Coughs Flashcards
T/F: coughs are not important defensive respiratory tract reflex
F
Coughs are the most common…
symptom for pt seeking healthcare
Coughs are often one of the most…
irritating and longest lasting symptom
More than _____ spent annually on OTC cough products
$4 billion
Coughs are a symptom of…
diverse infectious and noninfectious disorders
Coughs are initiated by…
stimulation of chemically and mechanically sensitive, vagally mediated sensory pathways in layngeal, esophageal, and tracheobronchial airway epi
What processes sensory input and stimulate motor efferents for coughs?
complex medullary brainstem network “cough control center”
Pathophysiology of coughs:
- deep inspiration followed by closure of glottis and forceful contraction of chest wall, abdominal wall, nad diaphragmatic muscles
- glottis opens, air is expelled and propels mucus, cellular debris, and foreign material out of respiratory system
Causes of coughs:
- airway inflammation
- excess mucus production
- post nasal drip
Classifications of coughs:
- acute
- subacute
- chronic
Duration of acute coughs:
< 3 weeks
Etiology of acute coughs:
- viral URTI
- pneumonia
- acute left ventricular failure
- asthma
- foreign body aspiration
Duration of subacute coughs:
3-8 weeks
Etiology of subacute coughs:
- post-infectious cough
- bacterial sinusitis
- asthma
Duration of chronic coughs:
> 8 weeks
Etiology of chronic coughs:
- upper airway cough syndrome (UACS)
- asthma
- GERD
- COPD
- ACE inhibitors
Symptoms of productive cough:
- wet/chesty cough
- expels secretions from lower respiratory tract
- secretions are typically clear w/ bronchitis and purulent w/ bacterial infections
Symptoms of nonproductive cough:
- dry/hacking cough
Nonproductive coughs are associated w/…
- viral infections
- bacterial infections
- GERD
- cardiac disease
- meds (ACE inhibitor)
Complications of coughs:
- exhaustion
- insomnia
- musculoskeletal pain
- hoarseness
- sore throat
- excessive perspiration
- urinary incontinence
Exclusions for self-treatment:
- w/ fever
- chest pain
- shortness of breath
- suspected drug associated cough
- children < 4 YO
- lasts > 7 days
- cough that produces thick yellow, tan, or green mucus
Duration of therapy for cough from viral URTIs:
2 weeks
Duration of therapy for post-viral coughs:
> 3 weeks
Duration of therapy for coughs from other respiratory infection:
3-4 weeks
Treatment goals of coughs:
- reduce bothersome symptoms
- prevent transmission to others
- reduce # and severity of episodes
- prevent complications
Non-pharm of cold relief:
- non-medicated lozenges
- humidification
- promotion of nasal drainage (rubber bulb for < 2 YO)
- hydration: helps form less viscous secretions
Pharm therapy of cold relief:
- cough suppressants (antitussive)
- expectorant (protussive)
- combination products
Examples of cough suppressants:
- codeine
- dextromethorphan
- diphenhydramine
- chlophedianol
Example of expectorants:
guaifenesin
MOA of cough suppressants:
- decreases sensitivity of cough receptors
- interrupts cough impulse transmission by depressing the medullary cough center
Cough suppressants treat…
nonproductive coughs
Types of antitussive agents:
- systemic
- topical
Examples of systemic antitussive agents:
- codeine
- dextromethorphan
- chlophedianol
Examples of topical antitussive agents:
- camphor
- menthol
MOA of codeine:
acts centrally on medulla to increase the cough threshold
Indication of codeine:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract irritation
Dosage of codeine:
10-20 mg Q4-6H
Onset of therapy of codeine:
15-30 minutes
Action of codeine occurs…
4-6H
Adverse effects of codeine:
- GI: nausea, vomiting, constipation
- CNS: sedation, dizziness
- respiratory depression w/ overdose
Drug interactions of codeine:
- other CNS depressants (sedatives, alcohol)
- other respiratory depressants (alcohol)
Pts that need to take caution w/ codeine:
- asthma/COPD
- at risk for drug abuse/misuse
Codeine is available with/without prescription
without
Codeine is a schedule ____ drug:
5
T/F: abuse is uncommon w/ codeine
F, also known as “purple drank”/”lean”
Lethal dose of codeine is…
- 5-1g
- causes death from respiratory depression and cardiopulmonary collapse
Codeine OTC sales may contain no more than…
65 mg in 30 mL (10mg/5mL)
MOA of dextromethorphan:
acts centrally in medulla to increase cough threshold (NMDA receptor antagonist)
Indication for dextromethorphan:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract infection
Dosage of dextromethorphan:
- 10-20 mg Q4H
- 30 mg Q6-8H
Onset of dextromethorphan:
15-30 minutes
Peak effect of dextromethorphan:
2-3 H
Adverse effects of dextromethorphan:
- GI: discomfort, nausea, vomiting constipation
- CNS: drowsiness
- respiratory depression w/ overdose
Drug interactions w/ dextromethorphan:
- other CNS depressants (alcohol, antihistamines)
- MAO inhibitors can cause serotonergic symptoms
Examples of serotonergic symptoms:
- hypertension
- fever
- arrhythmias
- seizures
Dextromethorphan abuse has occurred in 1 in ___ american teenagers:
10
- more than cocaine/ecstasy/LDS/meth in this age group
Dextromethorphan abuse occurs more commonly in:
male adolescents
Dextromethorphan abuse occurs b/c:
- cheap and easily obtained
- hard for parents/guardians to detect DXM abuse
Dextromethorphan can cause…
hallucinatory and dissociative effects
Euphoric effects of dextromethorphan are called…
robo-tripping
MOA of diphenhydramine:
- nonselective 1st gen antihistamine
- acts centrally in medulla to increase cough threshold
- significant sedating and anticholinergic properties
Indication of diphenhydramine:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract
Dosage of diphenhydramine:
25 mg Q4H
Onset of diphenhydramine:
30-60 minutes
Peak effect of diphenhydramine:
2H
Adverse effects of diphenhydramine:
- dizziness
- drowsiness
- sedation
- dryness of eyes and mucous membrane
- blurred vision
- constipation
Which topical cough suppressants are the only FDA approved ones?
- menthol
- camphor
MOA of topical cough suppressants:
stimulates sensory nerve endings w/in nose and mucosa, which creates local anesthetic sensation and sense of improved airflow
Indication for topical cough suppressants:
cough
Onset of action for topical cough suppressants:
immediate
Adverse effects of topical cough suppressants:
burning sensation in the mouth
Ingestion of 4 tsp of 5% camphor product has been shown to be…
lethal in children
Administration of ointments:
- rub on throat and chest in thick layer
- repeat up to Q8H
- loosen clothing around throat and chest
- cover w/ warm, dry cloth
Administration of lozenges:
allow lozenge to dissolve slowly in mouth QH
Administration of inhalations:
- place water in vaporizer
- place solution in medication chamber
- breathe in vapors Q8H
MOA of guaifenesin:
loosens and thins lower respiratory tract secretions, making minimally productive coughs more productive
Indication of guaifenesin:
symptomatic relief of productive coughs
- only FDA approved expectorant
Dosage of guaifenesin:
200-400 mg Q4H
Onset of action for guaifenesin:
15-30 minutes
Adverse effects of guaifenesin:
- dizziness
- headache
- rash
- drowsiness
- stomach pain
Cough combination medications:
- antitussive w/ expectorant
- topical products
Examples of antitussive w/ expectorant:
- guaifenesin and codeine
- guaifenesin and dextromethorphan
Examples of topical products:
- camphor
- menthol
T/F: cough combination medications are inconvenient
F
Cough combination medications carry the risk of…
unnecessary drug therapy
According to ACCP 2006 cough guidelines, you should recommend…
- combination of 1st gen antihistamine and decongestant to treat virus induced post-nasal drip and resolve cough
- codeine/DXM for short term symptomatic relief of cough associated post infection
- doesn’t say anything about guaifenesin
Pregnant women should be recommended _____ first
non-Rx products
Pregnant women can take…
codeine/DXM
Breastfeeding women should not take codeine and diphenhydramine b/c…
it’s excreted in breast milk
- can irritate and decrease milk flow
It’s unknown if _____ is secreted in breast milk
DXM
Elderly pt are more susceptible to…
- codeine
- DXM
- diphenhydramine
January 2008 FDA public health advisory states that children < 2 should avoid use of…
OTC cough and cold medications
- potential serious and life threatening adverse effects
