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OTC I > Cough > Flashcards

Cough Flashcards

1
Q

Classification of Coughs:

A

-Acute: < 3 weeks; <4 weeks for children
Viral, upper respiratory tract infection, some asthma

-Subacute: 3-8 weeks
Post-infectious, pertussis (whooping cough), bacterial sinusitis, some asthma

-Chronic: >8 weeks, > 4 weeks for children
Drug-induced, cancer-induced, GERD, COPD, smoking, some asthma

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2
Q

Purpose and characteristics of Productive cough:

A

-To expel mucus from the lungs -> wet, chesty
Effective (excretions are expelled), Ineffective (hard to expel excretions)

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3
Q

Purpose and characteristics of Non-productive cough

A

-no physiologic purpose. AKA dry, hacking
-Due to infections, gastroesophageal reflux disease (GERD), medications, and more

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4
Q

Complications of Cough

A
  • Exhaustion
  • Insomnia -> disturbing others at work or can’t sleep
  • Pain
  • Hoarseness
  • Incontinence -> hint: crossing legs when coughing
  • Rib fractures (rare)
  • Dysrhythmias (rare)
  • Stroke (rare)
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5
Q

Patient case: What might cause a Cough other than an infection?

A

Unresolved GERD, or ACE Inhibitors

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6
Q

What is an indicator for ACE Inhibitor-induced Cough?

A

-Dry, unproductive cough that is persistent and often worse at night
-might be due to the accumulation of bradykinin
-often when starting ACE therapy or dose change
-LISINOPRIL

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7
Q

Nonpharmacologic Treatments for Coughs?

A

-Humidified air
-Lozenges
-Elevate head during sleep
-Stay hydrated

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8
Q

Pharmacologic Treatments for Coughs?

A

-Expectorants
-Antitussives
-Dietary Supplements

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9
Q

How do Expectorants work?

A

-Increase mucin secretion and mucus hydration -> larger volume of mucus -> easier to expel via cough
-API: Guaifenesin, potassium citrate

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10
Q

How do Mycolytics work?

A

-Reduces viscosity of mucus by dissociating the disulfide bonds in mucin

-API: N-acetylcysteine, carbocystein

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11
Q

What are the common Non-prescribed Oral Antitussives and Expectorants?

A

-Codeine, Dextrometorphan, Diphenhydramine (1st Gen), Guaifenesin
-not for kids under age of 2

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12
Q

Guaifenesin (Expectorant):

A

-API of Robitussin and Mucinex
-loosen mucus, and make coughs more productive
-to treat CHEST CONGESTION
-no drug interactions
-not for pregnant women

-take with a glass full of water

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13
Q

Doses for Guaifenesin:

A

12y and older: 200-400mg orally every four hours
6-12y: 100-200mg orally every 4 hours
4-6 y: 100mg every 4 hours
2-4 y: 50-100mg every 4 hours

max dose: adults: 2400mg a day -> 6-12y: 1200mg -> 2-6y: 600mg

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14
Q

Who should not be treated with Guaifenesin?

A

-Patients with a cough that occurs with too much mucus
-patients with asthma bc increased mucus due to Guaifenesin increasing congestion of the airways

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15
Q

What are the Antitussives?

A

-Dextromethorphan (Delsym, DM)
-Codeine (Cheratussin AC)
-Diphenhydramine (Benadryl) -> 1 st Gen Antihistamine

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16
Q

Example of a 1st Gen Antihistamine:

Antitussives

A

-Benadryl
-active ingredient: Diphenhydramine hydrochloride

-it treats runny nose, and itchy nose -> used to prevent congestion to go down the throat, which causes the cough

17
Q

What are the Antitussives?

A

Try Benadryl, bc it prevents congestion to go down the throat (post-nasal drip)

18
Q

To which patients would Antihistamines be avoided to dispense?

A

-Breathing problems
-Glaucoma
-Trouble urinating due to enlarged prostate
-Generally older patients

-Side effects: drowsiness, Dizziness, Disturbed coordination, anticholinergic effects

19
Q

Doses of Benadryl:

A

Adults 12 years and older -> 25-50mg Q 4-6 hours
Children 6-12 years -> 12.5-25mg Q 4-6 hours

max dose: adults: 300mg, 6 and older: 150mg

20
Q

How does Dextromethorphan (f.e. Delsym) work?

Antitussives

A

-Works centrally (in the medulla oblongata) to elevate the
threshold for coughing
-Treats nonproductive coughs
-Coughs with irritation to the respiratory tract

-Case where patients with productive cough are treated with Antitussive (for non-productive cough) -> when they can’t sleep, but only used for the night for them to sleep

21
Q

Dextromethorphan polistirex (long-acting)
Dextromethorphan hydrobromide (short-acting)

A

-Delysm
-Cough due to minor throat and bronchial irritation, Impulse to cough to help you sleep

-Should not be used with MAOI drugs
-Serotonin syndrome: too much Serotonin -> often caused by 4-5 meds (not an issue with Dextromethorphan alone)
-not allowed for people under 18 - the risk of abuse (get high at very high dose - bottle-wise)

22
Q

What are the symptoms of Serotonin Syndrome?

A

– Clonus (repeated muscular spasms)
– Overresponsive reflexes
– Mild fever
– Hypertension
– Tachycardia

mild to life-threatening and occur shortly after serotonergic load (drug interaction)

23
Q

How does Codeine work?

A

-works centrally (in the medulla oblongata) to elevate the
the threshold for coughing -> so sight effects like drowsiness, dizziness

-best OTC product for nonproductive coughs (opioid)

-schedule C-V

24
Q

Codeine phosphate (usually with guaifenesin)

A

-Brand name: Cheratussin AC
-helps with non-productive cough, should be used short-term (a couple of weeks)

-Side effects:
-drowsiness
-Constipation
–Respiratory depression
–Dizziness
–Hypotension

25
Q

Which patients should NOT get Codeine?

A

-Ultra-rapid metabolizers of codeine experience a
45% higher median plasma morphine concentration
-> it is metabolized by CYP2D6 to morphine
-COPD or shortness of breath

26
Q

Why is Codeine available OTC?

A

-one or more non-codeine products have to be included to be sold OTC
-Limits to 200mg codeine per 100mL

27
Q

When can Honey be used?

A

-Most of the time, but not under the age of 1 -> bc of the risk of agricultural pesticides or Clostridium botulinum spores

-May increase salivation, and Calm sensory nerves
-antibacterial or anti-inflammatory effects

Adverse Effects ??
– Gastrointestinal upset
– Nervousness
– Insomnia

28
Q

How to treat a young adult with a dry cough mostly at night when laying down?

A

-The cough could be caused by an allergy -> congestant goes down the throat when laying down

-Benadryl (1st gen antihistamine) -> 25-50mg q4-6h for 2 nights and see if it improves

-CAUTION: Glaucoma, prostate enlargement, breathing problems
-> he is young so no worries

29
Q

CHEST guidelines:

A

-For adults and pediatrics only use OTC cough and cold meds unless they are shown to make cough less severe
-for adults only use NSAIDS for cough unless shown that it makes cough less severe

-for pediatrics (1-18y) with cough honey is better than no treatment and better than diphenhydramine, or placebo, but not better than dextromethorphan
-for pediatrics with cough avoid using codeine-containing medications bc of the side effects (respiratory distress)

30
Q

When would a combination product of Guaifenesin and Dextromethorphan be considered?

A

Guaifenesin (for productive cough) Dextromethorphan (non-productive, stops coughing)

-> for patients that have productive cough during the day, and cant sleep at night

31
Q

What is the risk when taking Antitussives and antidepressants?

A

-Serotonin syndrome
-intensify the side effects of antidepressants

32
Q

Matching Symptoms with active ingredients:

A

Night time relief: would rather have 1st Gen Antihistamine bc it makes drowsy (so not in the daytime product)
-minor aches, pain, and fever: Acetaminophen (Tylenol)
-nasal congestion and sinus pressure: Phenylephrine or Pseudoephedrine
-sneezing and runny nose: allergy -> Antihastiamine - Diphenhydramine (Benadryl)
-Cough: Dextromethorphan (night) or Guaifenesin
-Chest congestion: Guaifenesin (loosens mucus and bronchial secretion), could also be Phenylephrine

33
Q

When would we use 1st Gen Antihistamine?

A

Non-productive cough, congestion at the back of the throat -> related to viral infection in the upper respiratory tract

-counsel on drowsiness
-Adult dose: 25-50mg q4-6h

34
Q

When to use Codeine and Dextromethorphan?

A

Dry and non-productive cough, upper respiratory infection

-Codeine: for 18 and older, careful with metabolizers, COPD or shortness of breath; dizziness

-Dextromethorphan: not with MAOI drugs, serotonin syndrome, drowsiness, some states only over 18

OTC I (14 decks)

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