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Cold and Cough Flashcards

1
Q

What is the most common cause of colds?

A

Rhinovirus

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2
Q

How is a cold transmitted?

A

Via self-innoculation of the nasal mucosa or conjunctiva through touch or inhalation

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3
Q

What is the peak viral period

A

2-4 days after inoculation

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4
Q

What is the frequency of episodes?

A

Children:6-10/year
Adults:2-3/year
Older adults(60+): 1/year

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5
Q

When dose the main cold season occur?

A

August thru early April

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6
Q

What are some risk factors of a cold?

A

High population density, respiratory allergies, smoking, sedentary lifestyle, sleep deprivation

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7
Q

What symptoms appear on days 1-3 of a cold?

A

Sore throat and then nasal side effects dominate on dates 2&3
Nasal drainage is clean, thin and watery

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8
Q

What symptoms occur on days 4-5 of a cold?

A

Cough may occur in approximately 20% of people
Secretions can thicken and color may change

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9
Q

What happens during days 6-14 of a cold?

A

Secretions return to clear as cold resolves

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10
Q

When should you not self-treat for a cold?

A
  1. oral temp is more than 100.4F
  2. chest pain
  3. shortness of breath
  4. worsening of symptoms or new symptoms occur
  5. concurrent health conditions
    6.AIDs or chronic immunosuppressive therapy
  6. infants younger than 3 months of age
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11
Q

What are the goals of therapy when it comes to colds?

A
  1. prevent transmission of cold viruses
  2. reduce bothersome symptoms
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12
Q

Is it okay to recommend adequate rest as a non-pharmacologic option for colds?

A

Yes, there is no evidence but okay to recommend(placebo effect)

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13
Q

T or F: withholding dairy decreases cough and congestion

A

False, no evidence to support

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14
Q

What options are available to increase humidification?

A

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

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15
Q

What is the MOA of Zinc

A

Inhibits rhino virus binding and replications in the nasal mucosa thereby suppressing inflammation

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16
Q

What is the dosing for Zinc lozenges

A

1 lozenge (13mg/lozenge) every 2 hours while awake. Initiate at first sign of cold

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17
Q

T or F: Zinc reduces duration and symptoms when administered within 24 hours of cold symptom onset

A

True

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18
Q

What are side effects of zinc

A

Nausea, upset stomach, diarrhea, irritation of oral mucosa, distortion of taste, copper deficiency

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19
Q

What is MOA of vit C

A

The antioxidant properties stimulate neutrophil and monocyte activity

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20
Q

T or F: Vit C is effective after a cold starts

A

False, proven to be NOT beneficial after symptoms start

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21
Q

What are side effects of vit C

A

Diarrhea and GI upset at 4g/day or more

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22
Q

What are the OTC treatment options available for congestion?

A

Saline nasal spray, decongestants, 1st gen antihistamines

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23
Q

What OTC treatment options are available for pharyngitis?

A

Saline gargles, local anesthetic sprays, lozenges, systemic analgesics

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24
Q

What OTC can help with sleeplessness during a cold

A

Nasal decongestant AND 1st gen antihistamine

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25
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
26
What is the MOA of pseudoephedrine
It is a alpha-adrenergic agonist that constricts blood vessels, decreasing sinusoid vessel engorgement and mucosal edema/swelling
27
What is the typical onset of pseudoephedrine?
works within 30 minutes of taking
28
How long does pseudoephedrine last?
lasts for 4-6 hours
29
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
30
What drug interactions exist with pseudoephedrine?
Ergot derivatives, linezolid, MAOIs and SNRIs
31
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
32
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
33
What is the dosing for children aged - just under 12 years for pseudoephedrine?
30mg every 4-6 hours. Max of 120mg in 24 hours
34
What are the topical nasal decongestants available OTC
Naphazoline, oxymetazoline, phenylephrine, prophylhexedrine
35
How fast do the topical decongestants start working?
within minutes
36
What are the side effects of topical decongestants
Rebound nasal congestions, nasal burning/stinging, sneezing, nasal dryness
37
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.
38
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
39
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
40
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.
41
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
42
What is the MOA of 1st gen antihistamines ?
They block histaminic and muscarinic receptors in the medulla
43
What are 1st gen antihistamines indicated?
They relieve runny nose and sneezing due to common cold
44
What is the onset of 1st gen antihistamines?
15-30 minutes
45
What is this duration of 1st gen antihistamines?
lasts 4-6 hours
46
What are the side effects of 1st gen antihistamines
sedation, dry mouth/nose/throat, nausea, dizziness, difficult, urination, constipation, blurred vision, cognitive problems, excitation
47
What drug interactions exist with 1st gen antihistamines?
Duloxetine, alprazolam, MAOI, parkinson's medications
48
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.
49
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
50
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
51
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.
52
What are the characteristics of a productive cough?
wet and chesty
53
What are the characteristics of a nonproductive cough?
dry and hacking
54
What characterizes an acute cough?
Viral URTI, bacterial sinusitis, pertussis, allergic rhinitis, COPD, pneumonia, environmental irritants
55
What are the common cough complications?
exhaustion, sleep deprivation, social discomfort, MSK pain, hoarseness, excessive perspiration, urinary incontinence
56
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
57
What are our two goals of therapy when it comes to cough?
Reduce number and severity of episodes and prevent complications
58
What are complementary and non-pharmacologic options for cough?
Honey nonmedicated lozenges humidification nasal drainage techniques HYDRATION
59
Who should not be given honey to help with a cough?
Children under the age of 1 due to risk of botulism
60
What are the 3 types of oral antitussives that can be used?
Codeine, dextromethorphan and diphenhydramine
61
What is the MOA of codeine?
works centrally on the medulla to increase cough threshold
62
How fast does codeine work?
Onset is 15-30 minutes
63
How long does codeine last?
duration is 4-6 hours
64
What side effects can occur when taking codeine?
N/V, sedation, dizziness, constipation, respiratory depression and risk of abuse
65
Can codeine be taken while pregnant and lactating?
NO, can cause neonate dependence in pregnancy and can be excreted into the milk
66
What are the side effects of dextromethorphan?
drowsiness, N/V, stomach discomfort, constipation
67
What drug interactions exist with dextromethorphan?
strong CYP2D6 SSRIs MAOIs
68
What are the side effects of diphenhydramine?
drowsiness, disturbed coordination, respiratory depression, blurred vision, urinary retention, dry mouth, dry respiratory secretions, paradoxical excitability
69
What is the dosing of codeine in adults?
10-20mg every 4-6 hours. MDD 120mg in 24 hours
70
What is the dosing of codeine in children aged 6-12?
5-10mg every 4-6 hours. MDD 60mg in 24 hours
71
What is the adult dosing of dextromethorphan?
10-20mg every 4 hours OR 30mg every 6-8 hours. MDD 120mg in 24 hours
72
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
73
What is the adult dosing of diphenhydramine?
25mg every 4 hours. MDD 150mg in 24 hours
74
What is the child dosing of diphenhydramine?
12.5mg every 4 hours. MDD 75mg in 24 hours
75
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.
76
What drug interaction exists with camphor and menthol?
WARFARIN. decreases pts INR
77
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
78
What is the only protussive available OTC
Guaifenesin
79
What is the MOA of guaifenesin?
loosens and thins lower respiratory tract secretions
80
When choosing between guaifenesin and water for protussive effects, which should you choose?
Water, there is very limited data regarding guaifenesin efficacy.
81
What are possible side effects of guaifenesin use?
N/V, dizziness, headache, rash, diarrhea, drowsiness, stomach pain
82
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
83
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
84
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
85
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.
86
What is the golden rule for cough meds and older adults?
AVOID! refer to PCP

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