3 - Cough / Cold / Allergy Flashcards
1
Q
Patients should not use INCS / TAC if:
Intranasal corticosteroids
A
- First talk to your provider if:
- recent nasal ulcers / surgery / unhealed nasal injuries
- asthma meds
- prescription steroid medications
- currently have eye infection
- glaucoma or cataracts
2
Q
Types of Allergens
A
-
Outdoor = Seasonal
- Tree pollen / Grass / Ragweed
- Pollen.com to check pollen counts
-
Indoor = Perennial = HARDEST TO AVOID AND MANAGE
- Dust mites / Animal Dander
- Mold / Cockroach droppings
-
Airborn
- Smoke / perfume / fues
3
Q
Budesonide Nasal Spray
Rhinocort
A
-
LOWER VOLUME OF SPRAY
- vs fluticasone / TAC
- Scent / Alcohol free
- No Drug interactions! (like nasacort)
- Only indicated for Ages 6+
- still potential for slow growth rate
- see md if >2 mo use in a year
- Dose:
- 1-2 sprays en qd
- May take Up to 2 weeks for full symptom relief
4
Q
Dextromethophan Dose
Dayquil / Robitussin / Delsym
A
10-20mg q 4 hr
or
30mg q6-8
Max = 120mg/day
5
Q
Allergy Drugs with NO SEDATION
A
Loratadiine
Fexofenadine
6
Q
Guaifenesin Dose
A
only FDA approved expectorant
>12 years old
200-400mg Q4
take with a full glass of water
used for non-productive congested cough
Aka ineffective productive cough
7
Q
FDA Public Health Advisory for
OTC cold/cough medications
A
-
Should NOT be used to treat i_nfants & children <2 years old_
- mainly due to IMPROPER USAGE
-
For children 2-11 yrs old:
- understand that OTC drugs do NOT shorten duration of cold
- check drug facts, beware of overlap active ingredients
- Only use measuring spoons / cups
- do not use for sedation
8
Q
Short Acting Topical Decongestants
A
4-6 hours
Phenylephrine
0.25-1% Neo-Synephrine
Levmetamfetamine
Vapor Inhalor
Propylhexedrine
Benzedrex inhaler
9
Q
Intranasal Corticosteroids
INCS
Treatment for Allergic Rhinitis
A
Only for ALLERGIES
not for COLDS
even if symptoms are indicated, ONLY ALLERGIES
Triamcinalone (TAC) / Fluticasone Propionate
Budesonide / Fluticasone Furoate
10
Q
Cold Symptoms
A
-
Limited to Upper Respiratory Tract
- 1-3 days after infection
- 1st symptom = Sore Throat
- Days 2-3 = Nasal symptoms
- Days 4-5 = Cough (only 20% of patients)
- Typically does not cause soreness or fever
11
Q
Triamcinolone Nasal Counseling
A
- TAC use QD w/o missing a dose
- may take up to 1 week to provide full relief/benefit
- most will see improvement on FIRST DAY
- may take up to 1 week to provide full relief/benefit
- Pregnancy: talk to PCP before use
- Can be used in children 2+:
- but potential for slowed growth rate
- try not to use for >2 months in a year
12
Q
When to see Doctor for SORE THROAT
A
- If you have been in contact with someone w/ STREP THROAT
-
Sudden Onset
- w/ fever and/or Swollen glands
- or a RASH
- w/ fever and/or Swollen glands
- Trouble Swallowing liquids
- Sore throat for >1 week
- FRONT OF NECK = sore / stiff
13
Q
Which allergy medications are okay for children
2y/o and older?
A
ALL 2ndgen Antihistamines
Cromylyn Sodium
TAC
Fluticasone Furoate (sensimist
Fluticasone Propionate is 4+ y/o
14
Q
Pregnancy & Nursing
for Cough Supressants
A
Diphenhydramine is generall PREFERRED
DM is not a teratogen, and is generally safe during pregnancy
DM products w/o ethanol are SAFE for nursing mothers
15
Q
Sore Throat Treatment Options
A
-
Stay Hydrated / Warm Liquids = Tea/honey
- painful swallowing can lead to DEHYDRATION
- avoid citrus drinks
- painful swallowing can lead to DEHYDRATION
- Salt Water Gargling = 1-1.5ts of salt in 1 cup warm water
- salt water pulls liquid OUT of swollen membranes
-
Popsicles / Ice Chips
- cold has NUMBING EFFECT
-
Hard Candies
- reduce dryness / soothe pain
- Vaporizer / Humidifyer
- OTC PAIN MEDICATIONS for pain = Tylenol
16
Q
Avoiding Allergens
Treatment for Allergic Rhinitis
A
- Highest pollen conditions occur on DRY & Windy days
- Pollen.com
-
Stay indoors:
- highest pollen count is between 5am - 10am
- Keep windows closed / change filters
17
Q
Fluticasone FUROATE
flonase SENSIMIST
A
-
LOW VOLUME SPRAY
- vs fluticasone propionate / TAC
- Alcohol & Scent Free
- vs fluticasone propionate
- Approved for Ages 2+
- vs 4+ for fluticasone propionate
-
Same indicaitions & drug interactions as fluticasone propionate
- still indicate for watery EYES
- 1 week for full effect
18
Q
Productive Cough
A
Wet Cough
Expels secretions from LOWER respiratory tract
Can Be Effective if secretions are EASILY EXPELLED
ineffective if secretions are DIFFICULT to expel
19
Q
Cromylyn Sodium Dose
NasalCrom
A
Mast Cell Stabilizer, okay for 2+ & pregnancy & elderly
1 spray (5.2mg) EN 3TID/4-QID
USE BEFORE SYMPTOMS
max 6 times / day
takes up to 7days for effect
20
Q
Pregnancy / Nursing Use
of Antihistamines
A
-
Nursing: AVOID
- excreted in breast milk
- can inhibit lactation
-
Pregnancy: AVOID
- unless CLEARLY NEEDED
- benefits > risks
- unless CLEARLY NEEDED
21
Q
Age Considerations
for Antihistamines
A
-
Diphenhydramine = 1st gen OTC histamine
-
on BEER’s LIST
- Do not use in patients 65> age
- Risk of sedation & AC effects INCREASED
-
on BEER’s LIST
-
Most antihistamines have NO DOSING for <6yrs old
-
except for Loratadine / Fexofenadine / Cetirizine/levocet
- >2yrs old
-
except for Loratadine / Fexofenadine / Cetirizine/levocet
22
Q
Topical Decongestants for Pregnancy or Children?
A
DNU IN PREGNANCY
reduced uterine blood flow
All okay, including menthol for 2+ y/o
saline can be used for <2y/o
23
Q
Cetirizine Dose
A
5-10mg QD
Drowsiness warning
24
Q
Side Effects of
Topical Decongestants
Phenylephrine Spray / Vapor Inhalor / Benzedrex
oxymetazoline
A
-
Rebound Effect –> Vicious Cycle
- overuse of the topical products
- only use SHORT TERM
- for COLDS not allergies
- only use SHORT TERM
- can cause nasal membranes to be MORE congestion
- overuse of the topical products
- To treat Rebound effect:
- D/C offending drug -> use oral Decongestants or saline
- Takes 1-2 weeks for nasal membranes to return to normal.
25
**Diphenhydramine Dose**
as a Cough Supressant
**25mg Q4 hours**
okay for children **6+**, *but FDA PH advisory 2-11 years*
Acts centrallin in medulla to increase cough threshhold
Side effects:
***Drowsiness / Blurred Vision***
***Dry Mouth***
***Urinary Retention***
26
**Difference between ALLERGY vs Cold/URI**
* **Allergies:**
* *sometimes cough, less often than cold*
* **_NEVER ACHES / PAINS / FEVER_**
* *sometimes fatigue / sore throat*
* ****_ITCHY_** **eyes**
* *eyes can be watery in both cold and allergy*
* ****sneezing is more common**
* **Duration of Symptoms very depending on TRIGGER**
* **days-months**
27
**Counseling for Dextromethorphan**
* **DM:**
* *****Do not use if currently taking or 2 weeks after stopping*
* ***MAO INHIBITOR***
* *or **SSRIs***
* ********Diphenhydramine products:**
* *may cause drowsiness / avoid **alcohol***
* Stop Use & see MD if:
* cough **\>7 days** or returns or w/ **fever/rash/headache**
* cough w/ **too much phlegm**
* cough that is **chronic**, or occurs w/ smoking / asthma
28
**Considerations for**
**Guaifenesin (expectorant)**
*No association w/ developmental toxicity*
**_Pregnancy / Nursing SAFE_**
**Drink w/ FULL GLASS OF WATER**
* Ask doctor if:
* **too much phlegm** beforehand or chronic cough
* **cough \> 7 days**
* or comes back / fever / rash / headache
29
**Exclusions for Self-Treatment**
for Allergic Rhinitis
* **SYMPTOMS OF INFECTION**
* otitis media = **ear inflammation**
* **fever / wheezing / bronchitis / chest congestion**
* **_Thick respiratory secretions, NOT CLEAR_**
* Symptoms of undiagnosed / uncontrolled **ASTHMA:**
* ******wheezing / SOB / COPD**
* **Pregnant**:
* _common cause of nonallergic rhinitis_
* Patients who ***DO NOT respond or symptoms worsen***
* *after taking **OTC options***
30
**Topical Rub Products**
Include **Camphor / Menthol**
VICKS VAPORUB
**_ONLY FOR EXTERNAL USE_**
Apply on **_Chest / Throat_**
may cover w/ loose dry cloth
allow vapors to hit nose / mouth
*DO NOT APPLY TO IRRITATED SKIN*
31
**Nasal Strips**
Breathe Right
**Mechanically opens nasal passages**
Choose the RIGHT SIZE
Lavendar scent available
Indicated for **_5years and older_**
**_& PREGNANT WOMEN!_**
32
**Phenyephrine**
**PE**
Dose: **10mg q4** (adults)
* Half life is **much shorter 2-3 hours***
* vs 6 hours for PSE*
* Poor stability & **shorter shelf-life***
***Questionable efficacy vs PSE***
Exhibits large **_individual variability in Bioavailability_**
_Beware of **HIGH Fever** or no improvement in symptoms_
33
**Triamcinolone Nasal**
**TAC**
Nasacort Allergy
* **Corticosteroid** for Allergic Rhinitis, relieves symptoms of:
* **_RUNNY NOSE + CONGESTION_** (due to allergies)
* **sneezing / nasal itching / stuffy nose**
* *****no indication for EYES and UNSCENTED*
* **_1st Line therapy for Allergic Rhinitis_**
* MOST EFFECTIVE TREATMENT
* *_not indicated for patients with colds_*
* *No risk of **sedation** and no **_drug interactions_***
* Takes **about a week for results**, **use QD**
* ****Approved for use in **_Children 2+_**
34
**Saline Topical Products**
Ocean
Restore **Moisture**
Relieve **Dry/Inflamed Nasal Membranes**
caused by:
_Colds / low humidity_
**_Nasal decongestant OVERUSE_**
_Nose bleeds / allergies_
35
**Airborne**
***_No Date to show efficacy_***
more to **PREVENT** not to treat/decrease symptoms
High doses of Vit C --\> *may lead to **kidney stones***
36
**Sore Throat vs STREP Throat**
* Most SORE throats are due to:
* Viruses / Bacteria / Allergies
* Smoking / Dry air / YELLING
* Breathing through mouth often
* **Strep Throat = Most common Bacterial infection of THROAT**
* 5-10% of adult and 15-30% of children
* associated w/
* **Fever / Swollen Glands / White patches**
* **Headache / Nausea / Chills**
* **Difficulty swollowing.**
37
**Anesthetic Agents for Sore throat**
**Cepacol**
**Chloraseptic**
**Sucrets**
**Chloraseptic SPRAY**
38
**Anesthetic Agents**
for Sore Throat
Sore Throat Pain
**Benzocaine / Phenol / Dyclonine**
**_Look for higher concentrations of active ingredients_**
**Dissolve SLOWLY** in mouth
for **_spray_**: keep in place for **\>15 seconds then spit**
*if **numbing**, avoid **eating/drinking** esp HOT items*
39
**Cromolyn Sodium Spray**
NasalCrom
**Mast Cell Stabilizer**
--\> **itching / sneezing / rhinorrhea**
**_USE BEFORE ONSET OF SYMPTOMS_**
Can use for **\>2 yrs old & Pregnant & elderly**
**_1 Spray EN TID/QID_** (max 6x/day)
takes up to _**7 days** for initial effect_
_4 weeks_ for MAX benifit
*can cause sneezing / nasal stinging*
40
**Side Effects / Considerations**
**for Antihistamines**
* Paradoxical Excitation
* **Insomnia / Irritability**
* **Nervousness / Nightmares**
* ******Anticholinergic effects:**
* Dry mouth / constipation
* Urinary retention / Blurry Vision
* **GI Effects**:
* Anorexia / Diarrhea / Abdominal pain
* *Avoid in* ***narrow angle glaucoma / asthma***
* ***Do not diphenhydramine w/ others (even TOPICAL)***
41
**Oral Decongestants**
Only indication is **Relief of Nasal Congestion**
**Pseudophedrine / Phenylephrine**
* Adv:
* **Longer duration of action** vs topical agents
* ***NOT ASSOCIATED W/ REBOUND CONGESTION***
* *******Disadvantages:*
* *less **intense vasoconstriction** vs topical*
* ***DELAYED ONSET***
42
**Pediatric considerations**
**for Topical Decongestants**
***_Never Use for Children \<2 years old_***
*except for **SALINE***
***mentholated products** should NOT be used in **\<2 years old***
*_Non-drug measures:_*
*_Humidity / fluids / Propping head up_*
43
**Fluticasone Propionate Dose**
**Flonase**
**2 sprays (50mcg) EN QD**
## Footnote
for 1 week then -\> **1-2** **sprays**
**Age 4+**
Also treats **_ITCHY/WATERY EYES_**
has a floral scent, use less than ***\<6 months***
***HIV infection / Ketoconazole / Asthma / Steroids***
44
**Budesonide Dose**
Rhinocort
**1-2 Sprays (32mcg) EN QD**
## Footnote
**_Age 6+ only!_**
***Low volume of spray***
may take up to **2 weeks** for full symptom relief
*no drug interactions / scent free / alcohol free*
45
**Antihistamine Indications**
* **Rhinorrhea** (runny nose) / **Nasal Pruritus** (scratchy nose)
* **Sneezing**
* **Allergic Conjunctivitis** / **Lacrimation / Ocular Pruritis**
* *Not indicated for:*
* ***Colds***
* *****no good date to support indication for pts w/ cold*
* ***NASAL CONGESTION***
* *only _decongestants_ are indicated for this*
46
**Long Acting Topical Decongestants**
**_12 hours_**
**Oxymetazoline**
**(** **Afrin / Sinex )**
47
**Topical Zinc Info**
Proposed **Anti-Viral Agent**
***may reduce severity / length of symptoms***
**_Start within 24 hours of onset of symptoms_**
*some positive results in studies*
48
**Infection Transmission**
* Self-inoculation of **nasal mucosa / conjuctiva**
* touching bacteria then touching self on eyes / nose / mouth
* hand-to-hand contact
* High exposure = Density of classrooms or daycare
* Less common routes:
* aerosoled particles / kissing / contact w/ inanimate obj.
* ***Does not increase susceptability to colds by ITSELF***
* *cold weather / chills / walking barefoot*
* only makes symptoms WORSE if already sick
49
**Fluticasone Furoate Dose**
**Flonase Sensimist**
**Same as Flonase, but** **_32mcg/spray_**
***less volume of spray***
and approved for **_Ages 2+_**
*compared to 4+ for flonase*
_still indicated for **itchy & watery eyes**_
50
**Fluticasone Propionate DOSING**
**2 Sprays EN QD**
for 1 week then -\> ***1-2 sprays en qd for symptoms***
*Ask Doctor if **\>6 months of daily use***
**_May take 1 week to provide full benefit / relief_**
_most people have improvement on FIRST DAY_
51
**Questions to ask regarding ailment**
**Symptoms / Duration / Fever**?
**Thick or Discolored discharge**?
H/O **Allergy / Asthma / Bronchitis / Smoker**?
What medicines are you taking?
Has anything worked for these symptoms?
Are you **pregnant/breastfeeding**?
Are you participating in **athletic events**?
If child, **how old and weight?**
52
**Fluticasone Propionate**
Flonase / ClariSpray
* Compared to TAC/Budesonide, also approved for:
* **_Itchy / watery EYES_** due to allergy
* *No indication for PROPIONATE for children:*
* ***\<4 years***
* *****also potential for slowed growth rate*
* *talk to Dr if \>2mo in a year of use*
* Has a light **floral scent**, some patients find offensive
53
**Topical Antitussives**
**Camphor & Menthol**
**_Lozenge or Ointment dosage forms_**
only FDA approved topical antitussives
*little efficacy evidence*
54
**Side Effects**
**of Oral Decongestants**
* **Increased BP**
* **Cardiac Stimulation**
* *****typically only after prolonged use*
* *****May worsten symptoms of underlying diseases***
* ****Hyperthyroidism**
* **CAD / Ischemid Heart disease**
* **Prostatic Hypertrophy**
* **Intraocular Pressure**
55
**Pseudophedrine Dose**
Sudafed
**60mg Q6**
**120mg Q12** for SR
*_not for pregnancy_ nor children **\<6y/o***
okay for **breast feeding**
*consider stocking PSE in cabinet so you can have on hand*
Pseudoephedrine is **still the same safe and effective product** it always was; you will just find it in a **different place**
56
**Loratadine**
Claritin
***Non-Sedating***
2nd-gen-AH
**Only non-drowsy 24 hour product indicated for:**
**_Children 2 +_**
*fexofenadine is non-drowsy BUT is BID dosing for kids*
57
**TAC Dosing**
Nasacort
**2 sprays (55mcg) EN QD**
## Footnote
after symptoms controlled -\> **1 spray EN QD**
may take up to 1 week for relief, ***do not miss doses***
Okay for **2+**, watch out for slowed growth rate \<2mo
**only spray that treats _CONGESTION_**
*no sedation / no drug interactions / no scent*
58
**Differences between COMMON COLD vs Flu**
* **Cold has**:
* *headache / pain / fatigue is mild or absent*
* **Common: Rhinorrhea / Nasal congestion / sneezing**
* *******_both flu and cold have sore throat_***
* *cough is less common and is usually non-productive*
* **Watery eyes**
* **5-10 day** duration
* complications:
* **_sinus congestion / earache_**
59
**Pregnancy, cough medication**
**DPH vs DM?**
**DPH is preferred**
**DM *is NOT considered a major teratogen***
***and is considered safe though.***
60
**Nursing / Pregnant Considerations**
**for Oral Decongestants**
* **Nursing Mothers**:
* only a little data, *small amounts can --\> breast milk and cause irritability*
* _AAP **considers pseudophedrine safe during breast feeding**_
* **__****Pregnancy:**
* **risk in FIRST trimester**
* _***BANNED FOR USE IN ATHLETIC EVENTS***_
61
**Topical Decongestants Indications**
Relief of **Nasal Congestion**
## Footnote
*systemic absorption is typically minimal w/ TOPICAL dosage forms*
62
**Cetirizine**
Zyrtec
**_Drowsiness Warning_**
~10% of patients SEDATED
2nd-gen-antihistamine
dosing for **children 2+**
63
**Zinc Products & Dosage**
Cold Eeze / Zicam
**1 Lozenge Q2-4 hours** while awake
(Max 6 lozenges per day)
**_HAS TO BE LOCAL_** = *can not be taken orally*
**_Start within 24 hrs of symptoms_**
*long term admin can be hazardous*
**_DO NOT USE IF PREGNANT_**
64
**Side Effects of Guaifenesin**
**NAUSEA** / Vomitting
Dizziness / Headache
**Rash / Diarrhea**
**Sedation**
**_USUALLY MINOR_**
65
**Differences Between INFLUENZA vs Cold**
* **Flu** has:
* sudden onset **fever** \> 102-104
* **headache / myalgia / fatigue / weakness / exhaution**
* **non-productive / persistant cough**
* **eye-pain / burning**
* **1 week duration**
* complications of:
* **bronchitis / pneumonia**
* ***_both flu and cold have sore throat_***
66
**Triamcinolone Acetonide Nasal _Dosing_**
**TAC**
Nasacort
Approved for use in **_Children 2+_**
For adults / age 12+
**2 Sprays EN QD**
once symptoms are controlled -\> **1 Spray EN/day**
**_Use continiuously for at least a weak_**
UNSCENTED
67
**Fexofenadine** **Patient Counseling**
***Fruit Juices = Grapefruit / Orange / Apple***
* Do not take with **Aluminum / Magnesium Antiacids***
* may REDUCE Bioavailability*
**Renal Dysfunction --\> *decrease dose***
For **_Meltable Tablets:_**
**_Take on an EMPTY STOMACH_**
*do not chew / remove from pkg before hand*
68
**Fexofenadine**
Allegra
**_Non-Sedating_**
Once daily (180mg) 24 hour dose for adults
_For **children 2-11**: **30mg BID**_
(has a **meltable tablet dosage form**)
also has **special counseling points**
69
**What allergy medications are okay for PREGNANCY?**
**_Cromylyn Sodium Nasal Spray_**
*also okay for children 2+*, need to use BEFORE symptoms
**Diphenhydramine is also okay for pregnancy for COUGH**
*but PREGNANCY is technically contraindicated because ALLERGY is common with pregnancy*
70
**Prevention of Infections**
* **HANDWASHING** *can decrease transmission*
* virus can survive on hands for hours
* ***Not all hand sanitizers** are shown to eradicate RHINOVIRUS*
* **prefer **60-80% ethanol / _isopropanol_**
* *chlorhexidine / povidone-iodine / 4-ammonium*
* ****LYSOL kills \>99% of rhinovirus after _1 MINUTE_**
* Anti-viral tissues are 10% more effective.
71
**Nonproductive Cough**
**Dry / Hacking Cough**
*No congestion / **phlegm production***
Occurs in \<20% of patients with a COLD
72
**Irrigation**
## Footnote
**Neti Pot / Saline Nose Sprays**
* Can help with **Allergy Symptoms**
* **Flushes out allergen / irritant** (pollen
* Aids in **removal of dried/encrusted mucus** from nasal passages
* Tips for netipot:
* Use bottled/boiled/distilled water, *no tap water*
* **Saline Packs or 1ts salt-\> 16oz water**
73
**NON-Pharmacologic Options**
**for COLDS**
* **Fluid** intake
* **Rest**
* **Nutrition**:
* chicken soup ~anti-inflammatory
* **_Increased HUMIDIFICATION of air_**
* steamy showers / humidifyers / vaporizers
* for YOUNG CHILDREN:
* **Nasal aspiration / upright positioning**
74
**Guaifenesin**
Mucinex / Robitussin
* Only **FDA Approved Expectorant**
* ****Indicated for: **_Non-Productive Congested Cough_**
* *ineffective productive cough*
* Efficacy:
* *lack of evidence showing that these decrease **sputum viscosity / ease expectoration***
* _Important to have adequate **Fluid Intake & Humidity**_
* ****for expectoration
75
**Fluticasone Propionate** **DI / Considerations**
flonase / clarispray
* If you are taking medication for:
* **HIV** (ritonavir / teleprevir / tiprnavir)
* may INCREASE conc. of fluticasone
* **Ketoconazole**
* also may INCREASE conc of flutic
* **Asthma Medication**
* **Prescription Steroid Medicine**
* ***PREGNANCY***
* talk to dr before use
76
**Allergic Rhinitis**
* Can develop at **ANY AGE**
* can SUDDENLY get allergies,
* ***allergy history does not matter much***
* **Heredity plays a role**
* 1 parent w/ allergies -\> 48%
* 2 parents -\> 70%
* **ASTHMA Present in 20%** of patients
77
**Exclusions for Self-Treatment**
**for COLDS**
* Do not use if:
* **Fever \> 100.4** (oral)
* **Chest Pain / SOB**
* or underlying **pulmonary disease (COPD/asthma)**
* **_Worsening of symptoms_**
* during self-treatment
* **AIDS / Chronic immunosuppresant therapy**
* **Elderly** / infants **_\<3 months of age_**
78
**Diphenhydramine**
**Pregnancy / Contraindications**
**okay with pregnancy**, preferred over DM
**_AVOID ALCOHOL!_**
on **Beer's list**
***DNU in pts 65+***, due to AC / sedation
79
**Fexofenadine Dose**
**60mg q12**
**180mg q24**
**Non-Sedating**
but 30mg **BID CHEW dosing for kids 2-11**
*avoid **fruit juice / kidney fxn***
***Al / Mg antacids***
80
**Allergic Rhinitis TREATMENT**
* **Avoid Allergens!**
* **Immunotherapy**
* Pharmacotherapy:
* **Nasal Steroids**
* **Antihistamines** (2nd gen preferred)
* **Mast Cell Stabilizers**
* **Decongestants**
81
**Age for Self-Treatment to be Excluded**
**for COUGH**
**children \<4 y/o**
82
**Pregnancy / Nursing**
**for Topical Decongestants**
**Pregnancy** - Potential for
***Reducing Uterine Blood flow***
**Briggs - No human data for breat feeding**
**can be compatable**
83
**Counseling for Topical Decongestants**
Phenylephrine Spray / Vapor Inhalor / Benzedrex
oxymetazoline
Notify MD if: **Insomnia / Tremor**
**Weakness / Irregular Heart beat**
*Do NOT exceed recommended dosage or duration*
***\<3 days***
**Stinging / Burning / Drying**
of NASAL MUCOSA may occur
84
**Loratadine Dose**
**10mg Qd**
## Footnote
*non drowsy*
good for 2+
85
**Levocetirizine**
Xyzal
**_Taken in the EVENING_**
***Drowsiness** warning*
dosing for **children 2+**
2nd-gen-antihistamine
* Not recommended for **\>65 yrs old***
* or **kidney disease***
86
**Issues with Robitussin DM**
Has both **DM & Guaifenesin**
**Guaifenesin** = INCREASES secretions of Lower respiratory
**DM** = *decreases the cough threshhold*
**together may cause _retention of secretions_**
can lead to **_INFECTION / AIRWAY OBSTRUCTION_**
87
**Antitussives**
for COUGH
* Supress cough reflex by acting on **cough center @ medulla**
* Indicated to ***decrease frequency of cough:***
* ******for **_Dry / Non-productive cough_**
* Examples of FDA approvedd ingredients:
* **Dextromethorphan**
* **Diphenhydramine**
* **Codeine**
* **Chlophendianol**
88
**Primatine Mist / Tablets**
* Tablets = Ephedrine
* Mist = Epinephrine (not available)
* **_NOT RECOMMENDED IN ANY PATIENT_**
* for temporary relief of **SOB** due to **asthma**
* ***_RX Bronchodialators are MORE EFFECTIVE_***
* ***asthma patients are not good candidates for self-care***
89
**Levocetirizine Dosing**
**Xyzal**
**5mg QD**
## Footnote
**_TAKEN IN THE EVENING_**
***drowsiness** warning*
*not recommended in **\>65 y/o***
***or kidney disease***
90
**Exclusions to Self-Treamtment**
**of COUGH**
* Cough w/ **thick yellow or green sputum/phlegm**
* likely the cold can be treated (T_REAT UNDERLYING DISORDER TO STOP THE COUGH FIRST!)_
* _**CHILDREN \< 4 y/o**_
* __Cough w/:
* **Chest Pain / SOB /** tight-feeling throat
* **Swollen Legs/ankles**
* **Rash /** hemoptysis
* **Fever / Night Sweats**
* **Chronic Cough \> 7 days**, or if worsens w/ treatment
* H/O **COPD / Asthma / Bronchitis / CHF**
* Suspected **drug-associated** cough
91
**TAC IS ALSO APPROVED FOR CONGESTION**
**TAC IS ALSO APPROVED FOR CONGESTION**
