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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
Dextromethorphan brand names
(Delsym, Robitussin)
26
Dextromethorphan MOA
NMDA antagonist, centrally acting - increases threshold for cough reflex in cough center
27
Dexromethorphan ADEs
May cause CNS depression, N/V, drowsiness.
28
Dexromethorphan DDis
Contraindicated with monoamine oxidase inhibitors (aka MAOis- rasagiline, tranylcypromine, phenylzine, selegiline), caution with other serotonergic agents and CNS depressants
29
Camphor brand names
Vicks VapoRub, Vicks VapoSteam
30
Camphor MOA
Counter irritant
31
Camphor instructions
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
Camphor ADEs
Toxic if ingested, topical use only, keep out of reach of children; irritation/burning of eyes/nose/skin
33
menthol brand names
Cough drops (Ricola, Halls), Vicks VapoRub
34
Menthol MOA
Counter irritant
35
Menthol instructions
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
Menthol ADEs
irritation/burning of eyes/nose/skin
37
Hydrocodone/Chlorpheniramine brand names
Tussionex
38
Hydrocodone/Chlorpheniramine MOA
opioid agonist/ | antihistamine
39
Hydrocodone/chlorpheniramine ADEs
Sedation, dizziness, dry mouth, constipation/ | nausea/vomiting
40
Hydrocodone/chlorpheniramine DDIs
Contraindicated with MAOIs, caution with other serotonergic agents and/or CNS depressants
41
Benzonatate brand names
Tessalon
42
Benzonatate MOA
Anesthetizes stretch receptors in airways to suppress cough reflex
43
Benzonatate ADEs
Hypersensitivity reaction – avoid in pts with allergy to local anesthetics
44
Benzonatate DDIs
None, but avoid in pts with allergy to local anesthetics
45
No opioid cough products in children under
18; | this includes codeine and hydrocodone
46
Treatment of productive cough
Cough Expectorant
47
Cough expectorate example
Guaifenesin
48
Guaifenesin brand names
Mucinex, Robitussin
49
Guaifenesin MOA
Expectorant/protussive; incorporates water into mucus, increasing volume and changing consistency
50
Guaifenesin ADEs
rare, but may include: dizziness, headache, diarrhea/nausea/vomiting. Very high doses may cause kidney stones.
51
Guaifenesin DDIs
None
52
Problem with Robitussin
contains a cough suppressant and expectorant
53
Treatment of UACS
decongestant + 1st gen antihistamine
54
Decongestants are (effective/not effective) as a monotherapy
NOT effective
55
Brompheniramine brand name
Dimetapp
56
Chlorphenoramine brand name
Chlor-Trimeton
57
Diphenhydramine brand name
Benadryl
58
Doxylamine brand name
Unisom
59
1st gen antihistamines moa
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
1st gen antihistamines ADEs
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
1st gen antihistamines DDIs
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
Treatment of cough: Pregnancy
Recommend non-pharm and refer to OB Avoid codeine: birth defects possible in 1st trimester Dextromethorphan is considered “probably safe”
63
treatment of cough: Breastfeeding
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
Treatment of cough: pediatrics
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
Treatment of cough: geriatrics
If used, use lowest dose possible More likely to experience dizziness & sedation 1st gen antihistamines= Beers Criteria
66
Cough Follow up/ Monitoring
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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