Viral Rhinitis pt 2 Flashcards
what is Rhinitis Medicamentosa
happens when you overuse decongestants, get rebound congestion
- to prevent: only use topical decongestants for a max of 3-5 days
- Treatment
- slowly withdraw the nasal decongestant (1 nostril at a time)
- repleace decongestant wtih topical nasal saline
- for more severe cases: use a systemic decongestant and topical corticosteroid
- abrupt cessation works but is difficlt bc patient will be congested for several days - week
- takes mucous memrbane 1-2 weeks to return to normal
use of antihistamines for treatment of cold
*ex: diphenhydramine
- indicated for runnynose, but can also have antitussive action
- questionable benefit in cough/cold -> any benefit is bc of drying effect from anticholinergic activity (side effect of the 1st generation products)
- often used in combination w/ decongestations due to sedative effect (frist gen causes sleepyness, so if you use with oral decongestant which is stimulatroy then works for dayitme use)
use of 1st vs second genreation antihistamines for cold
ex: diphenhydramine
1st gen: benefit is due to anicholinergic side effects
-> ahs drying atction (god for runny nose and has sedative side effect used in night time medications)
2ns gen: not really any evidence but still in some emds
precautions of antihistamines
- sedation, anticholinergic side effects (dry mouth, constipation, inc HR)
*caution in elderly, sedative effect can cause falls
- use caution with narrow angle glaucoma, heart disease, hyperthyrodism, prostatic hypertrophy
treatment of cough an cold with antihistamines in children
no more effective than placebo for cough
- same if usign antihistamine + decongestant
what do the following mean on cold products
DM
D
E
Sinus
DM = dextromethorphan (antitissive)
D = decongestant
E = expectorant (guaifenesin)
sinus = analgesic + decongestant
use of combination products for cough adn cold
and common combo examples
- generally not recommended: less flexibility in dosing, consumption of unnecessary drugs, more adverse effects, possible overdose (multiple products with acetaminophen)
- may be more convenient for multiple symptoms: may also inc compliance and reduce cost
- often combo of analgesic + decongestant for sinus pain and headache
- combo of expectorant + antitssive doesnt make sense
decongestant + anthistamine: some beenft in acute cough due to postnasla drip: may be sueful at bedtime due to insomnia with decongestant
combo product with guanifenesin and dextromethorphan or codeine
dumb
expectorant = antitussive
what can be recomended to children with URTI symptoms
pasteurized honey
sade in children >1
demulcent, antioxidant and antimicrobial effects
*no strong evidence against use of honey
*parents rated honey highest for symptomatif relief of nocturnal cough and sleep difficulty due to URTI
non pharm measure for UTRI symptoms
rest
nasal bulk syringe
uprgith postitioning
adqeuate fluid intake
inc humidity of the air
normal saline
*rely mainly on thses for kids under 6
nasal irrigation with saline for cold symptoms
- can alleviate sore thraot, thins nasal secretions, improved nasal breathing and can reduce need for nasal decongestants and mucolytics
*may be effective in common cold fro children
use of analgestics/antipyretics for treamtnet of cold
- not useful in adults, but some efficacy in children
- used for headache, pain and fever
- acetaminophen 10-15mg/kg/dose
- ibuprofen 5-10mg/kg/dose
*did not significantly reude the totalsymptom score or cold duration but was beneficial for discomfort or pain caused by viral illness
what to counsel on for cough and cold meds before giving an OTC
- explain that very few interventions have evidence to suppoer use
- nothing will cure,can only try to manage the symptoms
- common cold is self limited
- nonpharm measures can help relieve some of the discomfort of cold symptoms
- screen for more serious symptoms warrenting a referral
when to follow up for cold
2-14 days to assess for efficacy and safety of therapy
- <7 days of non Rx drug therapy should relieve most symptoms
- if cough persists but has improved at follow up, patient should cont therapy until coughr esolves
- development of S/S complications -> refer
*monitor my measuring temp, assessing nasal secretions, respirations and facial/neck pain
what parameters should you be monitoring
- cold symptoms- can they perform daily activities
- patients to monitor daily RPh: next visit or phone 2-3 days
- insomnia (oral degongestant)
- make sure they are taking it at right right
- patients daily; RPh 1 week
- High BP (pat with hypertension): - is there an inc in BP
- patian to monitor daily, RPh: 2x/week
- stop med if BP goes above baseline
- Drowsiness (antihistamine)
- patient to monitor daily: RPh next visit or phone when checking efficacy
- Drowsiness (certain antitussives like codine)
- patient monitor daily, RPh nest visit or phone when chekcing eficacy
