module 2 colds and flu module 2 colds and flu introduction · adapted from smith ap, 2012. because...

INTRODUCTIONColds and flu are both classified as viral infections1a.

The Definition of a Virus

A virus is a small infectious organism – much smaller than a fungus or bacterium – that invades a living cell to reproduce (replicate)1b.

The Lifecycle of a Virus:

1. The virus enters a cell.

2. Once inside, it takes control.

3. The virus forces the cell to duplicate the virus.

4. The cell dies as it cannot return to its natural function.

5. This leads to the unpleasant symptoms we associate with a cold or the flu.

Module 2

Colds and Flu

Introduction

The Common Cold

How to Spot a Cold

How to Treat a Cold

Case study

The Flu

How to spot the Flu

How to Treat the Flu

Case study

Test your knowledge

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Contents 1

2

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5

3

Virus invading cell. Adapted from Porter RS (Ed.) Viral Infections: Overview of Viral Infections1b

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Module 2 Colds and Flu

THE COMMON COLD

The common cold is a viral infection of the membranes of the nose, sinuses and throat2a. It usually leaves the patient with unpleasant symptoms, but is not usually accompanied by a fever and the condition is self-limited and resolves itself when it has run its course3a.

The rhinovirus is most often the culprit when it comes to the common cold2b and it specifically infects the cells of the upper respiratory tract, which leads to symptoms such as a runny nose, coughing and a sore throat3b.

How does a head cold and its symptoms

come about?The pathophysiology of key head cold symptoms4,5,6,7,8

NASAL CONGESTIONDifficulty breathing and

possible occlusion of the ostia

SINUS PAINCaused by pressure changes in sinuses

HEADACHE

As a result of sinus pain

INFECTION WITH COLD VIRUS

Inflammatory mediators• Vasodilation/oedema• Swelling of the nasal venous tissue

Nasal congestion can lead to the feeling of a stuffy head4

Solution: Target your patients’ most bothersome cold symptoms for maximum benefit.

Lo

cal m

ediator

Lo

cal m

ediator

Sys

tem

ic mediator

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TAKE PRECAUTIONS:Wash your hands after being in contact with a person with a runny nose/mild cough2d

Sym

pto

ms

app

ear

Mo

st c

on

tag

iou

s

Day 1

2

3

4

5

Day

Day

Day

Day

KEY SYMPTOMS OF A COLD

ITCHY / SORE THROAT

Itchy or sore throat2e

SNEEZING

Sneezing9b

LOW-GRADE FEVER

Occasional low-grade fever2e

NASAL DISCHARGE

Discharge from the nose may become thick and yellow or green as the cold progresses2e

FATIGUE

Mild fatigue9b

COUGH

Generally mild and can last up to 2 weeks3b

ACHING PAIN

Slight body aches or a mild headache9b

RUNNY OR CONGESTED NOSE

Runny or congested nose2e

Cold symptoms appear 1 – 3 days after exposure9a

A cold is most contagious 1 – 2 days after symptoms develop2c

HOW TO SPOT A COLD

of cold sufferers experienced head or nasal congestion, while 85% or more reported headache or sinus pressure1090%

Over

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Cold Symptoms Affect How Patients

Feel Mentally

34% reduction in mental alertness amongst cold sufferers vs. healthy individuals12a

A larger reduction means a greater negative impact on the individual.

Cold present for at least 24 hours but no longer than 96 hours.

N=189.

Adapted from Smith AP, 2012.

Because antibiotics do not affect the course of a viral infection11, the cold symptoms are usually treated2f.

HOW TO TREAT A COLD

Alertness of subject with and without a cold

Mea

n c

han

ge

fro

m b

asel

ine

in

aler

tnes

s sc

ore

(%

)

5

-5

0

-10

-15

-25

-20

-30

-35

-34,8

2,4

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Inability to think clearly is one of the most important impairments12c

Top 5 functional impairments in order of importance

Patients were asked to rate the importance of selected cold symptoms on a 5-point scale with the descriptors “Not”, “Somewhat”, and “Very” aligned with the numbers 1, 3 and 5.

Top 5 out of 10 functional impairments in order of importance.

N=230 people with a common cold. Adapted from Barrett B, et al. 2009.

4,28%Diminished

Personal Life

4,26%Failure to

Complete Tasks

4,47%Can't Think

Clearly

4,35%Difficulty Breathing

4,59%Lack of Sleep

90% of sufferers reported a negative influence on clear thinking12b

Top 5 functional impairments in order of frequency

Top 5 out of 10 functional impairments in order of frequency.

N=230 people with a common cold. Adapted from Barrett B, et al. 2009.

An increase in symptom severity was significantly associated with a decrease in alertness12

95,7%Difficulty Breathing

90,0%Can't Think

Clearly

88,7%Diminished

Personal Life

91,3%Lack of Sleep

90,0%Failure to

Complete Tasks

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Ask the following questions

• How long have the symptoms lasted for?

• Where is she experiencing facial pain?

• Does she have toothache?

• Does she have a fever?

• Does she have a cough?

• Does she have discoloured nasal discharge?

• Is she experiencing a feeling of fatigue?

• Does she have a post nasal drip?

• Anna has come to the pharmacy to ask for advice

• She tells you that her nose is blocked and that she is experiencing some facial pain

• She also cannot smell anything and her head is aching

• She’s also feeling tired and is having trouble focusing on her tasks

• What can she take that will make her feel better, but won’t make her sleepy as she has to mark test papers at home?

Anna says that the symptoms started for the first time 48 hours before she came to your pharmacy. She is feeling fatigued and a bit shivery and she says her face aches underneath her eyes, but she does not have discoloured discharge or a post- nasal drip.

Diagnosis:

You establish that it’s a cold that has likely lead to mild sinusitis, but it’s not a severe case as she doesn’t have discoloured nasal discharge. It’s also an acute case as it only recently started and she doesn’t have a post-nasal drip.

CASE STUDYAnna, 39, Primary School Teacher

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Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.

Dosage• Adults & children over 12 years:

2 tablets every 4 – 6 hours. Do not exceed 8 tablets in 24 hours.

• Children 6 – 12 years: A half to 1 tablet every 6 hours. Do not exceed 4 tablets in 24 hours.

• Children under 6 years: Not recommended.


One spray into each nostril 2 – 3 times per day, as required. Do not exceed 3 sprays per day. Do not use for more than three days.


1 tablet every 4 – 6 hours. If symptoms do not respond to 1 tablet, a second may be taken. Do not use for more than three days.



Sinutab® Sinus Pain Non-DrowsySymptomatic relief of:

• Nasal congestion

• Pressure

• Headache

Sinutab® 3-WaySymptomatic relief of:


• Pressure

• Headache

• Inflammation

Sinutab® Nasal SpraySymptomatic relief of:

• Nasal congestion caused by colds, hay fever, allergic rhinitis and sinusitis

2

3

1

Treatment Since Anna needs to stay awake, the best products to recommend would be Sinutab® Sinus Pain Non-Drowsy and / or Sinutab® 3-Way as both have a non-drowsy formula.

If the congestion is severe and a hindrance to her, she can use the Sinutab® Nasal Spray to alleviate this. Daytime solution: Non-Drowsy

Daytime solution: Non-Drowsy

2

1

3

1. Remove the plastic cap from the nozzle.

2. On first use, press the plunger downwards and release until a single spray is delivered.

3. Hold the bottle upright and place nozzle into one nostril. Depress the plunger and at the same time breathe in through your nose. Release the plunger and remove nozzle from the nostril. Repeat this procedure for the other nostril.

4. To keep clean, wipe the nozzle and replace the plastic cap after use.

HOW TO USE NASAL SPRAY

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KEY SYMPTOMS OF INFLUENZA13d

BURNING SENSATION

Burning sensation in the chest

WARM, FLUSHED SKIN

Warm, flushed skin

SEVERE HEADACHES

Light sensitivity may occur

BODY ACHES & PAINS

Body aches and pains

FATIGUE AND WEAKNESS

Fatigue and weakness

CHILLS / CHILLY SENSATIONS

Usually the first symptom

DRY COUGH

Which may develop into a wet cough

RUNNY NOSE

Runny nose and watering eyes

SORE THROAT

Scratchy sore throat

FEVER

Fast onset of fever and up to 39°C


THE FLU

Flu is a viral infection of the lungs and airways caused by an influenza virus13a.

Symptoms tend to be more severe than those of a cold. They usually appear about 1 to 4 days after the patient has been exposed to the virus13b.

Flu becomes contagious 1 day before symptoms develop and can stay contagious for up to a week after the person becomes sick15.

Pneumonia is the most common complication of flu. This can present itself as a viral or bacterial infection13c. Key symptoms are a worsened cough, difficulty breathing, persistent fever, and blood in the sputum13d.

FAST FACT When it comes to the flu, the time from infection to illness, known as the incubation period, is about 2 days14a.

HOW TO SPOT THE FLU

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How to avoid the Flu or reduce its severity

Getting a yearly flu shot is advised. It typically takes 2 weeks for the influenza vaccine to become effective13h, so it is essential for the patient to be extra vigilant and boost their immune system during this time. Here are some of the things that can be done to avoid getting sick:

The majority of people recover from fever and other symptoms in about 7 days without needing medical attention14b, though coughing, wheezing, weakness, sweating and fatigue may continue for days or weeks13f. At the pharmacy, treatment is aimed at relieving symptoms and OTC remedies overlap with those used to treat symptoms of the common cold13g.

Wash your hands frequently18

It is recommended to wash your hands for 20 seconds at a time19, to make sure you get rid of any unwanted micro-organisms.

Avoid people who are coughing or sneezing

As with the cold, the flu virus can be transmitted through air or by touch13i.

Eat plenty of fruits and vegetables

A balanced diet with lots of vitamins and minerals will boost the body’s immune system, making it easier to fight off viruses. Make sure you eat a good mixture of green, red and yellow vegetables and a variety of fruit to get the maximum benefit17a.

Do aerobic exercises

Any activity that gets your heart pumping helps increase the natural virus-killing cells in your body17b.

Drink plenty of warm drinks in the winter months20

This helps you stay hydrated, it soothes the throat and also washes it clear of potentially harmful intruders.



Diagnosis: The Difference between Colds and Flu16a,13e

It can be difficult to assist patients who aren’t feeling well and are not quite sure about all the facts regarding their condition. It is especially tricky since colds and flu share many of the same common symptoms.

The table below will help you to ask your patients exactly the right questions, so you can quickly distinguish between the two ailments, and offer an effective solution.

Symptom Cold Flu

Sore throat (often scratchy)

Cough (mild and short duration) (can last for weeks)

Headache (usually mild) (usually more severe)

Discomfort in the eyes

(watering eyes)(often light sensitivity

and painful eyes)

General malaise or tiredness

(watering eyes)(often accompanied

by weakness)

Sneezing/runny nose/blocked nose

(often one of the first

symptoms to appear)

General aches and pains in the body

(mild or not at all)

Fever (usually not)

Appears suddenly (appears gradually)(appears quickly

within hours)

HOW TO TREAT

THE FLU

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Ask the following questions

• How long has he had the symptoms?

• Does he have a headache and how severe is it?

• Is he experiencing any sensitivity to light?

• Does he have a fever?

• Does he have a cough?

• Does he have any allergies?

• Does he have any other medical conditions?

• Is he short of breath?

• Is he experiencing pain in his chest or difficulty breathing?

• Has he experienced any dizziness or confusion?

• Is he on any other medication?

• Kagiso has come to your pharmacy to ask for advice

• He says that he has body aches and pains and that he is feeling very tired

• He also tells you that he has a runny nose and watering eyes

• He says that he has taken a sick day and will be going home to get some rest and that he would like to know which over-the-counter (OTC) product he can take to help him get better

Kagiso says that his symptoms started two days ago. He does not have a cough, but he is experiencing sensitivity to light. He might have a fever, since he is feeling hot and chilly. He does not have any allergies, does not have problems breathing and has not experienced any confusion or dizziness.

Diagnosis:

You have established that Kagiso has the flu without a cough. (A cough may still develop, but has not yet.)

He does not describe any warning signs that are a cause for concern.

CASE STUDYKagiso, 29, Banker

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Dosage: Benylin® 4 Flu Tablets • Adults & children over 12 years:

2 tablets 4 times daily. Do not exceed 8 tablets within 24 hours.

• Children 6 – 12 years: 1 tablet 4 times daily. Do not exceed 4 tablets within 24 hours.


Dosage: Benylin® 4 Flu Liquid • Adults & children over 12 years:

20 ml 4 times daily.


1 tablet every 4 – 6 hours. If symptoms do not respond to 1 tablet, a second may be taken. Do not exceed 6 tablets in 24 hours

1


Benylin® 4 Flu Tablets and LiquidSymptomatic relief of:

• Coughing

• Fever

• Headache

• Minor aches and pains


Benylin® Daytime Flu TabletsSymptomatic relief of:

• Fever

• Headache

• Body aches and pains


2

1

Note: Because this product contains Diphenhydramine HCl, Kagiso may experience drowsiness.

Kagiso has a choice between Benylin® 4 Flu Tablets and Benylin® 4 Flu Liquid if he does not like swallowing tablets.

Treatment Since Kagiso has a flu without a cough and can go home to rest and recover, his pharmacist can confidently recommend the following Benylin® product:

Daytime solution: Non-Drowsy

2

1

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Your adult patients should seek further medical advice if they answer yes to any of the following questions21a,22:

• Are you experiencing shortness of breath or difficulty breathing?

• Do you have pain or pressure in the chest or abdomen?

• Have you felt suddenly dizzy?

• Are you confused?

• Have you been experiencing severe or ongoing vomiting?

• Have you had an improvement in symptoms followed by a return of the fever and a worse cough?

• Have you been coughing up blood?

• Have you recently been in hospital?

• Has your cough lasted for more than 3 weeks?

• Have you felt unwell with a prolonged fever?

• Do you have conditions such as chronic bronchitis, heart disease, diabetes or asthma?

Advise the customers to take their child to a doctor when the answer is yes to any of the following questions21b:

• Is he/she breathing rapidly or finding it difficult to breathe?

• Is his/her skin bluish or grey in colour?

• Is he/she not drinking enough fluids?

• Is he/she experiencing severe or ongoing vomiting?

• Is he/she not waking up/not interacting?

• Is he/she irritable or does he/she not want to be held?

• Has he/she experienced an improvement in symptoms, followed by a return of the fever and a worse cough?

URGENT ASSISTANCE!


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4 When do flu symptoms appear?

a 1 to 4 days after the patient has been exposed to the virus

b 5 to 7 days after the patient becomes sick

c Within 12 hours of exposure

d Exactly 3 days after being exposed to the virus

5 Which OTC remedy would you recommend to a parent with a child aged between 6 and 12 years who is suffering from flu symptoms?

a Benylin® Daytime Flu Tablets

b Benylin® 4 Flu Tablets

c Sinutab® 3-Way

d Sinutab® Nasal Spray

6 What home care tips can you recommend to your patient to help speed up the recovery process?

a Rest at home

b Not sleep enough

c Drink too little

d Don't try and ease your temperature

7 Which of the following symptoms are key of a flu?

a Sore throat

b Headache

c Fever

d All of the above


1 Which of the following is not a key symptom of the common cold?

a Mild cough

b Runny nose

c Mild fatigue

d Skin rash

2 For which of the following cold symptoms can Sinutab® Sinus Pain Non-Drowsy be used?

a Nasal congestion

b Pressure

c Headache

d All of the above

3 Your patient has the flu with a cough, fever and a headache. Which one of the following products would you recommend?

a Benylin® Original

b Benylin® with Codeine

c Benylin® 4Flu Liquid

d Benylin® Bronchospect

TEST YOUR KNOWLEDGE


You’ve reached the end of the module. You can test your knowledge right away while the info is fresh, or you can complete the full Class Test in one go once you reach the end of this Study Pack. See the back page of the booklet for more details on how to complete and submit your test.

Below are the questions from the Class Test that applies to the module you just finished. The full Class Test appears on the Fax Sheet included separately.

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Product Portfolio

COLDS AND FLU

Sinutab® Nasal Spray

Sinutab® 3-Way

Sinutab® Sinus Pain Non-Drowsy

Sinutab® Saline Spray

Benylin® 4Flu Liquid

Benylin® 4Flu Tablets

Benylin® Daytime Flu Tablets

WHY CHOOSE SINUTAB®Sinutab® has a unique range specifically formulated to treat all types of upper respiratory congestion and allows you to breathe more freely.

WHY CHOOSE BENYLIN®The Benylin® range provides suitable product solutions for all cough and cold needs, for the whole family.


Congestion + Pain ReliefCongestion + Pain Relief + Inflammation

20s & 10s 20s & 10s

Non-Drowsy symptomatic relief of:


• Pressure

• Headache

Non-Drowsy symptomatic relief of:


• Pressure

• Pain and fever

• Inflammation

Ind

icat

ion

US

PA

ctiv

e In

gre

die

nts

Siz

e

AGE 6+ AGE 12+

COLD

Sinutab® Sinus Pain Non-Drowsy

Sinutab® 3-Way Non-Drowsy

Pseudoephedrine 30 mg*• Starts to work in 30 mins25

• Lasts up to 8 hours25

Ibuprofen 200 mg*• Starts to work within 1 hour23

• Lasts 6 – 8 hours23

Pseudoephedrine 30 mg*• Starts to work in 30 mins25


Paracetamol 500 mg*• Starts to work in 30 – 60 mins26

• Lasts 4 – 6 hours26

CLEARS YOUR HEAD FOR UP TO

6 HOURS23,24

COLD

Sinutab® Nasal Spray Sinutab® Saline Spray

AGE 12+ AGE ALL

Nasal Congestion Daily Nasal Hygiene

10 ml 15 ml

Fast (2 min) and long lasting (10 hours) relief from Nasal congestion caused by colds, allergic rhinitis, hay fever, sinusitis

Supports treatment of nasal decongestion

• Cleans & Moisturizes nasal passages

Xylometazoline hydrochloride 1 mg*

• Starts to work in 2 minutes26


Isotonic Saline Solution

26

27

* Each tablet contains * Each tablet contains * Per ml


AGE 12+

FLU

Benylin® 4Flu Liquid

For the relief of symptoms associated with the common cold, sinusitis, or flu, including nasal congestion, headache, fever, body aches and pain.

For the relief of symptoms associated with colds and flu; including coughing, fever, headache, minor aches and pains and nasal congestion.

For the relief of symptoms associated with colds and flu; including coughing, fever, headache, minor aches, and pains and nasal congestion.

20s 24s 100 ml & 200 ml

• 4 -way flu fighter: treats symptoms associated with coughing, fever, body pains and

congestion.

• Sugar free

• Alcohol free

Warning: Do not use continuously for colds

for more than 7 days or for fever for more

than 3 days unless directed by a doctor


congestion.

• Sugar free

• Alcohol free

Warning: May cause drowsiness

Do not use for more than 10 days


congestion.

• Sugar free

Warning: May cause drowsiness

Do not use for more than 10 days

Paracetamol 500 mg*

Diphenhydramine 12,5 mg*

Pseudoephedrine 22,5 mg*

Ibuprofen 200 mg*

Pseudoephedrine hydrochloride 30 mg*

Paracetamol 1000 mg*

Diphenhydramine 25 mg*

Pseudoephedrine 45 mg*

Ind

icat

ion

US

PA

ctiv

e In

gre

die

nts

Siz

e

AGE 12+ AGE 6+

FLU

Benylin® Daytime Flu Tablets

Benylin® 4Flu Tablets

* Per tablet * Per 5 ml* Per tablet


TOP TIP: HOME CARERemind your patient that when he/she has a cold he/she can do the following to help speed up the recovery process:

2g,16b,28

INHALE STEAM

(from a vaporiser to loosen secretions)

DRINK LOTS OF FLUIDS

(with added electrolytes)

REST AT HOME

(if you have a fever or more severe

symptoms)

AVOID STRESSFUL SITUATIONS

(which can tire out your immune system)

EASE HIGH TEMPERATURES

(with OTC remedies such as ibuprofen

and paracetamol)

STAY WARM & COMFORTABLE


S2 SINUTAB® 3-Way. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Ibuprofen 200 mg. Reg. No. 36/5.8/0207.

S2 Benylin® Four Flu Tablets. Each tablet contains Diphenhydramine HCI 12,5 mg; Paracetamol 500 mg; Pseudoephedrine HCI 22,5 mg. Reg. No. 33/5.8./0509.

S1 SINUTAB® Nasal Spray. Xylometazoline Hydrochloride 1 mg per ml (0,1 % w/v). Reg. No. P/16.1/184.

S2 Benylin® Daytime Flu Tablets. Each tablet contains Pseudoephedrine Hydrochloride 30 mg; Ibuprofen 200 mg. Reg. No. 36/5.8/0206.

S2 SINUTAB® Sinus Pain Non-Drowsy. Each tablet contains: Pseudoephedrine Hydrochloride 30 mg, Paracetamol 500 mg. Reg. No. 37/5.8/0138.

S2 Benylin® Four Flu Liquid. Each 20 ml contains Diphenhydramine HCI 25 mg; Paracetamol 1 000 mg; Pseudoephedrine HCI 45 mg. Reg. No. 33/5.8/0345.


References 1. Porter RS (Ed). Viral Infections: Overview of Viral Infections. The Merck Manual Home Health Handbook. Available at www.

merckmanuals.com/home/infections/viral-infections/overview-of-viral-infections. Accessed on 20 December 2017

2. Porter RS (Ed). Viral Infections: Common Cold. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/infections/viral-infections/common-cold. Accessed on 20 December 2017.

3. Porter RS (Ed). Respiratory Viruses: Common Cold. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/infectious-diseases/respiratory-viruses/common-cold. Accessed on 20 December 2017.

4. Graf P, et al. Expert Opin Pharmacother 2009;10:889-908.

5. Eccles R, et al. Curr Med Res Opin 2010;26:889-899.

6. Eccles R. Am J Rhinol 2000;14:335-338.

7. Eccles R. Rhinology 2011;49:131-138.

8. Eccles and Weber (ed). Common Cold. Birkhäuser Advances in Infectious Diseases. 2009 Birkhäuser. Verlag Basel/Switzerland.

9. Mayo Clinic Patient Care & Health Info. Common Cold: Symptoms. Available at www.mayoclinic.org/diseases-conditions/common-cold/basics/symptoms/con-20019062. Accessed on 20 December 2017.

10. Barrett B, et al. Health Qual Life Outcomes 2009;7(76).

11. Web MD Cold, Flu, & Cough Health Center. Coughs: Age 12 and Older. Available at www.webmd.com/cold-and-flu/tc/coughs-topic-overview. Accessed on 20 December 2017.

12. Smith AP. Brain Behav Immun 2012;26:1072-1076.

13. Porter RS (Ed). Viral Infections: Influenza. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/infections/viral-infections/influenza-flu. Accessed on 20 December 2017.

14. World Health Organization. WHO Facts Sheets: Influenza (Seasonal). Available at www.who.int/mediacentre/factsheets/fs211/en/. Accessed on 20 December 2017.

15. How Flu Spreads. Centers for Disease Control and Prevention. Available at www.cdc.gov/flu/about/disease/spread.htm. Accessed on 20 December 2017.

16. NHS Choices. Coping With Colds and Flu. Available at www.nhs.uk/Livewell/coldsandflu/Pages/Coldcomfort.aspx. Accessed on 20 December 2017.

17. WebMD. Cold, Flu & Cough Health Center. 8 Natural Tips to Help Prevent a Cold. Available at www.webmd.com/cold-and-flu/11-tips-prevent-cold-flu. Accessed on 20 December 2017.

18. WebMD. Cold, Flu & Cough Health Center. Coughs, Age 12 and Older – Prevention. www.webmd.com/cold-and-flu/tc/coughs-prevention. Accessed on 20 December 2017.

19. Centers for Disease Control and Prevention. When and How to Wash Your Hands. www.cdc.gov/handwashing/when-how-handwashing.html. Accessed on 20 December 2017.

20. Daily Mail. 10 Ways to Avoid Colds and Flu This Winter. Available at http://www.dailymail.co.uk/health/article-86521/Ten-ways-avoid-colds-flu-winter.html. Accessed on 20 December 2017.

21. The National Institute for Communicable Diseases (NICD) in collaboration with The South African National Department of Health and World Health Organization (WHO). Healthcare Workers Handbook On Influenza (last updated: May 2014). Available at www.nicd.ac.za/assets/files/Healthcare%20Workers%20Handbook%20on%20Influenza%20in%20SA%20_12%20May%202014(1).pdf. pp 17. Accessed on 20 December 2017.

22. Morice AH et al. Thorax 2006;61(Suppl 1):i1−i24

23. Tucci J, Bandiera E, Darwiche R, Medos Z, Nashed R, Trinh D. Paracetamol and Ibuprofen for Paediatric Pain and Fever. Jnl Pharmacy Practice Research. 2009; 39(3):223-225.

24. www.medsafe.govt.nz/profs/datasheet/c/codeine.

25. http://www.drugs.com/monograph/pseudoephedrine.html.

26. R Eccles. M Eriksson. S Garreffa, Shirley C. CHen, 2018. The nasal decongestant effect of xylometazoline in the common cold. American Journal of Rhinology, Vol 22, No. 5, 2008, page 493.

27. R Eccles, K Martensson, Shirley C. Chen, 2010, Effects of intranasal xylometazoline, alone or in combination with ipratropium, in patients with common cold, Current Medical Research & Opinion, Vol. 26, No. 4, 2010, page 889-899.

28. Boots WebMD. Flu guide. Available at www.webmd.boots.com/cold-and-flu/flu-guide/five-days-of-flu. Accessed on 20 December 2017.

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module 2 colds and flu module 2 colds and flu introduction · adapted from smith ap, 2012. because...

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