Clin Pharm 161 Respiratory Illnesses

Common cold

No specific cure, self-limiting, recovery within a week

Most likely cause/incidence of common cold

Viral infection

[T or F] Common colds is more prominent in adults (Children < adult)

False

Transmission of common cold

Direct contact, Fomite, coughing and sneezing

Infection with common cold

Invasion of nasal and bronchial epithelia —> inflamation —> edema —> nasal congestion —> sneezing and post-nasal drip —> cough, sore throat

unlikely incidence of common cold

Rhinitis, Rhinosinusitis, Otitis media

Quality or symptoms of common cold

Sore throat and sneezing followed by profuse nasal discharge and congestion

Mild to moderate fever with malaise

(PQRST) time of common cold

onset 1-2 days; occurs anytime throughout the year

[T/F] Common colds usually resolve within a week or sometimes 14 days

True

Common Cold Red Flag for Referral — possible need for antibiotics

acute sinus involvement that fails to respond to decongestant therapy

Mild ear pain that fails to respond to analgesia

Symptoms of Flu (Red flag for referral)

shivering, chills, malaise, aching of limbs, insomnia, non-productive cough, loss of appetite

Lifestyle advice for common colds

Good hygiene

• use disposable tissue rather than handkerchief

• wash hands frequently

• do not share hand towel

• avoid touching nose

Treatment options for common cold

Antihistamine

Decongestants or sympathomimetics

Alternative Therapies

Alternative therapy for common colds

Zinc lozenges

Vitamin C

Echinacea

Vapor Inhalation

Saline Spray

Drugs under antihistamine for common cold

Diphenhydramine

Chlorphenamine

Drugs under systemic decongestants for common cold

Phenylephrine

Pseudoephedrine

Drugs under topical decongestants for common cold

Oxymetazoline

Xylometazoline

Mechanism of Antihistamine

Antimuscarinic side effect —> drying of nasal secretion

[T/F] Antihistamine is co-formulated with decongestant

True

Counseling Points for use of antihistamine for common colds

Antihistamine is sedating —> avoid driving/operating of machinery

Benadryl

Diphenhydramine

Disudrin

Chlorphenamine + Phenylephrine

Decolgen, Neozep, Bioflu

Chlorphenamine + Paracetamol + Phenylephrine

Decolgen Forte, Symdex-D

Chlorphenamine + Phenylpropanolamine + Paracetamol

Mechanism of Systemic Decongestants

Constrict dilated blood vessels and swollen nasal mucosa —> easing of congestion

Counseling points for use of Systemic Decongestants

If patients have Hypertention or diabets, or taking drugs with interaction, consider topical decongestants

Have mild stimulant effect and may cause insomnia

[T/F] Systemic Decongestants can be taken beyond 5 days

False

Robitussin PS

Pseudoephidrine + Guaifenessin

Tuseran Forte

Phenylpropanolamine + Dextromethorphan

Topical decongestants counseling points

Nasal route is safer as it minimizes side effects and drug interaction

Maximum take to 5-7 days

Prolonged use of Topical Decongestant

Rebound congestion/Rhinitis medicamentosa

Sig. of Ephedrine and Phenylephrine

Taken TID or QID (short acting 3-4 hours)

Sig. for Oxymetazoline and Xylometazoline

Long-Acting (up to 12 hours)

Taken BID to TID

Nasofix, Nasofree

Oxymetazoline

Otrivine

Xylometazoline

Side effects of Zinc Lozenges

Bad taste, nausea

Zinc Lozenges

Beneficial in reducing duration and severity when taken within 24 hours of symptoms

Vitamin C

Routine Prophylaxis beneficial in px undergoing high physical stress

Echinacea

beneficial in reducing duration and frequency of colds

Vapor Inhalation

cheap without significant risk; may help in symptom relief

Saline Spray

beneficial but limited evidence

What to do in stuffy nose in babies?

Saline nose drops

[T/F] Combination Products increases medication adherence and cheaper

True

Paracetamol Maximum dose

4000mg per day

[T/F] powder products are added to hot drinks for placebo effect

True

Inhalant Volatile Oil and substance

Camphor, Methol, Eucalyptus

How to administer Nasal Drops and sprays?

Head in downward position facing the floor to prevent swollowing wing

[T/F] Sprays are preferable in Children < 6 y.o

False

Rhinitis

Inflammation of nasal lining

Causes of Rhinitis

Allergens

Activation of IgE antibodies on the surface of Mast Cell

Intermittent Allergens

Pollens, Fungal spores

Persistent Allergens

house dust mites, animal dander

[T/F] Rhinitis is a risk factor for asthma

True

Early Phase of Rhinitis symptoms

Nasal itch, rhinorrhea, sneezing, nasal congestion

Symptoms for late phase rhinitis

Nasal Congestion

Palliation of Rhinitis

Allergen

Quality or syptoms

Nasal itch, rhinorrhea, sneezing, nasal congestion

maybe accompanied by ocular irritation —> allergic conjunctivitis

Time of Rhinitis

Cold months (flu), summer months (seasonal allergic rhinitis)

Morning and Evening for intermittent symptom

[T/F] History of asthma and eczema increases incidence of rhinitis

True

Red Flags for Referral — Polyps

Nasal obstruction that fails to clear

Red Flag for referral - Trapped Foreign Body

Unilateral discharge especially in children

Lifestyle Advice for Rhinitis

• Allergen avoidance

  • Stay indoors

  • Close windows

  • pollen filter in air conditioning

  • Avoid walking in areas with high pollen exposure

  • limit exposure to animal dander and dusts

  • Strict cleaning regiment

First line treatment for rhinitis

Antihistamine

Preferred oral antihistimine

2nd generation antihistamine (loratidine and cetirizine)

[T/F] Second generation antihistamine is non sedating

False

There is an equal efficacy between loratadine and citirizine

True

Loratadine is more sedating than citirizine

False

Non-sedating antihistamine

third generation antihistamine

Drugs under third generation antihistamine

Desloratadine (Clarinex, Aerius)

Levocetirizine (Xyzal)

[T/F] Third generation antihistamines are OTC

false

Nasal Antihistamine

Azelastine

Ocular Antihistamine

Antazoline

Xylometazoline

Antazoline is combined with ___________

Long term use of antazoline

rebound conjunctivitis

Intranasal corticosteroid

First line therapy for moderator to sever intermittent symptoms, persistent AR, or if nasal congestion predominates

Drugs under Intranasal Corticosteroids

Beclomethasone, Fluticasone, Triamcinolone

Sodium Cromoglicate

Intraocular mast cell stabilizer

Sodium Cromoglicate

4x dosing, takes for to 6 weeks to reach maximal response

Antihistamine Treatment option for rhinitis

Cetirizine, Loratadine

Age bracket for Azelastine

>5 y.o.

Age bracket for antazoline

>12 y.o

Mechanism of Antihistamine for Rhinitis

Inhibits H1 receptors

Counseling Points for Antihistamine

Rapid onset (30 mins to 1 hour)

Have little effect on nasal congestion

2nd generation have (milder) sedating effects

[T/F] Dosing of cetirizine is age based

True

Dosing for Cetirizine if patient is > 6 y.o.

10 mg tablet daily

10 mL (10 mg syrup)

Dosing for Cetirizine if px is 2-5 y.o

2.5 mL (2.5 mg) syrup, BID

[T/F] Loratadine is age based

False

Dosing for Loratadine if px > 30 kg

10 mg tablet or syrup daily

Dosing for Loratadine if px < 30 jg

5mg tablet daily

Treatment with oral antihistamine efficacy

More effective if taken when symptoms are expected to occur rather than when the symptoms have started

Drug of choice for mild intermittent Rhinitis

Antihistamine

Drug of Choice for Sever intermittent

Intranasal Corticosteroids ± nasal decongestant

Drug of choice for persistent AR

Intranasal Corticosteroids ± nasal decongestant

Treatment option if rhinitis have ocular symptom

Add intraocular antihistamine (Antazoline) or Mast Cell Stabilizer (Sodium Cromoglicate)

How to corticosteroid nasal spray

Shake before use

Cough

Protective reflex primarily for airway clearance

[T/F] Cough is more prominent in children than adults

true

Qualities of cough

Dry, non productive

Chesty productive

Chesty non productive

Acute cough

< 3 weeks

Chronic cough

>8 weeks