Cold and Cough Flashcards
What is the most common cause of colds?
Rhinovirus
How is a cold transmitted?
Via self-innoculation of the nasal mucosa or conjunctiva through touch or inhalation
What is the peak viral period
2-4 days after inoculation
What is the frequency of episodes?
Children:6-10/year
Adults:2-3/year
Older adults(60+): 1/year
When dose the main cold season occur?
August thru early April
What are some risk factors of a cold?
High population density, respiratory allergies, smoking, sedentary lifestyle, sleep deprivation
What symptoms appear on days 1-3 of a cold?
Sore throat and then nasal side effects dominate on dates 2&3
Nasal drainage is clean, thin and watery
What symptoms occur on days 4-5 of a cold?
Cough may occur in approximately 20% of people
Secretions can thicken and color may change
What happens during days 6-14 of a cold?
Secretions return to clear as cold resolves
When should you not self-treat for a cold?
- oral temp is more than 100.4F
- chest pain
- shortness of breath
- worsening of symptoms or new symptoms occur
- concurrent health conditions
6.AIDs or chronic immunosuppressive therapy - infants younger than 3 months of age
What are the goals of therapy when it comes to colds?
- prevent transmission of cold viruses
- reduce bothersome symptoms
Is it okay to recommend adequate rest as a non-pharmacologic option for colds?
Yes, there is no evidence but okay to recommend(placebo effect)
T or F: withholding dairy decreases cough and congestion
False, no evidence to support
What options are available to increase humidification?
Humidifiers and vaporizers(cool vapors only)
Saline nasal sprays or drops
Saline gargles(0.25-0.5 tsp or salt in 8oz warm water)
Steamy showers
What is the MOA of Zinc
Inhibits rhino virus binding and replications in the nasal mucosa thereby suppressing inflammation
What is the dosing for Zinc lozenges
1 lozenge (13mg/lozenge) every 2 hours while awake. Initiate at first sign of cold
T or F: Zinc reduces duration and symptoms when administered within 24 hours of cold symptom onset
True
What are side effects of zinc
Nausea, upset stomach, diarrhea, irritation of oral mucosa, distortion of taste, copper deficiency
What is MOA of vit C
The antioxidant properties stimulate neutrophil and monocyte activity
T or F: Vit C is effective after a cold starts
False, proven to be NOT beneficial after symptoms start
What are side effects of vit C
Diarrhea and GI upset at 4g/day or more
What are the OTC treatment options available for congestion?
Saline nasal spray, decongestants, 1st gen antihistamines
What OTC treatment options are available for pharyngitis?
Saline gargles, local anesthetic sprays, lozenges, systemic analgesics
What OTC can help with sleeplessness during a cold
Nasal decongestant AND 1st gen antihistamine
What are follow up recommendations for a cold?
Follow up with PCP if:
-sore throat lasts several days, is sever or has a fever/headache or N/V
-symptoms worsen during nonrx
-thick and colored nasal secretions persist, temp higher than 101.5F, wheezing, rash, ear pain
What is the MOA of pseudoephedrine
It is a alpha-adrenergic agonist that constricts blood vessels, decreasing sinusoid vessel engorgement and mucosal edema/swelling
What is the typical onset of pseudoephedrine?
works within 30 minutes of taking
How long does pseudoephedrine last?
lasts for 4-6 hours
What are common side effects that can be expected with pseudoephedrine?
Elevated BP and HR, palpitations, arrhythmias, tremors, insomnia, anxiety, irritability, dizziness, headache, rebound nasal congestion, nausea/anorexia, difficult urination
What drug interactions exist with pseudoephedrine?
Ergot derivatives, linezolid, MAOIs and SNRIs
Can pseudoephedrine be taken while pregnant and lactating?
It is generally ok to use but exposure during the first trimester found a small risk for intestinal issues for baby
Taking during lactation found it can increase baby irritability and may reduce milk production
What is the adult dosing for pseudoephedrine?
For 12 years of age and older, 60mg every 4-6 hours and max of 240mg in 24 hours
What is the dosing for children aged - just under 12 years for pseudoephedrine?
30mg every 4-6 hours. Max of 120mg in 24 hours
What are the topical nasal decongestants available OTC
Naphazoline, oxymetazoline, phenylephrine, prophylhexedrine
How fast do the topical decongestants start working?
within minutes
What are the side effects of topical decongestants
Rebound nasal congestions, nasal burning/stinging, sneezing, nasal dryness
Can topical decongestants be used during pregnancy and lactation?
They are likely ok to use, but check with healthcare provider. Oxymetazoline is poorly absorbed, so it is preferred.
What is the dosing for naphazoline in those 12 and up?
1-2 drops/sprays no more than every 6 hours. NOT recommended for children under age of 12 except under PCP advice
What is the dosing of oxymetazoline?
2-3 drops/sprays every 10-12 hours. MDD is 2 doses in 24 hours.
Can be used in children 6-12 using same dosing
What is the dosing pf phenylephrine?
2-3 drops/sprays no more than every 4 hours. not recommended in children under the age of 12 except under PCP supervision.
What is the dosing of propylhexedrine?
2 inhalations each nostril not more than every 2 hours. Can be used in children ages 6-12 using same dosing as adult
What is the MOA of 1st gen antihistamines ?
They block histaminic and muscarinic receptors in the medulla
What are 1st gen antihistamines indicated?
They relieve runny nose and sneezing due to common cold
What is the onset of 1st gen antihistamines?
15-30 minutes
What is this duration of 1st gen antihistamines?
lasts 4-6 hours
What are the side effects of 1st gen antihistamines
sedation, dry mouth/nose/throat, nausea, dizziness, difficult, urination, constipation, blurred vision, cognitive problems, excitation
What drug interactions exist with 1st gen antihistamines?
Duloxetine, alprazolam, MAOI, parkinson’s medications
Can 1st gen antihistamines be taken during pregnancy and lactation?
During pregnancy avoid brompheniramine and diphenhydramine, chlorpheniramine is likely okay but still check with adults.
During lactation, avoid brompheniramine, low dose of diphenhydramine and chlorpheniramine likely okay for short-term used.
Why are systemic decongestants not recommended for older adults?
Older adults are more sensitive to side effects of systemic decongestants.
They may exacerbate diseases sensitive to adrenergic stimulation
T or F: OTC cold products are recommended in young children
FALSE, they are recommended due to lack of evidence of safety and efficacy. Recommend nondrug therapies
What are some nondrug therapies for infants?
Maintain and upright positioning to enhance nasal drainage, maintain adequate fluid intake, increase humidity of inspired air, irrigate nose with saline drops, carefully clear nasal passageways with bulb syringe.
What are the characteristics of a productive cough?
wet and chesty
What are the characteristics of a nonproductive cough?
dry and hacking
What characterizes an acute cough?
Viral URTI, bacterial sinusitis, pertussis, allergic rhinitis, COPD, pneumonia, environmental irritants
What are the common cough complications?
exhaustion, sleep deprivation, social discomfort, MSK pain, hoarseness, excessive perspiration, urinary incontinence
When should you not self-treat with a cough?
Difficulty breathing
Cyanosis
Hemoptysis
Weight loss
Night sweats
Worsens after 3-5 days
Persists after 2-3 weeks
Children younger than 4
Temp is higher than 100.4F
Returns after resolving
Temp higher than 100 for more than 3 days
Barking cough with squeaking
Severe spells with whooping
Sudden onset without fever or URI
Immunocompromised
TB exposure
HIV risk factors
Chronic conditions
What are our two goals of therapy when it comes to cough?
Reduce number and severity of episodes and prevent complications
What are complementary and non-pharmacologic options for cough?
Honey
nonmedicated lozenges
humidification
nasal drainage techniques
HYDRATION
Who should not be given honey to help with a cough?
Children under the age of 1 due to risk of botulism
What are the 3 types of oral antitussives that can be used?
Codeine, dextromethorphan and diphenhydramine
What is the MOA of codeine?
works centrally on the medulla to increase cough threshold
How fast does codeine work?
Onset is 15-30 minutes
How long does codeine last?
duration is 4-6 hours
What side effects can occur when taking codeine?
N/V, sedation, dizziness, constipation, respiratory depression and risk of abuse
Can codeine be taken while pregnant and lactating?
NO, can cause neonate dependence in pregnancy and can be excreted into the milk
What are the side effects of dextromethorphan?
drowsiness, N/V, stomach discomfort, constipation
What drug interactions exist with dextromethorphan?
strong CYP2D6
SSRIs
MAOIs
What are the side effects of diphenhydramine?
drowsiness, disturbed coordination, respiratory depression, blurred vision, urinary retention, dry mouth, dry respiratory secretions, paradoxical excitability
What is the dosing of codeine in adults?
10-20mg every 4-6 hours. MDD 120mg in 24 hours
What is the dosing of codeine in children aged 6-12?
5-10mg every 4-6 hours. MDD 60mg in 24 hours
What is the adult dosing of dextromethorphan?
10-20mg every 4 hours OR 30mg every 6-8 hours. MDD 120mg in 24 hours
What is the dosing of dextromethorphan in children aged 6-12?
5-10 mg every 4 hours or 15 mg every 6-8 hours. MDD 60mg in 24 hours
What is the adult dosing of diphenhydramine?
25mg every 4 hours. MDD 150mg in 24 hours
What is the child dosing of diphenhydramine?
12.5mg every 4 hours. MDD 75mg in 24 hours
What is the MOA of camphor and menthol?
Inhaled vapors create a local anesthetic sensation in sensory nerve endings in the nose and mucosa for sense of improved air flow.
What drug interaction exists with camphor and menthol?
WARFARIN. decreases pts INR
What should you avoid doing with camphor and menthol?
Avoid using 1 hour before or 30 minutes after a bath/shower
Eye/nostril contact
heat/microwave
use with tight bandages
placing on damaged skin
What is the only protussive available OTC
Guaifenesin
What is the MOA of guaifenesin?
loosens and thins lower respiratory tract secretions
When choosing between guaifenesin and water for protussive effects, which should you choose?
Water, there is very limited data regarding guaifenesin efficacy.
What are possible side effects of guaifenesin use?
N/V, dizziness, headache, rash, diarrhea, drowsiness, stomach pain
What is the adult dosing of guaifenesin in those 12 and older?
200-400mg every 4 hours as needed. MDD 2.4g in 24 hours
What is the dosing of guaifenesin for those 6 years- less than 12 years?
100-200mg every 4 hours as needed. MDD 1.2 grams in 24 hours
What is the dosing of guaifenesin in those aged 2- less than 6 years?
50-100mg every 4 hours as needed. MDD 600mg in 24 hours
What treatment recommendations should be recommended when you have a cough?
Start with a nondrug measure first. There is little evidence that oral antitussives and expectorants are effective at treating an acute cough. It is largely a placebo response.
What is the golden rule for cough meds and older adults?
AVOID! refer to PCP
