1. Seasonal Flu: Prescription (Rx) vs. Over-The-Counter (OTC) Medications
Healthy Transitions
Seasonal Flu: Prescription (Rx) vs. Over-The-Counter (OTC) Medications
Farah Barada, PharmD
Katelyn Vautrin, PharmD
Zachary Pentoney, PharmD

2. Table of Contents What is influenza? Transmission and Prevention
Background and flu statistics
Signs and symptoms
Transmission and Prevention
Proper hygiene
Vaccinations
Over-The-Counter (OTC) Therapy
Available medications
Drug-Disease Interactions
Prescription Therapy
When is it appropriate to see your doctor

3. What is Influenza? Also known as: “the flu”
Viral infection that attacks your respiratory system, including your nose, throat and lungs
3 types: Influenza A, B, and C
Populations most at risk:
Young children
Adults >65 years old
Pregnant women
People with weakened immune systems
People who have multiple chronic illnesses
Important to note that this is a viral infection, so ABX will not work!!
Type A & B: can cause seasonal epidemics of disease; Type C: usually more mild, non-epidemic producing

4. Flu Statistics:
53,470 confirmed cases of influenza in the United States
46,727 (87.4%) cases were Influenza A virus
6,743 (12.6%) cases were Influenza B virus
9,635 reported hospitalizations due to influenza
Peak mortality rate of 8.7% for “Pneumonia and Influenza (P&I)” mortality
Most hospitalizations attributed to Influenza A
CDC, Morbidity and Mortality Weekly Report

5. Flu Severity Severity can depend on a number of things:
Which strains of the flu are causing the epidemic
The availability and quantity of flu vaccine
When the vaccine becomes available
How many people choose to get vaccinated
How well the flu vaccine is matched to the flu viruses that are circulating

6. Signs and Symptoms Fever (or feeling feverish/chills) Cough
Sore Throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue
Potentially vomiting and diarrhea
*Not everyone with the flu will have a fever
**Vomitting and diarrhea more common with children than adults
***Symptoms usually last for a few days to less than 2 weeks

7. Complications from the Flu
Possibility of developing complications
Can range from mild to life-threatening complications or even death
Examples include pneumonia, bronchitis or sinus and ear infections
Can also trigger other chronic conditions you may have, such as asthma or congestive heart failure
*Can trigger asthma attacks, decompensated heart failure

8. Transmission Virus spreads mainly through droplets in the air
Occurs when someone who has the flu coughs, sneezes or spits
Can also be transmitted from contact with infected surfaces
Touching surfaces that contain flu virus and then either touching your eyes, nose or mouth

9. Transmission
**Important to note: you may pass on the flu to someone else before you even know you’re sick
Most healthy adults are able to infect another person 1 day before symptoms develop and up to 5-7 days after symptoms develop
Large window where you have the ability to infect someone else!
*Children or people w/ weakened immune systems may be able to infect people for a longer period of time because they can’t get rid of the virus fast enough

10. Prevention Wash your hands!!
Make sure healthcare providers also wash their hands and wear gloves
Cover your mouth and nose when sneezing or coughing
Germs can travel 3 feet or more!
Avoid sick contacts
If you are sick, avoid close contact with others
*Cough into your elbow, not your palm!

11. Audience Question: What is the recommended length of time to wash your hands per the CDC?
A: 15 seconds
B: 20 seconds
C: 30 seconds
D: 1 minute
Proper hand hygiene:
-Use soap and warm water, rubbing hands together for at least 20 seconds. Make sure to get your palms, fingernails, in between your fingers and backs of your hands
-If your hands are not visibly dirty, may use an alcohol based hand sanitizer

12. Hand Washing Tips Reiterate points just mentioned

13. Prevention
The most important way to prevent yourself from getting the flu is to get vaccinated!!!

14. Immunizations What is a vaccine? How do vaccines work?
Medication that helps our immune system fight certain bacteria and viruses that may invade our body and cause disease
Goal of vaccinating is to prevent or control infection
How do vaccines work?
Antibodies are produced because the vaccines are made of weakened or inactive forms of bacteria or viruses
Antibodies
made by the body’s immune system in response to the presence of a foreign substance such as a bacteria or virus
Antibodies target and destroy the bacteria or virus within the vaccine
Our immune system then records the process by which it was able to fight off the disease
If re-exposed the body remembers how it fought the virus or bacteria and it protects itself

15. SEASONAL INFLUENZA (Flu) VACCINE
Who should receive the vaccine?
EVERYONE over the age of 6 months
High risk for complications
6 months of age or younger and those 65 years of age or older
chronic medical conditions, including heart disease, lung disease (for example, asthma), diabetes, kidney disease, liver disease, and blood disorders
Residents of nursing homes and other long-term care facilities
Women who will be pregnant during the flu season
Health care workers and caregivers of those at highest risk

16. SEASONAL INFLUENZA (Flu) VACCINE
 When should you get the seasonal flu vaccine? 
Best to get in September or as soon as the vaccine is available
Can still get vaccinated in March or April
Best to receive the flu vaccine each year because disease protection is short-lived
Why do I need to get vaccinated against the seasonal flu every year?
Seasonal flu viruses change from year to year and your immunity can decline over time
Not protected from a new strain that is circulating in the present year

17. Types of Flu Vaccines Traditional flu shot High dose flu shot
Injection, Intramuscularly
High dose flu shot
Ages 65 and older
triggers the body to produce more antibodies against the virus
Intranasal (FluMist®)
Ages 2-49 years, healthy people
Live vaccine
Not for
People with compromised immune systems
Have a severe egg allergy
Pregnant

18. Myths vs Fact of the Flu Vaccine
You can get the flu from the flu vaccine
The flu is just a bad cold
The flu shot is covered under Medicare part B
Young/healthy people don’t need to get the vaccine
The risk of a true allergic reaction from the flu vaccine is very rare
Getting a shot is the only way to vaccinate against the flu
More than 9,000 people are hospitalized each year for flu-related complications
Getting a vaccine last year means I don’t have to get one this year
MYTH
MYTH
FACT
MYTH
FACT
MYTH
FACT
MYTH

19. PNEUMOCOCCAL (Pneumonia) VACCINE
What is pneumococcal disease?
Bacteria Streptococcus pneumonia
Affects the lungs (pneumonia), blood (bacteremia) and brain (meningitis).
Spread
Coughing, sneezing, or contact with respiratory secretions
Who should receive the pneumococcal vaccine?
All people 65 years of age or older
Residents of nursing homes or long-term care facilities
People from 19 to 64 years old who smoke or have asthma
People 2 to 64 years old who have chronic health conditions or a disease that weakens the immune system

20. Quick Reminder! ZOSTER (Shingles) VACCINE Tdap
Shingles is a viral disease caused by the varicella zoster virus same virus as the chickenpox
It is a painful skin rash with blisters that is usually localized to one side of the body and may last 2 to 4 weeks
60 years of age or older / ONE time dose
Tdap
provides protection against tetanus, diphtheria, and pertussis (whooping cough)
Adults age ≥ 65 who have close contact with an infant

21. Immunizations Recap
Important to keep up-to-date with you immunizations
Where can you go to get vaccinated?
Local pharmacies
Doctor’s offices

22. Managing the Flu at Home
“OTC” Approaches
Symptoms
Directed

23. Symptom-Targeted Therapies

24. Flu Symptoms Recap Headaches  pain medications
Body aches  pain medications/anti-inflammatory agents
Fever  antipyretics
Cough  antitussives
Fatigue/weakness  fluids* and rest
Sore throat  local “anesthetics”
Congestion  decongestants
*Caution on fluids if fluid restrictions

25. Managing Headache/Body Aches
Medication Options
General Facts
Acetaminophen (Tylenol)
mg every 4-6 hours as needed
Ibuprofen (Motrin)
mg every 4-6 hours as needed
Aleve (Naproxen)
220 mg every 12 hours as needed
Take ibuprofen or naproxen with food
Medication limits
Tylenol: 4,000 mg per 24 hours
Ibuprofen: 1,200 mg per 24 hours
Naproxen: 660 mg per 24 hours

26. Which option is best for you (aches)?
Medical Condition Interactions
Heart disease
Use Tylenol
High blood pressure
Heart failure
Medical Condition Interactions
Kidney disease
Use Tylenol
Diabetes
Glaucoma
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

27. Which option is best for you (aches)?
Medication Interactions
Coumadin or other “blood thinners”
Use Tylenol, but still need to be monitor closely
MAO-Is (e.g., Nardil, Parnate, Emsam, Azilect)
No preference
Medication Interactions
Anti-depressants (e.g., Lexapro, Zoloft, Celexa)
Use Tylenol
Blood pressure medications or “water pills”
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

28. Managing Fever Medication Options General Facts
Acetaminophen (Tylenol)
mg every 4-6 hours as needed
Ibuprofen (Motrin)
mg every 4-6 hours as needed
Aleve (Naproxen)
220 mg every 12 hours as needed
Take ibuprofen or naproxen with food
Medication limits
Tylenol: 4,000 mg per 24 hours
Ibuprofen: 1,200 mg per 24 hours
Naproxen: 660 mg per 24 hours

29. Which option is best for you (fever)?
Medical Condition Interactions
Heart disease
Use Tylenol
High blood pressure
Heart failure
Medical Condition Interactions
Kidney disease
Use Tylenol
Diabetes
Glaucoma
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

30. Which option is best for you (fever)?
Medication Interactions
Coumadin or other “blood thinners”
Use Tylenol, but still need to be monitor closely
MAO-Is (e.g., Nardil, Parnate, Emsam, Azilect)
No preference
Medication Interactions
Anti-depressants (e.g., Lexapro, Zoloft, Celexa)
Use Tylenol
Blood pressure medications or “water pills”
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

31. Managing Cough Medication Options General Facts
Determine type of cough
Dry cough
Delsym (dextromethorphan) two teaspoonfuls (10 mL) every 12 hours as needed
Wet cough
Mucinex (guaifenesin) mg tablets every 12 hours
Take Mucinex with a full glass of water (unless you have fluid restrictions).
Medication limits
Delsym: 4 teaspoonfuls (20 mL) per 24 hours
Mucinex: 2400 mg per 24 hours

32. Which option is best for you (cough)?
Medical Condition Interactions
Heart disease
Use either based on type of cough
High blood pressure
Heart failure
Medical Condition Interactions
Kidney disease
Use either based on type of cough
Diabetes
Look for sugar-free formulations
Glaucoma
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

33. Which option is best for you (cough)?
Medication Interactions
MAO-Is (e.g., Nardil, Parnate, Emsam, Azilect)
ABSOLUTELY CANNOT use Delsym or cough suppressants containing dextromethorphan
Use Mucinex for wet cough
Anti-depressants and related agents (e.g., Lexapro, Zoloft, Celexa, Reglan, Abilify)
Avoid Delsym and similar cough suppressants
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

34. Managing Fatigue/Weakness
Therapeutic Options
Avoid caffeine and other stimulants
Drink plenty of fluids unless you have fluid restrictions
Rest/sleep is key!

35. Managing Sore Throat Medication Options General Facts Cepacol Lozenges
Two lozenges (one after the other) every 4 hours as needed
Cough Drops
One drop every 2 hours as needed
Cepacol lozenges/cough drops
Allow to dissolve slowly in mouth
Do not chew
Medication Limits
Cepacol lozenges: 12 lozenges per 24 hours
Cough drops: 12 cough drops per 24 hours
Cepacol contains dextromethorphan and benzocaine

36. Which option is best for you (sore throat)?
Medical Condition Interactions
Heart disease
Use either
High blood pressure
Heart failure
Medical Condition Interactions
Kidney disease
Use either
Diabetes
Look for sugar-free formulations
Glaucoma
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

37. Which option is best for you (sore throat)?
Medication Interactions
MAO-Is (e.g., Nardil, Parnate, Emsam, Azilect)
CANNOT use Cepacol lozenges
Use cough drops that contain benzocaine or menthol
Anti-depressants and related agents (e.g., Lexapro, Zoloft, Celexa, Reglan, Abilify)
Avoid Cepacol lozenges
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)

38. Managing Congestion Therapeutic Options General Facts
Sudafed (sinuses)
60 mg every 4-6 hours as needed
120 mg every 12 hours as needed
240 mg every 24 hours as needed
Sudafed PE (sinuses)
10 mg every 4 hours as needed
Coricidin HBP Max Strength Flu
Two tablets every 6 hours as needed
Afrin (nasal)
2-3 sprays in each nostril two times per day
Other options
Humidified air
Saline rinses
Sudafed can be taken with or without food but faster onset on empty stomach (~30 min).
Medication limits
Sudafed: 240 mg per 24 hours
Sudafed PE: 60 mg per 24 hours
Afrin: 3 days
Coricidin: 8 tablets per 24 hours
Saline rinses must be with CLEAN water
Try the immediate release formulations first before the extended release ones

39. Which option is best for you (congestion)?
Medical Condition Interactions
Heart disease
Use saline rinse, humidified air or Afrin
High blood pressure
Heart failure
Use saline rinse, humidified air
Kidney disease
Diabetes
Use saline rinse, humidified air, or Afrin*
Medical Condition Interactions (cont’d)
Glaucoma
Use saline rinse, humidified air or Afrin
Prostatic hyperplasia/urinary obstruction
Use Use saline rinse, humidified air or Afrin*
Seizures
Thyroid disorders
Use saline rinse, humidified air or Afrin*
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)
*indicate caution still for Afrin but benefits seem to outweigh risks

40. Which option is best for you (congestion)?
Medication Interactions
MAO-Is (e.g., Nardil, Parnate, Emsam, Azilect)
CANNOT use Sudafed, Sudafed PE, or Afrin
Use saline rinse, or humidified air
Migraine medications (e.g., DHE 45, Migranal)
Use saline rinse or humidified air
Anti-depressants and related agents (e.g., Lexapro, Zoloft, Celexa, Effexor, Cymbalta)
Avoid Sudafed and Sudafed PE
Use Afrin, saline rinse, or humidified air
Marplan (isocarboxazid), Nardil (phenelzine), Parnate (tranylcypromine), Azilect (rasagiline), Emsam (selegiline)
*indicate caution still for Afrin but benefits seem to outweigh risks

41. Directed Therapy
Anti-viral medications

42. Directed Therapy: Seeing the Doctor
Tamiflu® (oseltamivir phosphate)
ONLY effective if started within 48 hours of onset of symptoms
5 days of therapy
Twice a day
May need it if no flu shot and exposed to someone with the flu (post-exposure prophylaxis)
Side effects
Common: nausea, vomiting
Rare: skin reactions, changes in behavior

43. When to the call or see the doctor?
No improvement/worsening in symptoms after a few days (especially if 7 days with OTCs and no improvement)
Difficulty breathing
Uncontrollable vomiting, dehydration
Stiff neck, severe headache
Good idea to let the doctor know if you have flu symptoms and you also have:
Diabetes
COPD
Asthma
Heart disease

44. What questions can we answer for you?

45. Thank You!

46. Seasonal Flu: Prescription (Rx) vs. Over-The-Counter (OTC) Medications
Healthy Transitions
Seasonal Flu: Prescription (Rx) vs. Over-The-Counter (OTC) Medications
Farah Barada, PharmD
Katelyn Vautrin, PharmD
Zachary Pentoney, PharmD