Acute Upper Respiratory Inflammation & Infections (URIs)

Question 1

What are URIs?

Answer 1

Upper respiratory tract is considered everything above the trachea

Most common problem is allergic rhinitis (“hayfever”) and sinusitis

If infection, most commonly viral origin, usually coronavirus (“common cold”)

May be bacterial infection

Chronic sinusitis can lead to sinus ‘infection’

Question 2

Allergic Rhinitis

Answer 2

Allergy symptoms

Infection will have FEVER and thicker drainage

ANTOBIOTICS ONLY IF BACTERIAL INFECTION

Question 3

Allergic Rhinitis

Answer 3

• relieve nasal/sinus congestion

1. Antihistamines (PO)
2. Steroids (intranasal)
3. Leukotriene blockers- montelukast
4. Saline nasal rinses
5. echinacea and zinc (zinc can cause smell loss)

Question 4

Intranasal Glucocorticoids

Answer 4

MOST EFFECTIVE WITH ALLERGIC RHINITIS
(reduces sinus inflammation)

1. budesonide
2. fluticasone
3. mometasone
4. triamcinolone

Question 5

Steps/Considerations for Nasal Medications

Answer 5

1. Takes up to 3 days to work
2. swish and gargle after because can cause thrush in throat
3. Blow nose first
4. use cross chest approach when spraying (left hand to right nostril vice versa)

Question 6

Antihistamine (H1 Receptor Blockers)
H1- respiratory
H2- GI

Answer 6

Histamine- released in response to tissue injury (inflammatory symptoms- leaky eyes, cough, runny nose, congestion)

Antihistamine- Antagonist that blocks receptors for histamine.

1. Centrally Acting (sedating)
2. Peripherally Acting (non-sedating)

Question 7

Centrally Acting Antihistamines
(sedating)

Answer 7

“MINE” FAMILY - CROSSES BBB

1. brompheniramine (Dimetap®)
2. clemastine (Tavist®)
3. chlorpheniramine (Chlor-Trimeton®)
4. diphenhydramine (Benadryl®)
5. RX: hydroxyzine (Vistaril®)- used in hospital after acute allergic reaction (epinephrine, beta 2 agonist, antihistamine (THIS), and then steroid)

Question 8

Peripherally Acting Histamine
(non-sedating)

Answer 8

“DINE” FAMILY or “ZINE”- CANNOT CROSS BBB

MOST COMMON OR ALLERGIES

1. cetirizine (Zyrtec®) KNOW ON SITE
2. loratadine (Claritin®)
3. fexofenadine (Allegra®)

Question 9

Mucolytics (breaks down mucus)

Answer 9

• Given Nebulizer or breathing treatment

Acetylcysteine (smells bad and leaves bad residue on face)

Question 10

Expectorants

Answer 10

MOA- reduces tension of mucus, results in thinner mucus that’s easier to cough up.

1. Guaifenesin- (example, Robitussin DM®)
   major ingredient in many OTC sinus, cough, and cold remedies in combination with other meds.
2. Mucinex® is the only single ingredient, extended-release version

Question 11

Decongestants

Answer 11

ADR: If nasal spray, rebound stuffiness common. If PO, systemic alpha effects (CV) possible (monitor BP).

1. oxymetazoline (afrin)- use only 5 days
2. pseudoephedrine- (Sudafed ®)

Question 12

Antitussive (cough suppressant)

Answer 12

3 KINDS OF DRUGS

1. dextromethorphan- primary ingredient in OTC cough med (DELSYM = SINGLE INGRED)
2. bebzonatate (Tessalon Pearls)
   ** DO NOT CHEW, SWALLOW WHOLE**
3. CODEINE - suppresses cough center in brain (BLACK BOX- NOT UNDER 18 YO)

-No food/liquid 30 minutes before
-Maximum hydration except 30 min before
-DO NOT SUPPRESS A PRODUCTIVE COUGH

Question 13

Pediatric Considerations

Answer 13

1. over-the-counter (OTC) cough and cold products not be given to children younger than 2 years of age (immature liver)
2. Causes Oversedation, seizures, tachycardia, and even death in toddlers
3. evidence that such medications are simply not effective in small children

Question 14

Alternative Antitussives for Infants

Answer 14

1. humidifiers, vaporizers (change water daily)
2. Topical antitussives (Vicks VapoRub, Mentholatum).

*Do not use topicals containing camphor in children under 2

Honey - *Do not give to infants under 1