A sudden, forceful release of air from the lungs - Reflex triggered by irritation or obstruction - Clears the lung passages via a rush of air

Cough Flashcards by Chelsea Luedtke

Describe a cough

A sudden, forceful release of air from the lungs

Reflex triggered by irritation or obstruction
Clears the lung passages via a rush of air

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What is the cough reflex?

Step 1: Airway sensory nerves respond to pro-tussive stimulus
Step 2: Impulse travels along the VAGUS NERVE to the medulla
- The cough control center
Step 3: Medullary center sends message to respiratory pattern generator, eliciting cough response

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Describe an Acute Cough:

Lasts less than 3 weeks

Usually associated with viral upper respiratory infections

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List possible causes of acute cough.

Possibly pneumonia
Acute L ventricular failure due to stretching caused by fluid backing into lungs
Asthma
Foreign body aspiration

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Describe a Subacute Cough:

Describe a Subacute Cough:
Lasts 3 to 8 weeks
- 3 to 4 weeks in kiddos

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List possible causes of a subacute cough

Post-infectious cough
Bacterial sinusitis
Asthma

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Describe a Chronic Cough:

Lasting over 8 weeks in adults

- >4 weeks in kiddos

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List causes of a chronic cough in non-smokers:

Upper Airway Cough Syndrome (UACS)
- AKA Post Nasal Drip
Asthma
GERD due to acid irritation
CHF
Aspiration (commonly pneumonia)
Lung Disorders
ACE Inhibitors (>20% of pts)
B-blockers in patients with COPD and asthma
- Even eye drops can cause effects

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What are the major causes of cough in children?

Viral/bacterial respiratory infection
Heart disease
Foreign body aspiration
Poor coordination of sucking and swallowing reflexes
Esophageal motility disorders

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What are symptoms and signs of a productive cough?

Wet or “chesty” cough

Expels secretions from the lower respiratory tract
Retention of secretions can cause impaired ventilation and decreases the lungs ability to resist infection

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Patient presents with a productive cough and has been diagnosed with an anaerobic infection? Describe the secretions the patient may cough up.

Malodorous = foul-smelling

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Patient coughs up yellow secretions. What is the possible cause?

yellow = inflammation (WBCs present)

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Patient coughs up red/pink secretions. What is the possible cause?

hemoptysis - blood that initially came from lower respiratory tract

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Patient coughs up clear secretions. What is the possible cause?

bronchitis

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Describe the signs/symptoms of a patient who has a dry cough and what can cause this?

"Hacking" cough that serves no physiological purpose
Causes:
Viral respiratory tract infections
Atypical bacterial infections
GERD
Cardiac disease
Medications: ACE inhibitors

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What are the concerning complications of a patient who has a persistent cough?

Exhaustion, insomnia, muscle pain, hoarseness, sweating, urinary incontinence
- Some may induce vomiting, cardiac dysrhythmias, syncope, stroke, rib fractures due to intensity

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When should you refer a patient to a physician for a cough?

Child under 4 years old
Cough lasting > 7 days
Violent cough, night sweats - May be Pneumonia or TB
Coughing up blood or non-clear sputum
SOB - may sound like barking or whooping
Fever ≥ 103° in adults or ≥ 102° in children
Abdominal swelling
Unintentional weight loss
Hx of chronic lung disease
Foreign object aspiration
Suspected drug-induced cough
Cough is unresponsive/worsening with self-treatment

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What are the top 3 causes of chronic cough in adults?

#1 UACS - Post nasal drip
#2 Asthma
#3 GERD

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When should you recommend a patient use Hydrocodone for a cough? What should you counsel the patient on?

Antitussive = non-producitve cough
Adults who no history of substance abuse disorders (CII)
Children 6+ years old

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What is the role of antitussives in cough treatment?

Control or eliminate cough by increasing the cough threshold for non-productive coughs

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What is the role of protrussives in cough treatment?

Decrease sputum viscosity, increase sputum volume and facilitate its removal for productive coughs with thick mucous

What age is safe for children to use cough drops?

> 6 years old according to the Academy of Pediatrics

What are the guidelines for giving children honey to relieve chronic cough?

DO NOT USE UNDER AGE 1
1 to 6 y.o. = Give dark honey or corn syrup
> 6 y.o. = can use cough drops/honey products

What can you recommend for a cough due to URI or chronic bronchitis?

ipratropium

What can you recommend for postinfectious cough?

``` #1 Ipratropium #2 Inhaled glucocorticoids #3 Short course of Oral GCs if severe #4 Central acting antitussive ```

What products are not recommend for a cough due to a common cold?

Zinc | Combo antihistamine-decongestants (2nd gen)

T/F: Codeine has been shown to provide significant benefit in reducing acute cough symptoms.

False; Dextromethorphan has been show while antihistamines and codeine have not show benefit

Why should you recommend licorice as an herbal treatment for cough?

TRICK You shouldn't! | - Due to Adverse Drug Reactions of CV effects and HYPOkalemic rhabdomyolysis

Which alternative product should you avoid in diabetes for cough? Why?

Marshmallow; Induces hypoglycemia

List the FDA-approved topical antitussives. How do they work?

Camphor and menthol; Pts inhale the vapors to stimulate the sensory nerve ending in the nose to create a sense of improved air flow - Eucalyptus is NOT FDA-approved

Guafenesin MOA + Side Effects

Expectorant MOA: Loosens and thins lower respiratory tract secretions and makes minimally productive coughs more productive SE: N/V, rash, diarrhea, headache

Diphenhydramine MOA + Side Effects

1st Gen Antihistamine - FDA approved antitussive MOA: Acts of the respiratory centers in the medulla to increase the cough threshold SE: Drowsiness, Disturbed coordination, dry mouth, blurred vision, urinary retention - Paradoxical excitement/hyperactivity in younger children may occur

Which patients should not receive diphenhydramine?

``` Narrow angle glaucoma CVD Asthma HTN Hyperthyroidism ```

Benzonatate MOA + Side Effects

Rx only Antitussive MOA: Local anesthetic effect on respiratory passages, lung and pleural stretch receptors SE: sedation, HA, nausea, rash, dizziness, numbness of chest *Do not use in children under 10 y.o.*

Dextromethorphan MOA + Side Effects

Opioid-derived antitussive MOA: acts on respiratory centers in the medulla to increase cough threshold SE: dizziness, drowsiness, fatigue, drunk-like behavior with overdose

Dextromethrophan is found to be _________ with codeine.

equipotent

Hydrocodone MOA + Side Effects

CII Antitussive MOA: Acts centrally on the respiratory center in the medulla to increase the cough threshold SE: N/V, drowsiness and constipation

Codeine MOA + Side Effects

``` CV Antitussive (OTC in some states, like IA) MOA: Acts centrally on the respiratory center in the medulla to increase the cough threshold ``` SE: N/V, drowsiness and constipation

Chlophendianol MOA + Side Effects

MOA: Antihistamine with antitussive, anesthetic and mild anticholinergic effects SE: dizziness, drowsiness, fatigue

Discuss the OTC product Coricidin HBP Cough and Cold.

"Triple C" - contains dextromethorphan + chlorpheniramine | - SE: May cause heart arrhythmias (chlorphen.)

Which drugs have the fastest on-set for antitussive activity?

15 to 30 minutes = dextromethorphan, hydrocodone, codeine

What medication history is important to ask about before recommending dextromethorphan?

MAOI use in the past 2 weeks: Fluoxetine, paroxetine | - Cause N/V, blurred vision, hallucinations or Serotonin syndrome

Serotonin Syndrome Signs

HTN, Hyperthermia, Myoclonus, Mental status changes

Dextromethorphan

- opioid derived antitussive - no analgesic - no sedative - no respiratory depressant - no addictive properties at therapeutic doses

MOA of dextromethorphan

Acts on respiratory centers in medulla to increase cough threshold

ADR dextromethorphan

- dizziness - drowsiness - fatigue

Abuse of dextromethorphan

- stupor/disorientation, euphoria, difficulty walking | - may cause seizures and be fatal

T/f codeine antitussives are the gold standard

False! Used to be, but current evidence suggests otherwise - dextromethorphan preferred

What is the only FDA approved non-prescription expectorant?

Guaifenesin (mucinex)

Which expectorant should you always drink plenty of water with?

Guaifenesin

Non-pharmacologic treatment of coughs

- increase hydration best - warm fluids - hard candies & lozenges (>6 y/o) - honey (avoid <1 y/o) - cocoa - vaporizers & humidifiers (may soothe irritated airways and decrease cough, cool mist preferred)

Treat post-infectious cough

1. Inhaled ipratropium 2. Inhaled glucocoritoids (GC) 3. Short course of PO GC if severe 4. Central acting antitussive