The document discusses common cold symptoms and treatment options. It provides details on collecting patient information such as age, duration of symptoms, and current medications. Common cold symptoms include runny nose, sneezing, cough, headaches, and sore throat. Fever is not usually present with a cold. Over-the-counter treatments discussed include decongestants, antihistamines, saline drops, steam inhalations, and when to refer to a doctor. The document cautions about potential drug interactions and side effects of various treatments.

1. Lok Raj Bhandari

2. Introduction
 The common cold comprises a mixture of upper
respiratory tract viral infections.
 Although colds are self-limiting, many patients choose
to buy OTC medicines for symptomatic relief.
 Some of the ingredients of OTC remedies may
interact with prescribed therapy, occasionally with
serious consequences.
 Therefore, careful attention needs to be given to taking
medication history and selecting appropriate product.

3. I. Information to be collected
1. Age
 Establishing who the patient is – child or adult – is
important.
 This will influence the pharmacist’s decision about the
necessity of referral to the doctor and the choice of
treatment.
 Children are more susceptible to upper respiratory
tract infection than adults.

4. 2. Duration
 Flu: Patients may describe a rapid onset of symptoms
which is said to be more commonly true of flu.
 Common cold: Patients may describe a gradual onset
over several hours .
 The symptoms of the common cold usually last for
about 7 days.
 Some symptoms, such as a cough, may persist after the
worst of the cold is over.
 Such guidelines are general rather than definitive.

5. 3. Symptoms
A. Runny/blocked nose
 Most patients will experience a runny nose
(rhinorrhoea) “This is initially a clear watery fluid
which is followed by the production of thicker and more
tenacious mucus”.
 Nasal congestion occurs because of dilation of blood
vessels, leading to swelling of the lining surfaces of the
nose.
 This narrows the nasal passages which are blocked by
increased mucus production.

6. B Summer Colds
 These are where the main symptoms are nasal
congestion, sneezing and irritant watery eyes, and are
more likely to be due to allergic rhinitis.
C Sneezing/coughing
 Sneezing occurs because the nasal passages are
irritated and congested.
 Cough may be present either because the pharynx is
irritated or due to irritation of the bronchus caused by
post-nasal drip.

7. D .Aches and pains/ headache
 Headache may be experienced due to inflammation
and congestion of the nasal passages and sinuses.
 A persistent or worsening frontal headache may be
due to sinusitis.
 People with flu often report muscular and joint aches.
 This is more likely to occur with flu than with cold.
E .Sore throat
 The throat often feels dry and sore during a cold and
may be the first sign that a cold is imminent.

8. High temperature
 Cold sufferers often complain of feeling hot, but in general, high
temperature will not be present.
 The presence of fever may be an indication of flu rather than a
cold.
 Flu often starts abruptly with hot and cold shivery feelings,
muscular aches and pains in the limbs, a dry sore throat, cough
and high temperature.
 These symptoms resolve over 3-5 days. There is a period of
generalized weakness and malaise following the worst of the
symptoms.
 A dry cough may persist for some time.
 Warning that complications are developing may be given by
severe or productive cough, persisting high temperature,
pleuritic-type chest pain or delirium.
 Flu can be complicated by secondary lung infection
(pneumonia). Complications are much more likely to occur in
the very young, the very old and those who have pre-existing
heart or lung disease (chronic bronchitis).

9. G. Earache
 Earache is a common complication of colds, especially in
children.
 When nasal catarrh is present, the ear can feel blocked.
This is due to middle ear to the back of the nasal cavity.
 Under normal circumstances the middle ear is an air-
containing compartment.
 However, if the Eustachian tube is blocked the ear can no
longer be ‘cleared’ by swallowing and may feel
uncomfortable and deaf.
 This situation often resolves spontaneously, but
decongestants and inhalations can be helpful. Sometimes
the situation worsens when the middle ear fills up with
fluids.
 This is an ideal site for secondary infection” otitis media” to
settle.
 When this does occur the ear becomes acutely painful and
usually requires antibiotics.

10. H .Facial pain/ frontal headache
 It may signify sinusitis.
 Sinuses are air-containing spaces in bony structure adjacent to
the nose (maxillary sinuses) and above the eyes (frontal sinuses).
 In a cold, their lining surfaces become inflamed and swollen,
producing catarrh. The secretions drain into the nasal cavity. If
the drainage passage becomes blocked, fluid builds up in the
sinus and can be secondarily infected with bacteria. If this
happens, persistent pain arises in the sinus areas.
 The maxillary sinuses are most commonly involved, causing pain
and swelling in the area of the face next to the nose.
 When the frontal sinuses are infected, the sufferer may complain
of a frontal (forehead) headache. The pain of sinusitis may be
worsened by bending forwards or lying down.

11. 4.Previous history
 Chronic bronchitics may be advised to see their doctors if they
have a bad cold or flu-like infection, as it is often complicated by
a secondary chest infection.
 Also, many asthmatic attacks are triggered by upper respiratory
tract viral infections.
 Certain medications are best avoided in those with heart
diseases, hypertension and diabetes.
5. Present medication
 The pharmacist must be aware of any medicines being taken by
the patient. It is important to remember that interactions might
occur with some of the constituents of commonly used
medicines.
 If medication has already been tried for relief of cold symptoms
with no improvement and if the remedies tried were appropriate,
referral to the doctor may be considered. In most cases of colds
and flu, OTC treatment will be appropriate.

12. III- Treatment timescale
 If symptoms have not improved within a week, the
patient should see the doctor.
IV- Management
 The use of OTC medicines in the treatment of cold
and flu is widespread.
 The pharmacist’s role is to select appropriate
treatment based on the patient’s symptoms.
 Polypharmacy abounds in the area of cold treatment,
and patients should not be ‘over treated’.

13. 1.Decongestants:Sympathomimetics
 Sympathomimetics (e.g., pseudoephedrine or
phenylpropanolamine) can be effective in reducing
nasal congestion.
 Nasal decongestions work by constricting the dilated
blood vessels in the nasal mucosa.
 The nasal membranes are effectively shrunk, so the
drainage of mucus and circulation of air are improved
and the feeling of nasal stuffiness is relieved.
 These medicines can be given orally or topically.
 Tablets and syrups are available, as are nasal sprays
and drops.

14.  If nasal sprays/drops are to be recommended, the
pharmacist should advise the patient not to use the
product for more than 7 days.
 • Rebound congestion (rhinitis medicamentosa) can
occur with topically applied, but not oral
Sympathomimetics.
 • The decongestant effects of topical products
containing oxymetazoline or xyloetazoline are longer
lasting (up to 6 hours) than those of other preparations
such as ephedrine. The longer acting topical
decongestants are said to be less likely to cause
rebound congestion. The pharmacist can give useful
advice about the correct way to administer nasal drops
and sprays.

15. PROBLEMS:
 1. The pharmacist should be aware that some of these drugs
(e.g., ephedrine, pseudoephedrine), when taken orally, have
the potential to keep patients awake, because of their CNS
stimulating effects. Generally, ephedrine is more likely to
produce this effect than the other members.
 Solution: It may therefore be reasonable to suggest that the
patient avoids taking dose of the medicine near bedtime.
 2. Sympathomimetics can cause heart stimulation and an
increase in blood pressure, and may affect diabetes control
because they increase blood glucose levels.
 They should not be used by diabetic patients, those with heart
disease or hypertension, or with hyperthyroidism. Hyperthyroid
patients’ hearts are more vulnerable to irregularity, so that
stimulation of the heart is undesirable.

16.  Sympathomimetics are most likely to cause these
unwanted effects when taken orally and are unlikely to
do so when used topically.
 Solution: Nasal drops and sprays containing
sympathomimetics can therefore be recommended for
those patients in whom the oral drugs are to be
avoided.
 Saline nasal drops or the use of inhalations would be
other possible choice for the patients in this group.

17.  3. The interaction between sympathomimetics
and MAOIs (phenelzine) is potentially serious – a
hypertensive crisis can be induced, and several
deaths have occurred in such cases.
 This interaction can occur up to 2 weeks after a patient
has stopped taking the MAOI, so the pharmacist must
establish any recently discontinued medication.
Solution: There is a possibility that topically
applied sympathomimetics could induce such a
reaction in a patient taking MAOI. It is therefore
advisable to avoid both oral and topical
sympathomimetics in patients taking MAOIs.

18. C/I and I

19. 2 Antihistamines
 They can reduce some of the symptoms of a cold as
runny nose (rhinorrhoea) and sneezing. These effects
are due to anticholinergic action of
antihistamines.
 • The older drugs (e.g., chlorpheniramine,
promethazine) have more pronounced anticholinergic
actions than do the non-sedating antihistamines (e.g.,
astemizole, terfenadine, loratidine). Antihistamines are
not so effective to reduce nasal congestion.
 • Some (e.g., diphenhydramine) may also be included in
cold remedies for their supposed antitussive action.

20. PROBLEMS:
1.The problem of using antihistamines, particularly the older
types, is that they can cause drowsiness.
 Alcohol will increase this effect, as well drugs which have
the ability to cause drowsiness or CNS depression e.g.,
benzodiazepines, phenothiazines or barbiturates.
 Solution: antihistamines with known sedative effects
should not be recommended for anyone who is
driving, or in whom an impaired level of
consciousness may be dangerous (e.g., operators of
machinery).

21.  2. Because of their anticholinergic activity, the older
antihistamines may produce the same adverse effects as
anticholinergics, i.e., dry mouth, blurred vision,
constipation, urinary retention.
 These effects are more likely if antihistamines are given with
anticholinergics such as hyoscine, or with drugs which have
anticholinergic action such as TCADs.
- Solution:
 They should be avoided in glaucoma and prostatic hypertrophy
because of possible anticholinergic side effects.
 Increased intra-ocular pressure is one of such side effects; hence
antihistamines are best avoided in patients with closed-angle
glaucoma. Anticholinergics can precipitate acute urinary
retention in predisposed patients, for example, men with
prostatic hypertrophy.
While the probability of such adverse effects is low, the pharmacist
should be aware of the origin of possible adverse effects from OTC
medicines.

22. 3. At high doses, antihistamines can produce stimulation
rather than depression of the CNS.
4. There have been reports of fits being induced at very
high doses of antihistamines, and it is for this reason it
has been argues that they should be avoided in
epileptic patients.
5. Chlorpheniramine has been reported to cause
elevated serum phenytoin levels and there could be
the risk of toxic effects when the two are given
concurrently.
6. Antihistamines can antagonise the effect of
betahistine.

23. Antihistamines: C/I and side effects

24. IV- Practical Points
A. Diabetics
 In short term use for acute conditions the sugar contents of
OTC remedies is less important.
B. Steam inhalations
 These may be useful in reducing nasal congestion and
soothing the air passages, particularly if a productive
cough is present.
 Inhalation which 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 inhalation.

25. C. Nasal spray or drops
 Nasal sprays are preferable for adults and children
aged over 6 years.
 Because the small droplets in the spray mist reach a large
surface area.
 Drops are more easily swallowed, which increases the
possibilities of systemic effects.
 For children under 6 years, drops are to be preferred
because in young children the nostrils are not
sufficiently wide to allow the effective use of sprays.
 Paediatric versions of nasal drops should be used when
appropriate.
 Manufacturers of paediatric drops advise consultation with
the doctor for children less than 2 years.