Cough/Colds/Fever Flashcards
Describe the differential for respiratory infections and there subsequent prevalence
Common Cold > Bronchitis > Influenza > Covid = Strep Throat
What is the most common cause of an upper respiratory tract infection?
Common cold or Bronchitis
Describe how one can distingusih between the common cold and influenza
Common Cold - often just feel feverish
Influenza –> Fever in HOURS, dry cough and aches and pains
What are some concerns regarding respiratory infections in the elderly? Examples?
Example –> Influenza
fever and cough not always present in seniors
Encourage vaccionation
Risk of double sickening
Sx of RSV compared to flu, covid and cold
Wheezing is common
What are some characteristic sx of the flu, cold and allergies
Describe covid-19 sx in comaprison to tje flu and common cold
Fever - Common in flu and covid, rare in cold
Fatigue - Common in flu, sometimes in covid and cold
Cough - Common (usually dry) in flu and covid, mild in cold
Runny or Stuffy Nose - RAre in Covid-19, common in cold, sometimes in flu
Shortness nof breathe - sometimes in covid
Sore Throat –> Copvid-19 and Cold
What is becoming the dominant Covid Sympton now?
2/3 of people with sore throat
fever and loss of smell are rare now
Describe influenza in the elderly
65 and older with influenza –> MAy not necessarily have a fever or a cough
- if require for diagnosis, miss more than half of people
Conditions such as asthma, COPD and HF often exacerbated or triggered by influenza
Only 31% had a diagnosable fever
Even when odler adults presented with fever amd influenza-like ilnness, they were still tested at lower rates
When as pharmacists are we concerned about ocation of sx? What is likely when in these areas with these sx?
Sx involving the head –> Head COld - less scary
Symptoms mainly in chest –> Chest cold –> More worrisome
Describe the difference between a productive and a non-productive cough
What are some causes of dry and wet coughs?
What is acute bronchitis? Sx? Sputum colour?
Cough starts as non-productive then becomes productive
Cough can last for up to 3 weeks –> Long (get it checked by MD if 3 weeks long)
Green Sputum (if known) can mean bacterial or viral
Does not necessarily warrant antibiotics
What is bronchitis sometimes referred to as? Severity of cough comapred to other conditions? Most common pathogen?
Sometimes referred to as a chest cold
Commonly viral in nature
Often described as being worse then the regular cold but not as bad as pneumonia
Describe where different chest infections occur? Which is a concern? Why?
Bronchitis –> Upper LUng
Bronchiolitis –> Deeper in lung
Pneumonia –> Deppest in the lung
RSV –> Hospital (kids)
Often commonly think bronchitis
If a fever is present with chest cold, refer –> Pneumonia potential
Pneumonia –> Likley present to the hospital as sicker
What is croup? Difference from Laryngitis? Severity?
Laryngitis is the same as croup (called this in older children)
Bark-like cough (‘croupy’) = very dry cough
–> Seal like
Viral in nature
Sounds worse than it actually is; benign in nature
Is croup a serious condition? When should it be better by?
Most cases, croup sounds worse than it actually is
Should clear up on its own within 5 to 7 days
Describe the therapy for croup
Humidity –> Soothing
Mist from a humidifier or sitting with the child in a bathroom
Allow child to breathe cool air during the night by opening window or door
Coughing can be treated with warm, clear fluid
No need for antibioptics as croup is caused by a virus and not by a bacteria
What is laryngitis? Duration?
Swellih and inflammation of the larynx
Acute or chronic
Often not serious and in most acses resolves without treatment in around 7 days
Describe laryngitis causes, children and tx
Viral infections such as colds are the most common cause of laryngitis
Children with laryngitis can develop a respiratory illness called croup
Acute laryngitis is best treated with self care measures and rest
Describ the symptoms of laryngitis in children
Symptoms of laryngitis in children can differ than in adults
COndition charceterized by hoarse barking caough –> Croup
Simple ilnnes to treat
What is epiglottis?
Inflamamed epiglottis
Affectes breathing
RAre - Kids are now vaccinated for it (Hib)
Can be very danageriys
Docs will consider sx and then look down the throat with a scope
What are the classic signs of epiglottis?
Dysphoria
Dysphagia
Drooling
Distressed repiration
Leaning forward –> Protects the airway and maximizes ventilation
What is often the cause of epiglottis?
Haemophilus Influenzae
Now vaccinated against so less of. acause
Mainly due to syrep now
Describe the symptoms of asthma
Persistent cough
No cold-like sx
Wheezing/shortness of breath
What are some trigegrs of asthma?
Exercise
Allergens
COLDS
What are some symptoms that would help discern asthma from the common cold?
Asthma does not cause a fever, chills, muscle aches or a sore throat
What is a trigger for asthma?
Colds are often a trigger for asthma attacks
So can have both at once occuring and sx of both conditions
Describe how a cold initially presents
Sore throat/throat discomfort
Followed by clear, watery nasal discharge
Sneezing, fatigue, feverish
Post nasal drip from nose and sinuses can cause one to have a cough
Describe the onset of asthma
42% of adults with active asthma reported an onset occuring before the age of 16
Mean age of onset - 7 years old
What is more worrisome in children than in adults? Is it able to distinguish the cause?
Sore throats are more worrisome in kids
Often difficult to discern whether bacetrial or viral
Describe the anatomy of the throat? Pharmacist role here?
Glands cans well up during an infection
Pharamcists are getting involved in strep throat testing
However, looking into the throat suggests you know what you are doing
Describe the different conditions of sore throats
What is strep throat? Sx? Common age? Pathogen?
Incraesed fever and incraesed pain
Cough is less common
Exudate/swollen glands/rash
More common in kids 5-15 years old
Strep Pyogenese (Group A strep)
What is the more common pathogen for a sore throat: Bacteria or Virus
Viral is still the most common
Describe the likelihood of strep throat? Bacteria?
Bacteria: Group A Beta-Hemolytic Streptococcal
Patients with a sore throat, likelihood of GABHS is highest in children five to fifteen years of age (37%) and lower in younger children (24%) and adults (5-15%)
What are some of the common causes of tonsillitis?
15-30% of tonsilitis cases are due to baceteria
Most often strep bacteria
Viruses are the most common cause of tonsilitis –> Epstein BArr Virus can casue tonsilitis and can also cause mononucleosis
What is a critical factor to cosnider in the treatment of strep throat?
If strep throat is left untreated and caused by streptococcus bacteria, it can lead to serious complications
How long does tonsilitis usually last?
Symptoms usually go away within 7-10 days
Describe the signs and symptoms of strep throat? What doe sit typically not include?
What is the practice relaity for strep throat regarding pharamcists?
1) Exudate
2) Swollen Glands
3) Pain
4) Fever
If all 4 –> 50% chance of strep throat
Still requires testing to confirm diagnosis
Can strep throat simply be diagnosed by looking at an individuals throat?
Strep throat cannot be diagnosed by a doctor simply looking at the childs throat
Describe why antibiotics are used in strep throat?
What can be used to determine if strep throat is likely?
Centro Score
Are antibiotics needed for strep throat?
Doctors sually treat strep throat with antibiotics
Antibiotics are not prescribed to treat the strep itself, but to prevent serious complications
ANtibiotics are often needed
What are antibiotics used to prevent after strep throat? Or is it to treat the strep throat?
Rheumatic fever
Rheumatic Heart Disease
Strep throat is self-limkting; however, downstream effects are the worry here
What is rheumatic fevere? Rate?
Fewer than 0.3% of people who have had strep get rheumatic fever
Most common among children aged 5-15, but adults can also get it
Symtoms of rheumatic fever
Fever
Non-itchy rash
Narrowed mitral valve cauisng heart murmur
Painful joints
What is rheumatic heart disease?
Damaged valves
What is fifth and sixth disease?
Skin conditions that occur in kids after cold symptoms
Will come across as typical cold until rash starts
Common after URTi’s
What is a common occurrence in children with an URTi?
A very common cause of HIves in children is URT infections (within the last 6 weeks)
Viral URTIs cause about 40% of hive rashed
These outbreaks resolve as the infection resolves
What are some main symptoms of mononucelosis?
Describe the diagnosis of mononucelosis
Will likely present like the flu or strep throat initially
Sore Throat (slower onset)
Fatigue
Fever
Swollen Neck Glands
Test after 3 or 4 tries (bronchitis, common cold, etc.)
NONO test finds it
Describe the differential algorithm for colds
Describe how pharamcists can play the odds?
What is another condition that will likely be brought up if the patient has it? Describe this situation?
Heart FAilure:
Cough
Shortness of Breath (not in bronchitis)
Hx of HF
Comes to mind when patient says they have had a cold that has lasted for months and mentions SOB
Patie nt should inform us of HF diagnopsis when ask about health status in the consult
How long does a cold last? How long does a cough last?
A cold typically wraps up around day 10
Some people experience a post-infectious cough shich is a nagging cough can last an average of 18 days after the cold subsides
When should a child be seen by a doctor for a cough?
1) Frequent persistent cough for 3-4 days (recall 18 days is normal)
2) Short, fast cough with whooping sound (whooping cough)
3) Loud, wet cough with faster breathing than normal
4) Wheezing cough (sounds like asthma)
5) Barky Cough (croup - oless worried)
6) Productive cough with persistent mucous, sneezing and nose-blowing
Describe how to rule in and rule out certain respiratory disorders?
Describe the distribution of acute cough amoung children in phaermacies?
Common Cold - 59%
Brochitis - 9%
Asthma - 9%
Influenza - 8%
When should a child see a physician for a cough?
If a child has a cough for greater than one month
OR
It’s a relapse
What is commonly seen for immunity boosting now a days?
Zinc is now commonly seen for immunity/colds
In cough and cold products for children for immunity
Not effective
Is there preventative therapies for a cold? If so, use and effectiveness?
VICK’s - Early Defence
Cold virus blocker - not useful and low chance of sucess here
Pump 2-3 times in the nostri;l
Allow 4 hours between administrations (max of 4/day)
Would need more like Q2H
What are the treatment options for a common cold? Efficacy?
Cough suppressants - Not that great
1) DM - Have low expectations
- best agent we have oTC but low effeicacy
2) Expectorant (gaufenisen)
- Not that great of an agent
- Some efficacy
3) ANtihistamines - Not indicated (except for sneezing, runny nose)
- Often added for nightime sedation
4) Decongestants are often helpful
Describe the role and efficacy of guaifenesin in the management of chronic brnchitis and URTi’s?
Considered a safe and effective expectorant for the treatment of mucus-related symptoms in acute URTi’s and stable chronic bronchitis
Clinical efficacy has been demonstrated most widely in chronic respiratory conditions, where excess mucous production and cough are more stable sx
How does gaufenisen work aws an expectorant?
Incraeses airway hydration
Increases volume of bronchial secretions
Decraeses mucuous viscosity
What is the dose of guafensisen?
200-400 mg Q4H up to 6x daily
Does honey have a role in cough and cold management? Efficacy? Dose?
CAn help diminish a cough and the discomfort experienced by children and parents
Safe to use but low efficacy
Single dose of 2.5 mL HS for children over the age of 1
Children under 1 years old - Risk of botulism
Describe the difference in efficacy between honey and DM?
DM and Honey had a similar efficacy to no treatment in regards to cough severity
Describe the meta-analysis and systematic review of the effectiveness of honey in URTi’s?
Honey was superior to usual care for the improvement of symptoms of a URTI
- Safe agent, but not great efficacy (similar to DM)
Improvement of sx refers ro:
- Combined Symptom Scores
- Cough frequency
- Cough severity
- 1-2 days shorter
The honey was delievered in different ways
What is the most common way that a parent will give honey to their child?
DIY Cough Syrups with Honey
Vast majority are going to get honey within a standard syrup formulation
Role of anti-histamines in the treatment of cough
Not indicated (except for sneezing, runny nose)
Added to products for nightime sedation
DayQuil Vs NyQuil
Dayquil –> Cough
NyQuil –> Sedation
Describe the role of decongestants in the common cold
Helpful agents; except phenylephrine
Best agents we have for symptom relief
Describe the SUDAFED agents and their efficacy
Sudafed - pseudoephedrine
- Great agent
- Can be used to make crystal meth
Sudafed PE - phenylephrine
- Formulated to prevent crytsal meth synthesis
- Does not work well due to variable metabolism
What are the different types of available decongestants?
Oral and Topical
How can one decide between oral and topical decongestants?
What are some concerns with topical decongestants?
Rebound congestion
Local irritation
Describe the available OTC topical decongestants
Describ ethe duration of usage of Otrivin? Concern and in who?
Xylometazoline
7 days of usage
Max of one month of usage
Head Cold - Use for 3-4 days
Big Worry here is in allergy users
What are some warnings for xylometazoline? Is this factual?
Xylometazoline should not be used for self-care for more than 3-5 days due to risk of rebound congestion
Wrong 7 days of use
What is rebound congestion with topical decongestants?
Persistent nasal congestion despite frequent use of a topical decongestant or when the medication is abruptly disocntinued
What topical decongestant agents are more concerning for rebound congestion?
Rebound congestion occurs more frequently with shorter actingd econgestants (phenylephrine) than with longer actinga gents such as xylometazoline
Is there a debate regarding topical decongestants?
A literature review by a medical panel
Analysis conducted by the task force tends to refute the concepts of rebound congestion and rhinitis medica-mentosa
Nasal decongestants must nevertheless be use din a controlled setting
What is rhinitis medicamentosa?
Rebpoung COngestion
Inflammation of the nsal mucosa caused by the overuse of nasal decongestants
When does rebound congestion occur?
After prolonged use
Sitiuation found to develop as early as 3 days and up to 4-6 weeks of use
Modern vasconstrictors such as imidazoline derivatives, the risk of developping RM is considered to be small
Still ma xout at 7 datys if use
Is the recommended days of use for oxymetazoline and phenylephrine the same?
Oxyymetazoline - 7 days of use
Phenylephrine - No more than 3-4 days pof use in a row
What are some concerns regarding oral decongestants?
CNS effects (like a cup of coffee)
CV effects (bp, hr) for 3 days max with HTN
- Do not recommend in HTN
Incraese in blood glucose (already incraesed due to virus)
Angle closure glaucoma
Urinary Retention/prostatet ***
Hyperthryoidism
Describe th CV risk of oral decongestants. Recommendation?
Can incraese blood pressure - do not use in individuals with HTN
The incraese is minimal in people with controlled high BP
Slight increase if anything, legal over clinical here
Evidence of CV risk with oral decongestants
Numerous case reports suggest that oral decongestants can raise BP to dangerous levels whereas other reviews suggest that the danger is exagerrated
Pseudoephedrine causes a small increase in SBP (1 mm Hg) and HR (2.8 beats/min). T
he effect in patients with controlled hypertension demonstrated an SBP increase of similar magnitude (1.2 mm Hg).
Higher doses were associated with greater increases.
Shorter duration of use was associated with greater increases in SBP and DBP.
Describe the risk to the prostate with oral decongestants
Decongestants are alpha-agonists and act to shrink blood vessels
Lots of alpha receptors in the prostate gland
Decongestant gets to prostate and cr5eates more tone leading to es speing and urinary retention
Topicals –> No effect
What medications can be used for urinaray retenion due to. en,arged prostate? MOA? Decongestant effect?
Proscar (finasteride) –> Decreases 5 α reductase –> Relaxes prostate
Flomax (tamsulosin) –> α adrenergic antagonist –> Blocks alpha receptrs and takes tension off prostate
If giev decongestant –> cancels each other out
What are some drug interactions with deocngestants?
TCA’s
MAOI’s (MAIN ONE HERE)
SSRI’s/SNRI’s (okay to use; monitor)
MonoAmine Oxidase breaks the neurotransmitters down to inactive cpds
MAOI’s and Decongestants –> Drug induced hypertensive crisis –> Extra noradrenaline flishes out into blood system and hits the heart
Concerns with the eyes regarding decongestant usage
Galucoma Eye Drops (oipen angle) - Decraeses pressure at the back of the eye
Narrow Angle –> Dilating the iris blocks fluid drainage
Decongetsnats do not interfere here
Statement on package for narrow angle; unlikely - can use in normal galucoma
What is narrow angle glaucoma?
As pupil dilates, block drainage process, acute spike in intra ocular pressure
Anything that dilates the pupil can cause this
Least common type of glaucoma
What can be used for nasal mucous in children?
Running Nose - May not need saline
Thick Mucous –> Likely needs saline first
–> let saline sit to soften mucous before suctioning
Vacuum
- Colear tip so parent can see what comes out
-The saline goes into the nose, not into the bulb
- Just for suctioning it out
Close other nostril while suctioning
Examples of Saline NAsal Sprays
Salinex
Rhinaris
Generic Brands
Describe the role of saline nasal mists
Plain saline applied into a congested nose, where the mucous has become dry, will be soothing and perhaps ‘moisturizing’.
But this effect will not last long; saline does not ‘soothe’ nor ‘moisturize’ beyond a minute or two.
That is where added lubricants come in, they will be soothing for a longer time and do better on irritated nasal tissue.
But, it is hard to tell which products have actually added lubricants, unless you see something like this on the pkg. (e.g. Rhinaris)
Describe the avilable benylin agents
Nonproductibve Cough; non-congested - DM
Non-productive; congested - Rather not supress; want to become productive –> Gaufenisen
Productive cough; congested - Nothing
DM + gaufenisen does not make sense
Describe the flu decision chart
Describe a difference between the flu and Covid-19 regarding residual side effects
A major difference between influenza and covid-19 is the expectation, that with influenza, once the illness has subsided, the impact of the infectious agent is over
Covid-19 can have lingering effects
Treatment of Influenza
Pharamcists can prescribe oral anti-viral agents only during an epidemic or pandemic declared by the chief medical officer of SK
What are some causes of a fever? WHich are the common ones?
Play the Odds Here
What are some sx of a fever?
Depending on the cause of the fever, additional feer signs and sx include:
Fever in head cold and stomach flu?
Head cold =
congestion,sneezing,
fever-ish
Stomach flu =
diarrhea, nausea,
fever-ish
Describe the best ways to measure a fever
Method of choice –> Rectal up to 5 yeaers of age
Armpit = Meh ««_space;Oral
Pharamcy: Most do not take the temp
What are the recommended methods to measure temperatur and the temperatures for fever?
What is the best way to describe how to use a specific thermomemter?
Showing the parent a video of this is FAR better than describing it in words !!
How to measure a temperature rectally?
Most reliable way to measure temperature is rectally
nTaking an ear temperature: Age and technqiue
5 year Old Patient –> Pull the ear up and back to help position the probe
For babies under 12 months, pull the lobe down and back
When do we treat a fever?
Is the child:
1) Showing a sick demeanor
2) Attentive
3) lethargic
4) Playing with something
When is fever a red flag?
A fever on its own with no other sx is a red flag
Describe when to treat a fever and its associated temp and duration?
Describe when an MD should be called for a fever in a child (age and temp)
Younger than 3 months –> Rectal temp > 38 C
Ages 3-6 months –> rectal > 39 C and seems unsually iriitable, lethargic or uncomfortab;le
Between the ages of 6 months and 2 years old –> Recral 39 C for longer than one day
Children and MD Rferall of Fever
Does a fever lead to brain damage?
Most healthy children and adults can tolerate a fever to 40C for short periods of time without problems
Can handle high temperatures without brain damage
Describe the 39C 1,2,3 rule in relation to MD thoughts about fevers
Doctors do not start worrying until a fever has lasted for 5 or more days
Non-Otc Management of a fever
Only treat regarding childs overall state
ANti-pyretic last option –> No value in alterating between acet and Ibu
When do we treat kids for a fever?
Child in distress - Tx
Help find a product
Which anti-pyertic to use?
Either Acet or IBu is fine
Advil –> Ibu
- less dosing frequency
- Ok for NSAID-induced asthma exacerbation (adulthood condition)
Descriobe acetaminophen dosing
Do not need to aaken child to give a dose
Publ;ic thoughts on a fever
Do not need to wake child up
Describe Tylenol fever and Sore Throat: USe?
Often in cough ane cold section
Does nothing for main cold sx
What is Ibuprofen used for?How long of releief of fever?
What does Ibuprofen do?
How fast is releief from pain expected with Ibuprofen?
relief from pain may be excpected in 0.5 hour
Slower with food
Ibuprofen dosinf
Strength of Avilable CHildren Advil
Acet or Ibu for fever
Either one is fine for majority of cases
Naproxen for fever n
Not for fever in Canada
Does a fever reeally need to be treated?
You only need to treat a fever if the child is miserable or distressed
often give before this
What is fever phobia?
Unrealistic and exagerrated misconceptions of parents whose children have a fever
Can Ibu and Acet be used for fever and Pain simultaneously?
Yes
Can give Q4H
Ok as long as you stay below limit of each med
Explain schedule on paper
RArarely wake child up for nightime doses
Combo can have greater efficcayb than individual for management –> Not necessary, just do one well
CFP stance on aceta and ibu alternation
Monotx has failed, a short trial of alternating regimen could be implemented
Optimal single therapeutic regimen is better than alternating plan
Studies of children with fever report no incraese ina dverse effects
Risk of alternating acet and Ibu alternation
Do not alternate between using acet and ibu as this can lead to dosing errors
What vaccinations can lead to a fever in children?
Diptheria, tetanus and acellular pertrususiis or pneumonoccal vaccine
How long does a fever following vaccination last for?
Fever with most vaccines begins within 24 hours and lasts 1-2 days
Overall, evidence about NSAID/ACet usage for vaccines
Short-term use of analagesics/antipyretics at non-prescription doses is unlikely to affect vaccine induced immunity
How common are febrile seizures?
Rare
Describe febrile seizures. Is it severe?
Usually last for a few minutes (less than 1-2 kins)
Occurs during first few hours of fever
Usually caised by a viral infx
A child will lose conciosuness and both arms and legs will shake
Very scar, they are harmless to the child
3-4% chance
Not caused by the drug (if given), caused by the fever
Child outgrows it as age
febrile seizure: Main management
Place child on his or her side to prevent chokung
Cool wascloths to forehead and neck
Sponge body with luke warm water
–> Cold water and alcohol may make shivers and make fevr worse
Give acet or Ibu once awake
Do anti-pyretics prevent febrile seizures?
No evidence that anti-pyretics reduce the risk of subsequent febrile seizure
fevers in the elderly
Attenuated
Number on theramorer tends to decraese with age
Which of the following has a more severe cough: influenza or the common cold
Influenza
