11 - Cough & Common Cold Flashcards
What are the 3 classifications of cough?
1) Acute (lasts less than 3 weeks)
2) Subacute (lasts 3-8 weeks)
3) Chronic (lasts longer than 8 weeks)
What is a productive cough?
- 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)
What is a non-productive cough?
- 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
What are some red flags for cough?
- 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)
What are some non-pharms for cough?
- 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)
What is dextromethorphan indicated for?
Suppression of non-productive cough
What is the mechanism of dextromethorphan?
Increases cough threshold by acting centrally in medulla
What is the dosing of dextromethorphan?
- 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
What is the onset of dextromethorphan?
15-30 minutes
What are the side effects of dextromethorphan?
- Occasional drowsiness
- Dizziness
- Nausea, vomiting
- Stomach discomfort
What drugs does dextromethorphan interact w/?
- MAOI
- SSRI
- CYP 2D6 inhibitors
Is dextromethorphan safe to use in pregnancy?
Yes, for short term use
What are sx of detromethorphan toxicity?
- Restlessness
- Euphoria
- Hallucinations
- Visual and auditory disturbances
- Delayed reaction times
- Mania, panic, delusions
- Partial or complete dissociation
What is the mechanism of codeine?
Increases cough threshold by acting centrally on medulla
What are side effects of codeine?
- Sedation
- Dizziness
- N/V
- Constipation
Can codeine be used in pregnancy and breastfeeding?
- Only short term use in 1st and 2nd trimesters
- Avoid in third trimester and in breastfeeding
What are the products available w/ codeine? What schedule?
- Schedule 1 in Manitoba
- Tylenol #1 tablets and benylin w/ codeine
What are some drug-disease interactions w/ antitussives (dextromethorphan and codeine)?
- 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)
Can dextromethorphan and codeine be used in px who smoke?
No
What is the mechanism of guaifenesin?
Reduces sputum viscosity and facilitates mucus removal from upper respiratory tract
What is the dosing of gauifenesin?
200-400 mg q4h (max 2.4g/day)
What are side effects of guaifenesin?
- Nausea
- Drowsiness
- Headache
- Rash
What is a precaution for guaifenesin?
COPD, caution regarding excess mucous production
When should combination products w/ guaifenesin and dextromethorphan be used?
Px whose cough is productive yet sleep is interrupted
