Cough Meds

Question 1

How do you define acute cough? What treatment is required?

Answer 1

Acute cough: < 3wk duration

Generally does not require pharm tx, especially in children

Suppression of cough may be harmful

Eliminate underlying causes and any precipitating factors

Question 2

Tell me about Honey, Honey

Answer 2

Single nocturnal dose to relieve airway irritation and decrease cough

As effective in suppressing cough as dextromethorphan (DM)

Question 3

What’s the origin of DM?

Answer 3

OTC derivative of morphine w/no analgesic or addictive properties at recommended doses

May reduce cough severity

Has NOT been shown to be effective or safe in young children

Question 4

What are DM ADRs?

Answer 4

Normal dose:
- CNS (confusion, excitement, irritability, nervousness)

High dose: NV, HA

Extreme high dose: euphoria and robo tripping

Question 5

Codeine Pk

Answer 5

Codeine –> 2D6 –> Morphine

Effective in suppressive cough

May produce analgesic and antitussive effects

Question 6

Who should you avoid using codeine in?

Answer 6

Do NOT use in pt < 18yo

Concerns of respiratory depression and death in children

Question 7

What is a prescription alternative to opioids for suppression of SEVERE cough?

Answer 7

Benzonatate

• liquid-filled capsule
• C.I. in kids < 10yo

Question 8

Benzonatate ADRs

Answer 8

Risks associated w/benzonatate clearly outweigh its benefits**

• Nausea
• CNS (dizzy, HA, sedation, confusion, hallucination)
• chest numbness

** FDA warning - single capsule can be fatal for young children **

Question 9

What is Guaifenesin MOA?

Answer 9

Increase volume of secretions in respiratory tract –> facilitate removal of viscous mucus by coughing

ER tab C.I. < 12yo
Rec dose = generally considered safe

Question 10

When would you use antihistamines for cough?

Answer 10

PND

Reduce cough by reducing postnasal drip

ADRs: classic anticholinergic effects

Question 11

When would you use decongestants for cough?

Answer 11

PND

May help reduce coughing by reducing PND

Not rec for children < 4yo

C.I. w/in 14d of MAOI

Question 12

What is the main OTC decongestant?

Answer 12

Phenylephrine

Pseudoephedrine (METH HEAD) products are more difficult to obtain

Question 13

Decongestants ADRs

Answer 13

(Act as sympathomimetics)

1. increase HR/BP
2. transient CNS effects (excitability, insomnia, HA, nervousness, confusion, dizziness)
3. dry nose/throat, rebound nasal congestion

Question 14

When would you use SABAs or SAMAs to treat cough?

Answer 14

If the cough has a bronchospastic component

Question 15

When would you use corticosteroids for a cough?

Answer 15

Inhaled & PO corticosteroids have been used for tx of cough in pt w/out asthma

Question 16

Cough General Recommendations

Answer 16

NONpharm

1. Saline nasal sprays & fluids
2. Mist inhaler (e.g. humidifier)
3. Sialagogues
4. Honey (up to 2tbs) qhs (if > 12mo)
5. Menthol or camphor rubs are okay for adults (Vicks VapoRub)

Question 17

Adults: Cough Secondary to Common Cold/PND

Answer 17

Step 1. Antihistamine-decongestant combos

• combo w/1st gen antihistamine have more drying effects
• pseudoephedrine > phenylephrine

Step 2. Naproxen** (reduce inflammation)

Step 3. Inhaled ipratropium - cough persisting 3-8wk)

Step 4. ICS, if ipratropium does not work

Step 5. DM or codeine NOT rec for acute cold cough

Question 18

Kids: Cough Secondary to Common Cold/PND (stepwise)

Answer 18

Step 1. Saline nasal spray/fluid to relieve nasal congestion/dryness

Step 2. Topical antitussives (Vicks, VapoRub) - inhaling camphor/menthol/eucalyptus helps w/cough and congestion
- local anesthetic sensation and improved airflow

Step 3. Honey can relieve cough by increasing saliva –> coats larynx and relieves irritation
- NO Honey in < 1yo (botulism)

Do NOT rec Codeine or DM containing products

Question 19

Adults: Acute bronchitis & Cough

Answer 19

Acute bronchitis - cough lasts up to 3wk, only sometimes productive

• DON’T routinely prescribe Abx
• Short-term Codeine or DM MIGHT help
• Save bronchodilator for pt who wheezes

Question 20

Adults: Chronic bronchitis & Cough

Answer 20

Chronic bronchitis: productive cough occurring most days for 3 or more months/yr for at least 2 years

• eliminate irritants
• treat per COPD

Question 21

Describe when you would use guaifenesin with bronchitis?

Answer 21

Don’t give expectorants (guaifenesin)

Not enough evidence they are effective

Question 22

Who should you avoid cough & cold meds in?

Answer 22

These meds withdrawn d/t concerns about efficacy and safety (e.g. seizures, OD)

NOT recommended in kids < 4yo

Question 23

How can you use saline nasal sprays/fluids in children?

Answer 23

Infants: saline drops to loosen mucus, then suction w/bulb syringe

Humidifiers/vaporizers add moisture to air to help ease cough/congestion

Question 24

What is the warning regarding topical antitussives (Vicks VapoRub)?

Answer 24

Do NOT use topicals w/camphor for children <2y d/t absorption concerns and LIVER damage