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CDM Exam 3 > Cough > Flashcards

Cough Flashcards

1
Q

Cough is categorized by

A

Duration
Productivity
Effectiveness

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2
Q

Acute cough

A

< 3 weeks

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3
Q

Subacute cough

A

3-8 weeks

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4
Q

chronic cough

A

> 8 weeks

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5
Q

Productive cough

A

Produces phlegm/mucus/sputum

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6
Q

Non-productive cough

A

Dry

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7
Q

Effective cough

A

Successfully clears airway of phlegm/mucus/sputum

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8
Q

ineffective cough

A

Does not successfully clear airway of phlegm/mucus/sputum

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9
Q

Upper Airway Cough Syndrome (UACS)

A

Post nasal drip

Situation where a productive or nonproductive cough is associated with other upper respiratory symptoms such as nasal congestion, runny nose, tickle in throat, throat clearing

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10
Q

Complications of untreated cough

A 
Exhaustion
Insomnia
Musculoskeletal pain
Hoarseness
Excessive perspiration
Urinary incontinence
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11
Q

Cough treatment goals

A

Reduce frequency and severity of cough episodes

Prevent complications

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12
Q

Self-care cough exclusions

A 
Chest pain
Chills
Cyanosis
Fever >103ºF
Hemoptysis
Lower extremity edema
Night sweats
Persistent HA 
Rash
Shortness of breath 
Throat tightness
Unintended weight loss
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13
Q

other exclusions

A

Duration > 7 days
Foreign object inhalation / aspiration
H/o cough associated w/ chronic disease (asthma/COPD)
Drug associated cough
Worsens or develops new symptoms during self-treatment

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14
Q

Non-pharm treatment

A

hydration

vaporizers & humidifiers

cough drops, lozenges, hard candy

honey

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15
Q

Appropriate dosage form for: infant/ young children

A

liquid suspensions

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16
Q

Appropriate dosage form for: children >4

A

chewable or melt-away tablets

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17
Q

Appropriate dosage form for: adults

A

regular or extended-release tablets

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18
Q

Treatment for non-productive cough

A

Antitussives

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19
Q

Antitussives are

A

cough suppressants

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20
Q

Antitussive examples

A 
Codeine 
Dextromethorphan
Camphor
Menthol
Hydrocodone/Chlorpheniramine
Benzonatate
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21
Q

Codeine brand names

A

Many, presence of codeine often indicated by C, AC, CD (ex. Robitussin AC)

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22
Q

Codeine MOA

A

opioid agonist, centrally acting - increases threshold for cough reflex in cough center

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23
Q

Codeine ADE

A

May cause CNS depression, N/V, drowsiness.

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24
Q

Codeine DDI

A

Contraindicated with monoamine oxidase inhibitors (aka MAOis- rasagiline, tranylcypromine, phenylzine, selegiline), caution with other serotonergic agents and CNS depressants

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25
Q

Dextromethorphan brand names

A

(Delsym, Robitussin)

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26
Q

Dextromethorphan MOA

A

NMDA antagonist, centrally acting - increases threshold for cough reflex in cough center

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27
Q

Dexromethorphan ADEs

A

May cause CNS depression, N/V, drowsiness.

28
Q

Dexromethorphan DDis

A

Contraindicated with monoamine oxidase inhibitors (aka MAOis- rasagiline, tranylcypromine, phenylzine, selegiline), caution with other serotonergic agents and CNS depressants

29
Q

Camphor brand names

A

Vicks VapoRub, Vicks VapoSteam

30
Q

Camphor MOA

A

Counter irritant

31
Q

Camphor instructions

A

VapoRub: for adults and children 2+: rub onto chest/throat up to 3 times daily
VapoSteam: add 1 tbsp to each pint of water in hot steam vaporizer, breathe in vapors. Use up to 3 times daily.

32
Q

Camphor ADEs

A

Toxic if ingested, topical use only, keep out of reach of children; irritation/burning of eyes/nose/skin

33
Q

menthol brand names

A

Cough drops (Ricola, Halls), Vicks VapoRub

34
Q

Menthol MOA

A

Counter irritant

35
Q

Menthol instructions

A

For adults and children 6+: dissolve 1-2 lozenges (one at a time) slowly in the mouth, repeat every 2 hours as needed. Do not chew/swallow.

36
Q

Menthol ADEs

A

irritation/burning of eyes/nose/skin

37
Q

Hydrocodone/Chlorpheniramine brand names

A

Tussionex

38
Q

Hydrocodone/Chlorpheniramine MOA

A

opioid agonist/

antihistamine

39
Q

Hydrocodone/chlorpheniramine ADEs

A

Sedation, dizziness, dry mouth, constipation/

nausea/vomiting

40
Q

Hydrocodone/chlorpheniramine DDIs

A

Contraindicated with MAOIs, caution with other serotonergic agents and/or CNS depressants

41
Q

Benzonatate brand names

A

Tessalon

42
Q

Benzonatate MOA

A

Anesthetizes stretch receptors in airways to suppress cough reflex

43
Q

Benzonatate ADEs

A

Hypersensitivity reaction – avoid in pts with allergy to local anesthetics

44
Q

Benzonatate DDIs

A

None, but avoid in pts with allergy to local anesthetics

45
Q

No opioid cough products in children under

A

18;

this includes codeine and hydrocodone

46
Q

Treatment of productive cough

A

Cough Expectorant

47
Q

Cough expectorate example

A

Guaifenesin

48
Q

Guaifenesin brand names

A

Mucinex, Robitussin

49
Q

Guaifenesin MOA

A

Expectorant/protussive; incorporates water into mucus, increasing volume and changing consistency

50
Q

Guaifenesin ADEs

A

rare, but may include: dizziness, headache, diarrhea/nausea/vomiting. Very high doses may cause kidney stones.

51
Q

Guaifenesin DDIs

A

None

52
Q

Problem with Robitussin

A

contains a cough suppressant and expectorant

53
Q

Treatment of UACS

A

decongestant + 1st gen antihistamine

54
Q

Decongestants are (effective/not effective) as a monotherapy

A

NOT effective

55
Q

Brompheniramine brand name

A

Dimetapp

56
Q

Chlorphenoramine brand name

A

Chlor-Trimeton

57
Q

Diphenhydramine brand name

A

Benadryl

58
Q

Doxylamine brand name

A

Unisom

59
Q

1st gen antihistamines moa

A

Antagonist at central and peripheral H1 receptors (readily cross BBB) as well as antagonist at cholinergic receptors.

Cough relief most likely due to anticholinergic effects that dry out nasal secretions and reduce post-nasal drip.

60
Q

1st gen antihistamines ADEs

A

Drowsiness (or possible excitability in children), CNS depression, respiratory depression, tachycardia, anticholinergic effects (blurry vision, urinary retention, dry mouth, dry eyes, CNS impairment: sedation, confusion, delirium, can mimic dementia)

61
Q

1st gen antihistamines DDIs

A

Avoid use with MAOIs. Additive CNS depression possible with sedative agents and other antihistamines. Will prevent reactivity of skin testing, discontinue 4-10 days prior to test

62
Q

Treatment of cough: Pregnancy

A

Recommend non-pharm and refer to OB

Avoid codeine: birth defects possible in 1st trimester

Dextromethorphan is considered “probably safe”

63
Q

treatment of cough: Breastfeeding

A

Recommend non-pharm and refer to OB

Codeine is excreted in breast milk and may cause sedation in infants

Diphenhydramine can reduce milk supply and may cause sedation in infants

Unknown if dextromethorphan or guaifenesin are excreted in breast milk

64
Q

Treatment of cough: pediatrics

A

Do not use cough and cold products in children < 4 years

Avoid opioid products in individuals < 18 years

May experience paradoxical excitation with antihistamines

65
Q

Treatment of cough: geriatrics

A

If used, use lowest dose possible

More likely to experience dizziness & sedation

1st gen antihistamines=
Beers Criteria

66
Q

Cough Follow up/ Monitoring

A

Refer to MD if:

Symptoms do not improve or worsen while taking non-prescription meds

Symptoms last >3 weeks

Symptoms of bacterial infection present: thick/colored nasal secretions, fever, trouble breathing, wheezing, ear pain, rash

CDM Exam 3 (8 decks)

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