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PharmD > Viral Rhinitis > Flashcards

Viral Rhinitis Flashcards

1
Q

What is viral rhinitis?

A

“Common cold” or “runny nose”

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2
Q

Viral rhinitis is usually b______ and a ____-_________ viral infection.
Symptoms generally resolve untreated in ___-___ days.

A

benign
self-limited
10-14

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3
Q

What are two common viruses that cause viral rhinitis?

A

Rhinoviruses and coronaviruses

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4
Q

How does viral infections trigger viral rhinitis?
Why are the typical symptoms of viral rhinitis

A

Virus triggers immune system to release inflammatory mediators that cause common symptoms like rhinorrhea and nasal congestion

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5
Q

Does symptomatic treatment lessen the risk of complications?

A

No evidence

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6
Q

What are some complications that can develop from viral infections?

A

Middle ear effusions
Otitis media
Sinusitis
Asthma exacerbations
Febrile seizures (infants/children)

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7
Q

What’s the difference between the common cold and influenza?

A

Influenza/Flu (more severe):
- Abrupt onset of fever, severe myalgias, anorexia,, sore throat, headache, cough
- Caused by influenza virus

Common cold:
- Runny or stuffy nose, slight cough, headache, chills, sneezing, sore throat
-Caused by variety of viruses (including rhinoviruses and coronavirus)

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8
Q

What symptoms make COVID-19 stand out?

A

SARS-CoV-2 is more contagious than coronavirus strains that cause colds.

Influenza symptoms but with SOB, chills, and anosmia/dysgeusia

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9
Q

What symptoms may suggest the infection is bacterial?

A

Sinus headache
Difficulty breathing
Chest pain

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10
Q

What are non-pharms to prevent spread?

A

-Avoid close contact with someone who has the cold
-Wash hands (abstain from touching eyes or nose)
-Sneeze and cough into elbow or tissue
-Wear mask

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11
Q

Which OTC product has evidence for prevention of common cold?

A

North American ginseng extract (Panax quinquefolius)
- Cold FX
- Taken daily for up to 4 months
- May reduce upper respiratory tract symptoms by about 6 days

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12
Q

What is the main side effect with Cold FX?

A

GI upset

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13
Q

Does Cold-FX work for treatment of viral rhinitis?

A

No

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14
Q

Is Cold-FX safe in children?

A

No efficacy or safety studies in children

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15
Q

Do probiotics have evidence in the prevention of URTI?

A

Yes, if used for more than 3 months.

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16
Q

Should patients drink more water during common colds?

A

No, maintain usual fluid intake

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17
Q

Should patients get more rest during common cold?

A

Experts recommend rest, but no studies available to support

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18
Q

Is steam inhalation helpful for the common cold?

A

Insufficient evidence. Advise caution if using to prevent burns. Vaporizers should be cleaned regularly.

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19
Q

Does exercise reduce occurrence, severity, or duration of common cold?

A

Uncertain

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20
Q

What are the first line therapies for viral rhinitis? (3 classes)

A
  1. Analgesic and Antipyretics
  2. Anticholinergic
  3. Decongestants and Antihistamines
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21
Q

What are the drug choices for analgesic and antipyretics?

A
  1. NSAIDs (ASA, ibuprofen, naproxen)
  2. Acetaminophen
22
Q

What ages can the following drugs be used in?
Acetaminophen
Ibuprofen
Naproxen
ASA

A

Acetaminophen (all ages)
Ibuprofen (≥6 months)
Naproxen (≥12 years)
ASA (≥18 years due to Reye’s syndrome)

23
Q

How does acetaminophen and NSAIDs help with viral rhinits?

A

Acetaminophen= reduces fever
NSAIDs= improves pain-related symptoms (headaches, muscle/joint pain). Does not improve respiratory symptoms

24
Q

What anticholinergic agent is used for viral rhinitis?

A

Intranasal ipratropium

25
Q

What age can intranasal ipratropium be used in?

A

≥5y of age

26
Q

Which symptoms do the intranasal ipratropium help with? What is the mechanism of action?

A

Helps with runny nose and sneezing.
Does not help with nasal congestion.
Blocks cholinergic-mediated vasodilation

27
Q

What adverse effects are associated with intranasal ipratropium?

A

Nasal dryness, blood-tinged mucous, and epistaxis

28
Q

What are examples of decongestants used in viral rhinitis?

A

-Pseudoephedrine (Sudafed)
-Oxymetazoline (Claritin, Dristan)
-Phenylephrine (Neo synephrine)
-Xylometazoline (Otrivin)

29
Q

At what age are decongestants recommended for?

A

≥12 years of age

30
Q

Are oral or intranasal decongestants recommended?

A

Intranasal
-faster symptom relief
-less adverse effects

31
Q

If patient prefers oral, what are the two oral decongestants?

A

Pseudoephedrine
Phenylephrine

32
Q

What is the difference between Sudafed and Sudafed PE?

A

Sudafed= pseudoephedrine (more effective)
- Requires pharmacy intervention
Sudafed PE= phenylephrine (not effective)
- Available over the counter

33
Q

What do we have to watch out for with decongestants?

A

Rebound congestion
To avoid this, limit to short-term use (≤3 days)

34
Q

Are antihistamines typically used alone in viral rhinitis?

A

No, they’re usually used in combo with a decongestant

35
Q

At what age are antihistamine/decongestant combos recommended?

A

≥6 y of age

36
Q

What are examples of antihistamine/decongestant products?

A
  • brompheniramine/​phenylephrine (Robitussin Children’s Cold)
  • Dexbrompheniramine / Pseudoephedrine (Drixoral)
37
Q

If patient does not want to use medicated therapies, what are three therapeutic alternatives?

A
  1. Saline Nasal Irrigation
  2. Honey
  3. Zinc Lozenges
38
Q

How does saline nasal irrigation help with viral rhinitis?

A

Reduce nasal secretion and congestion
Reduce the need for decongestants

39
Q

What is the saline concentration for saline nasal irrigation?

A

0.9% NaCl

40
Q

Is saline nasal irrigation safe for children?

A

Yes. Infants who are obligate nose breathers may benefit from regular administration in general. Helps clean the nose.

41
Q

What is the role of honey in viral rhinitis?

A

Unclear
Demulcent effects, may reduce cough
May improve sleep quality due to less cough

42
Q

What is dosing for honey in viral rhinitis?

A

One teaspoonful (5mL) at bedtime

43
Q

Is honey safe for children?

A

No, avoid honey in infants <12 months due to infantile botulism

44
Q

What is the role of zinc lozenges?

A

Shortened the average duration of common colds by almost 3 days

45
Q

What makes recommending zinc lozenges difficult?

A

Dosing is unclear
Unpleasant taste
Nausea

46
Q

Which therapies have insufficient evidence in treatment of viral rhinitis?

A
  1. Antibiotics
    - GI side effects
    - increase abx resistance
  2. Antitussives (codeine, dextromethorphan) and expectorants (guaifenesin)
    - Avoid in <6 years
    - Avoid codeine in <18
  3. Intranasal corticosteroids
  4. NHPs (including Cold-FX-> only good for prevention)
    - garlic
    - echinacea
  5. Topical menthol as monotherapy or in combo with camphor and eucalyptus
    - Avoid in <2 years old
    - Increase production and decreased clearance of mucus leads to respiratory distress in children. Never place directly under or in nostrils
    - Vitamin C
    - Vitamin D
47
Q

Is common cold or influenza a risk factor in pregnancy?

A

Yes, fever may be a risk factor for birth defects

48
Q

How do you manage viral rhinitis in pregnancy?
- Antihistamines
- Decongestants
- Anticholinergics
- Vitamins and NHPs

A
  1. Antihistamines
    - 1st generation (brompheniramine, chlorpheniramine, and diphenhydramine) are safe
  2. Decongestants
    - Oral (phenylephrine, pseudoephedrine) avoid in 1st trim due to malformation concerns
    - Topical (oxymetazoline, xylometazoline) are safe if used ≤3 days
  3. Anticholinergic no data
  4. Vit C: not recommended
  5. Echinacea: data not clear
  6. Ginseng: caution as teratogenic in animal studies
  7. Zinc: no data
49
Q

How do we manage viral rhinitis in breastfeeding?

A

Saline and topical decongestants preferred.
Honey is safe.
First safe antihistamines and decongestants are safe (watch for s/e in infant like drowsiness and irritability)

50
Q

What’s a counselling point to note about antihistamine and decongestant use in breastfeeding patient?

A

Especially when used in combo, it can reduce serum prolactin and reduce milk supply.
Use lowest effective dose and duration. Discontinue if decrease in breast milk production.

51
Q

Can you walk me through the general management algorithm for viral rhinitis?

A

If patient has rhinorrhea or nasal congestion, start this algorithm
≤5 years -> fever (Y= Tylenol or Advil, N= saline nose drops for infants)
6-11 years -> fever (Y= Tylenol or Advil, N= consider oral antihistamine/decongestant for 3 days)
≥12y -> fever (Y= Tylenol, Advil, or Naproxen, N= topical decongestant for 3 days or topical anticholinergic for 4 days).
*If no symptom relief, oral decongestant/antihistamine for 3 days)

PharmD (14 decks)

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