the common cold guide

C P E Program [COMMON COLD & ALLERGIC RHINITIS]

Alex syndicate of pharmacists

Continuing pharmaceutical education(CPE) program

Alexandria Syndicate of pharmacists

Common cold &allergic rhinitis

Prepared by :Ph/Esraa RefaiiPh/Esraa Basha

Revised by:Dr.Muhammad Teleb

Presented by:Ph/Fatma Naguib



Common cold

1-What is common cold?

An 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 maylast 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 coldbegins to resolve the secretions become clear and watery.

Feverishness (feeling hot without rise in body temperature)

Possible Complications

Bronchitis Ear infection


Alex syndicate of pharmacists Page 2

Common cold




2-Symptoms









Common cold




2-Symptoms









Pneumonia Sinusitis Worsening of asthma

3-How do I catch cold? (Transmission)

The 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 ortouches their nose and then touches someone else, that person can subsequently becomeinfected 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 acquiredfrom contact with these objects.

Your can catch a cold from person-to-person contact or by breathing in virus particlesspread through the air by sneezing or coughing.

4- Common cold VS flu

Many people confuse the common cold with influenza (the flu). Influenza is

caused by the influenza virus, while the common cold generally is not. While someof the symptoms of the common cold and influenza may be similar, patients with thecommon cold typically have a milder illness. Patients with influenza are usuallysicker and have a more abrupt onset of illness with fever, chills, headache,body aches, dry cough, and extreme weakness; also symptoms of fluappear suddenly while symptoms of common cold appear gradually.



5- Our goals in treatment

The 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 theduration of illness. Treatment is symptomatic support usually via providing analgesics,antihistaminics and decongestants.

Treatment timescale

Once the pharmacist has recommended treatment, patients should be advised to see their doctor in10–14 days if the cold has not improved.

6- Drugs

a- Decongestants (Sympathomimetics)

**Pharmacology

The vast majority of decongestants act via enhancing norepinephrine (noradrenaline) andepinephrine (adrenaline) or adrenergic activity by stimulating the α-adrenergic receptors. Thisinduces vasoconstriction of the blood vessels in the nose, throat, and paranasal sinuses, whichresults in reduced inflammation or swelling and mucus formation in these areas.

**Classifications:

1-Topical.

2-Oral (systemic).



**Common decongestants include:

Ephedrine.(oral) Pseudoephedrine.(oral) Levmetamfetamine. Naphazoline. (topical) Oxymetazoline. (topical) Xylometazoline (topical) Phenylephrine. (oral and topical) Phenylpropanolamine.(oral) Propylhexedrine. Synephrine. Tetrahydrozoline. (topical)

**Topical 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® adultdps, Rhinex® ped. dps, Nasostop®adult dps, Nasostop® ped.dps, Balkis®adult dps,Balkis® ped. Dps)

Oxymetazoline: (Afrin® adult dps, Afrin pediatric dps, Afrin® spray, Iliadin® adult dps,Iliadin® ped drops, Iliadin® spray, Oxymet®adult 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























Dose : 1 drop 3 times daily.

**Drops, sprays and gels:

Nasal sprays are preferable for adults and children over 6 years of age because the smalldroplets 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

Advantages of local decongestants:

Fast onset of action.

Avoiding systemic drug-drug interactions or drug disease interactions.

**Take 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. Thisoccurs due to down regulation of alpha receptors making thedecongestant ineffective.

Rhinitis medicamentosa (or RM) is a condition of rebound nasal congestion brought on byextended use of topical decongestants.



**Educating 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 byremoving the metal canister and placing it in a container of water. If the canister floats, it isempty. 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 containeror activating the pump or inhaler.



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.

**Oral decongestants:

Advantages:

No local irritation No rebound congestion More prolonged action

Examples:

Pseudoephedrine. Ephedrine. Phenylephrine. Phenylpropanolamine.

**Phenylpropanolamine'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 PPAas ingredient in common cold combinations (e.g. Congestal® (1 tablet 3:4 timesdaily) and Night and day® (white tablet at day, yellow tablet at night))

Now these drugs are labeled as PPA free drugs.







Advantages:


Examples:













Advantages:


Examples:









**Market:

They don’t exist in pharmaceutical products alone but usually in combinations with analgesics andanti-histaminics, so the drugs will be mentioned later….

**Who shouldn’t take oral decongestants?

Heart disease (they may cause tachycardia and palpitations e.g. pseudoephedrine ) High blood pressure ( they are α1 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 ( α1 receptors lie in the radial muscles of the eye causing mydriasis also they

might be not completely selective to α1 and stimulate β2 increasing formation of aqueoushumor)

Thyroid disease (thyroid hormones affect heart rate also) Diabetes (stimulation of β2 receptors causing glycogenolysis and increasing BSL) Trouble urinating from an enlarged prostate gland (stimulation of α1 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.

**Problems with other drugs:

Decongestants can interact with many other medicines you take. If you take any of the productslisted 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)



Decongestants are often combined with antihistamines and/or pain relievers. If you take one ofthese combination medicines, it’s important to understand each of the active ingredients and theinteractions they may have with other drugs you’re taking.

An advantage to combinations at last...

Theoretically, if the side effects could be properly balanced, the sleepiness caused byantihistamines could be cancelled by the stimulation of decongestants.

Side Effects:

High blood pressure.

Trouble sleeping(insomnia).

Feeling nervous or grumpy.

Increased pulse rate (tachycardia).

In men with an enlarged prostate, use ofdecongestants may cause difficulty inurination.

B-Antihistaminics

Histamine:

Histamine is a natural substance, one of the important inflammatory mediators produced incertain cells in the body.

When introduced into the nose, histamine causes dilatation and leakage ofblood vessels. Histamine is also a powerful stimulant of the sneeze reflex.These effects of histamine cause sneezing, coughing, runny nose, and stoppedup nose during colds. Histamine may also have a role in causing coughs, butthis is less certain.






Side Effects:






B-Antihistaminics

Histamine:








Side Effects:






B-Antihistaminics

Histamine:





How do they work?

o Antihistamines are a diverse group of drugs which possess the ability to inhibit varioushistaminic actions. By and large, they bear a certain structural resemblance to histamine,and act principally to prevent histamine-receptor interaction through competition withhistamine for histamine receptors. Consequently, they are helpful therapeutically inpreventing, rather than reversing, histaminic actions

o But now it has been discovered that these H1-antihistamines are actually inverse agonists atthe histamine H1-receptor, rather than antagonists

Classifications:

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 effectivefor treating colds.

o First generation( sedating or older antihistaminics):

They exist in combinations with decongestants.

**Members:

Chlorpheniramine, Diphenhydramine (Draminex® : 1 tablet 2:3 times daily) ,Carbinoxamine, and promethazine.

**Side effects:

The major side effect of first generation antihistamines isdrowsiness, which may be severe in some people due topassing blood brain barrier.

Anticholinergic actions (dry mouth, urine retentionespecially in cases of benign prostatic hypertrophy itmakes the case worse, constipation, blurred vision ,

Adrenergic blockade effects (orthostatic hypotension).



**Contraindications:

Benign prostatic hypertrophy Glaucoma Heart disease High blood pressure Pregnancy. Lactation.

**Precaution:

Sedating antihistamines cause drowsiness and may therefore affect your ability to drive oroperate machinery safely. This should not be a problem if you take them before going to bed.

**Drug-drug interactions:

Since sedating antihistamines cause drowsiness there is an increased riskof drowsiness if they are taken with any of the following medicines, whichcan 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 sedatingantihistamines 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.



Betahistine.(Betaserc® , Verserc® )

o Second generation( newer or non-sedating antihistaminics):

The newer (non-sedating) antihistamines do not appear to have the same degree of effectiveness fortreating the sneezing and nasal discharge of colds.

**Members:

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

**Advantages:

No Sedation and lower Anticholinergic actions.

**Disadvantages:

Expensive!


o Pregnancy.o Lactation.

**Market:

Loratadine: 1 tablet 2 times daily.

Cetirizine: 1 tablet at the evening.






**Members:


**Advantages:


**Disadvantages:

Expensive!



**Market:








**Members:


**Advantages:


**Disadvantages:

Expensive!



**Market:





Fexofenadine:

C-Analgesics

Role:

Analgesic and antipyretic medications are frequently used to treat thecommon cold. Non-steroidal anti-inflammatory drugs (NSAIDs) are drugswith analgesic (pain-reducing), antipyretic (fever-reducing) and, in higherdoses, anti-inflammatory effects. NSAIDs have been widely used for over a century for the treatmentof pain and fever associated with the common cold.

Members:

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)

Precautions:

NSAIDs cannot be used (are contraindicated) in thefollowing cases:

Allergy to aspirin or any NSAID Aspirin should not be used under the age of 16 years (so



Fexofenadine:

C-Analgesics

Role:


Members:






Precautions:





Fexofenadine:

C-Analgesics

Role:


Members:






Precautions:





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.

Take care:

-Aspirin is contraindicated in children under 14 years old to avoid the risk of occurrence of Reyessyndrome.

-Acetaminophen (Paracetamol) is contraindicated in patients with liverdisorders 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, renalimpairment, and asthmatic patients.

- Combination of more than 1 NSAID or with corticosteroids is impracticalas it only increases the side effects.

- All analgesics are never taken on an empty stomach.

Drug-drug interactions:




(coagulation)



Take care:












(coagulation)



Take care:











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

Dosage 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.

Role:

Temporary relief of sore throat...

Dose:

Every 3-4 hours.

E-Vitamin-C

A systematic review found that high-dose vitamin C (over 1 g per day) reduced theduration of colds. Vitamin C has been studied for many years as a possible treatmentfor 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



7- Antibiotics VS common cold

o Antibiotics should not be used to treat a common cold. They will not help and may make thesituation worse. Thick yellow or green nasal discharge is not a reason for antibiotics, unless itdoesn't get better within 10 to 14 days. (In this case, it may be a sinus infection calledsinusitis.)

o Antibiotics are medicines that kill bacteria, not viruses. Many antibiotics work by disruptingthe bacteria's cell wall. Viruses don't even have a cell wall.

o Antibiotics can actually make colds worse. By indiscriminately killing the beneficialbacteria, an environment more hospitable to the cold viruses is created.

o To make matters worse, all antibiotics have side effects. All antibiotics harm beneficialbacteria, and can cause diarrhea, yeast infections, and bacterial super-infections. Evensomething as 'mild' as amoxicillin has been known to cause bone marrow toxicity, seizures,acute interstitial nephritis, neuromuscular sensitivity, nausea, vomiting, and urticarialrashes.

So we use antibiotics only if the patient's case didn’t get better within 10-14 days to avoid secondarybacterial infections as sinusitis, Otitis media or bronchitis...

8-Home therapy (only helps to control symptoms)

Tell 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.

You cant kill me Mr.antibiotic

,,Nyahahahahahaha



Use saline nasal sprays.(HOW do they work? How to prepare?)

Use steam inhalations.

For infants: tell the mother to:

Keep the infant in upright position to enhance nasaldrainage.

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 clearnasal 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 theenvironment is cold and dry outside, hot and dry inside. When your nasal passages are dry, mildnasal crusting may occur, and bacterial infections can develop under these crusts. Saline spraysclean the nasal passages of crusts and mucus and also help the natural cleaning system of your nasalpassages.

How to prepare saline nasal wash?

To make your own saline, mix the following in a clean container:

½ 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 nasalpassages and out through the mouth.

If this makes you gag or hurts your ears, squeeze more gentlyand have the water come back out through the nose.

Repeat the same process for the other nostril.









































Saline irrigation may need to be performed on a daily (or multiple times per day) basis forpeople 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.

How 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 12feet through the air when someone with a cold coughs or sneezes, and secondhand smokecan 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 orcough 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 alsoshouldn't drink from the same glass, can, or bottle as anyone else — you never know whomight be about to come down with a cold and is already spreading the virus.

Not pick up other people's used tissues.



9- Common cold in market

Remember common cold drugs exist mainly in

combinations.

Advantages of the combination:

More clinical efficacy.

To cancel side effects of each individual drug alone (e.g. the sleepiness caused byantihistamines could be cancelled by the stimulation of decongestants)

Disadvantages of combination therapy:

More susceptibility to drug interactions.

10- Common cold in practice...

(Keep this in your mind)

Questions to be asked:

Who is the patient?

Age of the patient (To know if you are dealing with the patient, dosageform indicated, dose)

How does the patient feel (symptoms!!!)

When did the symptoms start?

Are you pregnant? (Will be discussed as a case later)





combinations.









Who is the patient?









combinations.









Who is the patient?







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-druginteractions )

Do you suffer (peptic ulcer, asthma, liver disorder)? ( to exclude paracetamol orNSAIDs)

Are you driving? Do you operate machinery? (to exclude first generationantihitaminics)

When to refer to the physician?

Earache not settling with analgesic Facial pain/frontal headache In the very young (we don’t deal with age extremes

below 3 and above 60 years old patients) In the very old (we don’t deal with age extremes below

3 and above 60 years old patients)

In those with heart or lung disease, e.g. chronicbronchitis.

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 mentionedbefore 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 mentionedbefore, take lozenges (Larypro®, Bradoral®, Strepsils®, Pectol®) and drinkplenty of fluids.













11- Cases


















11- Cases








A man looks to be in his forties enters the pharmacy and from his history you knowthat 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, Afrinadults, 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 thathe 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 sugarfree preparations.

For asthmatic patients avoid NSAIDs



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 preventthe bronchoconistrictionE.g.: cromolyn and ketotifen

They are the most effective drugs to act as prophylaxic agents from asthma attacks that occurdue to allergic rhinitis.

Pretreatment with cromolyn blocks allergen and exercise induced asthma attacks. To producean effect the administration of cromolyn sho

They are less effective in their ant inflammatory effect than corticosteroids; however because oftheir 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:



Nasotal® dropsvividrin® 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 IgEso, decrease the binding of these IgE to their receptors on the mast cell as a resultthe degree of the release of allergic response mediators will decrease

Trade names:Xolair® by novartis

The drug is administered subcutaneouslyonce every 2 or 4 weeks.

Disadvantages:High cost of the drugLimitation on the dosage and clinical trials



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 effectivefor nasal congestion.

A) First generation: Alimemazine(trimeprazine) Promethazine Chlorphenamine

They also called the old generation they cause sedation but promethazine andtrimeprazine may be more sedating.

This sedating activity is used to manage the pruritus associated with someallergies.

They have short half life time so; they should be taken more than twice.

Sedating antihistaminics have significant antimuscarinic activity and they should beused in caution with patients suffering from:

Prostatic hypertrophyUrinary retentionGlaucomaAsthma

They should not be used for persons who driving cars or working on a machinedue to sedation and psychomotor impairment



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 mayoccur and may affect performance of skilled tasks as driving this sedating effect isenhanced by alcohol.



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-allergic-

rhinitis/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)

the common cold guide

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