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 Flu
Symptoms: usually comes on much
runny nose beginning more quickly than a cold
with clear mucus that Symptoms:
develops into thicker,
green mucus as the cold sudden fever of 38-40C
progresses (100-104F)
blocked nose muscle aches and pains
sore throat sweating
sneezing feeling exhausted and
needing to lie down
cough
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
Analyse the information
gathered
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

 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 Medical conditions

Age (approximate) Allergic rhinitis
Child, adult Bronchitis
Signs and symptoms Heart disease
Duration Asthma
Symptoms Medication used
Runny/blocked nose Other information
Summer cold
Sneezing/coughing Allergy
Generalised aches/headache Family history
High temperature Social history
Sore throat
Earache
Facial pain/frontal headache
Flu symptoms
Warning signs and symptoms
When to refer
Earache not settling with analgesic
(see above)
In the very young
Next slide
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

Scolaro KL. In Berardi et.al 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 Covington et.al, Blenkinsopp et.al, Rutter P

ANTIHISTAMINES
DECONGESTANTS First generation might be
Indication: Temporary relief of nasal preferred due to its
stuffiness anticholinergic effect
Contraindications Indication: relief of rhinorrhea and
Oral formulations: Severe, poorly managed sneezing; limited value in ARTI (no
HTN; CAD; MAOI use; hypersensitivity benefit if used alone, may have some
Ophthalmic formulations: Glaucoma benefits when used together with
Cautious Use*: In patients with other agents)
hyperthyroidism, diabetes mellitus, Contraindications:
coronary heart disease, ischemic heart Hypersensitivity and lactation
disease, hypertension, increased Cautious Use*: In patients with
intraocular pressure, and prostatic glaucoma, prostatic hypertrophy,
hypertrophy breathing problems, chronic
Drug Interactions: MAOIs, bronchitis, and young or advanced
methyldopa, TCAs, and urinary age
acidifier/alkalinizers Drug Interactions: CNS
Adverse Effects depressants, MAOIs, phenytoin,
Oral formulations: Restlessness, ketoconazole, erythromycin, and
nervousness, irritability, insomnia, cimetidine
dizziness, tremor, headache, tachycardia, Adverse Effects: Drowsiness, dry
and elevated blood pressure
mouth, nervousness, and dizziness
Intranasal formulations: Rebound
congestion with application for >2-3 days,
local irritation *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 Zinc

Systemic analgesic Cochrane review 2011:
E.g., paracetamol, ibuprofen, beneficial in reducing the
duration and severity of the
Product for sore throat common cold in healthy
Local anesthetic lozenges / people, when taken 24 hours
spray, e.g., dequalinium of onset of symptoms.
chloride However, the authors are
Vitamin C reluctant to give
recommendation for the use
Inconsistent results of zinc for common cold due
May have some benefits for to high variability of dose,
people undergoing high formulation, and duration of
physical stress the zinc used in the trials
Echinacea Saline spray
Might be effective in the Insufficient evidence
early treatment common
cold in adults.
has been reported to cause
allergic reactions and rash.
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.