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Common etiology of cold
Usually viral, most commonly rhinoviruses
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Transmitting of cold
Transmitted through hand-to-hand contact followed by touching eyes or nasal mucosa
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Pathophysiology of cold
A cold results in the release of numerous inflammatory mediators, primarily cytokines
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Clinical presentation of a COLD
- Gradual onset with slow progression (1-2 weeks duration)
- sore throat
- nasal symptoms
- watery eyes
- sneezing
- cough
- malaise
- low-grade fever
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Three (3) non-pharmacologic therapy of cold
- 1. humidifiers
- 2. increased fluid intake
- 3. rest
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Four (4) types of OTC medications for symptomatic COLD
- Decongestants - for nasal decongestant
- Antihistamines - for excess nasal discharge
- Analgesics - for related pain or HA
- Loca anesthestic sprays/lozenges - for sore throat (pharyngitis)
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1st-Generation antihistamines
- chlorpheniramine (Chlor-Trimeton)
- brompheniramine (Lodrane)
- diphenhydramine (Benadryl)
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2nd-Generation antihistamines
- clemastine (Tavist)
- cetirizine (Zyrtec)
- loratidine (Claritin)
- desloratidine (Clarinex)
- fexofenadine (Allegra)
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Pharmacology of antihistamines: 1st-Generation vs. 2nd-Generation
- Antihistamines are H1-receptor antagonists
- 1st-gen: non-selective & sedating
- 2nd-gen: peripherally selective, non-sedating, & no anticholinergic effects
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SE of antihistamines
- sedation
- anticholinergic effect (only for 1st-gen)
- dry mouth
- dry eyes
- urinary retention
- constipation
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Major concern about using antihistamine in children & elderly patients
- paradoxical stimulation
- decrease performance in school
- death in children <2 y/o
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CI of antihistamines
- Do not drive or operate heavy machinery
- Avoid use with alcohol
- Prostatic hyperplasia can occur
- Narrow-angle glaucoma is possible
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Two (2) OTC oral decongestants
- phenylephrine
- pseudoephedrine (Sudafed)
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Pharmacology of oral decongestants
- alpha-adrenergic agonist & vasoconstriction
- constriction of blood vessels to decrease blood supply to nasal mucosa & decrease mucosal edema
- no effect on histamine or allergy-mediated reaction
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Four (4) requirements of the 2005 Combat Methamphetamine Epidemic Act
- 1. Pseudoephedrine must be kept either behind the counter or in a locked cabinet
- 2. Quantity is limited to 3.6g/d & 9g/month per patient
- 3. Pharmacist must maintain a logbook with the following information - product name, quantity sold, patient's name & address, & time and date sale
- 4. Patients must show valid identification and sign a logbook
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Are oral decongestants safety to use long-term?
These products are relatively safe with no dependence. They can be used long term.
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SE of oral decongestants
- nervousness
- irritability
- restlessness
- insomnia
- incr HR
- incr BP
- irregular heart beat
- palpitations
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Two (2) topical decongestant sprays
- Short-acting: phenylephrine (Neo-Syneprine)
- Longest-acting: oxymetazoline (Afrin)
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The use of topical decongestants > 3-5 days can cause what?
Rhinitis medicamentosa (rebound congestion)
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This solution is very safe & good for use in infants & children. It can be used with oral decongestants.
Nasal saline solution
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Pharmacology: mast cell stabilizer; prevention of the mast cells from releasing inflammatory mediators
cromolyn sodium (Nasalcrom)
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Patient education of cromolyn sodium (Nasalcrom)
Not efficacious if taken prn; must be taken on a scheduled basis (4-6 times a day)
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Three (3) analgesics for the treatment of pain, fever, & headaches associated with cold, flu, or allergies
- 1. APAP
- 2. Aspirin
- 3. NSAIDs (ibuprofen, naproxen, ketoprofen)
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