Minor Ailments - Coughs & colds Flashcards
1
Q
Upper respiratory tract
A
- Nasal cavity
- Pharynx
- Larynx
- Cold, cough, flu, tonsillitis pharyngitis laryngitis, sinusitis and hay fever
2
Q
What are colds?
A
- Common infection of the upper respiratory tract
- Most common illness
- Mild viral infection.= over 200 diff viruses can cause it.
- Incubation 1-4 days and symptomatic 3-4 days
- More prevalent in winter
- children = up to 5 colds/year
- adults = 2-3 colds/year
2
Q
Lower respiratory tract
A
- Trachea
- Primary bronchi
- lungs
- Bronchitis, pneumonia and influenza
2
Q
Signs and Symptoms of colds
A
- Cough
- Increased mucous production throughout the tract
- Pain/Discomfort due to local infection
- Voice change if Larynx Involved
- Airflow obstruction: muscular/mucus obstruction
- Haemoptysis (coughing up blood)- Serious = s/t you can cut yourself w/i the throat from perisitent coughing)
3
Q
How to manage colds
A
- Most available remedies are symptomatic ( treating symptoms)
- Anti-tussive: cough suppressant (Dextromethorphan)
- Mild pain killers : Paracetamol
- Sore throat sprays: Numb the pain. Contain Anaesthetics
- Antihistamines: as decongestants or sedation in night preparations- More likely to put you to sleep
- Non- medicinal = Steam inhalation: menthol, eucalyptus (evidence, placebo), not under 3 months
4
Q
Management of Cold:Decongestants(1)
A
- Nasal symptoms: Decongestants
- Pseudoephedrine( increases bp) - POM , Phenylephrine (OTC) , (Oxymetazoline)
- Sympathomimetic(mimics SNS): alpha adrenergic agonists: Vasoconstriction in nasal mucusa
- Reduce the swelling of the blood vessels in the nose, which helps to open the airways.
- Formulations: Tablets, capsules, Nasal drops, Nasal sprays, Liquids.
5
Q
Management of Cold:Decongestants (2)
A
- Compounds preparation: overdose of paracetamol = s/ things contain paracteamol too
- Non selective for nasal mucosa: all produce suppressor effect : increased bp
- Avoid in diabetes, hypertension,hyperthyroidism, pregnancy and heart disease
6
Q
Management of Cold:Decongestants (3)
A
- Topical decongestant: Pseudoephedrine, Phenylephedrine, Oxymetazoline, xylometazoline= more common
- Oxymetazoline and Xylometazoline have longer duration of action >12 hrs. others quick onset but < 3 hrs
- Reduced systemic effect= won’t cause substantial increase in bp
- can’t use for longer than 7 days
7
Q
Management of cold: Decongestants (4)
A
- pseudoephedrine and ephedrine can be extracted = used in illegal manufacture of the Class A (CD) methylamphetamine.
- Methylamphetamine = highly addictive drug = affects the CNS = can cause serious physical and psychological harm.
8
Q
Management of cold: Decongestants (5)
A
The legal sales restrictions were put in place by MHRA in the UK on 1 April 2008 which made it illegal to sell or supply:
* product that contains more than 720 mg pseudoephedrine
or 180 mg ephedrine w/o a prescription
* combination of meds that between them add up to more than 720 mg pseudoephedrine or 180 mg ephedrine w/o a prescription
* a medicine that contains pseudoephedrine and a medicine that contains ephedrine in one transaction
9
Q
what is Influenza?
A
- Influenza virus A, B or C. A, B most common
- Epidemic nature (occasionally pandemic) §Incubation phase 1-3 days
- Early symptoms: resemble cold
- Distinguished by v/ high fever, general discomfort , aching limbs, lack of energy. May affect the whole respiratory tract
- May be severe - can be fatal (elderly, very young)
- in pandemics = can be high mortality
10
Q
Influenza
A
- Contagious
- Spread to others via : nasal secretions, objects and airborne saliva droplets
- Most contagious = 1st 3 days after symptoms begin
- Viruses can last up to 5 hrs on skin and hard surfaces
11
Q
Spread of cold and flu
A
- each cough, about 1.5L of air is expelled from the body
- produces over 3000 saliva droplets in the air
- travel at speed of about 50mph
- Sneezes can travel 100mph & create 100,000 + droplets
12
Q
What are Coughs?
A
- symptom not a disease
- Bodys’ way of removing foreign material or mucus from the lungs and upper airway passage ]
- Usually an indictaion of s/t is occouring w/i the body
- Lasts 3+ weeks = refer to Gp or hospital
13
Q
Classifications of cough by duration: SUBACUTE
A
- 3-8 weeks
- Asthma, post infection airway inflammation, postnasal drip
13
Q
Classifications of cough by duration: ACUTE
A
- Less than 3 weeks
- Dry = pneumonia, cold/flu, asthma, allergen, irritant , COPD (Chronic obstructive pulmonary disease), CHF (Chronic heart failure), PE (Pulmonary embolism)
- Chesty = Cold & flu
14
Q
Classifications of cough by duration: CHRONIC
A
- 8+ weeks
- Dry = medicines, allergy, reflux
- Chesty = Infection, asthma, lung cancer, COPD (Chronic Obstructive Pulmonary Disease)
15
Q
Classification of cough: DRY
A
- Non productive, tickly, or tight
- No mucus/sputum production
16
Q
Classification of cough: CHESTY
A
- Mucus production
- Clear, yellow/green ( infection) , blood (refer)
17
Q
Treatment of cough(1)
A
- Diff ways depending on cause
- Most involves self-care
- If caused by virus= no antibiotics
18
Q
Treatment of cough(2)
A
- Cough suppressants
- Centrally acting – dextromethorphan
- Expectorants= chesty cough = - Hydration, ammonium salts, guaifenesin, ipecuanha, citric acid, squill,etc
- Demulcents= v/ symptomatic;
- Honey, glycerin, syrup, coat pharyngeal mucosa ( Viscous liquids that give a soothing effect)
19
Q
Cough suppressants- dry cough
A
- Codeine linctus= No longer used = dose = 15-30mg
- Dextromethorphan= widely used = dose range in adults 15-30mg e.g Sudafed Linctus 20mg/10ml e.g Covonia 6.8.mg/5ml
- Demulcent Linctuses= act in pharynx= reduce irritation & sensitisation of sensory receptors e.g Simple Linctus. Harmless and inexpensive. ( Unless you have diabetes)
20
Q
Expectorants- Chesty cough
A
- Makes you cough more:
-Direct stimulant action in respiratory tract
-Indirect activation of p-sympathetic tone secondary to gastro-intestinal irritation (in theory) - Water= expectorant = hydration of mucous to reduce viscosity = basis of steam inhalations. Menthol + Eucalyptus used as aid to liquidfication of mucous
21
Q
Treatment for children
A
- Can resolve itself in a few days or up to 2 weeks
- Non-pharmacological interventions = fluids, rest
- Fever and pain= Paracetamol= 1st line Ibuprofen = 2nd line
(SEE NICE FEVER guidance.) - Nasal congestion = Saline nasal drops, vapour rubs,
steam inhalation - Cough= Warm clear fluids, lemon and honey drink.
Glycerol or simple linctus ( = cough syrups) - Symptoms persist = Referral to GP
21
Q
Guaifenesin
A
- Widely used. Readily absorbed from oral
dose. - Plasma half-life 1 hour
- Well tolerated + free of major side effects
- barely interacts w/ other meds
- Reported dose 100-200mg every 2-4 hours
- No clear evidence of efficacy
22
Q
Cough treatments for children
A
- Very little is available or should be used ( limited studeis to support safe use)
- Under 6 = No antitussives (cough meds), expectorants, nasal decongestants, antihistamines
- 6-12= s/ cough meds + 2nd line to best practice, No more than 5 days
- Codeine = Not under 18
23
Q
Evidence of benefit of cough
medicines?
A
- Cochrane systematic review
- 26 trials in 4037 people (616 children)
- Outcome = No good evidence for the effectiveness of
OTC medicines in acute cough - Meds are dependant on individual
24
Q
OTC suppy
A
- Ask who , what
- airway secretions
- duration ( 3+ weeks = refer to GP)
- medication = i.e Ace inhibitors can cause a dry tickly cough
- Ethical issue – professionalism vs. retailing
25
Q
Lung cancer warning signs
A
- Cough = 3+ weeks
- Worsening or change of a long-standing cough
- Repeated or persistent chest infections
- Blood in the phlegm (Haemoptysis
- Unexplained persistent breathlessness, tiredness, lack of energy or weightloss
- Persistent chest and/or shoulder pain
- Unexplained persistent hoarseness
- Unexplained swelling of the face and neck
