Colds and Flu PDF - College of Pharmacy 2020-21

College of Pharmacy Fourth Year. Clinical Pharmacy 2020-21 Colds and Flu 1-Common cold: is a self-limiting viral infection of the upper respiratory tract (1). More than 200 different virus types can produce symptoms of the common cold, inc...

College of Pharmacy Fourth Year. Clinical Pharmacy 2020-21 Colds and Flu 1-Common cold: is a self-limiting viral infection of the upper respiratory tract (1). More than 200 different virus types can produce symptoms of the common cold, including rhinoviruses (accounting for 30-50% of all cases), coronaviruses, parainfluenza virus, ………...(2). 2-Transmission is primarily by the virus coming into contact with the hands, which then touch the nose (direct contact transmission). Droplets shed from the nose coat surfaces such as door handles and telephones. Cold viruses can remain viable on these surfaces for several hours and when an uninfected person touches the contaminated surface transmission occurs (2). 3-Transmission by coughing and sneezing infected mucus particles does occur, although it is a secondary mechanism. This is why good hygiene (washing hands frequently and using disposable tissues) remains the cornerstone of reducing the spread of a cold (2). 4-Children contract colds more frequently than adults with on average five to six colds per year compared to two to four colds in adults, although in children this can be as high as 12 colds per year. Children aged between 4 and 8 years are most likely to contract a cold and it can appear to a child's parents that one cold follows another with no respite (2). Patient Assessment with cold A-Age: Very young patients and very old patients required referral. Also the age affect the choice of treatment (3). B-Duration: In general: 1- Abrupt (rapid) onset of symptoms may indicates flu. Gradual onset of symptoms may indicates common cold. 2- The symptoms of the common cold usually last for 7–14 days. Some symptoms, such as a cough, may persist after the worst of the cold is over (3). C-Symptoms: Symptoms of common cold are: 1-Sore throat: The throat is often feels dry and sore during a colds and it is usually 1 st sign of common cold (3). 2-Runny / congested (or blocked) nose: (Most patients will experience a runny nose (rhinorrhoea). This is initially a clear watery fluid, which is then followed by the production of thicker and more tenacious mucus 3)). 3-Sneezing/ coughing (3). 1 4-Aches and pains: Headache may occurs but a persistent or worsening frontal headache (pain above or below the eyes) may be due to sinusitis and required referral for further investigations. (Note: headache of sinusitis increase by lying down or bending forwards) (3). 5-Low grade fever: Those suffering from a cold often complain of feeling hot, but in general Figure 2-1: location of sinuses (2). a high temperature will not be present. The presence of fever may be an indication that the patient has flu rather than a cold (3). Peak incidence of flu is in the winter months; the common cold occurs any time throughout the year (2). Differentiating between colds and flu is needed. Flu is generally considered to be likely if : 1-Temp. is 38c0 or higher.(37.5 c0 in elderly). 2-At least one of the respiratory symptoms (cough, sore throat, nasal congestion, or rhinorrhoea) is present. 3-At least one of constitutional symptoms (headache, malaise, myalgia, sweat, chills, and prostration) is present (3). Influenza is therefore normally debilitating and a person with flu is much more likely to send another person into a pharmacy for medication (2). Flu generally settle with no need for referral, however , flu can be complicated by secondary lung infection (pneumonia); therefore any patient with flu and warning sign and symptoms of complication (severe or productive cough, persisting high fever, delirium, pleuritic chest pain) required referral for further investigations (3). (However reference 2 recommends referring any patient with symptoms indicative of flu) (2). Note: A vaccine is available for flu (influenza), which is reformulated each year. While no vaccine is available for cold (4). 6-Earache: Earache is a common complication of colds, especially in children. Sometimes the situation worsens when the middle ear fills up with fluid (Under normal circumstances, the middle ear is an air-containing compartment). This is an ideal site for a secondary infection to settle. When this does occur, the ear becomes acutely painful and is called acute otitis media (AOM). 2 AOM is a common infection in young children. The evidence for antibiotic use is conflicting. In about 80% of children, AOM will resolve spontaneously in about 3 days without antibiotics (3). In summary, a painful ear can initially be managed by the pharmacist. There is evidence that both paracetamol and ibuprofen are effective treatments for AOM. However, if pain were to persist or be associated with an unwell child (e.g. high fever, very restless or listless, vomiting), then referral to the Dr. would be advisable (3). D-Previous history: Patient with a history of asthma (asthmatic attack can be triggered by respiratory viral infection) or chronic lung disease e.g. chronic bronchitis (which can be complicated by secondary chest infection) required referral for further investigations (3). (chronic bronchitis: defined as a chronic cough and/or mucus production for at least 3 months in at least two consecutive years) (2). E-Present medication : When to refer If one or more appropriate remedies have -Earache not settling with analgesic been tried without success (failed -In the very young medication), then referral for further -In the very old investigations is required (3). -In those with heart or lung disease, for Also patients taking chronic example, COPD, kidney disease, diabetes, immunosuppressive drug therapy (e.g. compromised immune system corticosteroid or ciclosporin) -With persisting fever and productive cough Required referral (1). -With delirium -With pleuritic-type chest pain Treatment timescale: -Asthma Once the pharmacist has recommended treatment, patient should be advised to see the Dr. in 10-14 days if cold has not improved (3). Management: 1-Antibacterials are not effective or appropriate as both infections are viral. Patients with suspected secondary bacterial infection should be referred to a doctor (4). 2-The same non-prescription medicines are used to treat the symptoms of both the common cold and influenza (4). To reduce the likelihood of catching or passing on infection (4): – If possible, stay away from people with colds or influenza. – Avoid crowded places where the risk of infection is greater. – Do not touch nose or eyes after being in physical contact with somebody who has a cold or influenza. – Wash hands thoroughly, especially after blowing the nose. – Throw away paper tissues after use to prevent the spread of infection. – Keep rooms well aired. 3 A-Non pharmacological measures: Non -drug therapy include: 1-Saline nasal sprays or drops moisten irritated mucosal membranes and loosen encrusted mucus (1). Nasal saline drops or sprays are a useful option to consider in nasal congestion in babies and young children (3). 2-Regarding influenza (4): -Rest, preferably by staying in bed. -Try to get plenty of sleep. -Drink as much as possible, as large amounts of fluid are lost during a fever. B-Pharmacological therapy: ‫ تؤخذ التوصيات الحديثة حول استخدام أدوية السعال والبرد عند األطفال دون سن السادسة من العمر‬:‫مالحظة‬ ‫المذكورة في محاضرة السعال‬ 1-Decongestants (sympathomimetics): Decongestants constrict the dilated blood vessels of the nose (4). A-Systemic (oral) decongestants: like Pseudoephedrine, phenylphrine and ephedrine (3, 4). C/I: Systemic (oral) decongestants cause stimulation of the heart, increase the BP and may cause hyperglycemia. Therefore they should avoid in : [Diabetes mellitus (D.M), ischemic heart disease (angina, M.I), hypertension, and hyperthyroidism). (The hearts of the hyperthyroid patients are more vulnerable to irregularity, so stimulation of the heart is particularly undesirable)] (3). B-Topical (drop/spray) Nasal Decongestants ( sympathomimetics): 1-Classification and Doses (1): Intranasal OTC decongestants include the short acting decongestants naphazoline, phenylephrine, and tetrahydrozoline, and the long-acting decongestants xylometazoline (8- 10hours) and oxymetazoline (12 hours) (1). 2-Topical Nasal decongestants (sympathomimetics) can be recommended for those patients in whom Systemic (oral) decongestants are less suitable (3). (i.e. D.M, Ischemic heart disease (angina, M.I), hypertension, and hyperthyroidism). 3-Dosage of some topical nasal decongestants are listed in table 2-1. 4-Nasal Spray or Drop: -Nasal sprays are preferable for adults and children aged over 6 years because spray has a faster onset of action and cover a large surface area. -Nasal drops are preferable for children aged below 6 years because their nostrils are not sufficiently wide to allow effective use of sprays. (But the drops cover a limited surface area and easily swallowed which increase the possibility of systemic effects) (3). Administration of nasal spray and nasal drop: )‫حخ الصزؼًبل قططح ٔثربخ األَف‬ٛ‫قخ انصح‬ٚ‫خ انطط‬ٚ‫(اَظط انًهحق يغ انًحبظطح نطؤ‬ 4  Table 2-1: dosage of some topical nasal decongestants Drug Dose 0.05%: >12 years 1-2 drops/sprays in each nostril not Naphazoline more often than every 6 hours (1) 0.025%: 6- 12 years 2-3 drops/sprays in each nostril not more often than every 10-12 Oxymetazoline hours (max: 2 doses/24 hours) (1) (Nazordine®): 0.025%: 6- 12 years 2–3 drops 2–3 times a day as required Xylometazoline for maximum duration of 7 days (5) (Otrivine®) 0.05%: 6-