 into morphine, we all metabolize it to a different extent, thus poor metabolizers might not get any morphine conversion
What causes serotonin syndrome?
high levels of serotonin
can be caused by high levels of DM or codeine with high levels of SSRIs
If an asthmatic or COPD wants codeine or DM for their cough. Should we concerned about these patients taking the antitussive?
probably not, the antitussive is probably not doing anything so it is probably not lowering their respiratory rate significantly
Which age group do we never recommend DM or codeine to?
under 6 years old
OTC codeine products such as Calmylin contain 3.3mg of codeine in a 5ml dose, will this be sufficient to suppress a cough?
no, this is subtherapeutic
minimum dose for cough suppression is 10ml
Why is the bar set so low for the effects of honey on cough suppression?
well if DM is practically ineffective, why would honey be any better
Are menthol or camphor good antitussives?
not really
they dont hit the cough centre in the brain, they act locally on cool receptors
What might be a situation where diphenhydramine is used as an antitussive?
people wanting to try sleep (sedation) through a cough
dph is almost the same as placebo
recommend DM most of the time so that people dont feel sedated, unless they want sedation
How does guiafenesin work?
irritates the esophagus thus stimulating the trachea which stimulates goblet cells to produce mucus
theoretically loosens stuff up
Which cough are we trying to hit with guiafenesin?
congested/non-productive
it wont flip a dry/np into congested/productive
Usually in pharmacy we want a patient to be on the lowest amount of medication as possible, except for what?
guiafenesin
rare time where we take the highest strength possible
Which cough/cold medicine is Taylor okay with for kids?
guiafenesin
on an exam dont recommend anything for <6yrs even if we know its safe
What do lozenges do?
hit the cool receptors at the back of the throat which can give some soothing feeling
How could 1st gen anti-histamines help with a cold?
they are anti-cholinergic so they can reduce rhinorrhea
still not huge for the cold
Who should avoid 1st gen antihistamines?
seniors due to anti-cholinergic effects
Which symptom of the flu is less common in seniors?
fever
What could cause a cough in a patient with allergic rhinitis?
the allergies cause PND, leading to a cough
What kind of cough can an ACE inhibitor produce? How do ACE inhibitors produce a cough?
dry, raspy cough
ACE inhibitors enhance the levels of Substance P or bradykinin which causes bronchoconstriction
What does a croup cough sound like?
bark like
What are the symptoms of bronchiolitis?
rapid or shallow breathing
wheezing
deeper cough than bronchitis
How do we describe Whooping cough?
whoop sound on inhale
100 day cough
bacterial
Should you refer everyone under the 6 of age with a cough/cold to an MD?
no, be selective
Do bacterial or viral cases of sinusitis last longer?
bacterial (viral is <10d, bacterial is >10d)
What should you do if you suspect sinus involvement?
consider MD referral
Which condition was caused by ASA use in kids?
Reyes syndrome, causes brain and liver damage
Do you really need to treat fever?
no, but do your clinical workup, let the parents or patient know that its not necessary but we can still recommend something
Are saline gargles a good idea for kids?
probably not, kids cant gargle well
more so for adults
If you were to use a suction for your childs nasal congestion, what must you apply first?
saline must be applied first to get the mucus loose
Why do oral decongestants cause CNS effects?
they are stimulants (noradrenaline is being released)
amphetamine sister drugs
A 70 year old man comes in and tells you he has nasal congestion and is looking for a decongestant. You do some questioning and discover he is on blood pressure medications and also takes tamsulosin. What would your recommendation be?
a topical decongestant such as xylometazoline or oxymetazoline
A mother comes in and tells you that her 2 year old has some nasal congestion and the kid is visibly irritated by it. She is holding Otrivin (xylo) in her hand and asks you if this is ok. What do you tell her?
tell her that topical decongestants such as xylo are not for use in kids
I would recommend a nasal saline drop to try help clear out the mucus that is causing the congestion
A patient comes in and tells you they have had a cough for a few days now. You ask about this cough and the patient describes the cough as “wet”. They are holding Benylin Mucous and Phlegm and ask what you think about this.
I would tell them that this product wont be effective for the congested/productive cough that they described (guaifenesin does not make a cough more productive)
Tylenol Sinus contains a strip of pills for day and a strip of pills for night. What is the difference?
the night time one contains a 1st gen AH for sedation
What is the claim that echinacea makes?
claimed to stimulate the immune system
minimal benefit but it is safe
Do we use topical nasal steroids for congestion due to the cold?
it can help with congestion but may need to take an oral decongestant in addition
probably more so for seasonal allergies
What is the best way to decide on a product for cough/cold?
aim for the most bothersome symptom (usually cough or congestion)
you wont be able to treat all symptoms
Combo products are the norm, are extra ingredients enough to reject product?
no, just live with it
accept that some ingredients will just be along for the ride
What are the pediatric guidelines on decongestants?
not for use
What should you try do when parents want something for their kid?
stress non-drug
educate on the benefits of a cough
What are the recommendations for cough/cold therapy during pregnancy?
avoiding product use is best option
What are the recommendations IF a pregnant lady is adamant for a therapy for her cough/cold?
selection process is the same (zero in)
decongestant (topical is safer)
analgesics are safe
DM is choice for anti-tussive
antihistamines are not needed
guiafenesin is safe
What is the key question to ask a hypertensive patient if they are looking at oral decongestants?
“have you used one before?”
How would you state a recommendation for a hypertensive that wants to use an oral decongestant?
I would rather not recommend this but if you want one then we can find one. If you have a blood pressure machine at home then I would recommend you monitor
What might be the key for an asthmatic using an anti-tussive?
adjusted inhaler use
