Self Care Mid Term Exam Lecture 5 Review

alchemist04's version from 2018-10-08 17:24

Cold Clinical Presentation

Question Answer
SymptomsSore throat, Nasal symptoms, Watery eyes, sneezing, cough, malaise, low-grade fever
OnsetGradual onset w/ slow progression
Duration1 - 2 wks

Nonpharm treatment for Cold

Question Answer
IIncreased fluid intake
HeHead propped upright
RURubber bulb nasal syringe for children < 4yo
IRIrrigation of nose w/ saline drops or mist

Nonprescription medication treatment (symptomatic)

Question Answer
For sore throat, useLocal anesthetic lozenges or spray for pharyngitis
For congestion, useDecongestants (Systemic, Topical, Steroidal, etc)
Nasal dischargeUse Antihistamine + decongestant (combination OTC)
Pain and Headache, useAnalgesics (APAP, ASA, NSAIDs)

Cold onset sequence

Question Answer
Common cold symptoms begins at1 - 3 days
The 1st symptom of common cold isSore throat
When does the nasal symptoms dominate2 - 3 days
rhinovirus sysmptoms persist for how long?7 - 14 days

Exclusions for Cold

Question Answer
Temperature/fever> 100.4F
PainChest pain
BreathingShort of breath or difficult breathing
CCDChronic cardioplumonary Diseases like Asthma, COPD, CHF
infant=/< 3 mo

Other questions on Cold

Question Answer
Maximum Pseudoephedrine per day and month?3.6 g/day or 9 g/month
Decongestants may exacerbate diseases sensitive to adrenergic stimulation, such as1. hypertension, 2. coronary heart disease, 3. ischemic heart disease, 4. diabetes mellitus, 5. hyperthyroidism 6. elevated intraocular pressure, and 7. prostatic hypertrophy.

Allergic Rhinitis - Clinical presentation

Question Answer
NasalCongestion, rhinorrhea, nasal pruritus, sneezing, postnasal drip
OcularItching, lacrimation, redness, irritation
GeneralHeadache, malaise, mood swings, irritability

Antihistamines - Pharmacology

Question Answer
MOAAntihistamines are histamine 1–receptor antagonists.
1st generation selectivityFirst-generation antihistamines are nonselective and sedating.
2nd generation selectivitySecond-generation antihistamines are peripherally selective and have a low incidence of sedation.
Side effects (Anticholinergic)Dry mouth, Dry eyes, Urinary retention, constipation, paradoxical stimulation in some children and elderly patient.
Precautions and ContraindicationsDo not drive or operate heavy machinery. Avoid use w/ alcohol. Prostatic hyperplasia can occur. Narrow-angle glaucoma is possible

Intranasal corticosteroids for Allergy

Question Answer
Triamcinolone acetonideAllergy 24HR
BudesonideRhinocort Allergy Spray
Fluticasone propionateFlonase Allergy Relief, ClariSpray
MOA of Intranasal CorticosteriodsDecrease the influx of inflammatory cells and inhibit the release of cytokines, thereby reducing inflammation of the nasal mucosa
Role of Intranasal Corticosteroid in TherapyConsidered first-line therapy for moderate to severe allergic rhinitis
Antihistamine Vs Intranasal CorticosteroidMore effective than antihistamines, especially for treatment of late allergic rhinitis symptoms such as nasal congestion
Side effects for Intranasal corticosteroidNasal irritation, dryness (or both), Epistaxis, Stinging, burning (or both), Bitter taste
Precautions and contraindicationsIf a patient < 12 years of age plans on using an intranasal corticosteroid longer than 2 months per year, encourage the patient to see PCP.

Dosing for Intranasal corticosteroids

Question Answer
Age 2–5 yearsRefer to primary care provider (PCP).
Age 6–12 yearsIncrease dose to 2 sprays in each nostril daily.
Age ≥ 12 yearsInitiate at 2 sprays in each nostril daily (220 mcg/day). Once symptoms are controlled, patient may be able to titrate down to 1 spray in each nostril daily.

Sysytemic/Oral decongestants for cough, cold and Allergy

GenericProducts and Adult dosage (maximum daily dose)
Phenylephrine Sudafed PE,10 mg q4h (60 mg)
Pseudoephedrine HClSudafed, 60 mg q4–6h (240 mg)
MOA(1) α-adrenergic agonists and vasoconstrictors (2) Constriction of blood vessels to decrease blood supply to nasal mucosa and decrease mucosal edema (3) No effect on histamine or allergy-mediated reaction
Side effects of Oral decongestantsNervousness, Irritability, Restlessness, Insomnia

Precautions and contraindications Oral decongestants

Question Answer
HypertensionThese agents are generally accepted with mild or well-controlled hypertension; they should not be used with uncontrolled hypertension.
Heart disease (arrhythmias and ischemic heart disease)They increase the heart rate.
DiabetesThey have a minimal effect on blood sugar level.
HyperthyroidismThis condition is more sensitive to sympathomimetics.
Enlarged prostateBenign prostatic hyperplasia is exacerbated by constricting smooth muscle of the bladder neck.
Narrow-angle glaucomaDilation increases intraocular pressure.
Blood pressureMAO inhibitors interact with decongestants to increase blood pressure.

Topical decongestants for Cough, Cold, and allergies

Question Answer
MOA(1) α-adrenergic agonists act locally as vasoconstrictors. (2) These agents constrict blood vessels, decrease blood supply to the nose, and decrease mucosal edema. (3) They have no effect on histamine or allergy-mediated reaction.
Side effects of Topical decongestantsMinimal systemic absorption results in few side effects. Local effects may include burning, nasal irritation, and sneezing.
Precautions and contraindicationsRhinitis medicamentosa (rebound congestion) may occur if duration of use is > 3–5 days. The FDA recommends using these products no more than 3 days in duration.

Mast cell stabilizer

Question Answer
Pharmacology/MOAPrevention of the release of inflammatory mediators from mast cells
DosageOne spray per nostril q4–6h
Onset of actionApproximately 1 week; 2–4 weeks for maximal effect
EfficacyNot efficacious if taken as needed; must be taken on a scheduled basis and is more effective if started at least 1 week before symptom onset
Side effectsNasal irritation, nasal burning, stinging, sneezing, cough, unpleasant taste

Special populations

Question Answer
Children age < 4Do not use cough and cold products
All children < 12 years of age areexcluded from self-care of allergy unless they have been diagnosed by a health care provider and are approved for nonprescription therapy.
Second-generation antihistamines and intranasal corticosteroids can NOT be used for self-care in children < 6 years of ageexcept they have been diagnosed by a health care provider and approved for nonprescription treatment


Question Answer
In the first trimesterAvoid products containing pseudoephedrine
The preferred topical decongestant for pregnancy isOxymetazoline
For allergy, What is the 1st line therapy?cromolyn is considered first-line therapy, followed by the second-generation antihistamines: loratadine and cetirizine. Chlorpheniramine can also be used.


Question Answer
Avoid using the following which topical decongestants?xylometazoline and naphazoline.
What is the effect of ALL antihistamines on lactation?can decrease milk production.
For allergy and during lactation, what is the 1st line of therapy?cromolyn is considered first-line therapy, followed by loratadine and chlorpheniramine.