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OTC > Coughs > Flashcards

Coughs Flashcards

1
Q

T/F: coughs are not important defensive respiratory tract reflex

A

F

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2
Q

Coughs are the most common…

A

symptom for pt seeking healthcare

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3
Q

Coughs are often one of the most…

A

irritating and longest lasting symptom

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4
Q

More than _____ spent annually on OTC cough products

A

$4 billion

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5
Q

Coughs are a symptom of…

A

diverse infectious and noninfectious disorders

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6
Q

Coughs are initiated by…

A

stimulation of chemically and mechanically sensitive, vagally mediated sensory pathways in layngeal, esophageal, and tracheobronchial airway epi

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7
Q

What processes sensory input and stimulate motor efferents for coughs?

A

complex medullary brainstem network “cough control center”

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8
Q

Pathophysiology of coughs:

A
  1. deep inspiration followed by closure of glottis and forceful contraction of chest wall, abdominal wall, nad diaphragmatic muscles
  2. glottis opens, air is expelled and propels mucus, cellular debris, and foreign material out of respiratory system
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9
Q

Causes of coughs:

A
  • airway inflammation
  • excess mucus production
  • post nasal drip
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10
Q

Classifications of coughs:

A
  • acute
  • subacute
  • chronic
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11
Q

Duration of acute coughs:

A

< 3 weeks

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12
Q

Etiology of acute coughs:

A
  • viral URTI
  • pneumonia
  • acute left ventricular failure
  • asthma
  • foreign body aspiration
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13
Q

Duration of subacute coughs:

A

3-8 weeks

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14
Q

Etiology of subacute coughs:

A
  • post-infectious cough
  • bacterial sinusitis
  • asthma
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15
Q

Duration of chronic coughs:

A

> 8 weeks

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16
Q

Etiology of chronic coughs:

A
  • upper airway cough syndrome (UACS)
  • asthma
  • GERD
  • COPD
  • ACE inhibitors
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17
Q

Symptoms of productive cough:

A
  • wet/chesty cough
  • expels secretions from lower respiratory tract
  • secretions are typically clear w/ bronchitis and purulent w/ bacterial infections
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18
Q

Symptoms of nonproductive cough:

A
  • dry/hacking cough
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19
Q

Nonproductive coughs are associated w/…

A
  • viral infections
  • bacterial infections
  • GERD
  • cardiac disease
  • meds (ACE inhibitor)
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20
Q

Complications of coughs:

A
  • exhaustion
  • insomnia
  • musculoskeletal pain
  • hoarseness
  • sore throat
  • excessive perspiration
  • urinary incontinence
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21
Q

Exclusions for self-treatment:

A
  • 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
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22
Q

Duration of therapy for cough from viral URTIs:

A

2 weeks

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23
Q

Duration of therapy for post-viral coughs:

A

> 3 weeks

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24
Q

Duration of therapy for coughs from other respiratory infection:

A

3-4 weeks

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25
Q

Treatment goals of coughs:

A
  • reduce bothersome symptoms
  • prevent transmission to others
  • reduce # and severity of episodes
  • prevent complications
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26
Q

Non-pharm of cold relief:

A
  • non-medicated lozenges
  • humidification
  • promotion of nasal drainage (rubber bulb for < 2 YO)
  • hydration: helps form less viscous secretions
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27
Q

Pharm therapy of cold relief:

A
  • cough suppressants (antitussive)
  • expectorant (protussive)
  • combination products
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28
Q

Examples of cough suppressants:

A
  • codeine
  • dextromethorphan
  • diphenhydramine
  • chlophedianol
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29
Q

Example of expectorants:

A

guaifenesin

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30
Q

MOA of cough suppressants:

A
  • decreases sensitivity of cough receptors

- interrupts cough impulse transmission by depressing the medullary cough center

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31
Q

Cough suppressants treat…

A

nonproductive coughs

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32
Q

Types of antitussive agents:

A
  • systemic

- topical

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33
Q

Examples of systemic antitussive agents:

A
  • codeine
  • dextromethorphan
  • chlophedianol
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34
Q

Examples of topical antitussive agents:

A
  • camphor

- menthol

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35
Q

MOA of codeine:

A

acts centrally on medulla to increase the cough threshold

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36
Q

Indication of codeine:

A

suppression of nonproductive cough caused by chemical/mechanical respiratory tract irritation

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37
Q

Dosage of codeine:

A

10-20 mg Q4-6H

38
Q

Onset of therapy of codeine:

A

15-30 minutes

39
Q

Action of codeine occurs…

A

4-6H

40
Q

Adverse effects of codeine:

A
  • GI: nausea, vomiting, constipation
  • CNS: sedation, dizziness
  • respiratory depression w/ overdose
41
Q

Drug interactions of codeine:

A
  • other CNS depressants (sedatives, alcohol)

- other respiratory depressants (alcohol)

42
Q

Pts that need to take caution w/ codeine:

A
  • asthma/COPD

- at risk for drug abuse/misuse

43
Q

Codeine is available with/without prescription

A

without

44
Q

Codeine is a schedule ____ drug:

A

5

45
Q

T/F: abuse is uncommon w/ codeine

A

F, also known as “purple drank”/”lean”

46
Q

Lethal dose of codeine is…

A
  1. 5-1g

- causes death from respiratory depression and cardiopulmonary collapse

47
Q

Codeine OTC sales may contain no more than…

A

65 mg in 30 mL (10mg/5mL)

48
Q

MOA of dextromethorphan:

A

acts centrally in medulla to increase cough threshold (NMDA receptor antagonist)

49
Q

Indication for dextromethorphan:

A

suppression of nonproductive cough caused by chemical/mechanical respiratory tract infection

50
Q

Dosage of dextromethorphan:

A
  • 10-20 mg Q4H

- 30 mg Q6-8H

51
Q

Onset of dextromethorphan:

A

15-30 minutes

52
Q

Peak effect of dextromethorphan:

A

2-3 H

53
Q

Adverse effects of dextromethorphan:

A
  • GI: discomfort, nausea, vomiting constipation
  • CNS: drowsiness
  • respiratory depression w/ overdose
54
Q

Drug interactions w/ dextromethorphan:

A
  • other CNS depressants (alcohol, antihistamines)

- MAO inhibitors can cause serotonergic symptoms

55
Q

Examples of serotonergic symptoms:

A
  • hypertension
  • fever
  • arrhythmias
  • seizures
56
Q

Dextromethorphan abuse has occurred in 1 in ___ american teenagers:

A

10

- more than cocaine/ecstasy/LDS/meth in this age group

57
Q

Dextromethorphan abuse occurs more commonly in:

A

male adolescents

58
Q

Dextromethorphan abuse occurs b/c:

A
  • cheap and easily obtained

- hard for parents/guardians to detect DXM abuse

59
Q

Dextromethorphan can cause…

A

hallucinatory and dissociative effects

60
Q

Euphoric effects of dextromethorphan are called…

A

robo-tripping

61
Q

MOA of diphenhydramine:

A
  • nonselective 1st gen antihistamine
  • acts centrally in medulla to increase cough threshold
  • significant sedating and anticholinergic properties
62
Q

Indication of diphenhydramine:

A

suppression of nonproductive cough caused by chemical/mechanical respiratory tract

63
Q

Dosage of diphenhydramine:

A

25 mg Q4H

64
Q

Onset of diphenhydramine:

A

30-60 minutes

65
Q

Peak effect of diphenhydramine:

A

2H

66
Q

Adverse effects of diphenhydramine:

A
  • dizziness
  • drowsiness
  • sedation
  • dryness of eyes and mucous membrane
  • blurred vision
  • constipation
67
Q

Which topical cough suppressants are the only FDA approved ones?

A
  • menthol

- camphor

68
Q

MOA of topical cough suppressants:

A

stimulates sensory nerve endings w/in nose and mucosa, which creates local anesthetic sensation and sense of improved airflow

69
Q

Indication for topical cough suppressants:

A

cough

70
Q

Onset of action for topical cough suppressants:

A

immediate

71
Q

Adverse effects of topical cough suppressants:

A

burning sensation in the mouth

72
Q

Ingestion of 4 tsp of 5% camphor product has been shown to be…

A

lethal in children

73
Q

Administration of ointments:

A
  • rub on throat and chest in thick layer
  • repeat up to Q8H
  • loosen clothing around throat and chest
  • cover w/ warm, dry cloth
74
Q

Administration of lozenges:

A

allow lozenge to dissolve slowly in mouth QH

75
Q

Administration of inhalations:

A
  • place water in vaporizer
  • place solution in medication chamber
  • breathe in vapors Q8H
76
Q

MOA of guaifenesin:

A

loosens and thins lower respiratory tract secretions, making minimally productive coughs more productive

77
Q

Indication of guaifenesin:

A

symptomatic relief of productive coughs

- only FDA approved expectorant

78
Q

Dosage of guaifenesin:

A

200-400 mg Q4H

79
Q

Onset of action for guaifenesin:

A

15-30 minutes

80
Q

Adverse effects of guaifenesin:

A
  • dizziness
  • headache
  • rash
  • drowsiness
  • stomach pain
81
Q

Cough combination medications:

A
  • antitussive w/ expectorant

- topical products

82
Q

Examples of antitussive w/ expectorant:

A
  • guaifenesin and codeine

- guaifenesin and dextromethorphan

83
Q

Examples of topical products:

A
  • camphor

- menthol

84
Q

T/F: cough combination medications are inconvenient

A

F

85
Q

Cough combination medications carry the risk of…

A

unnecessary drug therapy

86
Q

According to ACCP 2006 cough guidelines, you should recommend…

A
  • 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
87
Q

Pregnant women should be recommended _____ first

A

non-Rx products

88
Q

Pregnant women can take…

A

codeine/DXM

89
Q

Breastfeeding women should not take codeine and diphenhydramine b/c…

A

it’s excreted in breast milk

- can irritate and decrease milk flow

90
Q

It’s unknown if _____ is secreted in breast milk

A

DXM

91
Q

Elderly pt are more susceptible to…

A
  • codeine
  • DXM
  • diphenhydramine
92
Q

January 2008 FDA public health advisory states that children < 2 should avoid use of…

A

OTC cough and cold medications

- potential serious and life threatening adverse effects

OTC (23 decks)

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