1. Respiratory Disorders Presented by Muhammad H. Shamim Doctor of Pharmacy Candidate 2005

3. Anatomy of the respiratory tract

4. Nerve supply of the nose

5. Cough Most common symptom for which patients seek medical care Is an important defensive reflex Can be infectious or non-infectious Can be acute or chronic Can be productive or non-productive

6. Treatment of cough Drugs of choice What products should be avoided Exclusion to self-care Counseling patients for cough

7. DrugAdultsChildren 6-<12 years Children 2-<6 years Codeine10-20 Q4-6 (120mg) 5-10 Q4-6 (60mg) 1mg/kg/d in 4 equal doses or by ABW DM10-20 Q4 30mgQ6-8 5-10 Q4 15 Q6-8 2.5-5mgQ4 7.5 Q6-8 Diphenhyd- ramine HCl 25mg Q4 (150 mg) 12.5 Q4 (75 mg) 6.25 Q4 (37.5 mg) Guaifenesin200-400 Q4100-200 Q 4 50-100 Q4

8. Difference between cold & flu Both colds and flu are caused by viruses, and the real difference between them is simply the type of virus that causes the illness

9. SymptomsColdFlu Fever Common in children, usual in adults Common in children Muscle ache Mild, infrequentVery Common, often severe Fatigue Mild, briefCan be severe, can last several weeks N/V & Diarrhea UncommonCommon, especially in children Congestion, runny nose, sore throat Common, especially in early stages Common, but in the late stages

10. Statistics on cold Americans suffer from 1 billion colds annually Children have about 6-10 colds a year Adolescents and adults average 2-4 colds/year Adults greater than age 60 have fewer than one cold per year

11. The Most Common Cause of cold The most common agent is rhinovirus which is spread by contact, sneeze, or cough propelled airborne transmission Rhinovirus has >100 different serotypes Peaks in April-May and September During the peak autumn season, this virus can cause up to 80% of all upper respiratory infections

12. Other Viruses Causing cold Coronaviruses Parainfluenza viruses RSV Adenoviruses enteroviruses

13. Myths about common cold “ catching cold from wet feet or becoming chilled” “Susceptibility to colds requires a weakened immune system” “Central heating dries the mucus membranes of the nose and makes a person more susceptible to catching a cold ” “Having cold symptoms is good for you because they help you get over a cold, therefore you should not treat a cold” “ Drinking milk causes increased nasal mucus during a cold ” “You should feed a cold and starve a fever”

14. Why is cold more common in children?? Newborn children acquire temporary immunity to cold viruses from their mother. By six months this immunity has waned, and children are susceptible to >100 cold viruses Children are particularly at risk for virus infections which affect the lower airway such as pneumonia and bronchiolitis and to middle ear infection (otitis media). Sinus development is incomplete in young children, but they also develop viral and bacterial sinusitis. Sinus, ear drainage passages, and bronchial tubes are small in children and are easily obstructed by mucus and mucosal swelling

15. What Happens after exposure? Virus and the host’s inflammatory response Colonization of respiratory epithelial cells Triggering of histamine, leukotrienes, TNF, and other cytokines Well-known symptoms begin

16. What are the symptoms? Sore throat Sneezes Nasal congestion Rhinorrhea cough

17. Treating the Symptoms of common cold Oral and intranasal decongestants Antihistamines Analgesics and antipyretics Antitussives and mucolytics Natural products for Cold Treatments

18. What are Allergies? Allergies typically feature a clear nasal discharge with sneezing. Allergies There may be itchy, watery eyes and/or a dry cough.dry cough Often parents notice a "rabbit nose" -- a child crinkling her nose to relieve the itchy sensation inside. The "allergic salute" -- rubbing the nose with the hand, sometimes leaving a horizontal crease on the nose -- is another common sign. "Allergic shiners" -- dark circles under the eyes -- have long been associated with allergies, but are less predictive than the other symptoms

19. From allergen to allergic reaction

20. Location of Sinus Cavities

21. Sinusitis Is the infection of the sinuses Can be acute or chronic The goals of treatment

22. Sinusitis in children A sinus infection in a child often begins like a cold but lasts for greater than 10 to 14 days with no period of improvement. Sometimes a sinus infection begins with a high fever (>103 F), facial swelling, or facial pain.fever

25. Delsym dosing (DM 30 mg/5ml) < 12 monthsNot recommended 12-23 months1.25 mL (?tsp) 2-5 years2.5 mL 6-12 years5 mL >12 years(>95 lbs)10 mL

26. Lets apply the knowledge Case No:1: 28 years old woman comes to your pharmacy and asks for some OTC meds for cough. She says she is pregnant and is currently taking amoxacillin. What would you recommend to her to help her relieve her cough?

27. Case No:2 Allen is a 35 years old pharmacy student who is looking for something to help his congestion. He just measured his BP in the pharmacy and it was 155/98. Recently he has been taking a lot of ibuprofen to help him with his knee pain. He also takes elavil for nerve pain. Any recommendations????

28. Case No:3 Amy is a 31 years old lawyer who comes to your pharmacy asking for a decongestant. You graciously point her to where oral decongestants are in your pharmacy. Before she leaves her husband walks in with their 2 month old baby. You thought the baby was so cute. What is wrong with the picture??

29. Case No:4 Carl uses tylenol frequently for his arthritis pain. He comes to your pharmacy and is looking for some meds to relieve his symptoms of cold. You as an intern point to the section where cold OTC products are. you ring him up later for tylenol for cold and sinuses, a bottle of benadryl, Nyquil, and sudafed. What did you just do that could have been avoided??

30. Case No:5 My prescription medications include the following: Atenelol 25 mg once daily Zestril 20mg once daily HCTZ 25 mg daily Help me find OTC products which are safer for my cold, congestion in my chest, and a terrible cough which is productive

31. Questions Comments