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Pharmacy Practice 3 > L3 Colds > Flashcards

L3 Colds Flashcards

1
Q

How often do adults and children suffer from the common cold?

A

Adults: 2-4 per year
Children: 5-10 per year

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2
Q

Describe causes of the common cold

A

viral cause.
More than 50% of colds are caused by rhinovirus.
May also be caused by coronavirus, RSV, influenza, parainfluenza or adenovirus.

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3
Q

Describe the invasion process of the virus in common cold.

A

Virus attaches to ICAM-1 in the back of the nose and adenoid area.
Virus invades nasal and bronchial epithelium, and replicates over 8-12 hours.
Inflammatory mediators are released from immune cells which increases permeability of capillaries, vasodilation and increased secretion (over 10-12 hours), and odema, congestion, rhinorrhea and sneezing which peaks at 36-72 hours after exposure.

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4
Q

How is the common cold spread?

A

Direct transmission: hand to nose/mouth or eyes

Droplet: sneezing

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5
Q

How does the common cold present?

A

Begins with sore throat,

Nasal congestion, rhinorrhea, sneezing and cough followed by chills and fever or malaise and myalgia.

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6
Q

Describe the duration of illness and its symptoms.

A

Persists for 7-10 days in total, peaks at around 72 hours.
feverishness and sore throat present from onset to around 9 days.
Cough and nasal discharge are present from onset to around 14 days.

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7
Q

What are some rare complications of the common cold?

A

Sinusitis (2% of cases).
Middle ear infections (otitis media)
Pneumonia

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8
Q

When diagnosing common cold, what are other illnesses to eliminate?

A

Influenza
Sinusitis
otitis media
Rhinitis

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9
Q

Describe influenza in comparison to the common cold.

A

More common in winter and can occur in epidemics.
More abrupt onset (hours).
More severe symptoms, such as fever, myalgia and pain, loss of appetite, malaise.
Has complications in the elderly, immunocompromised and chronic respiratory conditions.

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10
Q

Describe sinusitis in comparison to the common cold.

A

Symptoms last more than 7-10 days despite treatment.
Localised to nasal cavities, and sometimes thick, mucopurulent discharge.
Dull headache and facial pain.
Worsens on sneezing or bending down or moving eyes.

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11
Q

Describe Otitis media.

A

Middle ear infection, with headache and pain, deafness and ear popping.

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12
Q

Describe rhinitis.

A

Allergic and seasonal. Runny nose and sneezing.

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13
Q

When should you refer a patient to a GP?

A

Symptoms have been present for more than 7-10 days.
Acute sinus pain
severe symptoms or rapid onset (may be influenza)
Significant ear pain (may be otitis media
If they are very elderly/frail or immunocompromised (at risk of more severe disease)

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14
Q

What are the aims of, and approaches to, treatment of the common cold?

A

AIMS: relieve symptoms, shorten illness and reduce complications.
APPROACHES: non-pharmacological, pharmacological and complementary/alternative medicines (CAM)

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15
Q

List non-pharmacological treatments of common cold.

A

Rest
Fluids
Steam inhalations
Saline sprays

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16
Q

Describe steam inhalations, including efficacy and adverse effects.

A

AKA rhinothermy. UK data supports its use, however US data is equivocal.
No evidence of worsening symptoms or outcomes.
Risk of scalding or irritation of lips, nose and eyes.
No added benefit of including method, eucalyptus or pine in water.

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17
Q

Describe benefits of saline sprays, and comment on efficacy.

A

Limited evidence of efficacy from observational studies. Has been shown to clear nasal passage in some studies. Can be useful in hay fever for clearing nasal passage of allergens in hay fever, and can be used to soften crusty nasal secretions.

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18
Q

What are the maximum doses of paracetamol for adults and children?

A

Adults: 4g per day
Children: 60mg/kg/day

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19
Q

Which products cannot be taken with panadol?

A

Cold and flu products containing paracetamol e.g. dimetapp

Lemsip

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20
Q

Describe the pharmacology of nasal decongestants, and give examples of topical and oral preparations.

A

alpha-sympathomimetics which lead to constriction of arterioles, reduction in blood flow to nasal passages and thus a reduction in nasal secretions.
Topical preps include nasal drops or spray containing: oxymetazoline, trampoline or phenylephrine/ephedrine.
Oral: psuedoephedrine or phenylephrine.

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21
Q

Describe the pharmacokinetics and adverse reactions of oxymetazoline/xylometazoline.
Give examples of preps containing these drugs.

A

Locally absorbed in nose, and absorbed in GI tract. Onset within 5-10 minutes and duration of action is 6-12 hours.
May cause local irritation, rhinitis medicaments or tachyphylaxis so limit use to 3-5 days.
Safety not established in pregnancy.
Present in Otrivin, vicks sinex, dimetapp and drixine nasal sprays.

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22
Q

Describe the use of ephedrine and phenylephrine nasal instillations, duration of action and cautions.

A

Use ephedrine up to 4 times per day. Use phenylephrine every 3 to 4 hours.
Act for 3-6 hours.
Cautions in high BP, MAOI use.
Use for up to 5 days.

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23
Q

Describe how to administer nasal drops.

A

Clear nose by lightly blowing.
Lie down with head back and insert drops.
Remain laying down for several minutes.

24
Q

Describe how to administer nasal spray.

A

Clear nose by blowing slightly and shake the bottle well.
Insert applicator tip into one nostril and hold the other nostril closed.
Hold head vertical and slightly forward. Sniff gently while pressing applicator tip down to spray, and breath out through the mouth.
Repeat for other nostril.
Clean the spray tip and replace cap.

25
Q

Describe the use of psuedoephedrine (oral) as a nasal decongestant. Mention pharmacokinetics and dose.

A

Orally active alpha agonist, direct and indirect effects.
Onset in 30-60 minutes and duration of 3-4 hours.
Dose is 60mg every 4-6 hours (max 240mg per day).
Available as SR (120mg bd)

26
Q

What are the adverse reactions associated with pseudo ephedrine use?

A

Hypertension, agitation, insomnia (antihistamines in some products to combat this), anorexia and contraindicated in pregnancy.

27
Q

What is the reaction that occurs if psuedoephedrine is combined with MAOIs?

A

May result in hypertensive crisis, so 14 day washout period must be observed.

28
Q

Describe pseudo ephedrine diversion in pharmacies.

A

PSA code of practice for psuedoephedrine:
Store in dispensary out of sight and reach of public is desirable.
Medical need must be established, and supplied quantity must reflect the medical need.
Guild Guidelines:
Keep stock levels in shop to a minimum.
Do not supply more than one pack unless exceptional circumstances apply
report suspicious sales.

29
Q

What is Project Stop?

A

Online tool to aid in deciding whether to supply psuedoephedrine to a patient.
Aims to prevent the use of psuedoephedrine-based products in the manufacture of methamphetamine.
Used in all states of Australia. records patient ID. Info is accessible by health authorities and police.

30
Q

Briefly describe phenylephrine.

A

Simmilar pharmacokinetics, adverse reactions and interactions as psuedoephedrine but cannot be used to make methamphetaimine. often combined with simple analgesics.

31
Q

Compare Oral vs Topical nasal decongestants.

A

ORAL: longer onset of action, short duration of action but no rebound effect.
TOPICAL: fast acting, little abuse, safer in hypertension or diabetes however has a rebound effect, so can only use for 5 days max.

32
Q

What can be used for a runny nose?

A

Antihistamines

33
Q

Describe dexchlorpheniramine including pharmacokinetics and adverse effects.

A 
Antihistamine with duration of action of 4-6 hours. taken 4 times per day, or twice daily for SR preps.
It is an anticholinergic drug, so side effects include dry mouth, constipation and has precaution in glaucoma and prostate enlargement.
Causes sedation (first gen antihistamine). May be combined with a sympathomimetic decongestant but Cochrane review found no significant reduction in sedation.
34
Q

Describe the results of the Cochrane review.

A

Use of antihistamines alone: no evidence of any significant effect in recovery from the common cold. Small improvement of rhinorrhea and sneezing, and caused sedation.
When antihistamines were combined with decongestants, there was a small reduction in nasal symptoms, however no effects shown in children.
non-sedating antihistamines also showed no benefit.

35
Q

What are three complimentary medicines used in the treatment of common cold?

A

Echinacea
Vitamin C
Zinc

36
Q

What is echinacea, and what is it’s mechanism of action?

A

Pressed leaf juice or alcoholic root extract from 3 species of echinacea plant.
It acts as an immunostimulator and immunomodulator by stimulating PMN leukocytes and non-specific immunity. It is a partial COX inhibitor so also has anti-inflammatory effects.

37
Q

Discuss the efficacy of echinacea in the treatment of the common cold.

A

Preparations tested in clinical trials differ greatly. There is some evidence that preps based on the aerial parts of the plant might be effective in early treatment of colds however results are not fully consistent.

38
Q

What are some adverse effects of echinacea?

A

Generally well tolerated, however may have some GI effects, headache and dizziness. May induce allergic reaction in some people, and should be avoided in pregnancy and lactation.
Theoretical antagonist of immunosuppressive drugs.

39
Q

Describe the mechanism of action of vitamin C?

A

Reducing agent and antioxidant that modulates lymphocytes and phagocytes, and enhances natural killer cells.

40
Q

What are some adverse effects of vitamin C supplements?

A

Diarrhoea, GI upset and possibly kidney stones from increased oxalate.

41
Q

Describe the efficacy of vitamin C in the treatment of the common cold.

A

No consistent differences from placebo for cold duration or severity.

42
Q

Describe the distribution of zinc in the human body, it’s dietary sources and RDI.

A

2g present in the body, 70% of which is in skeletal muscle.

RDI is 12mg/day. 50% of zinc from diet is absorbed. it is found in animal food sources.

43
Q

Describe the role of zinc in the immune response.

A

Essential for normal cell development. Mediates non-specific immune response. deficiency reduces cell-mediated and antibody responses

44
Q

Describe dosage forms of zinc., and adverse effects.

A

Zinc as zinc gluconate or zinc sulfate in lozenges, or combined in tablets.
Adverse effects include GI upset, and mouth irritation or taste perversion with lozenges.

45
Q

Describe the efficacy of zinc in the treatment of the common cold.

A

Cochrane study concluded that zinc administered within 24 hours of onset of symptoms reduces the duration and severity of the common cold in healthy people.

46
Q

What are 4 complimentary medicines used in the prevention of the common cold?

A

Echinacea
Vit C
Garlic
Zinc

47
Q

How effective is echinacea in prevention of colds?

A

Benefits may exist but have not been shown in independent randomised controlled trials.

48
Q

When is vitamin C effective in preventing colds?

A

Use could be justified to prevent colds in people exposed to brief periods of severe physical exercise and/or cold environments.

49
Q

What dosage forms is garlic available in? What are its active constituents and it’s mechanism of action?

A

available as powder, oil, or extract. Active constituents are allicin and ajoene.
Acts on macrophages and T lymphocytes to enhance the immune system.

50
Q

Describe the efficacy of garlic for cold prevention.

A

in one trial, people taking 180mg allicin daily for 12 weeks had a significantly reduced number of colds than those taking placebo, and days to recovery were shortened by 1 day.

51
Q

What are some adverse effects of garlic supplements, and drug interactions?

A

Adverse effects include odour, nausea, heartburn, headache and myalgia.
Garlic increases the action of anticoagulants, anti platelet drugs, antihypertensives and antilipidemic drugs.

52
Q

Describe the efficacy of zinc in regards to cold prevention.

A

after 5 months continuous treatment, there was a statistically significant reduction in development of a cold, school absence and prescription antibiotics.

53
Q

What is “Vicks First Defence” and how is it used? Is it effective?

A

Micro-gel nasal spray used at onset of cold symptoms or when a person feels “at risk” of developing a cold.
Claimed to trap, disarm and facilitate removal of viral particles.
No published evidence to it’s efficacy.

54
Q

What are some actions people can take to stop the spread of colds?

A

Cover mouth when sneezing or coughing.
Keep hands away from eyes, nose and mouth.
Use tissues to blow nose and throw tissues away after use.
Wash hands with soap, esp before preparing and eating food, and after blowing nose.
Avoid sharing cups, glasses and cutlery.

55
Q

As a pharmacist, how would you treat a patient that presents with a cold?

A

Symptom-based treatment, such as NSAIDs for body aches, oral decongestants (topical for hypertensive patients and saline spray for pregnant women).

Pharmacy Practice 3 (4 decks)

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