FINAL- Cough, Cold OTC, (72) Flashcards

1
Q

SCHOLAR-MAC

A

Symptoms
Characteristics
History
Onset
Location
Aggravating factors
Remediating Factors
Medications
Allergies
Conditions

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2
Q

Cough

A

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

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3
Q

Productive cough

A

Wet or chesty
Expelling secretions
Facilitates ventilation and ability of lungs to resist infection

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4
Q

Non-productive cough

A

“Dry “ or “Hacking”
NO SECRETIONS
Commonly caused by respiratory infections, atypical bacteria, medications and GERD

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5
Q

Cold

A

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

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6
Q

Cold vs flu

A

Cold:
-Gradual
-Sneezing common
-Rhinorrhea and congestion common
-Sore throat common

Flu:
-Abrupt onset
-Usually fever
-Usually aches
-Fatigue, weakness, headache

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7
Q

Cough, cold, and flu - exclusions for self tx

A

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

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8
Q

Symptom management - what can we treat?

A

Rhinorrhea
Congestion
Cough
HA
Sore throat

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9
Q

Rhinorrhea pharmacologic treatment

A

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

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10
Q

Rhinorrhea - Non: pharmacologic self tx

A

Environmental
Saline washes
Nasal strips

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11
Q

Congestion - pharmacologic tx

A

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

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12
Q

Tx of congestion - non-pharmacologic

A

Neti pot
Fridababy nasal aspirator
Bulb Syringe

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13
Q

Cough - Pharmacologic Self tx

A

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

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14
Q

Cough - Non pharmacologic tx

A

Honey
Lozenges
Humidifiers/Vaporizers

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15
Q

Headache and sore throat pharmacologic tx

A

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

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16
Q

HA and Sore throat - non pharmacologic treatment

A

Honey
Lozenges
Adequate rest and exercise

17
Q

OTC Label Hints - Common terminology

A

“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

18
Q

Tamiflu (Oseltamivir)

A

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)

19
Q

Cough, cold, flu - things to consider

A

Tamiflu
-How can I help patient out with symptoms?
Pain control
zinc
Echinacea
Vitamin C
-Not very helpful unless in VERY high doses

20
Q

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

A

D. Body aches

21
Q

Which of the following anthistamine brand and generic name pairs is mismatched?
A: Benadryl - Diphenhydramine
B: Xyzal - fexofenadine
C: Claritin - loratadine
D. Unisom - doxylamine

A

B - Xyzal - fexofenadine

22
Q

Guaifenesin may be helpful for patient complaining of a dry, hacking cough T/F?

A

False

23
Q

Five Guiding principles with OTC

A

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

24
Q

OTC updates - Naloxone

A

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)

25
Q

OTC Updates - Opill

A

-Daily progestin-only pill for contraception
-Opill approved by FDA on July 13 2023
-Available in retail pharmacies spring 2024