common outpatient resp. issues Flashcards
common cold incubation time
1- 3 days
medication for sneezing & rhinorrhea in common cold
* has SE of nasal dryness and epistaxis
ipratropium bromide
medication for mild improvement in rhinorrhea, throat pain & cough in common cold
* has SE of nasal dryness and epistaxis
cromolyn sodium
medication for sneezing & rhinorrhea in common cold
* has a lotttt of side effects
oral antihistamines
med for chronic cough in common cold
antitussives
- Self-limited, usually viral inflammation of the bronchi
- cough, which may include sputum production
acute bronchitis
rhonchi on auscultation, diffuse wheezing d/t bronchospasm, rhinorrhea, conjunctivitis, +/- adenopathy
acute bronchitis
though diagnosis of acute bronchitis is mostly clinical, if you did a spirometry what would you find?
low FEV1
what can you check to see if acute bronchitis is bacterial or viral?
procalcitonin level– if viral its low
- cough suppressant for short term relief
- SABA for sx
- PO NSAIDS
- decongestants
these are symptomatic treatments for what?
acute bronchitis
2 vaccines that can help in preventing bronchitis?
- flu vaxx
- pneumococcal for chronic bronchitis
ssRNA virus from orthomyxoviridae fam; HA & NA Ig important in immune response
influenza
why can you get the flu more than one time?
antigenic drift
flu incubation period and viral shedding timeline
incubation 1-4 days
viral shedding 24-48hrs before sx onset
- Abrupt onset of fever, HA, myalgia and malaise
- accompanied by URI, non-productive cough, ST, PND and rhinorrhea
- normal chest exam; cervical adenopathy more prominent in younger pt
influenza
myosititis and rhabdomyolysis most frequent in kids w/ markedly elevated serum CPK
influenza
2 populations to test for flu
- high risk
- immunecompromise or inpatient w/ acute fever or resp sx
can you stop antiviral tx based on a negative rapid flu test
No!
MOA: interfere w/ release of new influenza viruses from infected cells→ prevents new round of infection from starting
which class of flu medications
neuraminidase inhibitors
- ADR: N/V, rash; rare neuropsych effects (delirium, hallucinations, etc)
- Pregnancy category C
which flu medication class
neuraminidase inhibitors
oseltamivir and zanamivir are what kind of medication
neuraminidase inhibitors
oral med used to treat flu A & B in over 2 wks old patients when used w/in 48hrs and prophylaxis for over 1 y/o
tamiflu
inhaled med used to tx influenza A & B in over 7 yo and prophylaxis for over 5yo; increased risk of bronchospasm
zanamivir
MOA: blocks viral replication by blocking viral M2 protein ion channel, preventing virus & host cell fusion; prevents uncoating of the virus proceeding its entry into cells
* increased seizure risk in ppl w/ epilepsy
Amantadine
no longer used!!!
MOA: blocks viral replication by blocking viral M2 protein ion channel, preventing virus & host cell fusion; prevents uncoating of the virus proceeding its entry into cells
* increased seizure risk in ppl w/ epilepsy
Amantadine
no longer used!!!
top 4 causes of chronic cough
- upper airway cough syndrome
- asthma
- GERD
- ACE-i
most common cause of chronic cough in non-smoking immunocompetent pt w/ normal CXR
upper airway cough syndrome
PE: draining posterior pharynx, nasal discharge, throat clearing, cobblestone
Tx: decongestant, 1st gen antihistamine +/- SABA
upper airway cough syndrome
- cough can be silent
- oral PPI recommended
- do 24 hr esophageal pH monitoring if no response to therapy
GERD cough
