OTC - cold and flu

Question 1

Symptoms?

Answer 1

• blocked/runny nose, sneezing
• cough
• sore throat
• fever, aches and pain
• headache, sinus pain
• earache
• irritated, watery eyes (conjunctivitis)
• the flu is more sudden and severe. includes a headache, marked myalgia, chills, malaise or high-grade fever

Question 2

Referral criteria?

Answer 2

• no improvement in 2 weeks
• middle ear pain not improving with analgesics (acute otitis media?)
• persisting productive cough and high-grade fever (flu can be complicated by pneumonia?)
• duration >24hrs in 3-6 months, >72hrs in >6 months
• temp >/=38 in <3 months, >/=39 in 3-6 months
• vulnerable patients: COPD, asthma, kidney disease, diabetes or immunocompromised, very young (<3 months), very old)

Question 3

OTC products for fever aches and pains?

Answer 3

ORAL ANALGESICS

• paracetamol 500mg qds
• ibuprofen 200-400mg tds
• aspirin 1-3 x 300mg qds

Question 4

OTC decongestants?

Answer 4

NASAL CONGESTION
- nasal decongestants - sympathomimetics: constricts dilated blood vessels in the nasal mucosa

ORAL: psudoephedrine, phenylephrine (maximum quantity of pseudoephedrine (720mg) and ephedrine (180mg))

NASAL SPRAY: xylometazoline, oxymetazoline: do not use for >7 days = rebound nasal congestion

Question 5

What conditions and medications do you have to avoid decongestants in?

Answer 5

CONDITIONS:

• hypertension (raises BP)
• hyperthryoidism (vulnerable to heart irregularities)
• diabetes (hyperglycaemia)
• CVD (stimulant effect)
• glaucoma (raised intraocular pressure)
• prostatic enlargment (urinary retention)

MEDS:

• MAOIs (hypertensive crises if <14days after stopping)
• TCAs (theoretical risk of hypertensive crises)
• Beta-blockers (antagonised effect)

Question 6

Other OTC products?

Answer 6

ANTIHISTAMINES: e.g. diphenhydramine in cold/flu combo products
- dries up nasal secretions to relieve runny nose and sneezing via anticholinergic action

ANTI-TUSSIVES

• pholcodeine
• dextromethorpan

EXPECTORANTS

• guaifenesin
• ipecacuanha
• ammonium chloride
• squill

Question 7

Legal considerations for cough and cold remedies for children under 6 years

Answer 7

• certain ingredients in cough and cold remedies should not be given to children under 6
• in children aged 6-12 it should be given second line to best practice for 5 days only
• best practice for nasal congestion: steam inhalation e.g, with olbas oil (3 months+), saline sprays/drops in under 3 months

Question 8

Advice?

Answer 8

• vitamin C and echinacea: helps to prevent and alleviate cold symptoms
• wash hands regularly: avoids direct transmission
• cough or sneeze into a tissue: avoids air droplets transmission
• annual flu jab if at risk group e.g. diabetes