Cough and Cold: Congestion, Cough Flashcards
Cough and Cold - Congestion
stuffy nose
symptoms
Mucopurulent discharge Nasal mucosal edema Post‐nasal drip Choking or gagging feeling Mouth breathing (increased drying) Sinus headache (usually mild) ◦ Can be a sign of sinusitis ◦ Facial pain over sinus cavities, “splitting headache” ◦ Duration of symptoms > 20 days ◦ Purulent discharge
Cough and Cold - Congestion
Decongestants
general
Topical (onset 5‐10 mins) vs oral (onset 30 mins) formulations
Due to the sympathomime c effects, decongestants can cause elevate on in blood pressure →
caution in hypertensive patients
- lack evidence for children <12
Cough and Cold - Congestion
Decongestants
prolonged topical decong = rhinitis medicamentosa
which pdts are more common for it?
◦ Rebound vasodila on → rebound conges on and rhinitis
◦ Occurs after 3‐5 days of use
◦ More common with shorter‐acting agents (phenylephrine) than with longer‐acting (oxymetazoline,
xylometazoline)
◦ Patient may have to be titrated off topical decongestant with nasal saline and nasal steroids
Cough and Cold - Congestion
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Oral Decongestants
name 2
MOA?
evidence of effectiveness?
dosing see table
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Pseudoephedrine, phenylephrine
MOA: Sympathomimetic agents that relieve nasal congestion (a and b‐adrenergic agonists)
a: vasoconstriction in mucosa and respiratory tract (decreases edema and increases drainage of sinus cavities)
b: relaxation of bronchial smooth muscle
- moiderate efficacy for single doses, conflicting for repeated dosing
Cough and Cold - Congestion
Oral Decongestants
AE?
DI
Precautions
AE: Mild CNS stimulation, peripheral vasodilation, tachycardia, palpitations, increase in bp, may adversely affect blood sugar control in diabetics
DI: Effectiveness of b blockers may be reduced, MAOIs and ergot derivatives may increase hypertensive effects, SNRIs may
enhance tachycardic and vasopressive effects, antagonizes effects of a‐blockers
Precautions: heart disease, hypertension, hyperthyroidism, diabetes, angle‐closure glaucoma, prostatic
enlargement, seizure disorder, prostatic hypertrophy
Cough and Cold - Congestion
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Topical Decongestants
name 3
MOA?
evidence of effectiveness?
dosing see table
~~~
Oxymetazoline, phenylephrine, xylometazoline
MOA: Sympathomimetic agents that relieve nasal congestion
moderate efficacy for single doses, conflicting for repeated dosing
Cough and Cold - Congestion
Topical Decongestants
AE?
DI
AE: Local burning stinging, sneezing, dryness of nasal mucosa, rhinitis medicamentosa, brady/tachycardia, hypo/hypertension
DI: MAOIs may increase hypertensive effects
Other drug interactions less likely than with systemic
Cough and Cold - Congestion
other treatment options (4)
Saline spray or drops
Nasal syringing/irrigation
Counter‐irritants (eg. Buckley’s Mixture)
Neti‐Pot
Cough and Cold - Congestion
nasal rinses
evidence, safety?
- Limited evidence but may have some symptomatic relief
- Temporarily remove bothersome nasal secretions
- Improve mucociliary clearance
- Can lead to vasoconstriction (decongestion)
Safety
• Ensure that distilled, sterile, or boiled and cooled tap water is used
• Cases of amebic encephalitis have been associated with nasal irrigation with
contaminated tap water
• Ensure the device is washed properly and regularly
Cough and Cold - Cough
what are these?
◦ Upper airway cough syndrome [UACS] (Postnasal drip) ◦ Acute bacterial sinusitis ◦ Chronic bronchitis ◦ Allergic rhinitis ◦ Rhinitis due to environmental irritants ◦ Drugs: ACEI, beta blockers, ASA or NSAIDS ◦ Cigarette smoke ◦ Heart failure ◦ Cystic fibrosis ◦ Pulmonary embolism ◦ GERD ◦ Foreign body
common causes of cough
Cough and Cold - Cough
what are these?
◦ Upper airway cough syndrome [UACS] (Postnasal drip) ◦ Acute bacterial sinusitis ◦ Chronic bronchitis ◦ Allergic rhinitis ◦ Rhinitis due to environmental irritants ◦ Drugs: ACEI, beta blockers, ASA or NSAIDS ◦ Cigarette smoke ◦ Heart failure ◦ Cystic fibrosis ◦ Pulmonary embolism ◦ GERD ◦ Foreign body
common causes of cough
Cough and Cold - Cough
how is it induced?
when is it classified as acute, subacute, chronic
Symptom of many respiratory diseases
◦ Viral infections most common
Phlegm does not indicate a bacterial infection
voluntarily induced or involuntarily activated through a reflex arc to the cough center in the medulla oblongata via the afferent limb of the vagus nerve
Classified based on duration ◦ Acute: < 3 weeks ◦ Subacute: 3‐8 weeks ◦ Usually post‐infection ◦ Chronic: > 8 weeks
Cough and Cold - Cough
Upper airway cough syndrome (Post‐Nasal Drip)
symptoms of postnasal drip
READ
- hoarse voice
- occasional cough, persistent cough
- sore throat
- losing voice, scratching, tickling of back of throat
- burning of throat
- need to clear it
Cough and Cold - Cough
Red flags
- prolonged, high fever
- signs of choking on foreign body, food or vomit
- rapid breathing, SOB, wheezing
- chest pain
- blue lips, tongue/face, feeling of suffocation, bloody or frothy pink sputum
- acute confusion or recent change in mental status
- cough present > 3 wks
- comorbid illness, etc, etc, etc
Cough and Cold - Cough
pharm management - Anti-tussives
name 2
MOA
effective?
Dextromethorphan (opioid derivative), Codeine (only available as a combination schedule 2)
MOA: Unknown, acts centrally (likely at the brainstem) to suppress cough (inhibit motor control of cough)
Evidence of effectiveness: limited, does not recommend centrally acting suppressants for cough secondary to URTI
