Cough and Cold Flashcards
How many colds do children have yearly?
6-10
How many colds do adults < 60 have yearly?
about 2-3
How many colds do adults > 60 have yearly?
about 1
Etiology of common cold
> 200 viruses (majority are rhinoviruses)
Cold season in US
August - April
Risk factors for common cold
smoking, allergic disorders affecting the nose or pharynx, increased population density in classrooms or daycare, sedentary lifestyle, less diverse social networks, chronic stress, sleep deprivation
Transmission of cold
usually self-inoculation; aerosol transmission can occur
signs and symptoms of cold caused by
direct tissue damage by virus and inflammation
first day of cold
sore throat, sneezing (virus first colonizes nasopharynx)
day 2-3 of cold
nasal symptoms; clear nasal secretions initially, turning thick and yellow later
days 4-5 of cold
cough may develop (about 30%)
T/F: low grade fever can be symptom of cold
true (< 100.4 degrees)
duration of common cold
can take 7-14 days to resolve
cold treatment goals
- reduce bothersome symptoms
- prevent transmission to others
cold prevention strategies
- CDC recommends frequent handwashing with soap and water or hand sanitizers
- avoid touching nose, eyes, and mouth
- use viral disinfectants and antiviral tissues to help prevent transmission
Exclusions for self treatment of common cold
- fever > 100.4
- chest pain
- shortness of breath
- worsening of symptoms or additional symptoms while self treating
- concurrent underlying chronic cardiopulmonary disease
- AIDS or chronic immunosuppressant therapy
- frail patients of advanced age
- infants younger than or equal to 3 months
9, hypersensitivity to OTC recommendations
Non pharmacologic treatment of common cold
rest, fluid intake, warm fluids, vaporizers/humidifiers, saline nasal spray, nasal strips, aromatic oils, removal of nasal secretions in children < 4 w nasal aspirator
treatment if congestion and rhinorrhea most problematic
saline nasal spray or decongestant +/- humidifier/vaporizer
treatment if aches and pains are most problematic
systemic analgesics
treatment if fever is most problematic
systemic antipyretics
treatment if pharyngitis is most problematic
saline gargles or local anesthetic sprays/lozenges
treatment if sleeplessness is problematic
switch to nasal decongestant or use antihistamines and alcohol containing products only at night
indications for decongestants
nasal and eustachian tube congestion, cough associated w/ post nasal drip
MOA for direct acting decongestants
alpha-adrenergic agonists; constrict blood vessels which decreases vessel engorgement and mucosal edema; relieves congestion, not rhinorrhea
direct acting decongestants
phenylephrine, oxymetazoline, and tetrahydrozoline, and pseudoephedrine
MOA for indirect acting decongestants
displace NE from storage vesicles in pre-junctional nerve terminals
indirect acting decongestants
ephedrine and pseudoephedrine
adverse effects of decongestants (especially with oral)
- more common in systemic than topical
- children/older adults more susceptible
- DO NOT OVERDOSE
- CV - hypertension, tachycardia, arrhythmias
- CNS - restlessness, insomnia, anxiety, tremors
- Diseases sensitive to stimulation: hyperthyroidism, HTN, diabetes, CHD, IHD, glaucoma, BPH
- DDI - MAOIs, TCAs, methyldopa, antacids
pseudoephedrine
- direct and indirect
- well absorbed orally
- not subject to first pass liver metabolism
- half life greater than 6 hours
- adult dose: 60mg q4-6h (240mg/day max)
- behind the counter
phenylephrine
- direct acting
- oral bioavailability around 38%
- 1st pass liver metabolism
- half life 2.5 hours
- adult dose: 10mg q4h (60mg/day max)
- OTC
short acting topical decongestants
phenylephrine and naphazoline
dose q4-6h
intermediate acting topical decongestants
xylometazoline
dose q8-10h
long acting topical decongestants
oxymetazoline; less like to cause rebound congestion than short acting
dose q10-12h
dosage forms of topical decongestants
sprays, drops, inhalers
rhinitis medicamentosa (RM)
rebound congestion
associated with long duration of topical decongestants, preservatives
duration of use of topical decongestants
3-7 days max
treatment of RM
slow withdrawal (2-6 weeks); wean off one nostril at a time, switch to saline spray, nasal steroids in severe cases. symptoms subside after 1-2 weeks decongestant free
administration of nasal sprays
- insert into one nostril
- keep head upright and sniff deeply while squeezing bottle
administration of nasal inhalers
- warm inhaler in hand
- insert inhaler tip into nostril, sniff deeply
- wipe inhaler after each use
administration of pump nasal sprays
- prime for first use
- hold bottle between first two fingers and thumb on bottom of bottle
- tilt head forward
- insert nozzle tip and sniff deeply
administration of nasal drops
- lie on bed with head tilted back
- squeeze bulb to withdraw medication
- place drops into one nostril and tilt head side to side
- do not rinse dropper
local anesthetics
benzocaine, phenol, menthol, dyclonine HCl
antihistamines have use in treating cold?
may provide some relief in adults if started early in course of a cold
local anesthetics are used every
2-4 hours
for temporary relief only
Systemic analgesics effective for
aches or fevers sometimes associated with colds
NSAIDs or APAP more effective in cold?
NSAIDs, because of anti-inflammatory activity
pregnancy/lactation and cold
- consider r v. b assessment before any drug therapy
- non drug therapy preferred
- avoid any long acting, max strength, or combination
topical decongestant preferred in pregnancy
oxymetazoline - however decongestants in general are not preferred
decongestants compatible in breast feeding
pseudoephedrine
older patients and decongestants
use with caution due to increased AE and prevalence of concomitant disease states
Children and decongestants
- nothing for < 2 years
- discouraged in < 4 years
- avoid combo products
Complementary therapies for cold
- zinc
- vitamin C
- vitamin D
- probiotic products
- airborne
pathophysiology of cough
chemical or mechanical stimuli typically responsible for triggering our involuntary cough center in the medulla oblongata
productive cough
wet or chesty cough
non productive cough
dry or hacking cough
acute cough
subacute
chronic
< 3 weeks
3-8 weeks
> 8 weeks
goals of treating cough
- reduce number and severity of cough episodes
- prevent complications
exclusions of self treatment of cough
- dyspnea, SOB
- cyanosis
- hemoptysis
- weight loss
- night sweats
- cough worsens after 3-5 days
- cough doesn’t improve 2-3 weeks
- temp > 100.4 or temp > 100 for more than 3 days
- barking cough, whooping sound, cough begins suddenly w/o fever or URI symptoms
- immunocompromised status
- history of exposure to TB
- risk factors for HIV
- chronic illness
nonpharmacologic treatment of cough
lozenges, hydration, humidification
dry cough treatment
cough suppressant
wet/productive cough treatment
expectorant
ACCP cough guidelines
central cough suppressants
ineffective in cough associated with common cold
ACCP cough guidelines pediatric patients (<14)
no Otc medications recommended
cough suppressants
codeine, dextromethorphan, diphenhydramine HCl, Clophedianol
codeine MOA
act centrally in medulla to increase cough threshold
Codeine
- might be useful for cough from bronchitis
- schedule V drug; abuse potential
- adult dose: 10-20 mg q4-6h (max 120mg/day)
dextromethorphan MOA
act centrally in medulla to increase cough threshold
dextromethorphan
- codeine analogue
- adult dose: 10-20mg q4h or 30mg q6-8h (max 120 mg/day)
diphenhydramine HCl
- not first line
- also acts in medulla to increase cough threshold
- adult dose: 25mg q24h (max 150/day)
clophedianol
- only available in combo
- centrally acting
- side effects: excitation, hyperirritability, nightmares, hallucinations, hypersensitivity, and urticaria
guaifenesin MOA
loosens and thins lower RT secretions making minimally productive coughs more productive
guaifenesin
- adult dose 200-400mg q6h (max 2.4g/day)
- drink pent of water
topical antitussives
camphor and menthol (VICKX VAPORUB)
only in ages two and older
MOA of topical antitussives
stimulate nerve endings in nose, pt feels like they have improved airflow
dosage forms of topical antitussives
ointment, cream, patch, steam, lozenge
ingredients in baby rub
eucalyptus, lavender, aloe, rosemary
cough medications and pregnancy/lactation
- diphenhydramine considered sage
- codeine only used if risks outweigh benefits
cough medications and older patients
- may be more susceptible to sedating effects of codeine
- diphenhydramine may cause paradoxical excitation, restlessness, irritability, dizziness, sedation, syncope, confusion, or hypotension
