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

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Presentation on theme: "Healthy Transitions Seasonal Flu: Prescription (Rx) vs. Over-The-Counter (OTC) Medications Farah Barada, PharmD Katelyn Vautrin, PharmD Zachary Pentoney,"— Presentation transcript:

1 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?  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  Available medications

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 252/who-dont-antibiotics-unless-prescribed

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 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

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

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

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

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

12 Hand Washing Tips

13 Prevention The most important way to prevent yourself from getting the flu is to get vaccinated!!! vaccination-and-immunization

14 Immunizations  What is a vaccine?  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  Injection, Intramuscularly  High dose flu shot  Injection, Intramuscularly  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 FACT MYTH FACT

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  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 SymptomsDirected

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

25 Managing Headache/Body Aches Medication Options  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 General Facts  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  Use Tylenol  Heart failure  Use Tylenol  Medical Condition Interactions  Kidney disease  Use Tylenol  Diabetes  Use Tylenol  Glaucoma  Use Tylenol

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”  Use Tylenol

28 Managing Fever Medication Options  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 General Facts  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  Use Tylenol  Heart failure  Use Tylenol  Medical Condition Interactions  Kidney disease  Use Tylenol  Diabetes  Use Tylenol  Glaucoma  Use Tylenol

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”  Use Tylenol

31 Managing Cough Medication Options  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 General Facts  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  Use either based on type of cough  Heart failure  Use either based on type of cough  Medical Condition Interactions  Kidney disease  Use either based on type of cough  Diabetes  Use either based on type of cough  Look for sugar-free formulations  Glaucoma  Use either based on type of cough

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  Use Mucinex for wet cough

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  Cepacol Lozenges  Two lozenges (one after the other) every 4 hours as needed  Cough Drops  One drop every 2 hours as needed General Facts  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

36 Which option is best for you (sore throat)?  Medical Condition Interactions  Heart disease  Use either  High blood pressure  Use either  Heart failure  Use either  Medical Condition Interactions  Kidney disease  Use either  Diabetes  Look for sugar-free formulations  Glaucoma  Use either

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  Use cough drops that contain benzocaine or menthol

38 Managing Congestion Therapeutic Options  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 General Facts  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  Use saline rinse, humidified air or Afrin  Heart failure  Use saline rinse, humidified air  Kidney disease  Use saline rinse, humidified air or Afrin  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  Use saline rinse, humidified air or Afrin  Thyroid disorders  Use saline rinse, humidified air or Afrin*

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

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


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