Cough, Cold, Allergy Flashcards
What would you prescribe for cough?
Antitussives or expectorants
Antitussives MOA
block cough production via CNS, PNS, or both
Contraindications for antitussives
concurrent MAOI use
Types of Antitussives
OTC and opiates
Antitussives - Central Agents Examples
codeine, dextromethorphan (DM), hydrocodone
Antitussives - Central Agents MOA
block cough center in the medulla by elevating threshold for cough
Antitussives - Central Agents S/E
- opiates: sedation, constipation
2. DM: drowsiness, nausea, dizziness, high doses can cause HTN, respiratory depression, tachycardia
Antitussives - Peripheral Agents Examples
Camphor, eucalyptus, menthol (Vicks), benzonatate (tessalon perles)
Antitussives - Peripheral Agents MOA
anesthetize local peripheral nerve endings, soothe (demulcents)
Expectorants MOA
increase amount of fluid in respiratory tract, loosen mucus, clear irritants
Expectorants Contraindications
none
Expectorants Examples
Guiafenesin/Robitussin
Expectorants S/E
well tolerated
may have N/V, drowsiness at high doses
What can you give for colds?
Decongestants, others?
Decongestants MOA
pre-capillary blood vessel constriction
Decongestants Contraindications
concurrent MAOI use
–> HTN crisis
Decongestants S/E
- rebound nasal congestion = rhinitis medicamentosa
2. CNS stimulation - agitation, anxiety, insomnia, increase BP, urinary retention, dry mouth, sweating
Examples of Decongestants
- Direct agonists: phenylephrine/Sudafed PE, Dimetapp
2. Indirect Agonists: pseudoephedrine/sudafed
What can you give for allergies?
H1 antagonists, mast cell stabilizers, leukotriene receptor antagonists, intranasal steroids
Indications of H1 Antagonists
urticaria, allergic rhinitis, nasal sx from common cold, first generation for nausea
H1 Antagonists MOA
block histamine-mediated allergic response cascade, 1st gen have anti-cholinergic capabilities
H1 Antagonists Contraindications
none but do not use for acute anaphylactic reaction
H1 Antagonists S/E
Drowsy (can be given as off label insomnia medication), 2nd gen not as sedating
H1 Antagonists First Generation Examples
Benedryl, Atarax, Chlortrimeton, Periactin
H1 Antagonists Second Generation Examples
Loratidine/Claritin, Cetirizine/Zyrtec, Fexofenadine/Allegra
Mast Cell Stabilizers MOA
prevent degranulation of mast cells; inhibit release of proinflammatory factors
Mast Cell Stabilizers Contraindications
none
Route of administation
topical
Mast Cell Stabilizers indication
conditions w/ allergy component - asthma, rhinitis, conjunctivitis
systemic mastocytosis
What are Mast Cell Stabilizers not used for?
acute therapy, acute anaphylactic reaction
Mast Cell Stabilizers Examples
Cromolyn sodium (Nasal crom)
Mast Cell Stabilizers S/E
generally well tolerated, cough from throat irritation, nasal irritation
Indications for leukotriene receptor antagonists
allergic rhinitis, prevention of persistent asthma (not first line), exercise-induced bronchospasm
LTRAs MOA
prevent release of leukotrienes, prevent bronchoconstriction, reduce inflammation
LTRAs Contraindications
liver disease of any kind, not for acute asthma, only preventatively
Examples of LTRAs
Montelukast (Singulair)
Indications of intranasal steroids
allergic rhinitis, nasal congestion/sneezing/itching/rhinorrhea
intranasal steroids MOA
inhibit pro-inflammatory cells, including basophils, mast cells, eosinophils, lymphocytes, macrophages
Contraindications for intranasal steroids
hypersensitivity to any part of the medication
Examples of intranasal steroids
Fluticasone/Flonase
Mometasone/Nasonex
When is a good time to give intranasal steroids?
if patient cannot take decongestant because BP/HR side effects
S/E of intranasal steroids
nosebleeds
What should you definitely include in your patient education about intranasal steroids?
They will require continuous dosing to see response, slower response than antihistamines
What could you prescribe a 2 year old with allergic rhinitis/nasal congestion?
Mometasone
