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OTC > Cough > Flashcards

Cough Flashcards

1
Q

if a patient develops a cough and explains that its dry but feels it in their chest, is this a dry cough or chesty cough?

A

Chesty cough and should be treated as a chesty cough

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2
Q

How are acute and chronic coughs classified?

A

Acute cough - a cough that lasts less than 3 weeks

Chronic cough - lasts more than 8 weeks

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3
Q

What type of cough is it if it has lasted more than 3 weeks but less than 8 weeks?

A

difficult to define as this type of cough falls within the ‘grey area’ as all chronic coughs develop from an acute cough - so best to refer for further investigation

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4
Q

what is the main cause of an acute cough?

A

viral infection

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5
Q

What are the clinical features of a acute cough?

A

presents with sudden onset and associated fever. Sputum is minimal and symptoms are often worse in the evening
Cold symptoms usually last 7-10 days.

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6
Q

What are the likely causes of a cough? What is it characterised by?

A

Upper airway coughs syndrome (UACS)- postnasal drip, rhinosinusitis
a nasal discharge that flows behind the nose and into the throat.
AND
Acute bronchitis - dyspnoea, wheeze - viral but if bacterial - antibiotic tx is necessary

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7
Q

What should you ask patient if they have symptoms of UACS?

A

Are they swallowing mucous or notice that they are clearing their throat more than usual

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8
Q

What causes UACS?

A

allergies are the main cause which are usually non-productive and worse at night

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9
Q

What symptoms are usually associated with UACS?

A

sneezing, nasal discharge/blockage, conjunctivitis, itchy oral cavity

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10
Q

How would you treat UACS?

A

antihistamines, decongestants

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11
Q

What can trigger croup? Who does it affect? What are the symptoms? How would you treat?

A

Recent infection with parainfluenza virus
Affects infants aged 3 months and 6 years
symptoms: severe and violent like ‘barking’ (seal-like) quality, in between coughs pt is breathless and struggles to breathe properly, worse at night
treat with IM dexamethasone, nebuliser budesonide

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12
Q

How can you identify an asthmatic cough?

What drugs should an asthmatic not take and why?

A

wheezing, coughing, chest tightness and SOB, can be intermittent, worse at night and provoked by triggers

Do not take NSAIDS, BB are also not recommended

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13
Q

What causes pneumonia?
What are the symptoms of the cough?
What other symptoms will the patient experience?

A

streptococcus penumoniae

non-productive and painful (24-48 hours), rapidly becomes productive, with sputum being stained RED, worse at night
pt will

pt will be unwell, with high fever, malaise, headache and breathlessness, pleuritic pain that worsens on inspiration - urgent referral to the doctor

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14
Q

What drugs can cause a cough?

A

ACE inhibitors - cough ceases after withdrawal but can take 3-4 weeks to resolve

NSAIDS
BB

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15
Q

When HF progresses, what type of cough develops in pts?

A

productive, frothy cough with a pink-tinged sputum

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16
Q

What type of cough do patients with TB present and what symptoms are associated with it?

A

chronic in nature and sputum production can vary from mild to severe
accompanied with weight loss, night sweats, fever, malaise

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17
Q

What are 7 questions you would ask a pt about their cough?

A 
sputum colour 
nature of sputum 
onset of cough
duration of cough
periodicity 
Age of pt 
Smoking hx
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18
Q

If a pt presents with a mucoid colour sputum what does this suggest?

A

no infection present

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19
Q

If a pt presents with a yellow/green/brown colour sputum what does this suggest?

A

infection

mucopurulent sputum is caused by viral infection and does not require automatic referral

20
Q

If a pt presents with haemopytsis what does this suggest?

A

pneumonia

21
Q

If a pt presents with pink tinged colour sputum what does this suggest?

A

left ventricular failure

22
Q

If a pt presents with dark red colour sputum what does this suggest?

A

carcinoma

23
Q

If a pt presents with a thin and frothy sputum, what does this suggest?

A

left ventricular failure

24
Q

if a pt presents with a thick, mucoid sputum, what does this suggest?

A

ashtma

25
Q

if a pt presents with an offensive foul-smelling sputum, what does this suggest

A

either bronchoiecasis or lung abscess

26
Q

if a cough is worse in the morning, what does this suggest?

A

upper airways cough syndrome, bronchiectasis or chronic bronchitis

27
Q 
If a cough lasts for 
3 days 
3 weeks 
3 months 
what can this suggest?
A
  • URTI
  • acute or chronic bronchitis
  • chronic bronchitis, TB, carcinoma
28
Q

If a pt DOES present with green-yellow or brown sputum, when would it be considered a bacterial infection?

A

if the cough has persisted for more than 7-10days - could be possible it went from an initial viral infection and has become a secondary infection

29
Q

What are expectorants and what are they used for?

A

Expectorants are used to help expectoration - promotes secretion of sputum
used for productive cough

30
Q

Name the expectorants used.

A

Guaifenesin (thought to stimulate secretion of respiratory tract fluid, increasing sputum volume, decreasing viscosity), ammonium salts, ipecacuanha, creosote, squill

31
Q

What is given for dry irritating cough?

A

Codeine, pholcodeine, dextromethorphan and sometimes antihistamines are given ex diphenhydramine

32
Q

How do antitussive drugs work?

A

they act directly on the cough centre to depress the cough reflex

33
Q

Which pts would you not give a cough suppressant to?

A

pts with productive coughs as it may lead to accumulation in the lungs and this results in a higher chance of infection

34
Q

What is the purpose of demulcents?

A

they are pharmacologically inert but reduce irritation by coating the pharynx to prevent coughing, soothes the throat

35
Q

Name some demulcents

A

simple linctus, honey, glycerin

36
Q

What age can you prescribe a child and what dose should be given?

  1. guaifenesin
  2. Codeine
  3. Pholcodeine
  4. Dextromethorphan
  5. Diphenhydramine
  6. Simple linctus
A
  1. > 6 years 100mg QDS (but for adults and children over 12 take 200mg QDS)
  2. > 18 years - 5ml TDS/QDS
  3. > 6 years 5-10ml TDS/QDS
  4. > 12 years 10ml QDS
  5. > 6 years
  6. > 1 month TDS/QDS
37
Q

What are the likely side effects of:

  1. guaifenesin
  2. Codeine
  3. Pholcodeine
  4. Dextromethorphan
  5. Diphenhydramine
  6. Simple linctus
A
  1. NONE
  2. sedation, constipation
  3. possible seadtion
  4. ””
  5. dry mouth, sedation, constipation
  6. NONE
38
Q

What drugs can interact with the following:

  1. guaifenesin
  2. Codeine
  3. Pholcodeine
  4. Dextromethorphan
  5. Diphenhydramine
  6. Simple linctus
A
  1. NONE
  2. increased sedation with alcohol, opioid analgesics, anxiolytics, hypnotics, antidepressants
  3. ””
  4. ””
  5. ””
  6. NONE
39
Q

which patients must be careful when taking the following and why?

  1. guaifenesin
  2. Codeine
  3. Pholcodeine
  4. Dextromethorphan
  5. Diphenhydramine
  6. Simple linctus
A
  1. NONE
  2. asthmatics - cough suppressants can cause respiratory depression - but rarely occurs so can still give it
  3. ””
  4. ””
  5. glaucoma, prostate enlargement - increases intraocular pressure and precipitation of urinary retention
  6. NONE
40
Q

can the following be given in pregnancy and BF?

A
  1. OK
  2. avoid in 3rd trimester, short periods okay in BF
  3. ””
  4. ”” and cause drowsiness and poor feeding in the baby
  5. ok but some say avoid, BF ok as small amounts secreted however may reduce milk supply
  6. OK
41
Q

Why are antihistamines used as a cough suppressant?

A

the sedative effects allow pts to have an uninterrupted nights sleep
their MOA is thought to be through anticholinergic-like drying action on the mucous membranes and not via histamine

42
Q

What extra advice could you give for the tx of a child under 6?

A

extra fluid consumption as well as the use of a demulcent

43
Q

what advice would you give to a insulin-dependent diabetic?

A

check their glucose more frequently because insulin requirements increase during acute infections

44
Q

if a pt is taking theophylline and has a cough, what advice would you give?

A

can cause GI upset, nausea, palpitations, best avoided

45
Q

what advice would you give if a pt wanted to take illogical combinations?

A

avoid them - these are combinations of expectorants and suppressants

46
Q

When would you refer? (9)

A
  1. cough lasting longer than 3 weeks
  2. coloured sputum
  3. haemoptysis
  4. Persistent harsh barking cough - croup or laryngotracheitis
  5. difficulty breathing
  6. chest pain
  7. whooping cough
  8. recurrent night-time cough - asthma
  9. 2-10% of pts taking ACEI

OTC (39 decks)

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