1. Drugs 101 Colds

2. Colds are the most common infection Outnumber all others by 25 to 1

3. More than 200 viruses cause colds Rhinovirus 30 to 50 % Unknown 20 to 30 % Cornavirus 10 to 15 % Influenza virus 5 to 15 % Respiratory scincitial virus 5 % Parainfluenza virus 5 % Adenovirus <5 % Enterovirus <5 % HMPV 1 % Bocavirus 1 %

4. Influenza virus can be fatal

5. Virus destroys tissue, immune system makes symptoms

6. No cure for the common cold Average cold lasts a week Some cold medications relieve symptoms Many remedies do nothing –Doing something makes you feel better No medication will prevent colds

7. Common Cold research Unit Salisbury England

8. Free vacation for research

9. Test subjects in extreme comfort

10. The vacation was not exactly free

11. Sneezing does not spread colds well

12. Sneeze collector

13. Artificial sneeze

14. Being cold does not cause colds

15. Wet hair does not cause colds

16. Direct exposure to virus does not always cause cold

17. Cold virus in nasal secretions

18. Nasal secretions spread easily

19. Confirmed by the Mythbusters

20. Cold viruses are transferred by touching

21. Commonly touched objects

22. Colds are more common in crowds

23. School season is cold season

24. Tristan ca Cunha in the middle of nowhere

25. Incidence of colds and contact with outside

26. Cold viruses spread through crowds

27. Washing hands may reduce colds

28. Hand sanitizer may reduce colds

29. Don’t overdo it – avoid skin damage

30. Wearing a mask will not protect you

31. Masks protect others from the wearer

32. Trying to limit the spread of colds

33. Incidence of colds decrease with age Age

34. Young children more social

35. As you age you acquire immunity by being infected Exposure to virus causes illness –Immune response is too slow and weak to prevent Body makes large amounts of antibodies only during infection After each infection you build up “memory” cells Later exposure to the same virus does not make you sick –Rapid and strong immune response

36. $4.1 Billion on colds each year (North America)

37. Read the back not the front of the box

38. Cold remedy ingredients Pain reliever or fever reducer Decongestant Antihistamine Antitussive Expectorant

39. Acetaminophen for pain relief and fever

40. Some products contain ibuprofen

41. No such thing as a sinus cold

42. Menthol for sore throat?

43. Menthol is a weak topical analgesic Menthol 22 mg

44. Menthol cough drops for sore throat Menthol 2.5 mg

45. Cepacol contains topical anesthetic Benzocaine 15 mg

46. Decongestants dry a runny nose Pseudoephedrine Phenylephrine

47. Snot is mostly water with a little mucin

48. Water is supplied by the blood

49. Decongestants are vasoconstrictors

50. Amphetamine – the original decongestant

51. Amphetamines for cold symptoms

52. Phenylpropanolamine (PPA) became popular Side effect is appetite suppression

53. Diet pills used phenylpropanolamine (PPA) Side effect was decongestion

54. Over-use of diet pills caused hallucinations Amphetamine psychosis

55. Over use of diet pills caused strokes

56. PPA warnings on the internet are bogus

57. Sudafed contains Pseudoephedrine

58. Pseudoephedrine to make methamphetamine

59. Drug dealers used to buy direct Up to 50 % of pseudoephedrine used to make methamphetamine

60. Dealers turned to “smerfing”

61. Sudafed now “behind the counter”

62. Sudafed PE contains Phenylephrine

63. Phenylephrine is not effective

64. Pseudoephedrine is still widely available

65. Generic versions are available for all cold meds

66. Antihistamines for sneezing, runny nose, watery eyes

67. Antihistamine side effect is drowsiness

68. Chlorpheniramine is most common antihistamine for colds Side effect is drowsiness

69. New allergy antihistamines don’t make you sleepy

70. Dayquil does not contain antihistamines

71. Antihistamines reduce nausea Diphenhydramine (anithistamine) 8-chlorotheophyliine (stimulant)

72. Dry cough and productive cough

73. Cough syrup is a marketing trick

74. The best cough medicine money can buy

75. Dextromethorphan used today

76. Expectorant for productive cough

77. Thick mucus is difficult to remove

78. Watery mucus is easily coughed up

79. Guaifenesin makes mucus watery

80. Drink liquids with expectorants

81. Beware multi-symptom medications

83. No cold meds for children under 6

84. Some take vitamin C to prevent colds

85. Vitamin C will not prevent or cure a cold

86. #1 seller in Canada

87. Cold-fX ingredients

88. Ginseng is used for everything

89. Ginseng root resembles a human body

90. Cold-fX claims highly questionable

91. Clinical studies are low quality

92. 15 % of colds due to flu virus

93. Influenza causes seasonal colds Normally infects 5 to 15 % of population New virus formed every year Most forms not dangerous –Very young and very old are at risk

94. Occasional severe influenza pandemics Very virulent strain occasionally arises –1918 20,000,000 deaths –1957 1,000,000 deaths –1968 700,000 deaths

95. Virus contains an outer envelope –Hemagglutinin (viral entry into cell) –Neuraminidase (viral exit from cell)

96. Flu virus classified using envelope proteins Hemagglutinin (H) –16 types –Human flu H1 through H5 Neuraminidase (N) –9 types –Human flu N1 or N2

97. Disease and virus type Antibody responsevirus H1N1Spanish flu (1918) H2N2Asian flu (1957) H3N2Hong Kong (1968) H1N2, H3N2, H1N1“normal” flu (seasonal) H5N1Avian flu (2007) H1N1Swine flu (2009)

98. Mortality rates and pandemics (world) Infection rateDeathsFatality rate Spanish flu (1918)30%20 million2.5 % Asian flu (1957)1 million<0.1 % Hong Kong (1968)700,000<0.1 % “normal” (seasonal)5 to 15%250,000 - 500,000<0.1 % H1N1 (2009)12,000<0.05 %

99. Mortality rates in Canada Infection rateDeaths Average Flu Season5 to 15 %4000 Severe Flu SeasonUp to 30 %8000 Severe Pandemic (estimate) 11000 to 58000 H1N1 (2009)401

100. Name brands vs generic

101. Name brands vs name brand

102. They all use same ingredients same doses Pain and fever –Acetaminophen 500 mg –Ibuprofen 200 mg Decongestant –Pseudoephedrine 30 mg –Phenylephrine 10 mg Antihistamine –Chlorpheniramine 2 mg Antitussive –Dextromethorphan 15 mg Expectorant –Guaifenesin 200 mg

103. Price per 100 tablets Advil Cold & Sinus (pain & congestion)$35.93 Generic Cold & Sinus (pain & congestion)$9.99 Buckley’s DM (dry cough) (250 mL)$13.99 Generic DM (dry cough) (250 mL)$5.99 Benylen Congestion (productive cough) (250 mL)$15.35 Generic Guaifenesin (productive cough) (250 mL)$7.99 Nyquil (antihistamine)$56.63 Generic antihistamine$18.59

104. Medications for colds and flu You will get colds Nothing will cure it Nothing will prevent it Some medications may reduce symptoms –You cannot treat all symptoms –Choose which symptoms you want to treat Read the back not the front –Choose the right medication Avoid multi-symptom products Compare before you buy