Cough and Cold Flashcards
What is the first symptom of a cold?
Sore throat
On day 2 or 3 of the cold what symptom(s) usually begin?
NASAL (post-nasal drainage, nasal obstruction, mildly-moderate tender sinuses)
Clear, thin +/- watery nasal secretions
On days 4-5 of the cold, what symptom(s) usually begins?
COUGH
nasal secretions may become thicker and change to yellow or green
On days 7-14 of the cold what usually happens?
Resolution of symptoms
Rhinorrhea returns to celar, thin +/- watery nasal secretions
If you have a dry cough with flu like symptoms you may have __________ & _________ in your body.
ACHES and PAINS
If you have a cough +/- mucus with nasal congestion, and rhinitis, you may also have ______________ in your throat.
pharyngitis
If you have a chesty cough with clear/pale yellow/reen mucus you may also have ________ & __________ in your sinuses and __________in your chest.
rhinorrhea & congestion
congestion
Which of the following can be classified as "fever, rhinitis, pharyngitis, "barking" cough, stridor, and dyspnea?" A. Allergic Rhinitis B. Asthma C. Bacterial throat infection D. Colds E. Croup
E. Croup
Which of the following can be classified as "watery eyes, itchy nose, eyes or throat, sneezing, nasal congestion, watery rhinorrhea, & red, irritated eyes?" A. Allergic Rhinitis B. Asthma C. Bacterial throat infection D. Colds E. Croup
A. Allergic Rhinitis
Which of the following can be classified as "sore throat (mild-moderate), nasal congestion, rhinorrhea, sneezing, low-grade fever, chills. HA, malaise and cough?" A. Allergic Rhinitis B. Asthma C. Bacterial throat infection D. Colds E. Croup
D. Colds
Which of the following can be classified as a "sore throat (mod-sever), fever, exudate, and tender anterior cervical adenopathy?" A. Allergic Rhinitis B. Asthma C. Bacterial throat infection D. Colds E. Croup
C. Bacterial throat infection
Which of the following can be classified as a "ugh, dyspnea and wheezing?" A. Allergic Rhinitis B. Asthma C. Bacterial throat infection D. Colds E. Croup
B. Asthma
Which of the following can be classified as "chest tightness, wheezing, dyspnea, productive cough, changes in sputum color, persistent fever?" A. Influenza B. Otis Media C. Pneumonia or bronchitis D. Sinusitis
C. Pneumonia or bronchitis
Which of the following can be classified as "myalgia, arthralgia, nonproductive cough, and moderate-severe fever?" A. Influenza B. Otis Media C. Pneumonia or bronchitis D. Sinusitis
A. Influenza
Which of the following can be classified as "tenderness over the sinuses, facial pain aggravated by Valsalva's maneuver or postural changes, fever > 101.5˚ F, tooth pain, halitosis, URT symptoms for > 7 days" A. Influenza B. Otis Media C. Pneumonia or bronchitis D. Sinusitis
D. Sinusitis
Which of the following can be classified as "ear popping, ear fullness, otalgia, otorhea, hearing loss, dizziness?" A. Influenza B. Otis Media C. Pneumonia or bronchitis D. Sinusitis
B. Otis Media
What are some exclusions for self-care for treating a cold?
- Fever > 101.5˚ F (38.6˚ C)
- Chest pain
- SOB
- worsening of symptoms or development of additional symptoms during self-treatment
- Concurrent underlying chronic cardiopulmonary disease (asthma, COPD, CHF)
- AIDS or chronic immunosuppressant therapy
- Frail patients of advanced age
- Infants < 9 months
- Hypersensitivity to recommended OTC meds
How should you treat congestion or rhinorrhea?
topical saline or decongestant
how should you treat aches and pains?
systemic analgesics
How should you treat fever?
systemic antipyretics
How should you treat pharyngitis?
topical saline or local anesthetic
What if the patient also has additional sleeplessness?
change to topical decongestant & 1st gen AH or alcohol containing products
How soon should you reevaluate a patient who has been self-treated for a cold?
7-14 days
What are some non pharmacological therapies (LM) for a cold?
rest fluids (tea with lemon and honey + eight 8 oz glasses of water per day) Food (chicken soup and hot broths) raise the head of the bed for infants increase humidifications
Why is it good to increase humidification when treating a cold?
soothes the irritated airways
What are some ways to increase humidification?
steamy showers
humidifiers (cool mist!)
vaporizers (warm mist, can add essential oil inhalants)
What are some non-medicated products (NPT) that can help relieve some cold symptoms?
topical saline
essential oils
medical supplies
Saline irrigation such as a net-pot can be __________ to help sooth nasal passages
warmed
saline nasal _______ are preferred for toddlers
drops
Saline gargles help with sore throats and need _______ salt to 8 oz of warm water
1 tsp
What type of topical saline can increase risk of sinus infections, probably by impairing the nasal mucosa? How can you decrease this risk?
Neti-pots (saline irrigation)
ONLY use 1-2 times day
*Make sure to only use distilled, sterile, filtered or boiled water. Do NOT use tap water! (only wash in sterile water as well)
How to use nasal products?
- clear nasal passages (blow nose)
- aim away from the septum
- sniff deeply
- wait to blow nose for a few min
- wipe tip of device after use
Drops are better than nasal sprays in children between ___ and ___ years old.
2-6
What is the right head position when using a nasal spray?
keep head upright
What is the right head position when using a nasal pump spray?
tilt head forward
What is the right head position when using a nasal inhaler?
keep head upright (warm inhaler first, discard after 2-3 months)
What is the right head position when using a nasal drops?
told head from side to side and lay on bed. stay on bed for a few minutes
No need to sniff
What are 5 types of essential oils that may help relieve cough and congestion?
- Camphor
- Menthol
- Pepperment
- Lavender
- Eucalyptus
Olbas inhalers can be used in ages ≥ ____ years.
2
Triaminic Flowing Vapors are appropriate for children ≥ __________
3 months
Theraflu Vapor patch can be used in ages ≥ ____ years
2
Little Remedies is appropriate for children ≥ __________
3 months (apply to neck and chest up to TID)
True or false. Do not use essential oils under the nose or in the nostrils.
True (can cause toxicity)
True or false. It is okay to heat, microwave or add essential oils to hot water.
False
Study the Nasal bulb syringes and NoseFrida on slide 33 & 34.
:)
Nasal strips can be used ≥ ____ years old. Some contain menthol. ALL contain latex. One time use.
5 yo
intra-nasal aids are latex free and can be used in people ≥ ____ years old.
Which of the following can be used for 15 days?
A. AIR Breathe
B. Brez
C. SleepRight
12
C. SleepRight
Decongestants work in the _________ and _______ cavities to relieve congestion
sinus, nasal
What are 3 direct-acting decongestants?
- Phenylephrine (PE)
- Oxymetazoline
- Tetrahydrozoline
Which of the following is an indirect-acting decongestant? A. Phenylephrine (PE) B. Ephedrine C. Oxymetazoline D. Tetrahydrozoline E. Pseudoephedrine
B. Ephedrine
Which of the following is a mixed decongestant? A. Phenylephrine (PE) B. Ephedrine C. Oxymetazoline D. Tetrahydrozoline E. Pseudoephedrine
E. Pseudoephedrine
Pseudoephedrine (PSE) has been approved for children ≥ _____ years old.
2
What are the 3 different formulations of Pseudoephedrine (PSE)?
- regular (30 mg q 4-6 h)
- 12 hours (120 mg)
- 24 h (240 mg)
Phenylephrine (PE) has been approved for children ≥ _____ years old.
2
Is PE as effective as pseudo ephedrine? Why?
NO. it has a shorter half-life and undergoes extensive 1st-pass metabolism
What dose of PSE can you give to children between 2-5 yo? What is the max dose?
15 mg q 4-6 h
MAX: 60 mg
What dose of PE can you give to children between 2-5 yo? What is the max dose?
2.5 mg q 4 h
MAX: 15 mg
What dose of PSE can you give to children between 6-11 yo? What is the max dose?
30 mg q 4-6 h
MAX: 120 mg
What dose of PE can you give to children between 6-11 yo? What is the max dose?
5 mg q 4 h
MAX: 30 mg
What dose of PSE can you give to patients older than 12 yo? What is the max dose?
60 mg q 4-6 h
MAX: 240 mg
What dose of PE can you give to patients older than 12 yo? What is the max dose?
10 mg q 4 h
MAX: 60 mg
What are the adverse drug effects of systemic decongestants?
- Cardiovascular stimulation (increases bp, tachycardia, palpitations, arrhythmias)
- CNS stimulation (restlessness, insomnia, anxiety, tremors, fear, hallucinations)
- Loss of appetite
What are some drug interactions with systemic decongestants?
MAOIs
TCAs
Antacids
Avoid systemic decongestants in which patient populations?
patients with uncontrolled bp
elderly
Use caution with systemic decongestants in which patient populations?
DM (these drugs can cause sugars to go out of whack)
Thyroid disease
Glaucoma
Enlarged prostate
ADHD and ADD (increased risk of CV adverse effects, should recommend another agent for congestion)
Can you give a systemic decongestant to a pt who has controlled HTN?
Yes, they are generally safe
The FDA recommends that OTC cough and cold products NOT be used in pts < ______ years old.
2
Manufacturers voluntarily restrict the age to > ____ years old to be safer.
4
The US Combat Meth Act limits sedated to ____ g in 30 days or ____ g per day.
9 g
3.6 g per day
The Alabama law for sudafed purchases is even stricter than the federal law and says you can get _____ grams in 30 days. Must be ____ years or older.
7.5 g
18
What is the name of the tamper-resistant formulation of pseudo ephedrine?
Nexafed
__________ decongestants are used as self-medication for temporary relief of nasal congestion associated with acute or chronic rhinitis, common cold, hay fever, or other upper respiratory allergies.
TOPICAL
What are some ADEs of topical decongestants?
- propellant- or vehicle-associated side effects
- trauma to the nose from the tip of the device
- can cause systemic CB adverse effects
- rhinitis medicamentosa
What are 2 types of short-acting topical decongestants?
- Drops (PE) (max use: q 4 h)
• Neo-synephrine
• Little Noses (ages 2-6)
2. Inhalers (may contain lavender, camphor +/- menthol) approved for > 6 yo Max use: q 2 h •Propylhexedrine (Benzedrex) • Levmetamfetamine (Vicks VapoInhaler)
What are some long acting topical decongestants?
1. Xylometazoline • lasts 8-10 h • Triaminic is not currently available in the US 2. Oxymetazoline • Afrin, Dristan, Mucinex, Neo-Synephrine, Sudafed OM, Sinex • MANY FORMULATIONS!! • max use: q 12 h approved for > 6 yo
What is rhinitis medicamentosa? How can you prevent it?
REBOUND CONGESTION
• restrict topical nasal decongestant therapy to 3-5 days
How do you treat rhinitis medicamentosa?
Slowly withdrawal topical decongestants
• Replace with topical normal saline
• If needed, intranasal corticosteroids and systemic decongestants can be added
• The mucous membrane returns to normal within 1-2 weeks.
Patients with ACUTE COUGH (as well as post nasal drip and throat clearing) associated with the common cold can be treated with:
1st gen AH + decongestant
Are 2nd gen AH effective at treating patients with the common cold?
NO (do not use)
[SATA] Which of the following are 1st gen AH? A. Brompheniramine B. Loratadine C. Clemastine D. Cetirizine E. Doxylamine F. Chlorpheniramine G. Diphenhydramine
A, C, E, F, G
When should you NOT give a 1st gen AH?
in the elderly, due to fall risk and sedation
[SATA] Which of the following are only MILDLY sedating? A. Brompheniramine B. Promethazine C. Clemastine D. Doxylamine E Chlorpheniramine F. Diphenhydramine
A, E
[SATA] Which of the following are HIGHLY sedating? A. Brompheniramine B. Promethazine C. Clemastine D. Doxylamine E Chlorpheniramine F. Diphenhydramine
B, C, D, F
Beware of ___________ excitatory effect in children and elderly.
paradoxical
[SATA] Which of the following 2nd generation AH cause minimal - moderate sedation? A. Fexofenadine B. Loratadine C. Hydroxyzine D. Cetirizine E. Levocetirizine F. Desloratadine G. Meclizine
C, D, E, G
2nd generation AH have some ________________ effect and may reduce nasal congestion.
anti-inflammatory
True or false. It is best to just use single products.
TRUE
Combo products are usually _____ (more or less?) expensive per dose
MORE
T/F? Combo products are always correctly dosed.
False
Patients with ACUTE COUGH due to the common cold, OTC combination cold medications, WITH THE EXCEPTION OF 1ST GENERATION AHs AND DECONGESTANTS, are ______________ until CCTs prove they are effective as cough suppressants.
NOT RECOMMENDED
The following are all examples of \_\_\_\_\_\_\_\_\_\_\_\_. chlophedianol codeine dextromethorphan diphenhydramine benzonatate
Antitussives
Guaifenesin is an example of a _____________.
Protussive (expectorant)
What is Guaifenesin used for?
Ineffective productive coughs
True or false. The glass of water used to swallow the guaifenesin is just as effective as the med itself.
True
*There is no clinical evidence that guaifenesin is effective for acute coughs or colds
___________ is not available in the US. It is a centrally acting cough suppressant with AH and anticholinergic properties.
Chlophendianol
What are some side effects of Chlophendianol?
blurred vision
drowsiness
dry mouth
N/V
What are some ADEs of codeine?
N/V
sedation
dizziness
constipation
Drug interactions with codeine?
all drugs that cause drowsiness
Use caution with codeine because of. . .
impaired respiratory reserve
it is excreted in breast milk
Review slide 61.
:)
What drug increases the cough threshold and is only recommended in chronic bronchitis? It has product abuse due to euphoric effect
Dextromethorphan
What are some ADEs of Dextromethorphan?
drowsiness
N/V
constipation
Drug interactions with Dextromethorphan?
drugs that cause drowsiness, MAOIs
What is the only 1st gen AH to have antitussive properties?
Diphenhydramine (bendaryl)
Which antitussive is Rx only and is thought to inhibit neural activity of sensory nerves in the cough-reflex pathway?
Benzonatate
What are the side effects of Benzonatate?
It is generally free of side effects but it has a variable & unpredictable effectiveness
What is the dose for Benzonatate?
in > 10 year olds, 100-200 mg TID
MAX: 600 mg/day
*There is no difference in efficacy b/w the 100 and 200 mg dose
What drug has been approved for the symptomatic relief of acute, ineffective productive coughs and helps loosen the phlegm and thins the bronchial secretions to make coughs more productive?
Guaifenesin
What are some ADEs of Guaifenesin?
N/V/D dizziness HA rash drowsiness
What are ADEs of local anesthetics?
numb mouth and tongue
How often can you use a local anesthetic for your sore throat?
every 2-4 hours
Which of the following formulation dissolves slowly and does NOT need to be chewed?
A. Throat sprays
B. Throat lozenges/lollipops
C. Oral disintegrating strips
B. Throat lozenges/lollipops
Which of the following formulation needs to sit for 15 seconds and then be spit out?
A. Throat sprays
B. Throat lozenges/lollipops
C. Oral disintegrating strips
A. Throat sprays
Stop local anesthetics if not better in ____ days.
7 (could be strept throat)
Review slide 69.
:)
What type of local anesthetic coats the mucus membrane and relieves irrigation?
Demulcents
What are some examples of Demulcents?
pectin
glycerin
NSAIDs, APAP and ASA are all examples of ___________.
Systemic Analgesics and Antipyretics
NSAIDs, APAP and ASA are effective for ______, _____ and ______.
aches, coughs and fevers
Honey as a CAM for sore throats, etc should only be used in children older than ___________.
12 months
When should you use honey as a CAM for sore throats?
use 30 min BEFORE bedtime, due to botulism
Which of the following soothes sore throats and can help with influenza, sinusitis and bronchitis symptoms? A. Honey B. Elderberry C. Zinc D. Vitamin C
B. Elderberry
Avoid elderberry if you have a ___________ allergy.
ragweed
Beware of __________ with elderberry.
Cyanide toxicity
Which of the following as modest antiviral effects and is best if started within 24 h of symptom onset. Do not drink or eat for \_\_\_\_\_\_\_ after you take the dose? A. Vitamin C, 30 min B. Elderberry, 10 min C. Zinc, 15 min D. Magnesium 15 min
C. Zinc, 15 min
Nasal formulations of __________ have been linked to anosmia (loss of sense of smell) and are NOT recommended.
Zinc
Zinc __________ may have GI side effects.
lozenges
Doses of vitamin C around _____/day are associated with diarrhea and other GI symptoms
4 g
T/F. Vitamin C is a fat soluble vitamin.
False
T/F. There is not hard evidence that vitamin C helps treat a cold. If you are an athelete or a soldier and chronically take Vit C it may prevent your chance of catching a cold.
True
