Respiratory Disorders

Presented byMuhammad H. Shamim

Doctor of Pharmacy Candidate 2005

Anatomy of the respiratory tract

Nerve supply of the nose

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

Treatment of cough

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

Drug Adults Children 6-<12 years

Children 2-<6 years

Codeine 10-20 Q4-6 (120mg)

5-10 Q4-6(60mg)

1mg/kg/d in 4 equal doses or by ABW

DM 10-20 Q430mgQ6-8

5-10 Q415 Q6-8

2.5-5mgQ47.5 Q6-8

Diphenhyd-ramine HCl

25mg Q4(150 mg)

12.5 Q4(75 mg)

6.25 Q4(37.5 mg)

Guaifenesin 200-400 Q4 100-200 Q 4

50-100 Q4

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

Symptoms Cold Flu

Fever Common in children, usual in adults

Common in children

Muscle ache Mild, infrequent Very Common, often severe

Fatigue Mild, brief Can be severe, can last several weeks

N/V & Diarrhea

Uncommon Common, especially in children

Congestion,runny nose, sore throat

Common, especially in early stages

Common, but in the late stages

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

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

Other Viruses Causing cold

Coronaviruses Parainfluenza viruses RSV Adenoviruses enteroviruses

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”

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

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

What are the symptoms?

Sore throat Sneezes Nasal congestion Rhinorrhea cough

Treating the Symptoms of common cold

Oral and intranasal decongestants Antihistamines Analgesics and antipyretics Antitussives and mucolytics Natural products for Cold

Treatments

What are Allergies? Allergies typically feature a clear nasal discharge with

sneezing. There may be itchy, watery eyes and/or a 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

From allergen to allergic reaction

                                

Location of Sinus Cavities

Sinusitis

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

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.

Delsym dosing(DM 30 mg/5ml)

< 12 months Not recommended

12-23 months 1.25 mL (?tsp)

2-5 years 2.5 mL

6-12 years 5 mL

>12 years(>95 lbs) 10 mL

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?

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????

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??

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??

Case No:5 My prescription medications include the

following:Atenelol 25 mg once dailyZestril 20mg once dailyHCTZ 25 mg dailyHelp me find OTC products which are safer

for my cold, congestion in my chest, and a terrible cough which is productive

Questions

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