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)
Diphenhydramine (for cough): Antitussive
MOA: acts centrally in medulla to increase cough threshold
25mg q4h
Side effects: drowsiness, blurred vision, dry mouth, urinary retention
May cause drowsiness and impair physical or mental abilities; avoid driving and operating machinery. Avoid alcohol and other CNS depressants. Avoid use in elderly who are particularly at risk for anticholinergic effects.
Zinc (oral)
Dose: 1 lozenge (13.3mg Zn) q2-4h while awake
MAX: 6 lozenges/day
Children 12-17 y of age, 13.3 mg po q2-4h prn, max 4 doses/d
Start within 24h of symptoms of rhinitis
Long term use may be hazardous, if no relief in 7d then stop
DO NOT USE IF PREGANTE
Best if taken on an empty stomach, but take with food if GI upset occurs. If using the lozenge, allow to dissolve slowly; do not bite or chew.
Airborne
High dose of vitamin C (1667%) and A & E (100%)
No data to show efficacy
Some data that it MAY reduce duration by 8-10% in certain adults
diphenhydramine: 1st gen antihistamine
25-50 mg q 4-6 h
avoid nursing/ pregnancy(unless benefits outweigh risks)
• Anticholinergic effects (1st generation): • Blurry vision • Constipation • Dry mouth • Urinary retention • 1st generation: avoid in… • Glaucoma – may increase intraocular pressure • Asthma – may thicken bronchial secretions
clorpheniramine: 1st gen antihistamine
4mg q4-6h
avoid nursing/ pregnancy(unless benefits outweigh risks)
• Anticholinergic effects (1st generation): • Blurry vision • Constipation • Dry mouth • Urinary retention • 1st generation: avoid in… • Glaucoma – may increase intraocular pressure • Asthma – may thicken bronchial secretions
bromopheniramine: 1st gen antihistamine
4mg q4-6 h
avoid nursing/ pregnancy(unless benefits outweigh risks)
• Anticholinergic effects (1st generation): • Blurry vision • Constipation • Dry mouth • Urinary retention • 1st generation: avoid in… • Glaucoma – may increase intraocular pressure • Asthma – may thicken bronchial secretions
Phenylephrine HCL systemic nasal decongestant
Adults 10mg q4h (60mg)
6-12: 5mg q4h (30mg)
2-6: 2.5 q4h (15mg)
Phenylephrine bitartrate (PE) systemic decongestant
Adults: 15.6 q4h (62.4)
6-12 : 7.8 mg (31.2mg)
Not recommended for children under six
Less stable than PSE
No sustained release dosage form
Questionable efficacy
Pseudoephedrine systemic nasal decongestant
Adults 60mg q4h or 120 mg q12h (sr) (240 mg)
6-12 : 30mg q4-6h (120mg)
2-6: 15mg q4-6h (60mg)
