FINAL- Cough, Cold OTC, (72) Flashcards
SCHOLAR-MAC
Symptoms
Characteristics
History
Onset
Location
Aggravating factors
Remediating Factors
Medications
Allergies
Conditions
Cough
Irritates throat and chest
Interferes with work and sleep
Stressful for patients and bystandsers
Can be drug-induced
-20% of people on ACE inhibitors develop cough
Productive cough
Wet or chesty
Expelling secretions
Facilitates ventilation and ability of lungs to resist infection
Non-productive cough
“Dry “ or “Hacking”
NO SECRETIONS
Commonly caused by respiratory infections, atypical bacteria, medications and GERD
Cold
Commonly caused by rhinovirus
Spreads through direct contact or aerosol transmission
Factors which increases susceptibility
-Poor nutritional status
-Smoking
-High population density
-Sedentary lifestyle
-Fatigue
-Physical/emotional stress
Cold vs flu
Cold:
-Gradual
-Sneezing common
-Rhinorrhea and congestion common
-Sore throat common
Flu:
-Abrupt onset
-Usually fever
-Usually aches
-Fatigue, weakness, headache
Cough, cold, and flu - exclusions for self tx
Fever >101.5
Chest pain (new)
SOB (worse than baseline)
Worsening or new symptoms during self treatment
Comorbidities (AIDs, chronic immunosuppressant therapy)
Infants <3 months
Hypersensitivity to OTC meds
Symptom management - what can we treat?
Rhinorrhea
Congestion
Cough
HA
Sore throat
Rhinorrhea pharmacologic treatment
First gen antihistamines
-Benadryl (diphenhydramine)
-Unisom (doxylamine)
Pros:
-Relief of rhinorrhea and sneezing
Cons:
-Sedating
-Short acting
-Anticholinergic (avoid in older adults)
Second-gen antihistamines:
-Zyrtec (cetrizine)
-Allegra (fexofenedine)
-Xyzal (levocetirizine)
-Claritin (Loratadine)
Pros:
-Daily
-Non-sedating
-Relief of rhinorrhea
-Preferred treatment
Intranasal corticosteroids
-Rhinocort (budesonide)
Nasacort (triamcinolone)
Flonase (fluticasone)
Pros;
-Relief of allergic rhinorrhea
Cons:
Nasal spray
Rhinorrhea - Non: pharmacologic self tx
Environmental
Saline washes
Nasal strips
Congestion - pharmacologic tx
Oral decongestants
-Sudafed PE (phenylephrine)
-does not really do anything
-Sudafed (Pseudoephedrine)
Pros:
-Pseudoephedrine effective for decongestant
Cons:
-Phenylephrine ineffective as PO medicaton
-Pseudoephedrine should be avoided in uncontrolled BP
-NOT FOR USE IN UNCONTROLLED HTN
-Pseudoephedrine may cause insomnia
Nasal Decongestants
-Vicks Vapoinhaler (Levmetamfetamine)
-Afrin (Oxymetazoline)
Pros:
-Rapid relief
Cons:
-Max 3 days for oxymetazoline (rebound congestion)
-Temp relief
Other
Intranasal saline (sodium chloride)
Pros:
-Useful for pregnancy and pediatrics
Cons:
-Temp relief
Tx of congestion - non-pharmacologic
Neti pot
Fridababy nasal aspirator
Bulb Syringe
Cough - Pharmacologic Self tx
Expectorants (mucolytics for productive cough)
Mucinex (Guaifenesin)
Pros:
-Low concern for adverse effects
Cons:
-Poor evidence of efficacy
Cough suppressants (antitussives for non productive cough)
Delsym (dextromethorphan)
Vick’s vapo rub (Camphor, Menthol)
Pros:
-Reduce cough burden
Cons:
-Dextromethorphan has misuse potential
-Camphor is toxic to pediatric patients < 2 years
Cough - Non pharmacologic tx
Honey
Lozenges
Humidifiers/Vaporizers
Headache and sore throat pharmacologic tx
Non-opioid, non-NSAID Analgesic
-Tylenol (Acetaminophen)
Pros:
-Low concerns for adverse effects
-Unlikely to increase bleed risk in patients on anticoagulants and/or antiplatelets
Cons:
-Commonly appears in combo products
-Interacts w/alcohol
NSAIDs:
-Motrin, advil (Ibuprofen)
-Aleve (Naproxen)
-Bayer (Aspirin)
Pros;
-Available in longer acting formulations than acetaminophen
-Sometimes more efficacious antipyretic and analgesic activity than acetaminophen
Cons:
-Increases bleeding risk
-Concern for PUD, AKI, CV risk
HA and Sore throat - non pharmacologic treatment
Honey
Lozenges
Adequate rest and exercise
OTC Label Hints - Common terminology
“Night time” or “PM”
-May contain diphenhydramine or doxylamine
“Sinus”
-May contain a decongestant and or analgesic
“Cough”:
-may contain dextromethorphan
“Non-drowsy” “Day Time” or “AM”
-May contain a decongestant; usually lacks antihistamine
“Allergy”
-May contain an antihistamine
“Cold” or “Flu”
-My contain a combination of a decongestant, antihistamine, cough suppressant, and acetaminophen
Tamiflu (Oseltamivir)
Pharm therapy for influenza
Indication:
-Flu treatment
-Influenza Prophylaxis in patients at very high risk for complications
Considerations:
-Efficacy for tx not established in patients beginning therapy after 48 hours of symptom onset
-Can be used in infants <8 months (weight-based dosing)
Cough, cold, flu - things to consider
Tamiflu
-How can I help patient out with symptoms?
Pain control
zinc
Echinacea
Vitamin C
-Not very helpful unless in VERY high doses
Common symptom of the flu that is NOT a common symptom of a cold?
A. Sneezing
B. Stuffy nose
C. Sore throat
D. Body aches
D. Body aches
Which of the following anthistamine brand and generic name pairs is mismatched?
A: Benadryl - Diphenhydramine
B: Xyzal - fexofenadine
C: Claritin - loratadine
D. Unisom - doxylamine
B - Xyzal - fexofenadine
Guaifenesin may be helpful for patient complaining of a dry, hacking cough T/F?
False
Five Guiding principles with OTC
Take time to read drug labels
-Refer NaturalMedicines, LexiComp, or MicroMedex
-Run a drug-interaction checker if you can
-With many things, it is appropriate to say “I cannot guarantee that this will be effective or safe for you”
-Never guess
OTC updates - Naloxone
Used to reverse the effects of an opioid overdose
-OTC naloxone approved by FDA on March 29, 2023
~$40 for a 2-pack (patients may be able to get at no cost through community distribution programs)
OTC Updates - Opill
-Daily progestin-only pill for contraception
-Opill approved by FDA on July 13 2023
-Available in retail pharmacies spring 2024
