Exam 3 Colds

What causes the majority of colds?

rhinovirus

How long may symptoms of a cold persist?

7-14 days

On day 1 of a cold, what type of symptoms are we likely to see?

sore throat, clear secretions

On days 2-3 of a cold, what type of symptoms are we likely to see?

thicker yellow/green mucus

What appears around days 4-5 of a cold?

cough

What are the typical signs and symptoms of a cold?

slower onset (1-3 days)

sore throat

rhinorrhea

sneezing

nasal congestion

low-grade fever

headache

malaise

myalgia

cough

Should we refer patients with a cold that also have a fever greater than 103 (oral) or 104 (rectal) or fever for greater than 3 days?

yes

Should we refer patients with a cold that also have chest pain?

yes

Should we refer patients with a cold that also have SOB?

yes

Should we refer patients with a cold that have underlying chronic cardiopulmonary diseases such as asthma, COPD, and CHF?

yes

Should we refer patients with a cold that are immunocompromised or immunosuppressed?

yes

At what age should children be referred with a cold?

3 months or younger

Should we refer cold patients that are frail and of advanced age?

yes

True or false: self-treatment for colds should be specific to the patient’s current symptoms?

true

What are the nonpharmacologic options for a cold?

increase fluid intake

adequate rest

nutritious diet

increase humidification

nasal strips

What are some nonpharmacologic options specific for children?

position upright to promote adequate nasal drainage

bulb syringe to clear nasal passageways

How does a humidifier work?

adds moisture using cool mist

How does a vaporizer work?

adds moisture by heating water to produce steam

What should we counsel the patient about with humidifiers?

appropriate cleaning

What should we counsel patients about with vaporizers?

risk from burns

What symptoms of colds do humidifiers and vaporizers help with?

congestion

How do breathe right nasal strips work?

widens the nasal passages which temporarily helps improve nasal airflow

Which nasal spray can be used as often as needed, as long as needed, and for any age?

saline nasal spray

How do saline nasal sprays work?

moisturize nasal passages which helps wash away encrusted material

What is the age restriction for saline products?

less than 5 years old

Which patients should not use saline nasal wash?

complete blockage of nasal passage

ear infection, ear pain, or blocked ears

recent sinus or ear surgery

What are the 2 options for oral decongestants?

phenylephrine and pseudoephedrine

Which oral decongestant is largely ineffective?

phenylephrine

What is the dosing for oral phenylephrine?

10mg every 4 hours

What is the max dose for oral phenylephrine?

60mg per day

What is the age restriction for oral PE tablets?

not for use in children under 12

What is the dosing for oral PSE?

30-60mg (1-2 tablets) every 4-6 hours

What is the max dose for adult PSE?

240mg per day

What is the age restriction for the adult formulation of PSE?

no dosing for children under 6 years old

How long can we use oral decongestants to self-treat a cold?

7 days

What is the concentration of children’s sudafed PE?

2.5mg/5mL

What is the concentration of children’s sudafed PSE?

15mg/5mL

What is the age restriction for children’s pediatric formulations of PE and PSE?

not recommended for children under 4

What is the dosing for children’s PE ages 6-11?

5mg every 4 hours, max 30mg per day

What is the dosing for children’s PE ages 4-5?

2.5mg every 4 hours, max 15mg per day

What is the dosing for children’s PSE ages 6-11?

30mg every 4-6 hours, max 120mg per day

What is the dosing for children’s PSE ages 4-5?

15mg every 4-6 hours, max 60mg per day

What is the daily limit for buying PSE?

3.6 grams per day

What is the monthly limit for buying PSE?

9 grams per month

What are the adverse effects of oral decongestants?

cardiovascular stimulation

CNS stimulation

decrease appetite

urinary retention

What are examples of cardiovascular stimulation?

increased BP

tachycardia

palpitations

arrhythmias

What are examples of CNS stimulation?

restlessness

insomnia

anxiety

tremors

hallucinations

What is the main class of drugs that interacts with oral decongestants?

monoamine oxidase inhibitors

What are the precautions with oral decongestants?

HTN

coronary heart disease

ischemic heart disease

diabetes

hyperthyroidism

elevated intraocular pressure

prostatic hypertrophy

ADHD

insomnia

What are the 2 options for topical decongestants?

phenylephrine and oxymetazoline

Do topical decongestants result in the constriction of nasal blood vessels?

yes

What is the dosing for topical phenylephrine?

2-3 sprays/drops every 4 hours, dosing info for 2 and older

What is the dosing for topical oxymetazoline?

2-3 sprays/drops every 10-12 hours, dosing info for 2 and older

How long can we self-treat with topical decongestants?

3-5 days

What is the main adverse effect seen with topical decongestants?

rebound congestion

What is the warning with topical decongestants?

no child proof packaging so be sure to counsel about proper medication storage

What are 2 examples of nasal inhalers?

benzedrex and Vick’s Vapor Inhaler

How do nasal inhalers work?

place cylindrical tube into nostril and inhale

What is the age restriction with nasal inhalers?

not for those under 6 years old

How long can we self-treat with nasal inhalers?

3 days

True or false: There are different strengths of phenylephrine topical and oxymetazoline based on age.

true

When should we refer a sinus headache?

if nasal discharge is green or brownish

pain worsens or persists for more than 7-10 days

What 2 classes of products are used to treat a sinus headache?

analgesic and decongestant

Which antihistamines are usually seen in combo cold and cough products?

1st gen

What are examples of anesthetics?

sucrets

cepacol

chloraseptic

How many days can we self-treat sore throat pain?

2 days

What are the active ingredients seen in anesthetic products?

benzocaine, menthol, and camphor

What is the age restriction for most lozenges?

not for children under 6 due to choking hazard

What is the age restriction for topical decongestants for treating colds in pediatrics?

greater than 2 years old

What is the age restriction for systemic decongestants for treating colds in pediatrics?

greater than 4 years old

What is the age restriction for children’s benadryl?

older than 6

For treating a cold in older adults, should we use systemic or topical decongestants?

topical or a saline nasal spray

For treating a cold in pregnant or lactating patients, what is the key point?

to encourage use of nonpharmacologic options first

Which type of decongestant is not recommended for pregnant or lactating patients?

systemic

What is the drug of choice in pregnancy or lactation if a product must be used?

oxymetazoline

What is an additional counseling point for lactating patients treating a cold?

decongestants can impact production of breastmilk. So, these patients should increase hydration and monitor milk supply