Cough and Cold Part 1 Lecture Flashcards
When is cold season?
Late august to early april
Children have colds how often?
6-10 per year
Adults have colds how often?
2-4 colds
Colds are caused by viruses like?
Coranavirus Influenza Parainfluenza Adenovirus Echovirus Enterovirus Multiple viruses
Main cause of the cold?
Rhinovirus
Pathophysiology of the cold?
Rhinovirus enters via epithelial cells in the nose and nasopharynx in order to replicate (33-35 degrees celsius)
Peak concentration occurs in 2-4 days after initial infection –> linger for 2.5 weeks
Inflammatory responses in the nasopharynx
What are risk factors?
Smoking Allergic Disorders Sedentary lifestyle Long-term stress Day care/staying in small social circles
What are modes of transmission for a cold?
Self-inoculation (touching a viral object) Aerosol transmission (viral particles in mucous linger)
What is normal symptom progression?
Sore throat –> nasal congestion, rhinorrhea, sneezing (day 2-3) –> cough (day 4-5) –> symptom resolution (day 7)
What are symptom progressions?
Nasal drainage often will start out clear
- As it progresses, mucus becomes thicker and change to a yellow or green color before coming clear again
Rarely a fever over 100 degrees F
Symptoms of allergic Rhinitis?
Itchy, watery eyes and watery rhinorrhea
Symptoms of influenza?
Myalgia (muscle pain)
Moderate-severe fatigue
Symptoms of ashtma?
SOB and or wheezing
Symptoms of sinusitis
Facial pain upon Valsalva’s maneuver, tender sinuses, URTI for > 7 days
Symptoms of otitis media?
Ear pain, ear popping, hearing loss, otorrhea
What are exclusions for self-treatment of a cold?
Fever > 101.5 Chest pain SOB Worsening during self-treatment Hypersensitivity to OTC Concurrent cardiopulmonary disease Immunosuppression Elderly Less than 9 months
How long does an acute cough last? Cause?
3 weeks
Viral URTI, pneumonia
How long does a subacute cough last? Cause?
3-8 weeks
Bacterial sinusitis
How long does a chronic cough last? Cause?
8 weeks
Meds, acid reflux, COPD, lung cancer
Symptoms of pneumonia/bronchitis?
Productive cough and or change in sputum color
Symptoms of whooping cough
Distinctive high-pitch coughing sound
Define dry cough
Nonproductive
“hacking cough”
No physiologic purpose
Caused by viral URTIs, acid reflux and some meds
Define wet cough
Lungs are attempting to expel something
- Clear, purulent, discolored, malodorous
What are complications of cough?
Exhaustion and insomnia Hoarseness Musculoskeletal pain Syncope Rib fractures
Suppression of a productive cough leads to?
Lower respiratory tract infection, which is more serious and could lead to a bacterial infection
Exclusions for self-treatment for a cough?
Fever > 101.5 Cough with thick, yellow sputum or green phlegm Uninteded weight loss Drenching nighttime sweats Hemoptysis (coughing up blood) Foreign object aspiration History or symptoms with asthma, COPD, or heart failure Suspected drug-induced cough Cough lasting > 7 days Worsening cough New symptoms
Non-pharmacological options?
Get adequate rest Eat a nutritious diet as tolerated Maintain adequate fluid intake Increase humidifaction Saline gargle Hard candies Food such as tea with lemon and honey, chicken soup and hot broths Nasal strips Aromatic products
Define humidifiers
Cool mist
Define vaporizer
Warm mist
- potential for bacterial growth and burns
How are humidifiers and vaporizers maintained?
Clean daily and disinfect weekly
What are benzocaine, menthol, pectin, dyclonine, and phenol?
Provides temporary relief
Can be used every 2-4 hours
Patients with allergy to anesthetics (“caines”) should avoid
Decongestants direct acting MOA, PK, examples?
Bind directly to adrenergic receptors
- Faster onset, shorter duration
- IE: phenylephrine, oxymetazoline, tertrahydrozoline
Decongestants indirect acting MOA, PK, examples?
Displace NE from storage vesicles in prejunctional nerve terminals
- Slower onset, longer duration
- Ephedrine
Decongestants mixed MOA, PK, examples?
Have both direct and indirect acting properties
- Faster onset, longer duration
- Pseudoephedrine
Phenylephrine side effects?
Cardiovascular stimulation (hypertension, tachycardia, palpitations) CNS stimulation (restlessness, insomnia, anxiety) - Exacerbate certain diseases sensitive to adrenergic stimulation
Phenylephrine Interactions and contraindications?
MAO-I, Methyldopa, TCA
- Concomitant use with MAOIs
What is the combat Methamphetamine epidemic act?
Must be kept in secure areas
Must be logged with product name, wantity sold, name, address, time and date
Sales per patients daily?
3.6 grams
Sales per patients monthly?
9 grams
Side effects of topical decongestants?
Burning, stinging, sneezing, local dryness
What is the proper technique of nasal sprays?
Blow nose gently
Wash hands
Shake
Tilt head slightly forward and close one nostril
Insert and point back and outer side of the nose
Squeeze the nasal spray while breathing in slowly through the nose
Define neti-pots
Nasal wetting agent or saline nasal irrigation
Define antihistamines
First generation
Beneficial effects related to anticholinergic properties, not antihistamic properties
Antihistamines side effects?
CNS effects (sedation, impaired performance) and anticholinergic effects
Antihistamine drug interactions?
Alcohol or other sedating meds, MAOIs, phenytoin
- Potential for paradoxical effect in children and elderly
SLUDGE cholinergic effects?
Salvation Lacrimation Urination Defecation GI distress Emesis
Other non-pharmacologic options?
Non-medicated lozenges, hard candies, or honey –> not honey flavored but not in children less than 1 year old (risk of botulism poisoning)
Define guaifenesin
Loosens and thins the lower repiratory tract secretions to make minimal productive cough more productive
Guaifenesin side effects?
Nausea, vomiting, dizziness, headache, diarrhea, stomach discomfort
– take full of water and maintain adequate hydration
Antitussives dextromethorphan side effects?
Acts centrally to increase the cough threshold
- drowsiness, nausea, vomiting, stomach discomfort, constipation
- Potential for abuse
Dextromethorphan drug interactions?
Serotonergic meds (MAOIs, SSRIs) - Concomitant use MAOIs)
Antitussive diphenhydramine?
FDA approved
Acts centrally to increase the cough threshold
Antitussive codeine?
Acts to increase the cough threshold
Considered a schedule V narcotic
Topical Antitussives Vicks VapoRub?
Camphor and menthol
Apply TID
Toxic if ingested
Less than 2 years old
Topical Antitussives Vicks Baby Rub?
Petrolatum, fragrance, aloe extract, eucalyptus oil, lavender oil, rosemary oil
- Use in ages 3 months and older
Echinacea purpurea?
Immunostimulant properties
- Has not been shown to be effective in preventing colds
- Avoid if: allergy to plants, history of asthma, atopy, or allergic rhinitis, autoimmune disorder
- Not taken if pregnant or breast-feeding women or under 2 years old
Zinc?
Block adhesion of rhinovirus to the nasal epithelium
Thought to inhibit viral replication by disrupting viral formation
- Do not drink with citrus juices, taste abnormalities, anosmia
Vitamin C?
Acts a potent antioxidant and helps with the immune system
Can reduce duration by 8% in adults and 13.6% in children
Avoid high dosages if patients with diabetes or a history of kidney problems
Special regulations of infants and children under 2 years?
Non-pharmacologic treatment only unless otherwise given permission by physician
- Maintain upright position, adequate fluid intake, increase humidity, irritate the nose with saline drops, clear with a bulb syringe
Special regulations of children under 4?
Manufacturers of OTC meds update their labels to include precautions
- Non-pharmacologic treatments preferred
Special regulations of children 4-11?
OTC cold meds are controversial
Use pharmacologic meds with caution
Special regulations of pregnant women?
Decogestant: topical oxymetazoline
No systemic agents
Cough suppressant: dextromethorphan
Special regulation of lactation?
Decongestants: topical phenylephrine, pseudoephedrine
AVOID xylometazoline and naphazoline
Cough suppressant: dextromethorphan
