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Agents for fever, pain, cough,
cold and allergic rhinitis
Clinical diploma Alexandria university 2018/2019
Presented by:
S...
What is fever?
fever is defined as having a temperature above
the normal range due to an increase in the body’s
temperatur...
Etiology
 Viral or Bacterial infection
 Heat exhaustion
 Inflammatory conditions
 Medications
 Immunizations
Signs and symptoms
Fever is usually accompanied by sickness
behavior which consists of
 Lethargy
 Depression
 Anorexia
...
Diagnosis
A wide range for normal temperatures has
been found.
Fever is generally agreed to be present if the
elevated tem...
Diagnosis
Site of
measurement
Normal range Fever
Rectal 36.6°C-38°C ≥ 38.0°C
Oral 35.5°C-37.5°C ≥ 37.5°C
Axillary 34.7°C-3...
Fever, Hyperthermia & Hyperpyrexia
Fever:
a body temperature higher than the
normal core temperature of 37.8°C.
It is a re...
Fever, Hyperthermia & Hyperpyrexia
Hyperthermia represents a
malfunctioning of the normal
thermoregulatory process at the
...
Fever, Hyperthermia & Hyperpyrexia
Hyperpyrexia is a body temperature
greater than 41.1°C that typically results
in mental...
Non pharmacological treatment
Non-pharmacologic therapy consists
mainly of adequate fluid intake to
prevent dehydration.
Body sponging with tepid water may
facilitate heat dissipation, given that
only a small temperature gradient
between the b...
Bathing with ice water or sponging with
hydroalcoholic solutions (e.g., isopropyl
or ethyl alcohol) is uncomfortable,
dang...
Pharmacological treatment
Antipyretics
Antipyretics inhibit PGE2 synthesis,
which decreases the feedback between
the thermoregulatory neurons and th...
Antipyretics
Acetaminophen(Paracetamol)
Ibuprofen
Aspirin
Don’t give aspirin to children, because it
may trigger a rare, but potentially fatal,
disorder known as Reye’s Syn...
Complications of fever
1. Epileptic seizures
2. Dehydration
3. Hallucinations and Delirium
4. Febrile Seizures
What is pain?
The World Health Organization defines pain as
“an unpleasant sensory or emotional experience
associated with...
Etiology
Pain can occur from many causes, for
example:
 Surgery
 Trauma
 Labor
 Medical procedures
 Illnesses.
How pain occurs?
 Pain is a vital function of the human body, involving
nociceptors and the central nervous system (CNS) ...
There are two main types of nociceptors:
C-fibres are the most common type and are slow
to conduct and respond to stimuli....
The perception of pain results from processing
of the electrical signals in various regions of the
brain. This explains th...
Pain types and classification
 There are several ways to categorize pain. One is
to separate it into acute pain and chron...
 Chronic pain lasts longer than acute pain and is
generally somewhat resistant to medical
treatment. It's usually associa...
Both acute and chronic pain can be debilitating,
and both can affect and be affected by a person's
state of mind. But the ...
**Pain is also classified by the type of tissue that's
involved or by the part of the body that's affected.
For example, p...
CLINICAL PRESENTATION
SIGNS AND SYMPTOMS
Acute pain may be:
Sharp or dull Burning, Shock like,
Tingling, Shooting, Radiati...
Pain assessment
Practice essentials
Precise and systematic pain assessment is required to make
the correct diagnosis and d...
Management of pain
Prevention
Trying to prevent pain before it happens can be dangerous.
Acute pain is an important messag...
Treatment
Your doctor probably will treat your pain while he
or she tries to figure out the cause. Many drugs are
helpful,...
Aspirin
Ibuprofen
work in two ways:
1. by interfering with pain
messages
2. by reducing inflammation,
swelling and irritat...
Narcotic pain relievers:
Such as Hydrocodone ,Oxycodone, Hydromorphone,
Tramadol, morphine, codiene & nalbuphine.
are the ...
Other drugs
such as
anesthetics, antidepressants, anticonvulsants and
corticosteroids may work against certain types of
pa...
Non-drug treatments for pain include:
Acupuncture, Massage, Relaxation & psychotherapy
Transcutaneous electrical nerve sti...
In some cases, these treatments may stimulate
natural painkillers, called endorphins, which are
created within the body. I...
When To Call a Professional?
• Pain means some kind of problem exists. And
while different people tolerate different degre...
COUGH
Cough
A cough is a common reflex action that clears
the throat of mucus or foreign irritants.
Cough
• cough that lasts for less
than three weeks
Acute cough
• A cough that lasts between
3 and 8 weeks
Sub acute
cough
...
Causes of Cough
1-Clearing the throat:
When your airways become clogged with mucus or
foreign particles such as smoke or d...
Causes of Cough
2-Respiratory tract infection
Bacteria
• Pneumonia
• pertussis
Virus
• Common cold
• flu
Causes of Cough
3-Smoking:
Smoking is common cause of coughing. A cough
caused by smoking is almost always a chronic
cough...
Causes of Cough
4-Asthma:
A common cause of coughing in young children is asthma.
It’s possible for children to grow out o...
Causes of Cough
5-Medicines:
Some medications will cause coughing such as
Angiotensin-converting enzyme (ACE) inhibitors,...
Causes of Cough
6-Other conditions:
damage to the vocal cords.
postnasal drip.
Gastroesophageal reflux disease (GERD). ...
Classification of cough:
Wet cough
(Productive cough)
Dry cough
(Nonproductive cough)
Definition There is production of ph...
Management of cough
1-Keep hydrated by drinking plenty of
water.
2-Elevate your head with extra pillows
when sleeping.
3-T...
Management of cough (cont.)
4-Gargle hot salt water regularly to
remove mucus and soothe your throat.
5-Avoid irritants, i...
Management of cough (cont.)
7-There is no evidence that milk product
worsen the sputum production.
8-The FDA advises again...
Treatment of cough:
1-Home remedies.
2-Avoid triggers.
3-Time: Sometimes, the cough can last weeks
or months after the vir...
Drugs used to treat cough
A)Dry cough preparations
1-Dextromethorphan:
Dextromethorphan is a cough
suppressant.
It affects...
A)Dry cough preparations (Cont.)
2-Do not use dextromethorphan if you
have used an MAO inhibitor such as
isocarboxazid and...
A)Dry cough preparations (Cont.)
2-Pholcodine:
It is a cough suppressant for the
relief of acute non-productive
cough ass...
A)Dry cough preparations (Cont.)
Contraindications of Pholcodine :
1-liver & renal failure patients.
2-patients in risk of...
A)Dry cough preparations (Cont.)
3- Butamirate:
It is centrally acting cough suppressant with
bronchospasmolytic, used in ...
A)Dry cough preparations (Cont.)
4-pipazethate:
It suppresses the cough center and has also bronchodilator
effect.
Dose:
...
B)Wet cough preparation:
1-Ambroxol Hydrochloride:
• Ambroxol is the active
metabolite of bromohexine
hydrochloride.
• The...
B)Wet cough preparation (cont.):
Important information of ambroxol:
1-It is advisable to avoid use during the first
trimes...
B)Wet cough preparation (cont.):
2-carbocisteine:
It is mucolytic agent by reducing the
viscosity of sputum.
Note:
It shou...
B)Wet cough preparation (cont.):
3) Acetyl Cysteine:
Dose: dissolve one sachet in 100
ml water 3 times after meals.
Precau...
B)Wet cough preparation (cont.):
4- Guaifenesin:
Guaifenesin is an expectorant. It
works by thinning and loosening
mucus ...
B)Wet cough preparation (cont.):
Mucolytic with bronchodilator:
When cough is accompanied with
bronchospasm or difficulty ...
Cough preparation contain herbal
extract:
These drugs are suitable for pregnant,
nursing mothers & patients with liver or...
Cough preparation contain herbal extract
(cont.):
2-Balsam syrup:
Guava, Thyme, Tilia, Fennel &honey
3-Ivypront:
Dried Ivy...
Coughing Up Blood (Hemoptysis)
Causes:
•Bronchitis •Bronchiectasis
•Lung cancer •anticoagulant drugs
•Pneumonia •Tuberculo...
Coughing Up Blood (Hemoptysis)
Treatments for Hemoptysis:
•Antibiotics for pneumonia or tuberculosis.
•Chemotherapy and/or...
Common cold
 The common
cold is a viral
infection of the
nose and throat
(upper
respiratory tract).
 More than 200
types of viruses
...
Rhinovirus
which is thought to be responsible for at least 50% of
colds
Mode of transmission
 Through droplets in the air
• sharing contaminated
objects
• Hand to hand contact
with infected peo...
Risk factors
 Age: Children younger than six are at
greatest risk of colds, especially if they
spend time in child-care s...
Risk factors
 Exposure: If you're around
many people,
such as at school or on an
airplane
 Smoking: You're more
likely t...
When to see a doctor
• Fever greater than 38.5 C.
or lasting five days or
more or returning after a
fever-free period
• Severe headache or sinu...
Complications
• This occurs when bacteria or viruses
enter the space behind the eardrum
Otitis media
• A cold can trigger ...
Treatment
 There's no cure for the
common cold.
 Antibiotics are of no
use against cold viruses
and shouldn't be used
un...
Non pharmacological treatment
Drinking plenty of fluids Resting
Saline nasal sprays and saline drops Gargling can moisten a sore
throat
Pharmacological treatment
 Analgesics and antipyretics
acetaminophen or NSAIDs.
 Antihistamines
 Chlorpheniramine, diphenhydramine, and
loratadine help to dry secretions, but impair
clearance of thick...
 Over-the-counter oral decongestants
 containing pseudoephedrine and phenyl ephedrine can
help dry and clear nasal passa...
 Some OTC oral decongestant don't contain
antihistamines to avoid sedation during
day
 Nasal Decongestant
 like oxymetazoline, naphazoline, and
xylometazoline
 for more than 3 to 5 days, they may cause a
"...
 Local anesthetics lozenges and sprays.
 Cough syrups
 Cough suppressant such as dextromethorphan.
 Expectorants as guaifenesin.
 Vitamin C high dose only in prevention.
For pregnant
 Avoid all in one OTC
preparations, treat symptoms
separately
• Acetaminophen as analgesic.
• Herbal or
mentholated
throa...
Decongestants:
1-Nasal: Oxymetazoline, phenylephrine,
naphazoline, and xylometazoline are
pregnancy category C.
2-Oral Pse...
Prevention
Frequent Hand Washing
healthy lifestyle
Avoid contact with infected
people
Symptoms Cold Flu
Causative organisms
Most common rhinovirus
Others: coronavirus, respiratory
syncytial virus, influenza a...
Cold Flu
Sore Throat Common Sometimes
Chest Discomfort,
Cough
Mild to moderate Common; can become severe
Complications Sin...
It is a systemic disease
affecting the upper respiratory
system with prominent nasal
symptoms in response to
second expos...
1- Outdoor aeroallergens
i.e. pollutants(diesel exhaust particles)
Outdoor aeroallergens
i.e pollen,mold spores
Indoor aeroallergens
i.e house dust mites
Indoor aeroallergens
i.e. mold spores
The pathogenesis of allergic rhinitis is complex.
Classification of allergic rhinitis
Environmental or occupational rhinitis strong odors or cold air
Infectious rhinitis a)acute sinusitis viral infection last...
 Allergic rhinitis cannot be cured. The goal
of therapy is to reduce symptoms and
improve the patient’s functional status...
 1-reducing the mite population in
mattress,pillows
 2- lowering the household humidity to
less than 40%
 3-applying ac...
 Ventilation systems with HEPA filters
remove pollen, mold spores, and cat
allergens from household air.
 Filters need t...
*
 1-Intranasal corticosteroids
 2-Oral antihistamincs
 3-Oral leukotrien receptor antagonist
 4-Intranasal antihistam...
)
It is first line treatment for
most symptoms of allergic
rhinitis such as itching, rhinitis,
sneezing, and congestion.
Intranasal corticosteroids
 Beclomethasone(Qnasal) dry nasal
aerosol is the first non aquous nasal
formulation available.
 are indicated for relief of symptoms of
allergic rhinitis (e.g., itching, sneezing,
and rhinorrhea)
 Second generation,...
Oral leukotriene receptor
antagonist
 Montelukast is the only approved oral leukotriene
receptor antagonist for use in se...
Intranasal antihistamines
 i.e. Azelastine
 They ara targeted
delivery drugs
Decongestants
Intranasal mast cell
stabilizers
 useful for patients with
specific known allergy
and are planning to be in
contact with ...
Nasal wetting agents
 relieve nasal mucosal irritation and
dryness, thus decreasing nasal
stuffiness, rhinorrhea, and sne...
Subcutaneous
immunotherapy SCIT
First allergen skin testing
identifies a person’s
allergic triggers. A
personalized vaccin...
 Another form of allergy immunotherapy
was recently approved in the United
States called sublingual immunotherapy
(SLIT) ...
 Omalizumab (Xolair)
 shown effectiveness in
reducing nasal
symptoms and improving
quality of life.
 It only limitation...
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
Agents for fever, pain, cough, cold and allergic rhinitis
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Agents for fever, pain, cough, cold and allergic rhinitis

PowerPoint presentation of agents used in treatment of cough, fever,common cold and allergic rhinitis.

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Agents for fever, pain, cough, cold and allergic rhinitis

  1. 1. Agents for fever, pain, cough, cold and allergic rhinitis Clinical diploma Alexandria university 2018/2019 Presented by: Sherif Gamal Mona Kamel Mona Abd EL Gawad Heba Hammam Dina Mohamed
  2. 2. What is fever? fever is defined as having a temperature above the normal range due to an increase in the body’s temperature set point.
  3. 3. Etiology  Viral or Bacterial infection  Heat exhaustion  Inflammatory conditions  Medications  Immunizations
  4. 4. Signs and symptoms Fever is usually accompanied by sickness behavior which consists of  Lethargy  Depression  Anorexia  Sleepiness  Hyperalgesia  Inability to concentrate.
  5. 5. Diagnosis A wide range for normal temperatures has been found. Fever is generally agreed to be present if the elevated temperature is caused by a raised set point and ;  Rectal temperature is at or over 37.5-38.3  Oral temperature is over 37.7  Axillary or tympanic temperature is over 37.2
  6. 6. Diagnosis Site of measurement Normal range Fever Rectal 36.6°C-38°C ≥ 38.0°C Oral 35.5°C-37.5°C ≥ 37.5°C Axillary 34.7°C-37.4°C ≥ 37.4°C Tympanic 35.7°C-37.8°C ≥ 37.8°C Temporal 36.6°C-37.8°C ≥ 38.1°C for 0-2 months old ≥ 37.9°C for 3- 47 months old ≥ 37.8°C for ≥ 4 years old
  7. 7. Fever, Hyperthermia & Hyperpyrexia Fever: a body temperature higher than the normal core temperature of 37.8°C. It is a regulated rise in body temperature maintained by the hypothalamus in response to a pyrogen. It is a sign of an increase in the body’s thermoregulatory set point.
  8. 8. Fever, Hyperthermia & Hyperpyrexia Hyperthermia represents a malfunctioning of the normal thermoregulatory process at the hypothalamic level caused by excessive heat exposure or production. Because of their different mechanisms, treatment of fever versus hyperthermia also varies.
  9. 9. Fever, Hyperthermia & Hyperpyrexia Hyperpyrexia is a body temperature greater than 41.1°C that typically results in mental and physical consequences. Hyperpyrexia may result from either a fever or hyperthermia
  10. 10. Non pharmacological treatment
  11. 11. Non-pharmacologic therapy consists mainly of adequate fluid intake to prevent dehydration.
  12. 12. Body sponging with tepid water may facilitate heat dissipation, given that only a small temperature gradient between the body and the sponging medium is necessary to achieve an effective antipyretic response.
  13. 13. Bathing with ice water or sponging with hydroalcoholic solutions (e.g., isopropyl or ethyl alcohol) is uncomfortable, dangerous, and not recommended.
  14. 14. Pharmacological treatment
  15. 15. Antipyretics Antipyretics inhibit PGE2 synthesis, which decreases the feedback between the thermoregulatory neurons and the hypothalamus, thereby reducing the hypothalamic set point during fever. All antipyretics decrease the production of PGE2 by inhibiting the cyclooxygenase (COX) enzyme.
  16. 16. Antipyretics
  17. 17. Acetaminophen(Paracetamol)
  18. 18. Ibuprofen
  19. 19. Aspirin Don’t give aspirin to children, because it may trigger a rare, but potentially fatal, disorder known as Reye’s Syndrome
  20. 20. Complications of fever 1. Epileptic seizures 2. Dehydration 3. Hallucinations and Delirium 4. Febrile Seizures
  21. 21. What is pain? The World Health Organization defines pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage
  22. 22. Etiology Pain can occur from many causes, for example:  Surgery  Trauma  Labor  Medical procedures  Illnesses.
  23. 23. How pain occurs?  Pain is a vital function of the human body, involving nociceptors and the central nervous system (CNS) to transmit messages from noxious stimuli to the brain. The mechanism for neuropathic pain is distinct as it is caused by injury to the nervous system itself and can occur without the presence of noxious stimuli.  Nociceptors  Nociceptors are sensory receptors that are responsible for detecting harmful or noxious stimuli and transmitting electrical signals to the nervous system. The receptors are present in skin, viscera, muscles, joints and meninges to detect a range of stimuli, which may be mechanical, thermal or chemical in nature.
  24. 24. There are two main types of nociceptors: C-fibres are the most common type and are slow to conduct and respond to stimuli. As the proteins in the membrane of the receptor convert the stimuli into electrical impulses that can be carried throughout the nervous system. A-delta fibers are known to conduct more rapidly and convey messages of sharp, momentary pain. Additionally, there are silent nociceptors that are usually unresponsive to stimuli but can be “awoken” with high-intensity mechanical stimuli in response to chemical
  25. 25. The perception of pain results from processing of the electrical signals in various regions of the brain. This explains the varied responses and emotional reactions when an individual experiences pain Body modulates pain through several processes, including endogenous opioid system.
  26. 26. Pain types and classification  There are several ways to categorize pain. One is to separate it into acute pain and chronic pain. Acute pain typically comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress  Acute pain (eg, surgery, trauma, labor, and medical procedures) usually is nociceptive.
  27. 27.  Chronic pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It's usually associated with a long- term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, it's one of the defining characteristic of the disease. Chronic pain can be the result of damaged tissue, but very often is attributable to nerve damage.  Chronic pain can be nociceptive, neuropathic
  28. 28. Both acute and chronic pain can be debilitating, and both can affect and be affected by a person's state of mind. But the nature of chronic pain - the fact that it's ongoing and in some cases seems almost constant - makes the person who has it more susceptible to psychological consequences such as depression and anxiety. At the same time, psychological distress can amplify the pain.
  29. 29. **Pain is also classified by the type of tissue that's involved or by the part of the body that's affected. For example, pain may be referred to as muscular pain or joint pain. Or a doctor may ask you about chest pain or back pain.
  30. 30. CLINICAL PRESENTATION SIGNS AND SYMPTOMS Acute pain may be: Sharp or dull Burning, Shock like, Tingling, Shooting, Radiating, Fluctuating in intensity & Varying in location. Occurring in timely relationship with obvious noxious stimulus. Chronic pain can present similarly and often occurs without time relationship to noxious stimulus. Over time, chronic pain presentation may change (e.g. sharp to dull, obvious to vague). Acute pain can cause: Hypertension, Tachycardia, Diaphoresis, Mydriasis & Pallor. These signs seldom present in chronic pain
  31. 31. Pain assessment Practice essentials Precise and systematic pain assessment is required to make the correct diagnosis and determine the most efficacious treatment plan for patients presenting with pain. Techniques Pain must be assessed using a multidimensional approach, with determination of the following: Onset: Mechanism of injury or etiology of pain, if identifiable Location/Distribution Duration Course or Temporal Pattern Character & Quality of the pain Aggravating/Provoking factors Alleviating factors Associated symptoms Severity: Intensity or impact on function, sleep, mood
  32. 32. Management of pain Prevention Trying to prevent pain before it happens can be dangerous. Acute pain is an important message that is essential to survival. Some people are born with a rare disorder (congenital analgesia) and do not feel pain. They live in great danger because they miss warning signals that could mean life or death. Once the cause of pain is diagnosed, it may be possible to prevent the pain from coming back. For instance, a person diagnosed with a stomach ulcer can take medications to heal the ulcer and prevent continuation of the pain
  33. 33. Treatment Your doctor probably will treat your pain while he or she tries to figure out the cause. Many drugs are helpful, though how well they work depends on the patient and the nature of pain. Analgesics (painkillers) are the most common pain remedy. Acetaminophen interferes with pain messages.
  34. 34. Aspirin Ibuprofen work in two ways: 1. by interfering with pain messages 2. by reducing inflammation, swelling and irritation that can make pain worse. Non steroidal agents act mainly as analgesic ketorolac & ketoprofen
  35. 35. Narcotic pain relievers: Such as Hydrocodone ,Oxycodone, Hydromorphone, Tramadol, morphine, codiene & nalbuphine. are the most powerful pain treatments. These usually are reserved for the most intense pain. They can cause serious side effects, can be addictive and often cause constipation.
  36. 36. Other drugs such as anesthetics, antidepressants, anticonvulsants and corticosteroids may work against certain types of pain. Sometimes medications are injected directly into the region of pain or near a nerve to interrupt the pain signal.
  37. 37. Non-drug treatments for pain include: Acupuncture, Massage, Relaxation & psychotherapy Transcutaneous electrical nerve stimulation (TENS), which uses electrical impulses to stimulate the nerve endings at or near the site of pain Non-drug treatments may be especially useful for people with chronic pain.
  38. 38. In some cases, these treatments may stimulate natural painkillers, called endorphins, which are created within the body. In other cases, non-drug treatments work directly on nerves to interfere with pain messages. Sometimes, it isn't clear why the pain stops.
  39. 39. When To Call a Professional? • Pain means some kind of problem exists. And while different people tolerate different degrees of pain, you should never ignore pain. Consult a doctor if you cannot determine why you are experiencing pain, if pain continues or if it doesn't respond to simple treatment
  40. 40. COUGH
  41. 41. Cough A cough is a common reflex action that clears the throat of mucus or foreign irritants.
  42. 42. Cough • cough that lasts for less than three weeks Acute cough • A cough that lasts between 3 and 8 weeks Sub acute cough • cough that lasts more than eight weeks Chronic cough
  43. 43. Causes of Cough 1-Clearing the throat: When your airways become clogged with mucus or foreign particles such as smoke or dust, a cough is a reflex reaction that attempts to clear the particles and make breathing easier.
  44. 44. Causes of Cough 2-Respiratory tract infection Bacteria • Pneumonia • pertussis Virus • Common cold • flu
  45. 45. Causes of Cough 3-Smoking: Smoking is common cause of coughing. A cough caused by smoking is almost always a chronic cough with a distinctive sound. It’s often known as “smoker’s cough.”
  46. 46. Causes of Cough 4-Asthma: A common cause of coughing in young children is asthma. It’s possible for children to grow out of asthma as they get older.
  47. 47. Causes of Cough 5-Medicines: Some medications will cause coughing such as Angiotensin-converting enzyme (ACE) inhibitors, commonly used to treat high blood pressure and heart conditions such as captopril, lisinopril and enalapril. The coughing stops when the medication is discontinued.
  48. 48. Causes of Cough 6-Other conditions: damage to the vocal cords. postnasal drip. Gastroesophageal reflux disease (GERD). In this condition, stomach contents flow back into the esophagus.
  49. 49. Classification of cough: Wet cough (Productive cough) Dry cough (Nonproductive cough) Definition There is production of phlegm and sputum. There is no secretion of phlegm or mucus. Dry cough causes a lot of irritation and itchiness in the throat. Causes Wet cough occurs when a pathogen enters the respiratory system or occurs when an infection leads to bronchitis or pneumonia. Dry cough is a result of asthma, gastroesophageal reflux, smoking & use of medications like ACE inhibitors and dust and pollen. Treatment Mucolytic and expectorants soften the mucus and expel it easily. Antitussives (cough suppressant) help in suppression and treatment of dry cough.
  50. 50. Management of cough 1-Keep hydrated by drinking plenty of water. 2-Elevate your head with extra pillows when sleeping. 3-Take warm, steamy showers to help soothe the cough.
  51. 51. Management of cough (cont.) 4-Gargle hot salt water regularly to remove mucus and soothe your throat. 5-Avoid irritants, including smoke and dust. 6-Add honey or ginger to hot tea to relieve your cough and clear your airway. Never give honey to a child under one year (baby can get botulism by eating Clostridium botulinum spores found honey).
  52. 52. Management of cough (cont.) 7-There is no evidence that milk product worsen the sputum production. 8-The FDA advises against giving cold & cough medicine to children under age 2, Death can occur from the misuse of cough and cold medicines in very young children.
  53. 53. Treatment of cough: 1-Home remedies. 2-Avoid triggers. 3-Time: Sometimes, the cough can last weeks or months after the virus is gone. Over time your airways will heal and the cough will stop. 4-Treatment for another problem. 5-Medicines: Suppressants and Expectorants.
  54. 54. Drugs used to treat cough A)Dry cough preparations 1-Dextromethorphan: Dextromethorphan is a cough suppressant. It affects the signals in the brain that trigger cough reflex. Important information: 1-Do not give dextromethorphan to a child younger than 4 years old.
  55. 55. A)Dry cough preparations (Cont.) 2-Do not use dextromethorphan if you have used an MAO inhibitor such as isocarboxazid and selegiline within the past 14 days. 3-It is contraindicated in pregnancy &breast-feeding.
  56. 56. A)Dry cough preparations (Cont.) 2-Pholcodine: It is a cough suppressant for the relief of acute non-productive cough associated with upper respiratory tract infections. Important information: The dosage may be repeated after 4 hours if required but not more than 4 doses in any 24 hours.
  57. 57. A)Dry cough preparations (Cont.) Contraindications of Pholcodine : 1-liver & renal failure patients. 2-patients in risk of developing respiratory failure. 3-Do not use pholcodine if you have used an MAO inhibitor within 2 weeks. 4-Children under 6 years of age.
  58. 58. A)Dry cough preparations (Cont.) 3- Butamirate: It is centrally acting cough suppressant with bronchospasmolytic, used in non productive cough. Dose: Pediatric:7-15dp/8hrs. Children(3-6yrs):5ml/8hrs. Adult:15ml/8hrs. Note: Only take Butamirate Syrup during the second or third trimester of pregnancy.
  59. 59. A)Dry cough preparations (Cont.) 4-pipazethate: It suppresses the cough center and has also bronchodilator effect. Dose: Up to 2 years 4 drops /8 hrs. 2-6 years 1supp. or 8 drops/8 hrs. Adult 1 tab./8hrs.
  60. 60. B)Wet cough preparation: 1-Ambroxol Hydrochloride: • Ambroxol is the active metabolite of bromohexine hydrochloride. • The onset of action occurs after about 30 minutes. • It makes the sputum thinner and less viscous and therefore more easily removed by coughing.
  61. 61. B)Wet cough preparation (cont.): Important information of ambroxol: 1-It is advisable to avoid use during the first trimester of pregnancy. 2-safe for children <2 years (dose 2 cm every 8 hours)
  62. 62. B)Wet cough preparation (cont.): 2-carbocisteine: It is mucolytic agent by reducing the viscosity of sputum. Note: It should be used in caution in patient with peptic ulcer
  63. 63. B)Wet cough preparation (cont.): 3) Acetyl Cysteine: Dose: dissolve one sachet in 100 ml water 3 times after meals. Precautions: Like ambroxol and carbocisteine used with caution in asthmatic patient and patients with history of peptic ulcers ,because mucolytic may disrupt the gastric mucosal barrier
  64. 64. B)Wet cough preparation (cont.): 4- Guaifenesin: Guaifenesin is an expectorant. It works by thinning and loosening mucus in the airways, clearing congestion, and making breathing easier.
  65. 65. B)Wet cough preparation (cont.): Mucolytic with bronchodilator: When cough is accompanied with bronchospasm or difficulty in breathing. Example: All-Vent syrup: It contain bromohexine + guaiphensin + terbutaline sulphate + menthol. Dose: Children:2.5-5 ml./8hrs. Adult:15ml./8hrs.
  66. 66. Cough preparation contain herbal extract: These drugs are suitable for pregnant, nursing mothers & patients with liver or kidney impairment. Examples : 1-Bronchicum: It contain primula root fluid extract and thyme fluid extract
  67. 67. Cough preparation contain herbal extract (cont.): 2-Balsam syrup: Guava, Thyme, Tilia, Fennel &honey 3-Ivypront: Dried Ivy leaves extract
  68. 68. Coughing Up Blood (Hemoptysis) Causes: •Bronchitis •Bronchiectasis •Lung cancer •anticoagulant drugs •Pneumonia •Tuberculosis •Trauma •Autoimmune diseases
  69. 69. Coughing Up Blood (Hemoptysis) Treatments for Hemoptysis: •Antibiotics for pneumonia or tuberculosis. •Chemotherapy and/or radiation for lung cancer. •Steroids for inflammatory conditions.
  70. 70. Common cold
  71. 71.  The common cold is a viral infection of the nose and throat (upper respiratory tract).  More than 200 types of viruses cause common cold include Coronavirus Influenza virus parainfluenza RSV
  72. 72. Rhinovirus which is thought to be responsible for at least 50% of colds
  73. 73. Mode of transmission  Through droplets in the air • sharing contaminated objects • Hand to hand contact with infected people
  74. 74. Risk factors  Age: Children younger than six are at greatest risk of colds, especially if they spend time in child-care settings.  Weakened immune system: Having a chronic illness or otherwise weakened immune system increases the risk.  Time of year: Both children and adults are more susceptible to colds in fall and winter.
  75. 75. Risk factors  Exposure: If you're around many people, such as at school or on an airplane  Smoking: You're more likely to catch a cold and to have more severe colds if you smoke.
  76. 76. When to see a doctor
  77. 77. • Fever greater than 38.5 C. or lasting five days or more or returning after a fever-free period • Severe headache or sinus pain • Shortness of breath, Wheezing
  78. 78. Complications • This occurs when bacteria or viruses enter the space behind the eardrum Otitis media • A cold can trigger an asthma attack.Asthma • These include streptococcal pharyngitis, pneumonia or bronchiolitis. Other secondary infections
  79. 79. Treatment  There's no cure for the common cold.  Antibiotics are of no use against cold viruses and shouldn't be used unless there's a bacterial infection.  Treatment is directed at relieving signs and symptoms.
  80. 80. Non pharmacological treatment
  81. 81. Drinking plenty of fluids Resting Saline nasal sprays and saline drops Gargling can moisten a sore throat
  82. 82. Pharmacological treatment
  83. 83.  Analgesics and antipyretics acetaminophen or NSAIDs.
  84. 84.  Antihistamines  Chlorpheniramine, diphenhydramine, and loratadine help to dry secretions, but impair clearance of thick mucus.
  85. 85.  Over-the-counter oral decongestants  containing pseudoephedrine and phenyl ephedrine can help dry and clear nasal passages, but may increase blood pressure and heart rate.
  86. 86.  Some OTC oral decongestant don't contain antihistamines to avoid sedation during day
  87. 87.  Nasal Decongestant  like oxymetazoline, naphazoline, and xylometazoline  for more than 3 to 5 days, they may cause a "rebound" effect. That worsen congestion.
  88. 88.  Local anesthetics lozenges and sprays.
  89. 89.  Cough syrups  Cough suppressant such as dextromethorphan.  Expectorants as guaifenesin.
  90. 90.  Vitamin C high dose only in prevention.
  91. 91. For pregnant
  92. 92.  Avoid all in one OTC preparations, treat symptoms separately • Acetaminophen as analgesic. • Herbal or mentholated throat lozenges in order to ease a cough or sore throat.
  93. 93. Decongestants: 1-Nasal: Oxymetazoline, phenylephrine, naphazoline, and xylometazoline are pregnancy category C. 2-Oral Pseudoephedrine and phenylephrine are pregnancy category C they are vasoconstrictors and may lead to impaired blood flow to the fetus.
  94. 94. Prevention Frequent Hand Washing healthy lifestyle Avoid contact with infected people
  95. 95. Symptoms Cold Flu Causative organisms Most common rhinovirus Others: coronavirus, respiratory syncytial virus, influenza and parainfluenza Influenza virus types A, B, and C Type A and B viruses cause the large seasonal outbreaks. Fever low grade fever Usual; higher (<38.5 especially in young children); lasts 3 to 4 days Headache Less common Common General Aches, Pains Slight Usual; often severe Stuffy Nose, Sneezing Common Less common
  96. 96. Cold Flu Sore Throat Common Sometimes Chest Discomfort, Cough Mild to moderate Common; can become severe Complications Sinus congestion; Otitis media Sinusitis, bronchitis, pneumonia; can be life-threatening Prevention • Wash hands often • avoid close contact with anyone with a cold • Wash hands often; avoid close contact with anyone who has flu symptoms • get the annual flu vaccine Treatment Decongestants, analgesics ,antipyretics • Decongestants, analgesics, antipyretics • Antiviral drugs for flu may be given in some cases.
  97. 97. It is a systemic disease affecting the upper respiratory system with prominent nasal symptoms in response to second exposure to allergens.
  98. 98. 1- Outdoor aeroallergens i.e. pollutants(diesel exhaust particles)
  99. 99. Outdoor aeroallergens i.e pollen,mold spores
  100. 100. Indoor aeroallergens i.e house dust mites
  101. 101. Indoor aeroallergens i.e. mold spores
  102. 102. The pathogenesis of allergic rhinitis is complex.
  103. 103. Classification of allergic rhinitis
  104. 104. Environmental or occupational rhinitis strong odors or cold air Infectious rhinitis a)acute sinusitis viral infection last up to 10 days b)chronic sinusitis it is bacterial infection lasts up to12 weeks Hormonal Pregnancy, puberty, thyroid disorders Drug Induced Cocaine, beta blockers, ACEIs, chlorpromazine, clonidine, reserpine, hydralazine, oral contraceptives, aspirin or other NSAIDs, overuse of topical decongestants Structural Septal deviation, adenoid hypertrophy Traumatic Recent facial or head trauma Gustatory rhinitis hot or spicy foods Causes of non allergic rhinitis
  105. 105.  Allergic rhinitis cannot be cured. The goal of therapy is to reduce symptoms and improve the patient’s functional status .  Allergic rhinitis is treated in three steps:  allergen avoidance  pharmacotherapy  immunotherapy
  106. 106.  1-reducing the mite population in mattress,pillows  2- lowering the household humidity to less than 40%  3-applying acaricides  4-reducing mite harboring dust by removing carpets, upholstered furniture.
  107. 107.  Ventilation systems with HEPA filters remove pollen, mold spores, and cat allergens from household air.  Filters need to be changed regularly to maintain effectiveness.  HEPA filters are also found in some vacuum cleaners. Weekly vacuuming of carpets, drapes, and upholstery,
  108. 108. *  1-Intranasal corticosteroids  2-Oral antihistamincs  3-Oral leukotrien receptor antagonist  4-Intranasal antihistaminics  5-Decongestants  6-Intranasal mast cell stabilizers  7-Intranasal anticholinergics  8-combination therapy *2015 American academy of otolaryngology-head and neck surgery foundation(AAO-HNSF) guidelines for allergic rhinitis
  109. 109. ) It is first line treatment for most symptoms of allergic rhinitis such as itching, rhinitis, sneezing, and congestion.
  110. 110. Intranasal corticosteroids  Beclomethasone(Qnasal) dry nasal aerosol is the first non aquous nasal formulation available.
  111. 111.  are indicated for relief of symptoms of allergic rhinitis (e.g., itching, sneezing, and rhinorrhea)  Second generation, peripherally selective i.  e.acrivastine,ebastine, loratadine,cetrizine  Third generation i.e. levocetrizine ,desloratidine,fexofenadine
  112. 112. Oral leukotriene receptor antagonist  Montelukast is the only approved oral leukotriene receptor antagonist for use in seasonal and perennial allergic rhinitis
  113. 113. Intranasal antihistamines  i.e. Azelastine  They ara targeted delivery drugs Decongestants
  114. 114. Intranasal mast cell stabilizers  useful for patients with specific known allergy and are planning to be in contact with that allergen so it is given 30 minutes before allergen exposure Intra nasal anticholinergics  Ipratropium (atrovent)  relieving persistent rhinorrhia and congestion symptoms
  115. 115. Nasal wetting agents  relieve nasal mucosal irritation and dryness, thus decreasing nasal stuffiness, rhinorrhea, and sneezing.
  116. 116. Subcutaneous immunotherapy SCIT First allergen skin testing identifies a person’s allergic triggers. A personalized vaccine is then formulated using all natural protein extracts. This extract is then administered subcutaneously with small doses by developing immunity or tolerance to the allergen.
  117. 117.  Another form of allergy immunotherapy was recently approved in the United States called sublingual immunotherapy (SLIT) allergy tablets  one is for dust mites and one is for short ragweed and two for grass pollen allergy tablets
  118. 118.  Omalizumab (Xolair)  shown effectiveness in reducing nasal symptoms and improving quality of life.  It only limitation yet is its high cost.

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