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130: Professional Practice 2 > Viral Rhinitis > Flashcards

Viral Rhinitis Flashcards

1
Q

how frqeuently do children and adults get the common cold

A

children: 6-8 colds/year

adults <60: 2-4 colds/year

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2
Q

how many different viruses can cause the common cold?

which are most common

A

can be caused by over 200 viruses

-> Rhinovirus (30-50%) most common in all age groups

*inc prevalence durign early fall and late spring

  • > Coronaviruses (10-20%), inc prevalence during mid winter and early spring
  • > other common viruses: RSV, adenovirus, parainfluenca, enterovirus
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3
Q

how are viruses transmitted

A
  • self inoculation
    • from nasal mucosa or conjunctiva
    • following hand contact w/ viral laden secretions on
      • animate objects (hands)
      • inanimate objects: surfaces
  • prolonged contract with airborne droplets
    • produced by coughing sneezing, talking
    • small particle aerosols linger in the air
    • direct hit by large particle aerosols from an infected person
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4
Q

what are the symptoms, medicatiors and immune response facotrs of the cold

A

Symptoms: sore thraot, nasal congestion, rhinorhhea, sneezing, fever/chills, cough

  • mediators: bradykinin, PG’s, Histamine, other cytokines
  • immune response: killer T-cells activated & antbiody production begins
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5
Q

incubation period for the common cold

A

24- 72 horus

  • symtpoms are largely due to immune response to infection rather than direct viral damage to the respiratroy tract
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6
Q

describet he clinicla presentation and cold infection progression

A

*self limiting: total symptom duration 7-14 days

Day 1-2: throat discomfort

Day 2-3 nasal congestoin and rhinorrhea (clear and watery at beggingin then becomes mucopurulent)

Day 3-4 and on: cough can be present, may persit for 1-2 weeks (dry at first then becoems productive)

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7
Q

physical assessment of viral rhinitis

A
  • slightly red pharynx with evidence of psotnasal drainage
  • nasal obstruction

mild to moderate tender sinuses on palpation

-low grade fever possible: rarely >37.8 C (100F), more common in chidlren than adults

* can cause exacerbations of asthma or COPD and/or can predispose individuals to bacterial complications: sinusitis, pneumonia, bronchitis, otitis media( kids)

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8
Q

describe classifications of cough

A

acute <3 weeks (viral URIs)

subacute/post infectious (3-8 weeks) infection, bacterial sinusitis, asthma

*could be part of lingering infection

chronic (>8 weeks) post nasal drip syndrome, asthma GERD, some medications

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9
Q

describe a productive cough

A
  • expels secretions from lwoer resp tract
  • secretions can be clear (bronchitis), purulent (bacterial infection), discolored (yellow w/ inflammatory disorders) or malodorous (amaerobic bacterial infection
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10
Q

describe non productive cough

A

dry or hacking

*most common for upper resp infection

  • serves no useful purpose

*associated with viral RTI, gerd, cardiac disease, some meds and atypical bacterial ifnections

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11
Q

gneral URTI prevention measures

A
  • avoid touching the nasal muscosa and conjunctiva
  • routine handwashing
  • alcohol- based hand rub (ABHR)/sanitizers

*used as supplement to regular handwashing, not effective when hands are visibly soiled, need 62-95% ABHR for efficacy

  • proper sneeze/cough etiquette

avoid ahring beverages or food esp with children

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12
Q

what non prescription therapies are available for viral Rhinitis

A

decongestants

antihistamines (to dry)

antitussives nad protussives

local anesthetics

systemic analgesics (antipyretics)

NHP

*will only treat symptoms wont shorten duration

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13
Q

what are the buckets of symptom types for viral rhinits and what is used to treat each

A
  • Nasal symptoms
    • systemic or topical decongestants
    • 1st generation antihistamines
  • Cough
    • dry -> antitissive
    • productive -> protussive
  • Sore throat
    • anesthetic
    • antiseptic
  • fever/pain
    • analgesic/antipyretic
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14
Q

cough of cough and cold medications in children

A
  • although gnerally safe there is NO strong evidnece of efficacy within pediatric population
  • concerns with severe toxicities/side effects: convulsions, inc HR< dec consciousness, abnormal heart rhythms, hallucinations

- do not use in patients under 6

  • can be abused for sedation or incorrectly used in daycare
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15
Q

CCM for 6-11

A

limited evidence but dosage is still provided on packaging

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16
Q

according to heath Canada advisory of 2008 the following could and cold meds are banned in children under 6

A

antihistamins (only for cough and cold, not banned for allergy)

antitussives

expectorants

decongestants

17
Q

antitissives for treatment of viral rhinitis

A

MOA: act centerall on medulla to increase cough threshold

evidence for OTC cough products is limited and conflicting

*avoid use in productive cough -> dont want to supress productive cough

18
Q

what antitussives are available

A

codeine

dextromethrophen

diphenhydramine (antitissuive in benedryl)

hydrocodone (Rx only)

19
Q

dose of codine for antitissue

A

*only available when combo w/ 2 other ingredients

  • adult dose: >12y 10-20mg q4-6h

max 120mg/d

20
Q

dose for dextromethorphan

A

adult dose: 30 mg q6-8hr

age 6-11: 5-10 mg q4h or 15mg q6-8h (ER)

Max 60mg/day

*sort of works but not very well

*abuse potential

21
Q

precautions for codeine

A

Adverse Effects: include drowsiness/sedation, nausea, constipation

abuse potential: significant

contraindications : MAOIs

DI: CYP2D^ inhibitors; CNS depressants

22
Q

precautions for dextromethorphan

A

adverse effects: well tolerated, occasional dizziness, drowsiness, nausea

  • abuse potential: present if used in high doses
    contraindiation: MAOIs

DI: CYP2D6

*DM blocks serotonin reuptake -> can get serotonin syndrome

-> avoid other serotinergic modulating drugs (SSRIs)

23
Q

cough and cold products with opioids in youth

A

do not use codeine and other opiods in children <18

24
Q

use of ecpectorants to treat cold

A
  • limited evidence in acute cough and RUTI or any age group
  • act peripherally -> may reduce viscosity and aid in expectoration of sputum
  • may be used for chest congestion
  • side effects are rate
  • NO abuse potential NO DIs
25
Q

what is an expectorant used and its dose

A

guaifenesin

  • adult dose: 200-400mg q4-6h, max 2.4 g/day

6-11: 11-200 mg q4-6h (12mg/kg/day), max 1.2g/day

*limited evidence for effiacy but no abuse potential

26
Q

use of topial antitussives

A
  • Menthol and comphor
    • present in lozenges, topical ointments etc
    • increases perception of nasal breathing
    • no imporvement in objective measures (distracts brain to make you feel like you are breathing better)
  • when applied to chest and neck has been shown to improve cough severity and quality of sleep for the child and parents

*may be effective in common child in children

DO NOT apply in and arond nose, use v small amount on chest to start off with

27
Q

efficacy/ MOA/ and onset for oral decongestants for cold treatment

A
  • foudn to be moderately efefctive for cold symptoms (nasal congestion, sinus pain)
  • MOA: alpha adrenergic agonists: vasoconstriction of nasal blood vessels, reducing vessel engorgement and mucosal edema
  • onset of action: 30 min

*vasoconstriction relieves nasal stuffiness

*if have eye drops with vasocontrictors will dec redness for same reason

28
Q

what are the common oral decongestants

A

pseudoephedine

phenylephrine

phenylpropanolamine

29
Q

pseudoephedrine dose as oral decongestant

A

widely used, does have evidence to support efficacy

  • Adult
    • 60mg q4-6h or 120 mg q12h (long acting preps)
    • MAX 240mg/day
  • 6-11
    • 30mg q4-6hr
    • max 120mg/day
30
Q

dose of phenylephrine

A

* oral decongestant

adult: 10mg q4h, max 60 mg/d

6-11: 5mg q4h, max 30 mg/d

31
Q

dose of phenylpropanolamine

A

discontinues oral decongestant

*removed from market in 2000 due to risk of hemorrhagic stroke in women

32
Q

adverse drug reactions of oral decongestants

A

**has stimulatory effect so can cause

insomnia, tremor, irritability, nervousness, restlessness

dizziness, headache

tachycardia, palpitation, inc BP in hypertensive patients

DO NOT TAKE IF HAVE UNCONTROLLED HYPERTENSION

33
Q

oral decongestants are contraindicated in

A

pateitns with

uncontrolled hypertension

narrow angle glaucoma

prostatic hypertrophs

patients taking MAOIs (hypertensive crisis)

34
Q

describe use of Nasal decongestants for treatment of cold

A
  • contrict blood vessels in nose to make breathing easier -> reduced edema
  • onset of action <10 min
  • less systematic absorpton to fewer adverse effects (than oral decongestants like pseudoephedine)
  • avoid with MAOIs
  • can cause rebound congestion (medicamentosa), esp with short acting agents
35
Q

ex of long acting and short acting nasal decongestants and dosing

A
  • long acting:
    • Xylometazoline (Otrivin) 0.1%
    • Oxymetazoline (Dristan) 0.5%
      • Dose 2-3 sprays in each nostril Q10-12 hr (max BID)
  • Short acting
    • phenylephrine 0.25 or 0.5%
      • Dose 2-3 sprays in each nostil q4h
36
Q
A

130: Professional Practice 2 (30 decks)

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