Cecilia Brata

Eko Setiawan
Farmasi komunitas 1
2016

Learning objectives
Know what is common cold along with its pathophysiology,
clinical presentation, and causes.
Know the basic knowledge of common cold medications
Explained further in Praktikum session

Understand the BASIC PRINCIPLES of self-medication

consultation for patients with common cold
Know the important information that should be gathered when
handling patients with common cold.
Able to analyse the information gathered in order to give appropriate
recommendation.
Know what information that should be conveyed when recommending
product and/or non-pharmacological therapy

Common cold

Common cold
A common cold is a viral infection of the upper
respiratory tract
The majority of colds are caused by rhinoviruses

COMMON
COLD
VIRAL

Pathogenesis of symptoms associated with

common cold

Adopted from Brian C. http://www.microbiologybook.org/Infectious%20Disease/Upper%20respiratory%20tract.htm

Clinical presentation
Scolaro KL. In Berardi et.at; Blenkinsopp et.al

Sore throat
Rhinorrhea (runny nose)
Clear, thin, watery nasal secrets at the beginning of infection
progress to thicker, yellow secrets returning to clear,
thin, watery nasal secrets when the cold resolves

Nasal congestion (blocked nose)

Sneezing
Coughing
Fever (rarely), usually low grade
Aches, muscular paints (more likely related to flu)
Headache - frontal (more likely related to sinusitis)

Colds or flu
Colds
Symptoms:
runny nose beginning
with clear mucus that
develops into thicker,
green mucus as the cold
progresses
blocked nose
sore throat
sneezing
cough

Flu
usually comes on much
more quickly than a cold
Symptoms:
sudden fever of 38-40C
(100-104F)
muscle aches and pains
sweating
feeling exhausted and
needing to lie down
a dry, chesty cough

http://www.nhs.uk/Livewell/coldsandflu/Pages/Isitacoldorflu.aspx

Differentiation of colds and other respiratory disorders

(Scolaro KL. In Berardi et.al)

Complication
Sinusitis
Middle ear infections
Bronchitis
Bacterial pneumoniae
Exacerbation of asthma and COPD

Self-medication consultations for

common cold in community
pharmacy

Basic principle of self-medication consultation

in community pharmacy (simple model)
Patients come to the pharmacy
Information-gathering
Patient assessment
The provision of advice
The types of advice:
Refer to doctor
Product recommendation with the
associated medicine information
Non-pharmacological therapy
Other

Monitoring and follow up

Analyse the information

gathered

Information gathering
Patient identity
Signs and symptoms
chief complaints; CC look at warning signs and
symptoms
Action taken
Medications used (current and past medications)
Medical history (Past MEDICAL history) give
examples
Other appropriate information
Social history
Family history
Allergy and adverse drug reaction history
Tietze KJ. Clinical skills for pharmacists

Information-gathering
Important information to be gathered when handling patients
with cold (adopted from Blenkinsopp et.al)
Patient identity
Age (approximate)
Child, adult

Signs and symptoms

Duration
Symptoms
Runny/blocked nose
Summer cold
Sneezing/coughing
Generalised aches/headache
High temperature
Sore throat
Earache
Facial pain/frontal headache

Flu symptoms

Medical conditions
Allergic rhinitis
Bronchitis
Heart disease
Asthma

Medication used
Other information
Allergy
Family history
Social history

Warning signs and symptoms

When to refer

Next slide

Scolaro KL. In Berardi et.al

Earache not settling with analgesic

(see above)
In the very young
In the very old
In those with heart or lung disease,
e.g. COPD, kidney disease, diabetes,
compromised immune system
With persisting fever and productive
cough
With delirium
With pleuritic-type chest pain
Asthma

Blenkinsopp et.al

The provision of advice

The types of advice could be:
Medical referral (WARNING SYMPTOMS)
Product recommendation along with the associated
medicine information
Non-pharmacological advice
Other advice that may be appropriate

The provision of advice

Scolaro KL. In Berardi et.al

The objectives of self-treatment:

Reduce symptoms
Improve functioning and the sense of well being
Prevent the spread of the disease

The provision of advice

Product recommendation
DECONGESTANTS
Indication: Temporary relief of nasal
stuffiness
Contraindications
Oral formulations: Severe, poorly managed
HTN; CAD; MAOI use; hypersensitivity
Ophthalmic formulations: Glaucoma

Cautious Use*: In patients with

hyperthyroidism, diabetes mellitus,
coronary heart disease, ischemic heart
disease, hypertension, increased
intraocular pressure, and prostatic
hypertrophy
Drug Interactions: MAOIs,
methyldopa, TCAs, and urinary
acidifier/alkalinizers
Adverse Effects
Oral formulations: Restlessness,
nervousness, irritability, insomnia,
dizziness, tremor, headache, tachycardia,
and elevated blood pressure
Intranasal formulations: Rebound
congestion with application for >2-3 days,
local irritation

Covington et.al, Blenkinsopp et.al, Rutter P

ANTIHISTAMINES
First generation might be
preferred due to its
anticholinergic effect
Indication: relief of rhinorrhea and
sneezing; limited value in ARTI (no
benefit if used alone, may have some
benefits when used together with
other agents)
Contraindications:
Hypersensitivity and lactation
Cautious Use*: In patients with
glaucoma, prostatic hypertrophy,
breathing problems, chronic
bronchitis, and young or advanced
age
Drug Interactions: CNS
depressants, MAOIs, phenytoin,
ketoconazole, erythromycin, and
cimetidine
Adverse Effects: Drowsiness, dry
mouth, nervousness, and dizziness
*Do not exceed recommended dose or dosing frequency of any
nonprescription medication.
HTN = hypertension; CAD = coronary artery disease; MAOI =
monoamine oxidase inhibitor; TCA = tricyclic antidepressant;
ARTI = acute upper respiratory tract infection; CNS = central
nervous system.

The provision of advice

Other product recommendations
Blenkinsopp et.al, Rutter P, Scolaro KL. In Berardi et.al

Antitussive /Expectorant
Systemic analgesic
E.g., paracetamol, ibuprofen,

Product for sore throat

Local anesthetic lozenges /
spray, e.g., dequalinium
chloride

Vitamin C
Inconsistent results
May have some benefits for
people undergoing high
physical stress

Echinacea
Might be effective in the
early treatment common
cold in adults.
has been reported to cause
allergic reactions and rash.

Zinc
Cochrane review 2011:
beneficial in reducing the
duration and severity of the
common cold in healthy
people, when taken 24 hours
of onset of symptoms.
However, the authors are
reluctant to give
recommendation for the use
of zinc for common cold due
to high variability of dose,
formulation, and duration of
the zinc used in the trials

Saline spray
Insufficient evidence

The provision of advice

Non-pharmacological advice
Scolaro KL. In Berardi et.al

Monitoring and follow up

Scolaro KL. In Berardi et.al

Most colds are usually self-limiting. Symptoms usually

resolve within 7 to 14 days

Reference
Blenkinsopp A, Paxton P, Blenkinsopp J. Symptoms in the Pharmacy: A
Guide to the Management of Common Illness. 6th ed. West sussex:
Wiley-Blackwell; 2009.
Brian C. Upper respiratory tract infections and other infections of the head and
neck. Available from
http://www.microbiologybook.org/Infectious%20Disease/Upper%20respirator
y%20tract.htm. Accessed Sept 20, 2016
Covington et.al. Treating the common cold: an expert panel consensus
recommendations for primary care physician. The American Journal of Nurse
Practitioner. 2004; 8(11): 77-88
NHS. Colds or flu. Available from
http://www.nhs.uk/Livewell/coldsandflu/Pages/Isitacoldorflu.aspx. Accessed
Sept 13, 2016
Rutter P. Community pharmacy: symptoms, diagnosis, and treatment. 3rd ed.
Elsevier, Churchill livingstone; 2013

Scolaro KL. Disorders related to colds and allergics. In Berardi RR, Ferreri SP,
Hume AL, et al. Handbook of nonprescription drugs: An interactive approach to
self care. 16th ed. Washington DC: American Pharmacists Association; 2009:
177-201
Tietze KJ. Clinical skills for pharmacists: A patinet-focused approach. 3rd ed.
Missouri: Elsevier Mosby; 2012.