Cold

When should all drug therapy be avoided in pregnant women?

1st trimester through 14 weeks

Which analgesic is the best choice for a pregnant woman?

APAP - category B

Which analgesics are considered compatible with lactation?

APAP and ibuprofen. Avoid ASA

What is appropriate treatment of rhinorrhea and sneezing in a cold?

Antihistamine

Which analgesics should be avoided in pregnancy?

Aspirin NSAIDs in 3rd trimester (affect development, blood flow)

What is not ideal treatment for cold in children?

Aspirin or salicylate products Do not use antihistamine to make child sleepy Do not use other dosing devices (e.g. kitchen spoons)

Can cough agents be used in pregnancy?

Avoid if possible due to questionable efficacy

What are safety concerns with echinacea?

Avoid in children <2, pregnancy, breastfeeding moms May potentiate PO hypoglycemic May increase INR with warfarin

How are most colds transmitted?

By self-inoculation E.g. hand-to-hand contact; touching nasal mucosa; inhalation of aerosolized virus; virus infects respiratory epithelial cells; release of chemokines/inflammatory mediators

When should the caregiver call the health care provider?

Child <3 months Fever for >24 hrs in child less than 2 years Ear pain or sore throat May indicate other infection Symptoms don't improve after 10-14 days

Which antihistamines are generally recommended for pregnant women?

Chlorpheniramine, diphenhydramne, clemastine, doxylamine - safest choices Loratadine may be considered if 1st generation agent not tolerated One school of thought recommends older agents which are also shorter acting

What are appropriate treatments for nasal congestion in the common cold?

Decongestants - pseudoephedrine and phenylephrine 1st generation antihistamines

Are decongestants compatible with lactation?

Decongestants may decrease milk production, may cause irritability. Pseudoephedrine is considered "usually compatible." Avoid phenylephrine due to lack of evidence. Nasal sprays are best (local agents to avoid systemic effect)

How did drug manufacturers respond about FDA recommendations about cough/cold meds in children?

Drug Manufacturers voluntarily updated labels to recommend "Do not use in kids <4 years"

Who should not self-treat for cold?

Fever > 101.5 F; chest pain; SOB; symptoms that worsen during treatment; underlying cardiopulmonary disease (CHF, asthma, COPD); HIV+ or immunosuppressed; frail elderly; infants < 9 mos.

How/when is zinc used to treat a cold?

If used begin treatment within 24-48hrs of symptom onset. Use Q2hrs while awake for duration of cold.

How long can one take echinacea?

If used during URTI limit to < 10 days

What is the biggest risk in OTC treatment of children?

Incorrect dosing. Has led to deaths. Patients should not use kitchen spoons for dosing (range from 2-10ml), use dosing cups or droppers provided. Patient counseling is important. Note varying formulations, some products are very concentrated, others more dilute

What adverse reactions are associated with Vitamin C?

Large doses associated with GI complaints, diarrhea

What are appropriate treatments for pharyngitis in the common cold?

Local anesthetics for short-term relief Systemic analgesics (Ibuprofen, APAP)

What type of formulations in cold medications should be avoided in pregnant women?

Long-acting, ER, SR, or alcohol containing products

Which antihistamine is agent of choice for breastfeeding mothers?

Loratadine 1st generation antihistamines may cause sedation or paradoxical excitation in infant

What cautions should one take in treating elderly with codeine?

May be more sensitive to effects, use low doses

What cautions should one take in treating elderly with dextromethorphan?

May be more sensitive to effects, use low doses Sometimes sedating

How long do cold symptoms last? What pattern do they usually follow?

May persist 1-2 weeks; develop slowly w/similar pattern Sore throat, nasal congestion, rhinorrhea, sneezing, cough, chills, headache, malaise, myalgia, low grade fever (usually < 100 F)

How do you differentiate flu symptoms from cold symptoms?

More sudden onset; less nasal symptoms; higher fever; extreme tiredness; dry cough; aches and chills common

What are appropriate treatments to recommend for children w/cold?

Most - nonpharmacological treatment Fluids Single-ingredient pain-relievers (APAP, ibuprofen) Keeping child upright, gentle nasal suctioning, saline drops or humidifiers for congestion

What cautions should one take in treating elderly for colds?

Much higher risk of ADRs from OTC products and interactions with other drugs and disease states Local therapy a good choice if symptoms respond

What are adverse reactions associated with zinc?

Nausea, Upset stomach Bitter taste (metallic) Case reports of anosmia with nasal products Avoid citrus juices within 1 hr post dose (can chelate zinc)

What non-pharmacological treatments are appropriate for cold?

Non-caffeinated fluids; adequate rest; nutritious diet; vaporizers/humidifiers; steam showers; saline gargle; nasal irrigation/saline spray; staying upright; suction balls

How is Vitamin C used in colds?

Not effective to prevent # colds per year, 1 gr/day may reduce duration of cold if used; initiate early upon symptom presentation

What is considered to have a better safety record for pregnant women? Older or newer products?

Older

What did the FDA say about use of OTC cough and cold medications in children?

Per FDA : All OTC cough and cold meds should be avoided in kids under 2

Are cough medications compatible with lactation?

Probably okay, limited data Alcohol in formulations not a safety hazard at recommended doses

How does echinacea purpura treat cold? Is there good evidence?

Purported to be an immunostimulating agent. Not reliably shown to prevent URTIs, and most recent data show only ~1/2 day reduction in symptoms duration compared to placebo.

What are the goals of cold treatment?

Reduce symptoms; there is no cure, self-limiting

How does zinc treat a cold?

Reported to block adhesion of rhinovirus to nasal epithelium. Efficacy unproven but seems positive.

What type of infection is the common cold?

Self-limited viral infection. May be caused by several viruses, most commonly rhinovirus. Antibiotics are not effective.

What are possible complications of an untreated cold?

Sinusitis, Eustachian tube obstructions, Bronchitis, bacterial pneumonia, Asthma or COPD exacerbations, (Congestion leads to poor drainage of sinus)

When should a patient seek medical attention for a cold?

Symptoms worsen while self-treating Symptoms of bacterial infection Sore throat persists or is associated with persistent fever, headache, nausea, or vomiting

What cautions should one take in treating elderly with analgesics?

Use acetaminophen instead of NSAIDs when possible to avoid drug interactions and renal effects

What cautions should one take in treating elderly with antihistamines?

Use extreme caution with 1st generation agents, 2nd generation preferred Anticholinergic effects; sedation; fall risk/mobility; acute confusion / worsening dementia

Colds usually resolve in 7-10 days. If they don't, what should patients do?

Use maximal doses of medications Change medications Contact your HCP

Can decongestants be used in pregnancy?

avoid 1st trimester use, nasal sprays are drug of choice when used at recommended doses (limit to <3 days of use)

What most likely causes the cough in a cold?

most likely post-nasal drip (i.e., Upper Airway Cough Syndrome). no evidence to use antitussives, expectorants, or 2nd generation antihistamines