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Clinical Pharmacy > Cough and the Common Cold > Flashcards

Cough and the Common Cold Flashcards

1
Q

What is the physiological purpose of a cough?

A
  • helps to clear excessive secretions and foreign material from the airways
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2
Q

What are the 3 main types of coughs and how long do they last?

A
  1. Acute: usually lasts < 3 weeks
  2. Subacute: may last more 3-8 weeks
  3. Chronic: last > 8 weeks
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3
Q

Describe a productive cough

A
  • mucous production (chest) - may feel full or congested
  • may be associated with underlying inflammatory process (infectious) - therefore we don’t want to stop this type
  • secretions may vary- may be clear or purulent
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4
Q

Describe a non-productive cough

A
  • stimulated by a mechanical irritant or other type or irritant (irritation of the vagal nerve)
  • feeling of tightness or wheezing due to congestion of the bronchial airways (no mucous production)
  • often described as a “dry, hacking” cough
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5
Q

What are some of the most common causes of cough?

A
  • common cold
  • acute bacterial sinusitis/pneumonia
  • exacerbation of COPD/asthma
  • allergic rhinitis
  • CHF
  • GERD
  • lung cancer or smokers cough
  • ACE inhibitors
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6
Q

What are the red flags for cough?

A
  • cough of over 3 weeks
  • cough over 7 days that is unresponsive to self treatment
  • cough with thick yellow sputum or green phlegm
  • fever over 40.5 degrees or fever over 72 hours
  • drenching night sweats
  • sever headache/ prolonged nasal congestion
  • blue lips, tongue or face
  • difficulty breathing after exposure to smoke, flames, fumes or an allergen
  • acute confusion
  • cough having blood
  • history of symptoms suggestive of chronic underlying airway disease associated with a cough (COPD, ex)
  • difficulty breathing, chest pain, committing or choking
  • suspected drug induced cough
  • symptoms associated with croup or ear infections
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7
Q

What are the treatment goals when treating a cough?

A
  • reduce the number and severity of cough episodes
  • prevent complications
  • treat underlying cause when possible
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8
Q

What are some of the non-pharms for treating a cough?

A
  • increasing too humidity to soothe irritated airways (humidifier)
  • warm mist humidifier and cool mist humidifier are equally effective– prefer cool mist humidifier
  • vaporizers are humidifiers used with volatile inhalants such as camphor or menthol to produce a medicated vapour
  • throat lozenges to soothe the throat and decrease the cough (glycerol/honey)
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9
Q

What are the 3 medications that are cough suppressants?

A
  • codeine
  • DM
  • antihistamine
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10
Q

What are the 3 topical antitussives?

A
  • camphor
  • menthol
  • eucalyptus
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11
Q

Dextromethorphan is indicated for the suppression of a _____ cough

A

non-productive

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12
Q

Dextromethorphan is a non-opioid analogue of ____. No analgesic, sedative, or respiratory depressant properties

A

codeine

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13
Q

What is the MOA of DM?

A
  • increases the cough threshold by acting centrally in the medulla
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14
Q

What is the adult dose of DM?

A

po 10-20 mg Q4H or 30 mg Q6-8H (max 120 mg/day)

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15
Q

DM may be used in children over ______

A

6 y/o

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16
Q

What is the onset of action of DM?

A

15-30 minutes

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17
Q

What are the most common SE of dextromethorphan?

A
  • generally well tolerated, occasional drowsiness, nausea, vomiting, or stomach discomfort
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18
Q

What are the drug interactions that are most common with DM?

A
  • MAOI/SSRI: risk of serotonin syndrome
  • CYP 2D6 inhibitors: inhibit metabolism of DM leading to increased DM levels
  • polymorphic metabolizers: poor metabolizers will have longer half-lives
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19
Q

Is DM okay to take in pregnancy?

A
  • yes, it is considered are in pregnancy for short term use - avoid preparations containing alcohol
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20
Q

Explain DM abuse

A
  • at large doses, DM and its metabolite (dextrophan) causes dissociative effects
  • adrenergic effects (such as hypertension and diaphoresis) can occur due to dose related inhibition of catecholamine reuptake
  • serotonergic effects can result from agonist effects of serotonin receptors
  • toxicity effects: restlessness, euphoria, hallucinations, visual and auditory disturbances, delayed reaction times, mania, panic, delusions, ataxia, partial and complete dissociation
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21
Q

The efficacy of DM is _____

A

limited

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22
Q

What is the use of codeine for?

A
  • indicated for the suppression of non-productive coughs
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23
Q

What is the MOA of codeine?

A
  • increases cough threshold by acting centrally on the medulla
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24
Q

What is the adult dose of codeine?

A
  • 10-20 mg/dose Q4-6h (max 120 mg/day)
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25
Q

What is the onset of action of codeine?

A

1-2 hours

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26
Q

What are the side effects associated with codeine?

A

sedation, dizziness, nausea, vomiting, constipation

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27
Q

What are the drug interactions associated with codeine?

A

with other CNS depressants

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28
Q

What is the use of codeine in pregnancy and lactation?

A

pregnancy: can use short term
lactation: avoid use in breastfeeding

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29
Q

Codeine has questionable efficacy for treatment of an _____ cough, but has been found t suppress a ____ cough

A

acute

chronic

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30
Q

Codeine products are nationally schedule ___, but there are schedule ___ as well

A

2

1

31
Q

What would you recommend first - DM or codeine? Why?

A

DM- less side effects with a bit more efficacy. Only prescribe codeine if the patient needs to sleep and has not been sleeping because of the cough

32
Q

What is the interaction between codeine and asthma?

A

Asthma: use cautiously - can suppress coughs related to asthma (one of the first signs of an asthma exacerbation is a cough)

33
Q

What is the interaction between codeine and diabetes?

A

want to choose a sugar free, alcohol free option, but other than this it is fine to use

34
Q

What is the interaction between codeine and hypertension/CHF?

A
  • need to caution in CHF, need to rule out the cough is not caused by hearty failure
  • coughs do not just happen on their own (if it was viral in nature, then the person will have has a sore throat and runny nose) - a lack of these symptoms is indicative of the person potentially having heart failure
35
Q

What is the interaction between codeine and immunosuppression?

A
  • caution, need to rule out cough not due to condition
36
Q

What is the interaction between codeine and breastfeeding?

A
  • in general want to avoid
37
Q

What is an expectorant used for and what is the main expectorant used?

A
  • used for productive coughs

- guaifenesin

38
Q

What is the action of guaifenesin?

A
  • reported to reduce sputum viscosity and facilitate mucous removal from the upper RT (does NOT suppress the cough however)
  • considered sade and effective- lack of evidence to truly support efficacy
  • increasing hydration with oral liquids, humidifying air may prove more effective (or just as effective)
  • considered safe in pregnancy
39
Q

What is the dosing of guaifenesin?

A

200-400 mg q4h (max 2.4g/day)

40
Q

What are the SE associated with guaifenesin?

A

SE are rare- typically cause, drowsiness, headache, and rash have been reported at high doses

41
Q

What is the interaction between guaifenesin and asthma/COPD?

A
  • okay to give to people with asthma, but not generally recommended in COPD due to the need to refer if a person with COPD has an excessive amount of congestion
42
Q

What is the interaction between diabetes and guaifenesin?

A
  • an recommend it in diabetes
43
Q

What is the effectiveness of a combination therapy of guaifenesin and DM?

A
  • there is none! The retention of mucous with a productive cough can be counterproductive and can worsen the condition
44
Q

What is a common cold

A
  • an acute, viral and self-limiting infection
  • infection of the mucous membrane of the URT
  • most frequently managed illness
45
Q

What virus most likely causes the common cold?

A
  • rhinovirus
46
Q

Explain the transmission of the common cold?

A
  • spread via small and large particle aerosol
  • incubation period is 1-3 days
  • virus can be transmitted before symptoms occur
47
Q

What different surfaces can cold viruses be transmitted on?

A
  • contaminate skin surface (shake hands with an infected person) or environmental surface
  • aerosols in the air
  • direct hit by large particles (from an infected person)
  • inadvertently deposits the virus into his/her nose, eye, mouth
48
Q

What risk factors put a person at a higher risk of a cold?

A
  • smoking (cilia is damaged)
  • allergic disorders affecting the nose or the pharynx
  • increased population density
  • a sedentary lifestyle
  • chronic (duration 1 month or more) psychological stress
49
Q

Describe the pathogenesis of the common cold

A
  • virus binds to specific receptors on the nasal epithelial cells
  • viral replication, infected cells rupture
  • triggering of the host’s defence mechanism
  • release of inflammatory mediators (PG, LK, kinins)
  • vasodilation and increase vascular permeability in the sinus tissue
  • increase mucous production
  • accumulation of extracellular fluid in the mucous membrane (congestion)
  • cholinergic stimulation
  • nasal sneezing, mucous gland secretion
50
Q

What antihistamine can be used to treat colds?

A
  • 1st generation antihistamines - used for their anticholinergic and drying effects
51
Q

What are the signs prevalent in the early stages of the common cold?

A
  • dry, unproductive cough

- due to irritation of the vagal nerve by inflammatory mediators approx. 2 days

52
Q

What are the signs prevalent in the later stages of the common cold?

A
  • productive cough due to the body clearing mucous from lungs and sinuses (phlegm is clear or whitish in colour, thick/thin consistency)
  • post nasal drip syndrome
53
Q

What are the most prevalent red flags for the common cold?

A
  • fever over 38.5 degrees for more than 72 hours
  • chest pain, difficulty breathing, wheezing, stridor
  • infection signs
  • children under 6 y/o - cannot have cough and cold symptoms in this case
  • children under 1 y/o in general with cold sx
  • other respiratory or underlying conditions (chronic bronchitis/emphysema) or immunocompromised
  • frail patients over 65
  • severe throat pain
  • prolonged nasal congestion with purulent discharge
  • sever headache, neck pain
  • signs of dehydration in an infant
54
Q

What are the non-pharm approaches for treating the common cold?

A
  • increase fluid intake
  • avoid smoking
  • proper hand-washing
  • increase humidification
  • salt water gargle
  • bed rest
  • normal saline or nasal breathing strips (congestion)
  • cover mouth when coughing or sneezing
  • local menthol on the chest
  • hot fluids
55
Q

What are sympathomimetics?

A
  • alpha adrenergic agonist properties causes vasoconstriction of nasal blood vessels - decrease nasal congestion, increase nasal patency and drains nasal secretions
56
Q

What are the drug-drug interactions associated with decongestants?

A
  • MAOI’s, TCA’s, methyldopa, etc
57
Q

Explain first generation antihistamines?

A
  • symptoms of the common cold are not primarily histamine mediated
  • it is thought that the anticholinergic effect of drying the nasal mucosa
  • AH-decongestant combination: useful for patients with congestion, sneezing and runny nose
  • convenient but does not allow for flexibility
  • may be useful in the treatment for post-nasal drip related to the common cold
  • short term use/sedation still is a concern- combining agents does not decrease the side effects of either agent
58
Q

Can decongestants be used in a patient with high blood pressure?

A
  • no, they can not be
59
Q

What is saline nasal drops recommended for?

A
  • recommended to loosen thick nasal mucus
60
Q

What are topical antitussives?

A
  • combination of menthol, camphor, and eucalyptus oil. Perception of improvement in cough and congestion, but evidence is lacking
61
Q

What are local anesthetics used for in colds?

A
  • available for temporary relief of sore throats. May be used every 2-4 hours. Some products contain local antiseptics - not effective in viral infections
62
Q

What is the efficacy of vitamin C?

A
  • no evidence that it can treat or prevent the common cold
63
Q

What is the efficacy of zinc?

A
  • no real effect/unacceptable metallic taste for most patients
64
Q

What is the efficacy of ammonium salts?

A
  • ammonium chloride used as an expectorant (Buckley’s)
65
Q

What is the efficacy of echinacea?

A
  • no conclusive evidence (safety vs efficacy. Proposed to help the immune system fight infection better/faster. Cl- immunocompromised
66
Q

When is the ONLY time that cold fx will work?

A
  • if you take one everyday for 4 months and you happen to get a cold, it will decrease the duration of the cold by up to 6 days. 4 months of treatment will prevent ONLY 1 COLD
67
Q

How does North American Ginseng work?

A
  • insufficient evidence that this works to reduce incidence or severity of the common cold (systematic review)
  • some case reports that this works to reduce the duration by 6 days IF used for daily 4 months
  • any studies ONLY looked at healthy adult individuals
  • avoid if on anticoagulants, pregnant, impaired renal or liver, diabetes, insomnia, cancer and schizophrenia
68
Q

What is the action of honey? What does it help suppress?

A
  • potentially suppresses cough
  • soothing effect
    (SHOULD BE PASTEURIZED-risk of botulism and avoid in children under 1 year old)
69
Q

What is the recommended dosing of honey?

A

0.5 tsp for children 2-5, 1 tsp for children aged 6-11 and 2tsp for children 12-18 and adults

70
Q

What is the general rule of thumb over decongestant use?

A
  • topical agents are generally preferred over oral
  • re. systemic absorption in patients with chronic disease states
  • ex. if a person has severe cardiac disease- then they should not use either oral or topical decongestants
71
Q

In children with cough and cold symptoms likely du to a viral illness, what is the most effective course of treatment?

A
  • increase fluid intake
  • clear nasal passage
  • use a nasal secretion bulb and nasal saline
  • make sure there is adequate humidity
72
Q

Explain how to use a rubber bulb?

A
  • squeeze bulb syringe to expel air
  • insert tip of the bulb 0.25 to 0.5 inches into the baby’s nostril pointing toward the side of the nose
  • release bulb, holding in place to suction the mucous
  • remove syringe and empty contents onto a tissue
  • clean bulb syringe with soap and water (has to be used until the age of 4- children cannot blow their nose themselves)
73
Q

Cough associated with post nasal drip can be treated with what?

A
  • can be treated with a decongestant and antihistamine

1st generation as it is more effective for a runny nose and sneezing due to a cold

74
Q

OTC treatment of colds should not exceed _____ days

A

7 (exception of topical decongestants 3-5 days)

Clinical Pharmacy (24 decks)

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