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