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Phar 153 > Cough and Colds > Flashcards

Cough and Colds Flashcards

1
Q

What is the pathophysiology of colds?

A

Viral Invasion > 200 types

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2
Q

Is there a vaccine for the common cold?

A

NO

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3
Q

Day 1 Symptoms of a Cold

A

Sore throat
Rhinorrhea
Sneezing

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4
Q

Day 3 Symptoms of a Cold

A

Nasal Congestion
Sinus Headache
Plugged Ears

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5
Q

Day 6 Symptoms of a Cold

A

Cough

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6
Q

How does a sinus headache occur?

A

As nose gets plugged up, inflammatory issues in the sinuses in the skull –> Can’t discharge what is in there

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7
Q

What are the main symptoms that patients want treated in regards to cough and colds?

A

Nasal Congestion and Cough

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8
Q

Distinguish between head cold vs a chest cold

A
  • Deeper in the lungs
  • Head cold is easy to deal with; chest cold a little more worried but still very common

Bronchitis - Simple chest cold
Bronchiolitis - Little more worrying
Pneumonia - Serious, cough up blood, fever

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9
Q

Cough Types

A

a) Congested/Productive (useful to body) - Cough associated with chest congestion and the expectoration of phlegm

b) Congested/Non-productive (will become useful) - cough associated with chest congestion, but little expectoration of phlegm

c) Dry/nonproductive (not useful) -cough not associated with chest congestion; no phlegm

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10
Q

Cough and cold symptoms in Infants and children

A
  • Red Flag
  • Increase in frequency

Infants
- Similar symptoms
- May show early fever (up to 39 C)
- Gastrointestinal upset –> diarhhea
- Congestion a problem if breast feeding

Children
- Less fever
- More like adults

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11
Q

How can a cold be spread?

A

Direct contact with cold sufferer
Inhaled droplets
Eye/nose contact
Inanimate objects

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12
Q

What are some myths about spreading a cold?

A

Kissing
Cold/Wet Weather –> Vasomotor response
Stress –> Immune system functions a little less

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13
Q

How can the spread of a cold be prevented?

A

Hand-washing

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14
Q

What are some of the differential diagnoses associated with a cold?

A

Common Cold > bronchitis/sinusitis > Influenza > Covid > Strep throat

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15
Q

How can you distinguish a common cold from influenza?

A
  • Flu hits you hard
  • Faster onset
  • Systemic symptoms (especially body aches)
  • Cough more severe (and the dry type)
  • SPiking fever
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16
Q

Is the cold and influenza more severe in the elderly?

A
  • Yes
  • Can lead to severe issues/death
  • Influenza may present without a fever or cough in older individuals
  • Have more malaise than younger people
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17
Q

Does treatment change between a cold and influenza?

A

Treatment doe snot change much

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18
Q

Can pharmacists prescribe anti-virals for influenza?

A
  • Yes, but only in flu epidemics declared by the chief medical officer
  • Oseltamivir, zanamivir
  • Mainly focus on non-pharmacoligical tx and OTC tx
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19
Q

Covid-19 Symptoms in comparison to cold and influenza

A
  • Similar
  • Covid –> Runny nose rare, shortness of breath common, cough (usually dry), fatigue sometimes, and fever common
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20
Q

Asthma Symptoms

A
  • Persistent cough (usually worse at night)
  • No cold-like symptoms
  • Wheezing/shortness of breath
    Symptoms triggered by exercise/allergens/colds
  • Cough does not become productive
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21
Q

When is asthma symptoms most common?

A

September
- Kids back in school
- Exposed to numerous allergens as well as the common cold

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22
Q

Why is congestion worse at night?

A
  • Stomach acid (laying down) can cause irritation in the throat and nasal passageway
  • Increased blood flow aggrevates stuffiness caused by infection
  • It’s more difficult to clear mucus from the nose and sinus cavities while lying down
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23
Q

How can you tell the difference between influenza and covid-19?

A
  • hard to tell the difference without testing
  • Main difference is that covid-19 can have lingering symptoms; whereas once the viral agent subsides in influenza symptoms significantly resolve
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24
Q

Why symptoms does asthma not cause?

A
  • fever, chills, muscle aches and sore throat
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25
Q

What are the symptoms of GERD?

A
  • Acid at the back of the throat
  • Can get a chronic cough
  • Irritated throat/heartburn
  • Unproductive cough
  • Not high on radar screen
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26
Q

Post-nasal drip symptoms

A

sore throat (with throat-clearing)
unproductive cough
sinus involvement often

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27
Q

Allergic Rhinitis Symptoms

A
  • summertime colds
  • seasonal or chronic
  • last longer than colds
    Rhinitis, sneezing, itch, ocular symptoms
    Cough rarer (unless PND)
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28
Q

Smoker’s Cough Symptoms

A
  • Often worse in the morning
  • Minimal sputum
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29
Q

What can smoking lead to?

A

Chronic Bronchitis (COPD)
- Lots of sputum
- Dry at first but becomes productive with time
- 40% of smokers have a cough

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30
Q

Describe a cough after quitting smoking

A
  • Right after quitting, coughing often increases
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31
Q

Describe acute bronchitis

A
  • Lower respiratory infection (“chest cold”)
  • Similar to common cold, but increase cough (and seen earlier)
  • Cough starts non-productive…. become sproductive
  • Lasts up to 3 weeks
  • Green sputum (if catually seen) can mean bacterial or viral
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32
Q

If a patient has high blood pressure, why may they have a cough?

A
  • If on ACEI, enzyme that breaks down bradykinins similar to ACE enzyme leading to abundance of bradykinins that can cause a cough
  • 10-30% get this symptom
  • Cough –> Dry and raspy
  • Via substance P or bradykinin leading to bronchoconstriction
  • Can take 1 year to occur
  • Discontinue agent –> clears in 1-4 weeks up to 3 months
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33
Q

Strep Throat

A
  • 37% in kids 5-15
  • 15% in adults
  • Increase fever and pain
  • Cough is less common
    Exudate/swollen glands/rash
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34
Q

Strep Throat Differential Diagnosis Step

A

If patient has:

Fever, no cough, tender lymph nodes and tonsillar exudate

  • 50:50 chance of being correct
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35
Q

Treatment of Strep Throat

A

Antibiotics –> Preventative

  • Prevents rheumatic fever and heart or kidney damage
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36
Q

Treating sore throats stats

A
  • 40% symptom free in 3 days
  • 85% symptom free in 7 days
    –> Whether bacterial or viral

If it resolves in 3-5 days, it was just a sore throat

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37
Q

What is the common cause of tonsillitis? What happens if tonsillitis is left untreated?

A
  • Viruses
  • Can lead to strep throat, which can cause serious complications
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38
Q

What is laryngitis?

A
  • Viral Infection
  • Acute can be treated with self-care measures
    Generally not serious and most cases resolve w/t tx in about 7 days
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39
Q

Fifth/Sixth Disease

A
  • Skin conditions in kids after cold symptoms
  • No one will diagnose until rash starts

Fifth –> Flushed face
Sixth –> Maculopapular rxn

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40
Q

Hives in Children

A
  • Very common cause of hives in kids are URT infections (within last 6 weeks)
  • Viral URTI’s cause about 40% of hive rashes. These outbreaks resolve as the infection resolves
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41
Q

Bronchiolitis Differential

A
  • Determined by MD, not pharmacist
  • More common in young children
  • Respiratory Syncytical virus infection
    Most cases mild, but 1-2% lead to hospitalization in child’s first year
  • Wheezing after 3 days of other symptoms (cough, fever, runny nose)
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42
Q

Croup

A

Laryngitis in young kids
- bark-like cough that is very dry
- Mainly a viral cause
- Resolves within 5-7 days
True Croup –> Not to much of an issue –> does not go deeper

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43
Q

Tx of Croup

A
  • Humidity –> helps the cough
  • Warm fluids
  • Cool air at night
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44
Q

Whooping Cough

A
  • Pertussis
  • Bacterial
    Making a comeback despite vaccine
  • Cold for 2-3 weeks then a 100 day cough
  • Whoop sound on inhale
  • If cough has persisted for 2-3 weeks, antibiotics unlikely to be helpful
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45
Q

Mononucleosis

A
  • Will likley present like the flu or strep throat initially –> Slower onset

Sore throat, fatigue, fever, swollen neck gland, NO COUGHING

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46
Q

Lyme’s Disease

A
  • SOunds like a flu until rash appears
  • During summer, not flu season
47
Q

Rhinitis in pregnancy?

A
  • Can begin at almost anytime during preganncy
  • Just a runny nose
  • Pregannt woman with a cold is way more common
48
Q

What are the differential odds (steps)?

A

Common Cold

Bronchitis/Sinusitis

Influenza

Strep Throat

49
Q

Differential Diagnosis process

A
  • Rule in/ rule out
50
Q

Fever? Rule in/rule out?

A

Yes –> Flu, strep, covid
Out –> Allergies, cold, bronchitis

51
Q

Cough rule in/rule out?

A

Yes –> Covid, bronchitis, flu
No –> Allergies, strep, mono

52
Q

How long?

A
  • Helpful to decide if MD referral is required
53
Q

Rule in/rule out Bad sore throat?

A

yes –> Strep, flu

no –> bronchitis, allergies, cold

54
Q

When to refer?

A

Under 1 –> Automatic referral
1-2 - Be very cautious
3-6 years - Cautious

55
Q

Acute Viral cases last….

A

less than 10-14 days

56
Q

Bacterial cases last….

A

greater than 10-14 days

57
Q

How can one determine if Acute bacterial?

A

discoloured discharge
severe local pain
fever
double-sickening

58
Q

When to refer (sinuses)

A
  • If suspect sinus involvement, consider MD referral
59
Q

Double Sickening

A

I had a bad cold last week (chest cold), got better, gone for 3 days, but now its back”

original symptoms got better, now getting worse

referral and watch carefully

60
Q

How long can a cough with bronchitis last? When to refer?

A
  • 3 weeks
  • If a month, automatic refferal
61
Q

Cough referral

A

1) Infants
- always worry if younger than 1
- infants normlaly cough throughout the day

2) Kids
1-3 - 1 week
4-6 - 2 weeks

3) Adults typically have cough for 3-8 weeks due to post-cold inflammation, resolves sponstaneously

62
Q

When should we be worried?

A

“Not my usual …”
“It is worsening …” “Also have a fever …
“I got better, now its back …” (Double-sickening)

63
Q

What are some causes of chronic cough?

A

Smokers
Asthma
PND
GERD
ACE Inhibitors

64
Q

What is the ideal number of ingridients in a product?

A

1-2

65
Q

Non Drug Measures for Cough and Cold

A
  • Chicken Noodle Soup
    rest/fluids (enough to just stay hydrated)
  • Humidity
66
Q

Saline gargles

A
  • Do it for taste –> feels kind of salty, good enough
67
Q

Nose Drops

A
  • Kids under 6 get drops
  • Loosens up congestion and gets it out –. good move
  • Do not use it everyday
  • NOT A DECONGESTANT
68
Q

Age for Saline Non-drug tx

A

Gargles –> Adults
Nose drops –> kids and adults
- Irrigation –> Adults –> runs back of nose and out the other nostril

69
Q

Sinus Rinses

A
  • more effeicacy for allergic rhinitis over chronic sinus and colds
  • Full flush vs a spray/mist
70
Q

Is saline soothing?

A
  • No –> does not help with soreness
  • Soothing action –> saline and a moisturizer/lubricant
71
Q

Methol and Camphor

A
  • act on cool receptors in passageways, air feels cooler, relief
    NOT A DECONGESTANT
72
Q

Oral Decongestants

A

Phenylephrine (pe)
Psuedophedrine (pse)

73
Q

Topical Decongestants

A

Oxymetazoline
Xylometazoline

74
Q

Analgesics

A

Acetaminophen
Ibubrofen

75
Q

Cough Suppressants

A

DM
Codeine
Diphenylhydramine
Menthol
Honey

76
Q

Expectorant

A

Gaufenisen

77
Q

Zinc and Vitamin C in Colds

A
  • Not useful
78
Q

Aromatic Cpd’s Decongestants

A
  • Act on cool receptors in the nose
  • DO not pile on
  • Very safe –> Not right up on nose
    Camphor and menthol can be toxic to kids in large amounts
79
Q

Decongestants MOA

A

Noadrenalin-mediated decongestant

a) Direct Acting –> fast
- Putting the drug right on the spot (right on alpha receptors) and shrink blood vessels–> Less s/e

b) Indirect Acting –> Drug is absorbed after consumption and activates neurons to kick noradrenalin out of synaptic vesicle and that noradrenalin shrinks blood vessels as a decongestant

80
Q

Bioavlability Differences between phenylephrine and pseudophedrine

A
  • MAO Enzyme
  • Penylephrine –> Very variable. MAO has a big influence on the amount of the drug that is metabolized. Bioavailability is variable. MOA works at different levels, consistency, and speed in everybody’s body

Ineffective for some, very effective for others

Pseudophedrine –> didn’t care how much MAO you had –> going to be absorbed consistently and constantly

81
Q

How to choose between oral vs topical decongestants?

A
  • Preference
  • Speed of onset (topical&raquo_space;>oral)
  • Congestion + other symptom???
    Side effects/contraindications
82
Q

Oral Decongestants Side Effects. Which ones should we tell patients?

A
  • CNS effects + cardiovascular effects (bp, hr) for 3 days –> Stimulatory *
  • Increase in blood glucose x 3 days
    Angle closure glaucoma
    urinary retention/prostate*
    Hyperthyroidism
83
Q

Should oral decongestants be used in an individual with cardiovascular condition?

A

No –> Go topical

84
Q

Oral Decongestants in Diabetics

A

Use caution in Type I diabetics –> Sick day mangement –> blood glucose increase already cause of virus

Little impact in type II diabetics

85
Q

Can an individual with normal glaucoma use an oral decongestant?

A

Yes

86
Q

Define angle-closure glaucoma
Normal Glaucoma?

A

Narrow-angle glaucoma: dilating the iris blocks fluid drainage

Glaucoma of the eyes –> increase in pressure in eye

Trajectory for having blindness
Get blood pressure down –>drops for that –>easy to treat
Drainage system not working
Chronic

87
Q

Describe the process of urinary retention in regards to decongestants?

A
  • A lot of alpha receptors in prostate
  • decongestants are alpha agonists
  • gets to prostate and could create more tone in the prostate gland because gave decongestant
  • Less peeing, urinary retention
88
Q

Drug interactions Oral Decongestants

A
  • TCA’s, MAOI’s (more absorbed in gut), SSRI’s/SRNI’s
89
Q

Topical Decongestants s/e

A
  • Angle closure glaucoma
  • Rebound congestion*
    Local Irritation *
90
Q

Rebound Congestion

A

Already have congestion from cold (nose), give decongestant, works in nose (fast up to 12 hours), wears off, use agin, back and forth. Congestion last 3 days.

In allergies, more than 3 days.

Rebound –> blood vessels do not just go back to normal. They bounce back a little bit more dilated than what is normal. When drug wears off, vessel more dilated. Do it enough times for enough days, vessels are rebounding way more than they should and pushing against tissues of nose and drug is causing the congestant itself –> Vicious cycle

91
Q

How long should topical decongestants be used for?

A

3-5 days (7 days)

92
Q

Decongestants in Kids

A
  • Not under the age of 6
  • Push to nasal saline
93
Q

centrally acting cough suppresants

A
  • work in CNS
    DM
    Codeine
    BH
    Diphenylhydramine
94
Q

Locally-acting cough suppresants

A
  • Honey, Menthol and camphor
95
Q

DM Onset of Action, s/e, and interactions

A
  • 15-30 mins
    Minimal s/e
    Possible serotonin syndrome with SSRI’s
96
Q

Codeine Onset of Action, S/e, and interactions

A
  • Within 1-2 hours
  • S/e –> nauseau, constipation, sedative/dizziness
  • Interactions –> SSRI’s
97
Q

Codeine and DM in pregnancy

A

Codeine –> Worry
DM –> of choice

98
Q

Precautions/contraindications of DM and Codeine

A
  • Respiratory disorders (e.g. asthma, COPD)
99
Q

What age should codeine not be used in?

A
  • under 18 years old
100
Q

Why should children not be given pure raw honey?

A
  • Botulism spores
  • under age of 1, do not use honey
101
Q

Camphor/Menthol Cough Suppressant

A
  • Act locally at back of throat
  • Some analgesic effecr
  • Not anti-tussive –> not hitting cough cnetre in brain
102
Q

Diphenylhydramine in Coughs

A
  • Works in cough centre to suppress cough –> placebo level
  • Sedative effect more than anti-tussive
103
Q

Expectorant MOA and Example
Indication?

A

gaufenisen

  • Loosen up mucous
  • Congested/non-productive –> try to make the cough productive
  • Do not use in children under 6 years old
104
Q

Are anti-histamines useful for the common cold?

A
  • Not a major player
    Decrese rhinorhhea and sneezing; however, not major s/e in common cold
  • May worsen asthma (reduce secretions), nasal congestion, urinary retention (anti-cholinergic)
105
Q

Lozenges (and sprays)

A
  • Menthol, phenol/dyclonine/benzoczine, antiseptcis
  • Go for taste
  • Even just hard candy
106
Q

Provoiodine Spray

A

Providone Iodine –> Anti-septic at back of the throat –> very little therapeutic effects, not doing much –> do. Not fight this type of stuff

107
Q

Zinc Lozenges

A
  • Sub-therapeutic
  • May be useful if early on, but how much
108
Q

Echinacea

A
  • Claimed to stimulate the immune system
  • Used for prevention and tx
    Minimal benefit (if at all)
    Safe
109
Q

Vitamins, Antibiotics, probiotics

A
  • Vitamins doing nothing
  • Vitamin C and D –> Nothing
  • ANti-biotics –> No
  • Probitotics –> Showing promise but which strain and dose
110
Q

How to determine what product to choose?

A
  • Go for most bothersome symptom
111
Q

What should pharmacists tell patients who are persistent there child requires a product?

A

Stress non-drug and educate on benefits of a cough

112
Q

Pregnancy Cold

A
  • Avoid in 1st trimester

product selection process is the same
decongestants (topical safer than oral)
analgesics appear safe
DM of choice (vs codeine)
antihistamines? (safe but are they needed?)
guaifenesin appears safe

113
Q

In regards to diabetics, what is the only product to be concerned with?

A

Oral Decongestants. Has effects on blood glucose.

Phar 153 (7 decks)

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