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PHAR 153 > Cough and Cold Therapy > Flashcards

Cough and Cold Therapy Flashcards

1
Q

How to counsel a cough/cold?

A
  1. Is this for yourself?
  2. If the cough seems serious, ask if they have seen an MD
  3. Isolate bothersome symptoms (helps us find therapy that best suits our patient)
  4. Consider non-medical measures (chicken soup & hot tea)
  5. Consider a cough/cold product (1-2 indegredients is ideal)
  6. Consider precautions of use and modify your choice if medical conditions pose concern
  7. Consider non-medical measures? (warm or spicy food/soups help make unproductive coughs productive)
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2
Q

What are some non-drug measures for coughs/colds?

A

Chicken Soup

Rest

Normal amounts of fluid are fine
Humidity (doesn’t matter if the mist is hot or cold, humidity in general is more important)

Propping kids up uses gravity to make phlegm flow downwards

Saline solutions (used for throat relief during colds)

Nasal saline spray (great option for kids under 6, as we cannot give them decongestants)

Rhinaris(lubricant) helps keep saline in place and causes a soothing effect

Neti pots/navage (pour fluid through one nostril and flows out of the other)

Sinus rinses (more effective for allergic rhinitis, but can use for colds)

Menthol(mostly for hitting cool receptors, but have no effect on congestion)

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3
Q

What are some common drug therapies for coughs/colds?

A

Oral Decongestant (pseudoephedrine and phenylephrine)

Topical Decongestant (oxymetazoline)

Analgesics (acetaminophen and ibuprofen)

Cough Suppressants (DM)

Antihistamines (chlorpheniramine and diphenhydramine)

Expectorant (guafenasin)

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4
Q

How do direct-acting decongestants work ?

A

ex. pseudoephedrine

Noradrenalin-mediated decongestion

Direct acting (effects seen in minutes)
Pseudoephedrine stimulates alpha receptors on blood vessels and induces vasoconstriction. This shrinks the tissues and helps with decongestion

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5
Q

How do indirect-acting decongestants work?

A

Indirect acting (effects seen later)
Pseudoephedrine is absorbed and distributed around the body. It kicks out noradrenalin from neurons. Noradrenalin has the same effect as pseudoephedrine and it stimulates alpha receptors on blood vessels, causing vasoconstriction

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6
Q

What are some topical decongestants and what are their dosing intervals?

A

Great localized agents, but don’t use for extended periods (rebound congestion concerns)

oxymetazoline(every 12 hours)
xylometazoline (every 8-10 hours)

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7
Q

What is MAO (monoamine oxidase)?

A

MAO is an enzyme that degrades noradrenalin, and it can effect indirect-acting decongestants.

Pseudoephedrine is broken down at about the same rates and amounts in all people. This allows standardized effective doses. Phenylamine degradation is variable, this is why it isn’t as useful as pseudoephedrine

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8
Q

How to choose decongestants?

A

Patient preference

Onset (topical decongestants work much faster bc they are direct-acting)

Congestion + other symptom (oral decongestants can have more ingredients (pseudoephedrine + DM) and can be used as a shotgun approach to dealing with symptoms)

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9
Q

What side effects do oral decongestants present?

A

CNS effects (gives you a buzz)

Cardiovascular effects (low-level effects for a few days, only increases BP by a few points). the solution here is to use topical decongestants

Blood glucose increases due to increased metabolism, but cold is causing more metabolism than the drug. More of a concern for Type-1 diabetes

angle closure glaucoma. dilation of iris and results in headaches. Happens in people who are already at risk for glaucoma

Urine retention/prostate (the prostate is full of alpha receptors and decongestants are alpha receptors, decongestants induce tone in the prostate which causes urinary retention)

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10
Q

What is a drug interaction with oral decongestants?

A

MAO inhibitors (ex. reduce the breakdown of pseudoephedrine and replaces even more noradrenalin, causing extreme effects)

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11
Q

What are some concerns with topical decongestants?

A

angle closure glaucoma (bad nasal spray technique results in some molecules affecting the eye)

Rebound congestion (taking topical decongestant everyday causes the tissue to rebound more each time, you get to a point where you have to take topical decongestants all the time) up to 7 days of use should be safe

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12
Q

Are decongestants available for pediatric use?

A

No, we cannot give any medication for coughs/colds to kids under 6. Kids have to use saline as the best decongestant

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13
Q

What is an antitussive?

A

Drugs in this class are used for cough supression. Centrally-acting antussives act on the cough center and decrease the sensitivity of cough receptors

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14
Q

Is DM an opiate?

A

Yes, but it does not nearly pack the same punch as codeine.

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15
Q

What are some centrally acting antitussives?

A

DM
codeine
Hydrocodone (DH)
diphenhydramine

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16
Q

What are some locally acting antitussives?

A

Honey
Menthol
Camphor

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17
Q

When should I reccomend an antitussive?

A
  1. congested/productive or congested/non-productive:(leave it alone, but if patient can’t sleep bregrudgingly give decongestant)
  2. dry/non-productive:
    (They have irritating Post-Nasal Drip causing coughing. Go ahead and give cough supressant
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18
Q

How effective are antitussives like DM or codeine at OTC levels?

A

DM and codeine seems to have the same effect as placebo. We still give cough syrups even if they are ineffective.

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19
Q

What is the codeine - CYP 2D6 issue?

A

Metabolization rates for codeine(prodrug) into morphine is variable between people. Its possible that a fast metabolizer may overdose, while slow metabolizers my never see effects. This makes it hard to make a standardized effective dose

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20
Q

What is an important drug interaction involving antitussives?

A

Selective Serotonin Reuptake Inhibitors and antitussives interact and cause serotonin to be released en masse. This can cause unwanted activation of CNS

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21
Q

What are some precautions for antitussives?

A

These drugs could potentially exacerbate the symptoms of respiratory disorders like COPD or asthma.

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22
Q

Can we recommend antitussives to kids under 6?

A

No

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23
Q

How popular are codeine cough syrups in Canada?

A

OTC codeine medicines are per-capita most used in Canada than any other country

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24
Q

Is honey better than DM?

A

Patient-rated surveys say that honey helped them better than DM, but we go for DM regardless because it is centrally-acting. Honey is great for kids under 6.

25
Q

How does menthol or camphor work to help with coughs?

A

Menthol and camphor acts locally by activating cool receptors. It is mostly for TLC

26
Q

How is diphendydramine useful with coughs and colds?

A

Diphendramine has a sedating effect whuich can help with sleep

27
Q

What active ingredients are in Buckleys?

A

It contains menthol and diphendramine. It does not contain either DM or guafenasin

28
Q

What is Guafenasin?

A

Guafenasin helps with loosening things up. Coughing rate may remain the same or higher as the body tries to kick out mucous. It can also cause irritation in the esophagus

29
Q

When to use an expectorant like guafenasin?

A

Congested/productive (expectorants cannot make a productive cough more productive)

Congested/non-productive (this is where expectorants shine, cause shift from non-productive cough to productive)

dry/ non-productive (does not work as mucous is not a concern here ex. smokers cough)

30
Q

Do the guidelines in Canada allow guafenasin to be used at effective doses?

A

No, guafenasin guidelines result in sub-therapeutic doses. Give extra strength to bring dosing as close as possible to efective doses.

We also cannot use any amount of guafenasin to kids under 6

31
Q

What are some other expectorants besides guafenasin?

A

Humidity

Nin Jiom (herbal medication)

32
Q

Is honey as a cough supressant or expectorant effective?

A

No clear evidence, but it is very safe. Can be used for kids under 6

33
Q

How are antihistamines useful in colds?

A

1st gen antihistamines are mainly used for their sedating effect and anti-cholergic effects (drying effect on runny nose, diarrhea)

They are not helping the main symptoms of a cold.

Side effects:
urine retention in older guys due to anticholinergic effects

ex. diphenhydramine and chlorpheniramine

34
Q

How are lozenges important for coughs?

A

Go for taste, mostly for TLC and saliva production

35
Q

Do we need OTC antiseptic products for coughs?

A

Not really, doses aren’t high enough. Don’t fight it and let patient take the antiseptic product

36
Q

Is Zinc useful for coughs?

A

The relationship isn’t clear and the effective dose is also unknown

37
Q

How is echinacea useful for coughs?

A

Minimal benefit, but it is very safe. Don’t recommend this product

38
Q

How is cold-fx useful for coughs?

A

Gingseng is the main active ingredient, but it is not very effective in coughs

Studies that showed the benefits of cold-fx were biased

39
Q

What is homeopathy?

A

Give a dilute agent that causes symptoms of a given illness, and this is supposed to fight the real deal

40
Q

Is Vitamin C effective in colds?

A

Not useful for common cold, but don’t try to convince others

41
Q

Is Vitamin D effective in colds?

A

May help induce immune system, but evidence is not 100%. efective dosing is also unclear

42
Q

Are antibiotics effective for colds?

A

Colds are for the most part viral, so antibiotics have no effect.

43
Q

Are analgesics useful in colds?

A

Although fevers and body chills are not found in colds, acetaminophen and ibuprofen are fine to manage those symptoms

44
Q

Are topical nasal steroids useful in colds?

A

These are quite useful to reduce congestion if patient cannot take conventional decongstants

45
Q

How to give advice for line extensions?

A

Take a look at ingredients and talk about which ingredients you actually need

46
Q

What is the goal of cough and cold medications?

A

Our job is not to cure, but to reduce the number of days with symptoms

47
Q

How do cold medicines effect seniors differently?

A

1st gen histamines are found in a lot of cough/cold medicines, These products can have effects on asthma, urinary retention, and etc.

48
Q

How to pick what class of cough/cold medicine?

A

Aim for most bothersome symptoms:

decongestant (could go topical or oral depending on preference and medical conditions)

antitussive (DM easy to find alone)

expectorants (guafenasin is harder to locate on it own)

combo products (not reccommended)

49
Q

How to counsel older patients on selecting the right product?

A

Ask for typical therapy for cold (go with that if they feel like its a regular cold)
If they want something new, advise them of risks and if cold seems to be in the chest be more likely to refer

50
Q

What should a patient expect after taking a cough/cold medcine?

A

Will they feel better?
2/4 people do

How long will it take to see results?
3-4 days to a week. Colds may take longer to feel better

What side effects can I expect?
decongestants have similar effects as coffee

51
Q

What is wrong with combo cough/cold products?

A

Although they are convenient, they cause overmedication or inappropriate use

Ex. tylenol products always contain acetaminophen, you don’t need this agent for every case. Acetaminophen is going along for the ride in many cases

52
Q

Are combo cough/cold products common?

A

They are the norm, so we have to be careful about reccomending products that have products that are not useful

ex.
DM+expectorant
decongestant + antihistamine
sinus products (decongestant + analgesic)

53
Q

Are extra-strength products useful?

A

Check the exact dosages of ingredients before giving advise

54
Q

What are parents most pressing concerns about their kids having coughs/colds?

A

meningitis
breathing problems
febrile seizures

most of these concerns are unfounded, but if there are red flags then refer to doctor

unfortunately there is no OTC product for cough/cold in kids under 6

55
Q

What can parents do to help with cough/cold for kids under 6

A

Increase use of saline/suction
increase use of honey

stress non-drug options and tell them why a cough might be useful.

we cannot give cough medicines to kids under 6

56
Q

What can we give pregnant women cough/cold medicines?

A

Avoid in first semster, but if they need something be selective about what products are actually needed

topical decongestants seem safer

analgesics also appear safe

DM is safer than codeine

guafenasin is very safe

refer to your resources and make a professional decision

57
Q

What we have to worry about when giving a diabetic a cough/cold medicine?

A

Sick day management is key for Type1 diabetes

On sick days, metabolism goes up due to response to sickness. an oral decongestant could add a twig to the fire, but need to consider due to legal reasons

the following drugs are prefectly safe for diabetes
topical decongestant
antihistamines
antitussives (DM)
expectorant (guafenasin)

58
Q

What do we have to worry about when giving a cough/cold medicine to give a patient with high blood pressure?

A

Oral decongestants can cause vasocontriction. This elevates blood pressure by a few points.

I wouldn’t recommend cough/cold med

59
Q

What do I have to worry about asthma + cough/cold meds?

A

DM might cause mucous to build up in the lungs

1st gen antihistamines can stimiulate anticholinergic effects(dry out the lungs, could make asthma worse)

Inhaler use might have to be adjusted

PHAR 153 (20 decks)

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