1. Respiratory system (7)

A. NOSE :-
3. Sinusitis :- (part 2)

ACUTE SINUSITIS 

1. DEFINITION:-
Acute inflammation of mucous membrane lining the sinuses +/- nose 

2. ETIOLOGY :-

A. Causative organisms :-
1. BACTERIA:-

• Streptococci Pneumoniae
• Staphylococcus Aureus
• H. influenza 
• Moraxella   Catarrhal 
• Klebsilla 

2. FUNGAL:-

•  Mucormycosis ( very fatal, occurs with diabetic patients)

3. VIRAL :-

B. ROUTE :-

1. Nose 
2. Dental to maxillary sinus 
3. External through open fractures of sinus 

C. PREDISPOSING FACTORS :-

1. Allergic sinus 
2. Divided nasal septum 
3. Rhinitis 
4. Immunocompromised  patients 

3. PATHOLOGY:-

1. Suppurative ( purulent discharge )
2. Non - suppurative ( catarrhal discharge)

4. CLINICAL PICTURE :-

A. SYMPTOMS :-

1. Nasal discharge :-

• purulent in case of suppurative acute sinusitis 
• watery in case of non - suppurative acute sinusitis 

     2.  Nasal obstruction:-

• Unilateral or bilateral 

     3. Anosmia 

     4. Headache :-

• especially in the morning 
• increased with cough and strain
• especially areas over the sinus 

     5.  Epistaxis 

     6.  General Fatigue and malaise  

  B. SIGNS :- 

1. Nose ( Edema, Congestion )
2. Throat ( postnasal discharge )
3. Tenderness over the affected sinus 
4. Fever 

  C. INVESTIGATIONS :- 

1. Radiology ( X- ray and CT scan )
2. Bacteriology ( culture and sensitivity tests )
3. Immunology ( for allergic causes )

SPECIAL THANKS 

DR. MINIA EZT 

THANKS 

MILAD REDA 

Pharmacy To Be Easy : Respiratory system (6)A. NOSE :-3. Sinusitis :-...

Pharmacy To Be Easy : Respiratory system (6)
A. NOSE :-

3. Sinusitis :-...: Respiratory system (6) A. NOSE :- 3. Sinusitis :- ( part 1)     Inflammation of the mucous membrane which lines the paranasal sinus cavi...

Respiratory system (6)
A. NOSE :-

3. Sinusitis :- ( part 1)
    Inflammation of the mucous membrane which lines the paranasal sinus cavity .

1. Sinus :- 

• Bony structures filled with air 
• when filled with fluids ( bacteria, viruses and fungi can grow )
• structure of paranasal sinuses  :- 

1. Frontal sinus
2. Maxillary sinus 
3. Ethmoid sinus 
4. Sphenoid sinus 

NORMAL STRUCTURE :-

INFLAMED STRUCTURES

• Function of sinus :- 

1. Accommodation  of air temperature 
2. Lighting weight of the skull 
3. Resonance of the voice 

2. Types of sinusitis :- 

1. Acute :-

• Suppurative ( allergic the most )
• Non - suppurative 

     2. Chronic :-

• Specific 
• Non - specific  

3. Symptoms :-

• Headache or facial pain/ pressure ( morning or postural headache )
• Nasal discharge 
• Nasal congestion 
• Cough ( post nasal drip)
• Fever 
• In rare cases ( Epistaxis )

Types  and Symptoms will discussed next time in details. ( part 2)

BOOKS FOR TRAINING:-

FIRST BOOK:-

BNF ( British national formulary )

TO DOWNLOAD :-

https://app.box.com/s/cvprd78mc7nsjl00daj47up9eq20dpjs

THANKS 

MILAD REDA 

Pharmacy To Be Easy : Respiratory System (5)A. NOSE:- Common cold and ...

Pharmacy To Be Easy : Respiratory System (5)

A. NOSE:- Common cold and ...: Respiratory System (5) A. NOSE:- Common cold and Flu ( part 3) TREATMENT :-  2. Antihistamines:-  A. ACTION:-  block histamine re...

Respiratory System (5)

A. NOSE:- Common cold and Flu ( part 3)

TREATMENT :- 

2. Antihistamines:- 

A. ACTION:- 

• block histamine receptors 
• block histamine release from mast cells 
• decrease inflammation and edema 

 B. CLASSIFICATION :-

1. FIRST GENERATION ( sedating ) :- 

        A. sedating :-

• Bromopheniramine 
• Chloropheniramine 

      B. high sedating :-

• Clemastine 
• Diphenhydramine 
• Doxylamine 
• Promethazine 

      C. Minimum  sedating :-

• Cetrizine 
• Chlorcyclizine 
• Meclizine 
• Levocetrizine 

2. SECOND GENERATION ( non-sedating ) :-

• Fexofenadine 
• Loratidine
• Phenindamine 

C. USE:-

• used to treat symptoms as 

                                           1. Sneezing 

                                           2. Itching 

                                           3. Rhinorrhea 

D. DOSE :- 

Antihistamines Doses
No.	Drug	Dose / day
		Above 12 year	6- 12 year	2 – 6 year
1	Bromopheniramine	24 mg	12 mg	No
2	Chloropheniramine	24 mg	12 mg	No
3	Cetirizine	10 mg	5 – 10 mg	2 – 5 mg
4	Diphenhydramine	300 mg	150 mg
5	Doxylamine	75 mg	37,5 mg
6	Loratidine	10 mg	10 mg	5 mg
7	Fexofenadine	180 mg	60 mg

E. OVERDOSE :-

 Over dose of sedating drugs can lead to :-

1.   Toxic psychosis 
2.   Hallucination 
3.   Insomnia 
4.   Tonic - clonic seizures 
5.   Tachycardia 
6.   Urine retention 

 Over dose of non - sedating drugs can lead to :-

1.  Headache 
2.  Tachycardia   

F. SIDE EFFECTS:-

1. Mainly sedation and drowsiness in case of sedating drugs 

2. Anexity 

3. Hallucination

4. Dryness of ( eye, mouth, vagina)

5. constipation  

G. DRUG INTERACTIONS:- 

1. Alcohol

2. Benzodiazepines 

3. Barbiturates 

H. CONTRAINDICATIONS:-

1. Newborns and infants 

2. Lactating mothers ( all antihistamines secreted in milk)

3. Glaucoma ( narrow angle)

4. Acute asthma

5. Peptic ulcer

6. Prostate hyperatrophy 

7. Bladder obustraction 

8. Epilepsy 

9. Liver disease 

10. Chronic bronchitis 

I. CAUTIONS :- 

 

DO NOT USE SEDATING DRUGS WITH 

1. Drivers 
2. Factory workers 
3. Machine workers    

J. NOTE :- 

Antihistamines ...... photosensetizing agents 

patients must avoid sun exposure  or wearing  protective cloths or use sun screen 

3. ANALGESICS AND ANTIPYRETICS :-           

Most common used in cold preparations 

1. Paracetamol
2. Aspirin 
3. Ibuprofen 

4. Other products :-

1. Cough preparation ( dextromethorphan and guaifenesin )
2. Vit. C
3. Herbal products ( eucalyptus, thymol, menthol, camphor, tilia , fennel)
4. Vaccines 
5. Antibiotics 

5. MARKET :- 

1. COMBINATION OF (chloropheniramine+pseudoephedrine+paracetamol)

1.  1   2   3® 
2.   Babyrhino®
3.   Cetal cold and flu®
4.  Cold free® 
5.  Congestal® 
6.  Fever n flu®
7.  Flumol ®
8.  Flupy x® 
9.  Flustat ®
10.  Neomichealon® 
11.  No flu® 
12. Panadol cold and flu® 
13. Rhinomol s ®

2. Same combination + Caffeine 

1. Flurest

®

 

2.  Coldact

®

 

3.  Coldex 2 

®

4. Flustop

®

 

5. Nova c n

®

6. Power cold and flu

®

 

3. Combination with Ibuprofen 

1. Sinlerg 
   ®  
2. Cetaphed® 
3. Brufen flu 
   ® 
4. Brufen cold 
   ®
5. Advil cold and sinus® 
6. Dolo d
   ®
7. Farex 
   ®
8. Powercaps 
   ®
9. Rhinofen® 

4. Combinations containing Vit. C :-

1. Euopack plus® 
2. Flu C®
3. Grippostad C® 
4. GC  mol® 
5. Ezmol c ®
6. Panadol cold and flu ®
7. Cidal c® 

5. Combinations containing ASPRIN :-

1. Vegaskine d®
2. Cidal c ®

6. Combinations containing Dextromethorphan :- 

1. Cold stop® 
2. Congestal syrup® 
3. Vegaskine d®
4. Triaminic cold and cough ®
5. Day nurse ®
6. Vicks day quil®
7. Tylenol cold ® 

7. Combinations containing non- sedating antihistamines :-

1. Decongess 1 ®
2. Decodine plus® 
3. Clarinase® 
4. Allercet® ( minimum sedation or negligable )
5. Loratin d ®
6. Trimed flu 
7. Xinase® ( minimum sedation ) 

8. Other combinations :-

1. Cometrex ®
2. Balkis ®
3. Otrivin ®
4. Cafamol ®
5. Conta flu ®
6. Night and day® 
7. Sine up® 

9. Herbal products :-

1. Immuno flu® 
2. Vapozol ®
3. Propolis Lemon ®
4. Sekem cold and flu®

6. DEALING WITH SPECIAL CASES:-

1. Infants and children :-

• Use low doses 
• Use syrup dosage forms 
• For nose ...... use Otrivin® children   or baby saline according to age 
• Avoid products containing ASPIRIN  ( Ray's syndrome )

2. Cardiovascular :-

• Avoid decongestant ( especially systemic )
• Use topical decongestant in low doses 
• Use combination of analgesic + antihistamines + topical decongestant 

3. Diabetes :-

• Avoid products containing systemic decongestant 
• Avoid syrups containing sugars 

4. Pregnancy :-

• Avoid combinations 
• most of systemic decongestant is contraindicated 
• Use 

1. Topical decongestant as Oxymetazoline ( Affrin® )
2. Use Herbal products as Vapozol®       and    Flonaz® 
3. Use analgesics  as Paracetamol ( paramol®, panadol®, adol® )
4. Use Antibiotics ( if needed) as Amoxicillin ( Amoxil®)
5. Use analgesics + Vit. C  combinations  as ( Cevamol® )
6. Use packets as ( Sekem Flu®)

5. Lactating Mothers :-

• Avoid decongestant as decrease milk production 
• Use nasal phenylephrine 
• Must avoid topical oxymetazoline (Affrin®) and naphazoline 
• Use analgesics as Paracetamol and avoid Aspirin 
• Use herbal products as above 
• Must drink large amounts of fluids 

6. Liver disease :-

• Avoid decongestant and antihistamines in severe cases 
• USE topical products  as Otrivin®         Vapozol® 
• Use analgesics as ........... Hepamol® 
• Must decrease doses in systemic drugs 

7. Workers and drivers :-

• avoid products containing sedating antihistamines 

OTHER PRODUCTS :-

1. ANTIVIRAL :-

• AS Amantadine 

2. VACCINES :-

• Used in patients who are at high risk to influenza 
• avoid in case of flu+ fever ( wait until recovery to get vaccinated )
• Used in October 
• EX:-

1. Hiberix® 
2. Agrippal®
3. Fluarix ®
4. Influvac® 
5. Vaxigrip® 

THANKS 

MILAD REDA 

   

Pharmacy To Be Easy : Respiratory System(4)1. Nose :- Common cold an...

Pharmacy To Be Easy : Respiratory  System(4)

1. Nose :-  Common cold an...: Respiratory  System(4) 1. Nose :-  Common cold and Flu ( Part 2) Treatment :-  A. Asking :-  You must know the following information ...

Respiratory  System(4)

1. Nose :-  Common cold and Flu ( Part 2)

Treatment :- 

A. Asking :- 
You must know the following information before starting OTC treatment 

1. Age :- 

• approximative age of patient 
• child or adult or elderly 
• Age affects the following  

                                 1. choice of suitable treatment 
                                 2. choice of suitable dose 
                                 3. choice of suitable dosage form 

• children more susceptible to respiratory infections 
• elderly and above 65 years ............. at risk 

2. Onset of symptoms :- 

• Rapid onset means Flu (influenza )
• Gradual symptoms means Common cold 

3. Runny or Blocked Nose:-

• Runny nose ........... occurs at first days 
• start with rhinorrhea and clear watery fluid 
• then ........ production of thick mucous and may be purulent 
• Blocked ............. Occurs due to vasodilation of blood vessels in nasal mucosa and swelling of leaning surface and production of thick mucous discharge 
• Clear nose ......... most common in flu 

4. Summer cold :-

• Flu and common colds more common in winter months 
• summer symptoms as 

                                     1. Congestion 

                                     2. Sneezing 

                                     3. Irritant watery eyes 

( more likely due to Allergic Rhinitis not a common cold or Flu)

5. Sneezing /Cough:-

• most common with colds 

6. Headache :- 

• Occur due to inflammation and congestion of nasal passages and sinuses 
• pain above or blow eyes due to Sinusitis 
• Patients with Flu having 

                                        1. more headache and pain 

                                        2. more muscle and joints pain 

7. High temperature:-

• Common cold ................. Low grade fever 
• Flu .............. High grade fever ( 37,9- 38,9  c )

8. Sore throat:-

• feels dry and sore 
• More common in Colds than Flu
• sometimes be the FIRST symptom of Common Cold 

9. Earache :- 

• common complication of common cold 
• indicates .......... Otitis media 
• Especially in children 
• occur due to blocking of Eustachein tube ( connect between middle ear and nose )

10. Facial pain and frontal headache :-   

• strongly indicates Sinusitis ( next topic )

11. History :-

• Ask about the following :-

                     1. Medications ( to avoid interactions with OTC drugs )

                     2. Diseases ( CVS, Diabetes , CNS , Liver, Renal ) 

B. Refer :- 

When to refer to physician :-

1.       Fever more than 38.9 C 
2.       Elderly ( age above than 65 years )
3.       Infants ( less than 9 months )
4.       Chest pain 
5.       Earache 
6.       Asthma 
7.       Concurrent diseases 

C. Non-Pharmacological Treatment :-

• Increase fluid intakes 
• Bed rest 
• Good nutrition 
• Using of humidifier  or vaporizer ( steam )
• Using of tea, lemon , honey , orange , soaps  

D. PHARMACOLOGICAL TREATMENT:-

Most products of common cold and flu available in market present in a combination of two or three of the following categories :-

1. Decongestant 
2. Antihistamines 
3. Analgesic and Antipyretics 
4. Vitamin c 

Other medication can be used as ;- 

1.   Cough Products 
2.   Antibiotics ( complications )
3.   Antivirals 
4.   Vaccines 

1. Decongestant:-

A. Action:- 

Used to relieve  congestion by blood vessels vasocostriction and decrease edema

B. Classification :-

3 types of decongestant present :-

1. Direct Decongestant ( acts directly on receptors):-

• phenylephrine 
• oxymetazoline 
• tetrahydrozoline 

     2. Indirect :-

• ephedrine 

     3. Mixed type :-

• pseudoephedrine 

Decongestant available as OTC treatment :-

1. Systemic Decongestant :-

• phenylephrine
• pseudoephedrine

     2. Nasal Decongestant:- 

            A. Short Acting :-

• ephedrine 
• epinephrine 
• naphazoline 
• phenylephrine 
• propyl hexidine 
• tetrahydrozoline 

           B. Intermediate Acting :-

• xylometazoline 

           C. Long Acting ;-

• oxymetazoline 

C. Dose of Decongestant :- 

No.	Drug	Dose  per day
Systemic decongestant
Age		Above 12 years	6 – 12	2 - 6
1	Phenylephrine. HCL	60 mg	5 mg	2,5 mg
2	Phenyehrine bitartarate	62 mg	7.8 mg	No
3	Pseudoephedrine	240 mg	30 mg	15 mg
Topical decongestant
1	Ephedrine  0.5 %	2 – 3 drops	1 – 2 drops	No
2	Naphazoline  0.5 %        0.025 %	2 – 3 drops	1 – 2 drops	No
3	Oxymetazoline  0.5 %         0.025 %	2 – 3 drops	1 – 2 drops	No
4	Phenylephrine 1%       0,5 %	2 – 3 drops	1 – 2 drops	No
5	Xylometazoline    0.1 %     0.05%	2 – 3 drops	1 – 2 drops	No

D. Over dose of decongestant :-

causes 1. CNS Stimulation 

            2. CVS Collapse 

            3. Shock 

            4. Coma 

E. Side effects of Decongestant :- 

     1. CVS ( elevated blood pressure, tachycardia )

     2. CNS ( restlessness, insomnia, hallucination)

     3. side effects more common in systemic than topical products 

G. Duration of therapy:-

   

1.     3- 5 days are the accepted duration of therapy to avoid rebound congestion 

2. treatment of rebound congestion :-

• withdrawal of topical decongestant 
• replace with nasal saline 
• use systemic decongestant 
• using of topical hydrocortisone 
• mucosa will return to normal within 1 - 2 weeks 

H. Contraindications :- 

• hypertension 
• diabetes 
• hyperthyroidism 
• coronary heart disease 
• prostatic hyperatrophy 
• increased intra-ocular pressure (glaucoma ) 

I. Drug interactions :-  

• patients receive MAOIs as 

                                          1. tranylcypromine ( parentil 10 mg )

• TCAS ( amytriptyline)
• betablockers  

                  

other treatment and market products .......................  NEXT TIME 

THANKS 

MILAD REDA