Exam 3 Flashcards
(ND) mosquitoes s/s
Welt and itching, large blisters
(ND) fleas s/s
Erythematous, intense itching
(ND) scabies s/s
Papular rash and intense itching, contagious
(ND) bedbugs s/s
Intense itching and irritation
(ND) chiggers s/s
Red papules, intense itching
(ND) ticks s/s, remove with ___
- Intense itching, can transmit Rocky mtn spotted fever & Lyme disease
- Remove with fine tweezers
(ND) insect bite: nonpharmacological treatment
- DEET insect repellent (X kill)
- Apply after sunscreen
- Do not use in children <2 mo
(ND) DEET formulation % and its uses
- <30%: children
- 10-35%: adults in routine situations
- > 20%: prevent tick bites
- > 50%: no benefit
(ND) insect bite: pharmacological treatment options
Local anesthetics, topical antihistamines, counterirritants, hydrocortisone, skin protectants
(ND) insect bite: local anesthetics agents
- Pramoxine, benzyl alcohol: less AEs
- Dibucaine: allergen, toxic
- Phenol: avoid in preg & children
(ND) insect bite: topical antihistamine agent
Diphenhydramine
(ND) insect bite: counterirritant agents
- Camphor: avoid in children
- Menthol: safe and effective antipruritic
(ND) insect bite: skin protectants agents
- Zinc oxide, calamine
- Good for adults, children, infants (best)
(ND) insect bite: selfcare exclusions
- Hypersensitivity to insect bites
- <2 yrs
- Hx of tick bites and systemic effects
- Signs of secondary infections
- Suspected spider bite requiring medical attention
(ND) insects that sting
Wild honeybees, wasps, hornets, yellow jackets
(Bumblebees do not sting)
(ND) insect stings nonpharmacologic treatment
Remove stinger by scraping, ice, hydrogen peroxide or alcohol
(ND) insect stings pharmacologic treatment
- Local anesthetics, topical antihistatmines, counterirritants, hydrocortisone, skin protectants
- Oral diphenhydramine 25-50 mg
(ND) insect stings selfcare exclusions
- Hypersensitivity to insect bites
- <2 yrs
- Significant allergic response away from sting site
- Personal or FH of significant allergic rxn
- Hives, excessive swelling, dizziness, weakness, N, difficulty breathing
- Previous sting by honeybee, wasp, or hornet
(ND) pediculosis three types
- Head lice
- Body lice: “cooties”, transmit infections
- Pubic lice: “crabs”, through high-risk sexual contact
(ND) pediculosis nonpharmacologic treatment
- Visual inspection of hair
- FDA approved nit comb
- AirAlle applies heat to hair and scalp to dehydrate and kill lice
- Clothing and bedding washed in hot water
- Vacuum carpets and rugs
(ND) pediculosis pharmacological treatment (2)
- Pyrethrins: for head & pubic lice, do not use in <2 yrs, apply for 10 mins –> rinse/shampoo –> lice comb –> repeat in 7-10 days
- Permethrin: for head lice only, do not use in <2 mo, re-treatment not required
(ND) pediculosis selfcare exclusions
- <2 mo for permethrins, <2 yrs for pyrethrins
- Active tumors
- Secondary skin infection in lice-infested area
- Life infestation of eyelids or eyebrows
- Regional resistance to pediculicides
- Hypersensitivity to chrysanthermums, ragweed, or pediculicide ingredients
- Pregnancy or breastfeeding
(ND) sunburn s/s
- Acute reaction to excessive UVR exposure: inflammation
- Erythema, swelling, pain
- Max response at 6-24 hrs
- Resolves in 72 hrs
(ND) sunburn prevention 5 S’s
- Slip on protective clothing
- Slop on SPF 30+
- Slap on a hat
- Seek shade
- Slide on sunglasses
(ND) sunscreen SPF formulations
- 2-14: help prevent sunburn, must carry skin cancer/aging alert
- > 15: decreased risk of skin cancer and early skin aging, will be required to meet min UVA/B protection
- > 60: benefit up to 60, 60-80 must go through NDA
(ND) sunscreen age exclusion
<6 mo
(ND) sunscreen application
- 15-30 mins before UV exposure
- Reapply Q2H
- Apply 22.5 mL or 4.5 teaspoons (~2 fingers) total in each application
(ND) sunburn counseling points
- Apply sunscreen 15 mins before exposure
- Avoid sun exposure & other UVR sources
- Sun rays are the most direct & damaging from 10 am - 4 pm
- Sunburn on cloudy or overcast day: 0-90% of UVR penetrates clouds
- SPF 15 provides the greatest protection, wear protective clothing
- Check expiration date
(ND) types of burns
- Thermal
- Electrical, chemical –> refer to emergency department
(ND) types of wounds
- Abrasions: rubbing/friction on the epidermal layer of skin
- Lacerations: cuts/punctures from sharp edged objects piercing through skin layers
- Rule of Nine Method: estimate BSA into multiples of 9%
(ND) burns nonpharmacologic treatment
Continuous cooling
- Running water
(ND) wounds nonpharmacologic treatment
Wound cleansing
- Clean tap water
- Do not pull loose or burned skin (small blisters <6 mm)
- Large blisters may rupture on their own: wash with soap and water, apply moist wound dressing
(ND) burns and wounds pharmacologic treatment: topical anesthetics
- Temporary relief of pain, rapid onset
- Benzocaine, lidocaine, pramoxine
(ND) burns and wounds pharmacologic treatment: systemic analgesics
- Short term for minor skin injury
- ASA, naproxen, ibuprofen, APAP
(ND) burns and wounds pharmacologic treatment: skin protectants
- Emollients, moisturizers
- Protect from irritation, promote moist healing, prevent scarring
- Petrolatum, dimethicone, zinc oxide, glycerin, cocoa butter
(ND) burns and wounds pharmacologic treatment: first aid antiseptics
- Antibiotic activity
- Chlorhexidine, hydrogen peroxide, povidone-iodine solution
(ND) burns and wounds pharmacologic treatment: first line antibiotics
- Prevention, not treatment
- Bacitracin, neomycin, polymixin B
(ND) minor burns self care exclusion
- Suspected non-accidental injury
- Chemical, electrical, or inhalation burns
- Skin injury that worsens/ does not heal in 7 days
- Deep partial or full thickness, or subdermal injury
- Signs of infection
- Circumferential burns
- Pre-existing conditions that could prolong recovery/ mortality
- Injuries larger than 3 in in diameter
- Site of injury: face, hands, feet, major joints, genitals
(ND) wounds selfcare exclusion
- Suspected non-accidental injury
- Injuries larger than 3 in in diameter
- Wound secondary to animal bite
- Deep partial or full thickness, or subdermal injury
- Signs of infection
- Chronic wounds
- Pre-existing conditions that could prolong recovery/ mortality
- Wound containing foreign matter after irrigation
- Site of injury: face, hands, feet, major joints, genitals
- Skin injury that worsens/ does not heal in 7 days
(ND) Atopic Dermatitis (AD) s/s
Scaly, erythematous, edematous, papular, crusty
(ND) AD nonpharmacologic treatment
- Depends on age, severity, sites of lesions
- Education on trigger avoidance and skin hydration
- Lifestyle changes: avoid irritating fabrics/fragrances, lukewarm & short baths, mild nonsoap cleaners, moisturize
- Moisturizer: hypoallergenic/fragrance free, lotions have higher water content (can be drying), ointments more effective in dermal penetration (can be greasy and less tolerable)
(ND) AD pharmacologic treatment
- Topical hydrocortisone: safe for short period of time, >2 yrs, cream is most tolerable, ointments preferred for thick skin or lesions that are dry/lichenified/scaly
- If no improvement >2-3days –> refer
- Antipruritics not recommended
(ND) AD exclusions
- Moderate-severe condition with intense pruritus
- Involvement of large area of body
- <1 yr
- Infection
- Face or intertriginous areas
(ND) Xerosis s/s
Roughness, scaling, cracking, fissuring, erythema, pruritus
(ND) Xerosis nonpharmacological treatment
- Bathing & moisturizing: tepid water, w/i 3 mins out of shower apply body moisturizer, moisturize at least 3x during the day
- Environmental factors: humidity, hydration, limit alcohol, caffeine, spicy foods
- Cleansers: gentle, non-soap, glycerin soap
- Moisturizers: humectants, emollients, occlusives, skin protectants
(ND) Xerosis nonpharmacologic product selections
- Ointments: dry, scaly skin
- Creams: less potent but less oily
- Avoid gels, foams, mousses
(ND) Xerosis pharmacological treatment
Hydrocortisone
- If needed for excessive itching
- Apply a thin layer under moisturizer 1-2x daily for no more than 7 days
- If no improvement after 7 days –> refer
(ND) Dandruff s/s
Scalp scaling –> sloughing of small white/gray loosely bound flakes
(ND) Dandruff treatment
- Routine shampooing: mild-moderate
- Cytostatic agent: pyrithione zinc, selenium sulfide
- Non-rx ketoconazole shampoo
- Keratolytic agent: salicylic acid, sulfur
(ND) seborrheic dermatitis s/s
- Demarcated, dull, yellowish, oily, scaly areas on reddened skin
- Infantile form: cradle’s cap with scalp concentration
- Darker skinned individuals may have hypopigmentation and lack yellow scales
(ND) seborrheic dermatitis treatment
Similar to dandruff, but more aggressive due to inflammatory nature
- 1st line = antifungal ketoconazole
- If scales difficult to remove: olive or mineral oil
- Regular use of medicated shampoo: pyrithione zinc and selenium sulfide
- Keratolytic agents: salicylic acid, sulfur
(ND) seborrheic dermatitis treatment: infants
Usually self-limiting so oil massages + non-medicated shampoo → refer
(ND) Psoriasis s/s
- Symmetrical lesions
- ~90% pts have a plaque
- Well demarcated and covered with a silvery-white scales
- Painful and itchy
- Common sites: extensor surface of elbows/knees, lumbar region of the back, scalp, genital area
- Auspitz Sign: when scale is lifted and pinpoint bleeding occurs
(ND) Psoriasis treatment
- Mild cases: hydrocortisone + removal of loose scales
- Most: refer!
- Thick scales: salicylic acid
(ND) Dandruff, seborrheic dermatitis, psoriasis selfcare exclusions
- <2 yrs
- Worsening symptoms or no improvement after 2 wks of proper use
(ND) Psoriasis specific exclusions
- Involvement of more than 5% BSA or face
- Presence of joint pain
- More than a few lesions
- Lesions larger than a quarter
(ND) Irritant Contact Dermatitis (CD) s/s
- Inflamed, swollen, erythematous skin
- Delayed onset
- Dry or macerated, painful, cracked skin
- Chronically can cause lichenification &/or discoloration of skin
(ND) Irritant CD nonpharmacologic treatment
- Wash exposed area with lots of lukewarm water
- Cleanse with mild or hypoallergenic soap
- Saline soak (1 tsp salt in 1 pint of water)
(ND) Irritant CD pharmacologic treatment
- Burrow’s solution (Aluminum acetate): remove irritant
- Liberal emollient: restore moisture
- Topical hydrocortisone: reduce inflammation, relieve itching
(ND) irritant CD prevention
Protective clothing/gloves/equipment, frequent changing of coverings, routine post-exposure barrier cream use
(ND) Irritant CD exclusions
- <2 yrs
- Involvement of eyes, eyelids, mouth, face, neck, genitals
- Dermatitis involving more than 10% of BSA
- No improvement in 1 wk of proper self-tx or evidence of chronic dermatitis
(ND) Allergic CD s/s
- Rash, papules, small vesicles, bullae
- Urushiol-induced: linear distribution over wide area
(ND) Allergic CD nonpharmacologic treatment
Resolves on its own 10-21 days
- Limit exposure: wash clothes, remove jewelry, wash with mild soap
- Cold/lukewarm soapless showers
- Clipping nails
(ND) Allergic CD pharmacologic treatment
- Inflammation: hydrocortisone cream 1%
- Itching: colloidal oatmeal bath (slippery, clog drain), calamine lotion (pink stain), oral 1st gen antihistamine benadryl for sedation
- Weeping: Burow’s solution (aluminum acetate): astringent
(ND) Allergic CD exclusion
- <2 yrs
- Involvement of eyes, eyelids, mouth, face, neck, genitals
- Dermatitis involving >10% of BSA (20% if urushiol)
- S/S of infection: >100 oF, pus/tenderness on rash
- Numerous large bullae
- No improvement in 1 week of proper self-tx or evidence of chronic dermatitis
(ND) Diaper dermatitis nonpharmacologic treatment
ABCDE
- Air: let skin air dry frequently, allow diaper free time
- Barrier: use barrier skin protectant liberally with each change
- Cleansing: gently cleanse with soft cloth or baby wipe if stool present
- Diaper: change frequently (Q2H) and as soon as it’s soiled, use absorbent diapers if possible
- Education: Educate all parents & caregivers about diaper hygiene & appropriate pharmacotherapy
(ND) Diaper dermatitis pharmacologic treatment
Skin protectants
- Zinc oxide: most commonly used, need soap to remove
- Petrolatum/white petrolatum
- Calamine
- Topical cornstarch and talc: loose powders, reduce moisture & friction, risk respiratory SEs
(ND) Prickly Heat nonpharmacologic treatment
Usually resolves w/o pharmacologic intervention
- Decrease sweating, loose, light colored/weight clothing, do not apply occlusives
(ND) Prickly Heat pharmacologic treatment
Emollients, antipruritics, skin protectants
(ND) Diaper dermatitis & Prickly Heat exclusions
- Secondary infection
- Onion-skin like appearance or bulla formation
- Chronic or frequently recurring
- Systemic symptoms: fever, VND, swollen lymph nodes, rapid pulse, rash/lesions on other body parts)
- Comorbid conditions (HIV, organ transplant, immunosuppressive therapy, hx of hepatitis w/ skin manifestations)
Smoking Cessation (SC) annual deaths attributable to smoking Top 2
- Cardiovascular & Metabolic diseases
- Lung cancer
(SC) cigarette packs of ___ cigarettes
20
(SC) E-cigarettes aka
ENDS (Electronic, Nicotine, Delivery, Systems)
(SC) Drug interactions:
- Cigarette smoking induces ___
- Common drugs examples
- CYP1A2
- Caffeine, clozapine, olanzapine, ropinirole, tizanidine, oral contraceptives
(SC) Fagerstom Test for nicotine dependence questions to ask
- How soon after waking do you smoke your first cigarette?
- Do you find it difficult to refrain from smoking in places where it is forbidden?
- Which cigarette would you hate to give up?
- How many cigarettes a day do you smoke?
- Do you smoke more frequently in the morning?
- Do you smoke even if you are sick in bed most of the day?
(SC) Counseling: 5 A’s Model
Ask, Advise, Assess, Assist, Arrange
(SC) Counseling: Assist
- Not ready to quit
5 R’s Method: Relevance, Risks, Rewards, Roadblocks, Repetition
(SC) Counseling: Assist
- Ready to quit
STAR Method: Set a quit date, Tell family/friends/coworkers, Anticipate challenges, Remove tobacco products from environment
(SC) Counseling: Assist
- Recently quit
Prevent relapse, further counseling, medication refills
(SC) Nicotine patch dosing for Heavy smoker
> 10 cigarettes/day
- Weeks 1-4: one 21 mg patch/day
- Weeks 5-6: one 14 mg patch/day
- Weeks 7-8: one 7 mg patch/day
(SC) Nicotine patch dosing for Light smoker
=<10 cigarettes/day
- Weeks 1-6: one 14 mg patch/day
- Weeks 7-8: one 7 mg patch/day
(SC) Nicotine patch counseling points
- Discard by folding adhesive ends together in trash
- Water will not harm so pts may bathe, shower, etc
- Remove before MRI to avoid burns
- If vivid dreams, only wear for 16 hrs and remove before bed
- If skin irritation, rotate site & hydrocortisone OTC
(SC) Nicotine gum/lozenges dosing by when 1st smoking of waking
- Smoke 1st cigarette w/i 30 mins of waking → 4 mg
- Smoke 1st cigarette after 30 mins of waking → 2 mg
(SC) Nicotine gum/lozenges dosing by weeks
- Weeks 1-6: 1 piece Q1-2H
- Weeks 7-9: 1 piece Q2-4H
- Weeks 10-12: 1 piece Q4-8H
(SC) Nicotine gum/lozenges: use at least ___ daily
9 pieces of gum or lozenges daily
(SC) Nicotine gum/lozenges: MDD
- Gum: 24 pieces
- Lozenges: 20
(SC) Nicotine gum/lozenges counseling
- May delay weight gain associated with smoking cessation
- May use a second piece w/i the hr for strong or frequent cravings; do not continuously use one piece after another (SEs)
(SC) Bupropion SR Contraindications
- Seizure disorder
- Abrupt discontinuation of alcohol, benzodiazepines, barbiturates, or antiepileptic drugs
- History of bulimia or anorexia nervosa
- Use of MAO inhibitor w/i previous 14 days
- Initiation in pts receiving linezolid or intravenous methylene blue
(SC) Bupropion AEs, benefit (?)
- AEs: mostly insomnia
- Weight loss (delay weight gain)
(SC) EAGLES study
Study did not show a significant increase in neuropsychiatric AEs attributable to varenicline or bupropion relative to nicotine patch or placebo
Migraine/Headache, Fever (MHF): tension-type HA vs Migraine HA vs Sinus HA vs Medication overuse HA: nature
- TTH: bilateral, diffuse aching, “tight”, “pressing”, cold increases pain
- MH: unilateral, throbbing +/- aura
- Sinus: localized to facial area, pressure behind eyes/face
- Medication Overuse: “withdrawal” HA
(MHF) Migraine diagnosis
- At least 5 attacks lasting 4-72 hrs per year
- At least 2 of the following: unilateral, pulsating pain, intensity affecting daily function, aggravated by physical activity
- At least 1 of the following: N/V, light or sound sensitivity
(MHF) Medication overuse HA diagnosis
> =3 times/week for >=3 mo
(MHF) HA exclusions
- Severe head pain
- > 10 days (w/ or w/o tx) [vs. fever >3 days refer]
- Migraine HA symptoms w/o diagnosis
- <8 yrs, <2 yrs w/o MD advice or previous tx
- Pregnancy 3rd trimester
- High fever or signs of serious infection
- Hx liver disease or 3 drinks/day
Secondary HA
(MHF) NSAIDs Salicylate ASA: MoA, MMD, avoid in special populations
- MoA: irreversible COX1&2 inhibitor
- MMD: 4g
- Avoid in =<15 yrs (Reyes syndrome), pregnancy (3rd trimester), surgical pts (stop 2-7 days before)
(MHF) NSAIDs Nonsalicylate IBU, NAP: MoA, IBU child dosing, Avoid in
- MoA: reversible COX1&2 inhibitor
- IBU: 5-10 mg/kg Q6-8H
- Avoid in pregnancy
(MHF) APAP: MoA, children dosing, MDD, counseling point
- MoA: central PG inhibition w/o inflammatory
- Dose: <12 yrs; 10-15 mg/kg Q4-6H prn, MDD = 5 doses
- MDD adult = 3 g
- Counsel: do NOT exceed 3g in 24 hrs, do NOT consume alcohol, NOT for inflammation
(MHF) combination product when to refer
> =3 times/week
(MHF) Fever referrals
- Suspected infection
- Impaired immune function, oxygen utilization
- CNS damage
- Children w/ hx of seizures or febrile seizures
- <6 months w/ rectal temp 101 oF (38.3 C)
- > 6 months w/ rectal temp 104 oF (40 C)
- At risk for hyperthermia
- >3 days w/ or w/o treatment [vs. HA >10 days refer]
(MHF) Fever nonpharmacologic management
Hydration, loose clothing, remove blanket
(MHF) Fever: children IBU vs APAP selection recommendation, APAP vs IBU diff formulation dosage
- Alternating IBU, APAP not recommended
- APAP infant drops vs oral susp: same [ ]
- IBU infant drops vs oral susp: 2x more [ ]
Musculoskeletal Pain (MP): pain assessment too PQRSTU
Precipitating & palliative factors, Quality, Region, Severity, Time, yoU
(MP) exclusions: type of pain
- Increased intensity or change in character of pain
- Severe pain that limits function
- Pelvic or abdominal pain
(MP) exclusions: duration of pain
- Lasts >10 days
- Continues >7 days after tx w/ a topical analgesic
(MP) exclusions: special population
- <2 yrs
- Pregnant
(MP) exclusions: additional s/s
- Accompanying N/V, fever, signs of systemic infection/disorder
- Back pain and loss of bowel and/or bladder control
- Visually deformed joint, abnormal movement, weakness in any limb, numbness, or suspected fracture
(MP) Strains: pharmacologic, nonpharmacologic treatment
- NSAIDs (IBU, NAP)
- Ice
(MP) Muscle cramps: pharmacologic, nonpharmacologic treatment
- N/A
- Massage, heat
(MP) Tendonitis/Bursitis: pharmacologic, nonpharmacologic treatment
- NSAIDs +/- topical
- Stretching before activities, ergonomics
- T: RICE
- B: rest, immobilization
(MP) Osteoarthritis: pharmacologic, nonpharmacologic treatment
- APAP, NSAIDs (inflammatory or severe)
- N/A
- Adjunctive: topicals, glucosamine/chondroitin, heat pads
(MP) APAP: Ped dosing, MDD, FDA-approved age, arthritis formulation
- 10-15 mg/kg/dose
- MDD = 5 doses/day
- FDA label for >2 yrs
- Arthritis = ER –> do not crush/chew/split
(MP) NSAIDs (IBU, NAP): ped dosing, MDD, pediatric age, AEs
- 5-10 mg/kg/dose 3 to 4 times/day
- MDD = 4 doses/day
- 6 mo to 12 yrs
- GI upset –> take with food
(MP) ASA: dosing, age, SE
- NOT recommended for pain
- Dosing: CV indication lower dose
- C/I: <2 yrs
- GI –> take with food
(MP) Topical (2)
- Diclofenac 1% gel: may take up to 7 days, avoid using >21 days, C/I: hx of anaphylaxis to ASA or other NSAIDs
- Lidocaine: may take up to 7 days
(MP) Counterirritants: avoid in
- Burned/damaged skin
- <2 yrs
- Tight bandages or heat therapy
- Salicylates formulations in pts on anticoagulants
(MP) Methyl salicylate: C/I, avoid in
- C/I: hypersensitivity to ASA, NSAIDs, salicylates
- Avoid in <18 yrs
(MP) Cooling counterirritants
- Camphor: avoid in children
- Menthol
(MP) Capsaicin: age
> =18 yrs
(MP) Nonpharmacological treatment
- RICE: Rest, Ice, Compression, Elevation
- Heat therapy
- Heat wraps: no topicals, avoid in pregnant, rheumatoid arthritis, diabetes
- TENS: avoid on irritated/infected/broken skin
Cough and Cold (CC) Exclusions for self care
- Fever 100.4 oF
- Chest pain
- Shortness of breath
- Worsening symptoms or development of additional symptoms during self-treatment
- Underlying chronic cardiopulmonary disease
- Immunosuppressant therapy
- Frail pts of advanced age
- Infants 3 months of age
- Hypersensitivity to recommend OTC medications
(CC) Nonpharmacological management
- Maintenance of fluid intake, adequate rest, nutritious diet, increased humidification
- Handwashing: soap and water for at least 20 secs
- Hand sanitizers
(CC) Prevention supplements
- Zinc: early use w/i 24 hrs, >=12 yrs, avoid drinking/eating for 15 mins after & citrus drinks for 30 mins, frequent use Q2-4H while awake
- Vitamin C
(CC) Sore throat pharmacologic treatment
Local anesthetics: lozenges, throat sprays, oral disintegrating strips
(CC) Runny nose pharmacologic treatment: avoid in, special populations (elderly, COPD/Asthma, Peds), counseling
Diphenhydramine (Benadryl)
- Avoid: HTN, BPH, CHF, hyperthyroidism, glaucoma, GI, MAOIs
- Elderly: avoid due to increased delirium/fall
- COPD/Asthma: avoid
- Peds: potential excitability and irritability
- Counsel: sedation/dizziness, blurred vision, urinary retention, dry mouth, constipation, confusion
- Do NOT consume alcohol
(CC) Nasal congestion: AEs, warnings/precautions
Decongestants
- Systemic: CNS & CV stimulation
- Topical: propellant-vehicle-associated, trauma from administration
- Rebound congestion: use <3 days
- W/P: BPH, diabetes, elevated intraocular pressure, heart disease, HTN, hyperthyroidism
(CC) Decongestants DDI
MAOIs (phenelzine, tranylcypromine), linezolid, methyldopa, TCAs (amitriptyline, notriptyline, imipramine)
(CC) Decongestants children use
OTC cold meds not recommended <2 yrs (guidance: refer to MD <4 yrs)
(CC) Cough types: duration
- Acute = <3 weeks
- Subacute = 3-8 weeks
- Chronic = >8 weeks
(CC) Cough types: mucus production
- Nonproductive = (-)
- Productive = (+)
- Effective: secretions expelled
- Ineffective: secretions present but not expelled
(CC) Cough referral
- Thick tan, yellow or green phlegm
- 1 of the following: Unintended weight loss, profuse night sweats, hemoptysis, chest pain, SOB, swollen legs/ankles, cyanosis, rash, persistent headache
- High fever 103 F
- Low fever not resolving with selfcare
- Chronic underlying disease: asthma, COPD, chronic bronchitis, CHF, drug associated cough
- Lasting >7 days
- Worsens as cold/flu resolves
- Associated with inhalation of dust, particles, objects
(CC) Cough treatment Guaifenesin: use, MoA, avoid use in, safe to use in peds age, counseling point
- Use: Ineffective productive cough
- MoA: expectorant/protussive; thins and loosens respiratory tract secretions
- Avoid: asthma, COPD, LRTI
- Peds >4 yrs
- Drink plenty of water, NOT recommended to use guaifenesin + DXM (unless ineffective productive disturbing sleep)
(CC) Cough treatment Dextromethorphan (DXM): use, MoA, caution, special populations
- Use: nonproductive cough
- MoA: antitussive; increase cough threshold
- Caution: use w/ MAOIs/SSRIs, HTN, hyperpyrexia, arrhythmias, myoclonus, substance use
- Elderly: start low and titrate up
- COPD/Asthma: avoid if LRTI
- Peds: abuse potential
(CC) Cough topicals formulation, age, counsel
- Camphor and Menthol = FDA approved
- Camphor + Menthol + Eucalyptus: 2+ yrs
- Rosemary + Lavender + Eucalyptus: 3+ mo
- Counsel: do not place in mouth or nose (usually chest), apply and cover loosely
