Respiratory OTC Flashcards
define the common cold
A mild, self-limiting
upper respiratory tract infection
characterised by nasal stuffiness
and discharge, sneezing sore
throat and cough.
what are the causes of the common cold?
viral cause
how does a cold spread?
- Inhale drops of mucus containing cold virus
- Touch something carrying the virus and then rub
eyes/nose.
when is a cold most contageous?
Symptoms within 2-3 days - most contagious in
early stages
what are the symptoms of a cold?
Runny/blocked nose
* Sneezing/coughing
* Headache/aches and pains
* Temperature –unlikely to be raised much in a
common cold
* Sore throat
* Earache –blocked and uncomfortable = normal
* - Acutely painful = referral
what is the flu?
Acute respiratory illness caused by RNA viruses of the family Orthomyxoviridae (influenza viruses).
what are the different types of viruses?
Influenza A - occurs more frequently and is more
virulent. It is responsible for most major epidemics and
pandemics.
* Influenza B - often co-circulates with influenza A during
the yearly outbreaks.
* Influenza C - usually causes a mild or asymptomatic
infection similar to the common cold.
what are the symptoms of flu?
- As per the common cold –PLUS…
- Onset - very rapid
- Weakness and fatigue –Many patients bed bound
- Fever (if present) tends to be more severe in children.
- Resistance is reduced during long term illness, stress, fatigue, depression
what are the complications of flu?
- Acute bronchitis.
- Pneumonia….may require admission to hospital
- Exacerbations of asthma and COPD
- Otitis media.
- Sinusitis.
- Non-respiratory complications –rare
- In pregnancy, complications include perinatal
mortality, prematurity, smaller neonatal size, and
lower birth weight (DoH, 2013)
how do you treat cold/ flu?
paracteamol- fever/ chills/pains
sore throat-local anesthetics- benzocaine sprays
congestion- decongestants- sudafed
inability to sleep- antihistamines- promethazine/ diphenydramine
how do decongestants work?
Constrict blood vessels in nasal mucosa
* Relieve nasal stuffiness
* Ingredient in oral cold remedies, nasal sprays & drops
what are the ingredients in oral/ topical decongestants?
Oral Decongestants
1. Ephedrine
2. pseudoephedrine
3. phenylephrine
Topical Decongestants
1. ephedrine
2. oxymetazoline
3. xylometazoline
what are the side effects of decongestants?
- Rebound congestion (topical)
- CNS Stimulants –do not take at night (orally)
who are decongestants contraindicaed in?
- Hypertension/Heart disease - stimulation of heart and
increase in BP - Diabetes –can increase blood glucose levels
- Hyperthyroidism
what do decongestants interact with?
- MAOIs
- beta blockers
what is the legal amount of psudeoephedrine/ ephedrine you can sell to a patient?
- Misused to produce
methylamphetamine (crystal meth) - Max sale of 720mg packs (12x60mg tabs)
- Limit of 1 pack per person
what are the side effects of antihistamines?
- Drowsiness…counsel re driving etc
- anticholinergic
who are antihistamines contraindicated in?
- Severe respiratory disease
- closed angle glaucoma
- prostatic hypertrophy
- epilepsy
- liver disease
what do antihistamines interact with?
Alcohol…increased sedative effects
what is used to treat cold/ flu in children?
Antitussives - Dextromethorphan,Pholcodine
Expectorants - Guaifenasin,Ipecacuanha
Nasal decongestants - Ephedrine,Oxymetazoline,Phenylephrine, Pseudoephedrine,Xylometazoline
Antihistamines Brompheniramine,Diphenhydramine,Doxylamine,Promethazine,Triprolidine.
who can codeine be used in?
not u12
12-18 P
18+ OTC
what counselling should you give for a child with cold/ flu?
- Can only recommend analgesic/anti-pyretic
(check if appropriate) - Fluids
- Rest
- Child sleep on side
- Vapour rubs/ inhalants/saline nasal drops
when should you refer child for cold/flu?
- noisy breathing/wheezing
- croup or whooping cough
- ear tugging
- persistent / extremely high temperature
- persistent nocturnal cough
when should you refer adults for cold/flu?
asthmatics
coloured mucus- consider as a whole
blood
infant/elderly
cardiac/ lung disease
when can antivirals be prescribed?
- Antiviral drugs can be prescribed (oral oseltamivir or inhaled
zanamivir) for influenza in at risk groups.
what counselling should you give for a patient with cold/ flu symptoms?
- Steam inhalations v salt water nasal
cleaning - Avoid over treatment
- Care with analgesic dose
- Caution with sedative antihistamines
- Expect improvement after 1 week
- Diabetics
what is a cough?
- Part of body’s natural defense mechanism
- Not a condition but a symptom
reflex response to airway irritation
what are the causes of a cough?
Upper respiratory tract viral infections
* Cold/dry atmosphere
* Smoking
* Other conditions: asthma/COPD/Heart
failure/allergies
* Medication: ACEI
what are the different types of coughs?
Non-productive cough
* dry, tickly irritation of throat and chest
* no sputum
Productive cough
* excess sputum
* thin & clear removed by cough (Mucoid)
* thick and difficult to clear chest
* coloured sputum
what are the available cough suppressants? antitussives
Codeine Linctus –(> 18yrs)
* constipation
* abuse
Pholcodine Linctus
* fewer side effects
Dextromethorphan
* less potent
* few side effects
why would you give antihistamiens for a cough?
- Eg. Diphenhydramine, promethazine,
triprolidine - Dry secretions
- Reduce cough frequency
- Cause drowsiness –useful if cough is
disturbing sleep - Anticholinergic side effects
what is the purpose of demucents?
- Soothe throat/cough
- Sugar or syrup base - pleasant to take
- Glycerin, honey & lemon
what is the two possible MOA of expectorants?
- stimulate bronchial mucus secretion –liquefying
sputum - emetic reflex response
what counselling should be given for a cough?
- Increase fluid intake –liquefy
secretions/soothe throat - Steam inhalation?? –add
inhalant?? - Sugar free remedies - diabetics
when should you refer a cough?
- Lasting longer than 3 weeks (nhs.uk 2019)
- Coloured sputum associated with other
systemic symptoms - Chest pain (PE/Pleurisy)
- Shortness of breath and / or wheeze
- Recurrent nocturnal cough (particularly
children) - Whooping cough or croup
- ADRs
- Smokers with recurrent cough
what should you consider for someone who presents with a sore throat?
- Duration
- Other symptoms…dysphagia/ swollen glands
Glandular fever?? - Persistent hoarseness –refer if >3 weeks
- Previous history –recurrent tonsilitis
- Smoker?
- Current meds??
what are the different types of allergic rhinitis?
Seasonal - symptoms occur at the same time each year
❖response to grass and tree pollens (also known as
hayfever)
Perennial - symptoms occur throughout the year
❖house dust mite/animal fur/feathers/fungal
spores/dust
what are the symptoms of allergic rhinitis?
- sneezing
- rhinorrhoea
- nasal congestion
- nasal itch
- irritation of mouth & palate
- itching eyes with lacrimation &
conjunctivitis
what is the first line treatment for allergic rhinitis?
oral antihistamines
what nasal preparations are available for hayfever?
beclometasone and fluticasone
* For 18 years +
* anti-inflammatory
* start 2 weeks before symptoms expected
* regular use throughout season –ensure compliance
what are the side effects of corticosteroid nasal prep?
- dryness & irritation of nose
- nose bleeds
how do mast cell stabilisers work?
Stabilises mast cells to prevent histamine release - used
prophylactically
* Intra-nasal & intra-ocular
* Prophylactic treatment
* QDS dose
* Children from 6 years
* No specific cautions
what is a POM version of a mast cell stabiliser?
Lodoxamide
how does Lodoxamide work?
Alomide for allergic conjunctivitis –prevents
histamine release
* intra-ocular
* not for children under 4 years
no longer than 4 weeks
what are the combination topical antihistamines?
Otrivine-Antistin eye drops
* antazoline with xylometazoline
* antihistamine with vasoconstrictor
* short term use
* 2 or 3 times daily no more than 7 days
* not for children
who are topical antihistamines contra indicated in?
- children under 12 years
- pregnancy & breast feeding
what are the red flag symptoms for hayfever?
- Wheezing or shortness of breath (asthma?)
- Prolonged or severe earache (otitis media?)
- Facial pain (sinusitis?)
- Coloured nasal discharge
- Purulent conjunctivitis
- No improvement after 5-7 days
