Cough and Colds Flashcards
1
Q
What is the pathophysiology of colds?
A
Viral Invasion > 200 types
2
Q
Is there a vaccine for the common cold?
A
NO
3
Q
Day 1 Symptoms of a Cold
A
Sore throat
Rhinorrhea
Sneezing
4
Q
Day 3 Symptoms of a Cold
A
Nasal Congestion
Sinus Headache
Plugged Ears
5
Q
Day 6 Symptoms of a Cold
A
Cough
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
7
Q
What are the main symptoms that patients want treated in regards to cough and colds?
A
Nasal Congestion and Cough
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
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
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
11
Q
How can a cold be spread?
A
Direct contact with cold sufferer
Inhaled droplets
Eye/nose contact
Inanimate objects
12
Q
What are some myths about spreading a cold?
A
Kissing
Cold/Wet Weather –> Vasomotor response
Stress –> Immune system functions a little less
13
Q
How can the spread of a cold be prevented?
A
Hand-washing
14
Q
What are some of the differential diagnoses associated with a cold?
A
Common Cold > bronchitis/sinusitis > Influenza > Covid > Strep throat
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
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
17
Q
Does treatment change between a cold and influenza?
A
Treatment doe snot change much
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
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
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
21
Q
When is asthma symptoms most common?
A
September
- Kids back in school
- Exposed to numerous allergens as well as the common cold
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
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
24
Q
Why symptoms does asthma not cause?
A
- fever, chills, muscle aches and sore throat
25
What are the symptoms of GERD?
- Acid at the back of the throat
- Can get a chronic cough
- Irritated throat/heartburn
- Unproductive cough
- Not high on radar screen
26
Post-nasal drip symptoms
sore throat (with throat-clearing)
unproductive cough
sinus involvement often
27
Allergic Rhinitis Symptoms
- summertime colds
- seasonal or chronic
- last longer than colds
*Rhinitis, sneezing, itch, ocular symptoms*
Cough rarer (unless PND)
28
Smoker's Cough Symptoms
- Often worse in the morning
- Minimal sputum
29
What can smoking lead to?
Chronic Bronchitis (COPD)
- Lots of sputum
- Dry at first but becomes productive with time
- 40% of smokers have a cough
30
Describe a cough after quitting smoking
- Right after quitting, coughing often increases
31
Describe acute bronchitis
- 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
32
If a patient has high blood pressure, why may they have a cough?
- 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
33
Strep Throat
- 37% in kids 5-15
- 15% in adults
- Increase fever and pain
- Cough is less common
Exudate/swollen glands/rash
34
Strep Throat Differential Diagnosis Step
If patient has:
Fever, no cough, tender lymph nodes and tonsillar exudate
- 50:50 chance of being correct
35
Treatment of Strep Throat
Antibiotics --> Preventative
- Prevents rheumatic fever and heart or kidney damage
36
Treating sore throats stats
- 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
37
What is the common cause of tonsillitis? What happens if tonsillitis is left untreated?
- Viruses
- Can lead to strep throat, which can cause serious complications
38
What is laryngitis?
- Viral Infection
- Acute can be treated with self-care measures
Generally not serious and most cases resolve w/t tx in about 7 days
39
Fifth/Sixth Disease
- Skin conditions in kids after cold symptoms
- No one will diagnose until rash starts
Fifth --> Flushed face
Sixth --> Maculopapular rxn
40
Hives in Children
- 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
41
Bronchiolitis Differential
- 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)
42
Croup
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
43
Tx of Croup
- Humidity --> helps the cough
- Warm fluids
- Cool air at night
44
Whooping Cough
- 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
45
Mononucleosis
- Will likley present like the flu or strep throat initially --> Slower onset
Sore throat, fatigue, fever, swollen neck gland, NO COUGHING
46
Lyme's Disease
- SOunds like a flu until rash appears
- During summer, not flu season
47
Rhinitis in pregnancy?
- Can begin at almost anytime during preganncy
- Just a runny nose
- Pregannt woman with a cold is way more common
48
What are the differential odds (steps)?
Common Cold
Bronchitis/Sinusitis
Influenza
Strep Throat
49
Differential Diagnosis process
- Rule in/ rule out
50
Fever? Rule in/rule out?
Yes --> Flu, strep, covid
Out --> Allergies, cold, bronchitis
51
Cough rule in/rule out?
Yes --> Covid, bronchitis, flu
No --> Allergies, strep, mono
52
How long?
- Helpful to decide if MD referral is required
53
Rule in/rule out Bad sore throat?
yes --> Strep, flu
no --> bronchitis, allergies, cold
54
When to refer?
Under 1 --> Automatic referral
1-2 - Be very cautious
3-6 years - Cautious
55
Acute Viral cases last....
less than 10-14 days
56
Bacterial cases last....
greater than 10-14 days
57
How can one determine if Acute bacterial?
discoloured discharge
severe local pain
fever
double-sickening
58
When to refer (sinuses)
- If suspect sinus involvement, consider MD referral
59
Double Sickening
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
How long can a cough with bronchitis last? When to refer?
- 3 weeks
- If a month, automatic refferal
61
Cough referral
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
When should we be worried?
“Not my usual …”
“It is worsening …” “Also have a fever …
“I got better, now its back …” (Double-sickening)
63
What are some causes of chronic cough?
Smokers
Asthma
PND
GERD
ACE Inhibitors
64
What is the ideal number of ingridients in a product?
1-2
65
Non Drug Measures for Cough and Cold
- Chicken Noodle Soup
rest/fluids (enough to just stay hydrated)
- Humidity
66
Saline gargles
- Do it for taste --> feels kind of salty, good enough
67
Nose Drops
- Kids under 6 get drops
- Loosens up congestion and gets it out --. good move
- Do not use it everyday
- NOT A DECONGESTANT
68
Age for Saline Non-drug tx
Gargles --> Adults
Nose drops --> kids and adults
- Irrigation --> Adults --> runs back of nose and out the other nostril
69
Sinus Rinses
- more effeicacy for allergic rhinitis over chronic sinus and colds
- Full flush vs a spray/mist
70
Is saline soothing?
- No --> does not help with soreness
- Soothing action --> saline and a moisturizer/lubricant
71
Methol and Camphor
- act on cool receptors in passageways, air feels cooler, relief
NOT A DECONGESTANT
72
Oral Decongestants
Phenylephrine (pe)
Psuedophedrine (pse)
73
Topical Decongestants
Oxymetazoline
Xylometazoline
74
Analgesics
Acetaminophen
Ibubrofen
75
Cough Suppressants
DM
Codeine
Diphenylhydramine
Menthol
Honey
76
Expectorant
Gaufenisen
77
Zinc and Vitamin C in Colds
- Not useful
78
Aromatic Cpd's Decongestants
- 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
Decongestants MOA
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
Bioavlability Differences between phenylephrine and pseudophedrine
- 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
How to choose between oral vs topical decongestants?
- Preference
- Speed of onset (topical >>>oral)
- Congestion + other symptom???
Side effects/contraindications
82
Oral Decongestants Side Effects. Which ones should we tell patients?
- 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
Should oral decongestants be used in an individual with cardiovascular condition?
No --> Go topical
84
Oral Decongestants in Diabetics
Use caution in Type I diabetics --> Sick day mangement --> blood glucose increase already cause of virus
Little impact in type II diabetics
85
Can an individual with normal glaucoma use an oral decongestant?
Yes
86
Define angle-closure glaucoma
Normal Glaucoma?
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
Describe the process of urinary retention in regards to decongestants?
- 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
Drug interactions Oral Decongestants
- TCA's, MAOI's (more absorbed in gut), SSRI's/SRNI's
89
Topical Decongestants s/e
- Angle closure glaucoma
- Rebound congestion*
Local Irritation *
90
Rebound Congestion
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
How long should topical decongestants be used for?
3-5 days (7 days)
92
Decongestants in Kids
- Not under the age of 6
- Push to nasal saline
93
centrally acting cough suppresants
- work in CNS
DM
Codeine
BH
Diphenylhydramine
94
Locally-acting cough suppresants
- Honey, Menthol and camphor
95
DM Onset of Action, s/e, and interactions
- 15-30 mins
Minimal s/e
Possible serotonin syndrome with SSRI's
96
Codeine Onset of Action, S/e, and interactions
- Within 1-2 hours
- S/e --> nauseau, constipation, sedative/dizziness
- Interactions --> SSRI's
97
Codeine and DM in pregnancy
Codeine --> Worry
DM --> of choice
98
Precautions/contraindications of DM and Codeine
- Respiratory disorders (e.g. asthma, COPD)
99
What age should codeine not be used in?
- under 18 years old
100
Why should children not be given pure raw honey?
- Botulism spores
- under age of 1, do not use honey
101
Camphor/Menthol Cough Suppressant
- Act locally at back of throat
- Some analgesic effecr
- Not anti-tussive --> not hitting cough cnetre in brain
102
Diphenylhydramine in Coughs
- Works in cough centre to suppress cough --> placebo level
- Sedative effect more than anti-tussive
103
Expectorant MOA and Example
Indication?
gaufenisen
- Loosen up mucous
- Congested/non-productive --> try to make the cough productive
- Do not use in children under 6 years old
104
Are anti-histamines useful for the common cold?
- 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
Lozenges (and sprays)
- Menthol, phenol/dyclonine/benzoczine, antiseptcis
- Go for taste
- Even just hard candy
106
Provoiodine Spray
Providone Iodine --> Anti-septic at back of the throat --> very little therapeutic effects, not doing much --> do. Not fight this type of stuff
107
Zinc Lozenges
- Sub-therapeutic
- May be useful if early on, but how much
108
Echinacea
- Claimed to stimulate the immune system
- Used for prevention and tx
Minimal benefit (if at all)
Safe
109
Vitamins, Antibiotics, probiotics
- Vitamins doing nothing
- Vitamin C and D --> Nothing
- ANti-biotics --> No
- Probitotics --> Showing promise but which strain and dose
110
How to determine what product to choose?
- Go for most bothersome symptom
111
What should pharmacists tell patients who are persistent there child requires a product?
Stress non-drug and educate on benefits of a cough
112
Pregnancy Cold
- 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
In regards to diabetics, what is the only product to be concerned with?
Oral Decongestants. Has effects on blood glucose.
