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Clinical - Winter > 11 - Cough & Common Cold > Flashcards

11 - Cough & Common Cold Flashcards

1
Q

What are the 3 classifications of cough?

A

1) Acute (lasts less than 3 weeks)
2) Subacute (lasts 3-8 weeks)
3) Chronic (lasts longer than 8 weeks)

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2
Q

What is a productive cough?

A
  • Mucous production
  • May be associated w/ underlying inflammatory process, so don’t want to stop this type
  • Secretions may vary from clear to purulent (viral vs bacterial)
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3
Q

What is a non-productive cough?

A
  • Stimulated by mechanical irritant or other type of irritant
  • Feeling of tightness or wheezing due to congestion of bronchial airways
  • Often described as “dry, hacking” cough
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4
Q

What are some red flags for cough?

A
  • Lasting longer than 3 weeks
  • Lasting longer than 7 days that is unresponsive to self-treatment or worsens
  • Cough w/ thick, yellow sputum or green phlegm
  • Fever over 40.5 C or lasting longer than 72 hours
  • Drenching night sweats
  • Severe headache/prolonged nasal congestion
  • Blue lips, tongue or face
  • Mental status changes
  • SOB, chest pain
  • Suspected drug-induced cough
  • Sx associated w/ croup or ear infections (children)
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5
Q

What are some non-pharms for cough?

A
  • Increase room humidity (cool mist preferred)
  • Vaporizers (produce medicated vapour)
  • Throat lozenges to soothe throat decrease cough
  • Avoid exposure to inhaled irritants (smoke, dust, pollutants, allergens)
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6
Q

What is dextromethorphan indicated for?

A

Suppression of non-productive cough

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7
Q

What is the mechanism of dextromethorphan?

A

Increases cough threshold by acting centrally in medulla

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8
Q

What is the dosing of dextromethorphan?

A
  • Adults (12 y/o and older) = PO 10-20 mg q4h or 30 mg q6-8h ; max 120 mg day
  • Age 6-11 y/o = 5-10 mg q4h or 15 mg q6-8h ; max 60 mg/day
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9
Q

What is the onset of dextromethorphan?

A

15-30 minutes

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10
Q

What are the side effects of dextromethorphan?

A
  • Occasional drowsiness
  • Dizziness
  • Nausea, vomiting
  • Stomach discomfort
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11
Q

What drugs does dextromethorphan interact w/?

A
  • MAOI
  • SSRI
  • CYP 2D6 inhibitors
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12
Q

Is dextromethorphan safe to use in pregnancy?

A

Yes, for short term use

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13
Q

What are sx of detromethorphan toxicity?

A
  • Restlessness
  • Euphoria
  • Hallucinations
  • Visual and auditory disturbances
  • Delayed reaction times
  • Mania, panic, delusions
  • Partial or complete dissociation
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14
Q

What is the mechanism of codeine?

A

Increases cough threshold by acting centrally on medulla

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15
Q

What are side effects of codeine?

A
  • Sedation
  • Dizziness
  • N/V
  • Constipation
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16
Q

Can codeine be used in pregnancy and breastfeeding?

A
  • Only short term use in 1st and 2nd trimesters

- Avoid in third trimester and in breastfeeding

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17
Q

What are the products available w/ codeine? What schedule?

A
  • Schedule 1 in Manitoba

- Tylenol #1 tablets and benylin w/ codeine

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18
Q

What are some drug-disease interactions w/ antitussives (dextromethorphan and codeine)?

A
  • Asthma and COPD (use caution)
  • Diabetes (okay, but avoid sugar and alcohol)
  • Cardiac/hypertension (use caution, rule out cough not due to condition)
  • Immunosuppression (use caution, rule out cough not due to condition)
  • Breastfeeding (avoid routine use)
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19
Q

Can dextromethorphan and codeine be used in px who smoke?

A

No

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20
Q

What is the mechanism of guaifenesin?

A

Reduces sputum viscosity and facilitates mucus removal from upper respiratory tract

21
Q

What is the dosing of gauifenesin?

A

200-400 mg q4h (max 2.4g/day)

22
Q

What are side effects of guaifenesin?

A
  • Nausea
  • Drowsiness
  • Headache
  • Rash
23
Q

What is a precaution for guaifenesin?

A

COPD, caution regarding excess mucous production

24
Q

When should combination products w/ guaifenesin and dextromethorphan be used?

A

Px whose cough is productive yet sleep is interrupted

25
Q

Who should not use honey as a cough suppressant?

A

Immunocompromised and children younger than 1 y/o

26
Q

What is the dosing for honey?

A

2.5-10 mL at bedtime

27
Q

Can English Ivy be used for cough suppression?

A

No reliable evidence for efficacy

28
Q

Which px are candidates for self-treatment of cough?

A

Px w/ acute cough

29
Q

What is the monitoring and follow-up for cough?

A
  • Monitor cough daily; if QOL still affected, consider switching agents
  • Monitor drowsiness daily; if drowsiness occurring, consider changing medication schedule or tx
  • Follow-up at next visit or call 2-3 days later
30
Q

What is the common cold?

A

Acute, viral, self-limiting infection of mucous membrane of upper respiratory tract

31
Q

Which virus mainly causes the common cold?

A

Rhinovirus

32
Q

How is the common cold transmitted?

A
  • Contaminated skin surface or environmental surface
  • Aerosols in air
  • Direct hit by large particles
33
Q

What is the incubation period for the common cold?

A

1-3 days

34
Q

What are risk factors for the common cold?

A
  • Smoking
  • Allergic disorders affecting nose or pharynx
  • Increased population density
  • Sedentary lifestyle
  • Chronic psychological stress
35
Q

What is the pathogenesis of the common cold?

A
  • Virus binds to specific receptors on nasal epithelial cells
  • Triggers host’s defense mechanism to release inflammatory mediators
36
Q

What are the sx of the common cold?

A
  • Early stage = dry, unproductive cough

- Later stage = productive cough and post nasal drip

37
Q

What are some differential diagnoses for the common cold?

A
  • Sinusitis
  • Pharyngitis
  • Influenza
38
Q

What are some red flags for the common cold?

A
  • Fever over 38.5 for more than 72 hours
  • Chest pain, difficulty breathing
  • Infection (thick yellowish-green discharge)
  • Children under 6 y/o for all cough and cold products
  • Children under 1 y/o w/ cold sx
  • Other underlying conditions
  • Px over 65 y/o that are frail
  • Severe headache, neck pain
  • Signs of dehydration in infant
39
Q

What are some non-pharms for the common cold?

A
  • Most important = increase fluid intake, increase humidification, and bed rest
  • Avoid smoking
  • Proper hand-washing
  • Cover mouth when coughing or sneezing
40
Q

What are the possible products for the common cold?

A
  • Oral decongestant
  • Topical/nasal decongestant
  • Oral analgesic/antipyretic
  • Topical/local analgesic
  • 1st gen antihistamine
41
Q

Which decongestants can be used for a stuffy nose?

A

Topical or systemic

42
Q

Why are 1st gen antihistamines recommended for the common cold?

A

Sx of common cold are not histamine mediated, but anticholinergic effect of 1st gen are thought to help to dry nasal mucosa

43
Q

Can vitamin C prevent or treat the common cold?

A

No evidence

44
Q

Is Cold FX recommended for the common cold?

A
  • No evidence that it works to reduce incidence or severity of common cold
  • Some reports show it reduces duration by 6 days if used daily for 4 months
  • All studies only looked at healthy adults
45
Q

Which conditions are oral decongestants contraindicated w/?

A
  • Diabetes
  • Cardiac/hypertension
  • Glaucoma
  • Benign prostate hyperplasia
  • Hyperthyroidism
  • *For these conditions, choose topical decongestants only if condition well controlled
46
Q

What is the recommended tx for children under 6 y/o w/ common cold?

A
  • Non-pharms only
  • Fluid intake
  • Clear nasal passages w/ nasal suction bulb and/or nasal saline
  • Comfortable environment w/ adequate humidity
47
Q

What are instructions for use of a rubber bulb?

A
  • Squeeze bulb syringe to expel air
  • Insert tip of bulb 1/4 to 1/2 inch into baby’s nostril pointing toward back and side of nose
  • Release bulb, holding in place to suction mucous
  • Remove syringe and empty contents onto tissue
  • Clean bulb syringe w/ soap and water
48
Q

What is the recommended tx for a cough associated w/ post nasal drip?

A

Decongestant and antihistamine

49
Q

How long should OTC tx last for the common cold?

A
  • No more than 7 days

- Topical decongestants only 3-5 days

Clinical - Winter (24 decks)

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