The Common Cold Guide

C P E Program
[COMMON COLD & ALLERGIC RHINITIS]
Continuing pharmaceutical education

(CPE) program
Alexandria Syndicate of pharmacists
Common cold &

allergic rhinitis
Prepared by :
Ph/Esraa Refaii
Ph/Esraa Basha
Revised by:
Dr.Muhammad Teleb
Presented by:
Ph/Fatma Naguib
Alex syndicate of pharmacists
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Common cold
1-What is common cold?
n acute viral infection in the upper respiratory tract caused by
corona viruses and it is highly contagious. It has no known cure,

but it is rarely fatal.
Colds last on average for one week. Mild colds may last only 2 or 3 days while severe colds may
last for up to 2 weeks and it is a self limiting disease.
2-Symptoms
Runny nose
Sneezing
Tearing
Blocked nose
Sore throat (the first symptom to appear)
Scratchy throat
Cough
Headache
Fatigue
Nasal congestion
Chills
Loss of appetite
Impaired sense of smell
Impaired sense of taste.
Clear thin nasal secretions that become thicker as the infection
progresses and the color may change to yellow or green and when cold
begins to resolve the secretions become clear and watery.
Feverishness (feeling hot without rise in body temperature)
Possible Complications
Bronchitis
Ear infection
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Pneumonia
Sinusitis
Worsening of asthma
3-How do I catch cold? (Transmission)
he common cold is usually spread by direct hand-to-hand contact with infected
secretions or from contaminated surfaces. For example, if a person with a cold blows or
touches their nose and then touches someone else, that person can subsequently become
infected with the virus. Additionally, a cold virus can live on objects such as pens, books,
telephones, computer keyboards, and coffee cups for several hours and can thus be acquired
from contact with these objects.
Your can catch a cold from person-to-person contact or by breathing in virus particles
spread through the air by sneezing or coughing.
4- Common cold VS flu
any people confuse the common cold with influenza (the flu). Influenza is
caused by the influenza virus, while the common cold generally is not. While some
of the symptoms of the common cold and influenza may be similar, patients with the
common cold typically have a milder illness. Patients with influenza are usually
sicker and have a more abrupt onset of illness with fever, chills, headache,
body aches, dry cough, and extreme weakness; also symptoms of flu
appear suddenly while symptoms of common cold appear gradually.
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5- Our goals in treatment
he common cold usually resolves spontaneously in 7 to 10 days, but some symptoms can last
for up to three weeks. There are no medications or herbal remedies proven to shorten the
duration of illness. Treatment is symptomatic support usually via providing analgesics,
antihistaminics and decongestants.
reatment timescale
Once the pharmacist has recommended treatment, patients should be advised to see their doctor in
1014 days if the cold has not improved.
6- Drugs
a- Decongestants (Sympathomimetics)
**
harmacology
The vast majority of decongestants act via enhancing norepinephrine (noradrenaline) and
epinephrine (adrenaline) or adrenergic activity by stimulating the -adrenergic receptors. This
induces vasoconstriction of the blood vessels in the nose, throat, and paranasal sinuses, which
results in reduced inflammation or swelling and mucus formation in these areas.
**
lassifications:
1-Topical.
2-Oral (systemic).
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**
ommon decongestants include:
Ephedrine.(oral)
Pseudoephedrine.(oral)
Levmetamfetamine.
Naphazoline. (topical)
Oxymetazoline. (topical)
Xylometazoline (topical)
Phenylephrine. (oral and topical)
Phenylpropanolamine.(oral)
Propylhexedrine.
Synephrine.
Tetrahydrozoline. (topical)
**
opical decongestants:
Adult dose :1 drop in each nostril 2:3 times daily.

For kids above 1 year ped. Drops :1 drop in each nostril every 12 hours.
Xylometazoline :( Otrivin adult dps, Otrivin ped. dps, Otrivin spray, Rhinex adult
dps, Rhinex ped. dps, Nasostopadult dps, Nasostop ped.dps, Balkisadult dps,
Balkis ped. Dps)
Oxymetazoline: (Afrin adult dps, Afrin pediatric dps, Afrin spray, Iliadin adult dps,
Iliadin ped drops, Iliadin spray, Oxymetadult dps, Oxymet ped dps)
Naphazoline: (Neozoline, Nostamine, Prisoline, Prisoline zinc, Prisoline-blue,

Rhinosin dps, Rhinosin gel, Vibrocil gel, Vibrocil spray) used as nasal and eye drops
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Dose : 1 drop 3 times daily.
**
rops, sprays and gels:
Nasal sprays are preferable for adults and children over 6 years of age because the small
droplets in the spray mist reach a large surface area.
Drops are more easily swallowed, which increases the possibility of systemic effects.
For children less than 6 years of age drops are preferred because in young children the
nostrils are not sufficiently wide to allow the effective use of sprays.
Gels have slow onset of action, longer duration and demulcent effect.
So be wise while choosing your dosage form
dvantages of local decongestants:
Fast onset of action.

Avoiding systemic drug-drug interactions or drug disease interactions.
**
ake care your role comes here:
Topical decongestants should only be used by patients for a maximum of 3-5 days in a row,
because rebound congestion may occur in the form of rhinitis medicamentosa. This
occurs due to down regulation of alpha receptors making the
decongestant ineffective.
Rhinitis medicamentosa (or RM) is a condition of rebound nasal congestion brought on by

extended use of topical decongestants.
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**
ducating the patient:
How to take drops?

1. To apply nasal drops, first blow your nose to help improve penetration of the medication.
2. Lie flat on a bed or couch with your head hanging over the edge.
3. Apply the correct number of drops to each nostril affected being careful not to touch the
container to the inside of the nostril.
4. Move your head from side to side for a minute or two. Do not use this more often than
directed or increase your dose. Therapy usually lasts for 3 to 5 days.
How to use nasal sprays?

1. Blow your nose gently to clear your nostrils.
2. Shake the medication container. If you think a nasal inhaler might be empty, test it by
removing the metal canister and placing it in a container of water. If the canister floats, it is
empty. Reassemble the inhaler if the canister sinks; it is not empty.
3. Keep your head upright. Press a finger against the side of your nose to close one nostril.
With your mouth closed, insert the tip of the pump, spray, or inhaler into the open nostril.
4. Sniff in through the nostril while quickly and firmly squeezing the spray container
or activating the pump or inhaler.
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6. Hold your breath for a few seconds and then breathe out through your mouth.
7. Repeat this procedure for the other nostril only if directed to do so.
8. Rinse the spray, pump, or inhaler tip with hot water and replace the cap on the container.
**
ral decongestants:
Advantages:
No local irritation
No rebound congestion
More prolonged action
Examples:
Pseudoephedrine.
Ephedrine.
Phenylephrine.
Phenylpropanolamine.
**
henylpropanolamine's big problem:
A scientific study found an increased risk of hemorrhagic stroke in patients who used PPA,
although it is not clear which isomer is to blame.
The U.S. Food and Drug Administration recalled the products containing this drug.
The products with PPA were recalled from the market and reformulated again without PPA
as ingredient in common cold combinations (e.g. Congestal (1 tablet 3:4 times
daily) and Night and day (white tablet at day, yellow tablet at night))
Now these drugs are labeled as PPA free drugs.
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**
arket:
They dont exist in pharmaceutical products alone but usually in combinations with analgesics and
anti-histaminics, so the drugs will be mentioned later.
**
**
ho shouldnt take oral decongestants?
Heart disease (they may cause tachycardia and palpitations e.g. pseudoephedrine )
High blood pressure ( they are 1 agonists so they are vasoconstrictors making
hypertension worse)
Kidney disease (they decrease blood perfusion to kidney due to vasoconstriction and might
cause urine retention)
Glaucoma ( 1 receptors lie in the radial muscles of the eye causing mydriasis also they
might be not completely selective to 1 and stimulate 2 increasing formation of aqueous
humor)
Thyroid disease (thyroid hormones affect heart rate also)
Diabetes (stimulation of 2 receptors causing glycogenolysis and increasing BSL)
Trouble urinating from an enlarged prostate gland (stimulation of 1 receptors at the trigone
muscle of the bladder causing more urine retention)
IHD (the heart is already ischemic and the patient is administered vasoconstrictors).
Pregnancy.
roblems with other drugs:
Decongestants can interact with many other medicines you take. If you take any of the products
listed below, talk to your doctor before taking a decongestant:
Monoamine oxidase inhibitors (also called MAOIs) (hypertensive crises)

Insulin (cancel their effect to decrease BSL)
Seizure disorder medicines.(decongestants may cause CNS stimulation)
Diet pills (oral decongestants may be an ingredient in diet pills causing increasing severity of
side effects)
Asthma medicines.
High blood pressure medicines (counteract effect of antihypertensives)
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Decongestants are often combined with antihistamines and/or pain relievers. If you take one of
these combination medicines, its important to understand each of the active ingredients and the
interactions they may have with other drugs youre taking.
n advantage to combinations at last...
Theoretically, if the side effects could be properly balanced, the sleepiness caused by
antihistamines could be cancelled by the stimulation of decongestants.
ide Effects:
High blood pressure.

Trouble sleeping
(insomnia).
Feeling nervous or grumpy.
Increased pulse rate (tachycardia).
In men with an enlarged prostate,

decongestants may cause difficulty in
use of
urination.
B-Antihistaminics
Histamine:
Histamine is a natural substance, one of the important inflammatory mediators produced in
certain cells in the body.
When introduced into the nose, histamine causes dilatation and leakage of
blood vessels. Histamine is also a powerful stimulant of the sneeze reflex.
These effects of histamine cause sneezing, coughing, runny nose, and stopped
up nose during colds. Histamine may also have a role in causing coughs, but
this is less certain.
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ow do they work?
o Antihistamines are a diverse group of drugs which possess the ability to inhibit various
histaminic actions. By and large, they bear a certain structural resemblance to histamine,
and act principally to prevent histamine-receptor interaction through competition with
histamine for histamine receptors. Consequently, they are helpful therapeutically in
preventing, rather than reversing, histaminic actions
o But now it has been discovered that these H1-antihistamines are actually inverse agonists at
the histamine H1-receptor, rather than antagonists
lassifications:
There are two classes of antihistamines, the older ("first generation", "sedating") and the newer
("second generation", "non-sedating") classes. The older class of antihistamines is more effective
for treating colds.
irst generation( sedating or older antihistaminics):
They exist in combinations with decongestants.
**
embers:
Chlorpheniramine, Diphenhydramine (Draminex : 1 tablet 2:3 times daily) ,

Carbinoxamine, and promethazine.
**
ide effects:
The major side effect of first generation antihistamines is

drowsiness, which may be severe in some people due to
passing blood brain barrier.
Anticholinergic actions (dry mouth, urine retention
especially in cases of benign prostatic hypertrophy it
makes the case worse, constipation, blurred vision ,
Adrenergic blockade effects (orthostatic hypotension).
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**
**
ontraindications:
Benign prostatic hypertrophy

Glaucoma
Heart disease
High blood pressure
Pregnancy.
Lactation.
recaution:
Sedating antihistamines cause drowsiness and may therefore affect your ability to drive or
operate machinery safely. This should not be a problem if you take them before going to bed.
**
rug-drug interactions:
Since sedating antihistamines cause drowsiness there is an increased risk

of drowsiness if they are taken with any of the following medicines, which
can also cause drowsiness:
Tricyclic antidepressants, e.g. amitriptyline

Strong painkillers containing opioids, e.g. morphine, codeine,
dihydrocodeine
Benzodiazepines, e.g. diazepam, temazepam, lorazepam
Other sedating antihistamines, e.g. chlorphenamine
Sleeping tablets, e.g. zopiclone.
There may be an increased chance of side effects such as dry mouth and constipation if sedating
antihistamines are taken with other medicines that can have these types of side effects, including:
Antispasmodic medicines, e.g. hyoscine

Other antihistamines, e.g. meclozine
Anticholinergic medicines for Parkinson's disease, e.g. procyclidine
Anticholinergic medicines for urinary incontinence, e.g. oxybutynin, tolterodine
Antipsychotic medicines.
Muscle relaxants.
High blood pressure medicines.
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Betahistine.(Betaserc , Verserc )
econd generation( newer or non-sedating antihistaminics):
The newer (non-sedating) antihistamines do not appear to have the same degree of effectiveness for
treating the sneezing and nasal discharge of colds.
**
embers:
Non-sedating antihistamines such as Cetirizine or Loratadine, Fexofenadine.
Advantages:
**
No Sedation and lower Anticholinergic actions.
**
isadvantages:
Expensive!
**
ontraindications:
o Pregnancy.
o Lactation.
**
arket:
Loratadine: 1 tablet 2 times daily.
Cetirizine: 1 tablet at the evening.
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Fexofenadine:
C-Analgesics
ole:
Analgesic and antipyretic medications are frequently used to treat the

common cold. Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs
with analgesic (pain-reducing), antipyretic (fever-reducing) and, in higher
doses, anti-inflammatory effects. NSAIDs have been widely used for over a century for the treatment
of pain and fever associated with the common cold.
embers:
o Aspirin ( Aspocid 1:2 tablet daily for need)

o Acetaminophen ( Panadol 1 tablet 3:4 times daily)
o Ibuprofen (Brufen 1 tablet 3:4 times daily)
o Ketoprofen ( Ketofan 1 tablet 3 times daily)
o Metamizole ( Oblong novalgin 1:2 tablet daily)
recautions:
NSAIDs cannot be used (are contraindicated) in the

following cases:
Allergy to aspirin or any NSAID
Aspirin should not be used under the age of 16 years (so
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aspocid used only )

During pregnancy ( except paracetamol)
During breast feeding
On blood thinning agents (anticoagulants)
Suffering from a defect of the blood clotting system
(coagulation)
Active peptic ulcer or GERD.
Care is needed if you have:

Asthma.
Kidney impairment.
Heart impairment.
Liver impairment.
ake care:
-Aspirin
is contraindicated in children under 14 years old to avoid the risk of occurrence of Reyes
syndrome.
-Acetaminophen (Paracetamol) is contraindicated in patients with liver
disorders as overdoses cause liver necrosis.
-Metamizole (Novalgin) is not recommended as it causes agranulocytosis and
blue baby syndrome (Never recommend it as an OTC medication)
- NSAIDs are generally contraindicated in case of peptic ulcers, renal
impairment, and asthmatic patients.
- Combination of more than 1 NSAID or with corticosteroids is impractical
as it only increases the side effects.
- All analgesics are never taken on an empty stomach.
rug-drug interactions:
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NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics.
Decrease the elimination of lithium and methotrexate.
NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When
used with other drugs that also increase bleeding [for example, warfarin (Coumadin)],
there is an increased likelihood of serious bleeding or complications of bleeding. Therefore,
individuals who are taking drugs that reduce the ability of blood to clot should avoid prolonged
use of NSAIDs.
D- Local anesthetics
osage forms:
Lozenges, mouthwashes, sprays with local anesthetics (e.g.,

Benzocaine, Dyclonine hydrochloride) or/and local antiseptics (e.g.,
Cetylpyridinium chloride, Hexylresorcinol) and/or Menthol or Camphor.
ole:
Temporary relief of sore throat...
ose:
Every 3-4 hours.
E-Vitamin-C
A systematic review found that high-dose vitamin C (over 1 g per day) reduced the
duration of colds. Vitamin C has been studied for many years as a possible treatment
for colds, or as a way to prevent colds. But findings have been somewhat inconsistent. Overall,
experts have found little to no benefit for vitamin C preventing or treating the common cold.
Dose:1 tablet 1:2 times daily

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7- Antibiotics VS common cold

o Antibiotics should not be used to treat a common cold. They will not help and may make the
situation worse. Thick yellow or green nasal discharge is not a reason for antibiotics, unless it
doesn't get better within 10 to 14 days. (In this case, it may be a sinus infection called
sinusitis.)
o Antibiotics are medicines that kill bacteria, not viruses. Many antibiotics work by disrupting
the bacteria's cell wall. Viruses don't even have a cell wall.
o Antibiotics can actually make colds worse. By indiscriminately killing the beneficial
bacteria, an environment more hospitable to the cold viruses is created.
o To make matters worse, all antibiotics have side effects. All antibiotics harm beneficial
bacteria, and can cause diarrhea, yeast infections, and bacterial super-infections. Even
something as 'mild' as amoxicillin has been known to cause bone marrow toxicity, seizures,
acute interstitial nephritis, neuromuscular sensitivity, nausea, vomiting, and urticarial
rashes.
So we use antibiotics only if the patient's case didnt get better within 10-14 days to avoid secondary
bacterial infections as sinusitis, Otitis media or bronchitis...
You cant kill me Mr.
antibiotic
,,Nyahahahahahaha
8-Home therapy (only helps to control symptoms)
ell the patient to:
Drink plenty of fluids.(honey or better hot fluids as tea with lemon , soup..Etc)
Rest
Gargle with saline (HOW??)
Reduce smoking.
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Use saline nasal sprays.(HOW do they work? How to prepare?)

Use steam inhalations.
or infants: tell the mother to:
Keep the infant in upright position to enhance nasal

drainage.
Maintain adequate fluid intake
Use saline drops to clear nasal passages
Since children can't blow their nose till 4 years old tell the mother to carefully clear
nasal passages with a bulb syringe.
How do saline nasal sprays work?

Saline nasal sprays provide moisture to the nasal passages, especially during the winter when the
environment is cold and dry outside, hot and dry inside. When your nasal passages are dry, mild
nasal crusting may occur, and bacterial infections can develop under these crusts. Saline sprays
clean the nasal passages of crusts and mucus and also help the natural cleaning system of your nasal
passages.
How to prepare saline nasal wash?
To make your own saline, mix the following in a clean container:
to 1 teaspoon salt (such as pickling or canning salt).

Pinch of baking soda (to prevent burning can increase the amount as needed)
1 cup of warm water (filtered or previously boiled water).
How to use nasal wash?

The head should be tilted down, with the rinse bottle or bulb syringe placed into one nostril.
With your mouth open, the bottle or syringe is squeezed with
moderate force, so that the water can go through the nasal
passages and out through the mouth.
If this makes you gag or hurts your ears, squeeze more
gently
and have the water come back out through the nose.
Repeat the same process for the other nostril.
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Saline irrigation may need to be performed on a daily (or multiple times per day) basis for
people with severe symptoms, or less often as symptoms improve.
Saline gargle:
How to prepare saline gargle at home?!
1 tea spoonful of table salt on a glass of warm water.
Steam inhalations
These may be useful in reducing nasal congestion and soothing the air
passages, particularly if a productive cough is present. A systematic
review found that there was insufficient evidence to judge whether there
might be a benefit from this treatment. Inhalants that can be used on handkerchiefs, bedclothes
and pillowcases are available. These usually contain aromatic ingredients,
such as eucalyptus. Such products can be useful in providing some
relief, but are not as effective as steam-based inhalations in moistening
the airways.
ow to protect my self from common cold?
Because so many viruses cause them, there isn't a vaccine that can protect against catching colds.
But to help prevent them, patients should:
Try to steer clear of anyone who smokes or who has a cold. Virus particles can travel up to 12
feet through the air when someone with a cold coughs or sneezes, and secondhand smoke
can make you more likely to get sick.
Washing hands thoroughly and frequently, especially after blowing their noses
Cover your nose and mouth when coughing or sneezing with tissues (have them sneeze or
cough into a shirtsleeve, though, not their hands this helps prevent the spread of germs)
Not use the same towels or eating utensils as someone who has a cold. They also
shouldn't drink from the same glass, can, or bottle as anyone else you never know who
might be about to come down with a cold and is already spreading the virus.
Not pick up other people's used tissues.
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9- Common cold in market

Remember common cold drugs exist mainly in
combinations.
dvantages of the combination:
More clinical efficacy.

To cancel side effects of each individual drug alone (e.g. the sleepiness caused by
antihistamines could be cancelled by the stimulation of decongestants)
isadvantages of combination therapy:

More susceptibility to drug interactions.
10- Common cold in practice...
(Keep this in your mind)
uestions to be asked:
Who is the patient?

Age of the patient (To know if you are dealing with the patient, dosage
form indicated, dose)
How does the patient feel (symptoms!!!)
When did the symptoms start?
Are you pregnant? (Will be discussed as a case later)
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Do you suffer (hypertension, glaucoma, diabetes, epilepsy, thyroid, renal,

cardiac disorders? (if so exclude decongestants and first generation anti-histaminics)
Patient history and if he is taking other medications ( to avoid drug-drug
interactions )
Do you suffer (peptic ulcer, asthma, liver disorder)? ( to exclude paracetamol or
NSAIDs)
Are you driving? Do you operate machinery? (to exclude first generation
antihitaminics)
hen to refer to the physician?
Earache not settling with analgesic

Facial pain/frontal headache
In the very young (we dont deal with age extremes
below 3 and above 60 years old patients)
In the very old (we dont deal with age extremes below
3 and above 60 years old patients)
In those with heart or lung disease, e.g. chronic
bronchitis.
With persisting fever and productive cough.
With delirium.
With pleuritic chest pain.
11- Cases
(These are situations you might see in the pharmacy)
A female patient enters the pharmacy and you asked her the questions mentioned
before and you know that she is pregnant, what do you recommend??
1- Analgesic: Paracetamol only (Adol, Paramol, Panadol, Abimol)
2- Local decongestant (drops or sprays): Otirvin adults, Afrin adults,
Prisoline. (Not to be taken more than 5 days)
3- Advise her to gargle with warm salty water to be prepared as mentioned
before, take lozenges (Larypro, Bradoral, Strepsils, Pectol) and drink
plenty of fluids.
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A man looks to be in his forties enters the pharmacy and from his history you know
that he is a hypertensive patient
You may recommend the following:
1- Analgesic: paracetamol only (Adol, Paramol, Panadol,
Abimol)
2- Second generation anti histaminic: Loratidine (claritine),
citrizine (zyrtec), fexofenadine (telfast)
3- Local decongestant (drops or sprays): Otirvin adults, Afrin
adults, Prisoline. (Not to be taken more than 5 days)
4- Other home therapy advices.
A patient enters the pharmacy and from his history you knew that
he works as a machinery operator (or driving)
You have to avoid combinations with first generation antihistaminics.
For diabetic patients take care of OTC syrups with sugar content you must use sugar
free preparations.
For asthmatic patients avoid NSAIDs
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Allergic rhinitis
Allergic rhinitis is usually found in conjugation with asthma.
Pathophysiology:
Human body produces abnormal high amount of IgE.

These IgE bind to mast cells and destruct them to allow the release of histamine.
Histamine is called the initial mediator and it causes bronchoconstriction that leads to
the appearance of the symptoms.
Treatment:
1-Mast cell stabilizers:
They prevent degranulation of the mast cells so, prevent the release of histamine and prevent
the bronchoconistriction
E.g.: cromolyn and ketotifen
They are the most effective drugs to act as prophylaxic agents from asthma attacks that occur
due to allergic rhinitis.
Pretreatment with cromolyn blocks allergen and exercise induced asthma attacks. To produce
an effect the administration of cromolyn sho
They are less effective in their ant inflammatory effect than corticosteroids; however because of
their excellent safety profile they are used in children.
It is poorly absorbed so, it is of minor side effects. But the main side effects that may occur are:
bitter taste and irritation of pharynx and larynx.
Cromolyn is safe for children and for pregnant women.
Trade names in the market:

Cromolyn sodium:
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Nasotal drops
vividrin spray
ketotifen: It is a mast cell stabilizer and antihistaminic agent (H1 blocker)

ketoti tab.,syrup.
Zaditien
zedotefen
Zylofen
2-Omalizumab:
It is a recombinant DNA derived monoclonal antibody that selectively binds to IgE
so, decrease the binding of these IgE to their receptors on the mast cell as a result
the degree of the release of allergic response mediators will decrease
Trade names:
Xolair by novartis
The drug is administered
once every 2 or 4 weeks.
subcutaneously
Disadvantages:
High cost of the drug
Limitation on the dosage and clinical trials
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The most reported side effects:

There is a risk of anaphylaxis after administration of the drug .This
anaphylaxis may occur even after a year of regular administration of the drug
Injection-site reactions, viral infections, upper respiratory tract infection,
sinusitis, headache and sore throat.
Increasing in the heart rate is reported
Musculoskeletal, dermatological, and oncologic side effects are reported.
3- Antihistaminics:
They are used to reduce rhinorrhoea and sneezing but are usually less effective
for nasal congestion.
A) First generation:
Alimemazine(trimeprazine)
Promethazine
Chlorphenamine
They also called the old generation they cause sedation but promethazine and
trimeprazine may be more sedating.
This sedating activity is used to manage the pruritus associated with some
allergies.
They have short half life time so; they should be taken more than twice.
Sedating antihistaminics have significant antimuscarinic activity and they should be
used in caution with patients suffering from:
Prostatic hypertrophy
Urinary retention
Glaucoma
Asthma
They should not be used for persons who driving cars or working on a machine
due to sedation and psychomotor impairment
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B) Second generation:
They are called the non sedating generation or the newer generation.
Loratidine
Desloratidine
Cetrizine
Fexofenadine(terfinadine metabolite)
Levocetrezine
This group penetrates the blood brain barrier only to a slight extent.
Although drowsiness is rare nevertheless patients should be advised that it may
occur and may affect performance of skilled tasks as driving this sedating effect is
enhanced by alcohol.
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References:
Sites
http://www.cdc.gov/H1N1FLU/
http://www.who.int/csr/disease/swineflu/en/
en.wikipedia.org/wiki/Common_cold
www.niaid.nih.gov/factsheets/cold.htm
www.commoncold.org
www.wrongdiagnosis.com/c/cold/symptoms.htm
http://www.medicinenet.com/common_cold/article.htm
http://health.yahoo.com/allergy-medications/decongestants-for-allergicrhinitis/healthwise--hw118335.html
http://members.kaiserpermanente.org/kpweb/healthency.do?hwid=ug2505
http://www.hon.ch/Library/Theme/Allergy/Glossary/decongestant.html
http://www.patient.co.uk/showdoc/40025153/
http://www.entne http://www.nasal.net/allergy/rhinitis.htm
t.org/HealthInformation/coldRemedies.cfm
http://www.cochrane.org/reviews/en/ab001267.html
http://www.commoncold.org/trtmnt.htm
http://www.netdoctor.co.uk/skin_hair/eczema_antihistamines_003764.htm
www.drgreen.org
Books
Symptoms in the pharmacy (by ALISON BLENKINSOPP, PAUL PAXTON, and JOHN
BLENKINSOPP)
Clinical pharmacy and therapeutics (by By Roger Walker, BPharm PhD FRPharmS FFPH and
Catherine Whittlesea, BSc, MSc, PhD, MRPharmS )
Hand book of non-prescription drugs (Rosemary R. Berardi (Author), II, Edward M. DeSimone
(Author), Gail D. Newton (Author), Michael A. Oszko (Author), Nicholas G Popovich (Author),
Carol J. Rollins (Author), Leslie A. Shimp (Author), Karen J. Tietze (Author)
Introductory to clinical pharmacology (By Marilyn Winterton Edmunds, PhD, ANP/GNP)
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C P E Program

[COMMON COLD & ALLERGIC RHINITIS]

Continuing pharmaceutical education

Common cold &

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

1-What is common cold?

n acute viral infection in the upper respiratory tract caused by

corona viruses and it is highly contagious. It has no known cure,

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

3-How do I catch cold? (Transmission)

he common cold is usually spread by direct hand-to-hand contact with infected

4- Common cold VS flu

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

5- Our goals in treatment

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

ommon decongestants include:

Adult dose :1 drop in each nostril 2:3 times daily.

Naphazoline: (Neozoline, Nostamine, Prisoline, Prisoline zinc, Prisoline-blue,

[COMMON COLD & ALLERGIC RHINITIS]

Dose : 1 drop 3 times daily.

rops, sprays and gels:

So be wise while choosing your dosage form

dvantages of local decongestants:

Fast onset of action.

ake care your role comes here:

Rhinitis medicamentosa (or RM) is a condition of rebound nasal congestion brought on by

[COMMON COLD & ALLERGIC RHINITIS]

ducating the patient:

How to take drops?

How to use nasal sprays?

[COMMON COLD & ALLERGIC RHINITIS]

henylpropanolamine's big problem:

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

ho shouldnt take oral decongestants?

roblems with other drugs:

Monoamine oxidase inhibitors (also called MAOIs) (hypertensive crises)

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

n advantage to combinations at last...

High blood pressure.

In men with an enlarged prostate,

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

irst generation( sedating or older antihistaminics):

They exist in combinations with decongestants.

Chlorpheniramine, Diphenhydramine (Draminex : 1 tablet 2:3 times daily) ,

The major side effect of first generation antihistamines is

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

Benign prostatic hypertrophy

Since sedating antihistamines cause drowsiness there is an increased risk

Tricyclic antidepressants, e.g. amitriptyline

Antispasmodic medicines, e.g. hyoscine

Alex syndicate of pharmacists

[COMMON COLD & ALLERGIC RHINITIS]

econd generation( newer or non-sedating antihistaminics):

Non-sedating antihistamines such as Cetirizine or Loratadine, Fexofenadine.

No Sedation and lower Anticholinergic actions.

Loratadine: 1 tablet 2 times daily.