Cough/D,T,P pharm Flashcards
What is the difference between DTaP and Tdap
DTap - children
Tdap - adults
What is the pediatric DTaP schedule?
3 shots with 2 boosters:
-2 mos
-4 mos
-6 mos
-15-18 mos
-4-6 years
What additional vaccine should preteen get after DTaP childhood series?
Tdap 1 booster between ages 11 and 12
What is the recommendation for Tdap during pregnancy?
Get Tdap in early part of 3rd semester to protect newborn in first few months of life
What are the Tdap guidelines for adults?
If never received - 1 shot of Tdap at any time regardless of last Td
Every 10 years after by either Td or Tdap
What should risk vs benefit be weighed for Tdap?
- mod-severe acute illness with or without fever
- GBS within 6 weeks after a previous dose of tetanus or diphtheria toxoid containing vaccine
- Hx of arthus type hypersensitivity - wait at least 10 years
When should the Acellular Pertussis vaccines NOT be administered?
encephalopathy within 7 days of previous dose of DTP DTaP or Tdap
What are the options for cough suppressants?
- Menthol/Eucalyptus lozenges
- Topical aromatics
- Centrally acting antitussive agents
- Non-opioid agents
- Peripherally acting antitussive agents
- Opioid agents
- Ribavirin
What is the MOA of Menthol/Eucalyptus lozenges
- Not a decongestant, put sensation of improved nasal airflow
- Some antitussive activity
-airway sensor receptors
-smooth muscle - some sore throat relief
-local anesthetic effects
ADE of menthol/Eucalyptus lozenges?
hypersensitivity reactions
contact dermatitis
acute respiratory distress
nausea
abdominal pain
What are examples of topical aromatics?
menthol
camphor
eucalyptus oil
What is the MOA of topical aromatics?
May act of TRPM8 cation channel to produce a cooling sensation
What are the benefits of topical aromatics?
subjective improvement in nasal patency
Parenteral reports of symptomatic improvement of nocturnal cough and sleep
What are the ADEs of topical aromatics?
GI and CNS effects may result from accidental ingestion
What are the options for centrally acting antitussive agents?
Opioids - codeine, morphine
nonopioid - dextromethorphan
What is the MOA of CAAAs?
suppress cough via action of the central cough center
What is the approach to CAAAs?
non-opioid first then opioid
1st - dextromethorphan
then codeine or long acting morphine
What are the non-opioid agents for cough?
Peripheral - benzonatate, guaifenesin
central - dextromethorphan
+ diphenhydramine
What is the labeled indication for dextromethorphan
cough suppressant - temporary control of cough due to minor throat and bronchial irritation associated with the common cold or inhaled irritants
Temporary relief of cough impulse to improve sleep (extended release)
Dextromethorphan MOA, efficacy, formulations, and onset of action?
MOA: cough center in brainstem
efficacy: no concrete evidence
Formulations:
-oral syrup
-long acting liquid
-oral capsule
-extended release suspension
Onset: 15-30 minutes
Dextromethorphan ADE, Pt ed?
ADE:
CNS effects
Serotonin syndrome (avoid other serotonin containing meds)
Hallucinations
Respiratory distress (OD)
GI effects
Pt ed:
Shake well
only use dosing cup included NOT household teaspoon
notify provider if no improvement in 7 days of use
Can dextromethorphan be used in pregnancy/breast feeding?
pregnancy - acceptable
breast feeding - use caution, ensure no alcohol
What are some pediatric considerations with dextromethorphan?
Do not use in children with respiratory distress - hallucinations/death
be extra careful with products with multiple active ingredients - OD potential
Adolescents/teenagers - increased reports of abuse
What meds are likely to be in combination products?
analgesics
decongestants
expectorants
antihistamines
cough suppressants
Benzonatate MOA, route, indication
Peripherally acting antitussive agent acts by anesthetizing stretch receptors in the lungs and pleura
Oral capsule that must be swallowed whole
Indicated if dextromethorphan is not helpful
Benzonatate ADE, Onset, and duration?
Hypersensitivity
Sedation
Dizziness
Headache
15-20 minute onset
3-8 hours duration
Guaifenesin MOA, ADE, and pediatric use?
Expectorant that increases mucus production to make secretions easier to remove with cough or mucociliary transport
Mild GI irritation
Not recommended for patients <2 years old; caution used in ped patients 2+
What are the formulations for Guaifenesin?
Liquid
Granules
Immediate release tab
Extended release tab
Diphenhydramine MOA, efficacy, ADEs?
Anticholinergic effects to decrease mucous secretion
No clinically significant benefit for cough
ADE:
Sedation
Paradoxical excitability
Dizziness
Respiratory depression
Hallucinations
Tachycardia
Dry mouth
Urinary retention
What opioids can be used for cough?
Codeine and hydrocodone
Opioid MOA, efficacy, ADE and warning
Act on the cough center in the brainstem
No more effective than placebos
ADE:
Respiratory depression
Sedation
N/V/C
Dizziness
Palpitations
***Abuse potential
Codeine cough use
Off label for cough
7.5-120mg/day as single or divided dose
Vitamin C (Ascorbic acid) use and evidence in cough?
OTC remedy for common cold
8% reduction in duration of cold symptoms
Does not effect symptoms if taken after symptom onset
50% decrease in incidence of colds in a subset exposed to vigorous activity
What are the characteristics of severe bronchiolitis that often indicates hospitalization?
Persistent increased respiratory effort:
-tachypnea
-nasal flaring
-Retractions
-Accessory muscle use
-Grunting
Hypoxemia (<95%)
Apnea
Acute respiratory failure
Toxic appearing
Poor feeding
lethargy
dehydration
How should non-severe bronchiolitis be managed?
outpatient with supportive care:
-hydration
-monitor for disease progression
-relief of nasal congestion/obstruction
*pharmacologic interventions NOT recommended!
Monitor disease - should last 2-3 weeks
How should severe bronchiolitis be managed?
Supportive care
Fluid management
Respiratory support:
-Supplemental O2 to maintain SpO2>90-92%
What should be used for infants with severe bronchiolitis with risk for respiratory failure?
Heated humidified high-flow nasal cannula therapy
CPAP
Endotracheal intubation for children with hemodynamic instability, intractable apnea, or loss of protective airway reflexes
Nasal suctioning
Saline nasal drops
What is Ribavirin used for and when?
FDA approved for RSV treatment
Only drug effective against acute RSV bronchiolitis
Indications: documented RSV infection in an immunocompromised patient
How is ribavirin given and cautions?
Nebulized or oral
CI in pregnancy
Caution - associated with bronchoconstriction - use caution in asthma/COPD patients
Ribavirin MOA
Inhibits replication of RNA and DNA viruses, viral RNA polymerase activity and initiation and elongation of RNA fragments resulting in inhibition of viral protein synthesis
What is a small particle aerosol generator and what does it do?
Pneumatically powered nebulizer SPECIFIC for ribavirin
Helps create small particles of ribavirin to allow the patient to inhale
Ribavirin ADE?
Hemolytic anemia
Leukopenia
Cough
Dyspnea
Bronchospasm
Declined PFTs
Rash
Conjunctival irritation
Pregnancy precautions with ribavirin?
AVOID in pregnancy
Pregnant women should not enter a room if patient is receiving Ribavirin via nebulization
What populations should be RSV vaccination?
Everyone 75+
60-74 with increased risk of severe RSV
32-36 weeks gestation
antibody - Infants whose mother did not get vaccine and 8-19 months with increased risk for severe RSV
