hsp 1

• major functions of epithelial tissue

  • protect underlying tissues (e.g. skin)
  • permit passage of substances (e.g. epithelium in lungs)
  • absorb substances (e.g. intestine)
  • barrier to entry of substances (e.g. skin)
  • secrete substances (e.g. sweat glands)
• Types, locations and functions

  • simple squamous - lining of heart & blood vessels, alveoli of lungs - regulate permeability (diffusion, filtration)
  • simple cuboidal - kidney tubes, ovary surface - absorption & secretion
  • simple columnar - lining of stomach and intestine - absorption & secretion
  • transitional - lining of bladder - stretches to accommodate change in urine volume
  • pseudostratified columnar - lining of trachea & bronchi - secretes mucus, propel mucus out of respiratory tract
  • stratified squamous - lining of esophagus and outer skin layer - protect against abrasion &infection
• organ systems

  • integumentary - skin,hair, nails, sweat glands
  • skeletal - bones, joints
  • muscular - muscles, tendons
  • nervous - brain, spinal cord
  • lymphatic - lymphatic vessels, lymph nodes, spleen
  • cardiovascular - heart, blood, blood vessels
  • respiratory - nasal cavity, traches, bronchi, lungs
  • endocrine - pituitary gland, pancreas, adrenal glands, ovaries, testes
  • digestive - mouth, esophagus, stomach, intestines
  • urinary - kidneys, bladder
  • reproductive - ovaries, uterus, vagina, penis, testes
• Anatomy of nose - external nose, nostrils with nostril hair, nasal cavity lined with pseudostratified ciliated columnar epithelium. it has bony ridges to increase surface area and separated from oral cavity by hard palate

  physiology - nostril hair filters incoming air. nasal cavity warms, moistens and cleanses incoming air. olfactory receptors detect odour
• Nasal congestion pathophysiology - nose lined with mucus membranes that have many arteries, veins and capillaries. contact with irritants or "foreign body" causes vessels to dilate filling with membranes and excess blood. this results in redness and swelling, leading to stuffy and blocked nose. may or may not be accompanied by nasal discharge or runny nose
• MOA of decongestions

  1. Act on nasal mucosa advenergic receptors

  2. Vasoconstrict, shrink swollen mucosa to improve ventilation
• Topical decongestion

  • Iliadin (oxymetazoline, naphazoline)
• Topical decongestions


  • Special side effects - rhinitis medicamentosa/rebound congestion
  • Side effects - burning, stinging, sneezing, dryness of mucosa
  • Advantage - rapid onset action, less systemic side effect
  • Disadvantage - more invasive route than oral, rebound congestion
• Systemic decongestion


  • Telfast (pseudoephedrine, phenylephrine)
• Systemic decongestions

  • Effect of "hyper euphoria" (potential for misuse)
  • Side effects - insomnia, increase alertness, high blood pressure and heart rate
  • Advantage - convenient, no rebound congestion
  • Disadvantage - potential systemic side effect, slower onset of action
• Special counselling points for decongestions:

  effect sets in within a few min, stop when symptoms subsided. do not use >5 consecutive days
• Non-pharmacological advice for decongestion

  • Avoid known allergic triggers
  • Drink plenty of water
  • Try nasal saline sprays or rinses
• Refer to doctor if:

  symptoms last >10 days, high fever, discharge is yellow/green & accompanied by sinus pain or fever. blood in nasal discharge or persistant clear discharge after head injury.
• common cold pathophysiology: virus invades body via nasal mucous most of time. virus attaches to respiratory epithelium and spreads locally. Attachment elicit an immune response, resulting in airway inflammation and remodelling. Leads to presentation of typical cold symptoms
• Antihistamines

  Bind to H1 receptor, thus prevent physiological histamine from binding, decreases allergic reaction
• First generation antihistamines

  • Older
  • Drowsy as more lipid soluble
  • Cross blood brain barrier (BBB) more easily
• Cautions for first generation antihistamines


  • Bladder neck obstruction, lead to urinary retention
  • Concurrent anticholinergic therapy
  • Narrow-angle glaucoma
• First generation antihistamines are contraindicated in hypersensitivity to active ingredient or any component of formulation
• Second generation antihistamines

  Less lipid soluble, minimal/no CNS effect -> no drowsy
• Antihistamine usage

  1. Stop when symptoms when subsided

  2. Mindful when taking other OTC cough or flu medication

  3. Emphasize drowiness
• Non-pharmacological advice

  • Maintain healthy diet
  • Exercise regularly
  • Sufficient rest
  • Drink plenty fluids
• Refer to doctor if condition doesn't improve after 3-4 days, deteriorated after 2 days, high fever, shortness of breath, wheezing
• anatomy of throat: common passageway connectiving mouth and nose. extends from end of nasal cavity to larynx. lined with mucous membrane. divided into 3 regions, nasopharynx, oropharynx, larynopharyx, base on location

  functions: carries air to respiratory system, delivers food and liquid to digestive system, pushes food into esophagus so it is not breathed in, equalizes pressure in ears and drain fluids from ears
• sore throat pathophysiology: inflammation of thorat, usually caused by viral/bacteria infection, irritants or allergens. results in painful and sensation of scratchiness of throat, as well as difficulty swallowing
• Antiseptic - dequalinium

  • MOA: increase bacterial cell permeability and reduce enzymatic activity, thus causing cell death
  • side effects: relatively safe, no significant side effect, mouth discomfort
  • contraindications: hypersensitivity to dequalinium or any component of formulation. children <6 years old
  • special counseling point: dissolve slowly in mouth; do not chew. dont take >8 lozenges in a day, stop when better
• Nonsteroidal anti-inflammatory drug (NSAID) - benzydamine e.g. Difflam

  • MOA: inhibits production of proinflammatory cytokines to reduce local pain and inflammation. also has local anaesthetic activity
  • Side effects: localised numbness esp on tongue
  • Contraindication: hypersensitivity to benzydamine or any component of formulation
  • Special counselling: lozenges - dissolve slowly in mouth; do not chew. DO not take >12 a day, do not exceed 7 consecutive days, stop when better. throat spray - spray directly onto inflamed area and swallow gently, allergic see doc. Gargle - do not swallow
• anti-inflammatory enzymes - lysozyme (leftose)

  • MOA: natural enzyme derived from egg white with anti-inflammatory and mucolytic properties to reduce inflammation in sore throats and dissolve phlegm in chesty cough
  • side effects: relatively safe, mainly GI side effects
  • contraindication: egg allergy, hypersensitivity to serratiopeptidase or any component of formulation
  • special counselling: take with glass of water, take with or without food
• anti-inflammatory - serratiopeptidase (Danzen)

  • MOA: proteolytic enzyme with high enzyme activities and anti-inflammatory properties
  • side effects: relatively safe, mainly GI effects
  • contraindication: hypersensitivity to serratiopeptidase or any other component of formualtion
  • use with caution: patients with blood coagulation abnormalities, severe hepatic and renal impairment, anticoagulent
  • special counselling: take with glass of water, swallow without chewing
• non-pharm advice for sore throat: wash hands thoroughly and frequently, avoid sharing food, drinking glasses or utensils. Regularly clean telephones, TV remotes and computer keyboards with sanitizing cleanser. Avoid close contact with people who are sick

  refer to doc: last longer than a week, have earache, high fever, blood in saliva or phlegm, hoarseness lasting >2 weeks
• Tonsils

  • pathophysiology: inflammation of tonsils, usually caused by viral or bacteria infection. 3 types - acute tonsilities, subacute tonsilities, chronic tonsilities
  • non-pharm advice: plenty of rest, rest voice, drink plenty clear liquids, gargle with antiseptic or salt water, avoid smoke or other air pollutant, wash hands frequently
  • refer to doc: drooling, unable to eat or drink, difficulty breathing, recurrent tonsilities or sore throat
• pathophysiology of cough

  • dry cough: cough reflex is sensitized via medullary cough center by inhalation of irritants, environmental changes like temperature change or recent viral, flu or cold infection
  • wet cough: mucus present in excessive amounts due to overproduction and hypersecretion of mucus from mucus-producing goblet cells and decrease airway clearance mechanisms. mucus comes up from lungs to be cleared via coughing
  • post nasal: presents as dry cough caused by chronic dripping of excess mucus from back of nose to throat, triggering cough relfex.
• Mucolytics - agent that dissolves thick mucus, loosening mucus from respiratory tract. for wet cough
• mucolytics - acetylcysteine e.g. fluimucil

  • MOA: exerts mucolytic action on mucoproteins to lower mucus viscosity, making it easier for expectoration
  • special counselling: dissolve tablet in glass of water. drink once fully dissolved
  • side effects: usually quite well tolerated. GI most common. Increase frequency of cough
  • special counselling: increase in frequency of coughing to cough out phlegm, stop when feel better, don't take after 6pm
• mucolytic - bromhexine

  • MOA: increase amount of thin, watery, bronchial secretion thus decrease mucus viscosity
  • side effects: usually quite well-tolerated. GI most common. Increased frequency in cough
  • Speical counselling: increase in frequency of coughing to cough out phlegm, stop when feel better, don't take after 6pm
• suppressants - agent that suppress or reduce cough. for dry cough
• suppressant - codeine and dextromethorphan

  • MOA: depress medullary cough center thus reduce cough
  • common side effects: sedation, constipation
  • Codeine not first line of therapy recommended as conflicting evidence if it is helpful
• suppressant - pholcodine

  • MOA: depress medullary cough center thus reduce cough
  • Side effects: relatively safe, mainly GI side effects
  • contraindications: hypersensitivity to pholcodine or any component of formulation
  • Use with caution: decrease respiratory reserve, asthmatics, use of muscle relaxants during anaesthetics
  • special counselling: cause drowsiness. notice difficulty breathing stop medication, inform doc if taken medication (pholcodine)
• antihistamines - agent that targets on cough resulting from allergic component. for post nasal
• Antihistamines - diphenhydramine

  • MOA: selectively suppress central cough mechanism. also has antihistaminergic effect in drying secretion, relieving post nasal drip
  • special notes: usually combine with ammonium chloride, as product for wet cough
  • common side effects: drowsiness, antimuscarine effects
  • special counselling: drowsiness, feel better may stop, be mindful if taking any other cold or flu medications
• antihistamines - promethazine

  • MOA: selectively supress central cough mechanism. also has antihistaminergic effect in drying secretion, relieving post nasal drip
  • Special notes: avail by itself or combine product with codeine
  • side effects: drowsy, antimuscarine effects
  • special counselling: drowiness, feel better stop, mindful if taking any other cold or flu medications