Chapter 12 - Cough Flashcards
1
Q
Cough
A
- Respiratory defensive reflex
- Most common symptom for patients seeking medical care
- Most common reason for visits for emergency department
2
Q
Cough Pathophysiology
A
- Chemical or mechanical stimulation of vagal mediated pathways
- Number of nerves activated and their strength of activation is indicative of the intensity of the cough
- Medulla processes sensory input to activate motor efferent nerves to cause an involuntary cough
- Voluntary cough: cerebral cortex
3
Q
Cough Steps
A
- Deep inspiration
- Glottis closure
- Forceful chest wall, abdominal wall, and diaphragmic muscle contraction against glottis
- Glottis opens and air expelled with foreign debris
4
Q
Cough Categories
A
- Acute: <3 weeks
- Subacute: 3-8 weeks
- Chronic: > 8 weeks
- Medication induced
- Smoking induced
5
Q
Productive Cough
A
- Wet, “chesty,” expels secretions, can cause impaired ventilation/infection resistance
- Clear discharge: bronchitis
- Purulent discharge: bacterial infections
- Malodor: Anaerobic bacterial infections
6
Q
Nonproductive Cough
A
- Dry, “hacking”
- Viral, atypical bacterial infections, GERD, cardiac disease, and some medications cause this
- NO useful physiological purpose
7
Q
Cough Complications
A
- Exhaustion
- Insomnia
- Musculoskeletal pain
- Hoarseness
- Urinary incontinence
- Excessive perspiration
- Sore Throat
- Absence form work or school
8
Q
Cough Treatment Goals
A
- Decrease in number and severity of cough episodes
- Prevent complications
- Symptomatic relief , need to treat underlying disorder first
9
Q
Self-Care Exclusions - “3”
A
- Worsens after 3-5 days
- Cough that doesn’t improve after 2-3 weeks
- Temperature over 100 degrees Fahrenheit that lasts longer than 3 days
10
Q
Self-Care Exclusions - “4”
A
- Children < 4 y.o.
- Difficulty, SOB, labored, chronic conditions
- Temperature > 100.4 F
- Barking, whooping, aspiration, blood
11
Q
Condition Exclusions
A
- TB - night sweats, weight loss
- COPD
- CHF
- HIV
Debatable, the underlying conditions need to be treated but can give some relief in the mean time in most cases
12
Q
Antitussives
A
- Cough suppressants, control/eliminate coughts
- Better for nonproductive coughs
- Do not use for productive coughs unless the benefits outweigh the risks
- Retaining secretions when used with productive coughs increases the risk of airway obstructions and secondary bacterial infections
13
Q
Protussives
A
- Change secretion consistency and increases the volume of expectorated sputum
- Allows relief from expelling thick, tenacious secretions
14
Q
Non-Pharmacological Therapy
A
- Nonmedicated lozenges - decrease irritation
- Humidification - increases moisture to soothe irritated pathway
- Nasal drainage interventions
- Hydration - less vicious, easier to expel secretions
- Vaporizers - medicated vapor
Wet Cough: 4, 2/5, 1
Dry Cough: 1, 2/5, 4
15
Q
Children < 2 y.o. Treatment
A
- Use rubber bulb syringe to clear nose
- Prop upright at night
- Use humidifiers and vaporizers
- Keep hydrated
16
Q
Oral Antitussives
A
- Codeine
- Dextromethorphan
- Diphenhydramine
- Chlophedianol HCl
17
Q
Codeine
A
- CV, narcotic, available without a prescription in 30 states
- Antitussive at low doses, must contain <200 mg per 100 mL
- Abuse potential, purple drank, sizzurp
- MOA: Acts on medulla to increase cough threshold
- Onset: 15-30 minutes
- Duration: 4-6 hours
- Causes CNS depression, GI upset, sedation, and dizziness
18
Q
Codeine + Special Populations
A
- Do not use in children/adolescents younger than 18 y.o.
- Concerns in using with those who are pregnant or breast feeding
- Reduced dose with advanced ages
19
Q
Dextromethorphan
A
- Non-opioid with no analgesic, sedative, depressant, or addictive properties
- Equipotent to codeine with the same MOA and indication as codeine
- Onset: 30 mins-3 hours (depending on dosage form)
- Duration: 3-6 hours
- Wise margin of safety
- ADR: Drowsiness, N/V, upset stomach, sleep disturbances
- Follow up if no improvement in 2-3 weeks
- Can cause CNS depression, exacerbated with alcohol or antihistamines
- Don’t use within 14 days or using MAOIs
20
Q
Dextromethorphan + Special Populations
A
- Safety and efficacy not established in pediatric
- Probably safe in pregnant/breast feeding
- Reduce dose and monitor carefully in elderly
- Abuse potential - “Robo-tripping”
21
Q
Diphenhydramine
A
- Nonselective, first generation antihistamine
- Significant sedative and anticholinergic properties
- Same MAO and indication as codeine
- Onset: 15 minutes
- Duration: 4-6 hours
- SE: drowsiness, disturbed coordination, respiratory depression, blurred vision, urinary retention, dry mouth, respiratory secretions
- Interacts with narcotics, benzos, and alcohol
- Don’t use with narrow angle glaucoma and BPH
22
Q
Diphenhydramine + Special Populations
A
- Paradoxical reaction in children
- Commonly used during pregnancy
- Paradoxical reaction in elderly and increases their risks of falls, reduce dose and carefully monitor
23
Q
Cholphedianol
A
- Alkylamine antihistmaine with local anesthetic and mild anticholinergic effects
- Same MOA and indication as codeine
- Slower onset and longer duration than codeine
- Don’t use if used MAOIs within 14 days
- SE: Excitation, hyperirritability, nightmares, hallucinations, allergic reaction, urticaria
24
Q
Guaifenesin
A
- Only FDA-approved expectorant
- Indication: symptomatic relief of acute, ineffective productive cough
- MOA: Increases effective hydration of respiratory tract and reduces viscosity or musuc to facilitate its removal
- Give with large quantities of fluid
- SE: Dizziness, drowsiness, headache, nausea, GI upset
25
Topical Antitussives
- Camphor and Menthol - only FDA approved
- MOA: creates local anesthetic sensation and sense of improved air flow
- Toxic if injected, can be lethal in children
- Little evidence of efficacy
- Vapors may be ciliotoxic and proinflammatory, especially in children, apply to their cloths and avoid the skin
26
NSAID + Nonproductive Cough
- Use if due to cold
| - Viral infections increase upper airway afferent nerve sensitivity and Naproxen may reduce viral-associated cough
27
Decongestants + Nonproductive Cough
- Use in combination with first-generation antihistamine to decrease post-nasal drip
- Can also optionally used naproxen to decrease inflammation in these cases
28
Upper Airway Syndrome Treatment
- First generation antihistamine
| - Decongestant
29
Dry, Chronic Coughs/Post-infectious Subacute Coughs Treatment
- Short-term codeine or dextromethorphan
| - Dextromethorphan is preferred
30
Acute Productive Cough Treatment
-Guaifenesin
31
Herbal/Natural Options for Kids
- Zarbee's
| - Honey
32
Honey
- Safe in kids older than 1 y.o.
- Short term treatment
- Can significantly reduce nighttime cough frequency and severity and improve sleep in children older than 2 y.o.
- As effective or MORE effective than dextromethorphan and diphenhydramine
33
When to seek medical treatment...
- If symptoms don't improve or worsen after 7 days
| - Other exclusions for self-treatment are apparent at time of inquiry or develop after course of self-treatment
34
When to continue therapy...
- If symptoms improve but persist
| - Some conditions take 2-4 weeks to clear up
