Respiratory System Spring

Transcription

1 PHARMACY PRACTICE 1 PHCY 280; Respiratory System Spring Mrs. Beena Jimmy, M.Pharm, PDCR Pharmacy Practice School of Pharmacy University of Nizwa Outline of the presentation Objectives Anatomy of the respiratory system Differentiate the diagnosis of the common cold, sore throat, cough & rhinitis Recommend management of such disorders using over the counter medication 1

2 Respiratory System Upper Respiratory Tract Comprising of: the nasal cavity, the pharynx & the larynx Nasal cavity s main functions are to: Receive olfactory stimuli (smell) Filter out large dust particles Warm & moisten the breathed in air Common cold Most common disorder of the Upper Respiratory Tract OTC medicines for symptom relief Frequently affects Preschool and school children than adolescents and adults. Most of the time it is due to viral infection with rhinovirus (50%) adenovirus & influenza virus Symptoms of the common cold include: Sneezing Mucus buildup in your nose/running nose Difficulty breathing through your nose Sore throat Tiredness May even cause Cough, Sinusitis, Headache 2

3 High fever, severe sinus pain, and a cough that produces mucus may be signs that you have a complication or more serious illness. Common cold do not last longer than 14 days Direct contact transmission by shaking hands Droplet transmission is possible but secondary Influenza (flu) usually occurs in winter, abrupt onset (within hours), loss of appetite, muscular pain (myalgia), chills and malaise Management of Common Cold Decongestants- Sympathomimetics (e.g. ephedrine, pseudoephedrine, Oxymetazoline, Xylometazoline - Act by constricting the dilated blood vessels in the nasal mucosa, help to dry and clear nasal passage. - Nasal sprays/drops if used for more than 7days may cause rebound congestion(rhinitis medicamentosa); but not with oral sympathomimetics. - ADR- Stimulation of the heart, increases blood pressure, prostate problems, diabetes or thyroid problems. - Avoid use of decongestants in children less than 6years Ephidrine-5 to 50 mg ORALLY every 6 h; 0.5% solution INTRANASALLY every 4 h Oxymetazoline- 2-3 sprays or drops of 0.05% NASAL solution in each nostril twice daily for up to 3 days 3

4 Antihistamines- Chlorpheniramine, Diphenhydramine, Promethazine, Triprolidine. They reduce the symptoms of runny nose and sneezing The newer non-sedating/less antihistamines (e.g. loratadine, cetrizine, levocetrizine, acrivastine). Diphenhydramine included in cold remedies for antitussive action ADR- dry mouth, constipation & sedation, hence be careful while driving and operating machinery Use with caution in glaucoma & prostate patients Chlorpheniramine- 4 mg ORALLY every 4 to 6 hours; MAX dose: 24 mg/day Cetrizine mg ORALLY once daily Decongestants Drugs Adverse effects Sympathomimetic s Ephidrine Pseudoephedrine Xylometazoline Oxymetazoline Phenyl propanolamine CNS stimulant Heart rate blood pressure blood glucose Cautiously in patients with hyperthyroidsm SE more with oral drugs Stroke Antihistamines Chlorpheniramine Promethazine Loratidine Cetrizine Acrivastine diphenhydramine More sedating OTC Oman- Brompheniramine, Chlorpheniramine, Pheniramine, Diphenhydramine, tripolidine zinc lozenges, vitamin C, Echinacea (herbal preparation) are also shown to be effective 4

5 Non Pharmacological Treatment Resting in bed and drinking plenty of fluids Saline Gargling- helps relieve symptoms of sore throat and nasal congestion Using ice chips, throat sprays, or lozenges for a scratchy or sore throat Steam inhalation- helps to ease congestion by loosening mucus and easy to clear the mucus by blowing nose. Using petroleum jelly to soothe a raw nose Normal saline nasal drops- relieves the symptoms of nasal congestion in infants Taking aspirin or acetaminophen for headache or fever Colds may lead to bacterial infections of middle ear or sinuses, requiring treatment with antibiotics. However, antibiotics should not be used to treat a cold. Alternative therapies- decreases duration and severity of cold; lemon tea/ginger Check for drug interaction of OTC drugs with prescription drugs Sore Throat Occurrence of sore throat is very common Mostly sore throats are due to viral infection (90%) and are often associated with other symptoms of a cold Streptococcal (bacterial) throat infections are more likely in children of school age Smoking will exacerbate throat pain 5

6 Symptoms If due to viral infection scratchiness, pain sometimes severe, Difficulty to speak, to swallow Cough that is irritant and non productive, usually patient will be holding his neck Pharmacist could palpate the cervical glands located just below the jaw, Ask the patient to open the mouth & take a note of the colour of the innermost part of the mouth Symptoms usually resolve in 7 10 days Bacterial /Streptococcal Sore throat- Symptoms marked tonsilar exudates/ discharge, tender cervical glands, high temps of nearly 40 0 C, swollen glands, no cough & the sore throat has persisted for more than a week Management refer pt immediately Medicine-Induced Sore Throat Medicines may cause sore throat due to agranulocytosis (suppression of White cells in bone marrow): * Captopril * Carbimazole * Cytotoxics * Neuroleptics eg clozapine * Penicillamine * Sulfasalazine * Sulfur-containing antimicrobials Refer Patients: If symptoms do not resolve within 7-10 days. Hoarseness of longer than 3 weeks duration and difficulty in swallowing (dysphagia) Recurrent infection (tonsillitis) 6

7 Glandular Fever Also called infectious mononucleosis Caused by Epstein-Barr virus transmitted primarily through the saliva Common amongst adolescents & young adults Signs & symptoms are almost similar to streptococcal sore throat Enlarged cervical lymph nodes, fever, pharyngitis, throat is very inflamed with creamy exudates Patients are debilitated for some months after the infection Treatment is aimed at symptomatic relief Management Treatment is to provide relief from discomfort and pain Oral analgesics are first line- Paracetamol, Aspirin, Ibuprofen, recently Flurbiprofen (Lozenges) Local anaesthetics (spray)- Lidocaine, Benzocaine Anti-inflammatories- Benzydamine- to relieve pain, as sprays (>6yrs), mouthwashes (>12yrs); it causes numbness and stinging of mouth and throat OTC Oman- Domiphen, Dichlorobenzyl alcohol, Lignocaine 7

8 Be Aware Use with caution in children (all these preparations) Use Flurbiprofen with caution in pregnancy & during breast feeding Lozenge sucking stimulate production of saliva which will lubricate the throat thereby exerting a soothing action Gargles, mouthwashes have very short contact time; lozenges however, have a longer contact time it is preferred Patient should be reminded that mouthwashes and gargles should not be swallowed Check label to ensure if dilution is required or not. Cough Coughing is a protective reflex action caused when the airway is being irritated or obstructed; for airway clearance. The majority of coughs presenting in the pharmacy will be caused by a viral URTI. Age of patient child or adult will influence the choice of treatment and whether referral is necessary. Duration- Most coughs are self-limiting; be better within a few days with or without treatment. May be acute < 3 weeks or chronic > 3 weeks cough Cough of longer than 2 weeks duration that is not improving should be referred Nature of cough- productive (chesty) or non-productive (dry, tight, tickly) cough Non-productive (dry)- no sputum, usually caused by viral infection and are self-limiting. 8

9 Productive cough- Non-coloured (clear or whitish) sputum is uninfected and known as mucoid. Coloured sputum may sometimes indicate a bacterial chest infection; refer Likely causes- Viral infection, Allergy, Chronic bronchitis, Bronchial asthma, Pneumonia, Medications (ACEI), Cardiac failure, Cancer, tuberculosis, GERD Relevant Questions to Ask Colour of sputum- Mucoid (clear & white), yellow/green brown sputum suggests bacterial infection. Haemoptysis suggests sinister pathology. Duration of cough Nature of Sputum Onset of Cough Periodicity Age of the patient- to identify likely cause, choice and dose of medicine TRIGGER POINTS Chest pain Chronic cough (> 3 weeks) not improving Haemoptysis Recurrent nocturnal cough in children Wheeze and/or shortness of breath Sputum (yellow, green, or blood-stained) Suspected adverse drug reaction Failed medication 9

10 Management Demulcents- Simple Linctus: soothe the throat, useful in children and pregnant women. Ingredients are Glycerin, lemon and honey. Cough suppressants/ Antitussives- for unproductive/dry coughs. Codeine, Pholcodine, Dextromethorphan Pholcodine and dextromethorphan is less liable to be abused than codeine. Drowsiness, constipation, respiratory depression are problems with codeine and pholcodeine. Expectorants- for productive coughs. Act directly by stimulating bronchial mucus secretion, leading to increased liquefying of sputum, making it easier to cough up. Guaiphenesin, ipecacuanha, ammonium chloride, Glycerrhiza, squill Guaiphenesin the dose required to produce expectoration is mg PO Q4H; max 2400mg/d (/5ml??) Cautious use of cough formulations by diabetics Sympathomimetics- for its bronchodialatory and decongestant actions. Pseudoephedrine, ephidrine. 10

11 Antihistamines- These reduce the frequency of coughing and have a drying effect on secretions, but cause drowsiness. Diphenhydramine, promethazine. The non-sedating antihistamines have less anticholinergic actions. Theophylline is sometimes included in cough remedies for its bronchodilator effect. Steam inhalation- useful in productive coughs, to liquefy lung secretions, warm moist air comforting. Fluid intake- increased fluid intake helps to hydrate the lungs and hot drinks can have a soothing effect. Dose- refer ONF/BNF- Butamirate, Guaiphenisin, Ipecacuana extract, Ambroxol, Bromhexine, Carbocistine 11