Viral Rhinitis Flashcards
how frqeuently do children and adults get the common cold
children: 6-8 colds/year
adults <60: 2-4 colds/year
how many different viruses can cause the common cold?
which are most common
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
how are viruses transmitted
- 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
what are the symptoms, medicatiors and immune response facotrs of the cold
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
incubation period for the common cold
24- 72 horus
- symtpoms are largely due to immune response to infection rather than direct viral damage to the respiratroy tract
describet he clinicla presentation and cold infection progression
*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)
physical assessment of viral rhinitis
- 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)
describe classifications of cough
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
describe a productive cough
- expels secretions from lwoer resp tract
- secretions can be clear (bronchitis), purulent (bacterial infection), discolored (yellow w/ inflammatory disorders) or malodorous (amaerobic bacterial infection
describe non productive cough
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
gneral URTI prevention measures
- 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
what non prescription therapies are available for viral Rhinitis
decongestants
antihistamines (to dry)
antitussives nad protussives
local anesthetics
systemic analgesics (antipyretics)
NHP
*will only treat symptoms wont shorten duration
what are the buckets of symptom types for viral rhinits and what is used to treat each
- Nasal symptoms
- systemic or topical decongestants
- 1st generation antihistamines
- Cough
- dry -> antitissive
- productive -> protussive
- Sore throat
- anesthetic
- antiseptic
- fever/pain
- analgesic/antipyretic
cough of cough and cold medications in children
- 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
CCM for 6-11
limited evidence but dosage is still provided on packaging
according to heath Canada advisory of 2008 the following could and cold meds are banned in children under 6
antihistamins (only for cough and cold, not banned for allergy)
antitussives
expectorants
decongestants
antitissives for treatment of viral rhinitis
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
what antitussives are available
codeine
dextromethrophen
diphenhydramine (antitissuive in benedryl)
hydrocodone (Rx only)
dose of codine for antitissue
*only available when combo w/ 2 other ingredients
- adult dose: >12y 10-20mg q4-6h
max 120mg/d
dose for dextromethorphan
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
precautions for codeine
Adverse Effects: include drowsiness/sedation, nausea, constipation
abuse potential: significant
contraindications : MAOIs
DI: CYP2D^ inhibitors; CNS depressants
precautions for dextromethorphan
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)
cough and cold products with opioids in youth
do not use codeine and other opiods in children <18
use of ecpectorants to treat cold
- 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
what is an expectorant used and its dose
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
use of topial antitussives
- 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
efficacy/ MOA/ and onset for oral decongestants for cold treatment
- 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
what are the common oral decongestants
pseudoephedine
phenylephrine
phenylpropanolamine
pseudoephedrine dose as oral decongestant
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
dose of phenylephrine
* oral decongestant
adult: 10mg q4h, max 60 mg/d
6-11: 5mg q4h, max 30 mg/d
dose of phenylpropanolamine
discontinues oral decongestant
*removed from market in 2000 due to risk of hemorrhagic stroke in women
adverse drug reactions of oral decongestants
**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
oral decongestants are contraindicated in
pateitns with
uncontrolled hypertension
narrow angle glaucoma
prostatic hypertrophs
patients taking MAOIs (hypertensive crisis)
describe use of Nasal decongestants for treatment of cold
- 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
ex of long acting and short acting nasal decongestants and dosing
- 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
- phenylephrine 0.25 or 0.5%
