Colds Flashcards
Phenylephrine (Neo-Synephrine) 0.125-1%: Topical Decongestant
Short acting; 4-6h
Nasal decongestion, nasal: Adults and Children ≥12 y of age, 0.25-1%, 2-3 sprays in each nostril q4h prn for ≤3 d;
Contact physician/provider if insomnia, tremor, weakness, or irregular heart beat occur
- Do not exceed recommended dosage or duration (3 days) • Minimal systemic absorption • Ages 6 and above • Spray directions: • Squeeze bottle quickly and firmly • Do NOT tilt head backward while spraying • Wipe nozzle clean after each use
- Propellant or vehicle associated effects • e.g. Burning, stinging, sneezing, local dryness • Trauma from tip of administration device • Rhinitis medicamentosa (RM) = rebound congestion • To avoid RM, recommended to limit therapy with topical decongestants to 3 days (controversial) • Occurs from overuse of topical product • Causes nasal membranes to become more congested and edematous as drug action subsides • Congestion d/t ischemia cause by the drug’s intensive local vasoconstriction and local irritation from the agent itself • Treatment: slowly withdrawing the topical decongestant (one nostril at a time) replacing the topical decongestant with topical normal saline • D/C offending drug • Use systemic decongestants • Takes 1-2 weeks for nasal membranes to return to normal after use
Levmetamfetamine (l-desoxyephedrine): Topical Decongestant
generic vapor inhaler
Short acting: 4-6 h
Contact physician/provider if insomnia, tremor, weakness, or irregular heart beat occur
Do not exceed recommended dosage or duration (3 days) • Minimal systemic absorption • Ages 6 and above • Spray directions: • Squeeze bottle quickly and firmly • Do NOT tilt head backward while spraying • Wipe nozzle clean after each use
• Propellant or vehicle associated effects • e.g. Burning, stinging, sneezing, local dryness • Trauma from tip of administration device • Rhinitis medicamentosa (RM) = rebound congestion • To avoid RM, recommended to limit therapy with topical decongestants to 3 days (controversial) • Occurs from overuse of topical product • Causes nasal membranes to become more congested and edematous as drug action subsides • Congestion d/t ischemia cause by the drug’s intensive local vasoconstriction and local irritation from the agent itself • Treatment: slowly withdrawing the topical decongestant (one nostril at a time) replacing the topical decongestant with topical normal saline • D/C offending drug • Use systemic decongestants • Takes 1-2 weeks for nasal membranes to return to normal after use
Propylhexedrine (Benzedrex inhaler): Topical Decongestant
Short acting: 4-6h
2 inhalation’s in each nostril NO MORE than q2h prn
Contact physician/provider if insomnia, tremor, weakness, or irregular heart beat occur
Do not exceed recommended dosage or duration (3 days) • Minimal systemic absorption • Ages 6 and above • Spray directions: • Squeeze bottle quickly and firmly • Do NOT tilt head backward while spraying • Wipe nozzle clean after each use
• Propellant or vehicle associated effects • e.g. Burning, stinging, sneezing, local dryness • Trauma from tip of administration device • Rhinitis medicamentosa (RM) = rebound congestion • To avoid RM, recommended to limit therapy with topical decongestants to 3 days (controversial) • Occurs from overuse of topical product • Causes nasal membranes to become more congested and edematous as drug action subsides • Congestion d/t ischemia cause by the drug’s intensive local vasoconstriction and local irritation from the agent itself • Treatment: slowly withdrawing the topical decongestant (one nostril at a time) replacing the topical decongestant with topical normal saline • D/C offending drug • Use systemic decongestants • Takes 1-2 weeks for nasal membranes to return to normal after use
Topical Decongestants - Short Acting
Phenylephrine (Neo-Synephrine)
Levmetamfetamine (l-desoxyeohedrine)
Propylhexedrine (Benzedrex)
Topical Decongestants - Long Acting
Oxymetazoline (Afrin, Sinex)
Oxymetazoline 0.05% (Afrin, Sinex): Long Acting
Long acting topical decongestant = 12h
2-3 sprays in each nostril BID
MAX 2 DOSES IN 24H
Preferred topical decongestant during pregnancy
Contact physician/provider if insomnia, tremor, weakness, or irregular heart beat occur
Do not exceed recommended dosage or duration (3 days) • Minimal systemic absorption • Ages 6 and above • Spray directions: • Squeeze bottle quickly and firmly • Do NOT tilt head backward while spraying • Wipe nozzle clean after each use
• Propellant or vehicle associated effects • e.g. Burning, stinging, sneezing, local dryness • Trauma from tip of administration device • Rhinitis medicamentosa (RM) = rebound congestion • To avoid RM, recommended to limit therapy with topical decongestants to 3 days (controversial) • Occurs from overuse of topical product • Causes nasal membranes to become more congested and edematous as drug action subsides • Congestion d/t ischemia cause by the drug’s intensive local vasoconstriction and local irritation from the agent itself • Treatment: slowly withdrawing the topical decongestant (one nostril at a time) replacing the topical decongestant with topical normal saline • D/C offending drug • Use systemic decongestants • Takes 1-2 weeks for nasal membranes to return to normal after use
Budesonide (Rhinocort): Intranasal Corticosteroids
Adults + Children 12 and up: 4 sprays in each nostril daily
Ages 6 and older: 1 spray in each nostril daily
Max under 12yo: 2 sprays in each nostril daily*
Possible side effects: nasal discomfort, nose bleeding/irritation, sneezing, taste/smell alterations, and headache • Serious side effects: changes in vision, glaucoma, cataracts, increased risk of infection, and growth inhibition in children
Should be used daily regularly without missing a dose • Complete symptom control may not be seen for up to 1 week • Most people will see some improvement on the first day • Adults: after 6 months of daily use, as physician/provider if you can keep using (fluticasone products) • Children: talk to physician/provider if child needs to use it more than 2 months out of the year • Potential for a slowed growth rate in children • Pregnancy: talk to a health professional before use
Fluticasone (Flonase): Intranasal Corticosteroids
Adults 12 and up: 2 sprays in each nostril daily
4 years and older: 1 spray in each nostril daily
once symptoms resolves may titrate down to 1 spray in each nostril daily
Possible side effects: nasal discomfort, nose bleeding/irritation, sneezing, taste/smell alterations, and headache • Serious side effects: changes in vision, glaucoma, cataracts, increased risk of infection, and growth inhibition in children
Should be used daily regularly without missing a dose • Complete symptom control may not be seen for up to 1 week • Most people will see some improvement on the first day • Adults: after 6 months of daily use, as physician/provider if you can keep using (fluticasone products) • Children: talk to physician/provider if child needs to use it more than 2 months out of the year • Potential for a slowed growth rate in children • Pregnancy: talk to a health professional before use
Triamcinolone (Nasacort): Intranasal Corticosteroids
Ages 2-5: 1 spray in each nostril daily • Ages 6-12: 1 spray in each nostril daily • If symptoms not relieved, may increase to 2 sprays in each nostril daily • Adults: 2 sprays in each nostril daily • Once symptom control achieved, may titrate down to 1 spray in each nostril daily
Possible side effects: nasal discomfort, nose bleeding/irritation, sneezing, taste/smell alterations, and headache • Serious side effects: changes in vision, glaucoma, cataracts, increased risk of infection, and growth inhibition in children
Should be used daily regularly without missing a dose • Complete symptom control may not be seen for up to 1 week • Most people will see some improvement on the first day • Adults: after 6 months of daily use, as physician/provider if you can keep using (fluticasone products) • Children: talk to physician/provider if child needs to use it more than 2 months out of the year • Potential for a slowed growth rate in children • Pregnancy: talk to a health professional before use
Cromolyn Sodium: Mast Cell Stabilizer
For preventing and relieving symptoms: itching, sneezing, rhinorrhea
MOA: block Ca2+ influx into mast cells to prevent release of histamine.
Adults and Children ≥2 y of age, 1 spray/nostril 3-4 times daily to max of 6 times/d
Initial effect takes up to 3-7 days, maximal effect at 2-4 weeks, therefore not appropriate for acute symptom relief. Do not use to treat sinus infection, asthma, or cold symptoms.
Loratidine (Claritin) : 2nd gen antihistamine
Long acting H1 receptor antagonist - inhibits histamine secretion
Non sedating
on slide: adult dose : 10mg
preferred in pregnancy
avoid in nursing
ONLY non-drowsy 24hour product available for children 2+ years old
Cetirizine (Zyrtec): 2nd gen antihistamine
adult dose 10mg
(5mg maybe appropriate for less server symptoms)
MOA: compete with histamine at central and peripheral histamine (H1) receptor sites prevent histamine-receptor interaction and subsequent mediator release
Drowsy (sedating in 10% patients)
avoid nursing/ pregnancy(unless benefits outweigh risks)
Considered first-line therapy for allergic rhinitis*
rhinitis*
Levocetirizine (Xyzal): 2nd gen antihistamine
adult dose- 5mg
Drowsy so take in evening
NOT recommended for patients >65 yo or those with kidney disease
avoid nursing/ pregnancy(unless benefits outweigh risks)
Fexofenadine (Allegra): 2nd gen antihistamine
Non-sedating H1 antagonist activity
Children 2-11 y of age, 30 mg po bid;
Children ≥12 y of age and Adults, 60 mg po bid or 180 mg po daily
avoid nursing/ pregnancy(unless benefits outweigh risks)
Avoid taking with aluminum or magnesium antacids
Avoid fruit juices (grapefruit, orange, apple), separate by 4h
Headache, nausea (uncommon) • Paradoxical excitation: insomnia, irritability, nervousness, nightmares
• Do NOT take at the same time with aluminum or magnesium antacids • Administration within 15 minutes showed substantial decrease in absorption of fexofenadine • Substantially excreted by the kidneys, decrease dose with renal dysfunction • Meltable tablet: • Do NOT chew, place on tongue and allow to dissolve, followed by swallowing with or without water • Take on an empty stomach • Do NOT remove tablet from package until time of administration
Dextromethorphan (DM) : antitussive
Adults: 10-20mg q4 h or 30mg q6-8h (Max 120/24h)
Abusable
moa: Suppress cough reflex by acting on the cough center in the medulla
Non teratogenic, alcohol free forms preferred for pregnant patients
High doses can cause an “LSD-like” high with hallucinations, vivid dreams, or out of body experiences
Amount of drug needed for “high” ranges from: 1.5mg/kg to as much as 20mg/kg • Most common: 2.5-7.5mg/kg (70kg person: 175-525mg)
