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
Who should not use honey as a cough suppressant?
Immunocompromised and children younger than 1 y/o
What is the dosing for honey?
2.5-10 mL at bedtime
Can English Ivy be used for cough suppression?
No reliable evidence for efficacy
Which px are candidates for self-treatment of cough?
Px w/ acute cough
What is the monitoring and follow-up for cough?
- 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
What is the common cold?
Acute, viral, self-limiting infection of mucous membrane of upper respiratory tract
Which virus mainly causes the common cold?
Rhinovirus
How is the common cold transmitted?
- Contaminated skin surface or environmental surface
- Aerosols in air
- Direct hit by large particles
What is the incubation period for the common cold?
1-3 days
What are risk factors for the common cold?
- Smoking
- Allergic disorders affecting nose or pharynx
- Increased population density
- Sedentary lifestyle
- Chronic psychological stress
What is the pathogenesis of the common cold?
- Virus binds to specific receptors on nasal epithelial cells
- Triggers host’s defense mechanism to release inflammatory mediators
What are the sx of the common cold?
- Early stage = dry, unproductive cough
- Later stage = productive cough and post nasal drip
What are some differential diagnoses for the common cold?
- Sinusitis
- Pharyngitis
- Influenza
What are some red flags for the common cold?
- 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
What are some non-pharms for the common cold?
- Most important = increase fluid intake, increase humidification, and bed rest
- Avoid smoking
- Proper hand-washing
- Cover mouth when coughing or sneezing
What are the possible products for the common cold?
- Oral decongestant
- Topical/nasal decongestant
- Oral analgesic/antipyretic
- Topical/local analgesic
- 1st gen antihistamine
Which decongestants can be used for a stuffy nose?
Topical or systemic
Why are 1st gen antihistamines recommended for the common cold?
Sx of common cold are not histamine mediated, but anticholinergic effect of 1st gen are thought to help to dry nasal mucosa
Can vitamin C prevent or treat the common cold?
No evidence
Is Cold FX recommended for the common cold?
- 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
Which conditions are oral decongestants contraindicated w/?
- Diabetes
- Cardiac/hypertension
- Glaucoma
- Benign prostate hyperplasia
- Hyperthyroidism
- *For these conditions, choose topical decongestants only if condition well controlled
What is the recommended tx for children under 6 y/o w/ common cold?
- Non-pharms only
- Fluid intake
- Clear nasal passages w/ nasal suction bulb and/or nasal saline
- Comfortable environment w/ adequate humidity
What are instructions for use of a rubber bulb?
- 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
What is the recommended tx for a cough associated w/ post nasal drip?
Decongestant and antihistamine
How long should OTC tx last for the common cold?
- No more than 7 days
- Topical decongestants only 3-5 days
