Cough (2.5) Flashcards
Cough is a symptom of many diseases. Name some of these diseases and show where it occurs in the body
- Cold, influenza, allergy, pneumonia, heart failure, asthma, whooping cough, lung cancer, reflux disease, COPD, uppper airway cough syndrome (UACS) or post nasal drip
See attached image
For cough;
A) Who is the patient?
B) What are the symptoms?
C) How long have symptoms been present?
D) Actions taken?
E) Medications?
F) Medical conditions
G) Allergies
A)
- DO NOT USE COUGH AND COLD MEDICINES IN CHILDREN UNDER 6 YEARS OLD
- Children 6-11 years old: only on recommmendation of a pharmacist or medical doctor
- Child: if cough at night and non-productive –> may be asthma
- Smoker
B)
Characteristic of cough:
- Productive (wet): chesty, produing mucus/sputum
- Non-producitve (dry): no sputum, trickly, irritating
- Colour of sputum: clear and white;yellow, green or brown; pink; dark red
- Nature of sputum: think, thick, odour
- Any other symptoms? runny nose, whooping; chronic; wheeze, SOB; barking, cropy
C)
- Acute <2 weeks
- Sub-acute: 3-8 weeks –> refer
- Chronic > 4weeks –> refer
D)
Tx failure
E)
ACE inhibitors used as antihypertensive e.g. periondropril, ramipril (many others with ‘pril ending’)
- Can cause drug-induced cough in upto 44% of patients
- Persistent, dry, irritating cough
- Cough medicines not effective
- May require stopping the ACE-1 and substituting with another hypertensive
Antidepressants: SSRI antidepressants e.g. paroxetine, fluoxetine, venlafaxine; MAOI’s, TCA’s, tramadol, St Johns Wort
- Increased risk of serotonin toxicity and dextromethorphan
- Toxic state caused by excess serotonin in the CNS. Features of the toxicity include mental (confusion), autonomic (fever, fast heart rate) and neuromuscular (tremor, incoordination)
F)
- Heart and lung disease
- Gord
- IC
G)
- Codeine
- Seasonal allergies
OTC cough medicines are frequently request, there is little evidence for an gainst efficacy, uses principles of evidence based medicines
What are some choices?
- Antitussive cough suppressants
- Expectorants
- Mucolytics
- Demuclents
For Antitussive Cough Suppressants;
A) What is the active ingredients
B) How does it work
C) What type if cough is it used for
D) ADRs
E) CIs
F) Ix
G) Why is it a potential for abuse?
A)
- Pholcodine and dextromethorphan
- Opioid derivatives: codeine, pholcodine, dihydrocodeine, dextromethorphan
B)
- Depresses medullary cough centre
C)
- For dry and unproductive coughs
D)
- Drowsiness, constipation, nausea, vomitting
E)
- Codeine allergy, respiratory failure, asthma, COPD
F)
- Dextromethorphan: antidepressants (MAO-I’s, SSRI –> serotonin toxicity)
G)
- Cos of codeine bruv (codeine not available OTC anymore)
For Expectorants;
A) What is the active ingredients and how does dosage work
B) How does it work
C) What type if cough is it used for
D) ADRs
A)
- Guaiphenesin/Guaifenesin (formulated with bromhexine)
- Senega and ammonia (taken with hot water to volatilise the ammonnia)
- Ipecuacuanha and tolu (not popular)
B)
- Irritate mucous membrane –> stimulate bronchial mucus secretion –> increase volume of mucus and decreased viscoity –> easier to expectorate
C)
- Generally well tolerated (n,v,d)
For Mucolytics;
A) What is the active ingredient
B) How does it work
C) ADRs
D) C/Is
Cat in Pregnanacy
A)
- Bromhexine
B)
- Reduces mucus viscocity easier to expectorate
C)
- Generally well tolerated (n/v/d, allergy)
D)
- COPD, chronic bronchitis
For Demulcent;
A) What is the active ingredient
B) How does it work
C) What are some examples
D) What is an advantage
A)
- Simple Linctus APF
B)
- Forms protective coating over irritated mucosa of a throat to prevent coughing
C)
- Hard lollies containing honey, syrupt, treacle, glycerol, liquorice
D)
- Provides safe alternative for at risk groups such as elderly, pregnant women, young children and those on multiple medications
Should Antitussive combination products be used? Give some examples
NO, AVOID –> Illogical combinations
- Expectorant + suppressant (guaifenesin + dextromethrophan)
- Mucolytic + suppressant (bromhexine HCL + pholcodine)
Discuss cough treatments in children
- Lack of evidence of effectiveness in children under 6 years old
DONT USE ANY PRODUCTS CONTAINING
- b.malate, c.malate, d.hydrochloride
- Dextromethorphan hydrobromide and pholcodine
- Guaifenesin and ipecuanha
- Phenyelphrine hydrochloride and pseudoepehedrine hydrocholoride
What are some trigger points for the referral of cough
- Cough that is regularly recurrent
- Cough associated with severe flu-like symptoms
- Duration longer than 3 weeks
- Coughing up blood
- Chest pain on inspiration (pleuritic like)
- Persistent nocturnal cough in children
- Wheeze or shortness of breath
