Lecture 11: Cough/Cold and Cold Sores Flashcards
FDA Statement 2008
no cough and cold medications in children under 4
- Labels may be more conservative than drug monographs
- Self-care guidelines list ages as exclusions for treatment
Rule of thumb: If there are dosing guidelines available, the product may be used
Cough Pathophysiology
Caused by mechanical and chemical stimulation
Acute cough
less than 3 weeks
Subacute cough
3 to 8 weeks
Chronic Cough
more than 8 weeks
Drug Induced cough
ace-inhibitors, beta-blockers (systemic and ophthalmic)
Opthalmic
resembling or relating to the eye
Cough Clinical Presentation
Productive vs. Nonproductive
Productive: Wet or chesty cough which expels secretions from lower respiratory tract
Nonproductive - dry or hacking cough. No useful physiologic purpose
Cough Complications
Exhaustion Insomnia Musculoskeletal pain Hoarseness Excessive perspiration Urinary incontinence (loss of bladder control)
Cough- Exclusions to self care
- Lasting longer than 7 days
- high fever (>103 F) or low fever that does not resolve with self-care
- cough with more symptoms involving SOB, chest pain, chills, swollen ankles, cyanosis,
- Cough producing thick green or yellow mucus
- Cough that worsens as cold or flu resolves
- Drug induced cough
- History of symptoms of chronic disease such as COPD, asthma, CHF
- Cough associated with inhalation of dust, particles or objects, if irritant or object stays in lungs
Cough Treatment Goals
- Primary: reduce number and severity of cough episodes
2. Prevent complication
Nonpharmacologic Therapy - cough
non-medicated lozenges, humidifiers
vaporizers
Pharmacologic therapy - cough
Antitussive
Expectorant
First generation antihistamines + decongestant
Antihistamine for cough-MOA: Increase cough threshold and prevent postnasal drip
Antihistamine for cough Indication: Suppression of nonproductive cough
Oral Antitussive MOA
act centrally at medulla to increase cough threshold
Oral Antitussive Indication
suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation
Oral Antitussive PK
onset: 15-30 minutes
Duration: 3-6 hours
Oral Antitussive Adverse effects
all of these are rare however may experience: drowsiness nausea/vomiting stomach discomfort constipation
Oral Antitussive Drug Interactions
MAOIs (serotonin syndrome)
Oral Antitussive Overdose effects
Confusion Excitation Nervousness Irritability Restlessness Drowsiness Severe nausea/vomiting Respiratory depression
Oral Antitussive Adult dosing
10-20mg every 4 hours or 30mg every 6-8 hours
MDD: 120mg
Oral Antitussive 6-11 yrs old dosing old dosing
For 6 -11 years old: 5-10mg every 4 hours or 15mg every 6-8 hours
MDD: 60mg
Oral Antitussive 4-5 yrs old dosing
For 4-5 years old: 2.5-5mg every 4 hours or 7.5mg every 6-8 hours MDD: 30mg
Topical Antitussives
MOA is unknown, may create local anesthetic sensation
Menthol and Camphor are FDA approved options
Ointment - apply to chest and throat
Lozenges - cough drops, repeat hourly as needed
Inhalation - add to vaporizer to be inhaled up to 3 times/day
Expectorant MOA
Unknown: Loosens and thins secretions in the lower respiratory tract
- Makes it easier to cough things up but also think it makes it easier to get things out the nose
Expectorant Indication
Relief of acute, ineffective, productive coughs