Cough and Cold Flashcards
1) How do aromatic decongestants provide relief in cough and colds?
2) Outline the suitability of strong aromatic decongestants in children
1) Volatile substances e.g. eucalyptus oil encourage inspiration of warm moist air which is comforting in bronchitis. Avoid boiling water (risk of scalding)
2) Aromatic decongestants are not advised for infants under the age of 3 months
As aromatic decongestants (applied as rubs or to pillows) are not recommended in infants, how should nasal obstruction with mucus be managed in infants? (2)
1) Taught appropriate techniques of suction aspiration
2) NaCl 0.9% given as nasal drops is preferred; administration before feeds may ease feeding difficulties caused by nasal congestion
Cough may be a symptom of an underlying disorder, and this needs to be ruled out before prescribing cough suppressants. Which common conditions can a cough be an underlying symptom of? (3)
1) Asthma
2) Gastro-oesophageal reflux disease
3) Rhinitis
Codeine phosphate may be effective but it is constipating and can cause dependence. What other cough suppressants that can be considered instead in adults?
Dextromethorphan and pholcodine - fewer side effects
Which drugs can be used to control distressing cough in terminal lung cancer and in palliative care?
1) Morphine is preferred
2) Also diamorphine and methadone - but contraindicated in some due to side effects
1) Why might diamorphine and methadone be contraindicated in some palliative patients suffering with a distressing cough?
2) In particular why should methadone be avoided?
1) They induce sputum retention and ventilatory failure as well as causing opioid dependence
2) It has a long duration of action and tends to accumulate
What are the advantages of using demulcent cough preparations such as simple linctus?
1) Harmless and inexpensive; paediatric simple linctus is useful in children (1y+)
2) Contain soothing substances such as syrup or glycerol
Expectorants promote expulsion of bronchial secretions - is there any evidence to support this?
No evidence that any drug can specifically facilitate expectoration
Although oral nasal decongestants may not be as effective as local applications e.g. nasal sprays, what side effect can be avoided?
Do not give rise to rebound nasal congestion on withdrawal
1) OTC cough suppressants containing codeine should be avoided in children under what age?
2) They should also be avoided in children of any age with which genetic defect?
1) Under 12 years
2) CYP2D6 ultra-rapid metabolisers
Dextromethorphan and pholcodine should not be used in children under what age?
Avoided in children under 6 years
↳ also avoid in CYP2D6 ultra-rapid metabolisers
Outline the MHRA/CHM advice regarding the sale of OTC cough and cold medicines in children
Children under 6 years should not be given OTC cough and cold medicines containing: Antihistamines, cough suppressants, expectorants and decongestants
1) According to advice provided by the MHRA, OTC cough and cold medicines can be considered for children aged 6–12 years if what has already been tried first?
2) How long should treatment be limited for?
1) Basic principles of best care have been tried
2) Restricted to five days or less
↳ do not give more than 1 preparation at a time due to same ingredients. Give correct dose
When there is no identifiable cause, cough suppressants may be useful, for example if sleep is disturbed in adults. But why might they be harmful in patients with chronic bronchitis and bronchiectasis?
They may cause sputum retention which could lead to an infection
What is the purpose of dextromethorphan in cough?
Dextromethorphan is a cough suppressant
