Cough Meds Flashcards
How do you define acute cough? What treatment is required?
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
Tell me about Honey, Honey
Single nocturnal dose to relieve airway irritation and decrease cough
As effective in suppressing cough as dextromethorphan (DM)
What’s the origin of DM?
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
What are DM ADRs?
Normal dose:
- CNS (confusion, excitement, irritability, nervousness)
High dose: NV, HA
Extreme high dose: euphoria and robo tripping
Codeine Pk
Codeine –> 2D6 –> Morphine
Effective in suppressive cough
May produce analgesic and antitussive effects
Who should you avoid using codeine in?
Do NOT use in pt < 18yo
Concerns of respiratory depression and death in children
What is a prescription alternative to opioids for suppression of SEVERE cough?
Benzonatate
- liquid-filled capsule
- C.I. in kids < 10yo
Benzonatate ADRs
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 **
What is Guaifenesin MOA?
Increase volume of secretions in respiratory tract –> facilitate removal of viscous mucus by coughing
ER tab C.I. < 12yo
Rec dose = generally considered safe
When would you use antihistamines for cough?
PND
Reduce cough by reducing postnasal drip
ADRs: classic anticholinergic effects
When would you use decongestants for cough?
PND
May help reduce coughing by reducing PND
Not rec for children < 4yo
C.I. w/in 14d of MAOI
What is the main OTC decongestant?
Phenylephrine
Pseudoephedrine (METH HEAD) products are more difficult to obtain
Decongestants ADRs
(Act as sympathomimetics)
- increase HR/BP
- transient CNS effects (excitability, insomnia, HA, nervousness, confusion, dizziness)
- dry nose/throat, rebound nasal congestion
When would you use SABAs or SAMAs to treat cough?
If the cough has a bronchospastic component
When would you use corticosteroids for a cough?
Inhaled & PO corticosteroids have been used for tx of cough in pt w/out asthma
Cough General Recommendations
NONpharm
- Saline nasal sprays & fluids
- Mist inhaler (e.g. humidifier)
- Sialagogues
- Honey (up to 2tbs) qhs (if > 12mo)
- Menthol or camphor rubs are okay for adults (Vicks VapoRub)
Adults: Cough Secondary to Common Cold/PND
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
Kids: Cough Secondary to Common Cold/PND (stepwise)
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
Adults: Acute bronchitis & Cough
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
Adults: Chronic bronchitis & Cough
Chronic bronchitis: productive cough occurring most days for 3 or more months/yr for at least 2 years
- eliminate irritants
- treat per COPD
Describe when you would use guaifenesin with bronchitis?
Don’t give expectorants (guaifenesin)
Not enough evidence they are effective
Who should you avoid cough & cold meds in?
These meds withdrawn d/t concerns about efficacy and safety (e.g. seizures, OD)
NOT recommended in kids < 4yo
How can you use saline nasal sprays/fluids in children?
Infants: saline drops to loosen mucus, then suction w/bulb syringe
Humidifiers/vaporizers add moisture to air to help ease cough/congestion
What is the warning regarding topical antitussives (Vicks VapoRub)?
Do NOT use topicals w/camphor for children <2y d/t absorption concerns and LIVER damage
